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Bilateral vestibulopathy: Diagnostic criteria Consensus document of the Classification Committee of the Bárány Society1
Open accessAbstract
This paper describes the diagnostic criteria for bilateral vestibulopathy (BVP) by the Classification Committee of the Bárány Society. The diagnosis of BVP is based on the patient history, bedside examination and laboratory evaluation. Bilateral vestibulopathy is a chronic vestibular syndrome which is characterized by unsteadiness when walking or standing, which worsen in darkness and/or on uneven ground, or during head motion. Additionally, patients may describe head or body movement-induced blurred vision or oscillopsia. There are typically no symptoms while sitting or lying down under static conditions.The diagnosis of BVP requires bilaterally significantly impaired or absent function of the vestibulo-ocular reflex (VOR). This can be diagnosed for the high frequency range of the angular VOR by the head impulse test (HIT), the video-HIT (vHIT) and the scleral coil technique and for the low frequency range by caloric testing. The moderate range can be examined by the sinusoidal or step profile rotational chair test.For the diagnosis of BVP, the horizontal angular VOR gain on both sides should be <0.6 (angular velocity 150-300°/s) and/or the sum of the maximal peak velocities of the slow phase caloric-induced nystagmus for stimulation with warm and cold water on each side <6°/s and/or the horizontal angular VOR gain <0.1 upon sinusoidal stimulation on a rotatory chair (0.1 Hz, Vmax = 50°/sec) and/or a phase lead >68 degrees (time constant of <5 seconds). For the diagnosis of probable BVP the above mentioned symptoms and a bilaterally pathological bedside HIT are required.Complementary tests that may be used but are currently not included in the definition are: a) dynamic visual acuity (a decrease of ≥0.2 logMAR is considered pathological); b) Romberg (indicating a sensory deficit of the vestibular or somatosensory system and therefore not specific); and c) abnormal cervical and ocular vestibular-evoked myogenic potentials for otolith function.At present the scientific basis for further subdivisions into subtypes of BVP is not sufficient to put forward reliable or clinically meaningful definitions. Depending on the affected anatomical structure and frequency range, different subtypes may be better identified in the future: impaired canal function in the low- or high-frequency VOR range only and/or impaired otolith function only; the latter is evidently very rare.Bilateral vestibulopathy is a clinical syndrome and, if known, the etiology (e.g., due to ototoxicity, bilateral Menière's disease, bilateral vestibular schwannoma) should be added to the diagnosis. Synonyms include bilateral vestibular failure, deficiency, areflexia, hypofunction and loss.
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“For example, PPPD does not cause oscillopsia, but oscillopsia is present in only 30–40% of patients with bilateral vestibulopathy.”
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“Bilateral vestibulopathy is best distinguished from PPPD by its characteristic findings on physical examination and laboratory testing [45], such as bilaterally positive head thrusts and diminished responses on head impulse testing, caloric irrigation, or sinusoidal stimulation in a rotary chair.”
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Sprenger, A., Spliethoff, P., Rother, M., Machner, B., & Helmchen, C. (2020) · Journal of Neurology · doi:10.1007/s00415-020-09852-x · Cited by 30
Comparison of three video head impulse test systems for the diagnosis of bilateral vestibulopathy
van Dooren, T. S., Starkov, D. N., Lucieer, F., Vermorken, B. L., Janssen, A. M. L., Guinand, N., Fornos, A. P., Rompaey, V. V., Kingma, H., & van de Berg, R. (2020) · Journal of Neurology · doi:10.1007/s00415-020-10060-w · Cited by 30
Bilateral vestibulopathy decreases self-motion perception
van Stiphout, L., Lucieer, F., Pleshkov, M. O., Rompaey, V. V., Widdershoven, J. C. C., Guinand, N., Fornos, A. P., Kingma, H., & van de Berg, R. (2021) · Journal of Neurology · doi:10.1007/s00415-021-10695-3 · Cited by 30
Navigation strategies in patients with vestibular loss tested in a virtual reality T-maze
Gammeri, R., Léonard, J., Toupet, M., Hautefort, C., Nechel, C. V., Besnard, S., Machado, M., Nakul, E., Montava, M., Lavieille, J., et al. (2022) · Journal of Neurology · doi:10.1007/s00415-022-11069-z · Cited by 30
The effect of accompanying anxiety and depression on patients with different vestibular syndromes
Feng, S., & Zang, J. (2023) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2023.1208392 · Cited by 29
Persistent postural-perceptual dizziness: A functional neuro-otologic disorder
Yagi, C., Kimura, A., & Horii, A. (2024) · Auris Nasus Larynx · doi:10.1016/j.anl.2023.12.008 · Cited by 32
Bilateral vestibulopathy: the causes, diagnosis, and treatments
Kim, J., & Kim, H. (2021) · Current Opinion in Neurology · doi:10.1097/wco.0000000000001014 · Cited by 31
Eder, J., Kellerer, S., Amberger, T., Keywan, A., Dlugaiczyk, J., Wuehr, M., & Jahn, K. (2022) · Journal of Neurology · doi:10.1007/s00415-022-11033-x · Cited by 30
