Difficulties Faced by Patients Suffering from Total Bilateral Vestibular Loss

Abstract

A unilateral sudden loss of function generates intense and frightening symptoms urging patients to see a doctor. Generally, the symptoms and signs of the deficit are so obvious that doctors make the diagnosis quickly. The situation is quite different if the deficit is gradual and affects both sides. To better understand the difficulties faced by patients suffering from total bilateral vestibular loss, 19 subjects were interviewed in a semistructured talk. The discussion focused on five main topics: (1) symptoms, (2) the medical trajectory from the earliest symptoms to the diagnosis, (3) the prescribed treatments, (4) the impact of the disease on work, and (5) the impact on social functioning and recreational activities. The symptoms reported by patients are insidious, and they may suggest a neurological deficit or a cardiocirculatory or psychiatric disorder. The diagnosis is often made after several consultations with several doctors from different specialties. When the diagnosis is made, all kinds of treatment are undertaken, in particular vestibular rehabilitation. Indeed, most physicians believe that it can promote central compensation processes, even though it has been demonstrated that vestibular exercises are ineffective in most of these patients. Two thirds of our subjects were obliged to modify or even stop their professional activities due the bilateral vestibular loss. In some patients, the disability is such that they almost constantly require the presence of their spouse. In conclusion, the symptoms of bilateral vestibular loss are sometimes misleading. They are often not recognized by doctors. The deficit has an obvious impact on patients' social functioning and professional activities.

Full Spectrum of Reported Symptoms of Bilateral Vestibulopathy Needs Further Investigation—A Systematic Review

“…A high level of interrater reliability was reached on the full article selection with a Cohen’s kappa of 0.98. Finally, 1,385 unique patients from 41 clinical studies and 86 patients from 47 case reports were included ( 2 , 5 , 14 – 99 ). The characteristics of these articles can be found in Tables A1 and A2 in Supplementary Material.…”

“…Symptoms for diagnosis include unsteadiness when walking or standing, movement-induced blurred vision/oscillopsia during walking or quick head movements, or worsening of unsteadiness on uneven ground and/or darkness ( 1 , 3 , 4 ). However, clinical experience and current literature point to a wider variety of symptoms ( 5 ). For example, many patients report a negative impact on physical and social functioning, and compromised cognitive abilities ( 6 – 8 ).…”

The vestibular implant: A probe in orbit around the human balance system

“…Unfortunately, the picture is completely different for other conditions. The handicap suffered by patients with a complete loss of the vestibular function is significantly underestimated and the pathway to diagnosis is full of hurdles [46,64]. However, recent studies have unambiguously revealed that the complete loss of the vestibular function has a dramatic impact on the quality of life of affected patients [22].…”

Finding a Balance: A Systematic Review of the Biomechanical Effects of Vestibular Prostheses on Stability in Humans

“…Attempts to develop a viable prosthetic device to restore vestibular function have gained traction and have been evidenced to improve VOR, postural stability and gait speed in humans [14][15][16]. The successful development of a prosthetic device that restores vestibular function would confer great benefit on patients; improving their quality of life and reducing the frequency of falls and hospital visits [17]. The potential economic value in such a device is noteworthy; a recent study conducted a sensitivity analysis, predicting that a device recovering 75% of vestibular function would have a cost-utility of $37986/quality-adjusted life year (QALY), well below the $50,000/QALY willingness-to-pay threshold at which medical interventions are considered to be 'highly cost-effective' in the US [18].…”