Otolithic Vertigo

Abstract

There are several reasons why most vestibular syndromes involve both semicircular canal function and otolithic function:(1) The different receptors for perception of angular and linear accelerations are housed in a common labyrinth.(2) Their peripheral (eighth nerve) and central (e.g. medial longitudinal fascicle) pathways take the same course.(3) Otolith and semicircular canal input converge at all central vestibular levels, from the vestibular nuclei to the vestibular cortex.Thus, most vestibular syndromes are mixed as regards otolithic and canal function. A peripheral prototype of such a mixed syndrome is vestibular neuritis. It is caused by inflammation of the superior division of the vestibular nerve that subserves the horizontal and the anterior semicircular canals and the maculae of the utricle and the anterosuperior part of the saccule. A central prototype is Wallenberg's syndrome. In this disorder the medial and superior vestibular nuclei are involved where otolith and canal input converge. Wallenberg's syndrome typically causes ocular and body lateropulsion and torsional spontaneous nystagmus.Nevertheless, with caloric irrigation of the external acoustic meatus it is possible to selectively stimulate single canals. The prototype of a semicircular canal disease is benign paroxysmal positioning vertigo of the posterior or horizontal canal. Typical signs and symptoms of semicircular canal vertigo are:(a) Rotational vertigo and deviation of perceived straight-ahead. (b) Spontaneous vestibular nystagmus with oscillopsia. (c) Postural imbalance with Romberg fall and pastpointing. (d) Nausea and vomiting if severe.

Perilymph Fistula: Fifty Years of Controversy

“…This again raises the question of whether PLF patients have a unique balance abnormality that is not explained by hydrops or by vestibular hypofunction in the affected ear. References to the implication that the disequilibrium of PLF patients are attributable to a specific otolith organ dysfunction are rare [92], but it is a possibility which warrants further investigation. As yet there are no VEMP studies in PLF patients, but an abnormal VEMP in a PLF ear may provide (other than possible hydrops) some evidence.…”

Differences in Symptoms among Adults with Canal versus Otolith Vestibular Dysfunction: A Preliminary Report

“…However, the clinical diagnostic process has been limited because measurement of otolith function has not been readily available. Also, the qualitative nature of the symptoms of otolith dysfunction has not been formally investigated and determined [7,8]. Tomanovic and Bergenius [3], who studied the prevalence of different types of dizziness symptoms in subjects with P-VeD, expanded the understanding of subjective descriptors by concluding that in addition to the classic symptoms of vertigo, the presence of "nonclassical" symptoms, such as drop attacks, unsteadiness like walking on a boat, walking on pillows, stepping into a hole, and feeling like being pulled to one side, occur in these individuals.…”

“…Advances in vestibular function testing procedures has identified otolith dysfunction [6,[9][10][11] and several investigations have reported that subjects with otolith dysfunction described their symptoms as feeling like sensations of rocking, tilting, walking on pillows, being pushed or pulled, feeling drunk, and falling [7,12]. Even though these descriptions were only anecdotally associated with P-VeD, it questions whether the limited focus on symptoms of rotary vertigo 2 ISRN Rehabilitation impedes the diagnostic process.…”

Effect of Repositioning Maneuver Type and Postmaneuver Restrictions on Vertigo and Dizziness in Benign Positional Paroxysmal Vertigo

“…VAS has already been used to evaluate balance disorders [3, 4]. In a previous publication, we studied the validity of VAS in assessing vertigo and dizziness independently and on a daily basis after repositioning maneuvers in BBPV.…”