The Correlation between the Results of the Sniffin' Sticks Test, Demographic Data, and Questionnaire of Olfactory Disorders in a Hungarian Population after a SARS-CoV-2 Infection.

BACKGROUND: After a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, smell disorders frequently occur, significantly affecting patients' quality of life (QoL). METHODS: 110 patients with persistent olfactory disorder after coronavirus infection were enrolled. These patients underwent chemosensory testing using the Sniffin' Sticks test, and completed the Questionnaire of Olfactory Disorders (QOD). RESULTS: 30% of the patients reported anosmia, and 70% reported hyposmia. Upon comparing subjective and chemosensory testing categories, good category matching was observed in 75.3% (i.e., anosmia based on both methods in 10 and hyposmia in 48 cases). Statistical analysis using the Chi-square test revealed a significant result (p = 0.001 *). Between the TDI (i.e., Threshold, Discrimination, Identification) results of the three subjective report groups (i.e., hyposmia, anosmia, and parosmia), no significant differences were observed. When the TDI and QOD results were compared, no consistent significant correlations were found in most TDI and QOD outcomes. Between the TDI and Scale 2 results, a significant, although slight correlation was observed by the Spearman's (rho = 0.213, p = 0.027 *) and Pearson's (rho = 0.201, p = 0.037 *) tests. CONCLUSIONS: The nonsignificant correlation between objective and subjective methods suggests that these results should be interpreted independently. Moreover, adequate management is essential even in mild cases.

Comparison between caloric and video-head impulse tests in Ménière's disease and vestibular neuritis.

OBJECTIVE: To compare the diagnostic accuracies of air caloric testing with electronystagmography and the vHIT (video-head impulse test). DESIGN: Prospective, controlled study. STUDY SAMPLE: MD (Ménière's disease), 26; vestibular neuritis, 27; control, 56. RESULTS: In MD, CP (canal paresis) was pathological in 88.5%, the GA (gain asymmetry) on vHIT was pathological in 65.3%, and the gain was abnormal in only one patient. The GA and CP, were significantly higher in the MD group than in the control group, indicating hypofunction of the horizontal canals in MD, whereas a hyperfunction may also occur. No correlation was observed between the results of the two tests for evaluating MD, suggesting that pathological outcomes of one test do not guarantee abnormalities on the other test. For vestibular neuritis, significantly higher CP (96.3%), GA (81.5%), and gain (51.9%) values were detected. A correlation was identified between the two tests for vestibular neuritis, indicating a similar diagnostic efficiency. The higher percentage of pathological GA versus pathological gain values indicates that the asymmetry may be more informative. CONCLUSIONS: The vHIT showed a higher specificity, whereas the caloric test a higher sensitivity. No correlation between the two methods was observed; therefore, the tests appear to provide complementary information.

Long-term follow-up of patients with vestibular neuritis by caloric testing and directional preponderance calculation.

OBJECTIVES: This study focuses on the diagnostic precision of caloric testing in detecting vestibular neuritis (VN). MATERIALS AND METHODS: In this study, 99 patients (36 men, 63 women, mean age: 44.63 years [Formula: see text] 12.08 SD) with superior VN were involved, and 157 participants with a normal functioning vestibular system were also investigated. All patients underwent a complete neurotological examination, including the caloric test with electronystagmography registration. The canal paresis (CP) and directional preponderance (DP) values were analysed. RESULTS: A VN on the right side was diagnosed in 31.3% and on the left side in 68.7%. When the CP parameters between the control and VN patients were contrasted, a statistically significant difference was observed (p < 0.00001*, Mann-Whitney U test), indicating higher values in the latter group. The prediction of VN based on the CP value was successful in 71%, and statistical analysis indicated a significant result [p < 0.0001*; OR: 5.730 (95% CI 3.301-9.948)]. The DP values were also significantly higher in the VN group (p < 0.00001*). The prediction of VN according to the DP value was successful in 69.8%. A significant result was also observed in this case [p < 0.001*; OR: 4.162 (95% CI 2.653-8.017)]. When both CP and DP were considered, a predictive value of 84.8% with a significant outcome [p < 0.0001*; OR: 82.7 (95% CI 28.4-241.03)] was detected. CONCLUSIONS: Including the CP and DP parameters of the caloric test, VN could be detected in around 85%. Therefore, the caloric helps diagnose the disorder, but both parameters must be considered.

