Visual Vestibular Mismatch

A poorly understood presentation of balance system disease

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List of publications and Curriculum Vitae

Arthur Mallinson

Arthur Mallinson was born in Toronto, Canada on April 20, 1952. He hoIds a B.Sc. in Biological Sciences and an M.Sc. in neurophysiology, both from Simon Fraser University in Burnaby, Canada.

For the last 30 years he has been worked as a neurophysiologist in the Neuro-otology unit at Vancouver General Hospital, a diagnostic unit in a tertiary care teaching hospital. He performs clinical vestibular assessments and also serves as a consultant to other centres across Western Canada in interpreting difficult or unusual vestibular assessment results. He is a clinical instructor in the Faculty of Medicine at the University of British Columbia, and teaches vestibular physiology and clinical assessment to otolaryngology residents, medical students, audiology students, visiting clinicians and other paramedical professionals.

In the past Art has also been active in developing and teaching into the Electrophysiology program at the British Columbia Institute of Technology, which is the only English language program in Canada of its kind. He has also served as a Lecturer and Laboratory Demonstrator/Assistant, teaching Neuroanatomy/ Neurophysiology in the School of Rehabilitation Medicine, at the University of British Columbia.

He was involved in the initiation of the intra-operative monitoring program at Vancouver General Hospital, and also helped develop the ototoxicity monitoring program at the hospital.

Art has been performing and personally interpreting Computerized Dynamic Posturography assessments for 22 years, including hundreds of medical legal posturography assessments. He is the co-author of a booklet about medical legal evaluation of balance and also the co-author of a learning module on vertigo for the British Medical Journal.

Art has been actively involved in ongoing research for the last 30 years with his colleague Dr. Neil Longridge. He is a member of the Barany Society, the premier world society on dizziness and balance. He is also a member of the International Society for Posture and Gait Research (formerly called the International Society of Posturography). He serves on the editorial review board for five journals (Journal of Vestibular Research, Gait and Posture, Otology and Neurotology, Experimental Brain Research, Clinical Neurophysiology). He has been an invited speaker at a number of conferences, and has designed and given many seminars on vestibular assessment and evaluation to medical and paramedical professionals.


  1. Mallinson AI, Longridge NS, Dunn HG, McCormick AQ. Vestibular studies in Pelizaeus-Merzbacher disease. J Otolaryngol. 1983;12(6): 361-364.
  2. Longridge NS, Mallinson AI. Discussion of the dynamic illegible E test: A new method of screening for aminoglycoside vestibulotoxicity. Otolaryngol Head Neck Surg 1984;92:672-677.
  3. Longridge NS, Mallinson AI. Arnold-Chiari malformation and the otolaryngologist: Place of magnetic resonance imaging and electronystagmography. Laryngoscope 1985;95:335-339.
  4. Longridge NS, Mallinson AI. The dynamic illegible E test – a technique for assessing the vestibulo-ocular reflex. Acta Otolaryngol 1987;103:273-279.
  5. Longridge NS, Mallinson AI, MacLeod PM. Machado-Joseph disease: The vestibular presentation. J Otolaryngol 1987;16(2):93-95.
  6. Longridge NS, Mallinson AI. The dynamic illegible E test – a simple technique for assessing the ability of the vestibulo-ocular reflex to overcome vestibular pathology. J Otolaryngol 1987;16(2):97-103.
  7. Hamman RR, Mekjavic I, Mallinson AI, Longridge NS. Training effects during repeated therapy sessions of balance training using visual feedback. Arch Phys Ther Rehab 1992;73:738-744.
  8. Mallinson AI, Longridge NS, Peacock C. Dizziness, imbalance, and whiplash. J. Musculoskeletal Pain 1996;4(4):105-112.
  9. Mallinson AI, Longridge
  10. Mallinson AI, Longridge NS. Dizziness from whiplash and head injury: (Differences between whiplash and head injury). Am J Otology 1998;19:814-818.
  11. Longridge NS, Mallinson AI. Low dose intratympanic gentamicin treatment for dizziness in Ménière's disease. J Otolaryngol 2000;29(1):35-39.
  12. Gill C, Mallinson AI, Longridge NS. Effects of dimenhydrinate on computerized dynamic posturography. J Otolaryngol 2000;29(6):337-339.
  13. Carter, ND, Khan KM, Petit MA, Heinonen A, Waterman C, Donaldson MG, Janssen PA, Mallinson A, Riddell L, Kruse K, Prior JC, Flicker L, McKay HA. Results of a 10 week community based strength and balance training programme to reduce fall risk factors: a randomized controlled trial in 65-75 year old women with osteoporosis. Br J Sports Med 2001 Oct;35(5) 348-51.
  14. Longridge NS, Mallinson AI, Denton A. Visual vestibular mismatch in patients treated with intratympanic gentamicin for Ménière's Disease. J Otolaryngology 2002;31(1):5-8.
  15. Liu-Ambrose T, Eng JJ, Khan KM, Mallinson A, Carter ND, McKay HA. The influence of back pain on balance and functional mobility in 65-75 year old women with osteoporosis. Osteoporosis International 2002;13:868-873.
  16. Carter ND, Khan KM, Mallinson A, Janssen PA, Heinonen A, Petit MA, McKay HA. Knee extension strength is a significant determinant of static and dynamic balance as well as quality of life in older community- dwelling women with osteoporosis. Gerontology 2002;48:360-368.
  17. Mallinson AI, Longridge NS. Motion sickness and vestibular hypersensitivity. J Otolaryngology 2002;31(6):381-385.
  18. Mallinson AI, Longridge NS, Wong K. Using Swaystar to measure sway amplitude in an office setting. J. Otolaryngology 2004;33(1):17-21.
  19. Mallinson, AI, Longridge NS. Caloric response does not decline with age. J Vest Res 2004;14(5):393-396.
  20. Mallinson AI, Longridge NS. A new set of criteria for evaluating malingering in work related vestibular injury. Otol Neurotol 2005 Jul;26;(4):686-690.
  21. Longridge NS, Mallinson AI. Visual vestibular mismatch in work related vestibular injury. Otol Neurotol 2005 Jul;26;(4):691-694.
  22. Longridge NS, Mallinson AI. “Across the board” posturography abnormalities in vestibular injury. Otol Neurotol 2005 Jul;26;(4):695-698.
  23. Mallinson AI, Longridge NS, Morley, RE. Evaluation of the effects of alcohol on static and dynamic gait. J Otolaryngol 2008;37(6):856-859.
  24. Mallinson AI, Longridge NS. Increasing the usefulness of tandem walking evaluation. J Otolaryngol 2008;37(6):860-864.
  25. Longridge NS, Mallinson AI. Clinical Romberg testing does not detect vestibular disease. Otol Neurotol 2010;31:803-806
  26. Phillips J, Longridge NS, Mallinson AI, Robinson G. Migraine and vertigo: a marriage of convenience? Headache 2010 Sep;50(8): 1362-5.
  27. Mallinson AI, Longridge NS, Pace-Asciak P, Ngo R. Measuring caloric response – comparison of four different analysis techniques. J Vest Res 2010;20(6):419-426.


