Cited by 592Vestibular and auditory disordersCardiovascular Syncope and Autonomic DisordersNausea and vomiting management

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Bilateral vestibulopathy: Diagnostic criteria Consensus document of the Classification Committee of the Bárány Society1

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Strupp, Michael, Kim, Ji-Soo, Murofushi, Toshihisa, Straumann, Dominik, Jen, Joanna C., Rosengren, Sally M., Della Santina, Charles C., Kingma, Herman·2017·Journal of Vestibular Research

DOI 10.3233/ves-170619PMC PMC9249284

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Abstract

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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Diagnostic Criteria and Differential Diagnosis of Hemodynamic Orthostatic Dizziness/Vertigo
Kim, H. A., & Kim, J. (2020) · Research in Vestibular Science · doi:10.21790/rvs.2020.19.2.35 · Cited by 2
Catch-Up Saccades in Vestibular Hypofunction: A Contribution of the Cerebellum?
Hermann, R., Robert, C., Lagadec, V., Dupre, M., Pélisson, D., & Tilikete, C. (2023) · The Cerebellum · doi:10.1007/s12311-023-01512-w · Cited by 2
“Inclusion criteria were: • Age between 18 and 90 • Bilateral vestibular hypofunction (BVH) as defined by the Barany Society criteria [15] Cerebellar dysfunction: – Obvious cerebellar atrophy on MRI –”
BackgroundMethod
Vestibulotoxicity in Patients Undergoing Cisplatin-Based Cancer Treatment: A Phase IIIB Randomized Controlled Clinical Trial
Moreno, I., & Belinchon, A. (2023) · Audiology and Neurotology · doi:10.1159/000528435 · Cited by 2
Die sechs häufigsten peripherenvestibulären Syndrome
Strupp, M. L., Zwergal, A., & Goldschagg, N. (2023) · Nervenheilkunde · doi:10.1055/a-1928-4776 · Cited by 2
“Die diagnostischen Kriterien der bilateralen Vestibulopathie (BVP) sind wie folgt [57]:”
Background
Development of a diagnostic framework for vestibular causes of dizziness and unsteadiness in patients with multisensory neurological disease: a Delphi consensus
Male, A. J., Holmes, S. L., Hanna, M. G., Pitceathly, R. D. S., Ramdharry, G. M., & Kaski, D. N. (2023) · Journal of Neurology · doi:10.1007/s00415-023-11640-2 · Cited by 2
Laboratory Examinations and Imaging
Strupp, M. L., Brandt, T., & Dieterich, M. (2023) · Springer eBooks · doi:10.1007/978-3-030-78260-3_4 · Cited by 2
Ethanol-Induced Vestibular Dysfunction as a Model for Bilateral Vestibular Syndrome: Similarities in Video Head Impulse Test and Video-Oculography Data
Ojanperä, O. A. I., Haavisto, L. E., Sarin, J., & Salonen, J. N. (2023) · The Journal of International Advanced Otology · doi:10.5152/iao.2023.231030 · Cited by 2
“The vHIT is useful in providing diagnostic information regarding bilateral vestibulopathy 4 and is readily available in standard clinical practice.”
Background
慢性めまい (PPPD および加齢性前庭障害) の診断と治療
堀井, 新. (2023) · Nippon Jibiinkoka Tokeibugeka Gakkai Kaiho(Tokyo) · doi:10.3950/jibiinkotokeibu.126.11_1195 · Cited by 2
Vestibular Hypofunction Screening in Older Cochlear Implant Candidates
Lovin, B. D., Gorelik, D., Lin, K. F., & Vrabec, J. T. (2024) · Otolaryngology · doi:10.1002/ohn.800 · Cited by 2
Bilateral vestibulopathy – Loss of vestibular function and experience of emotions
Lahmann, C., Dieterich, M., Becker‐Bense, S., & Schmid‐Mühlbauer, G. (2024) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2024.111894 · Cited by 2
Evaluation of instability in patients with chronic vestibular syndrome using dynamic stability indicators
Ma, Y., Gao, X., Wang, L., Lyu, Z., Shen, F., & Niu, H. (2024) · Medical & Biological Engineering & Computing · doi:10.1007/s11517-024-03185-x · Cited by 2
“Some studies have found that patients with CVS generally have characteristics such as slower gait, shorter stride length, and prolonged contact between the feet and ground, and believe that gait changes are associated with decreased stability control [13].”
Exploration of sleep quality and rest-activity rhythms characteristics in Bilateral Vestibulopathy patients
Milot, E., Martin, T., Kuldavletova, O., Bessot, N., Toupet, M., Hautefort, C., Nechel, C. V., Clement, G. R., Quarck, G., & Denise, P. (2024) · Sleep Medicine · doi:10.1016/j.sleep.2024.08.034 · Cited by 2
