Bilateral Vestibular Loss

Abstract

Bilateral vestibular loss is a rare cause of visual disturbance (oscillopsia) and imbalance. When severe, the most common cause is iatrogenic-gentamicin ototoxicity. Bilateral loss is easily diagnosed at the bedside with the dynamic illegible E test. If this test is omitted, it can easily be misdiagnosed as a cerebellar syndrome. Treatment is largely supportive. Care should be taken to avoid medications that suppress vestibular function, and to encourage activity.

Keywords

vestibulopathy - ototoxicity - ataxia - oscillopsia

• References

• 1 Crawford J. Living without a balancing mechanism. N Engl J Med 1952; 246 (12) 458-460
• 2 Zingler VC, Cnyrim C, Jahn K , et al. Causative factors and epidemiology of bilateral vestibulopathy in 255 patients. Ann Neurol 2007; 61 (6) 524-532
• 3 Rinne T, Bronstein AM, Rudge P, Gresty MA, Luxon LM. Bilateral loss of vestibular function: clinical findings in 53 patients. J Neurol 1998; 245 (6-7) 314-321
• 4 Syms III CA, House JW. Idiopathic Dandy's syndrome. Otolaryngol Head Neck Surg 1997; 116 (1) 75-78
• 5 Brandt T. Bilateral vestibulopathy revisited. Eur J Med Res 1996; 1 (8) 361-368
• 6 Jen JC. Bilateral vestibulopathy: clinical, diagnostic, and genetic considerations. Semin Neurol 2009; 29 (5) 528-533
• 7 Fife TD, Baloh RW. Disequilibrium of unknown cause in older people. Ann Neurol 1993; 34 (5) 694-702
• 8 Barin K, Dodson EE. Dizziness in the elderly. Otolaryngol Clin North Am 2011; 44 (2) 437-454 , x x.
• 9 Jönsson R, Sixt E, Landahl S, Rosenhall U. Prevalence of dizziness and vertigo in an urban elderly population. J Vestib Res 2004; 14 (1) 47-52
• 10 Neuhauser HK, von Brevern M, Radtke A , et al. Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology 2005; 65 (6) 898-904
• 11 Rauch SD, Velazquez-Villaseñor L, Dimitri PS, Merchant SN. Decreasing hair cell counts in aging humans. Ann N Y Acad Sci 2001; 942: 220-227
• 12 Peterka RJ, Black FO, Schoenhoff MB. Age-related changes in human vestibulo-ocular reflexes: sinusoidal rotation and caloric tests. J Vestib Res 1990– 1991; 1 (1) 49-59
• 13 Rosenhall U, Rubin W. Degenerative changes in the human vestibular sensory epithelia. Acta Otolaryngol 1975; 79 (1-2) 67-80
• 14 Ishiyama G, Geiger C, Lopez IA, Ishiyama A. Spiral and vestibular ganglion estimates in archival temporal bones obtained by design based stereology and Abercrombie methods. J Neurosci Methods 2011; 196 (1) 76-80
• 15 Herdman SJ, Blatt P, Schubert MC, Tusa RJ. Falls in patients with vestibular deficits. Am J Otol 2000; 21 (6) 847-851
• 16 Selimoglu E. Aminoglycoside-induced ototoxicity. Curr Pharm Des 2007; 13 (1) 119-126
• 17 Dulon D, Hiel H, Aurousseau C, Erre JP, Aran JM. Pharmacokinetics of gentamicin in the sensory hair cells of the organ of Corti: rapid uptake and long term persistence. C R Acad Sci III 1993; 316 (7) 682-687
• 18 Roth SM, Williams SM, Jiang L, Menon KS, Jeka JJ. Susceptibility genes for gentamicin-induced vestibular dysfunction. J Vestib Res 2008; 18 (1) 59-68
• 19 Pappas S, Nikolopoulos TP, Korres S, Papacharalampous G, Tzangarulakis A, Ferekidis E. Topical antibiotic ear drops: are they safe?. Int J Clin Pract 2006; 60 (9) 1115-1119
