Dizziness-and-Balance Site Movies and DVD

Timothy C. Hain, MD Page last modified: June 18, 2009 . The latest version of the Site DVD was created in June, 2009

http://www.dizziness-and-balance.com is a large graphics rich site, best viewed on a fast connection. At this writing, there are approximately 1800 files, 500 pages, 75 anatomic or disease related images, and about 40 movies.

BPPV related movies include:

1. Posterior canal (PC) BPPV
   1. bppv.avi (nystagmus of PC BPPV live, 13M)
   2. bppv dix-hallpike.avi (dix-hallpike maneuver live, 44M)
   3. Brandt-Daroff.mpg (home treatment of PC BPPV, 17M)
   4. Semont.avi (treatment maneuver for PC BPPV, 13M)
   5. Hallpike-Dix.avi (diagnostic maneuver for PC BPPV, 47M)
   6. Epley.avi (treatment maneuver for PC BPPV, 53M)
   7. Debris-Redistribution.gif (canalithiasis mechanism, 1.8M)
2. Lateral Canal (LC) BPPV
   1. lateral canal short.avi (Lateral canal BPPV, geotropic variant 20M)
   2. lateral canal BPPV ageotrophic variant (7.53M)
   3. log roll2.avi (home treatment for lateral canal BPPV, 20M)
3. Anterior Canal BPPV (AC)
   1. acbbpv-short.avi (Anterior canal BPPV nystagmus, 10M)
4. Cervical Vertigo
   1. disk disease (30 meg, 1.5 min video)
   2. vat.avi -- vertebrobasilar insufficiency, 10M) Description of VBI case

Meniere's disease and Vestibular neuritis movies include:

1. Menieres.mpg (55 Meg)
2. vnsmall.avi (12 meg). Vestibular neuritis.
3. itg.avi (8 meg) -- nystagmus after intratympanic gentamicin

Bilateral Vestibular loss and Gentamicin Ototoxicity

1. bilatfuncloss.avi (15 Meg) (simulation of oscillopsia -- abstracted from Understanding your Dizziness and Balance DVD)

Congenital Nystagmus

1. Jerk type congenital nystagmus with and without fixation (both avi files, about 5 meg each). Note that these were mislabelled on the previous DVD.
2. PAN type congenital nystagmus (8 meg)
3. latent.avi (Latent nystagmus, 10 meg)
4. Torsional CN (fixation only, 15 meg)

Examination results for unilateral vestibular loss:

1. vibration acoustic.avi (7 meg). Demonstration of vibration induced nystagmus in person with unilateral vestibular loss
2. head-shaking nystagmus (61 meg). Demonstration of head-shaking nystagmus in person post-gentamicin injection for Meniere's disease.

Pressure sensitivity and related conditions -- these mainly show torsional nystagmus induced by pressure in SCD, but there is also an example of horizontal nystagmus in a patient who had fenestration of the horizontal canal (an old operation for otosclerosis).

1. tullio.avi (strong nystagmus elicited by sound -- superior canal dehiscence, 33 meg)
2. tullio L SCD.avi (very subtle torsional nystagmus elicited by sound -- superior canal dehiscence, 11 meg)
3. pressure.avi (nystagmus elicited by pressure -- fistula, 49 meg)
4. Valsalva L SCD.avi (Valsalva induced ocular torsion in superior canal dehiscence, 51 meg )
5. Valsalva Fenestration.avi (Valsalva induced horizontal nystagmus in patient post fenestration surgery, 13.730 meg)

Central nystagmus and condition (other than those above) include:

1. Alexanders law.avi (Alexander's law, 12 meg)
2. downbeating.avi (6 meg) -- see also the paraneoplastic nystagmus movie
3. Internuclear ophthalmoplegia in MS (10 meg)
4. upbeating.mpg (10 meg)
5. torsional nystagmus.avi (7 meg)
6. rebound bm.avi (Rebound nystagmus, 44 meg)
7. Saccadic nystagmus
   1. Voluntary nystagmus (30 meg, 10 second video -- high video resolution and speed is absolutely necessary to see VN)
   2. Opsoclonus (12 meg, 30 second)
   3. Square wave jerks (5meg)
   4. Macro square wave jerks (paraneoplastic).
8. Pendular nystagmus in oculopalatal myoclonus (6 meg)
9. Paraneoplastic cerebellar degeneration -- downbeating nystagmus in lateral gaze (8 meg)
10. Slow vertical saccades in PSP.
    1. Slow vertical saccades in patient with PSP (10 meg)
    2. Another example of slow vertical saccades in PSP (15 meg)
11. Global saccadic paresis in Kearn Sayre syndrome. (peo2.avi -- 3 meg)
12. Saccadic dysmetria (10 meg)
13. Superior oblique myokymia (SOM, 1 meg)

Cranial nerve palsies

1. Sixth nerve palsy
2. Bells phenomenon (8 meg). Video Frenzel goggles can easily show the characteristic up rolling of the eyes that occurs in peripheral facial nerve palsy (Bell's palsy).