  1. Mallinson AI, Longridge NS. ENG of the month – computed tomography and electronystagmography in conflict with minor symptoms and signs. Ann Oto Rhinol Laryngol 1984;93(5):525-527.
  2. Mallinson AI, Longridge NS. ENG of the month – findings in a posterior fossa lesion. Ann Otol Rhinol Laryngol 1984;93(2):195-196.
  3. Mallinson AI, Longridge NS. Visual vestibular mismatch in whiplash and Ménière's disease. In Claussen C-F, Haid C-T, Hofferberth B (eds) Equilibrium Research, clinical equilibriometry, and modern treatment. Elsevier Science BV 2000.
  4. Kaur H, Westerberg BD, Mallinson A, Calne D. Progressive supranuclear palsy as a cause of balance disorders (Case report). J Otolaryngol 2003;32(1):114-117.


  • Mallinson, AI, Longridge NS. Differentiating real from aphysiologic balance control using Computerized Dynamic Posturography. Neurocom Publications, Clackamas OR. July 2008.


  • Phillips, J, Mallinson AI. Vertigo: an update on diagnosis and management. BMJ British Medical Journal (BMJ web based module) 2010.


I am first of all extremely grateful to Maastricht University for allowing me to pursue this degree, and I would like to convey my sincere thanks to the members of the faculty and especially members of my committee who have supported me through this journey. A special word of thanks must go to prof. dr. Kremer who was my initial contact at Maastricht University and whose efforts enabled me to begin my journey. I am indebted as well to prof. dr. Stokroos for chairing my examining committee and spending the time to read my work.

It has been an honour and a privilege to be researching in the same field as the distinguished scientists gathered at Maastricht University to take part in my thesis defence. I value them as inquisitive researchers and colleagues but also value them as friends. They make the pursuit of knowledge much more enjoyable and extremely satisfying.

Several specific people need to be singled out for their encouragement. Prof. dr. Philippe Perrin has always been eager to share his knowledge and insight with me and to look at a research challenge in a different way. Prof. dr. Mans Magnusson has been an inspiration and an encouragement for many years, and has convinced me that scientists who think differently are not necessarily wrong and may in fact be increasing their contribution to science because they think differently. He has also emphasized to me that research must be enjoyable and if this is not the case, it is one's duty to make it enjoyable.

Despite our geographical separation, my promotor, prof. dr. Herman Kingma, has always shown by example how important it is to be passionate in pursuing one's interests. As my friend and research colleague over the years, he has been insightful and inquisitive, and as my promotor he has continually encouraged me, guided me and emphasized the importance of always trying to formulate new questions, and pursue answers to them, especially in a field where so little is understood. For his efforts on my behalf to help me complete this journey, he has my deepest gratitude.

Research endeavours always start with interests kindled and nurtured by others, and there are several people who have served this purpose in my research. A debt of gratitude goes out to prof. dr. Adolfo Bronstein whom I first met over 20 years ago, and who has always inspired me and served as a colleague, collaborator, sounding board and friend. We have shared many good times together and enjoyed fascinating stories and thoughts about research ideas, patients and future endeavours. Thanks also must go to Dr. Lewis Nashner, and Dr. Owen Black, whose work has fascinated me and inspired me for over 25 years.

In order to pursue this research endeavour successfully, while at the same time being a father, a husband and working in a busy diagnostic clinic, I have had the good fortune to have a solid source of encouragement, mentor, teacher and understanding medical director who is also a highly regarded clinician in my colleague, Dr. Neil Longridge. As research partners we have shared ideas and countless enthusiastic hallway conversations prompted by a particularly fascinating clinical case. Many thanks for all your support, Neil.

On a personal note, the joy of research is heightened immeasurably when you are a father to three wonderful, intelligent children who always listen and consistently show an interest in my latest research project. For Christopher, Daniel and Kyle, I am forever thankful.

And finally, to my amazing wife Tish, who has been my partner in all things for over 40 years, this is for you.