Einiges über die Entwicklung der klinischen Vestibularforschung während der letzten 25 Jahre, besonders bezüglich des Labyrinthfistelsymptoms und des Lagenystagmus

Abstract

The author gives an account of the attributions of Scandinavian investigators to the development of the labyrinth fistula symptom and positional nystagmus during a quarter of a century from 1917. At that time S. H. Mygind discovered the so called carotical fistula symptom, and during the following years Borries added the stasis fistula symptom. The clinical importance of the vascular fistula symptoms, to which the eyes-movements synchroneous with the pulse are included, have been treated in extensive treatises by Nylén 1923 and Lund 1933. The author describes two cases of labyrinth fistula recently operated, where among other things the vessels (V. jugularis, art. carotis) of one side of the neck have been isolated and compressed. The result of the different experiments makes the author accept a unitary theory for all the vascular or vasomotoric phenomena. Systole, as well as compression of the vessels of the neck, and stasis (straining, Bier's stasis, inhalation of amylnitrit) with certain exceptions cause endolymph- and cupular movements towards the labyrinth fistula wall, whereas diastole, decompression of the vessels, and ceasing of stasis give movements from the labyrinth fistula wall. The fact that the fistula wall itself changes its form is supported among other things by the author's experiment with pressure fistula test in the external auditory canal, whereby the carotical fistula phenomenon is prevented in its origin by a pressure of 4–12 cm water and the strainingnystagmus by a pressure of 27–40 cm. All different fistula symptoms by compression and aspiration in the auditory canal and direct pressure on the labyrinth fistula can be explained by the displacement of endolymph and the effect of this on the vestibular contents of the labyrinth, if proper consideration is taken into the pressure, on one hand exercised on the perilymphatic space, on the other on the membraneous labyrinth (Nylén, Wittmaack). Also the details of the anatomical structure of the membraneous semicircular canals are of importance (Werner). Hennebert's reverse fistula symptom by lues hereditaria may depend upon the direct influence of the stapes on the membraneous labyrinth (primarily utriculus) by luetic granulations between the plate of the stapes and the membraneous labyrinth. The complete pseudofistula symptom ofKarlefors-Nylen seems to depend upon the impression of the labyrinth windows by which compression of the perilymphatic space and the membraneous labyrinth occur with inter alia endolymph- and cupulae movements at first towards saccus endolymphaticus, which movements are then reversed. The chapter of positional nystagmus contains the summary of the results published up to this day. The author oompletely shares Meyer's opinion of the great clinical importance of this symptom. Our knowledge of its central mechanism is rather well known, whereas the mechanism of the peripheric positional nystagmus is to a large extent still unknown and obscure. The author classifies the positional nystagmus in three types: 1) Direction changing 2) Direction decided 3) Irregular. They have a different meaning from a local diagnostic point of view. Further clinical and experimental researches are, however, necessary for the explaining of the genesis and clinical importance of positional nystagmus.