Dizziness is not only one of the most frequent chief complaints that neurologists hear from their patients, but also, at times, among the most vexing. I'm sure many readers have reprised my silent groan when a patient offers the chief complaint, "Doctor, I'm dizzy." In this issue of Continuum, devoted to the subject of Neuro-otology, help is on the way! Ronald Tusa, MD, has recruited a cadre of experts from multiple disciplines to address not only issues of dizziness, but also of hearing.
In order to understand the variety of symptoms offered by the dizzy patient, one must have a basic sense of the anatomy and physiology of the vestibular system. The opening chapter by David Zee, MD, provides that framework to inform the clinical examination. Neil Shepard, PhD, then extends the examination in his thorough description of laboratory testing in the dizzy patient.
The next few chapters in this issue address specific neuro-otological disorders. Vestibular neuritis, which goes by a variety of other monikers, is probably the most common cause of acute vestibular loss. Robert Baloh, MD, provides a thorough discussion of this and other acute peripheral vestibulopathies. While most neurologists are familiar with Ménière's disease, our readers may be less comfortable with their understanding of the superior semicircular canal dehiscence syndrome and perilymphatic fistulae. The lucid chapter by Lloyd Minor, MD, and John Carey, MD, should help remedy any such deficiency. Positional vertigo, most notably benign paroxysmal positional vertigo (BPPV), is a very frequent characteristic of the dizzy patient. Terry Fife, MD, guides the reader through the differential diagnosis of positional vertigo, emphasizing the distinction between central and peripheral etiologies. In very clear fashion, he describes the canalith repositioning maneuvers, which should enable the reader to experience the sat-isfaction of relieving patients with BPPV of their extremely uncomfortable symptoms. Next, Joseph Furman, MD, and Dawn Marcus, MD, plunge into the more controversial area of migraine-related dizziness and, additionally, discuss the subjects of motion sickness and motion sensitivity. The authors' thoughtful position should help the reader better understand the relationship of these episodic disorders. Changing gears to move to the auditory aspects of neurootology, Douglas Mattox, MD, provides a very comprehensive discussion of the assessment and management of hearing loss and tinnitus. He clearly guides the neurologist through an understanding of the anatomy and physiology of hearing, the various patterns and differential diagnosis of hearing loss, and the management of the problem.
Although addressed partially in the chapters dealing with specific syndromes, the last portion of this issue of Continuum covers more broadly a variety of treatment modalities, which complement one another. First, Susan Herdman, PhD, provides a very logical and sequential approach to vestibular rehabilitation. Timothy Hain, MD, then discusses the use, as well as the misuse, of medications in the treatment of dizziness, including coverage of drugs used to suppress the nausea and vomiting that almost invariably accompany vertigo, particularly in the acute situation. Psychological problems are rife in the dizzy patient, sometimes as a cause and sometimes as a consequence of the symptom complex. Jeffrey Staab, MD, offers guidance to understanding and managing these issues.
The educational menu in this Continuum issue on neuro-otology by no means stops with the specific subject chapters. While they may provide the meat and potatoes, as usual we offer educational dessert in the form of the instructive multiple-choice questions and answers, this time ably authored by Eduardo Benarroch, MD, and Steven Lewis, MD, and the patient management problem, devised by the faculty chair Dr Tusa. With this issue, the end-of-dinner caffeine jolt comes with the Quintessentials bonus, also authored by Dr Tusa. By reading the pointers for practice and completing the case-based questionnaires, you will be able to achieve and demonstrate practice improvement in caring for patients with neuro-otological problems.
But we're not done yet. This is, indeed, the Continuum issue that keeps on giving! Once each year, an issue of Continuum is accompanied by a CD-ROM, which provides a visual supplement to the text-based information. We hope these moving images will further enhance your understanding of neuro-otology and ability to care for the dizzy patient.
Dr Tusa has gone well beyond the usual call of duty for Continuum faculty chairs. In addition to assembling a group of talented authors and overseeing their work, he willingly undertook the challenges of Quintessentials and organizing the collection of video segments for the CD-ROM. I'm sure our readers will join me in applauding his efforts and those of his faculty. Enjoy!
Aaron E. Miller, MD