Bilateral vestibulopathy can have various causes: ototoxicity (mainly caused by aminoglycosides), meningitis, bilateral tumours, neuropathies, bilateral sequential vestibular neuritis, or Meniére’s disease. Some types of bilateral vestibulopathy seem to arise from systemic autoimmune processes—for example, systemic lupus erythematosus, polychondritis, Cogan’s syndrome, or rheumatoid arthritis. About 20% of cases of bilateral vestibulopathy, however, remain “idiopathic” despite extensive diagnostic workup.¹ Prompted by studies on immune mediated sensorineural hearing loss,^2,3 we previously demonstrated IgG antibodies against the membranous labyrinth (ampulla, semicircular canal, saccule, and utricle) in sera from eight of 12 patients with “idiopathic” bilateral vestibulopathy, compared with one of 22 healthy controls and none of six patients with systemic autoimmune disease.⁴ Although the pathogenicity of these antibodies remains unclear, their appearance seems to indicate organ specific immune dysregulation.

Here we report a patient with a possible autoimmune bilateral vestibulopathy without hearing problems who recovered after steroid treatment. The recovery correlated with the disappearance of serum autoantibodies against …