IMPORTANCE Profound bilateral vestibular hypofunction (BVH) causes disabling oscillopsia, chronic disequilibrium, and postural instability, but little is known about its epidemiology and impact. OBJECTIVE To assess prevalence and functional impact of BVH in the US adult population. DESIGN AND SETTING National cross-sectional survey using a national database and corollary validation study. PATIENTS Adult respondents to the 2008 Balance and Dizziness Supplement to the US National Health Interview Survey (N = 21 782). MAIN OUTCOMES AND MEASURES Prevalence of BVH, socioeconomic and quality-of-life impact of BVH, and fall risk. Criteria for the survey-based diagnosis of BVH included all of the following: presence of visual blurring with head movement; unsteadiness; difficulty walking in darkness or unsteady surfaces and in a straight path; and symptoms being at least "a big problem" and present for at least 1 year, in the absence of other neurologic conditions or eye pathologic conditions affecting vision. RESULTS Adjusted national estimates from this survey indicate the prevalence of BVH in 2008 was 28 per 100 000 US adults (64 046 Americans). Of the participants with BVH, 44%reported changing their driving habits because of their symptoms, 56%reported reduced participation in social activities, and 58%reported difficulties with activities of daily living. Respondents with BVH had a 31-fold increase in the odds of falling in multivariate analyses compared with all respondents, with 25%reporting a recent fall-related injury. CONCLUSIONS AND RELEVANCE As estimated by the presence of specific symptoms in a nationally representative survey, BVH has considerable socioeconomic and quality-of-life impacts and significantly increases fall risk. These data support the need for new therapeutic strategies for BVH, including vestibular rehabilitation and implantable vestibular prostheses.
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