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

1. Ménière's disease (MD) is a vestibular disorder characterized by vertigo, sensorineural hearing loss, and fluctuating aural symptoms.

2. Traditional treatments for MD include pharmacotherapy, physical therapy, intratympanic pharmacotherapy, and surgery, but there is no definitive cure.

3. Many MD patients in the Netherlands and Belgium have been using weak asymmetric base-in prisms (WABIPs) as a complementary treatment for over 70 years, with reported positive results.

4. The article aims to provide a possible explanation for the effectiveness of WABIPs based on existing knowledge.

5. The proposed mechanism for WABIPs' effectiveness is related to their ability to address the star-like walking pattern in MD, induced by a drifting after-image similar to the oculogyral illusion.

6. WABIPs may eliminate the conflict between a net vestibular angular velocity bias in the efferent signal controlling the VOR (vestibulo-ocular reflex) and a net re-afferent ocular signal.

7. The article highlights the simplicity, low cost, and social acceptability of WABIP treatment and suggests further exploration of this approach.

8. The article provides background information on MD diagnosis, epidemiology, pathology, and current treatment options.

9. It mentions the placebo effect's role in MD treatment and how some treatments may have a placebo component.

10. The article describes the characteristics of WABIPs, including their prism power, asymmetric distribution, and inward base positioning.

11. The extended Utermöhlen test (EUT) is discussed as a method for determining the appropriate prescription of WABIPs.

12. The EUT involves walking with eyes open toward a luminous line, creating a retinal after-image, and then walking back and forth with closed eyes.

13. The article includes diagrams illustrating the walking patterns of MD patients in the EUT and the potential effect of WABIPs on these patterns.

14. It suggests that WABIPs may help straighten the walking pattern of MD patients and prevent the drift of the after-image.