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indicate which one is paretic Recording of eye movements during the test, as described below, allows quanti cation of these responses Galvanic stimulation of the labyrinths offers no particular advantage over caloric stimulation Vestibular (labyrinthine) stimulation can also be produced by rotating the patient in a Barany chair or any type of swivel chair The patient s eyes are kept closed or blindfolded or defocused with Frenzel lenses during rotation to avoid the effects of optokinetic nystagmus Electronystagmography (ENG) provides a more re ned method of detecting disordered labyrinthine function because it permits the accurate recording of eye movements without visual xation ENG is usually coupled with caloric stimulation or with modern devices for rotational testing that allow precise control of the velocity, acceleration, and extent of rotation beyond what can be done with the traditional Barany chair

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Labyrinthine disease is the most common cause of true vertigo The classic variety, Meniere disease, is characterized by recurrent ` attacks of vertigo associated with uctuating tinnitus and deafness One or the other of the latter symptoms rarely both may be absent during the initial attacks of vertigo, but invariably they assert themselves as the disease progresses and increase in severity during an acute attack Meniere disease affects the sexes about equally and ` has its onset most frequently in the fth decade of life, although it may begin earlier or later Cases of Meniere disease are usually ` sporadic, but hereditary forms, both autosomal dominant and recessive, have been described (see reviews by Konigsmark) The main pathologic changes consist of an increase in the volume of endolymph and distention of the endolymphatic system (endolymphatic hydrops) It has been speculated that the paroxysmal attacks of vertigo are related to ruptures of the membranous labyrinth and a dumping of potassium-containing endolymph into the perilymph, changes that have a paralyzing effect on vestibular nerve bers and lead to degeneration of the delicate cochlear hair cells (Friedmann) In typical Meniere disease, the attacks of vertigo are charac ` teristically abrupt and last for several minutes to an hour or longer The vertigo is unmistakably whirling or rotational in type and usually so severe that the patient cannot stand or walk Varying degrees of nausea and vomiting, low-pitched tinnitus, a feeling of fullness in the ear, and a diminution in hearing are practically always associated Nystagmus is present during the acute attack; it is horizontal in type, usually with a rotary component and with the slow phase to the side of the affected ear On attempting to touch a target with the eyes closed, there is past pointing as well as a tendency to fall toward the affected ear The patient prefers to lie with the faulty ear uppermost and is disinclined to look toward the normal side, which exaggerates the nystagmus and dizziness As the attack subsides, hearing improves, as does the sensation of fullness in the ear; with further attacks, however, there is a progressive increase of deafness The attacks vary considerably in frequency and severity They may recur several times weekly for many weeks on end, or there may be remissions of several years duration Frequently recurring attacks may give rise to a mild chronic state of disequilibrium and a reluctance to move the head or to turn quickly With milder forms of the disease, the patient may complain more of head discomfort and of dif culty in concentrating than of vertigo and may be considered neurotic.

rows, with lengths of up to 2n bits (taking the shifting into account) The total time taken to add up these rows, doing two numbers at a time, is O(n) + O(n) + + O(n), which is O(n2 ), quadratic in the size of the inputs: still polynomial but much slower than addition (as we have all suspected since elementary school) But Al Khwarizmi knew another way to multiply, a method which is used today in some European countries To multiply two decimal numbers x and y, write them next to each other, as in the example below Then repeat the following: divide the rst number by 2, rounding down the result (that is, dropping the 5 if the number was odd), and double the second number Keep going till the rst number gets down to 1 Then strike out all the rows in which the rst number is even, and add up whatever remains in the second column 11 5 2 1 13 26 52 104 143 n 1 times

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