Pl Ghilardi

Alternobaric and Hyperbaric Oxygen Therapy in the Immediate and Long-term Treatment of Meniere's Disease

Forty-five patients suffering from Menières disease were submitted to pressure chamber therapy: 20 with constant pressure (2.2 ATA, hyperbaric treatment) and 25 with continuous variations in pressure levels (from 1.7 to 2.2 ATA, alternobaric treatment). Oxygenation therapy consisted of one session per day lasting 90 minutes for 15 days during the acute attacks followed by five consecutive sessions per month during a follow-up of two years. For a control group we used 18 patients treated with 10 per cent intravenous glycerol during the acute episode and 8 mg tid of betahistine thereafter. We compared hearing loss, vertigo and tinnitus in the three groups 15 days after starting treatment and at the end of the follow-up, according to the criteria suggested by the 1995 Committee on Hearing and Equilibrium. We found no statistically significant differences in recovery from the cochlear-vestibular symptoms in the three groups at the end of the first 15 days of therapy, whereas hyperbaric and, in particular, alternobaric treatment permitted a significant control of the principal attacks of vertigo during the follow-up period. Hearing loss also showed a more significant and more persistent improvement in the patients treated with alternobaric oxygenation compared to the patients in the other two groups.

Static Posturography and Whiplash

The quiet upright position (Stance) is controlled by three distinct sensorial cues organs: visual, somatosensorial (from skin and pressure sensors in the feet) and vestibular (mainly from otolithic maculae).

Acupuncture and Chinese Medicine: Equilibrium Disorders

Acupuncture [1] may be considered a valid and efficacious tool in the treatment of cervically originated vertigo, since it intervenes on a known physiopathological substrate [2]. It exerts its function through the activation of the transducers in the skin and in the surface and deep muscles in the neck, which are capable of affecting the vestibulospinal reflex arc [3, 4].

Acupuncture and Neuroreflexology

Acupuncture [26] may be considered a valid and efficacious tool in the treatment of cervically originated vertigo since it intervenes on a known physiopathological substrate [7]. It exerts its function through the activation of the transducers in the skin and in the surface and deep muscles in the neck, which are capable of affecting the vestibulo-spinal reflex arc [5, 27]. It is well known, in fact, that vestibulo-spinal reflexes play a fundamentally important role in the maintenance of posture [1]. Experiments on animals have shown that the neurons of the lateral reticular nucleus (LRN), the bulbar relay station of the ascending somatosensorial pathway, are responsive to lateral tilting [15]. The response of these LRN neurons to head tilting does not appear to depend on either peripheral proprioception or skin feedback. While the LRN can receive signals from the macular receptors directly through Deiter’s lateral vestibular nucleus (LVN), responses to tilting can be also mediated, to a certain extent, by an indirect influence of the lateral vestibulo-spinal tract on the ascending neurons of the reticulo-spinal pathway [4]. It has already been demonstrated that the lateral vestibulo-spinal tract stimulates the extensor motoneurons of the lower limb muscles in a monosynaptic manner, whereas the descending fibers in the ventral quadrant, including those in the lateral vestibulo-spinal tract, are capable of exerting a monosynaptic stimulus in the neurons with ascending axons in the ventrolateral cord.