This book covers the clinical evaluation, testing, and management of patients suffering from dizziness, which is an immense and underserved population. It provides specialists (otolaryngologists, neurologists) and generalists (internal medicine, emergency medicine) with an accessible resource for diagnosing and managing these patients.
After the Introduction, the book is divided into three sections. The first includes chapters on Diagnoses with each containing an overview followed by epidemiology, mechanism of disease, clinical history, physical examination, ocular motor examination, instrumented audiologic and vestibular testing, imaging, differential diagnosis, treatment and prognosis. The second section has chapters focused on Testing, which includes particular physical examination techniques, instrumented oculomotor examination, otovestibular testing, and imaging. The chapters in the final section cover Treatments.
The goal of this unique book is to present as much physiology as is needed to explain the mechanism of disease, why it presents in the way that it does, and the rationale for treatments.
Introductory materials.- Part 1: Introductory materials:The field and
the diagnostic process.- 1.The field and its practitioners, logistics and
infrastructure.-
2. Symptom terminology. Does the description of dizziness
matter? Triggers, timing, etc.-
3. Diagnostic thinking.-
4. Questionnaires.-
5. Preliminary diagnostic algorithm.- Part 2: Introductory materials
Physiology, phenomena and concepts.-
6. Overview of the auditory system.-
7.
Overview of the vestibular system.-
8. Nystagmus, definition and
characterization.-
9. Vestibulo-ocular reflex.-
10. Vestibular tuning
spectrum.- Part 3: Introductory materials:Specific eye movements and their
normative ranges.-
11. Spontaneous nystagmus, normative ranges.-
12.
Saccades, normative ranges.-
13. Gaze evoked nystagmus, normative ranges.-
14. Smooth pursuit, normative ranges.-
15. Optokinetic nystagmus, normative
ranges Diagnoses.- Part 4: Diagnoses:Diseases of the labyrinth.-
16. Benign
paroxysmal positional vertigo (BPPV) in general.-
17. Posterior canal BPPV.-
18. Lateral canal BPPV.-
19. Anterior canal BPPV.-
20. Menieres disease.-
21. Otolithic catastrophe of Tumarkin.-
22. Post-traumatic endolymphatic
hydrops.-
23. Autoimmune inner ear disease (AIED).-
24. Sympathetic ear
disease.-
25. Noise induced hearing loss.-
26. Noise induced vestibular
damage.-
27. Otic barotrauma.-
28. Presbycusis (age-related hearing loss).-
29. Ototoxicity.-
30. Inner ear ischemia.-
31. Labyrinthine ossification.-
32. Audio-vestibular symptoms following cochlear implantation.- Part 5:
Diagnoses:Diseases of the vestibulo-cochlear nerve.-
33. Vestibular,
cochlear, and vestibulocochlear paroxysmia.-
34. Vestibular schwannoma.-
35.
Auditory neuropathy.-
36. Ramsay Hunt syndrome (herpes zoster oticus).-
37.
Multiple myeloma.- Part 6: Diagnoses: Diseases involving the middle ear.-
38.
Middle ear myoclonus (tensor tympani myoclonus, stapedial myoclonus).-
39.
Eustachian tube dysfunction (ETD).-
40. Otitis media and middle ear
effusion.-
41. Cholesteatoma.-
42. Glomus tympanicum.- Part 7:
Diagnoses:Diseases potentially involving multiple otologic structures.-
43.
Vestibular weakness in general.-
44. Bilateral vestibular weakness (BVW).-
45. Vestibular neuritis.-
46. Labyrinthitis.-
47. Sudden sensorineural
hearing loss (SSNHL).-
48. A continuum of vestibular neuritis, labyrinthitis
and sudden sensorineural hearing loss?.-49. Third window phenomena.-
50.
Semicircular canal dehiscence (SCD).-51. Perilymphatic fistula (PLF).-
52.
Idiopathic tinnitus.-
53. Exploding head syndrome.-
54. Pulsatile
tinnitus.-55. Tinnitus related to temporomandibular joint dysfunction.-56.
Tinnitus related to the neck (cervicogenic tinnitus).-
57. Otosclerosis.-
58.
Pagets disease of bone (osteitis deformans).-
59. Fibrous dysplasia.-
60.
Labyrinthine concussion.-
61. Temporal bone fracture.-
62. Hyperacusis.-
63.
