By Millie Brecheisen, physiotherapist in Basel. Updated: 1 October 2026.
You can walk during the day, but lose your bearings after dark. Signs seem to bounce with each step. A bilateral vestibular deficit is one possibility worth investigating, even when spinning dizziness is not your main symptom.
When vestibular function is reduced on both sides
Bilateral vestibulopathy involves a marked loss of vestibular function on both sides. Unlike an acute unilateral disorder, it does not necessarily cause intense spinning vertigo. The main difficulties are unsteadiness while walking, problems in darkness or on uneven ground, and sometimes oscillopsia: the surroundings appear to bounce when the head moves [1].
Why darkness makes such a difference
When vestibular signals are insufficient, the brain relies more on vision and proprioception. Darkness removes visual support. Uneven ground makes information from the feet and body less reliable. Someone may therefore walk well along a brightly lit corridor yet feel very unstable outdoors at night.
There are several possible causes
Causes include ototoxic medicines, inner ear disease, neurological or genetic disorders, and cases where the cause remains unknown. A 2023 clinical review proposes a diagnostic approach in which ENT, neurological and hearing assessments, as well as instrumented vestibular tests, may be needed [1].
Physiotherapy does not replace investigation of the cause. It addresses the functional consequences of the deficit.
Building compensation when the deficit may persist
Rehabilitation aims to make the best use of remaining function and alternative sensory strategies. It can include gaze exercises, static and dynamic balance, walking on different surfaces and practice in reduced lighting. A 2024 review also discusses sensory substitution, galvanic stimulation and vestibular implants, which belong to specialised approaches [2].
Vestibular implants remain an active research area. Electrical stimulation may partly restore vestibular reflexes, and improvements in dynamic visual acuity have been reported. This is not a routine treatment in a physiotherapy clinic [3].
Safety and participation come first
Falls, driving, journeys after dark and work demands should be discussed. For active people, progression towards real tasks is important; comfortable performance during a simple static exercise is not the final goal.
Points to remember in clinical practice
Difficulty in darkness and oscillopsia while walking are useful clues. The head impulse test is often abnormal on both sides, and dynamic visual acuity may be reduced. Instrumented diagnosis may involve vHIT, caloric tests or a rotational chair, depending on the centre. Neurological and ototoxic causes should also be considered.
Reduce fall risk while keeping activities possible
Rehabilitation can improve participation even when the deficit persists. Adapting the environment is part of the clinical approach.
- Provide sufficient lighting, light routes used at night and remove obstacles.
- Discuss supports or walking aids if needed, after an individual assessment.
- Progress gradually towards different surfaces, head movements and walking tasks in safe conditions.
If your fall risk is high, do not try exercises with your eyes closed or on unstable surfaces alone. Exercises should match your abilities and the level of supervision available.
An individual assessment in Basel
Vestibular physiotherapy in Basel can assess the functional effects of a bilateral deficit in coordination with ENT or neurological care. Bring any available test results. Goals can address falls, walking after dark, travel and work.
Frequently asked questions
Does it always cause spinning dizziness?
No. Unsteadiness, oscillopsia and difficulty in darkness are often more characteristic.
Can I recover completely?
This depends on the cause and remaining function. Compensation can bring substantial improvement even when the peripheral deficit persists.
Why are quick head movements difficult?
The vestibulo-ocular reflex keeps the image less stable. Head movement can therefore cause blurred vision or oscillopsia.
Related articles
- Dizziness and vestibular rehabilitation in Basel
- Oscillopsia: when your vision bounces as you walk
- Unilateral vestibular hypofunction: symptoms and rehabilitation
- Balance problems: feeling unsteady without spinning vertigo
Scientific references
[1] van Stiphout L et al. Bilateral vestibulopathy: a clinical update and proposed diagnostic algorithm. Frontiers in Neurology, 2023. Read the reference on PubMed.
[2] Rehabilitation in bilateral vestibulopathy: trends and perspectives. 2024. Read the reference on PubMed.
[3] Electrical stimulation of the vestibular nerve: effects and optimization in vestibular implants. 2024. Read the reference on PubMed.
This information explains possible mechanisms and rehabilitation options. Diagnosis and treatment depend on an individual assessment.
Leave a Reply