This issue of Continuum is devoted to the diagnosis and management of disorders related to dysfunction of the inner ear or its connections to relevant structures in the central nervous system (eg, the cerebellum and brainstem). A particular emphasis is on those disorders presenting with signs and symptoms of vestibular dysfunction, whether of peripheral or central origin. To achieve this important goal, I am so appreciative that Dr Terry D. Fife accepted my invitation to serve as guest editor of this issue, and I would especially like to thank him for organizing such an inclusive set of articles and inviting authors who are prominent experts and educators in neuro-otology.
The issue begins with the article by Dr Fife describing his thoughtful approach to the history and evaluation of patients with vertigo and dizziness, which serves as an important foundation to the articles that follow. Next, Drs Timothy C. Hain and Marcello Cherchi demystify the role and interpretation of vestibular testing in patients with neuro-otologic symptoms, also a helpful introduction to the issue.
Dr Kevin A. Kerber then reviews the pathophysiology, evaluation, and management of the disorders that present as episodic positional dizziness, providing well-illustrated step-by-step details of the important and effective repositioning maneuvers. Next, Dr Scott D. Z. Eggers reviews the differential diagnosis, evaluation, and management of the various disorders that can present to the neurologist and cause recurrent spontaneous episodes of dizziness or vertigo, whether of primary neurologic or otologic origin.
Dr Kristen K. Steenerson then reviews the acute vestibular syndrome, a condition neurologists frequently encounter in emergency department settings, and shares important pearls and pitfalls regarding the critical diagnostic dilemma as to whether a patient’s acute vertigo with nausea and vomiting is due to a self-limited peripheral vestibular disorder (eg, vestibular neuritis) or a potentially devastating central one (eg, cerebellar stroke). Dr Yoon-Hee Cha next reviews the clinical symptomatology, diagnosis, and management of the disorders that cause chronic dizziness, including persistent postural perceptual dizziness, mal de débarquement syndrome, motion sickness, bilateral vestibulopathy (eg, after ototoxic medications), and after mild concussion. Dr Kamala Saha discusses the differential diagnosis and management of vertigo related to central nervous system disorders, including migrainous, demyelinative, neoplastic, ischemic, hemorrhagic (eg, superficial siderosis), genetic, and autoimmune causes.
The final two review articles in the issue cover disorders that may present to the neurologist despite being classically considered mostly in the realm of the otolaryngologist. Dr Gail Ishiyama discusses the pathophysiology, diagnosis, and management of several primarily otologic disorders that may present with vertigo, including Ménière disease, superior semicircular canal dehiscence syndrome, perilymphatic fistula, barotrauma, cholesteatoma, Ramsay Hunt syndrome, enlarged vestibular aqueduct syndrome, and autoimmune inner ear disease. Dr Fife and Dr Roksolyana Tourkevich then review the diagnosis and current management of the other primary otologic syndromes that may present to the neurologist, including tinnitus, hyperacusis, otalgia, and hearing loss. They include a very helpful primer on hearing loss, interpretation of audiogram results, and hearing augmentation as a practical coda to this issue.
After reading the issue and taking the Postreading Self-Assessment and CME Test written by Drs Adam G. Kelly and James W. M. Owens Jr, readers may earn up to 20 AMA PRA Category 1 CreditsTM toward self-assessment CME or, for Canadian participants, a maximum of 20 hours toward the Self-Assessment Program (Section 3) of the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada. Additional credit can be obtained by listening to Continuum Audio interviews associated with this and other Continuum issues, available to all subscribers, and completing tests on the Continuum Audio web platform or mobile app. Continuum Audio is also accredited by the Royal College of Physicians and Surgeons of Canada.
...I am so appreciative that Dr Terry D. Fife accepted my invitation to serve as guest editor of this issue, and I would especially like to thank him for organizing such an inclusive set of articles and inviting authors who are prominent experts and educators in neuro-otology.
This issue is part of a pilot program of Continuum issues read aloud. Different from Continuum Audio, these are recordings read verbatim from the print articles by Dr Michael Kentris, a neurologist at the Clinical Neuroscience Institute in Dayton, Ohio. The audio files are available to all Continuum subscribers in the AAN’s Online Learning Center at continpub.com/CME. I encourage you to listen and submit the survey with your feedback on this pilot, which has been extended to include this issue, as well as the June and August 2021 issues.
My sincerest thank you to Dr Fife for his remarkable guest editorship of this issue, including his organization of the practical and inclusive article topics, enlistment of such outstanding content experts, and devotion to every step along the way toward publication. The result is a volume of Continuum that should enhance the expertise of each of us as we hear our patients’ histories, perform relevant examinations, and diagnose and treat the many patients who present to us with signs and symptoms of neuro-otologic (eg, vestibular) dysfunction, whether of peripheral or central origin.
—STEVEN L. LEWIS, MD, FAAN