[Mechanism of the effect of acupuncture in patients with vestibular disorders].
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A controlled trial comparing the effects of dibekacin and gentamicin in 30 patients has enabled us to standardise the most commonly used vestibulocochlear tests. None of the patients treated with dibekacin showed any auditory disturbance. The only abnormality detected was on vocal audiometry in 7 patients treated with gentamicin. Could vocal audiometry be the first paraclinical test capable of detecting aminoglycoside ototoxicity?
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Brainstem auditory evoked response (BAER) testing was done to evaluate inner ear/VIIIth cranial nerve (CN8) function in the horse. The BAER test consisted of stimulating the auditory system with clicks and recording far-field responses of the brainstem auditory components via cutaneous electrodes and a signal averaging system. The normal response was shown to be a series of waves occurring within the first 10 msec after the stimulus click. Functional loss of the auditory receptor organ (cochlea) or CN8 results in loss of the entire response on the side of the injury. Because of the anatomic relationships of the peripheral auditory and vestibular systems, trauma to one will injure the other. Therefore, auditory testing (BAER tests) may be used to advantage in the diagnosis of peripheral vestibular disease. The BAER test was used in a horse that had signs suggestive of vestibular dysfunction or a brain lesion. The test helped to demonstrate a unilateral inner ear/CN8 lesion and to discount the probability of a more central lesion.
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Aging in the peripheral vestibular apparatus is shown to consist of processes similar to those occurring in other parts of the nervous system. Sensory epithelium and primary efferents degenerate and are not replaced. Type I hair cells and elements of the pars inferior are most susceptible. Remaining cells show a build-up of lipofuscin and microstructural changes suggesting compromised metabolism. Rupture of the saccular membrane and microfractures of the otic capsule are frequently seen. Otoconia undergo degeneration, and the tissue between the endolymphatic duct and bony vestibular aqueduct becomes fibrotic. The recognition of these findings is a first step in the clinical delineation of the "dysequilibrium of aging" from symptoms related to specific disease processes. Further clinical correlation will remain difficult until changes in the central vestibular pathways and their connections with the optic and locomotor systems are better understood.
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