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The use of ENG in office practice and its use as a helpful, time-saving procedure is discussed. The following practical clinical questions are answered: 1. Is the vestibular mechanism normal or abnormal? 2. Is the vestibular pathology peripheral or central? 3. Is the peripheral disease right or left sided? Cost analysis of ENG in office practice is presented.
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Normal values of the caloric test are reported in 202 healthy subjects; besides the absolute values, these comprise the degree of side-difference of excitability and of directional preponderence in percent of the total reaction. In addition to mean values with standard deviations, the median values and the interquantile areas 80, 90, 94 and 100% have been reproduced in tabular form, because, according to statistical calculations, there is no normal distribution of the values in the strict sense. The problematic nature of borderline values for the separation of physiological from pathological responses is discussed in detail. In vieu of the considerable scattering, a knowledge of normal distribution areas appears to be absolutely necessary for an accurate evaluation of the caloric test in patients.
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Following inadvertent destruction of the left vestibular labyrinth during stapedectomy, a patient developed a transient abnormality of posture consisting of leftward ocular counterrolling, leftward had tilting, and a right-over-left skew deviation. This postural pattern, known as the "ocular tilt reaction," is the normal compensatory response of the dependent utricle to tilting. In this patient, the unopposed action of the intact right utricle was presumably responsible for the appearance of a normal leftward ocular tilt reaction.
The signs observed in 6 cases of peripheral vestibular disease included incoordination, head tilt and nystagmus. The intensity of the signs varied greatly with duration of the disease, and in 3 cases facial paralysis was also present. Tympanosclerosis was demonstrable in all cases subject to radiology. Trauma was the causative factor in most cases. The causes of, and relationships between, vestibular dysfunction and concomitant facial paralysis are discussed. The exact etiology of the tympanosclerosis is unknown.
Oculomotor response in the absence of vision was examined in 8 normal subjects, 11 unilaterally labyrinthectomised patients and 2 patients with suspected bilateral canal paresis. The experiments involved (a) voluntary oscillation of the head, (b) whole body oscillation on a turntable and (c) stimulation of neck afferents by oscillation of the body with the head fixed. In the patients with unilateral lesions there was a directional preponderance of the slow phase eye velocity towards the side of the lesion which differed significantly from that of the normal population. In the patients with bilateral paresis the oculomotor response to whole body oscillation was negligible, whereas the response to voluntary head movement had a mean gain of 0.45 and at high frequency could not be suppressed when viewing a head-fixed image. The saccadic activity during voluntary head movement was similar in all subjects and was correlated with slow phase velocity.
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The aim of a documentation in electronystagmography, that is to record as complete and definite as possible the information of a nystagmus relative to all its distinctive marks, hitherto has been reached just as little as the attempt, to develop a fine-quantitative investigatory method suitable for standardization for medical practice. The sources of error caused by the equipment and of physiological nature within a recorded nystagmus trace are exposed and illustrated by respective examples. Outgoing from the theory of the rotatory nystagmus based on the rotation test of the human vestibular system the fundamentels are developed for a complete evaluation method of an electronystagmogram including the elimination of artefacts by the authors' own research work in this field. However the pointed out problems of the electronystagmography are not yet answered in the clinical diagnostic of vestibular diseases, the systematic examination of spontaneous nystagmus and provoked nystagmus still represents the most important, most profitable and well-grounded part of the vestibular investigation in the medical practice.
Changes in the compensation of the sequences of the unilateral loss of the labyrinthine function were studied in rabbits. Destruction of the labyrinth was accompanied by ocular nystagmus, increase of frequency of respiration and heart contractions, and EEG-activation. Investigations carried out showed these reactions to be extinguished at different time. At the late periods of labyrinthectomy a considerable asymmetry of nystagmus reaction to the angular accelerations equal in intensity, but opposite in direction was revealed. Stimulation of an intact otolith labyrinth was accompanied by the appearance of positional nystagmus. The results obtained indicated imperfection of the compensatory mechanisms during complete unilateral loss of the vestibular function.
A case is reported of total bilateral cochleo-vestibular destruction following instillation of Framycetin into the middle ear, under pressure, through a transtympanic drain. Toxicity of Framycetin after local use is exceptional and only one case, reported by Ransome, was found in the published literature. The interest of this observation is that, by using puncture of the foot of the stapes, it was possible to find Framycetin in the perilymphatic liquid three weeks after the injection of the product.
The central compensation mechanisms for vertigo resulting from vestibular lesions are described together with the scientific basis for head exercises in vestibular rehabilitation. The indications and contra-indications for head exercises are discussed and the Cawthorne-Cooksey regime of exercises illustrated.