Otalgia and referred otalgia.- Part 8: Diagnoses:Congenital otologic
malformations.-
64. Large vestibular aqueduct.-
65. Large cochlear aqueduct.-
66. Mondini dysplasia.-
67. Pendred syndrome.-
68. Usher syndrome.- Part 9:
Diagnoses:Diseases involving the brain, spinal cord and peripheral nerves.-
69. Migraine associated vertigo (MAV).-
70. Cyclic vomiting syndrome.-71.
Motion sickness (constitutional motion sensitivity).-
72. Cybersickness.-
73.
Motorist disorientation syndrome.-
74. Mal de debarquement syndrome
(MdDs).-75. Persistent postural perceptual dizziness (PPPD).-
76. Concussion
and post-concussive disequilibrium.-
77. Stroke and disequilibrium.-
78.
White matter disease and disequilibrium.-
79. Encephalitis.-
80. Epileptic
vertigo.-
81. Superficial siderosis.-
82. Cervicogenic vertigo (CV).- 83.
Spinal cord disorders.- 84. Peripheral neuropathy in general.- 85.
Charcot-Marie-Tooth disease.- 86. CANVAS (cerebellar ataxia, neuropathy,
vestibular areflexia syndrome).- 87. Susac syndrome.- Part 10:
Diagnoses:Ataxias.- 88. Spinocerebellar ataxias and other genetic
ataxias.- 89. Episodic ataxias and acetazolamide responsive ataxias.- 90.
Gluten ataxia.- 91. Friedreich ataxia.- Part 11: Diagnoses:Movement
disorders.- 92. Parkinsonism.- 93. Idiopathic Parkinsons disease.- 94.
Progressive supranuclear palsy (PSP).- 95. Multiple system atrophy
(MSA).- 96. Huntingtons disease.- 97. Stiff person syndrome (SPS).- 98. Fahr
disease (FD).- Part 12: Diagnoses:Posterior fossa lesions.- 99. Chiari
malformations.- 100. Basilar invagination.- 101. Paraneoplastic
syndrome.- Part 13: Diagnoses:Intracranial pressure disorders.- 102.
Hydrocephalus with increased intracranial pressure.- 103. Normal pressure
hydrocephalus (NPH).- 104. Intracranial pressure fluctuations and hearing
loss.- Part 14: Diagnoses:Neurologically-mediated visual disorders.- 105.
Visual snow syndrome (VSS).- 106. Misokinesia.- Part 15:
Diagnoses:Neurologically-mediated auditory disorders.-
107. Cortical
deafness.- 108. Misophonia.- 109. Musical hallucinations.- Part 16:
Diagnoses:Specific ocular motor syndromes.- 110. Centripetal nystagmus.- 111.
Congenital nystagmus.- 112. Convergence-retraction nystagmus
113. Internuclear ophthalmoplegia (INO).- 114. Latent nystagmus.- 115.
Opsoclonus and the opsoclonus myoclonus syndrome.- 116. Oculopalatal
tremor.- 117. Periodic alternating nystagmus (PAN).- 118. Rebound
nystagmus.- 119. See-saw nystagmus.- 120. Spontaneous down beat
nystagmus.- 121. Spontaneous up beat nystagmus.- 122. Square wave
jerks.- 123. Staircase saccades.- 124. Windmill nystagmus.- Part 17:
Diagnoses:Eye movements elicited by specific provocative maneuvers.- 125.
Head-shaking nystagmus.- 126. Hyperventilation-induced nystagmus.- 127.
Valsalva-induced nystagmus.-
128. Vibration-induced nystagmus.- Part 18:
Diagnoses:Other central nervous system pathologies.- 129. Neurologic disease
processes that can involve any part of the central nervous system
(infarction, demyelination, space-occupying lesions).- 130. Selected vascular
phenomena in otoneurology.- Part 19: Diagnoses:Intersections between
otovestibular disease, psychology and psychiatry.-
131. Psychological disequilibrium.-
132. Dissociative experiences in
vestibular disorders.-
133. Psychiatric disease and vestibular dysfunction.-
134. Cognitive impairment and disequilibrium.-
135. Cognitive impairment and
hearing loss.-
136. Cognitive impairment and tinnitus.- Part 20: Diagnoses
Ophthalmologic and visual factors in disequilibrium.-
137. Visual vertigo
(VV).-
138. Ophthalmological visual deficits and disequilibrium.-
139.