Correlation Between Tinnitus Handicap and Depression and Anxiety Scores.

OBJECTIVES: This study aimed to analyse the correlation between depression, anxiety, and tinnitus handicap in patients with primary tinnitus. METHODS: A total of 102 patients (41 men, 61 women; mean age ± SD: 56.8 ± 11.6 years) were examined. They completed the Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI), and Symptom-Checklist-90-Revised (SCL-90-R). Correlations were analysed using Pearson's and Spearman's tests. Logistic regression analysis was performed. RESULTS: The demographic data suggested a slight female predominance. The THI questionnaires indicated a worsening handicap in 73.5% of the patients, of which the 'mild' category was the most frequent, followed by severe handicaps. According to BDI, 69.6% of individuals fell in the normal category, with mild cases being the most frequent. Of the two psychiatric symptoms, depression (BDI) and tinnitus were strongly correlated (rho= 0.579, P < .0001*). The correlation was also significant according to the SCL-90-R depression questions (rho= 0.523, P < .0001*). Upon comparing the depressive scores and the THI subscores (i.e., functional, emotional, and catastrophic), each showed a significant correlation, with the strongest correlation with functional and emotional scores. The correlation with anxiety was slightly weaker (rho= 0.480, P < .0001*) but also significant. According to the Kaplan-Meier curves and logistic regression, the appearance of depressive symptoms did not significantly influence the appearance of a worsening handicap [P = .428; OR: 1.124 (95% CI: 0.842-1.501)]. However, a worsening handicap significantly influenced the appearance of depressive symptoms [P < .0001*; OR: 1.35 (95% CI: 1.34-4.86)], indicating that tinnitus has a more expressed effect on the appearance of depressive symptoms than reversed. CONCLUSIONS: The correlation between tinnitus handicap and psychiatric comorbidities indicates the importance of psychological factors in tinnitus management. Tinnitus handicap has a more profound effect on depression scores. To avoid the occurrence of comorbidities, tinnitus handicaps must be reduced.

Results of the detailed examinations in patients suffering from tinnitus / A teljes köru kivizsgálás eredményei fülzúgásban szenvedokön

Introduction: Tinnitus is a sound without an external sound stimulus, usually only perceived by the sufferer. Inner ear damage might be found in its background, although many other possible causes exist. Therefore, there is a need for a detailed examination in all cases. Method: In the present investigation, 100 patients (38 men, 62 women; mean age +/- SD: 59 years +/- 11.3) suffering from tinnitus were enrolled. The data and examination results of these patients were analysed in detail. The outcomes of the brain MRI, carotid-vertebral ultrasound, cervical X-ray, pure-tone audiometry, and tinnitometry were analyzed regarding the detailed examinations. Results: In terms of tinnitus laterality, left-sided (34%) and both-sided (53%) were the most frequent ones. The frequency of the examinations was the following: audiometry and tinnitometry (100%), cervical X-ray (80%), cerebral MRI (76%) and carotid-vertebral Doppler ultrasound (21%). Cervical spondylosis/spondyloarthrosis (69 patients), vascular encephalopathy (56 patients) and atherosclerosis of the carotid artery (20 patients) were observed as the most common aberrations. Using the audiometry, normal hearing was detected in 14%, slight sensorineural hearing loss in 25%, moderate sensorineural hearing loss in 44% and severe sensorineural hearing loss in 17%. Tinnitometry detected tinnitus with a mean frequency of 4200 +/- 2200 Hz and intensity of 40 +/- 14.4 dB. Conclusion: The detailed examination of patients suffering from tinnitus is essential in multidisciplinary therapy planning. Possible complications in other organs can also be detected using the carotid-vertebral ultrasound as screening method. Based on the cervical X-ray, the somatosensory tinnitus form can be observed. Pure-tone audiometry and tinnitometry help detect hearing loss combined with tinnitus, pitch, and loudness, which are also essential in therapy planning.

