Follow-up of vestibular function in bilateral vestibulopathy

Objective: Bilateral vestibulopathy (BV) leads to a bilateral
deficit of the vestibulo-ocular reflex and has various aetiologies.
The main goal of this study was to determine the frequency and
degree of recovery or worsening of vestibular function over
time.Methods: 82 patients (59 males, 23 females; mean age at the
time of diagnosis 56.3 (SD 17.6) years) were re-examined 51 (36)
months after the first examination. All patients underwent a
standardised neuro-ophthalmological and neuro-otological
examination. Electronystagmography with bithermal caloric
irrigation was analysed by measurement of the mean peak slow phase
velocity (SPV) of the induced nystagmus. Patients evaluated the
course of their disease in terms of balance, gait unsteadiness and
health related quality of life.Results: Statistical analysis of the
mean peak SPV of caloric induced nystagmus revealed a
non-significant worsening over time (initial mean peak SPV 3.0
(3.5)°/s vs 2.1 (2.8)°/s). With respect to subgroups of aetiology,
only patients with BV due to meningitis exhibited an increasing,
but non-significant SPV (1.0 (1.4)°/s vs 1.9 (1.6)°/s). Vestibular
outcome was independent of age, gender, time course of
manifestation and severity of BV. Single analysis of all patients
showed that a substantial improvement ⩾5°/s occurred in two
patients on both sides (idiopathic n = 1, Sjögren's syndrome n = 1)
and in eight patients on one side (idiopathic n = 6, meningitis n =
1, Menière's disease n = 1). In 84% of patients there was
impairment of their health related quality of life (42% slight, 24%
moderate, 18% severe). Forty-three per cent of patients rated the
course of their disease as stable, 28% as worsened and 29% as
improved.Conclusions: Our data support the view that more than 80%
of patients with BV do not improve. Thus the prognosis of BV is
less favourable than assumed.