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PubMed2006

Transcanal approach to the singular nerve.

OBJECTIVES/HYPOTHESIS: Intractable benign paroxysmal positional vertigo is rare, and surgery is indicated in only a very small number of cases. Transcanal singular neurectomy is considered a difficult and risky procedure possibly leading to hearing loss and vertigo. The objective of this study was to evaluate the feasibility of the singular neurectomy through the external ear canal in an attempt to explain the contradictory results of previous reports of anatomists and of surgeons who abandoned the technique, considering that the singular neurectomy could not be reached via the external auditory canal without damaging the labyrinth. MATERIALS AND METHODS: Anatomical study on 100 halves of human heads in which the canal of the singular nerve (SN) was identified and opened at its extremities, the internal auditory canal and the ampulla of the posterior semicircular canal, via a posterior fossa approach. Next, the canal of the SN was dissected via the external auditory canal, at the floor of the round window (RW) niche. The relation of the SN canal to the ampulla of the posterior semicircular canal was evaluated. RESULTS: In 90 cases, the canal was transected medially to and away from the ampulla of the posterior semicircular canal, and in 8, at its emergence from the posterior ampullary recess. In these 98 cases, the RW membrane and the bony labyrinth were kept intact. In two cases, the canal of the SN could not be reached at the floor of the RW niche. CONCLUSION: Singular neurectomy is feasible via the external auditory canal, without damaging the RW membrane or the labyrinth in 98% of the cases. Because singular neurectomy is indicated in a very small number of cases, it is difficult to master this particular surgical procedure. This may explain why most surgeons abandoned the technique after a few attempts, followed by an unacceptable rate of sensorineural hearing loss.

Aged↗
PubMed1992

Extended middle fossa and retrolabyrinthine approaches in acoustic neuroma surgery: case reports.

Hearing conservation surgery for small acoustic neuromas is well accepted. At present, two approaches are primarily used: the suboccipital and the middle fossa. The middle fossa approach to the internal auditory canal has the advantage of using bony landmarks to identify and protect the facial nerve. Because of anatomic constraints presented by the superior semicircular canal however, its uses are limited to intracanalicular tumors or tumors protruding only slightly into the cerebellopontine angle. By extending the approach through the superior semicircular canal, a wide access to the cerebellopontine angle can be safely obtained. In this study three procedures, two through the superior semicircular canal and one through the posterior semicircular canal, were utilized for hearing conservation surgery. By immediately sealing off the canal ends, hearing preservation was accomplished in two out of three of these cases. The dictum that labyrinthine opening invariably leads to anacusis should be reconsidered. By utilizing approaches through the semicircular canal, it is possible that morbidity from this surgery may be reduced.

Cerebellar Neoplasms↗
PubMed1998

Site of cortical utricular representation with special reference to the somatosensory barrel field in the gerbil.

In mammals, the osseous semicircular canals of the vestibular labyrinths are usually embedded in the pyramis of the temporal bone. Thus, the osseous semicircular canals are a cavity system that can only be visualized by injection molding. Exceptionally, the walls of the osseous semicircular canals of the Mongolian gerbil are not embedded, but exposed in the hollow space in the temporal bone. Under urethane anesthesia, a window was made in the periotic capsule of the gerbil to reach this hollow space (semicircular canal triangle), and a pair of wire electrodes were inserted through an opening made in the horizontal semicircular canal toward the utricular nerve endings. Repetitive electric stimuli at 80 Hz were applied, and the direction of eye movements was noted. Subsequently, the stimulation frequency was reduced to 0.3 Hz, and evoked potentials were recorded from the neocortex. Positive surface potentials and negative deep potentials were recorded in the somatosensory area and, more specifically, in the vibrissa "barrel field," as judged by later histochemical staining of the cortical specimens. This unique anatomic feature of the gerbil labyrinth offers an opportunity whereby the vestibular organ can be reached without any heavy surgical insult, and the presence of fine-grain vibrissa barrels in this species (seven rows instead of five rows in most rodents) will help elucidate functional interactions between vestibular and somatosensory sensations.