• 20 Matz G, Rybak L, Roland PS , et al. Ototoxicity of ototopical antibiotic drops in humans. Otolaryngol Head Neck Surg 2004; 130 (3, Suppl): S79-S82
• 21 Haynes DS. Topical antibiotics: strategies for avoiding ototoxicity. Ear Nose Throat J 2004; 83 (1, Suppl): 12-14
• 22 Schaefer SD, Wright CG, Post JD, Frenkel EP. Cis-platinum vestibular toxicity. Cancer 1981; 47 (5) 857-859
• 23 Bovo R, Ciorba A, Martini A. Vertigo and autoimmunity. Eur Arch Otorhinolaryngol 2010; 267 (1) 13-19
• 24 Buniel MC, Geelan-Hansen K, Weber PC, Tuohy VK. Immunosuppressive therapy for autoimmune inner ear disease. Immunotherapy 2009; 1 (3) 425-434
• 25 Ruckenstein MJ. Autoimmune inner ear disease. Curr Opin Otolaryngol Head Neck Surg 2004; 12 (5) 426-430
• 26 Dayal VS, Ellman M, Sweiss N. Autoimmune inner ear disease: clinical and laboratory findings and treatment outcome. J Otolaryngol Head Neck Surg 2008; 37 (4) 591-596
• 27 Bovo R, Ciorba A, Martini A. The diagnosis of autoimmune inner ear disease: evidence and critical pitfalls. Eur Arch Otorhinolaryngol 2009; 266 (1) 37-40
• 28 Migliori G, Battisti E, Pari M, Vitelli N, Cingolani C. A shifty diagnosis: Cogan's syndrome. A case report and review of the literature. Acta Otorhinolaryngol Ital 2009; 29 (2) 108-113
• 29 Harris JP, Low NC, House WF. Contralateral hearing loss following inner ear injury: sympathetic cochleolabyrinthitis?. Am J Otol 1985; 6 (5) 371-377
• 30 Sepcić J, Bucuk M, Perković O , et al. Drug-induced aseptic meningitis, sensorineural hearing loss and vestibulopathy. Coll Antropol 2010; 34 (3) 1101-1104
• 31 Cushing SL, Papsin BC, Rutka JA, James AL, Blaser SL, Gordon KA. Vestibular end-organ and balance deficits after meningitis and cochlear implantation in children correlate poorly with functional outcome. Otol Neurotol 2009; 30 (4) 488-495
• 32 Wiener-Vacher SR, Obeid R, Abou-Elew M. Vestibular impairment after bacterial meningitis delays infant posturomotor development. J Pediatr 2012; 161 (2) 246-251, e1
• 33 Ogata Y, Sekitani T, Shimogori H, Ikeda T. Bilateral vestibular neuronitis. Acta Otolaryngol Suppl 1993; 503: 57-60
• 34 Schuknecht HF, Witt RL. Acute bilateral sequential vestibular neuritis. Am J Otolaryngol 1985; 6 (4) 255-257
• 35 Gianoli G, Goebel J, Mowry S, Poomipannit P. Anatomic differences in the lateral vestibular nerve channels and their implications in vestibular neuritis. Otol Neurotol 2005; 26 (3) 489-494
• 36 Black FO, Brackmann DE, Hitselberger WE, Purdy J. Preservation of auditory and vestibular function after surgical removal of bilateral vestibular schwannomas in a patient with neurofibromatosis type 2. Am J Otol 1995; 16 (4) 431-443
• 37 Nabi S, Parnes LS. Bilateral Ménière's disease. Curr Opin Otolaryngol Head Neck Surg 2009; 17 (5) 356-362
• 38 Huppert D, Strupp M, Brandt T. Long-term course of Menière's disease revisited. Acta Otolaryngol 2010; 130 (6) 644-651
• 39 Steckelberg JM, McDonald TJ. Otologic involvement in late syphilis. Laryngoscope 1984; 94 (6) 753-757
• 40 Kobayashi H, Mizukoshi K, Watanabe Y, Nagasaki T, Ito M, Aso S. Otoneurological findings in inner ear syphilis. Acta Otolaryngol Suppl 1991; 481: 551-555
