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With the introduction of potent synthetic analgesics , it became evident upon clinical evaluation that the ambulatory patient more frequently displayed the signs and symptoms of toxicity than the bedridden patient. Thus, the occurrence of dizziness, nausea and vomiting was appreciably increased in the patient who was up and about and who was receiving meperidine and methadon (1-4). This phenomenon was not readily appreciated in the case of morphine in ambulant patients because this drug is used principally for seriously-ill bed patients and because of its decreased effectiveness when administered by the oral route. However , it had been recognized by many studying the effects of morphine in man that untoward reactions may occur more frequently in the upright position (5). Two possible approaches to the investigation of this problem were considered, the influence of such medications upon cardiovascular dynamics and their possible alterations of vestibu-lar function. Since preliminary investigations in our laboratory failed to reveal any significant aberrations in cardiovascular dynamics with these drugs (6) this study was initiated to determine the effects of potent analgesics upon labyrinthine function. METHOD The methods employed were the cold micro-caloric test (7, 8) and galvanic stimulation of the mastoid area (9). The former consists of the injection of 2 cc. of ice water (water with floating ice) into the external auditory canal with the head inclined laterally so that the ear to be tested is uppermost. The same ear is used throughout the test. The time for the onset of nystagmus to the contralateral side is recorded with a stopwatch ; and, at that point, the head is returned to the upright position, and the canal emptied of water. The duration of the true nystagmus is then noted. This test measures the sensitivity and responsiveness of the peripheral end-organ in the labyrinth and lends itself to close repetition because of its simplicity and lack of unpleasantness to the subject. The ratio of the onset to the duration of nystagmus is used as a measure of labyrinthine sensitivity for comparative purposes, a decrease in this ratio being indicative of an increased responsiveness and an increase having the opposite implication. The galvanic stimulation test is performed with the subject standing balanced on a tilt board holding the moistened cathode in one hand while the examiner applies the moistened anode to the contra-lateral mastoid area. The milliamperage necessary to effect tilting is noted. This method …

THE EFFECTS OF POTENT ANALGESICS UPON VESTIBULAR FUNCTION