The vestibular system has long been the “poor relation” of the inner ear and its central pathways. Compared with its auditory neighbour it has been little understood, has generated little for the enthusiastic operating surgeon and was associated with remarkably ineffective medication. This book nicely illustrates how that has changed with its chapters on recent advances in vestibular implants, third window syndromes and disorders unrecognised a decade or two ago.
It is an international multi-author work of 16 chapters, from which I would highlight “Tests to Evaluate the Vestibular System”, “Vestibular Implants” and the chapters on vestibular disorders in youth and advanced years. “Tests to Evaluate the Vestibular System” opens with a very practical account of every conceivable bedside or office test and its value. Then follows the clever technology, looking at eye movements and nystagmus, neck muscles’ responses to sound and the challenge of the wobbly platform. All very familiar but, again, the value here is the description of the relevance and utility of such investigations.
The chapter titled “Menière's Disease” is typical of the content in carrying no fewer than 160 references, suggestions for further reading and even a self-assessment quiz (modesty forbids revealing my score but, in truth, it was not too difficult). In the chapter “Vestibular Neuritis” I was pleased to see the authors concede that it was unclear “whether inflammation of the nerve is the cause of this disorder” but was daunted by the suggested title change to Acute Unilateral Peripheral Vestibulopathy which, even as AUPVP, is a mouthful. A magnetic resonance imaging scan demonstrating nerve enhancement was impressive and something I have not seen before. The earliest descriptions of Third Window Syndromes, in the late 1990s, were met with scepticism and likened to the tale of “The Emperor's New Clothes.” The pioneering work of LB Minor (a co-author of this chapter) transformed our understanding, and I was encouraged to see many a reference to articles published in this journal.
There then follows a particularly well-illustrated chapter showing the various manoeuvres involved in the diagnosis and management of positional vertigo. That skill would be invaluable in primary care and in many a specialist medical discipline. Much of the content is then repeated in “Vestibular Rehabilitation; a Patient-Centered (even if they do spell it differently over the Pond) Approach”. If anything, the now-in-colour illustrations are even better. “Vestibular Migraine” is only relatively recently recognised and indeed “Persistent Postural-Perceptual Dizziness” only surfaced as a diagnostic term in 2017. Both chapters are excellent on differential diagnosis and potential treatments, with much-updated references (inevitably of course for the latter condition).
Enough of just listing the content. The message is, I hope, that this text has a relevance to any in otolaryngology, whether trainee or senior or even an advanced neurotologist. There is very practical advice for the physiotherapist involved in rehabilitation, for the geriatrician or for the neurologist, seeking to distinguish vestibular neuritis (or persistent postural-perceptual dizziness) from a brainstem stroke. But a personal favourite remains the section on balance testing in the office, with no technologic help. To the examination candidates, do recall that finding a patient with physical signs can be challenging and, in their absence, that this long-retired examiner often resorted to asking, “Can you show me how you would test this patient's balance in the clinic?” It should remain an important subject for those finals, so this book should be welcome in any postgraduate library.