Animals↗
PubMed1993

Activity of neurons in the beta nucleus of the inferior olive of the rabbit evoked by natural vestibular stimulation.

The inferior olive (IO) appears to be organized functionally in discrete subnuclei that receive transmitter-specific inputs. In particular, the IO receives a GABAergic input that is most densely concentrated in the beta-nucleus. In this experiment, we examined the functional specificity of neurons in the beta-nucleus of the IO of rabbits by recording their activity during natural vestibular and optokinetic stimulation. Rabbits were anesthetized and positioned in a triaxial servo- controlled rate table with the head fixed at the center of rotation. Contour-rich visual stimuli were rear-projected onto a 70 deg tangent screen and moved at constant velocities. Recording sites in the beta-nucleus were verified by subsequent histological analysis of marking microlesions. Neurons in the beta-nucleus responded to roll vestibular stimulation about the longitudinal axis. These neurons were excited when the rabbit was rolled onto the side which was contralateral to the recording site, and inhibited when the rabbit was rolled ipsilaterally. Thirty-eight of the 75 beta-nucleus neurons that were responsive to roll vestibular stimulation also responded to static tilt, indicating an otolithic as well as a vertical semicircular canal origin of the vestibular input. The modulated activity of none of the neurons could be attributed to stimulation of the horizontal semicircular canals. All the recorded neurons were found in a region of the beta-nucleus that was retrogradely labeled following HRP injections into the cerebellar nodulus. Using a "null point" technique, we found that there was a differential projection of information from the anterior and posterior semicircular canals onto to the beta-nucleus. Stimulation of the ipsilateral anterior-contralateral posterior semicircular canals modulates activity of the neurons in the caudal 500 microns of the beta-nucleus. Stimulation of the ipsilateral posterior-contralateral anterior semicircular canals modulates activity of neurons located more rostrally. beta-nucleus neurons and the olivocerebellar circuits in which they participate may constitute an important pathway for the control and adaptive modification of postural reflexes.

Action Potentials↗
PubMed2002

Three-dimensional Fourier transformation constructive interference in steady state magnetic resonance imaging of the inner ear in patients with unilateral and bilateral Menière's disease.

OBJECTIVE: In this study, three-dimensional Fourier transformation constructive interference in steady state (3DFT-CISS) magnetic resonance imaging was used to quantify the distance between the vertical part of the posterior semicircular canal and the posterior fossa as a measure of the endolymphatic sac and duct in patients with Menière's disease. Differences in this distance between affected and unaffected ears, as well as differences between unilaterally and bilaterally affected patients, were studied and compared with a control group. Also, possible correlations between the measured distance and the duration and severity of symptoms, patient age, and average hearing loss were investigated in the group of patients with Menière's disease. STUDY DESIGN: Retrospective clinical study. SETTING: Tertiary referral center (University Hospital) as part of a large, diagnostic research project on Menière's disease. PATIENTS: Of the 111 patients with Menière's disease initially included, 90 patients underwent 3DFT-CISS MRI. Eighty-six of these patients were analyzed in this MRI study. Fifty-six patients had unilateral Menière's disease, and 30 patients had bilateral Menière's disease (116 affected and 56 unaffected ears). Sixty-two ears in patients without Menière's disease were studied as controls. INTERVENTION: The distance between the vertical part of the posterior semicircular canal and the posterior fossa was determined by 3DFT-CISS MRI. MAIN OUTCOME MEASURES: Contiguous axial 3DFT-CISS MRI slices of 0.7 to 1.0 mm were made by a radiologist according to a strict protocol. Measurements of the distance between the vertical part of the posterior semicircular canal and the posterior fossa were taken by two professionals-a radiologist and an otolaryngologist-using a ruler and the original scan. RESULTS: A significantly smaller distance (2.9 mm) between the vertical part of the posterior semicircular canal and the posterior fossa as visualized on MRI scans was found in the ears of patients with Menière's disease than in the ears of patients in the control group (3.8 mm, p < 0.001). In both uni- and bilaterally affected patients (n = 56 and n = 30, respectively), no significant difference between ears was found (p = 0.44 and p = 0.19, respectively). In bilaterally affected patients, however, this distance (3.2 mm) was significantly greater than the distance in unilaterally affected patients (2.7 mm, p = 0.004). There was no relationship between the MRI-visualized distance between the vertical part of the posterior semicircular canal and the posterior fossa and the duration of disease, average hearing loss, or severity of symptoms in uni- and bilaterally affected patients. CONCLUSION: The difference in MRI-visualized distances between the vertical part of the posterior semicircular canal and the posterior fossa of uni- and bilaterally affected patients strongly suggests that unilateral and bilateral hearing loss are two different entities in patients with Menière's disease. The size of the endolymphatic sac seems not to be the only factor in the pathogenesis of Menière's disease. That the MRI-visualized distance between the vertical part of the posterior semicircular canal and the posterior fossa does not have any relationship to the duration of the disease or to patient age indicates that this distance is a congenital feature.

