42
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M É D I C A
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Médica
SUPLEMENTO
Otoneurología 2014:
comprendiendomejor lostrastornosvestibulares
SUPLEMENTO
Actual.Med.
2014; 99: (791). Supl. 42-60
Bilateral vestibularhypofunction
Abstract
BVH is a therapeutic challenge for theNeurotologist. Oftenoverlooked for its lackof “classic” vestibular signand
symptom (nystagmus and vertigo), is a rare but not exceptional condition that can be foundwith an estimated
incidence of 1,7 patients per 100000 adults. Medical interview and physical examination are the best allies for
its diagnosis, whereas complementary examinations usually add only confirmation info. However, these tests
are sometimesnecessary for clarificationof uncertain cases, etiologicdeterminationorobjectivemeasurement for
describingextent of injureor planning the follow-up.Outcomeof its treatment ispoorer than that ofUVH, but the
greatly impaireddaily lifeof thesepatientsmakesmandatory their inclusion inVestibularRehabilitationprotocols.
Gabriel Trinidad-Ruiz
1
, BeatrizSamaniego-Regalado
1
, LuisaAmador-Penco
2
1
Department of Otolaryngology-Head and Neck Surgery. University Hospital Complex of Badajoz. Neurotology
division
2
Department ofOtolaryngology-HeadandNeck Surgery. UniversityHospital Complexof Badajoz
INTRODUCTION
A fifty-six years old female without relevant ENT history is
referred from Primary Care to a randomNeurology department.
Hermaincomplainsareblurryvisionandsevereunsteadiness,but
she also claims to suffermemory loss, difficulties to concentrate
and intense intolerance to any kind of movement (not only of
her own body, but also of surrounding environment). Left aside
her physical incapacities, she feels extremely impaired for her social
and familiaractivitiesor, even, relationships, andher life isessentially
confinedtoherhouse.
Thisapparentlyunspecificcondition, thatcanbemisunderstood
asacognitive, psychiatricor complexneurologicdisorder, is theusual
appearanceof,possibly,oneofthemostchallengingscenariosthatcan
be found intheNeurotologyfield:bilateralvestibularhypofunction.
Neurotologistsarewell awareof this infrequent condition, as it
entailsthorough, long lastingandnotalwaysrewardedRehabilitation,
and impliesaquiteunderestimatedamountofdisability.
However, for theGeneral Practitioner or ENTnotworkingwith
Neurotology patients on a regular basis, bilateral vestibulopathy is
tightlyassociated (asclassically)withsystemicaminoglycosidetoxicity,
butmightbeoverlooked indifferentsituations.
As we intend to describe along this article, this impairment
canbe relatively easily diagnosed, so these patients canbe referred
to treatment as soon as possible, and alsowell informed about the
causesandpossibleoutcomesof theirsymptoms.
Wewill structure this review comparing the experienceof our
group since July 2007 (when theNeurotologyDivisionwas added to
our ENTDepartment) to January2014,with thefindings reported in
themostrelevantpaperspublishedonthismatter.
For reproducibility purposes, we defined bilateral vestibular
hypofunction (BVH) as a condition where coincident with physical
examination, a total or partial loss in the vestibular functionof both
sideswasdemonstrablewithcalorictestingasaconstantfindingalong
the evolution of the patient, regardless of its possible fluctuations.
Thus,weexcludedfromthisdefinitionallpatientsrecoveringanormal
caloric test inoneorboth sidesat anypointof theirhistory, andalso
thosewhose impairmentwas attributable tovestibular suppressants
ormedicationshavingsucheffect.
Unilateral vestibular hypofunction (UVH) was defined as a
condition where, coincident with physical examination, a total or
partial loss in the vestibular function of one sidewas demonstrable
with caloric testing as a constant finding along the evolution of the
patient, regardlessof itspossiblefluctuations.Thus,weexcludedfrom
thisdefinitionallpatientsrecoveringanormal caloric testatanypoint
of theirhistory, andalso thosewhose impairmentwasattributable to
vestibularsuppressantsormedicationshavingsucheffect.
Vestibular loss was assumed when a mean peak slow phase
velocity (SPV) of 10º/sgor lesswas obtainedafter both irrigations in
the bithermic caloric test, or, in the case of UVH group, a unilateral
weaknessof20%ormorewas found.
We alsodefined a third group containing the rest of the study
population, gatheredby thecommoncharacteristicofNoPermanent
Vestibular Hypofunction (NPVH). In this groupwe included patients
with temporal vestibular hypofunction (uni or bilateral), such as
Menière disease (MD) patients (with no persistent vestibular loss);
patientswithtemporalvestibular impairment(withouthypofunction),
suchasbenignparoxysmal positional vertigo (BPPV); andall the rest,
implyingornotvestibular impairment.
EPIDEMIOLOGY
Within the above-mentioned period, we evaluated 2607
patients in our unit suffering from vertigo, unsteadiness or any kind
of balance impairment. Among these, 55werediagnosedwithBVH,
Keywords: Bilateral Vestibular
Hypofunction,
Vestibular
Rehabilitation, Unsteadiness,
Dizziness.
Hipofunciónvestibularbilateral
Gabriel Trinidad-Ruiz
JulioCienfuegos Linares51ºA · 06006Badajoz, Spain
e-mail:
