What Is Bilateral Vestibular Hypofunction?

Bilateral vestibular hypofunction means that the balance organs in both inner ears, or their associated pathways, are working less effectively than normal.

The vestibular system helps keep our vision steady when we move our heads. It also contributes to balance and our awareness of movement through space.

When both sides are affected, everyday activities such as walking, turning the head, shopping or moving around in dim lighting can become difficult.

What are the symptoms?

Common symptoms include:

• Unsteadiness when walking, particularly on uneven ground or in darkness.
• Blurred or bouncing vision during head movements, sometimes called oscillopsia.
• Difficulty walking while looking around or turning the head.
• Reduced confidence with exercise and outdoor activities.

Unlike some causes of vertigo, bilateral vestibular hypofunction does not necessarily cause a spinning sensation. Some people feel relatively comfortable when sitting still but become unsteady as soon as they move.

Possible causes include certain medicines that can damage the inner ear, meningitis and some inner-ear disorders. In other cases, the cause remains unknown.

Can vestibular rehabilitation help?

Yes. Vestibular rehabilitation is an important part of management for many people with bilateral vestibular hypofunction.

A tailored programme may include gaze-stabilisation exercises, balance training, walking practice and strategies to reduce the risk of falls. The exercises need to be appropriate for the person’s level of vestibular function, mobility and overall health.

Recovery varies. Some people make substantial functional gains, while others need ongoing exercises and adaptations. Complete restoration of inner-ear function cannot be guaranteed.

Diagnosis usually requires a clinical assessment and, where appropriate, specialist vestibular tests such as the video head impulse test (vHIT) or caloric testing.

If you are struggling with blurred vision during movement or persistent unsteadiness, a vestibular physiotherapy assessment can help determine whether rehabilitation is appropriate.

Reference: Strupp M et al. (2017). Bilateral vestibulopathy: Diagnostic criteria. Journal of Vestibular Research, 27(4), 177–189. https://doi.org/10.3233/VES-170619