Pediatric Bilateral Vestibular Hypofunction: A Review of 26 Cases.

Objective: Peripheral bilateral vestibular hypofunction (BVH) is a rare condition that is well-studied in the adult population, whereas characterization in children has been limited. We report a pediatric cohort of patients with BVH at a multidisciplinary, tertiary care pediatric vestibular clinic.

Methods: A record review of 832 patients with balance-related complaints in our center was conducted. Multidisciplinary evaluations in Otolaryngology, Physical Therapy (PT), and Audiology were reviewed for each subject, and data were entered into a REDCap database for further analysis.

Results: Twenty-six individuals met diagnostic criteria for BVH. The cohort consisted of 17 females and nine males, with a mean age of 5.24 years (1.41-17.35; SD 3.97). Thirteen subjects had diagnoses of one or more concurrent neurodevelopmental syndromes. Sensorineural hearing loss (SNHL) was present in 21 (80.8%) subjects, of which 17 were profound in severity and 14 had undergone cochlear implant surgery. Seventeen (65.4%) children were able to complete vHIT testing, revealing reduced lateral semicircular canal (SCC) gains bilaterally in 11 cases. Twenty-one (80.8%) patients received recommendation for PT services, of which 15 were for vestibular therapy specifically. Patients who completed their course of vestibular PT achieved improved functional goal outcomes and discharge from therapy in nine of 11 (81.8%) cases.

Conclusion: We present a case series of pediatric patients with bilateral vestibular hypofunction. BVH in this population is often associated with SNHL and comorbid congenital or neurodevelopmental diagnoses. Vestibular physical therapy may provide a significant improvement in quality of life for patients.

Level of evidence: Level 4 Laryngoscope, 2025.