Perspectives in vestibular diagnostics and therapy

Abstract

Vestibular diagnostics and therapy ist the mirror of technological, scientific and socio-economics trends as are other fields of clinical medicine. These trends have led to a substantial diversification of the field of neurotology.The improvements in diagnostics have been characterized by the introduction of new receptor testing tools (e.g., VEMPs), progress in imaging (e.g., the endolymphatic hydrops) and in the description of central-vestibular neuroplasticity. The etiopathology of vestibular disorders has been updated by geneticists (e.g., the description of the COCH gene mutations), the detection of structural abnormalities (e.g., dehiscence syndromes) and related disorders (e.g. migraine-associated vertigo). The therapeutic options were extended by re-evaluation of techniques known a long time ago (e.g., saccus exposure), the development of new approaches (e.g., dehiscence repair) and the introduction of new drug therapy concepts (e.g., local drug delivery). Implantable, neuroprosthetic solutions have not yet reached experimental safety and validity and are still far away. However, externally worn neuroprosthetic solution were introduced in the rehab of vestibular disorders (e.g., VertiGuard system).These and related trends point into a medical future which is characterized by presbyvertigo as classical sign of the demographic changes ahead, by shortage of financial resources and a medico-legally over-regulated, even hostile environment for physicians in clinical medicine.

Keywords: Vestibular diagnostics; neurofeedback training; presbyvertigo; vestibular therapy.

Table 1. Average P1/N1 amplitudes in VEMP recordings – elicited by air and bone conduction – with respect to age and gender [due to 20]

Figure 1. Typical picture of a saccular dsiorder oft he left side (no VEMPs), but normal VEMP pattern oft he right side (P1/N1)

Figure 2. Dehiscence of the superior semicricular canal (SCDS) in thin-slice CT of the petrous bone

Figure 3. Surgical approach for the exposition oft he endolymphatic sac (due to PLESTER)

Figure 4. Vibrotactile neurofeedback training system VertiGuard^® in action

Figure 5. Typical evaluation of pre/post results after neurofeedback training with stance and gait tasks