Grey matter activation by caloric stimulation in patients with unilateral peripheral vestibular hypofunction.

PURPOSE: A combination of the caloric test with functional magnetic resonance imaging (fMRI) is a promising method for a comprehensive diagnostics of pathologies of the vestibular system. The aim of this study was to investigate the potential pattern of grey matter local activation in fMRI using cold and hot caloric stimulation in patients presenting unilateral peripheral vestibular injury. METHODS: Forty right-handed participants aged 27 to 56 with the diagnosis of right-sided peripheral vestibular hypofunction were included. Stimulation was performed separately for the right and the left ear with cold (C, 14-15 °C) stimulus and hot (H, 48-49 °C) stimulus. Grey matter activation was assessed in BOLD technique using a 3T scanner. RESULTS: We observed activity within the parieto-insular vestibular cortex (PIVC), thalamus, insula and retroinsular area, hippocampus, and cerebellum, as well as oculomotor centers located in the precentral gyrus, superior temporal gyrus, and intraparietal sulcus. Cold stimulus resulted in more areas of activation in response to the right ear activation rather than to the left ear. The ipsilateral activity was noted for insular cortex and intraparietal sulcus. The differences between hot and cold stimuli were noted for the right ear. CONCLUSIONS: In this preliminary study, the combination of the caloric test and fMRI allowed to present specific pattern of grey matter activation in patients with unilateral peripheral vestibular injury. Further studies are necessary to develop patterns or cortical maps differentiating various balance disorders and to analyze the dynamics of cortical plasticity after the injury.

An Analysis of the Association between Epilepsy-Related Genes and Vertigo in the Polish Population.

Considering the possibility of a common genetic background of vertigo and epilepsy, we genotyped an affected group of individuals with vertigo and an unaffected group, by studying 26 single-nucleotide polymorphisms (SNPs) in 14 genes which were previously reported to be of particular importance for epilepsy. Significant differences were found between the patients and the control group (χ2 = 38.3, df = 3, p = 1.6 × 10-7) for the frequencies of haplotypes consist ing of 2 SNPs located in chromosome 11 (rs1939012 and rs1783901 within genes MMP8 and SCN3B, respectively). The haplotype rs1939012:C-rs1783901:A, consisting of the minor-frequency alleles was found to be associated with a higher risk of vertigo (OR = 5.0143, 95% CI = 1.6991-14.7980, p = 0.0035). In contrast, the haplotype rs1939012:T-rs1783901:A showed a significant association with a decreased risk of the disease (OR = 0.0597, 95% CI = 0.0136-0.2620, p = 0.0002). Our results suggest that the SNPs rs1939012 and rs1783901 may play a potential role of gene regulation and/or epistasis in a complex etiology of vertigo.

Is immunohistochemical evaluation of p16 in oropharyngeal cancer enough to predict the HPV positivity?

AIM: Our goal was to determine the expression levels of p16 in the cohort of the OPSCC patients and evaluation of the pathological and clinical differences between these two groups including patients' survival. BACKGROUND: HPV infection is the main causative factor of oropharyngeal cancer (OPSCC). Identification of HPV status in OPSCC requires positive evaluation of viral DNA integration into host cell however, p16 accumulation in the proliferating cell layers has been accepted as an alternative marker for HPV infection. MATERIAL AND METHODS: The IHC staining for p16 has been performed in tumor tissue from 382 OPSCC patients. The sample was considered positive based on more than 70% of carcinoma tissue showing strong and diffused nuclear and cytoplasmic immunostaining. The clinicopathological characteristics of the patients including site, age, gender, tumor grade, tumor stage, the nodal status, smoking and survival have been analyzed when comparing p16 positive and p16 negative tumors. RESULTS: Out of our cohort in 38.2% cases positive staining for p16 has been recorded. Our analysis did not indicate significant differences in the distribution of the p16 positive patients and age of the patients, stage of the disease. Among the patients who have presented with the N+ neck, there were significantly more p16 positive tumors than in the group with N0 neck (p = 0.0062). There was highly significant correlation between the expression of p16 and smoking (p < 0.0001). The significant difference in survival (p < 0.0001) with more favorable prognosis in the p16 positive group has been observed. CONCLUSIONS: Overexpression of p16 is accepted as a surrogate diagnostic marker for detecting HPV infection in oropharyngeal cancer. However, one should remember about existence of the small subgroups of p16 positive but HPV negative tumors, with relatively worse prognosis. Immunostaining for p16, however useful on everyday basis, should be complemented with other techniques in terms of reliable identification of the HPV infection.