Tinnitus characteristics and associated variables on Tinnitus Handicap Inventory among a Hungarian population.

Background: Tinnitus is a sound precepted without an external sound stimulus. Its background can be categorised into primary and secondary cases. The secondary cases include pathologies of the external, middle and inner ear. Tinnitus can be objective or subjective; the latter can only identified by the sufferer. Previous research results have shown that tinnitus significantly affects the quality of life and daily functioning. Objectives: To analyse the impact of tinnitus on the daily functioning and the possible influence of demographical data and tinnitus duration on it. Methods: 630 patients (265 males and 365 females, 25-85 years of age) suffering from primary tinnitus were enrolled. In the Hungarian language, these patients completed the Tinnitus Handicap Inventory (THI) questionnaire and underwent a complete otorhinolaryngological examination. IBM SPSS V24 software was used for data processing; correlation tests, the Mann-Whitney U and Kruskal-Wallis non-parametric tests were used. Results: According to the THI questionnaires outcomes, most patients (62.5%) were presented with a mild handicap. Based on statistical analysis, no significant correlation was observed between the total THI points and the age of the patients, along with the duration and localisation of the symptoms. However, the total THI scores of male and female patients significantly differed, indicating higher THI values in the female group (p = 0.00052∗). Conclusions: The tinnitus severity was not affected by the duration, localisation of the symptoms and age but by gender, indicating higher values in the case of females.

The effects of tinnitus on the patients' quality of life / A fülzúgás hatása a betegek életminoségére

Introduction: Tinnitus can be considered a common complaint that may significantly affect the patients' quality of life. Tinnitus may be examined based on the Tinnitus Handicap Inventory (THI) questionnaire. Method: The current study involved a total of 559 patients with primary tinnitus who have filled in the validated Hungarian version of the THI questionnaire. The collected data were analysed using the IBM SPSS V24 software. Results: According to sociographic variables, a mild female dominance was observed in the study population, while the average age of the tinnitus sufferers was about 60 years. In terms of laterality of the complaint, left and bilateral tinnitus dominated (39.1% and 40%). The median value was 22 months, considering the duration of the onset of the symptoms. By analysing the categories of the THI questionnaire, it was seen that the ratio of patients categorised into normal handicap was approximately 24% and that most patients were categorized into the mild handicap category (36.1%). In contrast, only 5.5% of patients reported a severe handicap. There was a significant difference between the values of all three groups (p<0.0001*, Kruskal­Wallis test), comparing the values of the individual subscores (functional, emotional, and catastrophic). Conclusion: The use of the THI questionnaire is essential to assess the deterioration in the quality of life caused by tinnitus.

Depression scores and quality of life of vertiginous patients, suffering from different vestibular disorders.

