Vestibular Function Evaluation and Treatment Vestibular Function Evaluation and Treatment

Vestibular Function Evaluation and Treatment Vestibular Function Evaluation and Treatment Alan Desmond, Au. D. Blue Ridge Hearing and Balance Clinic Bluefield, West Virginia New York / Stuttgart Thieme Medical Publishers, Inc. 333 Seventh Ave. New York, NY 10001 Assistant Editor: Jennifer Berger Editor: Sharon Liu Director, Production and Manufacturing: Anne Vinnicombe Production Editor: Becky Dille Marketing Director: Phyllis Gold Sales Manager: Ross Lumpkin Chief Financial Officer: Peter van Woerden President: Brian D. Scanlan Compositor: Datapage International, Inc. Printer: The MapleÁ/Vail Book Manufacturing Group Library of Congress Cataloging-in-Publication Data Desmond, Alan. Vestibular function : evaluation and treatment / Alan Desmond. p. ; cm. Includes bibliographical references and index. ISBN 1-58890-166-1 (TMP :alk. paper) – ISBN 3-13-136011-9 (GTV :alk. paper) 1. Vestibluar apparatus - - Diseases - - Diagnosis. 2. Vestibular apparatus*/Diseases*/treatment. 3. Otology*/Practice.. [DNLM: 1. Vestibular Diseases*/diagnosis. 2. Practice Management, Medical. 3. Vestibular Diseases*/therapy. 4. Vestibular Function Tests. WV 255 D464v 2004] I. Title. RF260.D476 2004 617.8’82*/dc22 2003022585 Copyright # 2004 by Thieme Medical Publishers, Inc. This book, including all parts thereof, is legally protected by copyright. Any use, exploitation or commercialization outside the narrow limits set by copyright legislation, without the publisher’s consent, is illegal and liable to prosecution. This applies in particular to Photostat reproduction, copying, mimeographing or duplication of any kind, translating, preparation of microfilms, and electronic data processing and storage. Important note: Medical knowledge is ever-changing. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may be required. The authors and editors of the material herein have consulted sources believed to be reliable in their efforts to provide information that is complete and in accord with the standards accepted at the time of publication. However, in the view of the possibility of human error by the authors, editors, or publisher, of the work herein, or changes in medical knowledge, neither the authors, editors, or publisher, nor any other party who has been involved in the preparation of this work, warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from use of such information. Readers are encouraged to confirm the information contained herein with other sources. For example, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this publication is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain. Printed in the United States of America 54321 TMP ISBN 1-58890-166-1 GTV ISBN 3 13 136011 9 Contents Foreword vii Preface ix 1 The Need for Balance Centers 1 2 Function and Dysfunction of the Vestibular System 21 3 Screening Tests for Vestibular Dysfunction 44 4 Establishing and Equipping the Balance Clinic 63 5 Vestibular Evaluation 85 6 Treatment of Vestibular Dysfunction 111 7 Staffing Needs of the Balance Clinic 149 8 Marketing and Financial Aspects 179 Appendixes 193 A Dizziness Handicap Inventory 193 B Motion Sensitivity Quotient 194 C Rehabilitation Exercises 195 D Example of a Patient Flowchart for a Multispecialty Balance Disorders Clinic 207 E Sample of Newsletter to Physicians 209 F Referral Slip That Can Be Sent to Potential Referring Physicians 210 G Samples of Newspaper Advertisements 211 Glossary 213 Index 217 v Foreword The dizzy patient presents a unique diagnostic dilemma. With so many etiologies to consider, the patient is best served by a team of health care practitioners working together rather than by individual specialists, each with their own particular strengths and inherent limitations. This ‘‘balance center’’ concept is the basis for Alan Desmond’s book, Vestibular Function: Evaluation and Treatment. Written as an introductory text, the author takes the reader through a thoughtful explanation of the nature and variety of balance disorders and the treatment options for each, combined with some excellent practical advice regarding the establishment of a multidisciplinary balance team. Most important, emphasis is on the appropriate role for each member of the team*/physician, audiologist, therapist, technician*/to achieve the optimal outcome for the patient. I have followed Dr. Desmond’s work throughout its entire course, from conception to publication, when it began as a dissertation for his doctoral degree. Throughout its development, he has been open to suggestion and even criticism for the sake of a more precise and readable work. I am honored to write this foreword and to praise the finished product, which can serve as a valuable springboard for those interested in embarking along this lifelong path of learning and discovery that is necessary to caring for these challenging patients. It is hoped that we will all learn to work together within the scope of our own training for the common good of the dizzy patient. I wish the best to those who read this work and hope you all will gain the same satisfaction in this field of medicine that I have enjoyed over the last 18 years! Joel A. Goebel, M.D., F.A.C.S. Professor and Vice Chairman Director, Hearing and Balance Center Department of OtolaryngologyÁ/Head and Neck Surgery Washington University School of Medicine Saint Louis, Missouri vii Preface An Introduction to the Evaluation and Treatment of Vestibular Dysfunction The process of developing scientific truths is often the combination of meticulous research and serendipitous observation. The acceptance of those truths into standard practice typically requires replicable evidence; a need for a ‘‘better way’’; and advocates for change who are persistent, committed, and stubborn enough to differ publicly from the established norm. A quote by Max Planck (mined from Dr. Alec Salt’s Cochlear Fluids Lab Web page www.oto.wustl.edu/ cochlea/) highlights the struggle of proposing an alternative to conventional thinking: ‘‘A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that are familiar with it.’’ The development of current techniques used in the evaluation and treatment of vestibular dysfunction has a rich heritage of accidental discovery. One of the first published reports regarding nystagmus was the observation of Purkinje who, in the early 1800s, noticed postrotary nystagmus in mental patients. The rotary apparatus at the time was a large cage suspended from a rope. The cage was manually rotated to induce nausea (and a more passive nature, it was hoped) in violent patients (Barany, 1916). Postrotary nystagmus is still used as a measure of sensitivity in contemporary vestibular testing (Furman & Cass, 1996). Robert Barany, who won the Nobel Prize for his vestibular research in 1916, first began to examine the effects of caloric stimulation of the ear canal after several of his patients complained of dizziness following irrigation intended to remove cerumen from the ear canal (Barany, 1916). Currently, caloric irrigation is the mainstay of vestibular evaluation. One of the most dramatic recent developments in the treatment of vestibular dysfunction, ‘‘Canalith Repositioning Maneuvers for Benign Positional Vertigo,’’ began when Brandt and Daroff (1980) designed exercises they thought promoted central compensation by repeated exposure to the offending position. They soon realized that the rapid rate of recovery could not be explained by central nervous system habituation and suspected ‘‘dispersion of otolithic debris from the cupula.’’ ix xPREFACE Not all early observations have withstood the test of time. Bach (not the composer) in the late 1800s noted that nystagmus patterns differed among individuals following similar rotational stimulus. He observed that ‘‘one almost invariably finds pronounced nystagmus in normal persons of cultured status, and in sensitive easily excited and nervous persons, while on the contrary (one finds) often no nystagmus at all or only slight nystagmus in stupid, indifferent and phlegmatic personalities’’ (Bach, 1894). With the advent of computer-based diagnostic capabilities and nearly instant Internet access to current research, continued use of ‘‘conventional wisdom’’ in the evaluation and treatment of vestibular patients must be superseded by an evidence-based approach. The most critical aspect of improving the likelihood of successful treatment for vestibular disorders lies in the acceptance of evidence- based approaches to treatment and access to properly trained practitioners. This book hopes to provide assistance toward both these goals. References Bach, L. (1894).

Load more