Ear, Inner↗
PubMed1993

Partitioning the labyrinth for benign paroxysmal positional vertigo: clinical and histologic findings.

The incidence of benign paroxysmal positional vertigo (BPPV) has been documented at 17 percent of all vertiginous patients. Partitioning of the labyrinth is a laser technique for resolution of BPPV. In 1991 Anthony partitioned the posterior semicircular canal of two patients and eliminated their BPPV in 24 hours, which was much sooner than anticipated. This paper presents an animal study that was undertaken to determine why laser partitioning of the posterior semicircular canal resolved BPPV so promptly. The histologic changes 24 hours post-partitioning in the guinea pig showed bony semicircular canal fistula creation, and constriction of the membranous semicircular canal. The constriction caused decreased endolymphatic flow and led to BPPV-resolving long-term obstruction of the membranous canal described by Wilpizeski. Also, the clinical study of the application of partitioning to 14 patients with BPPV is described. The technique under investigation provided the resolution of positional vertigo within 7 days in most cases, and within 8 weeks in all uncomplicated cases. Results included some temporary postoperative motion sensitivity for 6-8 weeks, a transient sensorineural hearing loss in 6 of 14 (43%) patients, and a permanent hearing loss in one (7%) insulin-dependent diabetic patient. Location of the partition on the posterior semicircular canal did not affect the resolution of BPPV, the incidence of transient hearing loss, or the motion sensitivity. Partitioning provided prompt, permanent resolution of BPPV and did not put the hearing at risk in nondiabetic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Principles of linear and angular vestibuloocular reflex organization in the frog.

We compared the spatial organization patterns of linear and angular vestibuloocular reflexes in frogs by recording the multiunit spike activity from cranial nerve branches innervating the lateral rectus, the inferior rectus, or the inferior obliquus eye muscles. Responses were evoked by linear horizontal and/or vertical accelerations on a sled or by angular accelerations about an earth-vertical axis on a turntable. Before each sinusoidal oscillation test in darkness, the static head position was systematically altered to determine those directions of horizontal linear acceleration and those planes of angular head oscillation that were associated with minimal response amplitudes. Inhibitory response components during angular accelerations were clearly present, whereas inhibitory response components during linear accelerations were absent. Likewise was no contribution from the vertical otolith organs (i.e., lagena and saccule) observed during vertical linear acceleration. Horizontal linear acceleration evoked responses that originated from eye muscle-specific sectors on the contralateral utricular macula. The sectors of the inferior obliquus and lateral rectus muscles on the utricle had an opening angle of 45 and 60 degrees, respectively and overlapped to a large extent in the laterorostral part of the utricle. Both sectors were coplanar with the horizontal semicircular canals. The sector of the inferior rectus muscle was narrow (opening 5 degrees), laterocaudally oriented, and slightly pitched up by 6 degrees. Angular acceleration evoked maximal responses in the inferior obliquus muscle nerve that originated from the ipsilateral horizontal and the contralateral anterior vertical canals in a ratio of 50:50. Lateral rectus excitation originated from the contralateral horizontal and anterior vertical semicircular canals in a ratio of 80:20. The excitatory responses of the inferior rectus muscle nerve originated exclusively from the contralateral posterior vertical canal. Measured data and known semicircular canal plane vectors were used to calculate the spatial orientation of maximum sensitivity vectors for the investigated eye muscle nerves in semicircular canal coordinates. Comparison of the directions of maximal sensitivity vectors of responses evoked by linear or angular accelerations in a given eye muscle nerve showed that the two vector directions were oriented about orthogonally with respect to each other. With this arrangement the linear and the angular vestibuloocular reflex can support each other dynamically whenever they are co-activated without a change in the spatial response characteristics. The mutual adaptation of angular and linear vestibuloocular reflexes as well as the differences in their organization described here for frogs may represent a basic feature common for vertebrates in general.