PURPOSE: To contrast the quality of life (QoL) impairment and depression scores of patients suffering from different vestibular disorders. METHODS: 301 patients were examined due to vertiginous complaints at the Neurotology Centre of the Department of Otolaryngology and Head and Neck Surgery of Semmelweis University. These patients completed the Hungarian version of the Dizziness Handicap Inventory (DHI), the Beck Depression Inventory, and the Symptom Checklist-90-Revised questionnaires. RESULTS: According to neurotological examination, the distribution of the different diagnoses was as follows: Menière's disease (n = 101), central vestibular disorders (n = 67), BPPV (n = 47), vestibular neuritis (n = 39), other unilateral peripheral vestibulopathy (n = 18), PPPD (Persistent Postural-Perceptual Dizziness) (n = 16), vestibular migraine (n = 8), and vestibular Schwannoma (n = 5). The results of the DHI questionnaire have indicated worsened QoL in 86.4%, out of which 33.6% was defined as severe. The Beck scale has shown depressive symptoms in 42.3% of the cases, with severe symptoms in 6.3%. Significantly higher total DHI and Beck scale results were observed in patients with central vestibular disorders, vestibular migraine, PPPD and peripheral vestibulopathy, contrasted to the results of the other four diagnosis groups. The onset of the symptoms did not significantly affect the severity of QoL worsening and depression symptoms. CONCLUSION: In this study, the QoL of vertiginous patients was worse in general, with the occurrence of depression symptoms. A difference was observed in the case of the values of patients with different vestibular disorders, indicating the importance of different factors, e.g., central vestibular compensation, behavioural strategies and psychological factors.

The diagnosis of central vestibular disorders based on the complementary examination of the vestibulospinal reflex.

OBJECTIVES: Stance and gait unsteadiness along with vertigo contribute to a central vestibular disorder. For objective analysis ultrasound-computer-craniocorpography (US-COMP-CCG) can be used. Aim of the study was to characterize the unsteadiness in central vestibular disorders and discuss the possible diagnostic usage of US-COMP-CCG. METHODS AND RESULTS: Hundred-and-ninety patients (70 male and 120 female, mean age ± SD, 58.94 ± 15.27) suffering from central vestibular disorder and 230 healthy control patients (78 male and 152 female, mean age ± SD, 50.94 ± 15.27) were enrolled. Stance and gait analysis was according to vestibulospinal tests of US-COMPCCG. IBM SPSS V24 software was used for statistical analysis. Mann-WhitneyU test and Chi-square test were used, along with sensitivity and specificity categorization. The significance level was p < 0.05. According to schematic and statistical analysis instability and postural sway were increased in the vertigo population and statistically significant difference was shown. Upon categorical analysis significant correlation was detected [standing test: longitudinal sway (p < 0.00001), lateral sway (p < 0.00001), forehead covering area parameters (p = 0.0001); stepping test: longitudinal deviation (p = 0.05), lateral sway (p = 0.011) parameters]. CONCLUSIONS: Clinicians should consider that postural instability is prominently present in this population and might be of a diagnostic importance.

A possible objective test to detect benign paroxysmal positional vertigo. The role of the caloric and video-head impulse tests in the diagnosis.

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is characterized by vertigo lasting from seconds to minutes, induced by head movements. OBJECTIVES: Our study aimed to investigate the clinical significance of the caloric vestibular and video head-impulse tests (vHIT) diagnosing the disorder. METHODS: 68 patients suffering from posterior canal BPPV (25 male, 43 females, mean age ± SD, 54.5 ± 13.2 years) and 56 patients with a normal functioning vestibular system as control were investigated. Bithermal caloric test and vHIT was performed during the same medical check-up. Canal paresis (CP%), gain (GA) and asymmetry (GA%) parameters were calculated. RESULTS: The Dix-Hallpike manoeuvre was only positive in 4% of this population. The CP% parameter was only pathologic in two patients, and there was no significant difference between control and BPPV patients (p = 0.76). The GA value was never under 0.8 in this population, but GA% was abnormal in 63.2%. A significant difference comparing the GA% values to the control group was seen (p = 0.034). There was no correlation detected between the CP% and GA% values in BPPV. Regarding the GA% value, 61% sensitivity and 76% specificity was seen. CONCLUSION: The Dix-Hallpike manoeuvre was not often positive in the non-acute phase of BPPV; therefore, objective testing is essential. The caloric test does not have clinical significance in BPPV, but vHIT can be helpful based on the GA% parameter.

