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A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery
Indexed/Abstracted in: EMBASE, Scopus
Otorinolaringologia 2003 June;53(2):43-54
Proposal of a new classification of vestibular and cervical myofascial systems dysfunctions following whiplash injuries
Armato E. 1, Ferri E. 1, Andreella P. 1, Nicolai C. 2, Ulmer E. 3
1 Unità Operativa Autonoma di Otorinolaringoiatria Ospedale di Dolo, Venezia
2 Specialista in Medicina Legale e delle Assicurazioni in Mestre, Venezia
3 Service ORL, Hôpital Nord, Marsiglia, Francia
Aim. The ever-increasing number of road accidents has resulted in a remarkable increase of forensic medical cases and in the hospitalization of patients for whiplash injuries, therefore arousing interest in both the clinical-instrumental and in the legal-administrative fields. The consequent forensic medical and insurance disputes that regularly arise are closely linked to the quantification of the biological damage involved. Considering the increasing number of unfair and superficial forensic medical assessments, an attempt has been made to draft a protocol of clinical-instrumental study able to represent a real method of objectiveness in assessing the damage done to the system of balance. The aim of the present paper is to propose, within the field of the estimates made by forensic medicine, a new procedure of analysis to assess correctly symptoms of vertigo and possible damage to system of balance: a new analysis of the vestibular system which can identify the real functional alterations by using a series of diagrams correlating clinical-instrumental data and the extent of the post-trauma pathology.
Methods. Since 1992 videonystagmoscopy (VNS) and videonystagmography (VNG) have entered otorhinolaryngology practice and have modified to no small degree the approach to the vestibular syndrome, offering the ORL specialist the chance to conduct studies on the system of balance in an objective and scientific way. Between February 1998 and April 2002 a total of 853 patients with vertigo subsequent to cranial and/or cervical trauma underwent otovestibular study: tonal audiometry, auditory brainstem evoked potentials, clinical and instrumental otovestibulogical examination (bithermal tests, rotatory tests, visuo-oculomotory tests and static stabilometry). Eye movements analysis was performed using the Ulmer videooculographic system.
Results. Of the 853 patients examined, 179 (21%) proved normal while of the remaining 674 (79%) 634 were taken into consideration (40 were excluded because it was not possible to proceed with a correct re-processing of the vestibular test data). The 634 patients were subdivided into 4 groups: 1) 309 patients with monolateral labyrinth deficiency; 2) 162 patients with spontaneous-positional Ny not associated with labyrinth deficiency; 3) 66 patients with directional preponderance not associated with monolateral labyrinth deficiency (at calory testing) nor with spontaneous-positional Nnyy at physical examination; 4) 97 patients presenting changes on visuo-oculomotor testing compatible with a central disturbance of oculomotricity or with interference of the cervical structures on reflex oculomotricity.
Conclusions. To represent each of the 3 categories of dysfunctions of the balance system, 3 different diagrams were realised grouping functional alterations defined by the diagnostic-instrumental tests.