Although older patients may be subject to most of the common balance disorders of younger patients, they have more problems with chronic disequilibrium and falls. Prevention and rehabilitation play an important role in treating these patients.

Computerized dynamic platform posturography is defined in this technology assessment. The review discusses what computerized dynamic platform posturography measures, what the reliability and validity of the information are, and the uniqueness of the information provided. The clinical contribution and indications for testing are discussed. There are comments on future directions for research on computerized dynamic platform posturography and a summary and conclusion.

Scatter plots showing the amplitude versus velocity (maximum and average) relationship of horizontal saccades in 25 normal subjects and four groups of patients were statistically compared. Three patients with "subclinical" medial longitudinal fasciculus syndromes had significant slowing of adducting saccades, and two of these patients had unsuspected slowing of abducting saccades (although to a lesser degree). Five patients with olivopontocerebellar degeneration and three patients with myotonic dystrophy had significant slowing of saccades in both directions. Five patients with surgically documented acoustic neuromas did not have significant slowing despite brain-stem compression in three. It is concluded that the saccade velocity test can be a useful clinical tool in addition to its potential in clinical research.

Considerable knowledge has been accumulated regarding acquired and congenital deafness in children. However, despite the intimate relationship between the auditory and vestibular systems, data are limited regarding the status of the balance system in these children. Using a test population of 15 children, aged 8 to 17 years, we performed electronystagmography testing. The test battery consisted of the eye-tracking (gaze nystagmus, spontaneous nystagmus, saccade, horizontal pursuit and optokinetic) tests, positional/positioning (Dix-Hallpike and supine) tests, and rotational chair tests. With age-matched controls, five children were tested in each of the following three categories: normal hearing, hereditary deafness, and acquired deafness. The children in the hereditary deafness category were congenitally deaf and had a family history of deafness. Those subjects in the acquired deafness category had hearing loss before the age of 2 years, after meningitis. Analysis of variance demonstrated significant differences between the two deaf groups and the control subjects in the gaze nystagmus test, saccade latencies, horizontal pursuit phase, and Dix-Hallpike and supine positionally provoked nystagmus. Also, significant differences were found in rotational chair gain and phase between the deaf and normal-hearing children. The children with acquired deafness exhibited the most profound results. In addition, there were significant differences in rotational chair gain between the acquired and congenitally deaf children. No differences were noted in horizontal pursuit gains, saccade accuracies, or saccade asymmetries. These preliminary data demonstrate that the etiologic factors responsible for congenital and acquired deafness in children may indeed affect the balance system as well. These findings of possible balance disorders in conjunction with the profound hearing loss in this patient population will have prognostic implications in the future evaluation, treatment, and rehabilitation of these patients.

Tracheal bronchus is an aberrant bronchus that arises most often from the right tracheal wall above the carina and is the result of an additional tracheal outgrowth early in embryonic life. Its incidence ranges between 0.1 and 5%. This anomaly usually is diagnosed incidentally during bronchoscopy or bronchography performed for various respiratory problems. Occasionally, it represents the underlying etiology for chronic pulmonary disease such as emphysema, atelectasis, and persistent or recurrent pneumonia, especially if it involves the right upper lobe and reflects an abnormal pulmonary clearing mechanism. Tracheal bronchus may be associated with other bronchopulmonary anomalies, tracheal stenosis, or Down's syndrome. In the absence of clinical symptoms, a diagnosis of tracheal bronchus does not require any treatment. In patients with recurrent right upper lobe disease and a tracheal bronchus, therapy should include resection of the aberrant bronchus as well as the lobe it supplies.

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For this population, CDP was determined to be a more sensitive test for identifying patients who have fallen, with limits of stability testing the most significant part of the CDP battery; for ENG studies, the best falls indicator was the ocular motor battery.

Three patients with periodic alternating nystagmus (PAN) are described in detail. Digital computer methods were used to quantify their disordered eye movement in an attempt to understand the pathophysiology. One of the patients was unusual in showing rebound nystagmus with fixation and PAN without fixation. Each patient had hyperactive vestibular responses and the phase and gain of the PAN cycles were altered in a predictable fashion by vestibular stimuli. It is postulated that PAN represents cyclical firing between reciprocally connected groups of inhibitory neurons within the vestibular and oculomotor nuclei. The cyclical firing is initiated by a critical imbalance of tonic input to either group of normally functioning neurons.