Vestibular Implantation and the Feasibility of Fluoroscopy-Guided Electrode Insertion
Stultiens, J. J. A., Postma, A. A., Guinand, N., Fornos, A. P., Kingma, H., & van de Berg, R. (2019) · Otolaryngologic Clinics of North America · doi:10.1016/j.otc.2019.09.006 · Cited by 28
Dobbels, B., Mertens, G., Gilles, A., Moyaert, J., van de Berg, R., Fransén, E., de Heyning, P. V., & Rompaey, V. V. (2020) · Frontiers in Neurology · doi:10.3389/fneur.2020.00710 · Cited by 29
“…were (1) BVP disease duration of more than 6 months and (2) definite diagnosis of BVP as defined by the diagnostic criteria of the Bárány Society (28): a) Horizontal angular vestibulo-ocular reflex (VOR) gain 0.6 measured by the video head impulse test (vHIT), and/or b) Reduced caloric response…”
MethodInfluentialMcLaren, R., Smith, P. F., Taylor, R. L., Ravindran, S., Rashid, U., & Taylor, D. (2022) · Frontiers in Neuroscience · doi:10.3389/fnins.2022.1010239 · Cited by 28
Bilateral Vestibular Dysfunction
Lee, S., Kim, H., & Kim, J. (2020) · Seminars in Neurology · doi:10.1055/s-0039-3402066 · Cited by 27
Helmchen, C., Machner, B., Rother, M., Spliethoff, P., Göttlich, M., & Sprenger, A. (2020) · Human Brain Mapping · doi:10.1002/hbm.24963 · Cited by 27
Falls Among People With Bilateral Vestibulopathy
Herssens, N., How, D., van de Berg, R., & McCrum, C. L. (2022) · JAMA Otolaryngology–Head & Neck Surgery · doi:10.1001/jamaoto.2021.3673 · Cited by 27
Patterns of Vestibular Impairment in Bilateral Vestibulopathy and Its Relation to Etiology
van Stiphout, L., Pleshkov, M. O., Lucieer, F., Dobbels, B., Mavrodiev, V., Guinand, N., Fornos, A. P., Widdershoven, J. C. C., Strupp, M. L., Rompaey, V. V., et al. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.856472 · Cited by 27
Central Lesions With Selective Semicircular Canal Involvement Mimicking Bilateral Vestibulopathy
Chen, L., & Halmagyi, G. M. (2018) · Frontiers in Neurology · doi:10.3389/fneur.2018.00264 · Cited by 26
Genetics and the Individualized Therapy of Vestibular Disorders
Mei, C., Dong, H., Nisenbaum, E., Thielhelm, T. P., Nourbakhsh, A., Yan, D. L. S., Smeal, M. R., Lundberg, Y., Hoffer, M. E., Angeli, S. I., et al. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.633207 · Cited by 26
Dordevic, M., Sulzer, S., Barche, D., Dieterich, M., Arens, C., & Müller, N. G. (2021) · Life · doi:10.3390/life11121369 · Cited by 26
Prevalence of motion sickness in various vestibular disorders: a study on 749 patients
Strupp, M. L., Brandt, T., Huppert, D., & Grill, E. (2018) · Journal of Neurology · doi:10.1007/s00415-018-8961-1 · Cited by 27
Head impulse compensatory saccades: Visual dependence is most evident in bilateral vestibular loss
Pogson, J. M., Taylor, R. L., McGarvie, L. A., Bradshaw, A. P., D’Souza, M., Flanagan, S., Kong, J. H. K., Halmagyi, G. M., & Welgampola, M. S. (2020) · PLoS ONE · doi:10.1371/journal.pone.0227406 · Cited by 27
Ogihara, H., Kamo, T., Tanaka, R., Azami, M., Kato, T., Endo, M., Tsunoda, R., & Fushiki, H. (2022) · Auris Nasus Larynx · doi:10.1016/j.anl.2022.03.004 · Cited by 25
Age-related changes to vestibular heave and pitch perception and associations with postural control
Gabriel, G. A., Harris, L. R., Gnanasegaram, J. J., Cushing, S. L., Gordon, K. A., Haycock, B., & Campos, J. L. (2022) · Scientific Reports · doi:10.1038/s41598-022-09807-4 · Cited by 25
Clinical Characteristics and Etiology of Bilateral Vestibular Loss in a Cohort from Central Illinois
Kattah, J. C. (2018) · Frontiers in Neurology · doi:10.3389/fneur.2018.00046 · Cited by 24
Brandt, T., Grill, E., Strupp, M. L., & Huppert, D. (2018) · Frontiers in Neurology · doi:10.3389/fneur.2018.00406 · Cited by 24
The Impact of the COVID-19 Pandemic on Follow-Ups for Vertigo/Dizziness Outpatients
Ueda, K., Ota, I., Yamanaka, T., & Kitahara, T. (2020) · Ear Nose & Throat Journal · doi:10.1177/0145561320980186 · Cited by 24
Test Batteries and the Diagnostic Algorithm for Chronic Vestibular Syndromes
Kitazawa, M., Morita, Y., Yagi, C., Takahashi, K., Ohshima, S., Yamagishi, T., Izumi, S., Koizuka, I., & Horii, A. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.768718 · Cited by 26
Miura, M., Goto, F., Inagaki, Y., Nomura, Y., Oshima, T., & Sugaya, N. (2017) · Frontiers in Neurology · doi:10.3389/fneur.2017.00722 · Cited by 25
Riska, K. M., Bellucci, J., Garrison, D., & Hall, C. D. (2020) · Ear and Hearing · doi:10.1097/aud.0000000000000885 · Cited by 24
Oscillopsia in Bilateral Vestibular Hypofunction: Not Only Gain But Saccades Too
Caletrío, Á. B., Ruiz, G. T., Rey-Martínez, J. A., Matiñó-Soler, E., Martín-Sanz, E., & Pérez‐Fernández, N. (2019) · Ear and Hearing · doi:10.1097/aud.0000000000000760 · Cited by 23
Johnson, C., Hallemans, A., Verbecque, E., Vestel, C. D., Herssens, N., & Vereeck, L. (2020) · The Journal of International Advanced Otology · doi:10.5152/iao.2020.8287 · Cited by 28
Lajoie, K., Marigold, D. S., Valdés, B. A., & Menon, C. (2021) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2021.107751 · Cited by 23
Chronic vestibular syndromes in the elderly: Presbyvestibulopathy—an isolated clinical entity?
