[Medical documentation: from the labyrinth to Ariadne's thread].
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In 22 otoneurologically healthy subjects (44 ears) the response of the labyrinthine system to stimulation was studied for the method using water, standardized according to Mulch and Scherer (1980), and for our method of stimulation by air. The mean values of the speed of the slow phase and of the total amplitude of the vestibular nystagmus were significantly lower in case of air stimulation. If we consider each stimulus modality separately, the nystagmus parameters correlate significantly in the right-left comparison, and likewise the right predominant nystagmus with the left predominant nystagmus. However, on comparing the data measured for air stimulation and for water stimulation, no correlation could be established. The reason is thought to be an energetic one, since the method using air depends on heat capacity and heat transfer, whereas the method employing water depends on heat transfer only. Calculation shows that the energetic conditions of the method employing air are of the same order of magnitude as the roughly quantitative minimal rinse when filling the auditory meatus with water of moderate temperature. Hence, thermal stimulation of the labyrinthine system with air reacts very sensitively to changes in experimental conditions, so that all conditions must be strictly adhered to and standardised and the examination methods must be repeatable within narrow tolerance limits. On account of its low mean values and great susceptibility to variation, the method of air stimulation should be discouraged, especially in the assessment of patients who are suspected of suffering from a disease of the vestibulum auris.
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Labyrinthine trepanation was performed in the majority of 16 patients with minor agenesis of middle ear involving either stapedovestibular ankylosis or absence of fenestra vestibuli. Preoperative findings are discussed, as well as the prevention and treatment of labyrinthine geysers and the possibility of obtaining a functioning labyrinthine opening. Results were good in simple cases but poorer in more complex lesions, for which the indication for use of this procedure is debatable.
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The literature on the biophysics of the vestibular apparatus in weightlessness is reviewed. The results of caloric in the prone position are compared to those in the supine position. The rate of convection and expansion of the endolymph are evaluated. Bárány's theory continues to be valid, because the rate of convection forms a greater proportion of the effective total stimulus than expansion.
Caloric nystagmus in weightless condition is completely inverse to Bárány's nystagmus in optimum downward position. Therefore, another stimulation must prevail over the Bárány effect in the optimum up position which is observed only in weightless condition. The intensity of the two reactions is very different.
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