Multiple metastases of renal clear cell carcinoma to the organs of the head.

Metastases of renal clear cell carcinoma to the organs of the head are rare. Single cases show that they can appear either shortly after or many years after radical surgery. The diagnosis of this cancer is difficult because of its insidious course; therefore, it is often diagnosed too late. Late diagnosis is associated with a high risk of distant metastases and increased mortality. The paper presents a case of a patient whose kidney tumour was diagnosed during hospitalisation at the Department of Rheumatology. Further diagnosis and surgical treatment were performed in the Department of Urology, where a left-sided nephrectomy was carried out. After two years, the patient was hospitalised in the Department of Otolaryngology due to dysphagia. The patient was subjected to fine-needle biopsy, surgical biopsy, CT, and ultrasound. Metastases of renal clear cell carcinoma were diagnosed based on a histopathological examination and the results of imaging studies. Due to the extent of the tumour, diagnostics were extended to magnetic resonance imaging. The patient was qualified for tracheotomy, cytoreductive surgery, and chemoradiation. The patient was referred for further treatment at the Centre of Oncology in Bydgoszcz.

[Multiple complications of acute unilateral rhinosinusitis--a case report]. / Przypadek mnogich powiklan zatokopochodnych w ostrym jednostronnym zapaleniu zatok przynosowych.

INTRODUCTION: Intracranial or orbital complications after chronic and acute rhinosinusitis are rare, but could be dangerous. The complications of acute rhinosinusitis more often are observed in young patients. The combination of both intracranial and orbital complications together is found after acute inflammation. MATERIAL AND METHODS: We present a case of a patient with primary developed orbital complication during acute rhinosinusitis followed by intracranial abscess during the same treatment period. RESULTS: One week after intravenous antibiotic therapy with good outcome we observed an aggravated inflammation process with osteitis of frontal bone and brain abscess formation. We performed an external approach for frontal sinus surgery combined with neurosurgical brain abscess evacuation. Swabs taken during surgery were positive for: Streptococcus constellatus and Parvimonas micra sensitive for penicillin and metronidazol. We observed a good recovery after two weeks of treatment. CONCLUSIONS: We recommend performing a complementary CT of the sinus and CT of the brain with contrast when complications of acute rhinosinusitis are suspected. The coexistence of intracranial and orbital complications could be observed in younger patients mostly after acute sinusitis.

The visual-ocular and vestibulo-ocular reflexes in vestibular migraine.

Vestibular migraine is a disease from the border of neurology and otoneurology. The diagnosis depends on patient history. There are no valuable laboratory or imaging tests, therefore the examination of visual-ocular and vestibulo-ocular reflexes is very useful in this group of patients. The material was collected from patients diagnosed due to dizziness at the Department of Otolaryngology and Oncology with the Subdepartment of Audiology and Phoniatrics, CM UMK in Bydgoszcz in 2019-2021. We considered patients with vestibular migraine and analyzed videonystagmographic tests in this study. The most common VNG abnormalities in patients suffering from vestibular migraine were an increased labyrinthine response, increased time constant of the rotational response and abnormal optokinetic response. There was not a single case of canal paresis in the group of patients with vestibular migraine.

[Neurootological symptoms in Bruns' syndrome]. / Objawy neurootologiczne w zespole Brunsa.

