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HANDBOOK OF CLINICAL
NEUROLOGY
Series Editors
VOLUME 137
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vi AVAILABLE TITLES (Continued)
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Vol. 127, Traumatic brain injury Part I, J.H. Grafman and A.M. Salazar, eds. ISBN 9780444528926
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Vol. 129, The human auditory system: Fundamental organization and clinical disorders, G.G. Celesia
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Vol. 131, Occupational neurology, M. Lotti and M.L. Bleecker, eds. ISBN 9780444626271
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Vol. 134, Gliomas, M.S. Berger and M. Weller, eds. ISBN 9780128029978
Vol. 135, Neuroimaging Part I, J.C. Masdeu and R.G. González, eds. ISBN 9780444534859
Vol. 136, Neuroimaging Part II, J.C. Masdeu and R.G. González, eds. ISBN 9780444534866
Foreword
This is the first volume in the Handbook of Clinical Neurology series devoted entirely to neuro-otology, a relatively
young branch of clinical medicine that studies and treats neurologic disorders of the ear, eighth cranial nerve, and asso-
ciated central pathways, leading to symptoms such as vertigo, dizziness, and hearing disorders.
Herman Kingma and Raymond van de Berg start their chapter on the anatomy, physiology, and physics of the
peripheral vestibular system by quoting Wilson and Melvill-Jones’ preface to the famous book, Mammalian Vestibular
Physiology (1979): “It is easy to underrate the importance of a sensory system whose receptor is buried deep within the
skull and of whose performance we are usually not aware”. After reading this neuro-otology volume, it is no longer
possible to deny the importance of this complex system for our normal daily activities and the great impact of uni- or
bilateral vestibular loss.
We were very fortunate to have as volume editors two distinguished scholars, Joseph M. Furman from the
Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA and Thomas Lempert from the
Department of Neurology, Schlosspark-Klinik and Vestibular Research Group, Berlin, Germany. They have assem-
bled an excellent, international, and multidisciplinary group of experts and guided them firmly to create this com-
prehensive book. We are grateful to them and to all the contributors.
This volume will not only be of interest to clinical neurologists. Parts of it will appeal also to psychiatrists (e.g., the
chapter on functional and psychiatric vestibular disorders) and pediatricians (e.g., the chapter on vertigo and dizziness
in children). Moreover, the first part of this volume, which discusses the anatomy, physiology, neurotransmitters, phar-
macology, integration of information, and physics of the peripheral and central vestibular systems, will appeal to both
neuro-otologists and basic neuroscientists working in the field.
In addition to the printed version, the volume will be available electronically on Elsevier’s Science Direct website,
which is becoming increasingly popular with readers and will facilitate the book’s accessibility. Indeed, all of the vol-
umes in the present series of the Handbook are available electronically on this website.
As always, it is a pleasure to thank Elsevier, our publisher – and in particular Michael Parkinson in Scotland and
Kristi Anderson and Mara E. Conner in San Diego – for their assistance in the development and production of this
volume.
Michael J. Aminoff
François Boller
Dick F. Swaab
Preface
Vertigo and dizziness rank among the most common symptoms in primary care, otolaryngology, and neurology. Causes
vary from harmless but bothersome conditions such as benign paroxysmal positional vertigo to life-threatening emer-
gencies such as posterior fossa strokes. Our understanding of diagnosis, pathophysiologic mechanisms, and effective
treatments has increased considerably in the last two decades. New developments include algorithms for bedside detec-
tion of vestibular strokes, the delineation of vestibular migraine as one of the most frequent causes of recurrent vertigo,
description of variants of benign paroxysmal positional vertigo, devices for testing individual semicircular canals and
otolith organs, and the advancement of vestibular rehabilitation as the most important therapeutic tool in neuro-otology.
This volume of the Handbook of Clinical Neurology assembles contributions from leading international authors to
communicate the current clinical knowledge of neuro-otology and a comprehensive list of references. Chapters 1–14
deal with basic knowledge and general principles of neuro-otology, such as anatomy, physiology, epidemiology,
history taking, examination, and vestibular rehabilitation. This is followed by the disease-specific Chapters 15–28,
covering all common causes of vertigo and dizziness. The numerous tables and figures in this book make the field
of vestibular science and medicine even more accessible.
Joseph M. Furman
Thomas Lempert
Contributors
Chapter 1
Abstract
Many medical doctors consider vertigo and dizziness as the major, almost obligatory complaints in patients
with vestibular disorders. In this chapter, we will explain that vestibular disorders result in much more
diverse and complex complaints. Many of these other complaints are unfortunately often misinterpreted
and incorrectly classified as psychogenic. When we really understand the function of the vestibular system,
it becomes quite obvious why patients with vestibular disorders complain about a loss of visual acuity,
imbalance, fear of falling, cognitive and attentional problems, fatigue that persists even when the vertigo
attacks and dizziness decreases or even disappears. Another interesting new aspect in this chapter is that we
explain why the function of the otolith system is so important, and that it is a mistake to focus on the func-
tion of the semicircular canals only, especially when we want to understand why some patients seem to
suffer more than others from the loss of canal function as objectified by reduced caloric responses.