Vestibular Implant Surgery: How to Deal With Obstructed Semicircular Canals—A Diagnostic and Surgical Guide
van de Berg, R., Stultiens, J. J. A., van Hoof, M., Rompaey, V. V., Hof, J. R., Vermorken, B. L., Volpe, B., Devocht, E. M. J., Fornos, A. P., Postma, A. A., et al. (2025) · Journal of Otolaryngology - Head and Neck Surgery · doi:10.1177/19160216241291809 · Cited by 2
Assessing gait variability concurrently with dynamic visual acuity on a treadmill in people with bilateral vestibulopathy
McCrum, C. L., Zhu, M., Willems, P. J. B., Visser, I., Kastrinou, M., van de Berg, R., Meijer, K., Hallemans, A., & Herssens, N. (2025) · Journal of Vestibular Research · doi:10.1177/09574271251313806 · Cited by 2
Evaluating vestibulo-ocular reflex gain and catch-up saccades following head impulses in normal aging
Orsini, C., Dion, J., Pierre, A. S., Cedras, A. M., Bacon, B. A., Champoux, F., & Maheu, M. (2024) · Journal of Vestibular Research · doi:10.1177/09574271241295616 · Cited by 2
The Effect, Compliance and Satisfaction of Customized Vestibular Rehabilitation: A Single Center Experience
Lee, H., & Kim, H. A. (2019) · Research in Vestibular Science · doi:10.21790/rvs.2019.18.1.14 · Cited by 2
Modern Concepts of Pharmacological Treatment of Vertigo and Dizziness
Гусева, А. Л., & Zamergrad, M. V. (2020) · Russian neurological Journal · doi:10.30629/2658-7947-2020-25-3-04-10 · Cited by 3
Сhronic dizziness
Nak, O. V., & Galinovskaya, N. V. (2020) · Health and Ecology Issues · doi:10.51523/2708-6011.2020-17-2-2 · Cited by 2
Isolated bilateral posterior semicircular canal hypofunction: comparison with bilateral vestibulopathy
Murofushi, T., Monobe, H., & Ushio, M. (2023) · Acta Oto-Laryngologica · doi:10.1080/00016489.2023.2253270 · Cited by 2
The DizzyQuest Combined with Accelerometry: Daily Physical Activities and Limitations among Patients with Bilateral Vestibulopathy Due to DFNA9
Martin, E. C., de Hoon, S., Stultiens, J. J. A., Janssen, A. M. L., Essers, J. M. N. H., Meijer, K., Bijnens, W., van de Berg, M. R., Herssens, N., de Varebeke, S. J., et al. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13041131 · Cited by 1
“…during walking or head movements, and a bilaterally reduced bithermal caloric response (mean peak slow phase velocity 6 ◦ /s), and/or a bilaterally reduced vestibular–ocular reflex gain of 0.6 measured with the video head impulse test or 0.1 measured with the torsion swing test [34].”
MethodInfluential
A patient with neurosarcoidosis presenting with easy falling and dysphagia
Okamura, M., Hamaguchi, M., Suzuki, K., Nakamura, T., Fujita, H., & Hirata, K. (2020) · Rinsho Shinkeigaku · doi:10.5692/clinicalneurol.cn-001404 · Cited by 2
Bilateral vestibular hypofunction: a literature review and a case report
Miśkiewicz-Orczyk, K., Lisowska, G., Szostek-Rogula, S., & Szlęzak, M. (2020) · Medycyna Pracy · doi:10.13075/mp.5893.01040 · Cited by 2
Measuring threshold and latency of motion perception on a swinging bed
Guyon, M., Chea, C., Laroche, D., Fournel, I., Baudet, A., Toupet, M., & Grayeli, A. B. (2021) · PLoS ONE · doi:10.1371/journal.pone.0252914 · Cited by 2
Editorial: Epidemiology and Genetics of Vestibular Disorders
Lopez-Escamez, J. A., Cheng, A. G.-L., Grill, E., & Liu, T. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.743379 · Cited by 2
Assessing the cervico-ocular reflex system via modifying the ocular vestibular-evoked myogenic potential test
Hsu, S.-Y., & Young, Y. (2020) · International Journal of Neuroscience · doi:10.1080/00207454.2020.1807977 · Cited by 1
Schwindel: ein multisensorisches und häufiges Symptom
Strupp, M. L., Brandt, T., & Dieterich, M. (2022) · Springer eBooks · doi:10.1007/978-3-662-61397-9_1 · Cited by 1
Present Status of Dizziness in the Elderly People in a Super-aging Society and Its Problem
Iwasaki, S. (2023) · Equilibrium Research · doi:10.3757/jser.82.216 · Cited by 1
Neurotological emergencies: a narrative review
Rivero‐de‐Aguilar, A., Soto-Varela, A., Puente-Hernandez, M., & Porta-Etessam, J. (2023) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-023-08125-3 · Cited by 1
Mareo y vértigo ortostático, funcional y cinetosis
da Costa, L. F. I., Sánchez-Blanco, C., Yáñez-González, R., Gómez, H. S., Peña-Navarro, P., Pacheco-López, S., Marcos-Alonso, S., Almeida-Ayerve, C. N., Cabrera-Pérez, L., & Díaz-Sánchez, V. (2023) · Revista ORL · doi:10.14201/orl.31540 · Cited by 1
