Diseases and Disorders

What is the Vestibular Hypofunction? The Effects and Causes

Last updated on November 13th, 2022 at 10:12 am

With vestibular hypofunction, the balance part of the inner ear is not working properly. This can occur on one side (unilateral hypofunction), or on both sides of the head (bilateral hypofunction).

Unilateral hypofunction can occur after damage from a variety of causes, including vestibular neuritis, vestibular schwannoma/treatments for vestibular schwannoma, and Meniere’s disease/treatments for Meniere’s disease.

Bilateral hypofunction can occur after damage to the inner ear/balance nerve from a variety of causes, including exposure to aminoglycoside antibiotics (which are toxic to the inner ear), neurofibromatosis type II, CANVAS syndrome (cerebellar ataxia, neuropathy, and vestibular areflexia), autoimmune disease, congenital problems, trauma, superficial siderosis, and idiopathic causes.

Both unilateral and bilateral vestibular hypofunction are diagnosed with VNG (showing absent/diminished inner ear responses to thermal changes on one or both sides), rotary chair testing (showing decreased gain, phase leads, and decreased time constant on the affected side), and head impulse testing (showing that the eyes slip off the target during a rapid head movement, and then quickly correct, known as a catch-up saccade).

Hypofunction of the inner ear produces symptoms related to a loss of the normal balance reflexes- therefore patients can have oscillopsia (movement or bobbing of the visual world with head movement due to loss of the vestibulo-ocular reflex), dizziness, and postural instability. Both unilateral and bilateral vestibular hypofunction are treated with vestibular physical therapy.

In unilateral hypofunction, treatment is aimed at promoting central compensation and relies on the other ear (the normal side) to perform most of the inner ear functions. In bilateral hypofunction, vestibular physical therapy can still be helpful, but therapy is often longer and more difficult, as the Anchor absence of all inner ear function means that you have to rely on other systems (such as the COR- cervical-ocular reflex) to sense head movements.

When I turn to look, the room spin

Have you ever turned to look quickly over your shoulder and been left with a couple seconds of room-spinning vertigo? If so you may have experienced a very common condition, called a vestibular hypofunction.

The Cause of Vestibular Hypofunction

Your vestibular system is your balance organ and you have two (one in each ear). It looks like a bunch of swirling canals and is related to your hearing system, the cochlea. Your vestibular system and your hearing system meet and send information to your brain via the vestibulocochlear nerve. This nerve can be damaged by an underlying infection like an upper respiratory infection or some medications. Some of these medications can include chemotherapy drugs and some antibiotics.The vestibulocochlear nerve is responsible for a reflex between your eyes and your head. In order to allow you to keep something in focus while moving, you need this reflex called the Vestibular Ocular Reflex (VOR). The reflex causes an equal and opposite motion of your eyes relative to your head movement, so if you turn your head left and are continuing to read a sign, your eyes should move to the right the same amount/speed. If the vestibulocochlear nerve is damaged, this reflex becomes inefficient. What results is a lag in your eye movements relative to your head movements, which your body perceives as vertigo or dizziness. The feeling of dizziness is created by a mismatch of information from your head and your eyes

Effects of Vestibular Hypofunction

The most common side effects include oscillopsia, chronic vertigo-free dizziness, and issues with balance, walking, and driving.Patients might not be able to read signs when moving, for instance.may experience more fallsHave trouble walking at night or on uneven terrainVestibular hypofunction affects higher cognitive functions, affecting spatial memory, learning, and wayfinding.Bilateral Vestibular Hypofunction affects people more severely than unilateral Vestibular Hypofunction.

Why Drugs Don’t Help in Vestibular Hypofunction?

The most commonly prescribed drug, Meclizine (aka Dramamine), does not fix this reflex. This drug acts a depressant to your central nervous system (brain and spinal cord). Basically, it reduces the involuntary parts of our central nervous system that can be responsible for feelings of nausea. It masks the symptoms, but it will not address the real problem.

What Does Help Vestibular Hypofunction?

Vestibular Rehabilitation Therapy (VRT) is able to improve the efficiency of your damaged VOR reflex and decrease symptoms of dizziness. A physical therapist that has advanced training in VRT can assess a patient suffering from dizziness and vertigo and determine if they have a vestibular hypofunction or another condition.

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