Background and aim: Bilateral vestibulopathy (BV) is a rare disorder characterized by loss of vestibular function, leading to unsteadiness and blurred vision during head movements, particularly in visually challenging settings such as driving. Although difficulties with driving have been suggested in BV patients, this pilot study aims to further explore and quantify self-reported driving ability and behavior in this population using both generic and disease-specific questionnaires.

Methods: Twenty adults with confirmed BV (mean age 61.6 years) were recruited from a tertiary center. Participants completed a novel disease-specific questionnaire, developed collaboratively by ENT specialists and driving research experts to identify traffic situations that are particularly challenging for patients with BV. In addition, they completed the Driver Behavior Questionnaire (DBQ) and the Multidimensional Driving Style Inventory (MDSI). Participants also rated their driving competence and reported on crash involvement and traffic violations.

Results: Most patients reported little difficulty while driving in familiar daytime environments but experienced challenges during night driving, in poor weather conditions, on uneven roads, and while multitasking. Ordinary violations were the most common maladaptive behaviors per the DBQ, though errors and lapses were rare. The MDSI showed patient and careful driving styles predominated, with anxious and distress-reduction styles reported by a minority. Only one patient attributed a traffic accident to BV, and few reported recent violations.

Conclusion: BV patients mostly adopt safe, adaptive driving behaviors, a pattern also commonly observed among older drivers. However, specific situations requiring stable gaze and spatial orientation pose particular challenges for individuals with BV. Findings are limited by self-reporting and small sample size. Future research using objective driving assessments and control groups is needed to inform evidence-based guidelines for counseling BV patients about driving.