Superior oblique myokymia.-
140. Illusions of inversion and tilt.- Part 21:
Diagnoses:Cardiovascular causes of disequilibrium.-
141. Orthostatic
hypotension and postural orthostatic tachycardia.-
142. Orthostatic
hypertension.-
143. Cardiac arrhythmia.-
144. Vestibular syncope.- Part 22:
Diagnoses:Medical causes of disequilibrium.-
145. Pharmacologic causes of
disequilibrium.-
146. Postprandial disequilibrium.- Part 23:
Diagnoses:Infectious causes of disequilibrium.- 147. COVID-19.- 148.
Epstein-Barr virus.- 149. Human immunodeficiency virus (HIV) and
otovestibular symptoms.- 150. Lyme disease.- 151. Syphilis
(otosyphilis).- Part 24: Diagnoses Endocrinological, nutritional and
metabolic causes of disequilibrium.- 152. Thyroid disease and
disequilibrium.- 153. Vitamin B1 (thiamine) deficiency.- 154. Vitamin B12
(cyanocobalamin) deficiency.- 155. Vitamin D deficiency.- 156. Wilsons
disease.- 157. Zinc deficiency.- 158. Altitude sickness.- Part 25:
Diagnoses:Toxic causes of disequilibrium.- 159. Alcohol.- 160. Heavy
metals.- 161. Caffeine.- 162. Carbon monoxide.- 163. Cocaine.- 164. Marijuana
(cannabis).- 165. MDMA (ecstasy).- 166. Nicotine and tobacco.- 167.
Phencyclidine (PCP).- Part 26: Diagnoses:The role of electromagnetic fields
and radiation in disequilibrium.- 168. Radiation and its otovestibular
effects.- 169. Electromagnetic fields (EMFs).- Part 27:
Diagnoses:Presentations with multiple potential causes.-
170. Multifactorial
disequilibrium.- 171. Presbyvestibulopathy.- 172. Drop attacks.- 173. Coital
vertigo.- Part 28: Diagnoses:Otovestibular symptoms occurring in the context
of other conditions.-
174. Chronic fatigue syndrome (CFS) and otovestibular
symptoms.- 175. Fibromyalgia and otovestibular symptoms.- 176. Ehlers-Danlos
syndrome (EDS) and otovestibular symptoms.- 177. Pregnancy.- Part 29:
Diagnoses:Immunologically-mediated otovestibular symptoms.- 178. Allergy and
otovestibular symptoms.- 179. Lupus (systemic lupus erythematous) and
otovestibular symptoms.- 180. Rheumatoid arthritis (RA) and otovestibular
symptoms.- 181. Sarcoidosis and otovestibular symptoms.- 182. Scleroderma and
otovestibular symptoms Evaluation.- Part 30: Evaluation:Bedside physical
examination.- 183. Dynamic visual acuity testing.- 184. Ophthalmoscope
test.- 185. Bedside head impulse testing.- 186. Otoscopy (handheld,
monocular).- 187. Bedside hearing tests (finger rub, whisper, Weber,
Rinne).- 188. Romberg test.- 189. Fukuda-Unterberger stepping test.- 190.
Vertebral artery testing.- Part 31: Evaluation:Instrumented testing.- 191.
Why do we do testing at all? Confidence and uncertainty.- 192. Binocular
otomicroscopy.- Part 32: Evaluation:Audiometric testing.- 193.
Audiometry.- 194. Stenger effect and Stenger test.- 195. Tympanometry.- 196.
Otoacoustic emissions (OAEs).- 197. Auditory evoked brainstem responses
(ABRs).- 198. Electrocochleography (ECoG).- Part 33: Evaluation:Ocular motor
vestibular tests.- 199. Why do we look at eye movements?.- 200. Magnetic
scleral search coils.- 201. Electronystagmography (ENG).- 202.
Videonystagmography (VNG).- 203. Caloric testing.- 204. Video head impulse
testing (vHIT) and its variants.- 205. Rotatory chair testing (RCT).- 206.
Retinal imaging.- Part 34: Evaluation:Vestibular evoked myogenic
potentials.- 207. General comments on vestibular evoked myogenic
potentials.- 208. Cervical vestibular evoked myogenic potentials
(cVEMPs).- 209. Ocular vestibular evoked myogenic potentials (oVEMPs).- Part
35: Evaluation:Other vestibular tests.- 210. Computerized dynamic
posturography (CDP).- 211. Tests limited to research settings.- Part 36:
Evaluation: Cardiovascular testing in otoneurology
212. Tilt table testing (TTT).-
213. Cardiac monitoring.- Part 37: Evaluation
Imaging in otoneurology.- 214. General comments about imaging in
otoneurology.- 215. MRI of the brain and internal auditory canals.- 216.
