Unilateral Vestibular Loss -- example case

Unilateral Vestibular Loss -- example case Written by Deepseek AI on 07-15-2026

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What Is Unilateral Vestibular Loss?

Unilateral vestibular loss (UVL) refers to the sudden or gradual loss of function in one of the two vestibular organs located in the inner ear. This condition disrupts the brain's ability to process balance signals, often leading to severe dizziness, vertigo, and imbalance. In classical cases, the onset is acute, commonly attributed to viral infections such as vestibular neuritis, but it can also result from trauma, ischemia, or toxicity. Below, we explore a representative case that highlights the key features of this disorder.

Keywords: unilateral vestibular loss, vestibular neuritis, vertigo, nystagmus, balance rehabilitation, Romberg test, caloric testing, VOR (vestibulo-ocular reflex), oscillopsia, canal paresis

Example Case: A 45-Year-Old Female with Acute Vertigo

Patient Profile: A 45-year-old female, previously healthy, presented to the emergency department with a two-day history of sudden, severe spinning vertigo accompanied by nausea and vomiting. She reported that the symptoms began abruptly upon waking and were exacerbated by any head movement. She also noted a sensation of visual blurring when turning her head, especially to the left.

Clinical Examination:

Spontaneous nystagmus: Horizontal nystagmus with a torsional component was observed, with the fast phase beating toward the right ear, consistent with a left-sided vestibular deficit.
Head Impulse Test (HIT): A corrective saccade was noted when the head was rapidly turned to the left, indicating an abnormal vestibulo-ocular reflex (VOR) on that side.
Romberg Test: The patient swayed and fell toward the left side when standing with feet together and eyes closed.
Fukuda Stepping Test: The patient rotated >45 degrees to the left after 50 steps.

Diagnostic Testing:

Video Nystagmography (VNG): Confirmed a left-sided canal paresis of 45% during caloric testing, consistent with unilateral vestibular loss.
MRI Brain: Negative for central pathology (no stroke or tumor).
Romberg Test with foam: Positive for postural instability.

Diagnosis: Acute left-sided unilateral vestibular loss secondary to vestibular neuritis.

Management and Rehabilitation

In the acute phase, treatment focused on symptom relief using vestibular suppressants (e.g., meclizine) and antiemetics for 48 hours, followed by early mobilization. Once the acute vertigo subsided, the patient was referred for vestibular rehabilitation therapy (VRT), specifically:

Gaze stabilization exercises: Gaze fixation on a target while turning the head left and right to improve VOR gain.
Adaptation and substitution exercises: Turning the head while reading to reduce oscillopsia.
Balance training: Standing on uneven surfaces with eyes closed to enhance reliance on somatosensory cues.

Over the following 6 weeks, the patient's vertigo resolved completely, though she continued to experience mild imbalance in low-light settings. A follow-up caloric test showed persistent left canal paresis, but compensatory mechanisms, including cerebellar adaptation and visual substitution, allowed her to return to all daily activities.

Key Takeaways

Unilateral vestibular loss is a challenging condition that presents with disabling vertigo, nystagmus, and postural instability. This case illustrates the classic triad of vestibular neuritis: acute onset, positive head impulse test, and nystagmus. Early diagnosis using caloric testing and appropriate imaging rules out dangerous central causes. While vestibular suppressants are helpful in the first few days, long-term recovery depends on vestibular rehabilitation to promote central compensation. Even with persistent canal paresis, the prognosis is excellent for most patients who engage in tailored balance exercises.

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