Increased antisecretory factor reduces vertigo in patients with Ménière's disease: a pilot study.

It has been hypothesized that the symptoms of vertigo in patients with Ménière's disease somehow are related to impaired production and/or transport of endolymph. Antisecretory factor (AF) is a protein known to affect transport processes in the intestine and it has been shown that intake of specially processed cereals (SPC) can increase endogenous AF synthesis. In a prospective open pilot study, 24 patients with severe Ménière's disease (functional level scale 5-6 according to the criteria of AAO-HNS) received SPC for 14-30 days. AF levels in plasma increased by 83% in 20 of the 24 patients studied. The attacks of rotatory vertigo were reduced, to final AAO-HNS functional level scale 1-3, in 12 patients and in three of these hearing was normalized. Twelve patients had no or minor effects of the treatment. The correlation between AF activity after treatment and the final AAO-HNS functional level scale was -0.65, P<0.001. Studies in rats using immunohistochemistry methods showed that AF was localized to the cochlea and the vestibule of the inner ear. The present results suggest that AF might be a new regulator of the endolymph.

Clinical observations of effects on central nervous system in patients with acute facial palsy.

Twenty-eight consecutive patients with acute unilateral facial palsy were examined with special reference to clinical signs of central nervous system involvement. The clinical investigation in the acute stage of the disease showed that only seven patients had solitary facial nerve dysfunction, while the remaining patients had evidence of more widespread disease involvement. The most frequent finding was a trigeminal dysfunction of the paretic side, as shown by paresthesia and sensibility disturbance corresponding to the sensoritrigeminal area, as well as a dysfunction of the trigeminal component of the corneal reflex of the paretic side. Three patients showed migrating symptoms that were suggestive of a brain-stem disorder. In addition, four patients had an optic neuropathy, while an abnormal brain-stem audiometry response was demonstrated in five patients. The outcome of acute facial palsy one to two years after onset, however, could not be predicted from the clinical central nervous system signs. The degree of the palsy in the acute stage of the disease still seemed to be one of the most important prognostic factors. It is concluded that acute facial palsy is not a single entity, but rather a feature of different neurologic conditions.

Cortical evoked potentials in response to trigeminus nerve stimulation in humans.

A standard technique for recording trigeminal somatosensory evoked potentials (TEP) in response to stimulation of the second branch of the trigeminus nerve is described. Thirty-six nerves of 18 apparently healthy subjects have been investigated. A characteristic polyphasic wave was repeatedly observed. It consisted mainly of a P20, N30, P40, N50 sequence of deflections. Intraindividual variations were minimal. The response pattern varied according to the positions of the recording and stimulating electrodes. The method is useful in detecting functional integrity of the afferent pathways of the 5th cranial nerve, and it can be used as a diagnostic tool for routine investigation of the trigeminus nerve.

Auditory brain stem response abnormalities in patients with Bell's palsy.

To evaluate the hypothesis of CNS involvement in Bell's palsy, the auditory brain stem responses (ABR) of 31 patients were studied. In nine of these patients ABR abnormalities were found. None of these patients showed evidence of dysfunction of the cochlear nerve. Six of the patients who had abnormal ABR were retested after they recovered from the facial paresis. Five of these patients showed persistent ABR abnormality, and one showed a normalization of the ABR. These results may be consistent with an injury at the brain stem level in some patients with Bell's palsy. The possible causative agent of a reactivation of a herpes simplex virus infection is discussed.

Serum and cerebrospinal fluid pathology in patients with sudden sensorineural hearing loss.

