Vertigo and Disequilibrium: A Practical Guide to Diagnosis and Management (2nd ed)

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Review by L Flood
Middlesborough, UK

I well recall the first edition from 2008 and, even more,the videos that then came on a disc. They concentrated on ultra close up filming of eye movements, and especially nystagmus, that could upset any observer with a challenged sense of equilibrium!

I have gone through the two editions, page by page, and the immediate impression is how dated the first now seems. It is the print style, the cover design (that I lamented for months after it was changed by Thieme) and the difference that the addition of some colour illustrations makes. The book has only expanded from 174 to 225 pages, but seems a much more robust tome. This is indispensable in any ENT library, but I wanted to see if those who still have the first edition would find enough new to warrant further expenditure. The answer is a very definite ... maybe.

The Introduction promises us ‘outstanding modifications and additions’, and there are some novelties indeed. We are told that the references are expanded. There is (indeed) a new chapter on ‘Implantable Vestibular Devices’ and a new feature to close, an appendix of ‘Frequently Answered Questions’. In practice, the 20 questions posed are word for word from the first edition, as alas are the answers, after a decade of medical progress.

In the first edition, history and physical examination, so fundamental to assessment, was dismissed in just 2.5 pages, followed by no fewer than 11 pages on computerised vestibular testing. There is now much better coverage of the face-to-face consultation and basic clinical testing. Sure enough, the wonders of the vestibular laboratory then follow, but totally rewritten and with colour illustrations that transform it. I will forgive the change to chapter titles talking of ‘The Vestibular Patient’. ‘Imaging’ is largely unchanged, other than the addition of some advances in magnetic resonance imaging sequences, with acronyms that baffle me, but which produce nice images. The illustrations were always good, but they seem slightly sharper with greater contrast now.

Many chapters have had some changes to authorship,but few changes to the text. I read 10 pages of ‘Anatomy and Physiology’ before noticing that ‘because’ had become ‘since’. Indeed, the only change was two short paragraphs on vestibular-evoked myogenic potentials. Many chapters do now close with some self-assessment questions, to make sure one is paying attention.

‘Laboratory Testing’ has changed little. Of 22 references, only 6 are post-2008. ‘Ménière’s Disease’ has the same author, but has totally updated text, including discussion of the latest advances in imaging. I remain just as unconvinced by the computed tomography scan of a narrow vestibular aqueduct, however (but then I never believed our newly appointed consultant when he told me of this canal dehiscence idea). A chapter on positional vertigo does not have a single change to text or tables. In contrast, an original chapter that concentrated on black and white photographs of an unfortunate being thrown across an exam couch, at every possible angle, has now been dropped and shifted to the online videos. Instead, there is a far more readable account of the pathology and management. ‘Labyrinthitis’ is reproduced word for word, other than dropping the tautology of ‘inflammatory labyrinthitis’. ‘Allergy and Autoimmune Dizziness’ is an entirely new chapter. ‘Balance Disorders of Aging’ is totally rewritten, well written too, but oddly even briefer than the original. ‘Congenital Disorders’ was just an atlas of radiological abnormalities, but is now excellent at describing the assessment of balance disorders in the very young. ‘Migraine’ is totally rewritten, in contrast to ‘Rare Causes of Peripheral Vestibulopathy’, where a decade has clearly seen nothing new ( just possibly because they are indeed so rare?), the only change being a single alteration in the order of coverage.

The book closes with chapters on therapy, including medication, rehabilitation, and the promised new and very well updated chapter ‘Devices within the Vestibular System’.

In itself, the second edition is indeed an excellent practical guide, as its title claims. Curiously, the Introduction almost understates the novelty, for those who already have the first edition. Whole chapters are reproduced without one single change in text; others are indeed totally rewritten or represent whole new concepts. I will finally concede that the new cover style is far better. The first edition now seems a highly nostalgic museum piece.

Amazon Link: Vertigo and Disequilibrium: A Practical Guide to Diagnosis and Management (2nd ed)
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