Vertigo: Five Physician Scientists and the Quest for a Cure

Benign paroxysmal positional vertigo (BPPV), the most common cause of vertigo, affects one in five people at some point during their lifetime, triggering the sudden feeling like one is moving or spinning when perfectly still. Early pieces of this medical puzzle appeared in the early 19th century in studies of the inner ear, yet the cause and cure for BPPV was not clearly understood until the late 20th century and it took a few more decades before this simple cure was accepted. Vertigo: Five Physician Scientists and the Quest for a Cure follows this centuries long trek. The book follows the key discoveries made by Prosper Meniere (1799-1862) who first recognized that vertigo could originate from the inner ear, Josef Breuer (1842-1925) who conducted groundbreaking research on the inner ear during his evenings at home after he spent his days working in a busy private medical practice, Robert Barany (1876-1936) who received the Nobel Prize for his early work on the inner ear, Charles Hallpike (1900-1979) who showed that BPPV originates from the inner ear, and Harold Schuknecht (1917-1996) who provided key observations on the mechanism of BPPV. Dr. Robert W. Baloh spins together a fascinating history using detailed interviews from those close to the key investigators and historical documents previously unavailable in the English language to provide a historical approach to understanding the vestibular system and with it a better understanding of vertigo itself.

Table of Contents:
Preface Acknowledgments Chapter 1. Introduction The Inner Ear Dizziness, Vertigo and the Inner Ear What is Benign Paroxysmal Positional Vertigo (BPPV)? So Who Discovered the Cure? Section 1: Prosper Ménière (1799-1862) Chapter 2. Ménière recognizes that vertigo can originate from the inner ear What was known about the inner ear in the mid 19th century? First hint that the semicircular canals may be related to balance Ménière presents his findings in 1861 The first recorded case of Ménière's disease? More evidence that vertigo can originate for the inner ear Inconsistencies in Ménière's description of the young girl with vertigo Treatments for vertigo in mid 19th century Ménière 's comments trigger heated debate Chapter 3. Ménière, a man of many interests Ménière's academic career Ménière balances academic, patient and family activities Ménière's every day life Ménière's role in French society Section 2: Josef Breuer (1842-1925) Chapter 4. Breuer discovers how the balance portion of the inner ear works Eye movements and the semicircular canals The gravity sensing otolith organs Evolutionary development of the inner ear Mach and his psychophysical experiments Breuer and Mach work together to defend their theory Crum-Brown, the model maker Who contributed most to our current understanding of the vestibular system? Chapter 5. Breuer, the Renaissance man Upbringing and formative years Breuer's medical training Breuer chooses private practice over academic medicine Breuer, the family doctor Chapter 6. Breuer's experiments on the semicircular canals and otolith organs Studies on the semicircular canals Ewald's laws The Breuer-Von Cyon feud Studies on the otolith organs Overview of the inner ear sensory receptors Chapter 7. Breuer's contributions to psychiatry and philosophy Freud's early work in neuroanatomy Anna O. and the beginnings of psychoanalysis Breuer and Freud and "Studies in Hysteria" The friendship between Breuer and Freud dissolves Breuer's philosophical beliefs The final years Section 3: Robert Bárány (1876-1936) Chapter 8. Politzer's otology clinic and the discovery of the caloric test Politzer maneuver Teaching in Politzer's clinic Robert Bárány joins Politzer's clinic Bárány discovers the caloric test Chapter 9. Bárány's formative years and the conflict in Politzer's clinic Bárány's medical training Source of conflict in Politzer's clinic Accusations against Barany Chapter 10. The war years and Bárány's decision to leave Vienna Bárány receives the 1914 Nobel Prize in Medicine Formal charges against Bárány Nobel committee response Questions regarding Bárány's caloric theory Chapter 11. Bárány 's test battery and the first description of BPPV Romberg test Pastpointing test Bárány's syndrome First description of benign paroxysmal positional vertigo (BPPV) Chapter 12. Bárány 's life in Uppsala and his work with Lorente de Nó The brain and the neuronal theory Lorente de Nó and Bárány in Spain Lorente de Nó works on central vestibular pathways with Bárány Bárány's final years Section 4: Charles Hallpike (1900-1979) Chapter 13. Hallpike and the pathology of Ménière's disease Toynebee and early efforts to study pathology of the inner ear Wittmaack and his new technique for preparing temporal bones World-wide interest in Wittmaack's technique Hallpike and Cairns report on the pathology of Ménière 's syndrome Possible causes of Ménière's syndrome Yamakawa also describes the pathology of Ménière's syndrome Chapter 14. Hallpike's formative years The Indian connection Early education and dealing with Legg-Perthes disease Medical training Personal life Hallpike the inventor Appointment at Queen Square Hallpike's colleagues at Queen Square War years Queen Square neurotology clinic Chapter 15. Hallpike's caloric test Preparing the water Hallpike's caloric chart Meaning of a Directional Preponderance Importance of tonic signals originating from the inner ears Controversy regarding the affect of cortical lesions Chapter 16. Hallpike defines the syndrome of BPPV Clinical features of BPPV Confusion regarding the direction of the positional nystagmus Strong evidence for an inner ear origin Pathology of BPPV Final years Section 5: Harold Schuknecht (1917-1996) Chapter 17. Schuknecht and his breakthrough on BPPV John Lindsay and University of Chicago otology clinic Schuknecht begins his residency at the University of Chicago Schuknecht's formative years Schuknecht becomes interested in BPPV Search for the cause of BPPV Schuknecht suggests a new mechanism for BPPV Chapter 18. Schuknecht's temporal bone bank in Boston More temporal bone specimens from patients with BPPV The cupulolithiasis theory Schuknecht was not the first to propose the cupulolithiasis theory A key question-which way does the cupula deviate? How to explain the stereotypical nystagmus Problems with the cupulolithiais theory Chapter 19. Schuknecht's crusade against myths in otology Surgical treatments of Ménière's disease Viral neurolabyrinthitis Questionable surgical procedures The final years Section 6: The pieces of the puzzle come together Chapter 20. Semont and Epley maneuvers Treatments based on the cupulolithiasis theory Semont's maneuver Cupulolithiasis vs. canalithiasis Epley 's maneuver Visualization of the free floating otolith debri Chapter 21. Evolution of treatment maneuvers for BPPV Epley's maneuver Semont's maneuver Features shared by the maneuvers Variations on the theme Horizontal canal BPPV Chapter 22. Summary and Future Directions Difficulties facing early investigators Unanswered questions Can patients do the maneuvers on their own? Glossary