*Correspondence to: Herman Kingma, Department of ORL and Head and Neck Surgery, Maastricht University Medical Centre,
Maastricht, the Netherlands. E-mail: kingmaherman@gmail.com
2 H. KINGMA AND R. VAN DE BERG
chapter in the hope that the real value of this complex Physical principles teach us that the position and orien-
vestibular system in human life will become obvious tation of the sensors in the head are irrelevant for a precise
for everyone and that this awareness can lead to an earlier detection of rotations but crucial for detection of addi-
diagnosis and better patient management. tional translational components and centrifugal forces
A major misperception is that vertigo is the major (Kingma and Janssen, 2013). If we rotate around any
vestibular symptom of a peripheral vestibular function dis- axis, both labyrinths will always sense the same rota-
turbance, which only holds for abrupt asymmetries of tional acceleration (Fig. 1.1) and translational accelera-
vestibular function. A slowly decreasing or relatively sta- tion. In contrast, centrifugal forces during rotation
ble but permanent function loss is more frequent (e.g., increase with eccentricity (Fig. 1.2).
aging) and – despite central compensation and sensory The function of the labyrinth can be illustrated by the
substitution – leads to a diversity of other complaints following example. Imagine that you hold a glass of water
due to the impaired ability of the normally extremely sen- filled to the brim. Any movement (translation or rotation)
sitive labyrinthine sensors to detect head motion and head with small accelerations or small tilts will make the water
orientation relative to gravity (Kingma and Janssen, 2013). move and lead to spillage. Only very smooth movements
These persisting complaints are: a loss of visual (dynamic) and extremely small tilts avoid the water being spilled.
acuity, imbalance, fear of falling and actual falls, visual Basically, the human labyrinth acts like such a glass of
vertigo, chronically enhanced cognitive load, and fatigue water fixed in the head: it detects extremely small acceler-
reflecting the various functions of the labyrinth. ations or tilts. It is hard avoiding stimulation of this very
To serve all disciplines, we choose a multidisciplinary sensitive head motion sensor system, similar to avoiding
approach, including clinical sciences, physiology, and water spillage when moving the glass.
physics. The anatomy of the labyrinth in the head is of course
much more complex than a glass of water. In each tem-
poral bone, on either side (Fig. 1.3), we find a bony lab-
GENERAL INTRODUCTION TO THE
yrinth, composed of cavities and tubes. Inside the bony
LABYRINTH
labyrinth lies the membranous labyrinth (Fig. 1.4) sur-
The two balance organs located in the left and right rounded by perilymph that is supplied from the suba-
temporal bone of the skull, the vestibular nerves, the ves- rachnoid space via the ductus perilymphaticus. The
tibular nuclei, the vestibulocerebellum, and the vestibu- membranous labyrinth is filled with endolymph. The
lar cortex are not the only but the major structures that endolymph is a secretion product of the dark cells in
together form the vestibular system. In this chapter we the vestibular part of the labyrinth and the stria vascularis
will focus on the balance organs providing sensory input in the cochlear part of the labyrinth. Resorption of the
to the central vestibular system. endolymph takes place in the saccus endolymphaticus.
The vestibular system contributes to optimize visual The membranous labyrinth is kept in position within
acuity during head motion, enhances balance control, the bony labyrinth by a fine network of connective fibers.
and allows detection of self-motion and orientation rela- Within the membranous labyrinth we can distinguish
tive to gravity. As these tasks are quite complicated in three functional entities: the semicircular canals, the ves-
many conditions of daily life, we also use vision, propri- tibule, and the cochlea (Fig. 1.4). The semicircular canals
oception (including gravity receptors along the large and vestibule form the vestibular part of the labyrinth.
blood vessels), and learning processes. In fact, the brain The vestibule hosts the otolith organs, the utriculus
seems to neglect vestibular input under several condi- and sacculus. Together, the canals and otolith organs
tions when no other sensory input is available to verify are most sensitive for relatively low-frequency head
the interpretation of motion or spatial orientation (divers movements and head tilt. The auditory part, the cochlea,
in deep, dark water and skiers covered by snow in an ava- can be considered as a phylogenetically later developed
lanche). Only very fast vestibulo-ocular and vestibulosp- extension of the vestibule allowing the perception of
inal reflexes seem to be an exception to this rule. The high-frequency movements and vibrations (sound).
vestibular system makes use of specialized sensors The otolith organs are the most fundamental motion sen-
located in the head to monitor angular accelerations sors in the head. In invertebrates, the so-called statocyst
(rotations in three dimensions (3D)) and linear accelera- (Fig. 1.5) can be considered as a precursor of the human
tions (translations in 3D and tilt relative to the gravity statolith system. It is a sphere composed of ciliated hair
vector) of the head in space. During head movements, cells, mechanoreceptors, on the bottom of which lie rel-
many forces act upon these sensors and often all sensors atively heavy calcium carbonate crystals, the statoconia.
