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Vestibular Hypofunction

Vestibular hypofunction is when the balance part of the inner ear is not working properly. This can occur on one side (unilateral hypofunction) or on both sides (bilateral hypofunction).

Unilateral hypofunction can occur from a variety of causes:

  • Vestibular neuritis
  • Acoustic neuroma (non-cancerous brain tumour)
  • Treatments for acoustic neuroma
  • Meniere’s disease
  • Treatments for Meniere’s disease.

Bilateral hypofunction can also occur from a variety of causes:

  • Exposure to aminoglycoside antibiotics (which are toxic to the inner ear)
  • Neurofibromatosis type II
  • CANVAS syndrome (cerebellar ataxia, neuropathy, and vestibular areflexia)
  • Autoimmune disease
  • Congenital problems
  • Trauma
  • Superficial siderosis
  • Idiopathic causes.


What are the symptoms?

Hypofunction of the inner ear produces symptoms related to a loss of the normal balance reflexes:

  • Oscillopsia (movement or bobbing of the visual world with head movement due to loss of the vestibulo-ocular reflex)
  • Dizziness
  • Postural instability.
  • Visual Vertigo
  • Cognitive deficits such as fatigue or ‘brain fog’.



Both unilateral and bilateral vestibular hypofunction are treated with vestibular rehabilitation.

In unilateral hypofunction, treatment is aimed at promoting central compensation and relies on the other ear (the normal side) to perform most of the inner ear functions.

In bilateral hypofunction, vestibular rehabilitation can still be helpful, but therapy is often longer and more difficult, as the  absence of all inner ear function means that you have to rely on other systems (such as the COR- cervical-ocular reflex) to sense head movements.

Here at Hallamshire Physiotherapy clinic, our specialist therapists are experienced in vestibular conditions and can help with advice and education as well as vestibular rehabilitation. We can also direct you to an appropriate consultant if we feel that their expertise is also required in your management.

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