Comparative Study Between the Auditory and Vestibular Functions in Ménière's Disease.

OBJECTIVES: To evaluate the relationship between the loss of the cochleovestibular functions in Ménière's disease (MD). METHODS: Forty-three patients with definite MD underwent pure-tone audiometry (PTA) and caloric test. Canal paresis (CP%), dPTA (interaural difference), and average PTA results were contrasted. IBM SPSS V24 was used for statistical analysis. RESULTS: According to PTA, most patients were in stage C, and caloric weakness was found in 29 patients. Linear (R2 = 0.06) and nonlinear correlation tests (rho = 0.245, P = .113) between canal paresis (CP%) and dPTA showed no correlation, as well as between CP% and PTA analysis (R2 = 0.007, rho = 0.11, P = .481). As per the categorial analysis, no correlation was detected between the groups either (κ = 0.174, 95% CI: 0.0883 - 0.431). Based on the results of the analysis, it was concluded that a more advanced stage determined by audiometry does not indicate increasing values in the CP% parameter. CONCLUSIONS: Audiometric changes do not directly correspond with the vestibular ones; therefore, no specific correlation exists between them. Thus, for therapy planning and diagnosis, both tests are necessary.

The influence of dizziness on the quality of life in elderly / Az idoskori szédülés életminoségre kifejtett hatása

Összefoglaló. Bevezetés: A szédülés idoskorban gyakori panasz, amely jelentosen befolyásolja az életminoséget. Háttere sok esetben multifaktoriális, egyes esetekben azonban jól meghatározott ok kimutatható. Célkituzés: Kutatásunk célja az idoskori szédülo populáció panaszainak, valamint életminoségének felmérése volt. Anyag és módszer: Kutatásunkba 36 (13 férfi, 23 nobeteg, átlagéletkor ± SD, 72,78 év ± 4,6), Otoneurológiai Ambulanciánkon szédülés miatt vizsgált, 65 év feletti beteget vontunk be. Ok az általunk összeállított, panaszokkal és rizikófaktorokkal kapcsolatos kérdoív mellett a Dizziness Handicap Inventory-t is kitöltötték. Az utóbbi alapján meghatározható volt az életminoség-romlás, illetve annak mértéke. A statisztikai elemzést az IBM SPSS V24 szoftver segítségével végeztük, Mann-Whitney U-teszt és khi-négyzet-próba alapján. Minden esetben p<0,05 értéket tekintettünk szignifikáns különbségnek. Eredmények: A leggyakoribb diagnózisként a Ménière-betegséget, valamint a centrális vestibularis eltéréseket detektáltuk. A betegek visszajelzése alapján a szédülés volt a legdominánsabb tünet, amely a leggyakrabban órákig, illetve napokig tartott, és fele arányban volt forgó jellegu. Emellett a fülzúgás, a halláscsökkenés, valamint a vegetatív tünetek is dominánsak voltak. A leggyakoribb társbetegségek közül gyakoriságuk miatt kiemelendok a mozgásszervi, illetve szemészeti eltérések, a hypertonia, valamint a pszichiátriai betegségek. A betegek 77,8%-a jelzett valamilyen mértéku életminoség-romlást, és kiemelendo, hogy 30%-uk a súlyos kategóriába esett. A Dizziness Handicap Inventory kérdoívek alapján a fizikális, funkcionális, valamint emocionális részpontszámok hasonló értéket mutattak. Következtetés: Az idoskori szédülés lényeges a beteg romló életminosége szempontjából. A társuló komorbiditások mellett a háttérben álló vestibularis eltérések kizárása, illetve diagnosztizálása fontos feladat. Ennek függvényében tervezheto a terápia, amely kapcsán a kíséro tünetekre is fontos hangsúlyt fektetni. Így az érintett betegek életminosége javítható. Orv Hetil. 2021; 162(47): 1891-1896. INTRODUCTION: Vertigo is a common complaint in elderly, which has significant influence on the patients' quality of life. In many cases its background is complex, although, in some cases specific diagnosis can be made. OBJECTIVE: Our study aimed to analyze the symptoms and quality of life of old-age vertiginous population. MATERIAL AND METHOD: 36 patients (13 males, 23 females, mean age ± SD, 72.78 years ± 4.6) over 65 years, examined due to vertigo at our Neurotologic Department, were enrolled. A questionnaire including questions regarding the symptoms, risk factors, along with the Dizziness Handicap Inventory was used. Statistical analysis was carried out using IBM SPSS V24 software. Mann-Whitney U and chi square tests were used. Statistical significance was defined as p<0.05. RESULTS: Ménière's disease and central vestibular disorders were found as the most frequent diagnoses. Vertigo was the most tormenting symptom, which usually lasted for hours or days, and was defined as rotatory in 50%. Tinnitus, hearing loss and vegetative symptoms were also dominant. The most frequent comorbidities were musculoskeletal disorders, hypertension, ophthalmological diseases and psychiatric disorders. 77.8% of the patients have reported worsened quality of life, of which 30% was detected as severe. Based on the Dizziness Handicap Inventory, physical, functional and emotional scores showed similar results. CONCLUSION: Vertigo in elderly is important due to its influence on patients' quality of life. Besides comorbidities, the diagnosis of vestibular pathologies is of great importance. Therefore, therapy planning is possible, and patients' quality of life can be improved. Orv Hetil. 2021; 162(47): 1891-1896.

