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The vestibular labyrinth consists of ? ve compartments: the lateral, anterior, and posterior semicircular canals, the utricule, and the saccule. At the beginning of the twentieth century, Robert Bárány proposed the caloric test as a clinical test of the lateral semicircular canal. This test enabled clinicians to assess the individual lateral semicircular canal function easily by using the simple method of irrigating the external ear canal with cold or warm water and observing the induced nyst- mus. We believe that the caloric test was a breakthrough in the ? eld of vestibular research. However, as far as the other compartments were concerned, there was no simple clinical test equal to the caloric test for the lateral semicircular canal function. At the end of the twentieth century, the vestibular evoked myogenic potential (VEMP) test was proposed as a new method for assessing the individual saccule function. This test has some unique attributes. First, it uses sound stimulation, even though it is a test of the vestibular system. This appears to be a contradiction n- rophysiologically. As a result, in its early stages there were controversies conce- ing the origin of the responses. However, such controversies have been overcome by basic neurophysiological studies and clinical studies. Above all, sound sensit- ity of the saccular afferents shown in cats and guinea pigs with single-unit recording methods became the main supporting evidence. Nowadays, VEMP is one of the routine clinical tests for balance disorder.
"It is uncertain whether clinically useful information of otolith function can be well characterized by vestibular-evoked-myogenic-potentials (VEMPs), i.e., electromyogenic activity recorded from sternomastoid muscles in response to brief loud auditory clicks. We aimed to assess the utility of VEMP testing in the differential diagnosis of dizziness (81 dizzy patients, 12 normals). We found that: (1) VEMP was reliably elicited from all controls and from 96% of patients without loss of vestibular function; (2) in patients with documented unilateral peripheral vestibular disorders, VEMP could reveal loss of otolith function that usefully facilitated diagnoses; and (3) such otolith function loss was independent of canal function loss revealed by caloric testing. We conclude that the VEMP-test is clinically useful to assess vestibular (otolith and/or inferior vestibular nerve) function, providing information complementary to that obtained from caloric testing (horizontal semicircular canal and/or superior vestibular nerve function)." --
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This text reviews the current understanding of vestibular anatomy allowing for a framework of reference, and how it's applied to vestibular testing, diagnosis and management of dizziness. Vestibular testing is an important tool in the evaluation and management of the patient with dizziness. It aids in establishing a diagnosis and determining the side or site of the lesion. In addition, it guides practitioners in selection of treatment and allows the ability of the patient’s condition to be evaluated over its time course. Common vestibular pathologies such as benign positional vertigo, Meniere’s disease, multisensory imbalance, vestibular neuritis, superior canal dehiscence, and vestibular migraine will be addressed in a concise and understandable manner. The text follows a clear format in which the etiology, pathophysiology, diagnostic features and medical or surgical management of such pathologies are discussed. The book gains increased importance as superior canal dehiscence and vestibular migraine are relatively new hot topics. Lastly, relatively rare entities such as bilateral vestibular hypofunction, pediatric vestibular disorders and central vestibular disorders are discussed. This text serves as a complete reference for clinicians, students and researchers interested in this common and severe disorder allowing for improved patient care and advancement of knowledge in the field. Chapters are written by acknowledged experts, allowing summary review of the newest and most up-to-date understanding of scientific information. Diagnosis and Treatment of Vestibular Disorders will be an invaluable resource for otolaryngologists, neurologists, otologists and neurotologists, basic science and translational researchers with interests in the vestibular system, fellows and residents in aforementioned fields, and general practitioners with an interest in patients with symptoms of dizziness.
(cont.) In the second part of the thesis, we develop a computational model of VEMP physiology, and use the model to separate external sources of variability from internal noise. The model outputs are also used to define a statistical measure, the inverse coefficient of variation (iCOV), which correlates with altered vestibular sensitivity, but is relatively robust to other changes. When applied to the experimental data, the iCOV is found to yield estimates of vestibular sensitivity that are more stable than the conventional VEMP amplitude. This measure also reveals a diversity of response threshold and growth characteristics within the clinically normal population. These findings suggest that the proposed approach could lead to the development of an improved clinical tool, but could also yield new insights into the physiological mechanisms of vestibular pathology.
