Skip to main content

Bilateral vestibulopathy treatment: update and future directions


Bilateral vestibulopathy or BVH is a disorder of both labyrinths and/or vestibular nerves which have various etiologies. BVH is most often a chronic condition in which patients can suffer from blurred vision (oscillopsia), impaired spatial orientation and postural instability. Moreover, there is no continuing distressing vertigo, spontaneous nystagmus, or postural falls, which are typical signs of a vestibular tone imbalance caused by acute unilateral lesions. Those symptoms lead to an important decrease in physical activity, social functioning and vitality that dramatically impact the patients’ quality of life. The treatment options for various forms of BVH could be one of the following four lines of treatment: (a) Preventive treatment through prevention of ototoxicity, (b) therapeutic treatment through medical treatment of the causative underlying disease, (c) rehabilitative treatment through the vestibular rehabilitation therapy, (d) future directions through sensory substitution devices (balance prostheses technology). The prognosis of BVH is poor and more than 80% of the patients do not improve. The aim of this study was to discuss the update and the future directions in the treatment of the bilateral vestibular hypofunction (BVH).


  1. 1

    Rinne T, Bronstein AM, et al. Bilateral loss of vestibular function. Acta Otolaryngol Suppl 1995; 520: 247–250.

    Article  Google Scholar 

  2. 2

    Lanska DJ. Dandy, Ford, and Walsh, and the clinical features of bilateral vestibulopathy. Ann Neurol 2007; 62: 530–531. author reply 531

    Article  Google Scholar 

  3. 3

    Brandt T. Bilateral vestibulopathy. Brandt T. Vertigo: its multisensory syndromes. London: Springer, 1999. 127–139.

    Google Scholar 

  4. 4

    Vibert D, Liard P, Häusler R. Bilateral idiopathic loss of peripheral vestibular function with normal hearing. Acta Otolaryngol 1995; 115: 611–615.

    CAS  Article  Google Scholar 

  5. 5

    Brandt T. Bilateral vestibulopathy revisited. Eur J Med Res 1996; 1: 361–368.

    CAS  PubMed  Google Scholar 

  6. 6

    Brandt T, Dieterich M, et al. Introductory remarks, vertigo and dizziness: multisensory syndromes. Brandt T, Dieterich M, Strupp M. Vertigo and dizziness. London: Springer-Verlag; 2005. 1–5.

    Google Scholar 

  7. 7

    Herdman SJ, Clendaniel RA. Assessment and interventions for the patient with complete vestibular loss. Herdman SJ. Vestibular rehabilitation. Philadelphia: F. A. Davis Company; 2007. 54–75.

    Google Scholar 

  8. 8

    Magnusson M, Padoan S. Delayed onset of ototoxic effects of gentamicin in treatment of Meniere’s disease. Rationale for extremely low dose therapy. Acta Otolaryngol 1991; 111: 671–676.

    CAS  Article  Google Scholar 

  9. 9

    Hain TC, Cherchi M, Yacovino DA. Bilateral vestibular loss. Semin Neurol 2013; 33:195–203.

    Article  Google Scholar 

  10. 10

    Deutschlander A, Glaser M, Strupp M, Dieterich M, Brandt T. Immunosuppressive treatment in bilateral vestibulopathy with inner ear antibodies. Acta Otolaryngol 2005; 125: 848–851.

    Article  Google Scholar 

  11. 11

    Bittar RS, Pedalini ME, Ramalho JR, Carneiro CG. Bilateral vestibular loss after caloric irrigation: clinical application of vestibular rehabilitation. Rev Laryngol Otol Rhinol (Bord) 2005; 126: 3–6.

    CAS  Google Scholar 

  12. 12

    Krebs DE, Gill-Body KM, et al. Vestibular rehabilitation: useful but not universally so. Otolaryngol Head Neck Surg 2003; 128: 240–250.

    Article  Google Scholar 

  13. 13

    Herdman SJ, Schubert MC, Tusa RJ. Role of central preprogramming in dynamic visual acuity with vestibular loss. Arch Otolaryngol Head Neck Surg 2001; 127: 1205–1210.

    CAS  Article  Google Scholar 

  14. 14

    Zee DS. Vestibular adaptation. Herdman SJ. Vestibular rehabilitation. Philadelphia: F.A. Davis Company; 2007. 19–27.

    Google Scholar 

  15. 15

    Clendaniel RA. Vestibular rehabilitation strategies for patients with unilateral and bilateral vestibular deficits. Lustig LR, Niparko J, Minor LB, Zee DS. Clinical neurotology: diagnosing and managing disorders of hearing, balance and the facial. Baltimore, MD: Informa HealthCare; 2002. 333–343.

    Google Scholar 

  16. 16

    Lord SR, Ward JA. Age-associated differences in sensori-motor function and balance in community dwelling women. Age Ageing 1994; 23: 452–460.

    CAS  Article  Google Scholar 

  17. 17

    Horak FB, Hlavacka F. Somatosensory loss increases vestibulospinal sensitivity. J Neurophysiol 2001; 86: 575–585.

    CAS  Article  Google Scholar 

  18. 18

    Moore S, Woollacott MH. The use of biofeedback devices to improve postural stability. Phys Ther Pract 1993; 2: 1–19.

    Google Scholar 

  19. 19

    Tyler M, Danilov Y, Bach-Y-Rita P. Closing an open-loop control system: vestibular substitution through the tongue. J Integr Neurosci 2003; 2: 159–164.