Acceleration↗
PubMed1992

Three-dimensional analysis of caloric nystagmus in the rhesus monkey.

The aim of this study was to investigate whether caloric nystagmus contains response components that can be attributed to a stimulation of the vertical semicircular canals. Three dimensional eye movement recordings with a dual search coil technique revealed important horizontal, vertical and torsional nystagmus components following irrigation of the external ear canal with cold water in various head positions relative to gravity. Horizontal nystagmus components, i.e. lateral semicircular canal vectors, followed a cosine function of both the pitch and yaw angle of the head relative to gravity, confirming a mainly thermovective mechanism for stimulation of the horizontal canals. Vertical and torsional nystagmus components behaved differently following left and right ear irrigations. Right-left symmetrical vectors emerged only when the vertical and torsional components were transposed into vectors of single semicircular canal directions. The intensity of these vertical semicircular canal vectors as a function of the position of the corresponding canal relative to gravity, however, excludes important thermovective mechanisms acting at the vertical canals. It remains an open question whether these vertical canal vectors represent a non-thermovective caloric stimulation of vertical canal afferents.

Animals↗
PubMed1997

Involvement of programmed cell death in morphogenesis of the vertebrate inner ear.

An outstanding challenge in developmental biology is to reveal the mechanisms underlying the morphogenesis of complex organs. A striking example is the developing inner ear of the vertebrate, which acquires a precise three-dimensional arrangement of its constituent epithelial cells to form three semicircular canals, a central vestibule and a coiled cochlea (in mammals). In generating a semicircular canal, epithelial cells seem to 'disappear' from the center of each canal. This phenomenon has been variously explained as (i) transdifferentiation of epithelium into mesenchyme, (ii) absorption of cells into the expanding canal or (iii) programmed cell death. In this study, an in situ DNA-end labeling technique (the TUNEL protocol) was used to map regions of cell death during inner ear morphogenesis in the chicken embryo from embryonic days 3.5-10. Regions of cell death previously identified in vertebrate ears have been confirmed, including the ventromedial otic vesicle, the base of the endolymphatic duct and the fusion plates of the semicircular canals. New regions of cell death are also described in and around the sensory organs. Reducing normal death using retrovirus-mediated overexpression of human bcl-2 causes abnormalities in ear morphogenesis: hollowing of the center of each canal is either delayed or fails entirely. These data provide new evidence to explain the role of cell death in morphogenesis of the semicircular canals.

Animals↗
PubMed2001

Selective vestibular ablation by KTP laser in endolymphatic hydrops.

