Vestibular Diagnosis and Rehabilitation: Science and Clinical Applications

Vestibular science, clinical evaluation, and treatment have advanced significantly in a short span of 50 years. Sir Isaac Newton, with regard to his own scientific contributions, once said, ``If we can see far, it is because of those who have come before us; we are merely dwarfs riding on the shoulders of giants.'' This is certainly germane for those of us who continue to build on and advance the work of those who have contributed so much to our knowledge of this field.

This issue of Seminars in Hearing includes clinically oriented aspects of vestibular science. While there is an abundance of literature from the disciplines of audiology, otology, neurology, aviation, space medicine, physical therapy, and occupation therapy, the articles that have been included here have the most applicability for the rank and file clinician. Virtually all audiologists, physicians, and therapists have the ability to participate in some aspect of the continuum of care for the vestibular patient. Clinicians-even those that do not specialize in this field-should possess the ability to identify and triage the vestibular patient.

We begin this issue with an article by T. Oma Hester and Herbert Silverstein who examine the importance of good history taking from the otologist's point of view. Dr. Silverstein has been in the vanguard in the development of otologic surgical innovations, including the endo-lymphatic shunt, vestibular nerve section, laser assisted stapedectomy, and most recently, the Microwick intratympanic gentamicin treatment for intractable Meniere's disease.

Our next contributor, Anita Pikus, has had a 25-year career with the National Institutes of Health. Dr. Pikus' article on heritable vestibular conditions is particularly important for those clinicians working with a pediatric population. We often forget that hearing-impaired children also may have vestibular anomalies that occur within the impaired auditory vestibular system.

Michael Lombardo, a renowned biochemist whose career has focused on research in prostate and breast cancer, takes an interesting look at the biochemistry of benign paroxysmal positional vertigo. Dr. Lombardo presents a hypothesis that may explain the prevalence of the disorder in some individuals, while others benefit from spontaneous resolution.

A clinical article by Richard and Patricia Gans on Benign Paroxysmal Positional Vertigo (BPPV) examines the longitudinal treatment histories of BPPV patients over a seven-year period. The doctors Gans review treatment efficacy with modified Canalith Repositioning / Liberatory Maneuvers. Results from 376 patients suggest that both methods are highly effective in successfully treating this condition.

The importance of the vestibular ocular reflex, and its role and importance in human equilibrium is reviewed by Dennis O'Leary. Dr. O'Leary, a professor of otolaryngology at the University of Southern California, has spent much of his career in the development of tests of the Vestibular Ocular Reflex (VOR) during active head movement. It is the development and clinical implication of many of these simple and easily accessible technologies that often reveal otherwise undetected vestibular dysfunction in patients.

A review of Vestibular Rehabilitation Therapy, along with a critical decision analysis of the triage of vestibular patients in their continuum of care, is presented by Richard Gans. Dr. Gans' contribution will assist clinicians in identifying the appropriate management of patients with nonmedical or nonsurgically manageable chronic vestibular dysfunction.

The final contribution comes from Gary Jacobson. His prolific writing has provided us with a wealth of articles and edited textbooks that have become classic references for those pursuing this specialty. Dr. Jacobson's article, ``Development of a Clinic for the Assessment of Risk of Falls in Elderly Patients,'' is timely. Falling among the elderly has been identified as a potentially major crisis for the healthcare system. Healthcare providers and insurers have, over the past decade, begun to seriously consider the long-term benefit of prophylactic intervention.

It is hoped that this issue of Seminars will provide its readers with a combination of clinically applicable tools, new ideas and theories to contemplate, as well as information that will assist those who serve the needs of the vestibular patient.

I wish to thank all of our contributing authors who have taken time from their hectic schedules to write for this Seminars' issue. I also wish to thank my support and clinical staff at The American Institute of Balance for their assistance and support in the preparation of my article. I would like to recognize the late David Cyr, Ph.D., who spent much of his career at Boys Town Neurological Institute researching and writing on pediatric vestibular issues.