Objective: Bilateral vestibulopathy (BV) leads to a bilateral deficit of the vestibulo-ocular reflex and has various etiologies. The main goal of this study was to determine the frequency and degree of recovery or worsening of vestibular function over time.
Methods: Eighty-two patients (59 males, 23 females; mean age± SD at the time of diagnosis 56.3 ± 17.6 years were re-examined 51 ± 36 months after the first examination. All patients underwent a standardized neuro-ophthalmological and neuro-otological examination. Electronystagmography with bithermal caloric irrigation was analyzed by measurement of the mean peak slow phase velocity (SPV) of the induced nystagmus. Patients evaluated the course of their disease regarding imbalance, gait unsteadiness and their health-related quality of life.
Results: Statistical analysis of the mean peak SPV of caloric induced nystagmus revealed a non-significant worsening over time (initial mean peak SPV 3.0 ± 3.5°/sec vs. 2.1 ± 2.8°/sec). With respect to subgroups of etiology, only patients with BV due to meningitis exhibited an increasing, but non-significant SPV (1.0 ± 1.4°/sec vs. 1.9 ± 1.6°/sec). Vestibular outcome was independent of age, gender, time course of manifestation, and severity of BV. Single analysis of all patients showed that a substantial improvement ≥ 5 °/sec occurred in 2 patients on both sides (idiopathic n=1, Sjögren’s syndrome n=1) and in 8 patients on one side (idiopathic n=6, meningitis n=1, Menière’s disease n=1). In 84% of the patients there was an impairment of their health-related quality of life (42% slight, 24% moderate, 18% severe). Forty-three percent of patients rated the course of their diseases as stable, 28% as worsened and 29% as improved.
Conclusions: Our data support the view that more than 80% of the patients with BV do not improve. Thus, the prognosis of BV is less favorable than assumed.
- bilateral vestibulopathy