Assessment of the patients' quality of life visiting the emergency department with dizziness / A sürgosségi osztályon szédüléses panaszokkal megjelent betegek életminoségének vizsgálata.

Összefoglaló. Bevezetés: A szédülés gyakori panasz, amellyel a betegek felkeresik a sürgosségi osztályt. Emellett fontos tünet, hiszen kihívást jelent mind a diagnosztika, mind a terápia szempontjából, és nagy hatással lehet a betegek életminoségére. Célkituzés: Kutatásunk célja annak vizsgálata, hogy mennyire befolyásolta a szédülés a betegek életminoségét a sürgosségi osztály elhagyását követoen. Módszer: A vizsgálat idotartama alatt 879, szédülést panaszoló beteg jelent meg a Semmelweis Egyetem sürgosségi osztályán. Részükre kérdoív került kiküldésre, amely tartalmazta a 'Dizziness Handicap Inventory' (DHI-) kérdoívet is. Megkeresésünkre 308 beteg (110 férfi, 198 no; átlagéletkor: 61,8 ± 12,31 SD) válaszolt, az általuk visszaküldött kérdoíveket részletesen elemeztük. Eredmények: A leggyakoribb diagnózisok közé a benignus paroxysmalis positionalis vertigo, a centrális egyensúlyrendszeri eltérések és a szédülékenység tartoztak. Az elemzés alapján különbség volt látható a fizikális, a funkcionális és az emocionális pontszámok között. Kiemelendo, hogy a legmagasabb értékeket a fizikális csoportban regisztráltuk. A részletes otoneurológiai kivizsgáláson átesett betegek DHI-értékeit összevetettük azokéival, akik nem jártak ilyen vizsgálaton, a két csoport értékei között azonban nem volt szignifikáns különbség (p = 0,97). Emellett a DHI-érték emelkedése volt látható a végleges diagnózisig eltelt ido függvényében. Következtetés: A végleges diagnózisig eltelt ido, illetve a megfelelo kivizsgálás hiánya jelentos hatással van a szédülo betegek életminoségére. Lényeges a kivizsgálás, a mielobbi diagnózis és a részletes egyensúlyrendszeri vizsgálat szerepe, ugyanakkor az utóbbi indokolt esetben kell, hogy történjen. Orv Hetil. 2021; 162(30): 1216-1221. INTRODUCTION: Dizziness and vertigo are among the most common complaints in the emergency department. This may require interdisciplinary cooperation due to their complex presentation in the department and the effects on the patients' quality of life. OBJECTIVE: Our study aimed to assess the effect of an acute vertigo episode on the quality of life after patients' discharge from the emergency department. METHOD: 879 patients examined at the Semmelweis University emergency department with vertigo and dizziness were included in the study. A questionnaire, including the Dizziness Handicap Inventory (DHI), was addressed to this population. We received 308 answered questionnaires back (110 males, 198 females; mean age 61.8 years ± 12.31 SD), which were further analyzed. RESULTS: The most frequent diagnoses were benign paroxysmal positional vertigo, central lesions and dizziness. According to the analysis of the DHI questionnaire, a difference between physical, functional and emotional scores was shown, whereas the highest scores were registered in the physical group. The DHI questionnaire scores of patients undergoing a neurotological examination and those who did not were further compared, whereas no significant statistical difference was indicated (p = 0.97). In addition, an increase in DHI scores was seen depending on the time elapse for the definitive diagnosis. CONCLUSION: The absence of adequate examination and a late diagnosis of the dizziness cause have a significant impact on the quality of life of patients. Therefore, substantial investigation, early diagnosis, and detailed vestibular examination are essential, but the latter should take place in justified cases. Orv Hetil. 2021; 162(30): 1216-1221.