The serum and cerebrospinal fluid (CSF) pathology of patients with sudden sensorineural hearing loss (SHL), both seropositive and seronegative to Borrelia burgdorferi (Bb), was prospectively studied. Nineteen consecutive patients were included and trends between the degree of hearing recovery and serum/CSF pathology and given therapy were examined. The pilot study showed a high prevalence (68%) of pathology in serum and CSF in patients with SHL. In 54% of the patients, elevated levels of CSF proteins and/or pathological CSF cell counts were present without positive antibodies to Bb. Positive levels of antibodies against Bb or pathological proteins in CSF were associated with better hearing recovery (means of 47.2 and 51.7%, respectively). The audiometric configuration "high frequency sloping" hearing impairment was associated with the lowest degree of hearing recovery. Patients with SHL and positive serology to Bb who received antibiotic treatment (oral tetracycline), with or without steroids, had the best hearing recovery in this study (61.7 and 48.4%, respectively). In conclusion, we found a high prevalence of serum and CSF pathology in a consecutive group of patients with SHL. Early appropriate antibiotic treatment may prevent the development of major late complications of Lyme disease/borreliosis. We also find it justified to perform more general serological analyses, including CSF analysis, in patients with SHL. A more liberal approach to testing and development of test protocols for SHL patients will increase our knowledge in this field.

Borrelia infection and vertigo.

73 patients with vertigo were studied regarding serum antibodies to Borrelia spirochete antigen, using an indirect immunofluorescence method. Ten patients (14%) had serological evidence of Borrelia infection. All 10 patients had severe, incapacitating vertigo. Four of the Borrelia patients had positional vertigo and all 10 had positional nystagmus when tested using ENG. Five of them had unilateral caloric weakness. Five patients had abnormal oculomotor tests. Borrelia infection is an etiological factor which should be considered in patients suffering from vertigo especially if positional nystagmus is present.

Trigeminal dysfunction in patients with Bell's palsy.

The trigeminal function was investigated in 30 consecutive patients with acute unilateral peripheral facial palsy. The patients were tested with electrophysiological methods within 5 weeks after onset of the disease. Trigeminus-evoked potential test (TEP) disclosed trigeminal dysfunction in 47%, while the blink reflex test (BR) showed trigeminal pathology in 60% of the patients. A topographical analysis of the trigeminal system showed that 24% of the patients had BR patterns that were consistent with brainstem involvement. In 2 cases (7%), TEP was pathological though the BR test proved normal. These findings suggest a more central trigeminal affection and may demonstrate multifocal lesions. This was further underlined by the investigation of the auditory brainstem response (ABR) which indicated brainstem involvement in 28%. It is concluded that acute facial palsy is frequently a symptom of a central nervous affection.

Elevated levels of myelin basic protein in CSF in relation to auditory brainstem responses in Bell's palsy.

Myelin basic protein (MBP) in the cerebrospinal fluid (CSF) was quantified from 28 patients with acute facial palsy. The mean value of MBP in CSF in the study group was 3.4 +/- 0.22 micrograms/l (mean +/- SEM), which was significantly higher than the found in 37 healthy subjects (2.4 +/- 0.13 micrograms/l). Using a 95% confidence interval, 10 patients demonstrated significantly increased CSF concentrations of MBP (greater than 3.95 micrograms/l). Auditory brainstem response (ABR) test showed that 5 patients had abnormal brainstem responses. No significant correlation was observed between elevated MBP in CSF and either pathologic auditory brainstem responses or the clinical degree of the palsy. These results suggest that a brainstem involvement may occur in patients with Bell's palsy. Furthermore, our data accord with previous reports suggesting Bell's palsy to be part of a polyneuropathy.

Elevated levels of myelin basic protein in CSF in relation to auditory brainstem responses in Bell's Palsy.

Myelin basic protein (MBP) in the cerebrospinal fluid (CSF) was quantified from 28 patients with acute facial palsy. The mean value of MBP in CSF in the study group was 3.4±0.22 µg/1 (mean±SEM), which was significantly higher than the found in 37 healthy subjects (2.4±0.13 µg/1). Using a 95% confidence interval, 10 patients demonstrated significantly increased CSF concentrations of MBP (>3.95 µg/I). Auditory brainstem response (ABR) test showed that 5 patients had abnormal brainstem responses. No significant correlation was observed between elevated MBP in CSF and either pathologic auditory brainstem responses or the clinical degree of the palsy. These results suggest that a brainstem involvement may occur in patients with Bell's palsy. Furthermore, our data accord with previous reports suggesting Bell's palsy to be part of a polyneuropathy.

