Vestibular oscillopsia

Specialty: Otolaryngology.

• Ambient Motion Illusion
• visual instability when walking
• bounce of vision during head movement

Why it occurs

• Bilateral vestibular loss due to severe ototoxicity due to aminoglycosides (e.g., gentamicin)
• Dehiscence syndrome of the superior semicircular canal (due to failure in the vestibulo-ocular reflex)
• Bilateral vestibular neuritis or autoimmune involvement of the inner ear
• Auditory neuropathy or selective involvement of the superior and inferior vestibular nerves bilaterally

Initial workup

Video head impulse test (vHIT) to assess the gain of the vestibulo-ocular reflex in the six semicircular canals, computerized dynamic posturography, ocular and cervical vestibular evoked myogenic potentials (VEMPs), and brain MRI with posterior fossa protocol.

Standard management

• Adapted intensive vestibular rehabilitation therapy — the fundamental pillar of treatment through non-pharmacological habituation and gaze stabilization exercises
• Immediate suspension of any drug with active ototoxic potential
• Systemic corticosteroids if an autoimmune or acute inflammatory origin of the inner ear is suspected, such as methylprednisolone (descending regimen starting from 1 mg/kg/day orally).