Vertigo: Five Physician Scientists and the Quest for a Cure

ISBN : 9780190600129

Robert W. Baloh
256 Pages
156 x 235 mm
Pub date
Dec 2016
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Benign paroxysmal positional vertigo (BPPV), the most common cause of vertigo, affects one in five people at some point during their lifetime, triggering the sudden feeling like one is moving or spinning when perfectly still. Early pieces of this medical puzzle appeared in the early 19th century in studies of the inner ear, yet the cause and cure for BPPV was not clearly understood until the late 20th century and it took a few more decades before this simple cure was accepted. Vertigo: Five Physician Scientists and the Quest for a Cure follows this centuries long trek. The book follows the key discoveries made by Prosper Meniere (1799-1862) who first recognized that vertigo could originate from the inner ear, Josef Breuer (1842-1925) who conducted groundbreaking research on the inner ear during his evenings at home after he spent his days working in a busy private medical practice, Robert Barany (1876-1936) who received the Nobel Prize for his early work on the inner ear, Charles Hallpike (1900-1979) who showed that BPPV originates from the inner ear, and Harold Schuknecht (1917-1996) who provided key observations on the mechanism of BPPV. Dr. Robert W. Baloh spins together a fascinating history using detailed interviews from those close to the key investigators and historical documents previously unavailable in the English language to provide a historical approach to understanding the vestibular system and with it a better understanding of vertigo itself.


Chapter 1. Introduction
The Inner Ear
Dizziness, Vertigo and the Inner Ear
What is Benign Paroxysmal Positional Vertigo (BPPV)?
So Who Discovered the Cure?
Section 1: Prosper Meniere (1799-1862)
Chapter 2. Meniere recognizes that vertigo can originate from the inner ear
What was known about the inner ear in the mid 19th century?
First hint that the semicircular canals may be related to balance
Meniere presents his findings in 1861
The first recorded case of Meniere's disease?
More evidence that vertigo can originate for the inner ear
Inconsistencies in Meniere's description of the young girl with vertigo
Treatments for vertigo in mid 19th century
Meniere 's comments trigger heated debate
Chapter 3. Meniere, a man of many interests
Meniere's academic career
Meniere balances academic, patient and family activities
Meniere's every day life
Meniere's role in French society
Section 2: Josef Breuer (1842-1925)
Chapter 4. Breuer discovers how the balance portion of the inner ear works
Eye movements and the semicircular canals
The gravity sensing otolith organs
Evolutionary development of the inner ear
Mach and his psychophysical experiments
Breuer and Mach work together to defend their theory
Crum-Brown, the model maker
Who contributed most to our current understanding of the vestibular system?
Chapter 5. Breuer, the Renaissance man
Upbringing and formative years
Breuer's medical training
Breuer chooses private practice over academic medicine
Breuer, the family doctor
Chapter 6. Breuer's experiments on the semicircular canals and otolith organs
Studies on the semicircular canals
Ewald's laws
The Breuer-Von Cyon feud
Studies on the otolith organs
Overview of the inner ear sensory receptors
Chapter 7. Breuer's contributions to psychiatry and philosophy
Freud's early work in neuroanatomy
Anna O. and the beginnings of psychoanalysis
Breuer and Freud and Studies in Hysteria
The friendship between Breuer and Freud dissolves
Breuer's philosophical beliefs
The final years
Section 3: Robert Barany (1876-1936)
Chapter 8. Politzer's otology clinic and the discovery of the caloric test
Politzer maneuver
Teaching in Politzer's clinic
Robert Barany joins Politzer's clinic
Barany discovers the caloric test
Chapter 9. Barany's formative years and the conflict in Politzer's clinic
Barany's medical training
Source of conflict in Politzer's clinic
Accusations against Barany
Chapter 10. The war years and Barany's decision to leave Vienna
Barany receives the 1914 Nobel Prize in Medicine
Formal charges against Barany
Nobel committee response
Questions regarding Barany's caloric theory
Chapter 11. Barany 's test battery and the first description of BPPV
Romberg test
Pastpointing test
Barany's syndrome
First description of benign paroxysmal positional vertigo (BPPV)
Chapter 12. Barany 's life in Uppsala and his work with Lorente de No
The brain and the neuronal theory
Lorente de No and Barany in Spain
Lorente de No works on central vestibular pathways with Barany
Barany's final years
Section 4: Charles Hallpike (1900-1979)
Chapter 13. Hallpike and the pathology of Meniere's disease
Toynebee and early efforts to study pathology of the inner ear
Wittmaack and his new technique for preparing temporal bones
World-wide interest in Wittmaack's technique
Hallpike and Cairns report on the pathology of Meniere 's syndrome
Possible causes of Meniere's syndrome
Yamakawa also describes the pathology of Meniere's syndrome
Chapter 14. Hallpike's formative years
The Indian connection
Early education and dealing with Legg-Perthes disease
Medical training
Personal life
Hallpike the inventor
Appointment at Queen Square
Hallpike's colleagues at Queen Square
War years
Queen Square neurotology clinic
Chapter 15. Hallpike's caloric test
Preparing the water
Hallpike's caloric chart
Meaning of a Directional Preponderance
Importance of tonic signals originating from the inner ears
Controversy regarding the affect of cortical lesions
Chapter 16. Hallpike defines the syndrome of BPPV
Clinical features of BPPV
Confusion regarding the direction of the positional nystagmus
Strong evidence for an inner ear origin
Pathology of BPPV
Final years
Section 5: Harold Schuknecht (1917-1996)
Chapter 17. Schuknecht and his breakthrough on BPPV
John Lindsay and University of Chicago otology clinic
Schuknecht begins his residency at the University of Chicago
Schuknecht's formative years
Schuknecht becomes interested in BPPV
Search for the cause of BPPV
Schuknecht suggests a new mechanism for BPPV
Chapter 18. Schuknecht's temporal bone bank in Boston
More temporal bone specimens from patients with BPPV
The cupulolithiasis theory
Schuknecht was not the first to propose the cupulolithiasis theory
A key question-which way does the cupula deviate?
How to explain the stereotypical nystagmus
Problems with the cupulolithiais theory
Chapter 19. Schuknecht's crusade against myths in otology
Surgical treatments of Meniere's disease
Viral neurolabyrinthitis
Questionable surgical procedures
The final years
Section 6: The pieces of the puzzle come together
Chapter 20. Semont and Epley maneuvers
Treatments based on the cupulolithiasis theory
Semont's maneuver
Cupulolithiasis vs. canalithiasis
Epley 's maneuver
Visualization of the free floating otolith debri
Chapter 21. Evolution of treatment maneuvers for BPPV
Epley's maneuver
Semont's maneuver
Features shared by the maneuvers
Variations on the theme
Horizontal canal BPPV
Chapter 22. Summary and Future Directions
Difficulties facing early investigators
Unanswered questions
Can patients do the maneuvers on their own?

About the author: 

Robert W. Baloh, MD is a professor of Neurology and Head and Neck Surgery at UCLA who has written more than 300 research articles and several textbooks focusing on the vestibular system. His interest in the history of Neurotology dates back to a series of conversations with Raphael Lorente de No in the early 1970s.

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