The aim of the study was to present clinical neurootological symptoms in the case of early stage of the fourth ventricle tumor diagnosed finally on the base of MRI. Visual-oculomotor, vestibular-oculomotor, vestibulo-spinal and other electrophysiological signs of the vestibular damage of the brainstem were: paresis of the sixth nerve unilaterally, prolonged latency of III-V waves on brain stem audiological responses (BERA), asymmetry of the fusion limit of optokinetic nystagmus, bilateral areflexia of the caloric and kinetic labyrinth reaction, abnormal Unterberger's test in craniocorpography, the presence of gaze nystagmus. The study stressed the value of the widen and careful neurootological examination in such cases.

The Role of Vitamin D in Primary Headache-from Potential Mechanism to Treatment.

Some studies have suggested a link between vitamin D and headache; however, the underlying physiological mechanisms are unclear. We aimed to summarize the available evidence on the relationship between vitamin D and the various subtypes of primary headaches, including migraines and tension-type headaches. All articles concerning the association between primary headache and vitamin D published up to October 2019 were retrieved by searching clinical databases, including: EMBASE, MEDLINE, PubMed, Google scholar, and the Cochrane library. All types of studies (i.e., observational, cross-sectional, case-control, and clinical trials) were included. We identified 22 studies investigating serum vitamin D levels in association with headaches. Eight studies also evaluated the effect of vitamin D supplementation on the various headache parameters. Among them, 18 studies showed a link between serum vitamin D levels and headaches, with the strongest connection reported between serum vitamin D levels and migraine. Overall, there is not enough evidence to recommend vitamin D supplementation to all headache patients, but the current literature indicates that it may be beneficial in some patients suffering headaches, mainly migraineurs, to reduce the frequency of headaches, especially in those with vitamin D deficiency.

To Eat or Not to Eat: A Review of the Relationship between Chocolate and Migraines.

Migraine is a chronic disorder with episodic attacks, and patients with a migraine often report that certain factors can trigger their headache, with chocolate being the most popular type of food-based trigger. Many studies have suggested a link between chocolate and headaches; however, the underlying physiological mechanisms are unclear. As premonitory symptoms may herald migraine attacks, a question arises regarding whether eating chocolate before a headache is a consequence of a food craving or indeed a real trigger. Here, we aim to summarize the available evidence on the relationship between chocolate and migraines. All articles concerning this topic published up to January 2020 were retrieved by searching clinical databases, including EMBASE, MEDLINE, PubMed, and Google Scholar. All types of studies have been included. Here, we identify 25 studies investigating the prevalence of chocolate as a trigger factor in migraineurs. Three provocative studies have also evaluated if chocolate can trigger migraine attacks, comparing it to a placebo. Among them, in 23 studies, chocolate was found to be a migraine trigger in a small percentage of participants (ranging from 1.3 to 33), while all provocative studies have failed to find significant differences between migraine attacks induced by eating chocolate and a placebo. Overall, based on our review of the current literature, there is insufficient evidence that chocolate is a migraine trigger; thus, doctors should not make implicit recommendations to migraine patients to avoid it.

[The value of the Halmayi-Curthoysa test in neurological diagnostic procedures]. / Wartosc testu Halamagyi-Curthoysa w diagnostyce neurootologicznej.

THE AIM OF THE STUDY: The goal of the study was to state the usefulness of the Halmagyi-Curthoys' test in the patients with unilateral vestibular weakness. The influence of the heaviness of the canal paresis, spontaneous nystagmus and compensation on the test results was observed. MATERIAL AND METHODS: The investigation was performed in 68 patients with unilateral vestibular weakness of the various origin. Halmagyi-Curthoys' test was done using passive way. RESULTS: In healthy subjects the test results were negative. In patients: 47% demonstrated positive test, 44,1% negative proof, in 8,9% test was difficult to estimate. CONCLUSIONS: The obtained results pointed out that Halmagyi-Curthoys test is useful as orientation, preliminary examination, generally in cases with deep canal paresis (according to Dix- Hallpike's classification).

Cerebral Blood Flow in Low Intracranial Pressure Headaches-What is Known?

