Charles Skinner Hallpike and the beginnings of neurotology

Although the symptom of vertigo had been well-recognized for several thousand years, it was not until the pioneering work of Prosper Ménière in the mid-19th century that it was appreciated that vertigo could originate from damage to the inner ear. Before that time, patients with vertigo (regardless of the cause) were said to have "cerebral congestion," a condition resulting from excessive blood filling the brain. Bloodletting and leeches to relieve the congestion were the treatment of choice. The discovery of endolymphatic hydrops in temporal bone specimens from patients with Ménière's disease by Hallpike and Cairns in 1938 marked the beginning of modern neurotology. For the first time, vertigo was correlated with specific pathophysiology. Propelled by his temporal bone work, Charles Hallpike received an appointment at the National Hospital at Queen Square, where he developed an internationally renowned neurotology clinic. His bithermal caloric test and positional tests are still routinely used in evaluation of the vertiginous patient.