Bilateral vestibular hypofunction: Are the Barany Society criteria too strict?

BackgroundBilateral vestibular hypofunction (BVH) is a debilitating condition presenting acutely or progressively with oscillopsia, floating sensation, imbalance, and disequilibrium.ObjectiveThis study aims to identify the sensitivity of the Barany Society criteria for definitive diagnosis of patients with symptoms of BVH but not meeting the strict criteria and to explore the dissociation of objective testing and subjective patient experience.MethodsRetrospective case study of patients (n = 71) diagnosed at a tertiary vestibular clinic between 2015 and 2021. Diagnostic vestibular testing included caloric testing, rotary chair, and video head impulse testing (vHIT) to quantify vestibular function for definitive diagnosis. Subjective data was collected by means of questionnaires.ResultsThe sensitivity of Barany Society criteria for definite BVH in any vestibular test was 49% (n = 35). The highest sensitivity for an individual test was vHIT (51%). Those meeting Barany Society criteria had a mean Dizziness Handicap Inventory (DHI) score of 59.5 in comparison to 66.7 in those meeting expansive criteria.ConclusionsBarany Society criteria show poor sensitivity (49%). When comparing this criterion with the more widely used expansive criteria, about 50% of patients in our population will be excluded from a BVH diagnosis. This is compounded with the fact that those meeting Barany Society criteria and expansive criteria were at large not significantly different in terms of symptoms types, chronicity, postural stability, and subjective disability. It should be considered that the definite BVH category may need to be renamed "vestibular areflexia" since patients with less severe dysfunction on reflexive testing may still have similar disability from symptoms and can be characterized as having BVH.