[Function disorders of otoliths: clinical aspects and therapy options]

[Diagnosis of otolith disorders in routine otolaryngology]

Nowadays, specific and reproducible side-separated neurotologic testing of all vestibular receptors is possible. Assessment of saccular function by measuring cervical vestibular-evoked myogenic potentials (cVEMP) is well established. Reliable screening tests exist for the isolated assessment of utricular function. These tests can be performed even in less well-equipped surroundings to generate information regarding a possible partial dysfunction of the otolith organs. Apart from assessing the functionality of the semicircular canals by caloric irrigation and the head impulse test, screening for otolith disorders should be part of a comprehensive modern vestibular examination. Neurofeedbacktraining is an effective therapy in the treatment of otholith disorders.

[Recording cervical and ocular vestibular evoked myogenic potentials. Part 2: influencing factors, evaluation of findings and clinical significance]

VEMP measurements are subject to various influencing factors: patient age, threshold, sound intensity and frequency. Using air (AC) and bone conduction (BC) the vestibular receptors and afferents of the otolith organs can be activated to varying degrees. Recordings of cervical (cVEMP) and ocular VEMP (oVEMP) are clinically possible. AC-cVEMP are primarily an indicator of the sacculocollic reflex pathway. Together with findings on the vestibuloocular reflex (VOR) and complimentary otolith tests, VEMP enable otolith function analysis of each side separately. In addition, the distinction between combined or isolated canal and otolith dysfunction in terms of subtyping and patterns of damage in mono- and bilateral disorders, such as vestibular neuritis or bilateral vestibulopathy, is possible. Moreover, VEMP is relevant in terms of prognostic and therapeutic considerations as well as expert assessments.

Falls and dizziness in the elderly

The complaint of dizziness is one of the most common reasons that older adults feel constrained to visit the doctor's office. Because of a growing number of older people in the industrial society the problem grows. Therapeutic process of elderly people with vertigo and dizziness needs more than vestibular diagnostics. In addition to sufficient anamnesis, presence of visual deficits, extrasensory changes and even psychological circumstances are necessary. Frequently the indication and the encouragement of vestibular rehabilitation have significant value. The initiation of fall prevention may also be essential.