Issue N# 2 - 2016
OTONEUROLOGY
Vertebro and cranio veinous sinuses insufficiency pathogenesis and treatment of dizziness vascular theory
Authors : Camicas Van Gout M. (St Martin)
Ref. : Rev Laryngol Otol Rhinol. 2016;137,2:47-51.
Article published in french 
Downloadable PDF document french
Summary :
Introduction: In order to identify and study a plausible etiology of vertigo, we had the idea in 2007 of measuring multi-frequency impedance (clinical audiometry test); A test which provides data about the pressure of intralabyrinthine fluids. The test was performed on healthy subjects in the sitting and supine position, on patients with benign positional paroxysmal vertigo (BPPV) and on patients with Menière's disease. Why in the supine position? Because it is well recognized that the supine position significantly improves vertigo attacks. Material and method: We used the TeflaG III which consists in exploring and evaluating the changes in impedance of the annular ligament of the stapes of the ossicular chain, using a multifrequency impedancemetry. The test is reproduced several times on the same ear. It is done first in a sitting position then in a supine position. In the latter case, it is performed after a resting period of 35 minutes in this position. We mainly focused on the study of the resonance frequency (RF). These tests were performed on 11patients with normal hearing (group 1), 10 BPPV patients (group 2) and 11 patients with Menière’s disease (group 3). Results: In the sitting position, the RF average is: Group 1 (1131 Hz), group 2 (1065 Hz), group 3 (1568 Hz). In the supine position, the RF average is: Group 1 (999 Hz), group 2 (1005 Hz), group 3 (904 Hz). The difference in RF between sitting and supine is: group 1 (average 32 Hz), group 2 (average 60 Hz), group 3 (average 664 Hz) for the 11 Menière's disease patients during an attack. Moreover, after 35 minutes in the supine posi¬tion, the change (decrease in FR), is on average 20 times higher in Menière’s group (664 Hz) than that recorded in normal hearing, which is 32 Hz and 60 Hz for BPPV. Conclusion: The modification of intracranial venous drainage between upright and recumbent posture seems to be important in understanding the improvement of vertigo while lying down. The decrease in the resonance frequency in BPPV and Meniere's disease as reported in this work seems to confirm the close relationship between CSF pressure and vertigo. We propose the theory of Vertebro Cranio Venous insufficiency based on these hydraulic phenomena which could explain these two pathologies. Also, we have changed our diagnostic and therapeutic management which are much more focused on finding a problem (obstacle) at the occipito-cervical level.
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