are stimulated simultaneously. On earth, head move- With tilts relative to gravity or movements with substan-
ments always occur within the gravitational field and tial acceleration (rotational or translational), these crys-
are often composed of both rotations and translations. tals will move and activate the hair cells, leading to
ANATOMY, PHYSIOLOGY, AND PHYSICS OF THE PERIPHERAL VESTIBULAR SYSTEM 3
Fig. 1.1. A movement of an object is generally the sum of rotations and translations. Any movement can be divided into a rotation
around a freely chosen rotation axis combined with an appropriate translation. So, the rotation component of the labyrinth is always
the same irrespective the position of the rotation axis relative to the labyrinth and always similar for both labyrinths: only the
additional translation component depends on the eccentricity.
Fig. 1.3. Schematic drawing of the orientation of the two labyrinths in the skull. HC, horizontal (or lateral) canal; PC, posterior
canal; AC, anterior (or superior) canal.
Fig. 1.7. Schematic drawing of the hair cell. From left to right: the hair cell in rest, hair cell in response to a deflection toward the
kinocilium and the hair cell in response to a deflection away from the kinioocilium. Note that the hair cell is a mechano-receptor
with asymmetric sensitivity.
The hair cell receptor potential at rest is about 80 mV The specific difference in sensitivity for rotations,
and changes about 20 mV per micron lateral shift of the translations, and tilt of the vestibule is explained solely
cilia (Fig. 1.7). Afferent nerve fibers of the hair cells by the specific anatomic shape and structure of the canals
show a spontaneous firing rate in the range of about and statolith organs, and basically not due to any differ-
100 spikes per second (Hudspeth and Corey, 1977; van ences in hair cell structure.
de Berg et al., 2011). The receptor potential decreases
and nerve fiber spike rate increases when the stereocilia
THE OTOLITH ORGANS
move towards the kinocilium, and vice versa. The max-
imum change in receptor potential due to a deflection of There are two otolith (synonym: statolith) organs in each
cilia in the direction of the kinocilia is substantially larger labyrinth: the utriculus and sacculus that are located in
than in the case of a cilia deflection away from the kino- the membranous labyrinth, in the vestibule. Both organs
cilia, making the hair cell an asymmetric sensitive mech- contain a sensory epithelium, the macula of the utriculus,
anoreceptor cell (second law of Ewald); in the hair cell of and the macula of the sacculus. When we keep our head
the frog’s sacculus the maximum differs by a factor of upright, the surface of the macula of the utriculus is ori-
about 4: a change of –1.8 mV versus + 7.0 mV ented in the horizontal plane and curves slightly towards
(Hudspeth and Corey, 1977). the anterior and upwards by about 20–30°. The macula of
Each of the two balance organs that make use of hair the sacculus is oriented against the medial wall of the
cells as mechanoreceptors hosts five primary sensors to sacculus, parallel to the sagittal plane, orthogonal to
detect movements and orientation of the head in space. the macula of the utriculus. The stereocilia of the hair
Three semicircular canals detect angular acceleration cells expand into a gelatinous, deformable, elastic mass
in 3D (rotations). Two otolith organs, the utriculus and (Fig. 1.10). Relatively heavy calcium carbonate crystals
sacculus, detect accelerations in 3D (translations and or otoconia are attached on the top of this gelatinous mass
rotations) and head orientation (tilt) relative to the gravity by fine collagen connective fibers. These mostly hexag-
vector. During rotation the head is subject to centrifugal onally shaped crystals have a specific mass of 2.95 g/cm3
forces directed away from the rotation axis; these forces and a diameter varying from 3 to 30 mm. The hair cells in
are also detected by the utriculus and sacculus. The the utriculus are oriented with their polarization direction
canals are able to detect angular accelerations exceeding towards an imaginary line, the striola, in the middle of the
0.5°/s2. The otolith organs detect linear accelerations surface (Figs. 1.8 and 1.9). At the level of the utricular
exceeding 2 cm/s2, angular accelerations exceeding striola, the membrane is very thin and the hair cells have
3.0°/s2, and head tilt with an accuracy of about 0.5°. short cilia. The hair cells in the sacculus are oriented with
6 H. KINGMA AND R. VAN DE BERG
Fig. 1.10. Schematic representation of the otolith membrane, with the macula as sensory epithelium. Like the statocyst, the utric-
ulus and saculus are mechanoreceptor systems that are sensitive for any movement and to a limited extent to sound. They are the
most rudimentary sensors of head motion and tilt. Compared to the statocyst, the utriculus and sacculus have a more specific 3D
orientation and the hair cells are oriented in different direction and amplitude sensitivities.
ANATOMY, PHYSIOLOGY, AND PHYSICS OF THE PERIPHERAL VESTIBULAR SYSTEM 7
Now the erect position of the antenna indicates constant
velocity or standstill. Upon deceleration of the car, due to
the inertia of the orange, the antenna will bend forwards.