This book reviews how we can record the human brain's response to sounds, and how we can use these recordings to assess hearing. These recordings are used in many different clinical situations--the identification of hearing impairment in newborn infants, the detection of tumors on the auditory nerve, the diagnosis of multiple sclerosis. As well they are used to investigate how the brain is able to hear--how we can attend to particular conversations at a cocktail party and ignore others, how we learn to understand the language we are exposed to, why we have difficulty hearing when we grow old. This book is written by a single author with wide experience in all aspects of these recordings. The content is complete in terms of the essentials. The style is clear; equations are absent and figures are multiple. The intent of the book is to make learning enjoyable and meaningful. Allusions are made to fields beyond the ear, and the clinical importance of the phenomena is always considered.
Neuro-Otology: a volume in the Handbook of Clinical Neurology series, provides a comprehensive translational reference on the disorders of the peripheral and central vestibular system. The volume is aimed at serving clinical neurologists who wish to know the most current established information related to dizziness and disequilibrium from a clinical, yet scholarly, perspective. This handbook sets the new standard for comprehensive multi-authored textbooks in the field of neuro-otology. The volume is divided into three sections, including basic aspects, diagnostic and therapeutic management, and neuro-otologic disorders. Internationally acclaimed chapter authors represent a broad spectrum of areas of expertise, chosen for their ability to write clearly and concisely with an eye toward a clinical audience. The Basic Aspects section is brief and covers the material in sufficient depth necessary for understanding later translational and clinical material. The Diagnostic and Therapeutic Management section covers all of the essential topics in the evaluation and treatment of patients with dizziness and disequilibrium. The section on Neuro-otologic Disorders is the largest portion of the volume and addresses every major diagnostic category in the field. Synthesizes widely dispersed information on the anatomy and physiology of neuro-otologic conditions into one comprehensive resource Features input from renowned international authors in basic science, otology, and neuroscience Presents the latest assessment of the techniques needed to diagnose and treat patients with dizziness, vertigo, and imbalance Provides the reader with an updated, in-depth review of the clinically relevant science and the clinical approach to those disorders of the peripheral and central vestibular system
Written by experts with extensive clinical and scientific experience, this comprehensive textbook presents the state of the art in auditory evoked potentials. Opening chapters explain the nature of electrical fields that generate surface recorded potentials, summarize the imaging modalities that complement evoked potential studies, and review acoustics and instrumentation. Major sections examine the anatomy and physiology of the auditory periphery, brainstem, and cortex and the principles and clinical applications of auditory, myogenic, visual, somatosensory, and vestibular evoked potentials. Chapters present hands-on laboratory exercises and clinical case studies. A full-color insert includes 3D images from multi-channel evoked potentials and functional imaging.
Scott-Brown's Otorhinolaryngology is used the world over as the definitive reference for trainee ENT surgeons, audiologists and trainee head and neck surgeons, as well as specialists who need detailed, reliable and authoritative information on all aspects of ear, nose and throat disease and treatment. Key points: accompanied by a fully searchable electronic edition, making it more accessible, containing the same content as the print edition, with operative videos and references linked to Medline highly illustrated in colour throughout to aid understanding updated by an international team of editors and contributors evidence-based guidelines will help you in your clinical practice features include key points, best clinical practice guidelines, details of the search strategies used to prepare the material and suggestions for future research new Endocrine section. Scott-Brown will provide trainee surgeons (ENT and Head and Neck), audiologists and ENT physicians with quick access to relevant information about clinical conditions, and provide them with a starting point for further research. The accompanying electronic edition, enhanced with operative videos, will enable both easy reference and accessibility on the move.