[Early diagnosis important in hearing loss in children]. / Tidig diagnostik viktig vid hörselnedsättning hos barn.

Owing to the identification of pre-, peri- and post-natal risk factors for the development of hearing loss or impairment, diagnosis is now possible at 10-14 months of age and rehabilitative measures can be implemented. It is vital that hearing impairment is discovered at an early stage, as language development occurs predominantly before the age of three. Several methods have been evolved for testing hearing in infants.

Acute acoustic trauma. An emergency condition.

This paper reviews 16 selected patients reporting for acute acoustic trauma (AAT). All patients had a fairly recent pre-accident audiogram. Most of the patients were tested audiologically immediately after the acoustic accident. All patients were men, with ages varying between 16 and 50 years. Eight patients received pharmacological treatment with low-molecular-dextran intravenously, papaverin perorally and prednisolone perorally. The high-frequency pure-tone average (3-4-6 kHz) was more affected than the pure-tone average (0.5-1-2 kHz). In 2 patients, the converse was true. The most affected frequencies were 3, 4, and 6 kHz. The initial maximum hearing loss varied between 15 and 70 dB. In 6 patients, extra-high-frequency audiometry (8-20 kHz) was performed and in all patients an asymmetry was demonstrated. Younger patients had somewhat more hearing improvement after AAT than older patients. It also appears that patients reporting early had a somewhat better healing course than patients reporting later.

Changes in prevalence, aetiology, age at detection, and associated disabilities in preschool children with hearing impairment born in Göteborg.

The prevalence of hearing impairment (HI) in preschool children born in Göteborg in 1980 to 1984 was 2.0 per 1000. This was significantly lower than the 3.8 per 1000 found in a previous study for 1970 to 1974. The decrease took place in the moderate to severe range of HI, while deafness and mild HI remained unchanged during the period. The cause was considered to be prenatal in 58% with heredity in 33% as the main causative factor. Following the introduction of the MPR (Morbilli-Parotitis-Rubella) vaccination programme in Sweden, no cases of rubella- or mumps-induced HI could be found. The number of HI of perinatal origin decreased by half, in spite of the fact that the figures for preterm baby survival almost doubled during the period. Associated disabilities were diagnosed in 62% of the children with HI; speech retardation in 33%, visual abnormalities in 30%, mental retardation in 12% and neuropsychiatric disorders in 9% of the cases. The importance of collaborative efforts between the otolaryngologist and the neurologically and neuropsychiatrically interested paediatrician in the complete evaluation of additional difficulties in the HI child is emphasized.

Borrelia infection in patients with vertigo and sensorineural hearing loss.

Tick-borne Borrelia infection gives rise to symptoms from different organs. Neurologic manifestations are common. The aim of this study was to evaluate to what extent the cochleovestibular functions are involved in this disease. A total of 73 patients with vertigo were studied. The patients had Meniere-like conditions, positional vertigo or unilateral loss of the vestibular function. Antibodies in serum to the Borrelia spirochete were determined in the acute and convalescent periods. Ten patients, 14 per cent, had serological evidence of Borreliosis. All these patients had severe vertigo and four of them had sensorineural hearing loss, furthermore they had positional nystagmus and the nystagmus showed patterns of both central and/or peripheral vestibular lesions. Treatment with high doses of penicillin-G was favourable in five of the patients with vertigo and in one patient with sensorineural hearing loss. Borrelia infection is an etiological factor which should be considered in patients suffering from vertigo and/or sensorineural hearing loss of unknown origin.

Hearing impairment in patients with antibody production against Borrelia burgdorferi antigen.

This study aimed to evaluate the extent to which hearing disorders may be a result of tick-borne Borrelia burgdorferi infection. 98 patients with different patterns of hearing dysfunction were studied. The patients had a history of sudden hearing loss, disorders similar to Menière's disease, or hearing loss in combination with acute facial palsy or with vertigo. Serum antibodies against the B burgdorferi antigen were determined during the acute and convalescent periods. 17 patients (17%) showed serological evidence of borreliosis (reciprocal titre of 320 or above). All but 3 of these patients also had vertigo and 3 subjects had peripheral facial palsy. All the 17 patients were treated with high doses of intravenous benzylpenicillin. The hearing of 5 patients improved on treatment. Although the specificity of antibody production against borrelia antigen has not been completely clarified, it is concluded that repeated serological examinations are worthwhile in patients with unexplained hearing disorders.