A rare case report of bilateral vestibulopathy due to otosyphilis
Gu, H., Xu, Y., Xu, J., & Zhuang, J. (2024) · Medicine · doi:10.1097/md.0000000000038149 · Cited by 1
“[1] BVP can develop as a result of a broad spectrum of etiological causes, and 1 analysis of 255 patients revealed that the condition was of unknown etiology in 50% of cases.”
Background
High-Frequency Vestibular Function Is Vulnerable to Presbyvestibulopathy
Bae, S. H., Yun, J., Kwak, S., Jung, H., Lee, H. C., Kim, J., Kim, C., Lee, Y., & Kim, S. O. (2024) · Diagnostics · doi:10.3390/diagnostics14121224 · Cited by 1
Efficient gaze stabilization during video Active Gaze Shift Test (vAGST) in bilateral vestibulopathy
Nechel, C. V., Duquesne, U., Toupet, M., & Hautefort, C. (2024) · Frontiers in Neurology · doi:10.3389/fneur.2024.1509762 · Cited by 1
Sensory feedback curbs the impact of nGVS on postural control in older adults
Paromov, D., Augereau, T., Moïn-Darbari, K., Maheu, M., Bacon, B. A., & Champoux, F. (2025) · Neuroscience · doi:10.1016/j.neuroscience.2025.02.025 · Cited by 1
“…ocular vestibular evoked myogenic potential (oVEMP: Eclipse EP-25/VEMP, Interacoustics, Denmark). cVEMP and oVEMP were considered to be normal when a replicable waveform was present at 95 dB nHL when using a 500 Hz tone burst and when interaural amplitude asymmetry was < 40 % (Strupp et al., 2017).”
Bilateral Vestibulopathy: What Can the Video Head Impulse Test Tell Us?
Sofia Waissbluth, A., Macarena Viñuela, M., Escobedo, E., Pastoré, A., & Iván Novoa, C. (2025) · Audiology Research · doi:10.3390/audiolres15020020 · Cited by 1
“According to the Bárány Society, the diagnosis of BV includes the presence of gains lower than 0.6 in both lateral semicircular canals with VHIT [4].”
Influential
Effects of Customized Web Video-Based Vestibular Rehabilitation for Patients With Vestibular Hypofunction: A Randomized Controlled Study
Kamo, T., Ogihara, H., Tanaka, R., Azami, M., Kato, T., Tsunoda, R., & Fushiki, H. (2025) · Otology & Neurotology · doi:10.1097/mao.0000000000004494 · Cited by 1
Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes: Higher odds of adverse mental health when physical function is impaired
McConnell, C., Allen, P. D., & Anson, E. R. (2025) · Journal of Vestibular Research · doi:10.1177/09574271251335958 · Cited by 1
Clinical Characteristics of Dizzy Patients Showing Discordant Results Between Bithermal Caloric Test and Video Head Impulse Test
Jung, H. J., Lee, S., Oh, H. K., Wee, J. H., Cho, C. G., & Park, J. H. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14124350 · Cited by 1
“…(MD) by the Bárány Society (2015) [19]; vestibular migraine by the Bárány Society (2012) [20]; bilateral vestibulopathy by Bárány Society (2017) [21]; presbyvestibulopathy by the Bárány Society (2019) [22]; benign paroxysmal vertigo by ICHD-3 (2018) [23]; and persistent postural-perceptual…”
Correlation of skull vibration-induced nystagmus test and video head impulse test in patients with sudden sensorineural hearing loss with vertigo
Guo, Q., Lin, Y., Hang, P., & Zha, D. (2025) · Frontiers in Neurology · doi:10.3389/fneur.2025.1642700 · Cited by 1
Using the gait disorientation test to measure spatial navigation in children with cochlear implants
Kingsley, E., Wagner, A. R., Patterson, J. N., Chiao, J., Choudhry, B. N., Christy, J. B., & Janky, K. L. (2025) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/j.ijporl.2025.112632 · Cited by 1
Vestibular Implants: The Present Status and Future Prospects
Karabulut, M., van Soest, A., Stultiens, J. J. A., Guinand, N., Fornos, A. P., van de Berg, R., & Devocht, E. M. J. (2025) · Springer eBooks · doi:10.1007/978-981-96-8671-1_26 · Cited by 1

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: Strupp, Michael
Kim, Ji-Soo
Murofushi, Toshihisa
Straumann, Dominik
Jen, Joanna C.
Rosengren, Sally M.
Kingma, Herman
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
DOI: 10.3233/ves-170619
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: cc-by-nc
creativecommons.org/licenses/by-nc/4.0/ (unspecified)
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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