About the Author :
Robert W. Baloh, MD is a professor of Neurology and Head and Neck Surgery at UCLA who has written more than 300 research articles and several textbooks focusing on the vestibular system. His interest in the history of Neurotology dates back to a series of conversations with Raphael Lorente de Nó in the early 1970s.

Review :
"I read this book from cover to cover and found it engaging, enlightening and inspiring. It has many revealing vignettes about the personal lives of the giants in neuro-otology whose eponymous names we all recognize. Bob Baloh's story illustrates how science, and especially medicine, moves forwards, sideways, backwards and then often belatedly, forwards again. And the book points out, as always, the human failings of even our most brilliant scientific heroes; jealousy, selective memory, and an unwillingness to give up one's own theories in the face of incontrovertible opposing evidence. Lessons for us all." -David S. Zee, MD, Professor, Neuro-Visual & Vestibular Division, Departments of Neurology, Ophthalmology, Otolaryngology-Head and Neck Surgery, and Neuroscience, The Johns Hopkins Hospital, Baltimore, MD "A riveting account by one of the giants in the field, of how clinician-scientists, have managed over the last century to unravel the secrets of the 6th sense, the sense of motion and to apply their findings to the treatment of balance disorders to give relief to those suffering from terrifying vertigo attacks. Full of fascinating information for both patients and professionals - a must read." -Michael Halmagyi, BSC, MBBS, MD, Royal Prince Alfred Hospital, Sydney, Australia "A fascinating story of scientific discovery. Mysterious and disabling spinning sensations, psychoanalysis, pigeons, the Nobel prize, imprisonment in Russia, exile to Sweden, bouncing eyes, ear stones, and a simple but elusive cure. Dr. Baloh, a giant in the field himself, tells the story like no one else could." -Kevin Kerber, MD, Department of Neurology, University of Michigan, Ann Arbor, MI "The sense of balance was one of the first sensory systems to emerge in evolution, but it was also the last to be discovered. In his remarkable book Vertigo - Five Physician Scientists and the Quest for a Cure Robert W. Baloh transports the reader back to the early days of vestibular discoveries, exemplified by five eminent figures in the history of neurotology. Dr. Baloh brings to life the colourful personalities that deepened our understanding of the balance system and paved the way for current vestibular diagnostics and treatment. This meticulously researched book, written by an eminent specialist in the field, will make a significant contribution to the history of vestibular science." -Gerald Wiest, MD, Professor of Neurology, Medical University Vienna, Vienna, Austria