Vertigo: Five Physician Scientists and the Quest for a Cure

by Robert W. Baloh

Overview

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W. Baloh spins together a fascinating history using detailed interviews from those close to the key investigators and historical documents previously unavailable in the English language to provide a historical approach to understanding the vestibular system and with it a better understanding of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.

Product Details

ISBN-13:	9780190600129
Publisher:	Oxford University Press
Publication date:	11/18/2016
Pages:	256
Product dimensions:	6.00(w) x 9.30(h) x 0.90(d)

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 Nó in the early 1970s.

Table of Contents

Preface
Acknowledgments

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 Ménière (1799-1862)
Chapter 2. Ménière 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
Ménière presents his findings in 1861
The first recorded case of Ménière's disease?
More evidence that vertigo can originate for the inner ear
Inconsistencies in Ménière's description of the young girl with vertigo
Treatments for vertigo in mid 19th century
Ménière 's comments trigger heated debate
Chapter 3. Ménière, a man of many interests
Ménière's academic career
Ménière balances academic, patient and family activities
Ménière's every day life
Ménière'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 Bárány (1876-1936)
Chapter 8. Politzer's otology clinic and the discovery of the caloric test
Politzer maneuver
Teaching in Politzer's clinic
Robert Bárány joins Politzer's clinic
Bárány discovers the caloric test
Chapter 9. Bárány's formative years and the conflict in Politzer's clinic
Bárány's medical training
Source of conflict in Politzer's clinic
Accusations against Barany
Chapter 10. The war years and Bárány's decision to leave Vienna
Bárány receives the 1914 Nobel Prize in Medicine
Formal charges against Bárány
Nobel committee response
Questions regarding Bárány's caloric theory
Chapter 11. Bárány 's test battery and the first description of BPPV
Romberg test
Pastpointing test
Bárány's syndrome
First description of benign paroxysmal positional vertigo (BPPV)
Chapter 12. Bárány 's life in Uppsala and his work with Lorente de Nó
The brain and the neuronal theory
Lorente de Nó and Bárány in Spain
Lorente de Nó works on central vestibular pathways with Bárány
Bárány's final years

Section 4: Charles Hallpike (1900-1979)
Chapter 13. Hallpike and the pathology of Ménière'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 Ménière 's syndrome
Possible causes of Ménière's syndrome
Yamakawa also describes the pathology of Ménière'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 Ménière'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?

Glossary

Editorial Reviews

"I read this book from cover to cover and found it engaging, enlightening and inspiring. It has many revealing vignettes about the personal lives of the giants in neuro-otology whose eponymous names we all recognize. Bob Baloh's story illustrates how science, and especially medicine, moves forwards, sideways, backwards and then often belatedly, forwards again. And the book points out, as always, the human failings of even our most brilliant scientific heroes; jealousy, selective memory, and an unwillingness to give up one's own theories in the face of incontrovertible opposing evidence. Lessons for us all." -David S. Zee, MD, Professor, Neuro-Visual & Vestibular Division, Departments of Neurology, Ophthalmology, Otolaryngology-Head and Neck Surgery, and Neuroscience, The Johns Hopkins Hospital, Baltimore, MD

"A riveting account by one of the giants in the field, of how clinician-scientists, have managed over the last century to unravel the secrets of the 6th sense, the sense of motion and to apply their findings to the treatment of balance disorders to give relief to those suffering from terrifying vertigo attacks. Full of fascinating information for both patients and professionals - a must read." -Michael Halmagyi, BSC, MBBS, MD, Royal Prince Alfred Hospital, Sydney, Australia

"A fascinating story of scientific discovery. Mysterious and disabling spinning sensations, psychoanalysis, pigeons, the Nobel prize, imprisonment in Russia, exile to Sweden, bouncing eyes, ear stones, and a simple but elusive cure. Dr. Baloh, a giant in the field himself, tells the story like no one else could." -Kevin Kerber, MD, Department of Neurology, University of Michigan, Ann Arbor, MI

"The sense of balance was one of the first sensory systems to emerge in evolution, but it was also the last to be discovered. In his remarkable book Vertigo - Five Physician Scientists and the Quest for a Cure Robert W. Baloh transports the reader back to the early days of vestibular discoveries, exemplified by five eminent figures in the history of neurotology.
Dr. Baloh brings to life the colourful personalities that deepened our understanding of the balance system and paved the way for current vestibular diagnostics and treatment.
This meticulously researched book, written by an eminent specialist in the field, will make a significant contribution to the history of vestibular science." -Gerald Wiest, MD, Professor of Neurology, Medical University Vienna, Vienna, Austria

From the Publisher