Basic physiology/Anatomy animations (this section is under construction) include:

1. Hearing animation.gif
2. Middle-Ear-Pressure.gif
3. Outer-middle-inner-ear.gif
4. Vestibular nerve.gif
5. Vestibule and canals.gif

Miscellaneous movies

1. Palatal myoclonus of throat (not eye). For eye see "pendular nystagmus in oculopalatal myoclonus" above.
   1. pm_gb.avi (14 meg)
   2. pm.avi (6 meg)
2. hvt small.avi (15 meg) Hyperventilation induced nystagmus in person with left sided acoustic neuroma. This is a rather long (1.5 minute) clip.
3. Spinal fluid in ear ventilation tube (1.5 meg). This short movie is courtesy of Dr. Richard Wiet. It shows spinal fluid from a leak into the middle ear, pulsating in a PE tube. It is very dramatic.
4. Rotatory Chair in motion.

Other interesting content:

1. Audio recording of stapedius myoclonus. This type of tinnitus can be also heard by the examiner (as long as you put your ear close to the patient's ear).

"mpg" and "avi" files are digitized movies of eye movements or treatment procedures. Most of them are 320/240 in size, some are larger, and intended for slide presentations. Some "avi" files are cartoon like animations. The "gif" files are large animated gifs. Outside links on the site (there are not very many) will work if you are connected to the internet.

The "search" function on the DVD will work similarly on the internet, but it requires javascript to be enabled on your web browser. Occasionally the site will contain a movie not on the site-DVD master, because we make new master-DVD's roughly once every 6 months.

SITE DVD

Site DVD.

As of 1/2009, the site contained 1,812 files and occupied 1.5 gigabytes. If you don't have a fast connection, or would just like to browse the site at your leisure, or keep it around as insurance that it doesn't disappear, we can mail you a DVD containing a "snapshot" of the site (www.dizziness-and-balance.com) as of 1/2009. The DVD+ media (PC format, not MAC) includes everything on the site, html code, graphics, etc, as well as some extras not on the site (mainly some large files).

Movies display MUCH faster on the DVD than over the web. We update the DVD every 6 months -- and sell about 10 of these every month. DVD's are burned and sent out next working day.

The DVD includes some large movies (greater than 10 meg). Many are related to BPPV including the Epley maneuver and others -- many of these movies are impractical to view on the internet because of their size. You will need the relevant plug ins to view movies on your browser -- Windows Media Player will do most, and Quicktime will do the rest. These are indicated by a graphic

Most of these movies are compressed with the Cinepack codec. For details about how I am presently doing this using a commercial digital video recorder and readily available GPL software, see here.

The DVD should autoplay. If for some reason this doesn't work for you, another method is to click on "\autorunpro.exe". You can also browse to "\dizziness-and-balance.com\index.html" on the DVD, just as you would do on the web. You can also just copy the DVD directory "\dizziness-and-balance.com" to your hard-drive, and everything should still work. If you don't copy the whole thing, things probably won't work, as you will be missing some pieces. To my knowledge, there is no virus or spy software on this product. I check everything with antivirus software.

We charge $30 for this service.

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Legal stuff:

The intent of this distribution is to disseminate information about otoneurology. Dr. Hain does retain the copyright to this material. However, we do want you to use it. Noncommercial use of graphics and movies is permitted and encouraged (with attribution to the source). In other words -- you do not need to contact me to use this material in your lecture !

Please attribute the source by providing the address of the webpage from which the image was abstracted, and the date downloaded or of this distribution.

On the other hand, purchase of this DVD or downloading copyrighted pages, graphics or movies does not automatically entitle the purchaser to use material or graphics commercially, or as part of their practice marketing material (without separate permission). In general though, we permit this use with attribution to the source.