Changes in balance performance in physically active elderly people aged 73-80.

In our hospital in 1989 a series of 30 healthy elderly people participated in a study to evaluate the effect of physical training on improving balance. Thereafter, the majority of the people in this group continued with some kind of balance training. Seven years later we followed up 17 of the people who had participated in the original study. We wanted to evaluate the balance performance of these physically active elderly people (mean age 80.5 years) and compare it with their balance performance 7 years previously. Balance was found to be significantly impaired compared with 1989 in four out of six static balance tests. The time required to walk 30 m had increased significantly. The subjective ratings of vertigo and balance problems had not changed significantly, neither had the number of correct steps when walking forwards on one line and backwards between two lines. In dynamic posturography, the test with sway-referenced visual cues showed improved postural control, but no change in sway was seen in the other five sensory conditions. When sudden backward translations of the platform occurred, increased latencies of force response were seen.

Benign paroxysmal vertigo in childhood: a long-term follow-up.

Benign paroxysmal vertigo in children is characterized by sudden attacks of vertigo lasting seconds or minutes. During the attack, the child has nystagmus and is unable to stand without support. Initially, the attacks are frequent, later slowly disappearing. Nineteen children who were diagnosed in 1975-1981 participated in a follow-up study. Sixteen of them were examined with audiometry and electronystagmography. Age at onset was from 5 months to 8 years, and the symptoms disappeared after 3 months to 8 years. The follow-up was performed 13 to 20 years after diagnosis. Twenty-one percent developed migraine which is somewhat more than in a normal population of this age. Thirty-nine percent had a family history of migraine which is a figure considerably lower than in a migraine population. None still had vertigo or a balance disorder. Our conclusion is that benign paroxysmal vertigo has a favorable outcome, and it is not a general precursor of migraine.

Temperature Order Effects in the Caloric Reaction.

Does it matter in what order the four irrigations are conducted in the caloric test? It has been suggested that warm water (44 degrees C) elicits stronger reactions than does cold water (30 degrees C), which might be explained simply by slight differences in water temperatures. However, if it can be shown that starting with cold water diminishes the difference between the warm and cold irrigations, it might be worthwhile to apply the cold irrigations first. Binaural, bithermal caloric irrigation was conducted in darkness using electrooculography. Maximum slow-phase velocity was measured. One hundred and eighteen consecutive patients from our laboratory were tested with warm water first and then with cold irrigations. In a second run, 108 subjects were irrigated with cold water before the warm. Employing cold irrigations first produces a smaller difference between the warm and the cold irrigations than does the opposite order. However, the lateral and directional preponderances, according to the formulas of Jongkees, are not affected by this change of irrigation order. The fact that initial warm-water irrigations cause the temperature effect differences to be larger than do initial cold-water irrigations is a phenomenon having only marginal clinical implications.

Subjective Visual Horizontal Determination During Otolith Stimulation by Eccentric Rotation in Conservatively Treated Meniere's Disease.

Peripheral vestibular equilibrium disorders may originate in various parts of the labyrinth or of the vestibular nerve. Traditionally, the function of the lateral semicircular canals has been assessed by caloric irrigation and has been interpreted (sometimes falsely) as demonstrating a vestibular nerve lesion. The vertical semicircular canals are not assessed easily. Caloric testing with the head in various positions is not very helpful, but the canals may be tested in pairs using specific rotational techniques. Often, the otolith organs, detecting linear acceleration forces, are forgotten as a source of vertigo and dizziness. The extent of otolith involvement in Meniere's disease is not well understood. The tested subject is seated eccentrically in a rotatory chair and faces the direction of rotation. Thus, the otolith organs are stimulated in steady-state rotation. The subject experiences a lateral tilt and, in darkness, is instructed to point a short light bar in the position that he or she thinks a water surface would have (identical to the perceived tilt). Patients with conservatively treated unilateral Meniere's disease were tested. In the eccentric rotation test, the patients with unilateral Meniere's disease showed highly variable, sometimes even paradoxical, responses. No correlation was noted between the eccentric otolith test and pure-tone audiometry or the side difference of the caloric responses. Otolith and lateral semicircular canal functions may differ in patients with Meniere's disease, the nature of which remains to be elucidated in further studies.