• 41 Durham JS, Longridge NS, Smith JM, Jones H. Clinical manifestations of otological syphilis. J Otolaryngol 1984; 13 (3) 175-179
• 42 Wilson WR, Zoller M. Electronystagmography in congenital and acquired syphilitic otitis. Ann Otol Rhinol Laryngol 1981; 90 (1 Pt 1) 21-24
• 43 Lee H, Kim JS, Chung EJ , et al. Infarction in the territory of anterior inferior cerebellar artery: spectrum of audiovestibular loss. Stroke 2009; 40 (12) 3745-3751
• 44 Colvin IB. Audiovestibular manifestations of sarcoidosis: a review of the literature. Laryngoscope 2006; 116 (1) 75-82
• 45 Sando I, Orita Y, Miura M, Balaban CD. Vestibular abnormalities in congenital disorders. Ann N Y Acad Sci 2001; 942: 15-24
• 46 Satar B, Mukherji SK, Telian SA. Congenital aplasia of the semicircular canals. Otol Neurotol 2003; 24 (3) 437-446
• 47 Wu CC, Chen YS, Chen PJ, Hsu CJ. Common clinical features of children with enlarged vestibular aqueduct and Mondini dysplasia. Laryngoscope 2005; 115 (1) 132-137
• 48 Feneley MR, Murthy P. Acute bilateral vestibulo-cochlear dysfunction following occipital fracture. J Laryngol Otol 1994; 108 (1) 54-56
• 49 Benitez JT, Bouchard KR, Lane-Szopo D. Pathology of deafness and disequilibrium in head injury:a human temporal bone study. Am J Otol 1980; 1 (3) 163-167
• 50 Cass SP, Furman JM, Ankerstjerne K, Balaban C, Yetiser S, Aydogan B. Migraine-related vestibulopathy. Ann Otol Rhinol Laryngol 1997; 106 (3) 182-189
• 51 Honaker J, Samy RN. Migraine-associated vestibulopathy. Curr Opin Otolaryngol Head Neck Surg 2008; 16 (5) 412-415
• 52 Stewart WF, Lipton RB. Migraine headache: epidemiology and health care utilization. Cephalalgia 1993; 13 (Suppl. 12) 41-46
• 53 Murdin L, Davies RA, Bronstein AM. Vertigo as a migraine trigger. Neurology 2009; 73 (8) 638-642
• 54 Szmulewicz DJ, Waterston JA, MacDougall HG , et al. Cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS): a review of the clinical features and video-oculographic diagnosis. Ann N Y Acad Sci 2011; 1233: 139-147
• 55 Pothier DD, Rutka JA, Ranalli PJ. Double impairment: clinical identification of 33 cases of cerebellar ataxia with bilateral vestibulopathy. Otolaryngol Head Neck Surg 2012; 146 (5) 804-808
• 56 Demer JL, Honrubia V, Baloh RW. Dynamic visual acuity: a test for oscillopsia and vestibulo-ocular reflex function. Am J Otol 1994; 15 (3) 340-347
• 57 Longridge NS, Mallinson AI. A discussion of the dynamic illegible “E” test: a new method of screening for aminoglycoside vestibulotoxicity. Otolaryngol Head Neck Surg 1984; 92 (6) 671-677
• 58 Weber KP, Aw ST, Todd MJ, McGarvie LA, Curthoys IS, Halmagyi GM. Horizontal head impulse test detects gentamicin vestibulotoxicity. Neurology 2009; 72 (16) 1417-1424
• 59 Zee DS. Ophthalmoscopy in examination of patients with vestibular disorders. Ann Neurol 1978; 3 (4) 373-374
• 60 West PD, Sheppard ZA, King EV. Comparison of techniques for identification of peripheral vestibular nystagmus. J Laryngol Otol 2012; 126 (12) 1209-1215
• 61 Atkin A, Bender MB. Ocular stabilization during oscillatory head movements. Arch Neurol 1968; 19 (6) 559-566
• 62 Furman JM, Kamerer DB. Rotational responses in patients with bilateral caloric reduction. Acta Otolaryngol 1989; 108 (5-6) 355-361
