Preface ........................................................ xi
Acknowledgments ............................................... xii
1 Introduction .................................................. 1
THE INNER EAR ................................................. 1
DIZZINESS, VERTIGO, AND THE INNER EAR ......................... 1
WHAT IS BENIGN PAROXYSIVIAL POSITIONAL VERTIGO? ............... 3
WHO DISCOVERED THE CURE? ...................................... 4
SECTION 1. PROSPER MENIERE (1799-1862)
2 Meniere Recognizes That Vertigo Can Originate from the
Inner Ear ..................................................... 7
WHAT WAS KNOWN ABOUT THE INNER EAR IN THE MID-19TH CENTURY? ... 7
FIRST HINT THAT THE SEMICIRCULAR CANALS MAYBE RELATED TO
BALANCE ...................................................... 10
MENIERE PRESENTS HIS FINDINGS IN 1861 ........................ 12
THE FIRST RECORDED CASE OF MÉNIÈRE'S DISEASE? ................ 13
MORE EVIDENCE THAT VERTIGO CAN ORIGINATE FROM THE INNER EAR .. 15
INCONSISTENCIES IN MÉNIÈRE'S DESCRIPTION OF THE YOUNG GIRL
WITH VERTIGO IS TREATMENTS FOR VERTIGO IN THE MID-19TH
CENTURY ...................................................... 17
MÉNIÈRE'S COMMENTS TRIGGER HEATED DEBATE ..................... 18
3 Meniere, a Man of Many Interests ............................. 21
MÉNIÈRE'S ACADEMIC CAREER .................................... 21
MÉNIÈRE BALANCES ACADEMIC, PATIENT, AND FAMILY ACTIVITIES .... 23
MÉNIÈRE'S EVERYDAY LIFE ...................................... 25
MÉNIÈRE'S ROLE IN FRENCH SOCIETY ............................. 26
SECTION 2 JOSEF BREUER (1842-1925)
4 BREUER DISCOVERS HOW THE BALANCE PORTION OF THE INNER EAR
WORKS ........................................................ 31
EYE MOVEMENTS AND THE SEMICIRCULAR CANALS .................... 33
THE GRAVITY-SENSING OTOLITH ORGANS ........................... 33
EVOLUTIONARY DEVELOPMENT OF THE INNER EAR .................... 34
MACH AND HIS PSYCHOPHYSICAL EXPERIMENTS ...................... 35
BREUER AND IVIACH WORK TOGETHER TO DEFEND THEIR THEORY ....... 38
CRUM-BROWN, THE MODEL MAKER .................................. 39
WHO CONTRIBUTED MOST TO OUR CURRENT UNDERSTANDING OF THE
VESTIBULAR SYSTEM? ........................................... 41
5 Breuer, the Renaissance Man .................................. 43
UPBRINGING AND FORMATIVE YEARS 43 BREUERS MEDICAL TRAINING ... 44
BREUER CHOOSES PRIVATE PRACTICE OVER ACADEMIC MEDICINE ....... 47
BREUER, THE FAMILY DOCTOR .................................... 49
6 Breuer's Experiments on the Semicircular Canals and Otolith
Organs ....................................................... 51
STUDIES ON THE SEMICIRCULAR CANALS ........................... 52
EWALD'S LAWS ................................................. 54
THE BREUER-VON CYON FEUD ..................................... 55
STUDIES ON THE OTOLITH ORGANS ................................ 57
OVERVIEW OF THE INNER EAR SENSORY RECEPTORS .................. 59
7 Breuer's Contributions to Psychiatry and Philosophy .......... 63
FREUD'S EARLY WORK IN NEUROANATOMY ........................... 64
ANNA O. AND THE BEGINNINGS OF PSYCHOANALYSIS ................. 64
BREUERAND FREUD AND STUDIES ON HYSTERIA ...................... 66
THE FRIENDSHIP BETWEEN BREUERAND FREUD DISSOLVES ............. 68
BREUER'S PHILOSOPHICAL BELIEFS ............................... 69
THE FINAL YEARS .............................................. 71
SECTION 3. ROBERT BДRДNY (1876-1936)
8 Politzer's Otology Clinic and the Discovery of the Caloric
Test ......................................................... 75
POLITZER MANEUVER 76 TEACHING IN POLITZER'S CLINIC ........... 78
ROBERT BÁRÁNYJOINS POLITZER'S CLINIC ......................... 79
BÁRÁNY DISCOVERS THE CALORIC TEST ............................ 79
9 Bдrдny s Formative Years and the Conflict in Politzer's
Clinic ....................................................... 83
BÁRÁNY'S MEDICAL TRAINING .................................... 84
SOURCE OF CONFLICT IN POLITZER'S CLINIC ...................... 85
ACCUSATIONS AGAINST BÁRÁNY ................................... 87
10 The War Years and Bдrдny s Decision to Leave Vienna .......... 89
BÁRÁNY RECEIVES THE 1914 NOBEL PRIZE IN MEDICINE ............. 91
FORMAL CHARGES AGAINST BÁRÁNY ................................ 93
NOBEL COMMITTEE RESPONSE ..................................... 94
QUESTIONS REGARDING BÁRÁNY'S CALORIC THEORY .................. 94
11 BÁRÁNY s Test Battery and the First Description of Benign
Paroxysmal Positional Vertigo ................................ 97
ROMBERG TEST ................................................. 98
PAST-POINTING TEST ........................................... 99
BÁRÁNY'S SYNDROME ........................................... 100
first DESCRIPTION OF BENIGN PAROXYSMAL POSITIONAL VERTIGO ... 101
12 BÁRÁNY's Life in Uppsala and bus Work with Lorente de N6 .... 105
THE BRAIN AND THE NEURONAL THEORY ........................... 107
LORENTE DE NÓ AND BÁRÁNY IN SPAIN ........................... 109
