The clinical experience is increasing, but still there is no uniform understanding in the substrate of Ménière's disease. The criteria of the diagnosis is loose and great controversy exists in the therapeutic efforts. A bewildering number of concepts and methods have been suggested and praised as the best answers in solving the problem until the next claim of success shatters the popularity of earlier allegations. The array of articles in the world literature for the past 25 years treats the entity of Ménière's disease in general and from the viewpoint of etiology, pathology, histology, clinical diagnosis and treatment. This review is concerned primarily with the treatment aspect of the literature. All the published ideas, regimens and techniques have one significant feature in common. They all claim success but not in 100% of the cases. Recovery varies from about 60% to 80%. Those cases considered “improved” are 20% to 30% and the rate of failure is between 10% and 25%. The diagnostic tools and capabilities have improved considerably. For treatment, except for reasonable medical or surgical palliation, nothing more can be offered than was offered a half century ago.
Usher's syndrome is a recessive hereditary disorder in which a congenital hearing loss is combined with nyctalopia, retinal degeneration, and restriction of visual fields. The results of a comprehensive ophthalmic and neurotologic study on 70 patients are reported. Two distinct clinical and presumed genetic types were discernible on the basis of hearing impairment and vestibular sensitivity and, to a lesser extent, deterioration of retinal photoreceptor function. Such a classification has proved valuable in diagnosis, prognosis, and genetic counselling.
The standardization of vestibular examination is still far from being accomplished. Not only are there various schools of thought but almost each individual examiner employs different methods to perform the tests, the caloric one in particular. The usual cause of the numerous errors and one of the greatest hindrances to the proper standardization of the procedures can be found in the fact that the nystagmus, with all its characteristics, is a phenomenon very difficult to observe and analyze. And even the determination of the starting and stopping time of a reactive nystagmus following calorization is not simple.In order to improve the methods of vestibular examination, the first requirement is to obviate, so far as possible, the troublesome and unreliable subjective observation. This need was recognized by the first pioneers of vestibular physiology, and the search for objective registration or graphical representation of nystagmus has been going on since their time. Many different instruments have been constructed and advocated for this purpose and the more recent ones have given excellent results in the hands of research workers in the specialized laboratory.Surveying the efforts made to obtain graphical recordings of nystagmus, one must go back to Hogyes,! the outstanding vestibular physiologist, who solved the problem simply by inserting a light metal rod into the eye, using the other end of this rod as a scriber over a moving paper roll. About the same time Dewar'' was experimenting with electrical methods.
To quantify the vestibulo-ocular reflex in relation to sensoriorgan sensitivity is an age-old endeavor. The uncertainty of this attempt discredited vestibular testing for a half century, mainly because of inexact testing procedures. Improved reliability became imperative, requiring constant stimulus strength and measurement of the sound, proven parameters of the nystagmic response. Whereas the value of the frequency count per time unit and the velocity of the slow component of the nystagmus are generally accepted and utilized, the individual investigator or clinician often sets one modality above the other. Such preference may be determined by experience with only one of the methods, availability of certain electronic testing equipment, etc. Our study attempts to examine critically these two parameters of the evoked vestibular nystagmus. Both the frequency count and the slow phase velocity have been assessed simultaneously from the same nystagmograms which were obtained through an arrangement of graded rotatory and thermic stimulation series.Vestibular stimulation by rotation is based upon the effect of angular acceleration and deceleration. The most practical mode of rotatory stimulation involves the horizontal canal end-organs. Because of the inevitable bilateral exposure, even the most meticulous and controlled acceleratory and deceleratory stimulations are not adequately suitable for the best clinical evaluation. The thermic From the
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.