• 63 Zapala DA, Olsholt KF, Lundy LB. A comparison of water and air caloric responses and their ability to distinguish between patients with normal and impaired ears. Ear Hear 2008; 29 (4) 585-600
• 64 Myers SF. Patterns of low-frequency rotational responses in bilateral caloric weakness patients. J Vestib Res 1992; 2 (2) 123-131
• 65 Karlsen EA, Mikhail HH, Norris CW, Hassanein RS. Comparison of responses to air, water, and closed-loop caloric irrigators. J Speech Hear Res 1992; 35 (1) 186-191
• 66 Baloh RW, Jacobson KM, Beykirch K, Honrubia V. Static and dynamic posturography in patients with vestibular and cerebellar lesions. Arch Neurol 1998; 55 (5) 649-654
• 67 Cevette MJ, Puetz B, Marion MS, Wertz ML, Muenter MD. Aphysiologic performance on dynamic posturography. Otolaryngol Head Neck Surg 1995; 112 (6) 676-688
• 68 Staecker H, Praetorius M, Baker K, Brough DE. Vestibular hair cell regeneration and restoration of balance function induced by math1 gene transfer. Otol Neurotol 2007; 28 (2) 223-231
• 69 Porciuncula F, Johnson CC, Glickman LB. The effect of vestibular rehabilitation on adults with bilateral vestibular hypofunction: a systematic review. J Vestib Res 2012; 22 (5-6) 283-298
• 70 Sylvestre MP, Abrahamowicz M, Capek R, Tamblyn R. Assessing the cumulative effects of exposure to selected benzodiazepines on the risk of fall-related injuries in the elderly. Int Psychogeriatr 2012; 24 (4) 577-586
• 71 Della Santina CC, Migliaccio AA, Hayden R , et al. Current and future management of bilateral loss of vestibular sensation - an update on the Johns Hopkins Multichannel Vestibular Prosthesis Project. Cochlear Implants Int 2010; 11 (Suppl. 02) 2-11
• 72 Albu S, Muresanu DF. Vestibular regeneration—experimental models and clinical implications. J Cell Mol Med 2012; 16 (9) 1970-1977
• 73 Staecker H, Praetorius M, Brough DE. Development of gene therapy for inner ear disease: Using bilateral vestibular hypofunction as a vehicle for translational research. Hear Res 2011; 276 (1-2) 44-51
• 74 Gillespie MB, Minor LB. Prognosis in bilateral vestibular hypofunction. Laryngoscope 1999; 109 (1) 35-41
• 75 Zingler VC, Weintz E, Jahn K , et al. Saccular function less affected than canal function in bilateral vestibulopathy. J Neurol 2008; 255 (9) 1332-1336
• 76 Black FO, Gianna-Poulin C, Pesznecker SC. Recovery from vestibular ototoxicity. Otol Neurotol 2001; 22 (5) 662-671
• 77 Yates BJ, Miller DM. Integration of nonlabyrinthine inputs by the vestibular system: role in compensation following bilateral damage to the inner ear. J Vestib Res 2009; 19 (5-6) 183-189
• 78 Vibert N, Babalian A, Serafin M, Gasc JP, Mühlethaler M, Vidal PP. Plastic changes underlying vestibular compensation in the guinea-pig persist in isolated, in vitro whole brain preparations. Neuroscience 1999; 93 (2) 413-432
• 79 Dieterich M, Brandt T. Functional brain imaging of peripheral and central vestibular disorders. Brain 2008; 131 (Pt 10) 2538-2552
• 80 Taura A, Kojima K, Ito J, Ohmori H. Recovery of hair cell function after damage induced by gentamicin in organ culture of rat vestibular maculae. Brain Res 2006; 1098 (1) 33-48