PP1504 - Bilateral Vestibular Hypofunction Clinical Presentation, Vestibular Testing, Barany Society Criteria

Abstract:

Background: Bilateral vestibular hypofunction is a debilitating condition that may present acutely or progressively with variable symptoms including oscillopsia, floating sensation, imbalance and disequilibrium. While there are certain recognized causes of BVH (vestibulotoxic medications, autoimmune ear diseases, Menière’s disease and meningitis) the majority of those cases are idiopathic.

Objectives: This study aims to identify the correlation between possible cause, symptoms and vestibular testing outcomes pertaining to a diagnosis of BVH. Furthermore, we aim to identify the sensitivity of the Barany Society criteria pertaining to the definitive diagnosis of patients with symptoms of BVH but not meeting full vestibular testing criteria.

Summary:

Design: This is a retrospective case study aimed to review a cohort of patients diagnosed at a tertiary vestibular clinic with bilateral vestibular hypofunction between 2015 and 2021.

Results: We reviewed 75 cases of BVH. Two were subsequently excluded because they fulfilled criteria for presbyvestibulopathy. The majority of the cases were idiopathic (n=34) and Meniere’s Disease (or treatment of Meniere’s Disease) was the second most common. 5/75 were identified as having probable BVH according to Barany Society (n=5). Overall, diagnostic sensitivity of The Barany Society criteria in identifying definite BVH in any vestibular test in this battery is 49.3% (n=35). The highest sensitivity found in an individual test for Barany criteria was the vHIT based on our results (66.4%). The PPV of the Barany Society criteria is 100% as there are no false positives and the NPV is 86% in a population of patients presenting with the hallmark symptoms. Only 23.6% of patients diagnosed with BVH, by Barany Society, met criteria in all three vestibular tests.

Conclusion: The current criteria show poor sensitivity (49.3%) and a low PPV (40%). Criteria set forth by the Barany Society when compared with the more widely used expansive criteria has revealed that it will exclude from categorization about 50% of patients. It should be considered that the definite BVH category may need to be renamed Vestibular Areflexia since patients with less robust reflexive testing may still have similar disability from typical symptoms and can be labeled as having BVH.