Now the inclination of the antenna is proportional to the
deceleration. Due to its elasticity, the antenna will return
to its vertical orientation as soon as the car stops. When
we tilt the car, the antenna will deflect in the direction
of tilt over an angle proportional to the tilt angle relative
to the gravity vector. No distinction is possible between
tilt and translation (compare with Figs. 1.11 and 1.12).
Also, when we start to rotate and hold the antenna
upright, the antenna will start to bend outwards due to
centrifugal force.
The otolith system is sensitive to linear accelerations,
rotations/centrifugation and tilt thanks to the principle of
inertia of mass. Assume that the head undergoes linear
acceleration (Fig. 1.11). The lower part of the utricular
membrane immediately follows the head movement, Fig. 1.12. Schematic deflection pattern of the cilia of the hair
but the otoconia on the top of the membrane will lag cells in the utriculus and sacculus upon tilt.
behind, resulting in a deflection of the cilia. This bending
causes depolarization or hyperpolarization of the hair versus tilt or translation is still the subject of study. At
cells depending on the direction of deflection of the cilia constant rotational head velocity, the canals are not stim-
(Fig. 1.7). The hair cells of the macula are polarized in all ulated. However, during both constant and changing
directions, in contrast to the semicircular canals. A tilt rotational head velocity the otolith system is still stimu-
relative to the gravity vector or centrifugation also lated due to centrifugal force, probably having a support-
induces a shear force in the plane of the otoconial ing and regulatory function for the canals (see below).
membrane and a deflection of the cilia. The otolith
organs cannot distinguish between head tilt, rotation,
THEORETIC MODEL
and head translation (for example, an acceleration for-
wards leads to a similar deflection of the cilia as a back- During linear head acceleration, centrifugation, or head
ward tilt of the head: Fig. 1.11). The only exception to tilt, the otoconia mass shifts relative to the macula due
this may be that the eccentricity of the otolith membranes to otoconial mass inertia, causing opposing viscous fric-
can be different relative to the rotation axis. This may tion and an elastic force. Therefore the otolith organ
result in a difference in direction and/or strength of the semicircular canals can be modeled similarly to the semi-
centrifugal forces acting upon the otolith membranes. circular canals with a simple mechanic analog, using
Whether this provides a physiologically relevant and suf- inertia (I), viscosity (B), and elasticity (K) as physical
ficient sensitivity to discriminate between rotations quantities (Fig. 1.13). The moment of inertia is given
Fig. 1.11. Schematic deflection pattern of the cilia of the hair cells in the utriculus and sacculus upon translation.
8 H. KINGMA AND R. VAN DE BERG
Fig. 1.14. (A) Bode plot of the frequency response of the transfer function equation 4, representing the dynamic response of the
mechanical analog of the otolith organ. Upper trace: amplitude spectrum (gain ¼ sensitivity). Lower trace: phase as a function of
frequency. (B) Response amplitudes of c-VEMP (asummed to reflect saccular function) and o-VEMP (assumed to reflect utricular
function) as a function of age (after Agrawal et al.).
ANATOMY, PHYSIOLOGY, AND PHYSICS OF THE PERIPHERAL VESTIBULAR SYSTEM 9
Fig. 1.15. Schematic presentation of the semicircular canals with the cupula holding the hair cells. Due to the similar orientation of
all hair cells in the cupula, the asymmetric sensitivity of the hair cells results in an asymmetric sensitivity of the semicircular canals.
Fig. 1.16. Back view of the two vestibular labyrinths. The arrows indicate the preferred (maximum sensitivity) rotation direction
in each canal. HC, horizontal canal; PC, posterior canal; AC, anterior canal. Note that the direction of the sensitivity of the canals is
opposite for the HC compared to that of the AC and PC (opposite orientation of the hair cells in the cupulae).
The hair cells of the canals are located in the basal part The polarization direction of the hair cells in the cupula
of a gelatinous mass, the cupula, that extends through the of the horizontal canal is such that the canal is more sen-
ampulla of each canal and forms a flap that closes the sitive for a cupula deflection towards the ampulla (ampul-
semicircular canal, preventing endolymph from passing lopetal), which corresponds to a head rotation in the
the ampulla (Fig. 1.15). The cilia extend into the cupula. opposite direction (arrow; see explanation below related
As indicated above, the hair cells have the highest sen- to the physics of cupula deflection). The polarization
sitivity for deflections to the kinocilium: the polarization direction of the hair cells in the cupula of the vertical
direction. In the cupula all hair cells are arranged with the canals is such that the canal is more sensitive for a cupula
same direction of polarization. As a consequence, the deflection away from the ampulla (ampullofugal), which
receptor potential of all hair cells in a cupula decreases again corresponds to a head rotation in the opposite direc-
or increases in synchrony upon a cupula deflection. tion (arrow). As a rule of thumb, each canal is maximally
But again, as the maximum sensitivity is in the polariza- sensitive for rotations in the direction of that canal about
tion direction, there is also a preferred direction of a an axis orthogonal to the plane of that canal.