OBJECTIVES AND HYPOTHESIS: Vertigo, the cause of disability in many patients with Ménière's disease, may be the result of the effects of endolymphatic hydrops on the semicircular canals. We hypothesize that intractable vertigo may be controlled by destruction of the semicircular canal neuroepithelium using visible light lasers without the need for extensive fenestration of the bony labyrinth. This study was designed to assess the cochlear effects of potassium titanyl phosphate (KTP) laser-assisted triple semicircular canal ablation (TSCA) in endolymphatic hydrops. STUDY DESIGN: Randomized, prospective, and controlled. METHODS: Forty-one adult guinea pigs underwent either a unilateral endolymphatic duct occlusion to induce hydrops or a sham procedure. Ten weeks after induction of the hydrops, a KTP laser-assisted TSCA or a sham surgery was performed. RESULTS: Electrocochleographic thresholds to clicks and tone-bursts (2-20 kHz) did not change significantly up to 4 weeks after TSCA in hydropic ears. Cross-sectional histology confirmed the presence of hydrops and the ablation of the semicircular canals. Cochlear whole-mounts for hair cell counts showed no significant loss of outer or inner hair cells in hydropic ears treated with TSCA. CONCLUSION: KTP laser-assisted TSCA can be performed in the guinea pig model of endolymphatic hydrops without significant loss of hearing. Evaluation of this technique may be warranted in patients with intractable Ménière's disease.

Animals↗
PubMedDate not supplied

[Reaction of the human vestibular apparatus to periodic effects of the ship-rocking type].

Reactions of the semicircular canals to periodic effects of the ship rolling type have been studied, using a mathematical model. The data obtained give evidence that during the above effects linear combinations of reactions of all semicircular canals may describe changes in the angular velocity of man's movement in an absolute (static) space. Besides, the common segment of the vertical semicircular canals (the common limb) allows a more accurate description of time changes in angular velocity. The mathematical model has demonstrated the dependence of absolute angular velocity as approximated by the semicircular canals from head orientation as related to the body. In addition to general discussions about rolling effects on the semicircular canals, the paper presents calculations of such reactions as applied to a specific object, i. e. a medium-size trawler.

Biomechanical Phenomena↗
PubMed2004

Acoustic responses of vestibular afferents in a model of superior canal dehiscence.

HYPOTHESIS: Afferents innervating the superior semicircular canal are rendered especially sensitive to acoustic stimulation when there is a dehiscence of the superior canal. Other vestibular end organs are also more sensitive to acoustic stimulation. BACKGROUND: Dehiscence of the superior semicircular canal is associated with vertigo and nystagmus caused by loud sounds (Tullio phenomenon) or changes in middle ear or intracranial pressures. The mechanisms by which acoustic stimuli act on the vestibular end organs are unclear. The nystagmus caused by acoustic stimuli generally aligns with the affected superior canal. METHODS: Responses to acoustic stimuli in the superior vestibular nerves of anesthetized chinchillas were recorded before and after fenestration of the superior canal. RESULTS: Two acoustic response patterns were seen: rapid phase locking and slow tonic changes in firing rate. Phasic responses principally occurred in irregular afferents and tonic responses in regular afferents. Afferents from all of the vestibular end organs encountered could respond to acoustic stimuli, even before fenestration. However, fenestration lowered the thresholds for acoustic stimulation in superior canal afferents with phasic responses and increased the magnitude of tonic responses. CONCLUSIONS: Superior canal dehiscence may render the irregular afferents innervating the superior canal particularly sensitive to loud sounds. Rapid phase-locking responses may explain the short latency of nystagmus seen in patients with superior canal dehiscence syndrome. The mechanisms by which acoustic stimuli activate the vestibular end organs may differ from the damped endolymph motion associated with head acceleration.

Acoustic Stimulation↗
PubMed2002

Influence of vestibular activation on respiration in humans.

