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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.”
In the citing paper
“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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“The current diagnostic criteria for bilateral vestibulopathy (BVP) are shown in Table 3 [83].”
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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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