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Treatment of vestibular disorders with weak asymmetric base-in prisms: An hypothesis with a focus on Ménière's disease

Author: Bos, J.E. · Lubeck, A.J.A. · Vente, P.E.M.
Source:Journal of Vestibular Research: Equilibrium and Orientation, 5-6, 27, 251-263
Identifier: 810164
doi: doi:10.3233/VES-170630
Keywords: Psychology · After-image · Efference · Ménière's disease · Oculogyral illusion · Prisms · Re-afference · Star-walk · Treatment


BACKGROUND: Regular treatments of Ménière's disease (MD) vary largely, and no single satisfactory treatment exists. A complementary treatment popular among Dutch and Belgian patients involves eyeglasses with weak asymmetric base-in prisms, with a perceived high success rate. An explanatory mechanism is, however, lacking. OBJECTIVE: To speculate on a working mechanism explaining an effectiveness of weak asymmetric base-in prims in MD, based on available knowledge. METHODS: After describing the way these prisms are prescribed using a walking test and its effect reported on, we give an explanation of its underlying mechanism, based on the literature. RESULTS: The presumed effect can be explained by considering the typical star-like walking pattern in MD, induced by a drifting after-image comparable to the oculogyral illusion. Weak asymmetric base-in prisms can furthermore eliminate the conflict between a net vestibular angular velocity bias in the efferent signal controlling the VOR, and a net re-afferent ocular signal. CONCLUSIONS: The positive findings with these glasses reported on, the fact that the treatment itself is simple, low-cost, and socially acceptable, and the fact that an explanation is at hand, speak in favour of elaborating further on this treatment. © 2017 - IOS Press and the authors. All rights reserved.