The purpose of this study was to determine the effects of the semicircular canals and otolith organs on respiration in humans. On the basis of animal studies, we hypothesized that vestibular activation would elicit a vestibulorespiratory reflex. To test this hypothesis, respiratory measures, arterial blood pressure, and heart rate were measured during engagement of semicircular canals and/or otolith organs. Dynamic upright pitch and roll (15 cycles/min), which activate the otolith organs and semicircular canals, increased respiratory rate (Delta2 +/- 1 and Delta3 +/- 1 breaths/min, respectively; P < 0.05). Dynamic yaw and lateral pitch (15 cycles/min), which activate the semicircular canals, increased respiration similarly (Delta3 +/- 1 and Delta2 +/- 1, respectively; P < 0.05). Dynamic chair rotation (15 cycles/min), which mimics dynamic yaw but eliminates neck muscle afferent, increased respiration (Delta3 +/- 1; P < 0.05) comparable to dynamic yaw (15 cycles/min). Increases in respiratory rate were graded as greater responses occurred during upright (Delta5 +/- 2 breaths/min) and lateral pitch (Delta4 +/- 1) and roll (Delta5 +/- 1) performed at 30 cycles/min. Increases in breathing frequency resulted in increases in minute ventilation during most interventions. Static head-down rotation, which activates otolith organs, did not alter respiratory rate (Delta1 +/- 1 breaths/min). Collectively, these data indicate that semicircular canals, but not otolith organs or neck muscle afferents, mediate increased ventilation in humans and support the concept that vestibular activation alters respiration in humans.

Adult↗
PubMed1990

[Experimental endolymphatic hydrops and its related morphological and functional changes in guinea pigs].

The endolymphatic hydrops was induced successfully in 13 guinea pigs by blocking the endolymphatic duct and sac, and the morphological and functional alterations (especially on semicircular canal function) after hydrops were studied by means of ENG, EcochG and serial section techniques. Hydrops in the cochlear duct was evident in the apical and/or near apical turns, especially in earlier stages. Dilation of the saccule was seen in all samples, but was barely noticeable in the utricle and semicircular canal's endolymphatic space. Degeneration in the corti's apparatus, stria vasculi and spiral ganglion occurred late. No evident changes of the sensory components in the saccule, utricle and semicircular canals were seen under the light microscope. The hearing loss in earlier stages of hydrops was evident at lower frequencies: later stages showed effects at all frequencies. The cochlear recruitment and fluctuation phenomena were observed in a few of the operated animals. The value of -SP/CAP in a few animals was significantly after operation. The functional changes of semicircular canals were demonstrated by the semicircular paralysis (CP), directional preponderance (DP), vestibular recruitment (VR) and elevated threshold of nystagmus to angular acceleration stimuli. There was no significant correlation between the degrees of hearing loss and impaired semicircular function. The criteria of ENG elicited by the quantitative angular acceleration stimuli for evaluating the semicircular canal function in guinea pigs is proposed for the first time in our experiment.

Animals↗
PubMed1993

Bilateral communication between vestibular labyrinths in pigeons.

Extracellular action potentials from single horizontal semicircular canal primary afferent fibers were recorded in paralysed decerebrate pigeons during pulse mechanical stimulation of the contralateral horizontal semicircular canal. Clear responses to the contralateral membranous duct displacement stimuli were observed in 51% of the tested 158 horizontal semicircular canal afferents. Generally, three different types of responses were obtained in the primary afferent fibers including excitation, inhibition, and a few complex type neural activity profiles. Inhibitory responses were of larger amplitude and had longer time constants than did excitatory responses. The few complex type responses observed were characterized by an initial excitatory discharge followed by a longer duration decrease in the fiber's firing rate. The sensitivity to stimulation and type of response obtained for each afferent was significantly correlated with the fiber's coefficient of variation value. Regular firing afferents were less sensitive and exhibited primarily excitatory responses (71%) to contralateral canal stimulation. Irregular firing afferents were more sensitive and exhibited mostly inhibitory responses (84%). The present results demonstrate that a communication network for information exchange between the bilateral labyrinths exists in pigeons. The observed responses in primary afferent fibers to contralateral horizontal semicircular canal stimulation are proposed to be mediated by the vestibular efferent system, which could provide an anatomical pathway for information exchange from vestibular receptors on opposite sides of the head.

Afferent Pathways↗
PubMed2003

Dynamics of vestibular neurons during rotational motion in alert rhesus monkeys.