LORENTE DE NÓ WORKS ON CENTRAL VESTIBULAR PATHWAYS
WITHBÁRÁNY .................................................. 111
BÁRÁNY'S final YEARS ........................................ 116
SECTION 4 CHARLES HALLPIKE (1900-1979)
13 Hallpike and the Pathology of Meniere's Disease m
TOYNBEE AND EARLY EFFORTS TO STUDY PATHOLOGY OF THE INNER
EAR ......................................................... 121
WITTMAACKAND HIS NEWTECHNIQUE FOR PREPARING TEMPORAL BONES .. 123
WORLDWIDE INTEREST IN WITTMAACK'S TECHNIQUE ................. 124
HALLPIKE AND CAIRNS REPORT ON THE PATHOLOGY OF MÉNIÈRE'S
SYNDROME .................................................... 125
POSSIBLE CAUSES OF MÉNIÈRE'S SYNDROME ....................... 129
YAMAKAWA ALSO DESCRIBES THE PATHOLOGY OF MÉNIÈRE'S
SYNDROME .................................................... 132
14 Hallpike's Formative Years us
THE INDIAN CONNECTION ....................................... 135
EARLY EDUCATION AND DEALING WITH LEGG-PERTHES DISEASE ....... 137
MEDICAL TRAINING ............................................ 137
PERSONAL LIFE ............................................... 138
HALLPIKE THE INVENTOR ....................................... 139
APPOINTMENT AT QUEEN SQUARE ................................. 140
HALLPIKE'S COLLEAGUES AT QUEEN SQUARE ....................... 140
WAR YEARS ................................................... 141
QUEEN SQUARE NEUROTOLOGY CLINIC ............................. 143
15 Hallpike's Caloric Test ..................................... 145
PREPARING THE WATER ......................................... 145
HALLPIKE'S CALORIC CHART .................................... 147
THE MEANING OF A DIRECTIONAL PREPONDERANCE .................. 148
IMPORTANCE OF TONIC SIGNALS ORIGINATING FROM THE INNER
EARS ........................................................ 149
CONTROVERSY REGARDING THE EFFECT OF CORTICAL LESIONS ........ 150
16 Hallpike Defines the Syndrome of Benign Paroxysmal
Positional Vertigo .......................................... 153
CLINICAL FEATURES OF BPPV ................................... 154
CONFUSION REGARDING THE DIRECTION OF THE POSITIONAL
NYSTAGMUS ................................................... 156
STRONG EVIDENCE FOR AN INNER EAR ORIGIN ..................... 157
PATHOLOGY OF BPPV ........................................... 158
FINAL YEARS ................................................. 159
SECTION 5 HAROLD SCHUKNECHT (1917-1996)
17 Schuknecht and His Breakthrough on Benign Paroxysmal
Positional Vertigo .......................................... 165
JOHN LINDSAY AND THE UNIVERSITY OF CHICAGO OTOLOGY CLINIC ... 165
SCHUKNECHT BEGINS HIS RESmENCYAT THE UNIVERSITY OF CHICAGO .. 166
SCHUKNECHT'S FORMATIVE YEARS ................................ 167
SCHUKNECHT BECOMES INTERESTED IN BPPV ....................... 170
SEARCH FOR THE CAUSE OF BPPV ................................ 170
SCHUKNECHT SUGGESTS A NEW MECHANISM FOR BPPV ................ 172
18 Schuknecht's Temporal Bone Bank in Boston ................... 177
MORE TEMPORAL BONE SPECIMENS FROM PATIENTS WITH BENIGN
PAROXYSMAL POSITIONAL VERTIGO ............................... 178
THE CUPULOLITHIASIS THEORY .................................. 180
SCHUKNECHT WAS NOT THE FIRST TO PROPOSE THE
CUPULOLITHIASIS THEORY ...................................... 181
A KEY QUESTION: WHICH WAY DOES THE CUPULA DEVIATE? .......... 182
HOW TO EXPLAIN THE STEREOTYPICAL NYSTAGMUS .................. 182
PROBLEMS WITH THE CUPULOLITHLAIS THEORY ..................... 185
19 Schuknecht's Crusade Against Myths in Otology ............... 189
SURGICAL TREATMENTS OF MÉNIÈRE'S DISEASE .................... 189
VIRAL NEUROLABYRINTHITIS .................................... 191
QUESTIONABLE SURGICAL PROCEDURES ............................ 194
THE FINAL YEARS ............................................. 195
SECTION 6 THE PIECES OF THE PUZZLE COME TOGETHER
20 Semont and Epiey Maneuvers .................................. 201
TREATMENTS BASED ON THE CUPULOLITHIASIS THEORY .............. 201
SEMONT'S MANEUVER ........................................... 203
CUPULOLITHIASIS VERSUS CANALITHIASIS ........................ 204
EPLEY'S MANEUVER ............................................ 206
VISUALIZATION OF THE FREE-FLOATING OTOLITH DEBRIS ........... 208
21 Evolution of Treatment Maneuvers for Benign Paroxysmal
Positional Vertigo .......................................... 211
EPLEY'S MANEUVER ............................................ 211
SEMONT'S MANEUVER ........................................... 212
FEATURES SHARED BY THE MANEUVERS ............................ 213
VARIATIONS ON THE THEME ..................................... 214
HORIZONTAL CANAL BPPV ....................................... 215
22 Conclusions ................................................. 221
Glossary ....................................................... 225
Index .......................................................... 229
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