Vestibular Hypofunction - Causes, Symptoms, Diagnosis, and Treatment

Introduction

The vestibular system is situated in the inner ear. It works with the eyes and muscles to keep the balance. This condition may occur at any age but is more common in older age. When the inner ear does not work properly, there may be an alteration in the balance resulting in vestibular hypofunction.

What Is Vestibular Hypofunction?

Vestibular hypofunction is a condition in which an individual tends to lose his balance. This is due to the inner ear system that does not function properly. The inner ear consists of three parts. They are:

• Semicircular canals (labyrinth).

• Cochlea.

• Vestibule.

The cochlea helps in hearing, and semicircular canals and vestibule help in balancing. The ear is a complex organ that contains many tiny parts that help in the conduction of sound. The inner ear has receptors that carry signals to the brain. The vestibular system consists of all these parts.

Vestibular hypofunction can affect either one or both sides of the head. When this vestibular system gets affected, the brain starts receiving the wrong messages, due to which the balance is lost.

What Are the Causes of Vestibular Hypofunction?

The causes of vestibular hypofunction are the following.

• Medications.

• Infections like labyrinthitis or vestibular neuritis.

• Injuries to the brain.

• Problems of inner ear system.

• Deposits of calcium in semicircular canals.

• Changes in the balancing system due to aging.

Vestibular dysfunction may be caused by increased levels of stress and anxiety, while conversely, dizziness and imbalance may be seen in other anxiety disorders.

What Are the Symptoms of Vestibular Hypofunction?

Symptoms generally depend on the cause. The symptoms of vestibular hypofunction are:

• Nausea and vomiting

• Dizziness.

• Loss of balance.

• Changes in the hearing process.

• Change in vision- blurred or bouncing.

• Mood changes like anxiety.

• Difficulty walking in dark and busy areas.

• When things move fast, there may be a feeling of motion.

• The illusion of movement of the environment.

How to Diagnose Vestibular Hypofunction?

There are no standard vestibular tests available for diagnosis. To detect vestibular hypofunction, normal values of tests are to be known, and technicians should be well-trained. The following tests are used to diagnose vestibular hypofunction.

• Video Oculography: This method is used to measure eye movements. It is a clinically tested method.

• Video Head Impulse Test (vHIT): It is used to measure vestibulo-ocular reflex (VOR) quantitatively. First, when suspected vestibular hypofunction, vHIT is recommended. If vHIT gives results as abnormal, then there is no need for other tests to be done. If vHIT comes as normal, then caloric testing is to be done.

• Testing of Dynamic Visual Acuity (DVA): Impaired VOR causes vision blurring during movement of the head. This causes loss of DVA. DVA is used to test the functioning of the vestibular system.

• Functional Head Impulse Test (FHIT): It is a new method for high-frequency DVA. They do not substitute for each other.

• Caloric Testing: It is a widely used method to test vestibular function using water and air.

• Rotatory Chair Testing: This method is used to test the horizontal semicircular canal function using low and middle-frequency domains.

• Vestibular-evoked Myogenic Potentials: It tells about the otolith function.

• Perceptional Threshold Testing: It is used to measure the self-motion perceptual thresholds.

There is no standardization of tests of the vestibular system. It is yet to be standardized. Along with these tests, hearing tests, blood tests, eye tests, imaging tests of the head and neck, posturography, etc., are done. In bilateral vestibulopathy, rotatory chair testing can be added to increase the specificity of the testing.

What Is the Treatment for Vestibular Hypofunction?

Treatment depends on the cause, diagnostic values, medical history, and physical examination of an individual. Treatments include

• Treating the Cause: Any underlying cause to be identified and treated. Antibiotics and antifungals can be given to treat infections of the ear.

• Lifestyle Changes: Making changes in lifestyle, like changing diet and activity, may solve the problem.

• Epley Maneuver: In this, specialized movements of the head and chest are done to place the particles in the semicircular canal into a place where they do not cause any problems.

• Surgery: This strategy is utilized when other procedures have failed to fix the problem. The purpose of this surgery is to repair the inner ear system.

• Rehabilitation Therapy: Vestibular rehabilitation therapy (VRT) consists of specialized exercises that help solve symptoms of vestibular disorders. It includes specialized exercises for the head, body, and eye. VRT exercises vary from one individual to another.

• Yoga: Exercises related to yoga can be practiced to reduce symptoms and stress.

Individuals recover from vestibular hypofunction, but this condition cannot be cured completely. This can be managed by handling the symptoms. Individuals with unilateral vestibular loss recover within six to eight weeks. In this type of condition, asymmetry in the signals from the inner ear remains, and there is no change in the preset level of the brain stem’s vestibular center but the response of the brain changes. The body adapts to the changes over a period of time.

What Are the Complications of Vestibular Hypofunction?

Complications of vestibular hypofunction are the following.

• Injury to the head or other parts of the body due to a fall.

• Affected quality of life.

• Discomfort due to symptoms.

Symptoms may affect the activities of day-to-day life and may result in depression and frustration. This can be solved by lifestyle changes and taking counseling. Vestibular syndrome looks like a stroke, but actually, it is an acute inflammation of the vestibular nerve. This nerve passes through the inner ear and stems out from the brain stem. The function of this nerve is to help stay physically balanced.

Conclusion

The ear is an important organ of the body. It also plays an important role in staying physically balanced. Balance is very much essential for leading a good quality of life. If affected, all work, including day-to-day life, will be hampered. Hence it is important to know about vestibular hypofunction, its causes, symptoms, diagnosis, treatment, and complications. Knowing helps in seeking medical help early. Early diagnosis helps in effective treatment. This, in turn, helps achieve a good quality of life.