The temporal processing in the encoding of head rotation was investigated by comparing the dynamics of vestibular nuclei neurons with those of the regularly and irregularly firing semicircular canal afferents in alert rhesus monkeys. During earth-vertical axis rotations, neurons without eye movement sensitivity differed in their response dynamics from both regularly and irregularly firing semicircular canal afferents. At high frequencies, central responses increased in sensitivity and maintained phase leads of nearly 30 degrees relative to head velocity. These persistent high-frequency phase leads resembled those of irregularly firing (but not regularly firing) semicircular canal afferents. However, at low frequencies, central responses exhibited significantly smaller phase leads than those of irregularly firing semicircular canal afferents, and dynamics resembled more those of the regularly firing afferents. The response dynamics of central non-eye movement cells were significantly different from those of position-vestibular-pause and eye-head neurons (collectively referred to as eye movement cells). In contrast to the persistent phase leads of non-eye movement neurons, all eye movement cells modulated closely in phase with head velocity at all frequencies down to 0.05 Hz during visual suppression tasks. Vertical canal non-eye movement neurons that were insensitive to both translations and static head tilts led head velocity by approximately 5-30 degrees during high-frequency earth-horizontal axis rotations. Unlike the earth-vertical axis responses that led head velocity at low frequencies by as much as 20-40 degrees, vertical canal neurons only slightly led or even lagged behind head velocity during low-frequency earth-horizontal axis rotations. Posterior canal central non-eye movement cells lagged behind head velocity significantly more than anterior canal neurons. These frequency dependencies of central vestibular neurons in comparison with those of the afferents suggest that both low- and high-pass filtering might be necessary to convert primary semicircular canal afferent response dynamics to central neuron ones.

Action Potentials↗
PubMed2005

The Dix-Hallpike test and the canalith repositioning maneuver.

The Dix-Hallpike test and the canalith repositioning maneuver (CRM) are used to diagnose and treat benign positional vertigo (BPV). Dix-Hallpike is the standard procedure for diagnosis of BPV, but if the horizontal canal is not tested for BPV and the Dix-Hallpike is only carried out once, the condition may not be diagnosed and appropriately treated. We describe our method of testing for BPV and treating it with CRM. The Dix-Hallpike test involves rapidly moving the patient from a sitting position to "head hanging," where the patient's head is at least 10 degrees below horizontal. This is performed initially for the posterior semicircular canals. If these movements fail to elicit vertigo and nystagmus, tests of the horizontal semicircular canals are performed by laying the patient on each side. Importantly, if there is no vertigo or nystagmus elicited by testing the horizontal semi-circular canals, the posterior semicircular canals are tested again. It appears that being held in the head hanging positions and then left and right lateral positions will often allow the canaliths to collect such that the Dix-Hallpike test will become positive. Failure to repeat the tests of the posterior semicircular canals may result in a falsely negative test. Testing the horizontal canals and repeating the Dix-Hallpike test will reduce the likelihood of patients undergoing extra testing or other consequences of misdiagnosis. If, during any of this testing, a movement elicits vertigo or nystagmus, the appropriate CRM is then carried out.

Diagnostic Techniques, Otological↗
PubMed1994

Computer generated three-dimensional reconstruction of the bony labyrinth in Mondini's dysplasia.

The bony labyrinth obtained at necropsy in four cases was studied by a new computer-generated three-dimensional (3-D) system. One case was normal (control) and the other three were histopathologically confirmed cases of Mondini's dysplasia. In case 1, the cochlea had only 2 turns and the lateral semicircular canal did not make a circle but appeared as a spherical mass projecting from the utricle even though the posterior semicircular canal made a normal circle. In case 2, there were no turns in the cochlea even though the semicircular canals and the vestibule appeared normal. In case 3, the cochlea showed 1 to 1 and 1/2 turns and the semicircular canals were premature showing only bud-like projections. This 3-D imaging system, which utilizes the toggling method, provides a way of obtaining satisfactory images without markers, and the time required to obtain these 3-D images was reduced by using a video camera instead of a digitizer. One of the problems associated with the use of 3-D imaging is the long processing time. We resolved this by inputting the section images with a video camera and by picking up structures using density segmentation instead of tracing with a digitizer.

Child, Preschool↗