Headaches attributed to low cerebrospinal fluid (CSF) pressure are described as orthostatic headaches caused by spontaneous or secondary low CSF pressure or CSF leakages. Regardless of the cause, CFS leaks may lead to intracranial hypotension (IH) and influence cerebral blood flow (CBF). When CSF volume decreases, a compensative increase in intracranial blood volume and cerebral vasodilatation occurs. Sinking of the brain and traction on pain-sensitive structures are thought to be the causes of orthostatic headaches. Although there are many studies concerning CBF during intracranial hypertension, little is known about CBF characteristics during low intracranial pressure. The aim of this review is to examine the relationship between CBF, CSF, and intracranial pressure in headaches assigned to low CSF pressure.

Post-Lumbar Puncture Headache-Does Hydration before Puncture Prevent Headache and Affect Cerebral Blood Flow?

Headache is a common complication after diagnostic lumbar puncture (DLP). We aimed to check whether hydration before puncture influences the incidence of post-lumbar puncture headache (PLPH) and affects cerebral blood flow. Ninety-nine patients enrolled for puncture were assigned to a group with (n = 40) or without hydration (n = 59). In the hydration group, 1000 mL 0.9% NaCl was infused and a minimum of 1500 mL oral fluids was recommended within the 24 h before puncture. A Transcranial Doppler (TCD) was performed before and after DLP. Mean velocity (Vm) and pulsatility index (PI) were measured in the middle cerebral arteries (MCAs). PLPH occurred in 28 patients (28.2%): six (15.4%) from the hydrated and 22 (37.3%) from the non-hydrated group (p < 0.023). Patients with PLPH were younger (p < 0.014) and with headaches in their histories (p < 0.036) compared with the non-headache group. Vm values in both MCAs after puncture were significantly lower than before puncture in all patients. In the PLPH group, Vm in MCAs before puncture were significantly higher and the PI was lower than in the non-headache group. Our findings suggest that hydration of patients within 24 h before puncture prevented PLPH. Twenty-four hours after puncture, significant decreases in Vm were observed in the MCAs of all patients. Low baseline values of PI and high Vm predisposed patients to PLPH.

Results of cystadenolymphoma treatment of superficial parotid gland.

Introduction Warthin's tumor is a non-malignant tumor that occurs in major salivary glands. Diagnostics include an interview and physical examination as well as additional tests - ultrasonography, magnetic resonance tomography, fine-needle aspiration biopsy. Surgical tumor resection remains the method of treatment, the scope of which includes techniques from extracapsular tumor resection to a full range of parotidectomy. Material and methods A retrospective analysis was conducted for available medical records of 53 patients treated surgically at the Department of Otolaryngology and Laryngological Oncology at the Collegium Medicum of the Nicolaus Copernicus University in Torun in 2009-2016. Each patient underwent an interview, physical examination and a routine ultrasound examination. Results of treatment of 57 tumors were analyzed. Results The study showed that in the case of extracapsular tumor excision in 57 patients in the treatment of Warthin's tumors of the lower pole of the parotid lobe, there were no complications in the form of: permanent paralysis or facial nerve palsy, mucocele, symptoms of Frey's syndrome or cosmetic facial defect. Ultrasound examination in 8 (14%) patients revealed changes requiring further diagnostics or periodic ultrasound monitoring. Conclusions 1. Extracapsular tumor excision appears to be an accurate surgical technique in Warthin's tumor of the lower pole of the parotid gland's superficial lobe. 2. After removal of a cancerous lesion of the parotid gland, every patient requires periodic laryngological monitoring.

Risk factors of tympanoplasties in long-term observation.