cupula deflection, explaining the asymmetric sensitivity Through this orientation we are supplied with three
of each semicircular canal: actually, each canal is most pairs of canals with a complementary and opposing opti-
sensitive for rotations in the direction of that specific mal sensitivity (Fig. 1.16): (1) the left and right horizon-
canal (Fig. 1.16). tal canal; (2) the left anterior and right posterior canal;
10 H. KINGMA AND R. VAN DE BERG
Fig. 1.17. (A) Clockwise angular acceleration of the canals leads to a ampullopetal endolymphatic flow and a deflection of the
cupula and hair cells that all have the same polarisation. Clockwise angular acceleration leads to cupula deflection in the opposite
direction. (B) When rotation velocity becomes constant, the cupula starts to move back to the original (resting) position, which
takes about 20 seconds on average (time constant about 6 seconds). This implies that it is not possible to distinghuish on the basis of
canal input to the brain between standstill and constant rotation.
will not move when the rotation axis is in the plane of the
canal: Ewald’s first law). As mentioned already (Fig. 1.1),
the impact of rotation on an individual canal does
not depend on the distance between the axis of rotation
and the center of the canal – parallel axis theorem
(Feynman, 2011). In contrast, the centrifugal component
related to rotation depends on the location of the labyrinth
relative to the rotation axis.
The brain receives opposite signals from the two lab-
yrinths and detects the difference between both of them,
which in engineering terms is considered as working as a
differential amplifier. The redundancy in a system with
two labyrinths (similar to hearing and vision) makes it
Fig. 1.18. First law of Ewald: cupula deflection will be maxi- less vulnerable for unilateral loss of function. But, also,
mal for rotations around an axis orthogonal to the plane in which
detecting the difference between the two oppositely
the canal is situated; cupula deflection will be minimal for rota-
tions around an axis in the plane in which the canal is situated.
sensitive labyrinths enhances the sensitivity twofold,
whereas a common disturbance from outside is sub-
tracted (common-mode rejection).
and (3) the right anterior and left posterior canal. The sen-
sitivity (gain) of the semicircular canal is such that it gen-
PHYSICS OF THE CANALS
erates close to 1 spike/s per °/s at 0.5 Hz in the afferent
nerve fibers (Yang and Hullar, 2007). An analog of a canal without cupula is a closed bottle
When the head is rotated, the endolymph fluid lags completely filled with water (without any air on top)
behind due to mass inertia and exerts a force against fixed on a turntable. As soon as the turntable starts to
the cupula (Fig. 1.17A), causing the cupula to bend. rotate, the bottle will follow the rotation immediately.
When constant rotation is reached (Fig. 1.17B) and accel- However, due to the inertia of mass, the water will lag
eration becomes nil, the driving inertial force will become behind and only after a while – due to the adhesion of
nil too (Newton’s law: force ¼ mass acceleration). Now the water to the bottle wall and the internal cohesion of
the cupula will bend back to its original position, driven the water molecules – will the water start to rotate and
by the cupula elasticity against the viscosity of the endo- then rotate with the same angular velocity as the bottle
lymph and the friction between endolymph and membra- and turntable. Without this friction (adhesion) and vis-
nous labyrinth. The endolymph will move maximally cosity (cohesion), the water would not move at all; with
when the rotation axis is orthogonal to the plane in which more friction and viscosity the water will follow the bot-
the canal is oriented (Fig. 1.18; the endolymph and cupula tle movement faster. Besides friction and viscosity, the
ANATOMY, PHYSIOLOGY, AND PHYSICS OF THE PERIPHERAL VESTIBULAR SYSTEM 11
total mass and specific mass of the fluid or inertia play a deflection: within milliseconds an equilibrium will be
crucial role: the greater the fluid mass, the more force reached between the inertial force acting upon the cupula
(acceleration) is needed in order to move the water. Fric- and the elastic force from the cupula. As long as the
tion, viscosity, mass, and acceleration all determine how acceleration continues, this equilibrium will remain,
much the water lags behind the bottle movement and resulting in a persistent deflection that stimulates the hair
over which angle it will be displaced until the water cells in the cupula. The stronger the acceleration, the
has reached the same angular velocity as the bottle. As more the cupula will bend: the constant deflection of
long as the turntable, bottle, and water rotate at a constant the cupula will be proportional to the acceleration.
velocity, no further change will occur. The angle over Low cupula stiffness (high elasticity), high endolymph
which the water is rotated compared to the bottle is pro- mass, and low friction will all result in a larger cupula
portional to the applied angular acceleration of the bottle. deflection (higher sensitivity). When constant angular
As soon as the turntable stops, the bottle will stop as well, velocity is reached, the cupula will start to bend back
but the water will still rotate inside the bottle. The veloc- to its neutral position as there is no driving force (accel-
ity of the water will decrease over time due to the friction eration) any more to maintain the cupula deflection.
