Vestibular function assessment in patients with Meniere's disease: the vestibulospinal system

The state-of-the-art approach to clinical assessment of vestibular disturbances includes a number of procedures in which it is assumed that the status of major vestibular pathways is quantified independently from converging somatosensory and visual influences. Although it has been known for some time that this approach has limitations in a highly integrative system in which inputs from a number of sensory modalities interact, a practical remedy has been only recently forthcoming. Using an approach to assessment of the vestibulospinal system developed by Nashner, the application of moving platform techniques has been the first to systematically identify the interactions among vestibular, visual, and proprioceptive senses and determine the role of vestibular losses in the process of postural control. A group of Meniere's disease patients were studied in order to determine whether or not such tests could be used as an effective vestibular screening method for Meniere's disease patients in remission, and whether the ability of Meniere's disease patients to use vision and proprioception to compensate for their vestibular disorders, could be assessed. Results indicated that quantitative evaluation of the vestibulospinal system was a very effective vestibular screening test. Furthermore, the adaptive ability of the subject can be estimated by varying the amounts of visual and proprioceptive vestibular information available to the patient for the control of postural sway. Preliminary results indicate that such a technique would be of great value clinically for the initial and on-going evaluation of patients with Meniere's disease and for pre and post-therapeutic evaluation of the Meniere's disease patient.