OBJECTIVES: The aim of the study was to evaluate risk factors influencing the results of tympanoplasties on the base of material taken from the Department of Otolaryngology and Laryngological Oncology Collegium Medicum of Nicolaus Copernicus University in Bydgoszcz between 2004-2009. In this period 98 operations were done. The time from operation to hearing examination was 3 to 7 years, mean 5,43. Tympanoplastic operation were divided according to Tos classification. Measuring hearing results, tonal audiometry was done and mean air bone gap on four frequencies was assesed (500, 1000, 2000, 3000 Hz), according to AAO-HNS guidelines (1995). This parameter was compared between groups separated according to risk factors, that could potentially affect the results. Those risk factors were: disfunction of the Eustechian tube, localisation and size of the perforation of the tympanic membrane, damage of the ossicles, the state of the mastoid process, the number of operations, the presence of the cholesteatoma or granulating tissue, chronic otitis media in the opposite ear, smoking cigarettes, mastoidectomy, canal wall down technique. The results were analysed using statistical test. RESULTS: The most impotant risk factor affecting treatment's results (besides discharge from the ear) is damage of the ossicles, especially the malleus and stapes. Well done operation ensures good hearing results irrespectively of the presence of cholesteatoma or granulating tissue, and also in case of reoperation. For all types of tympanoplasties neither the localisation, nor the size of perforation do not influence on hearing results in long term observation.

Circulating Immune Complexes and Heat Shock Protein 70 in the Sera of Patients with Sudden Sensorineural Hearing Loss.

OBJECTIVES: The aim of this paper is to analyze and assess the usefulness of heat shock protein 70 (Hsp70) and circulating immune complexes (CIC) in patients with sudden sensorineural hearing loss (SSHL) in a tertiary care hospital in a research university (2014-2017). MATERIALS AND METHODS: Patients were interviewed about the history of diseases; underwent an ear, nose, and throat (ENT) examination; a hearing test; and were analyzed for the presence of CIC and Hsp70 protein. A simple dot blot method was designed for the purpose of identification of Hsp70 bound to CIC and free Hsp70. RESULTS: In 59.4% of patients with idiopathic SSHL, elevated levels of immune complexes were observed. Compared with healthy subjects, a significant difference was noted (p=0.00016). Positive reactions to the presence of free Hsp70 protein were noted in the sera of 48.4% of patients. In the control group, free Hsp70 was observed in 8% of patients (p=0.0000034). Hsp70 bound to CIC was detected in the sera of 62.5% of patients; and in healthy cases, in 12% (p<0.0001). CONCLUSION: In the sera of persons with SSHL, there are elevated levels of CIC and Hsp70. After the application of the innovative method for determining the occurrence of Hsp70 bound to CIC, it was stated that its presence is greater than that of free Hsp70, commonly detected by means of the Western-blot method. The dot blot method applied in the present study increases the Hsp70 identification and by the same token increases the probability of detection of autoimmunological background of SSHL.

Assessment of the State of the Natural Antioxidant Barrier of a Body in Patients Complaining about the Presence of Tinnitus.

BACKGROUND: Tinnitus is defined as a phantom auditory perception, i.e., sound experience despite the lack of acoustic stimuli in the environment. The aim of this study was to assess the state of the natural antioxidant barrier of a body in patients complaining about the presence of tinnitus. MATERIAL AND METHODS: The study included a total of 51 patients aged from 20 to 62 years with diagnosed idiopathic tinnitus and 19 healthy subjects as a control group. All patients underwent the audiometric tone test, speech audiometry, distortion otoacoustic emission product testing, study of evoked auditory potentials of short latency, and biochemical analysis of venous blood concerning values of activity or concentration of glutathione, glutathione peroxidase, S-transferase, glutathione reductase superoxide dismutase, malondialdehyde, and ceruloplasmin as the selected parameters of oxidative stress. RESULTS: Disorders of the auditory pathway were not only limited to the cochlea but also covered its further episodes. Mean values of activity or concentration of the selected parameters of oxidative stress in the study and control groups showed reduced effectiveness of the body's natural antioxidant barrier. DISCUSSION: Patients complaining about the presence of tinnitus showed reduced effectiveness of the body's natural antioxidant barrier compared to the control group. CONCLUSIONS: The main indication to undertake further research on the functioning of the antioxidant barrier in people suffering from ailments in the form of tinnitus is to determine a suitable therapy aimed at improving the quality of life of these patients, which might be the administration of antioxidant medications.

[Looking for the auditory and vestibular pathology in celiac disease]. / Poszukiwanie patologii sluchowo-przedsionkowej w celiakii.

