Hey, friend. Welcome to Grounded, the vestibular podcast. I'm doctor Madison Oak, AKA the vertigo doctor. I am the vestibular physical therapist who is here to help you with all things dizziness, imbalance, and vertigo. In this podcast, we explore the fascinating world of vestibular disorders. Come with me as we dive into the journey to discover the mysteries of dizziness, the brain, inner ear, and the balance mechanisms that keep us grounded.
Whether you've been managing your dizziness for one day or for twenty five years, we are going to get real about what it takes to manage dizziness, handle the anxiety cycle, and thrive, not just survive with your vestibular disorder. First, I want to remind you that this is never medical advice. Remember this podcast is for informational purposes only and may or may not be the best fit for you and your personal situation. It shall not be construed as medical advice.
The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and or diagnosis. Always check with your own physician, medical professionals, and health care team before trying or implementing any information found here. Meet me in your coziest chair while we navigate the highs and lows and the twists and turns of the vestibular universe. Welcome to Grounded. Let's dive in. Hello, and welcome to another episode of Grounded.
My name is doctor Madison Oak, and this week's win of the week is by Christine. Christine says, my elementary school aged kids had a school dance last night, and there was two hours of blasting music and strobing lights in the gym. I did a lot of supportive things leading up to it. I wore my earplugs and sunglasses since I didn't I don't have blue light glasses yet. She knows already that she's not supposed to wear sunglasses inside, which
is a one in itself. And regularly closed my eyes and did quick meditations. That coupled with some ginger gum and a couple of tools from the dizzy box, which is by RuWell, discount code vertigo doc if you want to get in on that, helped a lot with overstimulation. I love this. Nowhere in here was she, like, I had a panic moment and needed to leave and had so much dizziness and whatever. And even if that is the case, even if you're listening to this right now, you're like, that did happen.
You know that's the case, you did the things that you needed to to cope with a lot of stimulation. Anyone knows an elementary aged kid at a dance with strobe lights and mute plastic music knows that that is hard to tolerate for pretty much literally everyone. So congratulations to you, Christine, for making it through this and using all of your tools and honestly just doing well with it overall because this is a huge step in the right direction, and I can't wait to see what you
do next. Congrats. Alright. We are now talking about bilateral vestibular hypofunction. This is a frequently asked question, but but I think it's a frequently asked question because I think a lot of people are misdiagnosed with it. Bilateral vestibular hypofunction or bilateral vestibular dysfunction, BVH or BVD. Not to be confused by binocular vision dysfunction, BVD, it's very confusing. Bilateral vestibular hypofunction is when both of your vestibular systems, both of your inner ears, are not
working properly. So the system in your inner ear, your vestibular system, both of them should be firing at the same time saying, I am looking forward and if you're watching on YouTube, you can watch me do this. But basically they say, I'm looking forward. I'm looking forward all the time. When you look to the right, the right side fires more. The left side fires less. And it says, okay. I'm looking to the right and then to the left and vice
versa all day long. Now the problem is when this is not happening, when you have a unilateral vestibular hypofunction, let's say for argument's sake you have 0% function on your right side, your left side is pretty cool. It can compensate for that. But if for some reason you have 0% function, which is really what we're talking about here, on both sides, it is going to pose a pretty significant vestibular disorder. Now that being said, I, again, think a lot of people are
misdiagnosed or overdiagnosed with this. Not because it doesn't exist. It absolutely, positively exists, but because the VNG or video nystagmography exam is not a perfect test. And so the calorics portion of the VNG test where they put the air or the water in your ear, they see how long your eyes move around for that's supposed to happen. If it is done incorrectly, it can come back with a BVH diagnosis.
So if you have a caloric test that says you have 0% function on either side, I highly recommend getting it redone at least one more time. So this chronic lack of signal is a problem, but a lot of people don't end up having it. And I I send people back for VNGs enough and they come back that say, actually, it showed function in both sides that it is there. Bilateral vestibular hypofunction is about lack of signal.
It is not about spinning. You could technically still have spinning if you had vestibular migraine, which makes it a little bit confusing. But if you have no signal through either vestibular nerve from your vestibular system, it is your vestibulocochlear nerve, but from the vestibular portion. If you have no signal from either side, you cannot spin. So your symptom, usually the prevalent symptom here, is ultimately going to be imbalance. If you have a history of taking gentamicin
or certain chemotherapy drugs, this can happen. They're called ototoxic medications, some autoimmune inner ear diseases, some genetic conditions. If you had bilateral vestibular neuritis, it caused 0% function on both sides. That is very rare, like very rare. But I guess it's possible because most neuritis is you still have some function on one side. Sometimes it's idiopathic, meaning we do not know why it happens.
