Its functioning and the assessment of its functional integrity

Giddiness, dizziness, instability and vertigo all indicate a disorder of the balance system. Technically, the balance system is known as the Vestibular system. It is one of the most complicated and rather fragile systems of the body and derangements of the balance system are quite common.

Fortunately most disorders of the balance system are self-limiting and can be adequately managed by the enlightened general practitioner. However, in some cases proper management of vestibular disorders is difficult and these patients require specialized management by a competant and experienced neurotologist. The management of the balance disorder patient is easy, if the clinical tests and investigations point to a specific disorder like BPPV, Vestibular Neuronitis, Meniere's disease, Acoustic Neuroma, Cerebellar abscess etc. Each of these individual diseases have definite and well-defined management protocols, e.g. BPPV is treated by physical therapy, vestibular neuronitis by steroids, anti-viral drugs and B-Complex vitamins along with vestibular sedatives, Meniere's disease by diuretics and dehydrating agents, and acoustic neuroma and cerebellar abscess by surgery. The management becomes difficult when the clinical tests and investigations point to a non-specific vestibular disturbance of unknown etiology, as is usually the case. In such cases,....

Introduction :-
Tinnitus is the perception of sound (s) in the ear (s) / head in the absence of any external or internal auditory stimulation, i.e., without any corresponding mechanical activity in the cochlea. It is now believed to result exclusively from some neural activity within the CNS. This abnormal neural activity in the brain causing the sensation of sound in the absence of any peripheral auditory stimulation, i.e. without any detectable physical sound may be induced by decreased / absent input from the auditory periphery (tinnitus with deafness) or may occur solely due to disorders in the higher auditory pathways without any dysfunction of the peripheral auditory system (tinnitus without deafness). The current consentious on the pathophysiology of tinnitus is that this abnormal perception of sound is caused by some obscure abnormality in the higher auditory pathways in the brain and is intimately linked with stress / anxiety / psychological trauma and various involvements of the limbic system. Tinnitus is now conceptualized as a phantom auditory perception caused by dysfunctional neuronal firing in large neuronal circuits in the brain that also include regions located outside the primary auditory cortex (area 41) particularly in the attentional and limbic systems of the....

It has been found that 5% of all patients going to the general practitioner and 10% of patients going to the ENT specialist or neurotologist suffer from balance disorders. Giddiness / vertigo / instability is one of the most common complaints heard in a doctor's chamber. All of them indicate a disorder of the balance system. Exact figures of prevalence of balance disorder in our country is not available, but the American National Institute of Health Statistics has reported that 42% of the nation's population presents to the doctor's clinic with vertigo / imbalance sometimes in their lives. According to the National Ambulatory medical Care Survey from1991, balance related problems (giddiness - instability) are among the 25 most common causes for which Americans visit the doctor. There is more than 5 million vertigo - instability related visits to the doctor every year in USA. Instability and unsteadiness are very common in old aged persons and the apprehension of falling or losing balance is a very common health concern in people above 65 years of age. The American National Institute of Health Statistics has reported that balance related falls account for 50% of accidental deaths in the population above 65 yrs.....