The aim of the study was looking for the vestibular or/and auditory pathology in patients with celiac disease. The group of 30 cases aged 6-18 (mean: 9,2) were tested. The results were compared with 30 healthy persons aged 6-18. The tonal audiometry, distorsion product otoacoustic emission, brain stem auditory evoked potentials, electronystagmography and vestibular evoked myogenic potentials were performed. There were no pathological findings on the base of audiological tests (till upper brain stem) in celiac disease. In electronystagmography gaze nystagmus, disordered eye-tracking test and optokinetic nystagmus were observed the most frequently. Gluten-free diet and time of the disease did not influence the results. The electrical conduction through the auditory and vestibular pathways were analyzed as well. No disturbances were noted in celiac disease. The results confirm the hypothesis that neurological signs--vestibular in our study--appeared early, were connected with the histopathological changes of jejunum and remained despite of correct treatment of the disease.

Benign paroxysmal vertigo of childhood.

OBJECTIVE: To relate the authors' experience to the diagnosis and follow-up of patients with benign paroxysmal vertigo of childhood (BPV) who were followed-up at the Children's Hospital of Bydgoszcz between 1999 and 2004, and to review and discuss controversial issues regarding the disease. METHODS: Among 124 children suffering from vertigo 14 were classified as having BPV. All the children were submitted to differential diagnosis protocol which consisted of meticulous history, otolaryngological, ophthalmological, psychological, neurological examination, biochemical tests and standard neurootological examination including caloric tests. The children were followed-up and the tests were repeated if no improvement was observed. RESULTS: All the children suffered from episodic vertigo of variable intensity and frequency. All of them were neurologically intact. In 8 patients pathologic ENG results were found, only 1 patient with canal paresis could be considered as having peripheral lesion, 7 patients had central/mixed pathology. The follow-up was favorable in majority of patients. Six of them recovered completely, in 6 an improvement was noted and in 2 no improvement was observed. Three patients after remission of BPV attacks developed migraine. One child before development of BPV attacks suffered from paroxysmal torticollis of infancy. CONCLUSIONS: Childhood BPV is a disorder of vestibular system with the onset occurring mainly in preschoolers aged 1-7. Older children with the onset of BPV - like symptoms should be suspected for functional background of the disease. There are no typical ENG features for BPV. The only objective evidence of vestibular dysfunction is the presence of nystagmus during the attack. The disease is probably of vascular origin and there is strong evidence for close relationship between spasmodic torticollis, BPV and migraine.

The value of the examination of visuooculomotor reflexes in diagnosis of posterior cranial fossa lesions.

The aim of this study was to compare the frequency of pathological types of smooth-pursuit and saccadic movements in different localizations of vestibular lesions. We tested 112 patients using videonystagmography. The smooth pursuit was appreciated qualitatively on the basis of Malecki's patterns. We analyzed the saccadic movements taking three parameters into consideration: latency, velocity, and accuracy. The patients suffered from posterior cranial fossa lesions, supratentorial damage, and peripheral vestibular disorders. We discovered that testing of smooth pursuit and saccades was very helpful in pointing to the localization of the damage in the posterior fossa. The frequency of the pathological saccadic and eye-tracking movements was similar for the different sites of deficit inside the posterior fossa, so recognizing the precise localization of lesion in this anatomical region was difficult.

Vertigo in children.

The aim of this study was to search for the reason for vertigo in children who complain of it. We tested 30 children who had been treated by a pediatrician for various diseases. We performed the detailed protocol of anamnesis, videonystagmography, posturography, and additional tests ordered by the pediatrician and then compared the results of these procedures with those of a group of 30 healthy children. Respiratory system infections, gastritis, and spondylosis were diagnosed most often by pediatricians in young people with vertigo. From videonystagmography results, we observed only four types of pathological reactions: positional nystagmus, cervical nystagmus, abnormal eye-tracking test results, and square wave abnormalities. Only 40% of children demonstrated objective signs of vertigo. Posturography results did not provide specific findings as compared with those from the healthy children. We discussed the probable reasons for vertigo, among which psychogenic origin, side effect of medications, hormonal disturbances, spondylosis, and diet errors had to be taken into consideration.