Peripheral facial palsy: antibody levels to Borrelia in serum and CSF.

Serum antibodies to Borrelia burgdorferi antigen were determined in 71 consecutive patients with an acute peripheral facial palsy. The study was conducted for one year in a south western coastal region in Sweden. Twenty-one per cent of the patients had significantly elevated serum levels of antibodies to Borrelia burgdorferi antigen. CSF was examined in 13 of the sero-positive patients. In three of these (23%) Borrelia antibodies were found. Another five patients had a pathological protein and cell pattern in the CSF. No seasonal differences were observed. Four of the sero-positive patients had a long-term history of dermatological neurological manifestations compatible with the late third stage of the disease.

Otoneurological abnormalities in asymptomatic HIV-seropositive patients.

Twenty-four male patients, all homosexual except one, with asymptomatic HIV-infection were studied. The patients had no signs of opportunistic CNS-infections but 6 had been treated for syphilis. The patients were tested with auditory brainstem response (ABR) audiometry and with oculomotor tests (saccades and smooth pursuit eye movements). The ABR-recordings were pathological in 38% of the cases and the oculomotor tests in 50% of the cases. Abnormality of either one or of both methods were seen in 67% of the patients tested. The duration of the HIV-infection had no influence on the test results. The abnormal otoneurological tests indicate that occult CNS-dysfunction is a frequent finding in asymptomatic HIV-positive patients.

Possible association of herpes simplex virus infection with demyelinating disease.

Administration of herpes simplex virus (HSV) in sublethal doses to experimental animals may cause a relapsing demyelination in the central nervous system (CNS) but will leave the peripheral myelin unimpaired. Demyelination will be followed by remyelination by oligodendroglial cells or by invading Schwann cells. Relapsing episodes of CNS demyelination seen in HSV latently infected animals may be caused either by reactivation of HSV residing in the CNS itself or virus transported to the CNS after reactivation of a latent infection in peripheral sensory or autonomic ganglia. Although HSV is not the only virus known to induce a demyelination in the CNS of experimental animals, the similarities of this HSV induced demyelination and multiple sclerosis (MS) are intriguing, albeit an association of HSV reactivation and MS has not as yet been reported. However, circumstantial evidence for HSV induction of restricted CNS demyelination in man has recently been obtained: Several laboratories have reported on association of HSV with acute idiopathic facial palsy (Bell's palsy). If HSV be the cause of this palsy, the site of a lesion giving the nerve dysfunction should be located in the brain stem of the CNS rather than in the extrapontine part of the facial nerve. Indeed, most of Bell's palsy patients studied had signs of a brain stem disorder revealed by either one or more of the following tests: auditory brain stem response test, trigeminal evoked potential test or extensive clinical neurological examination. Furthermore, 35% of patients with Bell's palsy had increased concentrations of myelin basic protein in the cerebrospinal fluid collected in the acute stage of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)

The use of doxycycline in nervous system Borrelia burgdorferi infection.

Alternatives to high dose benzylpenicillin treatment are sought for in patients with mild Borrelia burgdorferi nervous system infection. Doxycycline 100 mg twice daily for 10-20 days was used in nine patients with radicular pains, vertigo or weakness in the legs caused by B. burgdorferi infection. The patients had suffered from neurologic symptoms for a median time of five months. In eight patients doxycycline was orally administered and in one intravenously. All nine patients had remission of radicular pain and vertigo during the treatment period. Two patients with weakness in the legs improved slowly in muscle strength over a three month period. The doxycycline concentration in the cerebrospinal fluid was 0.2-1.0 mg/l and in serum 1.9-7.1 mg/l after five days treatment. Doxycycline treatment was found successful in our patients with mild tick borne neuroborreliosis.