Surgery – Diagnostic testing – Measuring anatomical characteristic or force applied to or...
Reexamination Certificate
2001-07-02
2002-05-07
Hindenburg, Max (Department: 3736)
Surgery
Diagnostic testing
Measuring anatomical characteristic or force applied to or...
C600S300000
Reexamination Certificate
active
06383150
ABSTRACT:
FIELD OF THE INVENTION
The invention relates to the diagnosis of balance disorders, and particularly to a network-based system for remotely evaluating balance-related diagnostic test data.
BACKGROUND
The brain maintains a sense of spatial orientation and equilibrium by integrating and interpreting a variety of different sensory inputs from the visual, vestibular (inner ear), and somatosensory (muscles, skin, and joints) systems. The most complex source of spatial cues is the vestibular system of the inner ear. Indeed, studies have shown that the vast majority of patients complaining of dizziness have a vestibular abnormality.
The inner ear has two types of spatial orientation sensors. Three endolymphatic-fluid-filled semi-circular canals provide sensory information about velocity, rotation, and angular motion. Two otolith organs in each inner ear, the utricle and the saccule, sense horizontal and vertical acceleration, respectively. Specialized hair cells in the otoliths and the ampullae (the dilated portions of the semi-circular canals) are displaced by movement in one direction or the other. These displacements are converted in neural signals, which are transmitted by the vestibular nerve to the brain. When the head is in a normal upright position, the hair cells in each ear fire equally at a static rate. When the head tilts to the right or to the left, the hair cells in each ear fire at different rates. The central nervous system recognizes the difference in the firing rate to determine where the head is in space.
The sensory data from the inner ear is complemented by visual cues from the eyes and somatosensory spatial cues from the muscles and skin, which sense pressure and muscle tensioning caused by standing, sitting, or lying down.
Sensory mismatch occurs when the various sensory inputs of the body do not agree with one another. For example, a room on a ship in a stormy sea may look upright at the same time the gravity sensors in the inner ear and pressure sensors in the feet indicate that the room is tilted at an angle. Sensory mismatch can result in nausea, queaziness, and disorientation.
Several different conditions can cause the balance system to malfunction. Labyrinthitis and Vestibular Neuronitis are conditions that describe the inflammation of the inner ear or the vestibular nerve, typically caused by a viral infection. These conditions are characterized by a sudden onset of vertigo which is “spinning” in nature, extreme nausea, and vomiting.
Endolymphatic Hydrops is a condition of the inner ear related to the inability of the ear to regulate its fluid balance, resulting in an episodic buildup of pressure within the balance and hearing organs. This disorder is characterized by spontaneous episodes of vertigo lasting up to several hours, fullness of the ear, “ringing” or noise in the ear, and/or hearing loss. When all of these symptoms are present, the disorder is described as Meniere's Disease. Endolymphatic Hydrops has many causes, including Labyrinthitis, perilymphatic fistula, concussions, noise trauma, autoimmune inner ear disease, and ear surgery. This disorder is thought to be related to herpetic group viruses. Immune stimulation from allergies, stress, illness or hormonal changes tend to worsen these symptoms.
Benign Paroxysmal Positional Spinning (BPPV) is a condition characterized by the positional onset of vertigo. Brief episodes of vertigo may be caused by lying down, rolling over in bed, or tilting the head back to look up. Canalithiasis, a form of BPPV associated with vertigo lasting only a few seconds, is thought to be caused by misplaced calcium carbonate crystals (otoconia) that have been dislodged from the inner ear and which float freely within the semi-circular canals in response to gravity. Cupulolithiasis, a form of BPPV associated with vertigo lasting several minutes, is caused by misplaced otoconia stuck to the cupula that constantly stimulate the balance sensor.
Perilymphatic fistula is caused by a hole in the inner ear that leaks endolymphatic fluid into the middle ear. Leakage results in brief episodes of vertigo triggered by rapid changes in middle ear pressure, such as that caused by coughing, sneezing, lifting, scuba diving, head trauma, or rapid changes in altitude.
Vertebribasular Insufficiency (VBI) is a common vascular disorder characterized by decreased blood flow through the vertebrobasilar artery system, which can result in an abrupt onset of vertigo that resolves after several minutes of lying down. Such episodes are accompanied by other VBI symptoms, including visual hallucinations, drop attacks, visual field deficits, diplopia, and headache.
Otoxicity is a condition characterized by damage done to the hearing and balance systems by drugs. Common medications that can permanently damage the inner ear system include Aminoglycoside antibiotics and Cisplatin. Symptoms may include gait unsteadiness, imbalance, and oscillopsia (a bouncing sensation of the horizon).
Other disorders are characterized by gravity sensors in the otolith organs being excessively responsive to internal pressure changes such as that caused by physical activity and sound. Damage can also be caused by tumors and viral infections that affect the vestibular nerve.
Vestibular abnormalities cause not only the common symptoms of dizziness, spinning, unsteadiness, and nausea, but also cognitive dysfunction, including short-term memory deficits, inability to concentrate or focus on a task, panic attacks, and depression. These cognitive symptoms are caused by the brain's natural compensation mechanisms. To suppress the sensory input from the malfunctioning ear, the brain decreases the relative function of the brain's reticular activating system (the portion of the brain responsible for “awareness” or the feeling of being “awake” or “clear”) which secondarily increases the activity of the limbic system (the portion of the brain responsible for moods and emotions).
Approximately 12.5 million physician's office visits per year, or five to ten percent of all office visits, are for the complaint of dizziness. A National Institutes of Health study estimates that forty percent of the population over the age of forty have experienced or will experience a “dizziness” disorder during their lifetime. But dizziness affects the young as well. Each year over 450,000 people, mostly young adults, suffer concussions or mild head injuries. Of those requiring short-term hospitalization, a large majority complain of persistent symptoms of dizziness or memory loss.
Unfortunately, many sufferers of dizziness or vertigo disorders do not receive proper diagnosis or therapy. Because the symptoms are vague, and the possible causes multitudinous, sufferers are often improperly diagnosed. Worse, sufferers are often treated as “problem patients” or inappropriately referred to psychiatrists and neurologists.
Athletes in contact and high-impact sports experience a high incidence of vestibular abnormalities caused by mild to severe head injuries. Unfortunately, athletes in professional and even college sports are seldom adequately diagnosed for vestibular abnormalities following a jarring collision, blow to the head, or other minor injury before being sent back onto the playing field.
There are a variety of tests for diagnosing balance disorders of the vestibular system. One test is a hearing test. Balance disorders are often accompanied by problems with hearing especially hearing of low frequencies. Another test is a posturography test, in which a person stands on a moving platform and the movement of the ankles and hips are measured. Posturography tests the vestibular-spinal reflex, which is manifested in the movements various body muscles make to maintain postural balance and coordination. Posturography is useful for detecting disorders in the otolith organs of the ear, because both the somasensatory system and the otoliths detect acceleration (including gravity).
The Vestibular Autorotational Test (VAT®) evaluates the function of the vestibulo-ocular reflex (VOR) by measur
Stewart Kendal L.
Wallace Bridgett D.
Gunn, Lee & Hanor P.C.
Hanor Charles W.
Hindenburg Max
Lee Ted D.
Vestent, L.P.
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