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Clinical neurophysiology of the vestibular system, 3rd edition
  1. G M Halmagyi

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    Edited by R.W. Baloh and V. Honrubia (Pp 408, US$98.50). Published by Oxford University Press, New York, 2001. ISBN 0-19-513982-8.

    The first edition of Clinical neurophysiology of the vestibular system, published in 1979, had a significance beyond its content: it affirmed that neurology had a stake in the vestibular system. Here was a neurologist (Baloh) writing with an otolaryngologist (Honrubia) about semicircular canals, endolymph, audiograms, and above all the vestibulo-ocular reflex—the “VOR”. The VOR is no ordinary reflex; one can measure accurately both its input and its output and come up with a transfer function for gain—a new concept then for neurology. We have learnt a lot more about measurement of vestibular function and about disorders of the vestibular system since 1979. The 2nd edition, published in 1990, and now the third edition, incorporate these advances.

    And what a terrific book it still is: based on concepts, packed with facts, lucidly written, and rigorously referenced. Its structure is logical and its language is clear, so that it is not only easy to search and browse but a pleasure to read from cover to cover. And it is comprehensive—no vestibular stone is left unturned.

    There are four main parts, dealing in turn with: the structure and function of the vestibular system (four chapters); the clinical and laboratory evaluation of the dizzy patient (four chapters); specific diseases affecting the vestibular system (10 chapters); and the treatment of vertigo and vestibular loss (two, yes only two, chapters—but then that’s neurology for you).

    It’s impossible to single out any one chapter, they are all outstanding. For example, I particularly liked the new material in chapter one on the phylogeny of the vestibular system. Now one would have to admit that familiarity with the otocyst of the sea anemone is not a lot of use in the consulting room, but this section is so clearly written and matter so interestingly explained that one happily dispenses with such utilitarian demands.

    The great strength of the book and what has made it such a classic, is that although it is based on physiology, full comprehension of physiology is not a prerequisite for retrieving useful information from the disease based chapters. Although the structure is there, one can put this aside and simply delve. The chapters on the three most common vestibular diseases, benign positional vertigo, migraine, and Meniere’s diseases, are absolute gems. Each could be published as a self-contained review in its own right.

    The book is an elegant conceptual and factual account of the vestibular system, its disorders and diseases, rather than a self-help or how I do it manual. Some readers might miss not having, a “frequently asked clinical questions” section, or at least a “frequently encountered clinical pitfalls” section, but then no one can have it all. Anyone who sees dizzy patients needs one dizzy book on the desk. This is the one I have on mine.

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