Vestibular atelectasis (VA)

Timothy C. Hain, MD • Page last modified: August 2, 2022


Normal Membranous labyrinth
Normal labyrinth -- blue area is endolymph. Surrounding is perilymph.


Vestibular atelectasis is an obscure syndrome, mainly documented by case reports or pathological findings. The basic idea is that the membranous labyrinth consists of two compartments, the perilymph (outer), and the endolymph (inner). The inner compartment resembles a balloon that is suspended within the outer bony labyrinth. In vestibular atelectasis the walls of the labyrinth, potentially including the ampullae and utricle have collapsed. This was first described by Merchant and Schuknecht (1988) in autopsy specimens. They stated that "The principal clinical symptom is chronic unsteadiness, precipitated or aggravated by head movement, and sometimes associated with short episodes of spinning vertigo. It is presumed that the collapsed membranes interfere with the motion mechanics of the cupulae and otolithic membranes. "

Several papers and recent case reports have suggested (without proof) that the combination of bilateral vestibular weakness and pressure sensitivity is caused by vestibular atelectasis.

Subsequent papers:



Of course it is possible for the labyrinth to collapse. If it can distend (from Meniere's/Hydrops), it should be able to collapse as well. This would lead one to allow for the possibilty that "parts" of the labyrinth might be moving around. For example, the utricle might be "floppy", or the geometry of the ducts of the semicircular canal might not always be aligned.

This would seem most likely to occur in conditions like Meniere's or perilymph fistula.

The association between bilateral vestibular loss and pressure sensitivity seems to us to be quite a stretch. It would seem that these authors are reporting the combination of lack of lateral canal function, and preserved something else -- perhaps utricular function. We would like to see more anatomy.


Vestibular atelectasis is obviously a possible cause of vestibular disturbance, but it remains poorly characterized as of 2020. Most papers are either case reports, unencumbered by any anatomic evidence. A recent development are papers about 3T delayed contrast MRI of the inner ear. Lots more work needs to be done here.

There does appear to be a small group of patients with both vestibular loss of their canal function, and pressure sensitivity.