between bottle and water and ultimately the water will However, the return lasts quite long, as now the elastic
come to a complete standstill. If the deceleration is the force of the cupula alone will have to move the endo-
same as the acceleration, the same time will be needed lymph mass against friction. A low cupula stiffness (high
for the water to come to a standstill and the water will elasticity ¼ small elastic force), a high endolymph mass,
have rotated to exactly the same position as in the begin- and strong friction will result in a slower return of the
ning of the experiment: no net relative angular displace- cupula to its neutral position. In pathology and aging,
ment is left. In fact, deceleration and acceleration need endolymph viscosity (friction) and cupula stiffness can
not be the same: the same position is always reached change; in benign paroxysmal positional vertigo
when the steps in velocity during acceleration and decel- (BPPV) the specific mass of the endolymph can be
eration are opposite but have the same magnitude. For assumed to increase. In summary:
example, the velocity step is the same but opposite
1. increase of cupula stiffness or increase of endo-
(120°/s and –120°/s) when we accelerate in 12 seconds
lymph viscosity: lower canal sensitivity and
with 10°/s2 to 120°/s, and the bottle stops when we decel-
shorter postrotatory sensations
erate in 2 seconds by 60°/s2 from 120°/s to standstill.
2. increase of absolute endolymph mass: higher
So the relative displacement is proportional to the veloc-
canal sensitivity and longer postrotatory
ity step: ¼ acceleration Tacceleration. This has a direct
sensations
clinical application: velocity steps are used widely in
3. change of endolymph specific mass compared
vestibular diagnostics using rotatory chairs.
to that of the cupula: sensitivity of the canals
When we put a very light fluid or gas (low specific
for gravity and linear accelerations is induced.
mass) in the bottle (decreasing the mass inertia) or a very
viscous fluid that has a strong adherence (high friction) to A canal is physiologically insensitive to (coincidental)
the bottle wall, the displacement of the content relative to linear accelerations (Melvill Jones, 1979) because the
the bottle will be almost negligible. cupula and endolymph have the same density. If differ-
So, the relative displacement increases with mass, ences in densities occur, the canal dynamics will be
decreases with friction (adhesion and cohesion), and more complex, and would lead to a dependency on the
increases with the magnitude of the step in velocity. orientation of both the gravity vector relative to the canal
Any translation of the turntable and bottle on top will plane and the axis of rotation, as well as on the distance
not lead to any movement of the water as the water cannot between the axis of rotation and the center of the semicir-
be compressed. The water will only start to move by cular canal (Kondrachuk et al., 2008). This effect is a
rotation. familiar experience after alcohol intake, resulting in the
The situation is slightly more complex in the semicir- sensation of rotation when lying in bed, and can even
cular canal: here the cupula prevents the endolymph from induce eye movements known as positional alcohol
rotating freely in the canal (Fig. 1.15). The cupula can be nystagmus (Goldberg, 1966). This is also the effect expe-
considered as an elastic membrane that can slightly bend rienced in the common vestibular disorder BPPV. In
in both directions. As soon as the canal starts rotating, the BPPV, otoconia are present in the semicircular canals.
endolymph lags behind due to its inertia of mass. Again, These particles make the semicircular canal system sen-
the less friction and the more endolymph mass are in sitive to the orientation of gravity and can adhere to the
the canal, the more the fluid will tend to lag behind cupula – cupulolithiasis (Schuknecht, 1962) – or remain
and the stronger will be the force acting upon the cupula. free-floating, which is called canalithiasis (Rajguru et al.,
The stiffness of the cupula will, however, prevent a large 2004, 2005).
Another random document with
no related content on Scribd:
chrétiennes Raisin noir Raisin blanc
ocques kilogr. ocques kilogr.
Kiziklar (5
villages) Turcs » » 500,000 625,000
Ak-sou dito » » 200,000 250,000
Gheuzédé et
Tchatal-Tépé dito » » 10,000 12,500
Dimboz dito » » 15,000 18,750
Kestel dito » » 15,000 18,750
Doudakli et
Barakeuy dito » » 150,000 187,500
Kara-Hidir et
Narli-Déré dito » » 200,000 250,000
Jydir, Kazikli et
Agha-Keuy dito 100,000 125,000 200,000 250,000
Kélèssen Chrétiens » » » »
Démirdeche dito 400,000 500,000 400,000 500,000
Alachar Turcs » » » »
Kara-Baltchick Turcs » » 50,000 62,500
Sètche-Keuy dito » » 50,000 62,500
Tchourdané dito » » 150,000 187,500
Philadar Chrétiens 100,000 125,000 1,000,000 1,250,500
Aksounghour Turcs » » 15,000 18,000
Ahmed-Bey dito » » 120,000 130,750
Plaine de Turcs et
Brousse chrétiens » » 100,000 125,000
Brousse, Missi
et
Tchékirglhé dito » » 1,800,000 2,250,000
Démirdji-Keuy Turcs » » 300,000 375,000
Tchali-Keuy dito » » 300,000 375,000
Fodra et
Yayladjik dito » » 400,000 500,000
Tahtali Turcs et » » 500,000 625,000
chrétiens
Kayapa Turcs » » 500,000 625,000
Hassan-Agha dito » » 500,000 625,000
Aktchaklar dito » » 200,000 260,000
Dansari-
Ghuruklé Chrétiens 25,000 31,250 375,000 718,750
Quitté Turcs » » 200,000 250,000
Yénidjé-Keuy dito » » 15,000 18,750
Déré-
Tchavouchou dito » » 15,000 18,750
Totaux 625,000 781,250 8,480,000 10,600,000
II
LA FABRICATION DES VINS
Le tiers de la quantité de raisin blanc énumérée ci-dessus se vend
dans la ville pour être consommé en fruit. Les deux autres tiers sont
employés : 1o à la fabrication du vin ; 2o à la confection d’une sorte de
jus épais appelé Pekmès dont on se sert pour faire des confitures
dans les familles.