Temporal bone CT.- Part 38: Evaluation:Miscellaneous modalities.- 217.
Telemedicine in otoneurology
Management.- Part 39: Management:General comments on pharmacological
intervention.-
218. Comments on medication side effects.- Part 40:
Management:Classes of pharmaceutical agents.-
219. Aminopyridines (4-AP,
3,4-DAP).-
220. Anti-nauseant and anti-emetic medications.-
221.
Anti-oxidants.-
222. Benzodiazepines.-
223. Beta blockers.-
224. Botulinum
toxins.-
225. cGRP inhibitors.-
226. Corticosteroids.-
227. Diuretics.-
228.
Serotonin-norepinephrine reuptake inhibitors (SNRIs).-
229.
Serotonin-specific reuptake inhibitors (SSRIs).-
230. Tricyclics.- Part 41:
Management:Individual medications.-
231. Acetazolamide.-
232. Baclofen.-
233.
Betahistine.-
234. Botulinum toxin.-
235. Dimenhydrinate.-
236.
Fludrocortisone.-
237. Fluticasone and azelastine.-
238. Gabapentin.-
239.
Meclizine.-
240. Melatonin.-
241. Memantine.-
242. Midodrine.-
243.
Oxcarbazepine.-
244. Scopolamine.-
245. Topiramate.-
246. Trimetazidine.-
247. Venlafaxine.-.-
248. Verapamil.- Part 42: Management:Nutritional
supplements.-
249. Coenzyme Q10.
250. Magnesium.-
251. Riboflavin.-
252.
Vitamin D.- Part 43: Management:Herbal supplements.-
253. Butterbur.-
254.
Feverfew.- Part 44: Management:Procedures, non-surgical.-
255. Acupuncture.-
256. Nerve blocks for headache.-
257. Transcutaneous electrical nerve
stimulation (TENS).-
258. Transcranial magnetic stimulation (TMS).-
259.
Vagal nerve stimulation (VNS).-
260. Hyperbaric oxygen therapy (HBOT).- Part
45: Management:Procedures, surgical.-
261. Tympanostomy tube placement.-
262.
Transtympanic injections.-
263. Tympanoplasty.-
264. Silverstein MicroWick.-
265. Positive pressure therapies for Menieres disease.-
266. Labyrinthectomy
and vestibular neurectomy.-
267. Surgery for superior semicircular canal
dehiscence.-
268. Surgery for benign paroxysmal positional vertigo.- Part 46:
Management:Vestibular rehabilitation therapy.-
269. General comments about
physical therapy for benign paroxysmal positional vertigo (BPPV).-
270.
Physical therapy for BPPV of the posterior canal, unilateral.-
271. Physical
therapy for BPPV of the posterior canal, bilateral or unknown.-
272. Physical
therapy for BPPV of the lateral canal (geotropic or apogeotropic),
unilateral.-
273. Physical therapy for BPPV of the lateral canal, geotropic,
unilateral.-
274. Physical therapy for BPPV of the lateral canal,
apogeotropic, unilateral.-
275. Physical therapy for BPPV of the lateral
canal (geotropic or apogeotropic), bilateral.-
276. Physical therapy for BPPV
of the anterior canal, unilateral.-
277. Physical therapy for BPPV of the
anterior canal, bilateral.-
278. Physical therapy for BPPV, other maneuvers.-
279. Mechanical chair treatment for benign paroxysmal positional vertigo.-
280. Physical rehabilitation therapy for vestibular weakness.- Part 47:
Management:Therapies for the neck.-
281. Physical therapy for the neck.-
282.
Chiropractic manipulation.- Part 48: Management:Other vestibular therapies.-
283. Motion desensitization (Puma method).
284. Mingjia Dais treatment for
MdDs.- Part 49: Management:Auditory interventions.-
285. Hearing
amplification.-
286. Hearing amplification, balance and falls.-
287.
Treatment of idiopathic tinnitus.- Part 50:. Management:Other interventions.-
288. Vestibular compensation.- Part 51: Management:Bureaucratic issues.-
289.
Provision of hearing aids.-
290. Functional capacity evaluation (FCE).-
291.
Disability.-
292. Driving.
Marcello Cherchi, MD, PhD
Clinical Associate and Director of Otoneurology and Vestibular Medicine
University of Chicago Medicine
Department of Neurology
5841 South Maryland Avenue
Chicago, IL 60637.
