Best of five
- A. Repeated Epley manoeuvres
- B. Long-term prochlorperazine
- C. Strict bed rest
- D. Immediate cochlear implantation
- E. Specialist vestibular rehabilitation emphasising gaze stabilisation and substitution
FRCS (ORL-HNS) · SECTION 1 SBA
Bilateral vestibular hypofunction
A patient develops oscillopsia while walking and marked imbalance in darkness after prolonged aminoglycoside exposure. Head-impulse testing is abnormal bilaterally. What is the most useful rehabilitation strategy?
E. Specialist vestibular rehabilitation emphasising gaze stabilisation and substitution
Bilateral vestibular loss has no simple repositioning manoeuvre. Adaptation where possible, gaze-stability exercises, visual and somatosensory substitution, falls prevention and stopping vestibulotoxic exposure are central.
Why every option is right or wrong
A. Repeated Epley manoeuvres: Epley treats canalithiasis, not bilateral hypofunction.
B. Long-term prochlorperazine: Vestibular suppressants can worsen compensation and function.
C. Strict bed rest: Inactivity increases deconditioning and dependence.
D. Immediate cochlear implantation: The primary disability is vestibular; hearing status is not given.
E. Specialist vestibular rehabilitation emphasising gaze stabilisation and substitution: Bilateral vestibular loss has no simple repositioning manoeuvre. Adaptation where possible, gaze-stability exercises, visual and somatosensory substitution, falls prevention and stopping vestibulotoxic exposure are central.
What if the scenario changed?
If examination showed a unilateral posterior-canal positional nystagmus instead, a canalith-repositioning manoeuvre would be appropriate.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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