Ces confitures de jus de raisin jouent un grand rôle dans les
villages et les villes d’Asie. Elles se divisent en deux catégories : le
Bêtchel, confiture de fruits mélangés de certains légumes ; le
Boulama, pâte jaunâtre, fort épaisse, remplaçant dans quelques
localités le sucre ou plutôt la mélasse. Certains pays de l’intérieur font
un très grand commerce de Bêtchel et de Boulama.
Le marc du raisin provenant de ces diverses fabrications est
employé à fabriquer le Raki, sorte d’eau-de-vie de marc anisée et
résinée dont on fait une très grande consommation. Ce spiritueux se
prend comme apéritif aussi bien que comme digestif ; il remplace tous
nos divers alcools de France qui ne pourront jamais, dans ces pays,
faire une concurrence sérieuse au Raki.
Le raisin noir est uniquement employé à la fabrication du vin.
Le prix de ces diverses qualités de raisin, vendues dans les villes,
franco au domicile de l’acheteur, varie, suivant les années, de 50 à 80
piastres les 100 ocques, soit 11 à 18 fr. les 125 kilog. (L’ocque = 1 kil.
225 gr. ; la piastre = 0 fr. 22 centimes.)
Chaque année, le gouvernement vend la dîme des localités
spécifiées plus haut à des prix déterminés. Le chiffre de vente de
chaque localité aurait évidemment sa place ici. Mais la dîme des
raisins se vend généralement avec celle des blés, de sorte qu’il est
presque impossible de déterminer le prix de perception que le
gouvernement reçoit pour les raisins. Quelquefois cependant, faute
d’entente avec les dîmiers, le gouvernement perçoit directement du
paysan l’impôt sur le raisin ; le Trésor ne reçoit alors environ que la
cinquième partie de l’impôt, tant le contrôle est défectueux dans cette
branche de l’administration.
Que la dîme soit vendue aux dîmiers ou perçue directement par
l’autorité locale, le vigneron paye toujours 10 % sur la valeur du raisin
produit. Chaque année le gouvernement fixe un prix pour l’ocque de
raisin, et ce prix sert de base à la perception.
Les vignerons turcs vendent généralement leur raisin ou
l’emploient pour la fabrication du Pekmès.
Ce sont les vignerons chrétiens qui fabriquent le vin. Il y a à
Brousse des fabricants et des marchands. Ils forment une corporation
composée en grande partie de l’élément grec. La plupart ont
transformé en fabriques d’anciens bains qui constituent des locaux
assez bien aménagés pour cette industrie.
La fabrication des vins, à Brousse, est encore pour ainsi dire dans
l’enfance. Les systèmes employés sont des plus primitifs. Le vin n’est
pas travaillé ; il est brut, naturel.
Quand le raisin en grappes est écrasé, on place le jus dans des
tonneaux où on le laisse fermenter pendant deux mois environ, puis
on transvase ce jus dans d’autres tonneaux et le vin est fait. C’est très
simple.
Les vins blancs sont ordinairement légèrement colorés, dorés
presque. Ils sont généralement doux et très capiteux. Certains
vignobles fournissent des vins qui possèdent les qualités des vins
d’Espagne et des vins de Madère.
Un Hongrois, établi depuis peu à Brousse, a imaginé de fabriquer,
avec certaines espèces de raisins du pays, des vins qui, après un
séjour de quatre à cinq mois en bouteille, acquièrent toutes les
propriétés des vins du Rhin. Et aujourd’hui il vend comme vins du
Rhin à Constantinople, en Russie et en Roumanie, à des prix élevés,
ses produits dont le coût de revient est pour lui très minime.
Quelques Français font aussi pour leur consommation des vins
blancs, secs, qui, mieux fabriqués, se rapprocheraient beaucoup de
nos vins de France et ne laisseraient rien à désirer comme saveur et
comme goût. Ces vins-là peuvent se conserver et sont facilement
transportables. Il en est de même des vins noirs, qui sont fort riches
en degrés, mais doux et surtout capiteux.
