Bilateral vestibulopathy treatment: update and future directions

Bilateral vestibulopathy or BVH is a disorder of both labyrinths and/or vestibular nerves which have various etiologies. BVH is most often a chronic condition in which patients can suffer from blurred vision (oscillopsia), impaired spatial orientation and postural instability. Moreover, there is no continuing distressing vertigo, spontaneous nystagmus, or postural falls, which are typical signs of a vestibular tone imbalance caused by acute unilateral lesions. Those symptoms lead to an important decrease in physical activity, social functioning and vitality that dramatically impact the patients’ quality of life. The treatment options for various forms of BVH could be one of the following four lines of treatment: (a) Preventive treatment through prevention of ototoxicity, (b) therapeutic treatment through medical treatment of the causative underlying disease, (c) rehabilitative treatment through the vestibular rehabilitation therapy, (d) future directions through sensory substitution devices (balance prostheses technology). The prognosis of BVH is poor and more than 80% of the patients do not improve. The aim of this study was to discuss the update and the future directions in the treatment of the bilateral vestibular hypofunction (BVH).