Electronystagmorgraphic studies of vestibular function. II. Basic problems of calibration.
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The caloric test procedure as suggested by Fitzgerald & Hallpike is still widely used. With a carefully standardized procedure it is well suited to identify the affected side in patients with unilateral vestibular impairments. By repeated testing it is also possible to follow the course of a vestibular affection.
Vertigo is not a disease, but a symptom. Therefore, the therapy of vertigo is primarily directed at eliminating the underlying cause. In about half of the cases the cause will not become apparent, however, and the therapy is doomed to be symptomatic. Several types of drugs have been found to have an anti-vertigo activity, e.g. antihistamines, calcium antagonists, anti-emetics. For the selection of vestibular depressants, the vestibular caloric test and the rotation test can be used. The duration of the nystagmus induced by rotation is the most useful parameter. The lag-period, the extent and duration of the vestibular effects can be determined and compared with that of other substances. A stronger action on a nystagmus does not necessarily mean a stronger anti-vertiginous action. The final proof of an anti-vertiginous activity can only be established in clinical studies in patients with vertigo.
For the thermal test, adaptation time constants of about 100 s are described in the literature. By automatically alternating hot-cold irrigation, as designed by us, precision of stimulus application of different temperatures was considerably improved. Furthermore, temperature was registered with a thermocouple device. The actually effective thermal stimulus on the horizontal canal was calculated by a mathematical model. Nystagmus analysis was carried out automatically with the Kiel-program. With 15 radical cavities (where stimulus intensity is very strong) non-linearities were especially distinct. After switching to the 44 degrees C stimulus, there was an extremely steep rise in the reaction in the form of a so-called "on-effect" or "post-inhibitory overshoot". After reaching maxima of up to 150 degrees/s, the reaction decreased quickly with time constants of 22-45 s.
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