    Article  Google Scholar 

  20. 20

    NeuroCom International Inc.. Management of balance and mobility disorders bibliography: a compilation of resources assembled by NeuroCom International Inc. 11:Clackamas, OR NeuroCom. 2002; 12–19

  21. 21

    Nichols DS. Balance retraining after stroke using force platform biofeedback. Phys Ther 1997; 77: 553–558.

    CAS  Article  Google Scholar 

  22. 22

    Nichols DS, Glenn TM, Hutchinson KJ. Changes in the mean center of balance during balance testing in young adults. Phys Ther 1995; 75: 699–706.

    CAS  Article  Google Scholar 

  23. 23

    Mizrahi J, Solzi P, Ring H, Nisell R. Postural stability in stroke patients: vectorial expression of asymmetry, sway activity and relative sequence of reactive forces. Med Biol Eng Comput 1989; 27: 181–190.

    CAS  Article  Google Scholar 

  24. 24

    Dettmann MA, Linder MT, Sepic SB. Relationships among walking performance, postural stability, and functional assessments of the hemiplegic patient. Am J Phys Med 1987; 66: 77–90.

    CAS  PubMed  Google Scholar 

  25. 25

    Walker C, Brouwer BJ, et al. Use of visual feedback in retraining balance following acute stroke. Phys Ther 2000; 80: 886–895.

    CAS  Article  Google Scholar 

  26. 26

    Viirre E, Sitarz R. Vestibular rehabilitation using visual displays: preliminary study. Laryngoscope 2002; 112: 500–503.

    Article  Google Scholar 

  27. 27

    Corna S, Nardone A, Prestinari A, Galante M, Grasso M, Schieppati M. Comparison of Cawthorne-Cooksey exercises and sinusoidal support surface translations to improve balance in patients with unilateral vestibular deficit. Arch Phys Med Rehabil 2003; 84: 1173–1184.

    Article  Google Scholar 

  28. 28

    Vuillerme N, Cuisinier R. Head position-based electrotactile tongue biofeedback affects postural responses to Achilles tendon vibration in humans. Exp Brain Res 2008; 186: 503–508.

    Article  Google Scholar 

  29. 29

    Goebel JA, Sumer B. Vestibular physiology. Hughes GB, Pensak ML. Clinical otology. New York: Thieme Publishers Inc; 2007. 44–54.

    Google Scholar 

  30. 30

    Lewis RF, Nicoucar K, Gong W, Haburcakova C, Merfeld DM. Adaptation of vestibular tone studied with electrical stimulation of semicircular canal afferents. J Assoc Res Otolaryngol 2013; 14: 331–340.

    Article  Google Scholar 

  31. 31

    Golub JS, Ling L, Nie K, Nowack A, Shepherd SJ, Bierer SM, et al. Prosthetic implantation of the human vestibular system. Otol Neurotol 2014; 35: 136–147.

    Article  Google Scholar 

  32. 32

    Rubinstein JT, Bierer S, Kaneko C, Ling L, Nie K, Oxford T, et al. Implantation of the semicircular canals with preservation of hearing and rotational sensitivity: a vestibular neurostimulator suitable for clinical research. Otol Neurotol 2012; 33: 789–796.

    Article  Google Scholar 

  33. 33

    Perez Fornos A, Guinand N, van de Berg R, Stokroos R, Micera S, Kingma H, et al. Artificial balance: restoration of the vestibulo-ocular reflex in humans with a prototype vestibular neuroprosthesis. Front Neurol 2014; 5:66.

    Article  Google Scholar 

  34. 34

    Guyot JP, Sigrist A, Pelizzone M, Kos MI. Adaptation to steady-state electrical stimulation of the vestibular system in humans. Ann Otol Rhinol Laryngol 2011; 120: 143–149.

    Article  Google Scholar 

  35. 35

    Furman JM, Cass SP. Vestibular disorders: a case-study approach. New York: Oxford University Press; 2003; p. 360.

    Google Scholar 

  36. 36

    Moscicki RA. Immune-mediated inner ear disorders. Baillieres Clin Neurol 1994; 3: 547–563.

    CAS  PubMed  Google Scholar 

  37. 37

    Telian SA, Shepard NT. Update on vestibular rehabilitation therapy. Otolaryngol Clin North Am 1996; 29: 359–371.

    CAS  Article  Google Scholar 

  38. 38

    Gans RE. Vestibular rehabilitation: protocols and programs. San Diego: Singular Publishing Group; 1996. 55–82.

    Google Scholar 

  39. 39

    Luinge HJ, Veltink PH. Inclination measurement of human movement using a 3-D accelerometer with autocalibration. IEEE Trans Neural Syst Rehabil Eng 2004; 12: 112–121.

    Article  Google Scholar 

  40. 40

    Danilov YP, Tyler ME, et al. Efficacy of electrotactile vestibular substitution in patients with bilateral vestibular and central balance loss Conf Proc IEEE Eng Med Biol Soc 2006; Suppl: 6605–6609.

  41. 41

    Danilov YP, Tyler ME, Skinner KL, Hogle RA, Bach-y-Rita P. Efficacy of electrotactile vestibular substitution in patients with peripheral and central vestibular loss. J Vestib Res 2007; 17: 119–130.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. 42

    Liston RA, Brouwer BJ. Reliability and validity of measures obtained from stroke patients using the Balance Master. Arch Phys Med Rehabil 1996; 77: 425–430.

    CAS  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Mohamed Fawzy MD, AuD.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

Rights and permissions

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

To view a copy of this licence, visit

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Fawzy, M., Khater, A. Bilateral vestibulopathy treatment: update and future directions. Egypt J Otolaryngol 32, 83–92 (2016).

Download citation


  • bilateral vestibulopathy
  • dizziness
  • oscillopsia
  • sensory substitution devices