Effectiveness of intratympanic dexamethasone for the treatment of vertigo attacks in patients with Ménière's disease compared with betahistine pharmacotherapy.

OBJECTIVE: This study analyzed the possible effects of intratympanic steroid (ITS) therapy in the symptomatic treatment of vertigo attacks in patients with Ménière's disease. METHODS: Thirty-five patients treated with ITS (dexamethasone) plus betahistine (Group A) and 35 patients treated with betahistine alone (Group B) were enrolled in this investigation. Complaints were analyzed using medical records and vertigo diaries. Statistical analysis was conducted using IBM SPSS V24 software. RESULTS: Based on the analysis, there were no significant differences in baseline features between the two groups. When the occurrence of vertigo attacks was compared using the Kaplan-Meier method, no significant difference was detected between Groups A and B (odds ratio [OR] = 1.051, 95% confidence interval [CI] = 0.965-1.067; p = 0.972). In addition, no difference in the incidence of vertigo attacks was noted in group A between the periods of treatment with betahistine alone and betahistine plus ITS when the groups were analyzed via logistic regression (OR = 1.07, 95% CI = 0.065-1.467; p = 0.614). CONCLUSION: It can be concluded that the addition of ITS therapy to betahistine did not improve outcomes in patients with Ménière's disease. Further prospective studies should be conducted to analyze the results in a more detailed manner.

[What happens to vertiginous population after emission from the Emergency Department?] / Mi történik a szédülô beteggel a sürgôsségi osztály elhagyása után?

Background - Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose - The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods - 879 patients were examined at the Semmel-weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results - Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion - The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion - Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.

Intratympanic gentamycine for Ménière's disease: is there a selective vestibulotoxic effect?

PURPOSE: The aim of our study is to investigate the effectiveness and safety of the treatment, based on vertigo diaries and pure tone audiograms. METHODS: The complete medical documentation of 105 definite patients suffering from Ménière's disease was analyzed. In the studied group, nine patients were treated with intratympanic gentamycine. Long-term follow-up of the patients was carried out, using vertigo diaries, medical letters, anamnestic data, and pure tone audiograms. Audiometric results and vertigo complaints before and after treatment were contrasted using IBM SPSS V24 software. RESULTS: Based on our analysis, vertigo attacks appeared significantly less often after gentamycine treatment [p < 0.001; Odds ratio 0.003 (95% CI 0.001-0.012)], which confirms the efficacy of the therapy. Pure tone stages before and after the application of gentamycine were contrasted using the Mann-Whitney U test. When comparing the audiometric results of long-term follow-ups by using the logistic regression, a statistically significant difference was observed between the treated and not treated groups [p = 0.001; Odds ratio 0.141 (95% CI 0.064-0.313)], and based on the survivorship curve hearing impairment was more common in the not treated group which also supports our results. Based on the non-parametric test, there was no significant difference (p = 0.84) between the pure-tone stages of the control group and of those treated with gentamycine. CONCLUSION: Our results indicate that intratympanic gentamycine is effective in controlling vertigo attacks, and there is no higher risk for hearing loss than in case of spontaneous progression of the disorder.