Un autre système employé dans le pays consiste à fabriquer des
vins cuits. Aussitôt que le raisin est pressé, on fait cuire le jus jusqu’à
ce qu’il obtienne une légère épaisseur. On le place alors dans des
tonneaux où il peut se conserver indéfiniment. On parvient ainsi à
faire vieillir les vins de certaines contrées. Mais ce procédé enlève au
liquide la plus grande partie de ses qualités et lui donne des défauts
qui le rendent impropre à un usage continuel.
C’est le marc de raisin pressé qui fournit le Raki. Ce marc est
placé dans des tonneaux découverts où il fermente après 20 à 25
jours. On le met alors dans un alambic sans serpentin ; quand il entre
en ébullition on y ajoute une certaine quantité d’anis, et on obtient
ainsi l’extrait du marc en différents degrés.
Le vin blanc se vend de 40 à 80 paras l’ocque (ou 1 à 2 piastres
l’ocque), soit de 22 à 44 centimes les 1225 grammes ;
Le vin noir se vend de 60 à 100 paras l’ocque (ou 1 ½ à 2 ½
piastres l’ocque), soit 33 à 55 centimes les 1225 grammes ;
Le Raki se vend de 4 à 10 piastres l’ocque, soit 0 fr. 88 centimes à
2 fr. 20 les 1225 grammes.
Les vins vieux se vendent jusqu’à 10 piastres l’ocque, soit jusqu’à
1 fr. 75 le litre.
Tous ces prix sont les prix de vente au détail.
III
LES VIGNES DANS L’INTÉRIEUR
Dans le tableau que nous avons donné plus haut nous n’avons
indiqué que les vignobles ayant des communications faciles avec le
littoral et distants tout au plus de 40 kilomètres des lieux
d’embarquement, c’est-à-dire la valeur approximative de la récolte
vinicole de Brousse, chef-lieu du vilayet, et de la banlieue.
Voici maintenant l’énumération des principales localités qui
produisent le raisin dans toute l’étendue du vilayet de Hudavendighiar.
Mais il faut observer que les voies de communication reliant ces
localités soit avec Brousse, soit avec les ports de Ghemlek et de
Moudania, ou n’existent pas, ou sont dans un tel état d’impraticabilité
que les frais de transport absorberaient tous les bénéfices que l’on
pourrait espérer d’une exportation.
Le vilayet est divisé en quatre sandjaks :
1o Le Sandjak de Brousse comprend les cazas de Mohalitz, de
Ghemlek (littoral), de Biledjik, de Moudania (littoral), de Einégeul et de
Yeni-cheir.
Le premier et le dernier de ces cazas, Mohalitz et Yeni-Cheir, ne
cultivent pas la vigne. Les quatre autres la produisent en grande
quantité, notamment Biledjik, situé à dix-huit heures de Brousse, dont
le raisin noir est fort apprécié pour la fabrication du vin.
2o Le Sandjak de Karassi comprend les cazas d’Aivalik, d’Erdek,
de Panderma, d’Edrémid, de Bihadiz, de Kemer-Edrémid et de Sorna.
A l’exception de l’avant-dernier caza, tous les autres sont des pays
vignobles.
3o Le Sandjak de Kara-Hissar comprend les cazas de Sandoukli,
de Tchal, de Boulvadin et d’Azizié.
A l’exception des deux derniers cazas, les autres cultivent le
raisin.
4o Le Sandjak de Kutahia comprend les cazas d’Ouchak, de
Ghuduss, de Simari et d’Eski-cheir.
Seul, le caza d’Ouchak produit du vin.
Comme on le voit, sur 21 cazas composant le vilayet, 13 sont des
pays vignobles.
Les voies de communication, par routes ou par canaux, manquant,
chaque pays consomme son produit.
Les prix du raisin et ceux du vin dans l’intérieur sont naturellement
bien inférieurs aux prix de Brousse et de sa banlieue.
Une statistique générale sur le produit vinicole de tout le vilayet
serait évidemment très intéressante. Mais on ne pourrait la mener à
bonne fin qu’en passant un long temps sur les lieux mêmes ; encore
rencontrerait-on les plus grandes difficultés, l’administration locale,
dans l’intérieur, ayant peu de documents où l’on puisse trouver des
données statistiques, les eût-elle d’ailleurs, qu’il est fort peu probable
qu’elle consentît facilement à les communiquer.
CHAPITRE II
L’INDUSTRIE DE LA SOIE
I
LES CENTRES DE PRODUCTION
II
LES PROCÉDÉS DE FABRICATION
III
LES MURIERS. LES GRAINES. LES MAGNANERIES. — LE
SYSTÈME PASTEUR
IV
LA RÉCOLTE SÉRICICOLE DE 1880-81
Cocons et Soies
Récapitulation :