Müller, K. J., Becker‐Bense, S., Strobl, R., Grill, E., & Dieterich, M. (2022) · European Journal of Neurology · doi:10.1111/ene.15308 · Cited by 23
Application of machine learning in the diagnosis of vestibular disease
Anh, D. T., Takakura, H., Asai, M., Ueda, N., & Shojaku, H. (2022) · Scientific Reports · doi:10.1038/s41598-022-24979-9 · Cited by 31
“Bilateral vestibular hypofunction as evaluated by MSPV is defined as 6°/s in each ear after caloric stimulation 18 .”
MethodVestibular-Evoked Myogenic Potentials in Bilateral Vestibulopathy
Rosengren, S. M., Welgampola, M. S., & Taylor, R. L. (2018) · Frontiers in Neurology · doi:10.3389/fneur.2018.00252 · Cited by 23
van Esch, B. F., Abolhosseini, K., Masius-Olthof, S., van der Zaag–Loonen, H. J., van Benthem, P. P. G., & Bruintjes, T. D. (2019) · Journal of Vestibular Research · doi:10.3233/ves-190654 · Cited by 23
“[29] used Vmax cut-off values of less than 6 degrees per second to define vestibular hypofunction whereas a cut-off value of 35 degrees per second is used by the University Medical Centre in Maastricht.”
Method
Metadata
- Authors
- Strupp, M., Kim, J.-S., Murofushi, T., Straumann, D., Jen, J. C., Rosengren, S. M., Della Santina, C. C., & Kingma, H.
- Affiliations
- LMU Klinikum (DE)
- Seoul National University (KR)
- Teikyo University Hospital, Mizonokuchi (JP)
- University of Zurich (CH)
- University of California, Los Angeles (US)
- The University of Sydney (AU)
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, USA
- National Research Tomsk State University (RU)
- Corresponding author
- Strupp, Michael
- ORCID
- Venue
- Journal of Vestibular Research
- Publisher
- SAGE Publications
- Published
- 2017-10-21
- Volume
- 27
- Issue
- 4
- Pages
- 177-189
- ISSN
- 0957-4271 (ISSN-L)
- 1878-6464
- PMC
- PMC9249284
- OpenAlex
- W2758384006
- Cited by
- 592
- References
- 172
- Citations by year
- 2026: 55 · 2025: 92 · 2024: 67 · 2023: 83 · 2022: 66 · 2021: 82 · 2020: 73 · 2019: 42 · 2018: 28 · 2017: 4
- FWCI
- 19.94
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Vestibular Research (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by-nc)
- Research Publications (Maastricht University) (submittedVersion, cc-by-nc)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by-nc)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- Bundesministerium für Bildung und Forschung (01EO0901, 01EO1401)
- Russian Science Foundation (17-15-01249)
- Deutschen Schwindel- und Gleichgewichtszentrum
- Topics
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Surgery › Nausea and vomiting management
- Keywords
- bilateral vestibulopathy, diagnostic criteria, vestibulo-ocular reflex, head impulse test, video head impulse test, caloric test, oscillopsia, vestibular function testing, otolith function, dynamic visual acuity, Romberg test, vestibular evoked myogenic potentials
- MeSH terms
- Point-of-Care Testing, Bilateral Vestibulopathy, Caloric Tests, Diagnosis, Differential, Head, Humans, Functional Laterality, Motion, Movement Disorders, Nystagmus, Pathologic, Reflex, Vestibulo-Ocular, Rotation, Sclera, Vestibular Function Tests, Vision Disorders, Vestibular Evoked Myogenic Potentials, Head Impulse Test
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