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International Bulletin of Otorhinolaryngology

Anatomical factors in otoneurological dysfunction and compensation

M. Milkov, G. Marinov


Sharing the standpoint that physician otoneurologist should combine detailed knowledge about the anatomy, physiology and pathological physiology of central vestibular and oculomotor systems as well as about the peripheral part of vestibular and acoustic systems, the authors emphasize the necessity of knowledge about the complex anatomical links and functional relationships of these systems with the somatosensory and somatomotor systems of human organism. Otoneurologists’ attention is focused on the ‘trigemino-vascular
system’ as an anatomical and physiological substrate of migraine and accompanying headache, on comorbidity between balance disorders, anxiety disorders and migraine and on the ‘trigemino-cervical system’ as an anatomical and physiological substrate not only of the patients in whom the pathological alterations of upper cervical vertebrae and their connections cause painful sensations in completely intact areas such as paranasal sinuses and teeth provided with sensory innervation by the trigeminal nerve but also on the so-called ‘startle reflex’ as a component of reflex defense of man and animal against sudden stroke on head or sudden fall.


otoneurology, trigemino-vascular system, trigemino-cervical complex, ‘startle reflex’

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