The main symptom of bilateral vestibular hypofunction is going to be unsteadiness when walking, especially in the dark or uneven ground because now you only have proprioception and vision to depend on. You are going to be visually dependent and that is ultimately going to be a coping strategy for you because if you were not visually dependent and you were trying to depend on something that is
not there, it's not gonna work. It would be like if someone who is completely blind attempted to rely on their eyes for balance, and you can no longer rely on your vestibular system for balance. The next is oscillopsia. So that is gaze instability. So when your vision bounces or blurs with head motion, this is pretty common honestly. But when it's with BVH, it does not compensate because in unilateral hypofunction, you're using your opposite ear to attempt to compensate.
In bilateral, you cannot compensate using your other side. Therefore, some level of oscillopsia is relatively permanent for people. It will be worsened in low light and visually complex environments, again, because you are going to have visual dependence and it's not something we're trying to get rid of. A lot of times, like, your visual dependence, we're gonna try to wean you off of being visually dependent, but here we need to use it as a coping and compensation strategy.
And again, it does not cause a spinning sensation if you have 0% function on both sides. It does not. Most people report feeling like they're uneasy or swaying on a boat, things like that, walking on marshmallows, which are not to be confused with vestibular migraine. If you have these symptoms, it does not mean that you have BVH. You need to get a calorics exam to confirm that because, again, all vestibular symptoms go in every single vestibular disorder bucket. Like,
spinning goes in almost every single one. Like, you can have spinning with BPPV, vestibular migraine, vestibular neuritis, vestibular labyrinthitis, meniere's disease. These symptoms are not specific to diagnoses, so I just want you to know that. You can get tested again with a rotary chair test. You could actually get tested with a VHIT or Videohead impulse test, VEMP and caloric testing, VNG, and then a DVA, which is a
bedside exam, a dynamic visual acuity test. Is there improvement to be had to improve your function and quality of life? Yes, absolutely. It is really, really important for people with bilateral vestibular hypofunction to strength train. I know I say this all the time for every single vestibular disorder, and this applies to every single vestibular disorder.
It really does. But especially if you have bilateral vestibular hypofunction, and this is because, basically, your proprioception is going to need to be really, really, really excellent. And one of the best ways to strengthen your proprioception are going to be balance exercises and then strength training. It also builds confidence and does other things you need to strength train. There's no which way about it, and we have safe ways for you to do
so. Of course, obviously, in vestibular group fit, there's a sale next week in the twenty eighth and the twenty ninth. I will get you the code soon as well. Other things like wearing flatter shoes, bringing a walking stick, making sure you have a partner with you if you are going to go on, like, a hike with really uneven ground. Things like that, are all really going to be helpful. You can compensate usually a little bit with gaze stability. So VOR times one, VOR times two exercises.
So when I see a patient with BVH, I typically try to get them the best that I can, but they're not gonna get all the way up to that, like, 240 beats per minute. So we're probably not gonna get all the way there. We're gonna get part of the way there. So your oscillopsia is not as significant. But compensation strategies, again, are still going to be a big piece of this. And then habituation to reduce sensory
overwhelm. Although we do need you to be slightly more dependent on your vision than in other vestibular disorders, we still don't want it to feel like when you walk into a room full of people, like there's so much overwhelm and panic and, just feeling not like yourself and things like that. So there is going to be some level of figuring that out. And so habituation, nervous system regulation, sensory practice, things like that are all going
to help. Again, assistive devices are also going to be really important. So as much as you can, put a nightlight or motion sensor to prevent falls in the dark, don't have a super squishy rug in your room, avoid walking on super uneven surfaces, be cautious in crowds and busy visual environments, take breaks if you're feeling overloaded, build gentle movement and strength training, please, please, please, please, please, into your day to keep your system adapting and kind of moving forward.
This is not the most common vestibular disorder, but it is one that I get really commonly asked about. So if you have 0% function on either side, this is what most applies to you. It is very real. It is very frustrating. Getting the correct support therapy mindset work is all important because improvement is definitely possible. You are not alone. There are is a growing community of vestibular warriors, who do get it. We get it in
vestibular group fit if you need us. Other resources like a local PT, there are probably some support groups, and then of course the Vestibular Disorders Association can all be helpful as well. Thank you so much for tuning in. All about bilateral vestibular hypofunction, not binocular vision dysfunction. If you found this helpful, please subscribe, leave a five star review, and share it with someone who might need it. Until next time. I love you. Bye.
Listening. If you liked this episode, head to the show notes and take the free vestibular migraine and persistent postural perceptual dizziness master classes. If you're interested in undoing your chronic dizziness and feeling better faster, join us in vestibular group fit using code grounded, all caps, for 15% off. Find me on Instagram at the vertigo doctor and doctor jenna at dizzy dot rehab dot therapist.
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