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PubMed1994

[Vertigo and middle ear pathology].

The association of vertigo and diseases of the middle ear is not uncommon. It occurs especially during the course of chronic or acute otitis but can also occur as a sequela. Vestibular involvement is due to several pathophysiological mechanisms that influence the choice of treatment. The same is true for expansive processes of the tympanic cavity. When associated to otospongiosis, vertigo occurring during Ménière's disease can transiently contraindicate an operation on the tapes. On the contrary, vertigo resulting from traumatic lesion of the middle ear can suggest surgical intervention. Surgery of the middle ear can itself cause severe vertigo which sometimes requires a new operation. Lastly, the fortuitous association of disease of the middle ear with labyrinth disease, especially retrolabyrinthic such as eighth cranial nerve neurinome, is not uncommon, but can be long overlooked if it is not routinely suggested in the presence of labyrinth type symptoms.

Acute Disease↗
PubMed1975

[The two-phase occurrence of head-shaking nystagmus (author's transl)].

The report deals with 22 cases of two-phase head-shaking nystagmus. The results can be summarised as follows: 1. The two-phase head-shaking nystagmus is only found in connection with peripheral-vestibular disorders and particularly with unilateral disorders. It occurs only temporarily in the course of the vestibule disorder and may be observable for several months. 2. The head-shaking nystagmus, which follows immediately after the head-shaking (first phase), is to be considered a deficiency nystagmus. After a short period of latency after the disappearance of the first phase, a nystagmus in the opposite direction appears (second phase). This is considered to be a recovery nystagmus. 3. In the case of unilateral labyrinth lesions, the direction of nystagmus of the second phase of two-phase head-shaking nystagmus indicates the side of the lesion. The functions of the diseased labyrinth, however, have not been completely destroyed in this case. In the case of bilateral lesions, the direction of nystagmus of the second phase probably points toward the more heavily damaged side. While it is found only rarely, the two-phase head-shaking nystagmus thus permits reliable diagnosis and detection of the probable side where a peripheral vestibule disorder is located.

Adolescent↗
PubMedDate not supplied

Autonomic dysfunction on the affected side in Meniere's disease.

For ascertaining the existence of autonomic dysfunction on the affected side as being the cause of Meniere's disease, the mecholyl tests were conducted by means of conjunctival instillation in normal subjects as well as in patients with Meniere's disease, labyrinthitis and vestibular neuritis. The rate at which significant miosis (more than 10%) appeared in the mecholyl test was 3.1% among normal subjects, whereas the rate among Meniere's disease patients on the affected side was significantly higher during the attack, quasi-attack and interval stages. The appearance rate among Meniere's disease patients on the unaffected side was not different from that in normal subjects during any of the three stages. None of the patients with labyrinthitis or vestibular neuritis showed significant miosis on the affected side alone in the mecholyl test. This indicates that abnormality of vestibular-autonomic reflex in itself does not cause a positive reaction in the mecholyl test. Hence it can be concluded that the cause of Meniere's disease is related to the existence of autonomic dysfunction on the affected side.

Adult↗