Book Review

Disorders of the Vestibular System

N Engl J Med 1997; 336:814March 13, 1997

Article

Disorders of the Vestibular System
Edited by Robert W. Baloh and G. Michael Halmagyi. 687 pp., illustrated. New York, Oxford University Press, 1996. $135. ISBN: 0-19-509006-3

Vertigo, dizziness, and balance disorders occur in many sometimes very different diseases. More than 100 pathologic conditions can cause these disorders, so nearly all medical specialties have to deal with them.

This book describes in detail the anatomy, physiology, and physical mechanisms. The many contributing authors do not share the same opinions, but this adds to the value of the book, which makes clear that there is no consensus about many aspects of the vestibular system.

The section on clinical evaluation and the descriptions of the many diseases in which vestibular problems such as vertigo and dizziness occur provide good guidance. The simple vestibular tests and the essential features of bedside examination are clearly presented.

The chapters entitled “Vestibular Tests in Evolution” discuss otolith tests, which are not of great value for the clinician (with otolith tests an examination is done of the part of the vestibular system responsible for the detection of linear accelerations). Examination of eye movements is still the most important technique for evaluating oculomotor function. Oculovestibular reflexes offer an entry to highly developed parts of the oculomotor system. Several chapters deal with aspects of ocular–vestibular interactions and give a clear overview of the state of the art. There is much attention to diagnostics, including imaging techniques and audiometry, with illustrative cases.

There are very good chapters. Some, however, are not up to current standards. The chapter on Ménière's disease does not give information on the original cases and on the history of this condition. The method for reporting treatment results in Ménière's disease published by the American Academy of Ophthalmology and Otolaryngology in 1972 is discussed extensively; however, there is no mention of the 1995 guidelines.

In the past decade, theories about motion sickness have changed considerably, and agreement on its origin, treatment, and prevention is developing. It is thus regrettable that the authors of this chapter do not take into account important articles published in the past five years. The paragraph on treatment and prevention lacks a summary of the most common drugs in use and general measures for prevention. The most popular drugs for motion sickness are not even mentioned.

Therapy for vertigo embraces drug treatment, adaptation exercises, and surgery. The choice depends not only on the type and origin of the disorder, but also on the opinion and skills of the doctor. The book makes clear that a consensus is still far away.

The book is valuable for all physicians who deal with vertigo and dizziness. Scientists interested in the vestibular system will find a lot of valuable information.

Wil J. Oosterveld, M.D., Ph.D.
University of Amsterdam, 1105 AZ Amsterdam, the Netherlands