Skip to Main Content

Condition/Disorder Synonyms

  • Bilateral vestibulopathy

  • Bilateral vestibular loss (BVL)

ICD-9-CM Code

  • 386.54 Hypoactive labyrinth, bilateral

ICD-10-CM Code

  • H81.23 Vestibular neuronitis, bilateral

Preferred Practice Pattern

Key Features


  • Disorder of the peripheral vestibular system (part of the inner ear).

  • The peripheral vestibular system of each ear is made up of five sensory organs (hair cell receptors contained within the superior, posterior, and horizontal semicircular canals as well as within the utricle and saccule) and the vestibular nerve.

  • The vestibular sensory organs detect head position and head motion to provide input for gaze stability, orientation, and balance.

  • Reduction or loss of vestibular function of both systems causes a reduction or lack of neural input and results in gaze instability, disorientation, and imbalance.

Essentials of Diagnosis

  • Physical examination normal.

  • Audiogram normal.

  • Neurotologic examination abnormal.

  • Thorough and detailed history is essential to distinguish bilateral vestibulopathy from other vestibular disorders and central pathology.

General Considerations

  • The hallmark of bilateral vestibulopathy is gaze instability and imbalance.

  • These impairments tend to develop slowly and progressively in the majority of cases and impairments tend to be more severe as compared to those with unilateral dysfunction.

  • Patients' complaints may be overlooked as due to inner ear pathology because report of vertigo is rare.

  • For symptoms of vertigo to occur, there needs to be a pathologic asymmetry of the neural activity between the two inner ears; however, with bilateral vestibulopathy, the neural impairment or loss is generally equal between the two ears, thus not creating the mechanism for vertigo to occur.

  • Patients may or may not report head movement-induced dizziness.

  • Most of the time, patients do not report hearing loss, aural fullness, or tinnitus.


  • Bilateral vestibulopathy is rare among vestibular disorders.

  • In clinics specializing in vestibular disorders may account for between 4% and 9% of diagnoses.

  • Although it can occur at any age, bilateral vestibulopathy primarily occurs from 61 to 70 years.

Clinical Findings

Signs and Symptoms

  • Report of blurred (bouncing, jumping) vision that is most noticeable when moving head and walking which is due to oscillopsia (apparent movement of the environment) from vestibuloocular reflex deficit

  • Sometimes complain of vague type of dizziness

  • Postural and gait instability when sensory input is challenged

  • Increased risk of falling

  • Abnormal neurotologic examination (impulse test, dynamic visual acuity test, caloric test)

  • Usually, no report of hearing loss

  • No central signs (diplopia, dysarthria, dysphagia, dysmetria, numbness, or weakness)

Possible Contributing Causes

  • In half ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.