[Objective diagnostic possibility in the differentiation of idiopathic and secondary benign paroxysmal positional vertigo]. / Objektív vizsgálati lehetoség az idiopathiás és a másodlagos benignus paroxysmalis positionalis vertigo elkülönítésében.

Introduction: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder. The most important symptom is vertigo, which is triggered by changes in head position and sometimes is accompanied by vegetative symptoms. Furthermore, etiology may be subcategorized into idiopathic and secondary (connected to other vestibular disorder, like Ménière's disease, vestibular neuritis, or vestibular migraine). Aim: To identify such parameter of ultrasound-computer-craniocorpography (US-COMP-CCG), which could be useful in the differentiation of idiopathic and secondary BPPV. Material and method: 135 patients suffering from BPPV and 140 normal vestibular functioning patients were examined with UC-COMP-CCG. Statistical analysis was completed by using IBM SPSS V24 software. Results: 109 patients suffered from idiopathic BPPV (i-BPPV), and 26 patients from secondary BPPV (s-BPPV). Parameters indicating the imbalance were observed in both the standing test and the stepping test. Respectively, remarkable results were given in the forehead covering and the self-spin parameter. Conclusion: By applying and examining both study groups with US-COMP-CCG, we were able to use modern diagnostics and thus have an objective evaluation based on their properties. The objective results from the US-COMP-CCG parameters show the deterioration of the vestibular system as well as the change in values, based on the cause of BPPV in secondary cases. Orv Hetil. 2020; 161(6): 208-213.

[Effect of the stapedius and tensor tympani muscles tenotomy on the quality of life of patients suffering from Ménière's disease]. / A musculus tensor tympani és a musculus stapedius ín átvágásának hatása a Ménière-betegségben szenvedok életminoségére.

Introduction: Tenotomy of the tendon of the stapedius and tensor tympani (TT) muscles is a minimal-invasive surgical therapeutic procedure in Ménière's disease (MD). It has been assumed that the TT medializes the stapes into the oval window, resulting in changes in perilymphatic pressures of the inner ear. By cutting the tendons of both middle ear muscles, they affect the pressure dynamics by not augmenting this pressure even further. Aim: The immediate and long-term investigation of the effect of middle ear muscle tenotomy on the quality of life of patients suffering from Ménière's disease, measured by the Dizziness Handicap Inventory (DHI) and the Tinnitus Handicap Inventory (THI). Method: A follow-up study of 22 patients with definite, unilateral Ménière's disease had undergone tenotomy under general or local anesthesia through an endaural approach. Pre- and postoperative DHI values were compared for all patients. Statistical analysis: The statistical analysis was completed by using the IBM SPSS V24 software. Since the parameters did not show normal distribution, non-parametric test (Mann-Whitney U test) was used. The significance level was specified as p<0.05. Results: A statistically significant reduction of DHI scores was noted in all patients. The tinnitus significantly reduced and all of the patients mentioned improved symptoms of MD. Conclusion: Although the follow-up period is short, and the pathomechanism (decrease of stapes medialization in the oval window) is not exactly clear, tenotomy seems to be a successful promising surgical treatment method with a high reduction of dizziness handicap score in conservative therapy-resistant Ménière's disease. Orv Hetil. 2020; 161(5): 177-182.