Vertigo as One of the Symptoms of Lyme Disease.

OBJECTIVES: The aim of the study was to evaluate the frequency of vertigo symptoms and potential labyrinth damage in patients with diagnosed Lyme disease (LD). LD can affect the vestibulocochlear nerve, leading to hearing loss and vertigo/dizziness. MATERIAL AND METHODS: The study included a group of 38 patients between the ages of 20 and 77, who were hospitalized due to vertigo/dizziness between 2018 and 2019. All of the patients underwent a detailed medical interview and an otolaryngological and neurological examination, including video electronystagmography (VENG), in addition to audiological and diagnostic tests. Additionally, ELISA and Western blot tests were performed to confirm the diagnosis of LD. RESULTS: In 20 patients (53%), the Romberg trial was positive (p < 0.001). The degree of vestibular dysfunction as shown by the VENG test was associated with the rate of hearing loss as confirmed by the Auditory Brainstem Response (ABR) test (p = 0.011), and it mainly concerned high-frequency sounds (p = 0.014). CONCLUSION: Vertigo can be a symptom of LD. It is often associated with labyrinth and hearing-organ damage, which can imply that the inner ear or nerve VIII is dysfunctional in the course of this disease. Antibiotic therapy is effective in reducing otoneurological symptoms.

Association between Sudden Sensorineural Hearing Loss and Lyme Disease.

OBJECTIVES: Sudden sensorineural hearing loss (SSNHL) is defined as sensorineural hearing loss of 30 dB or more over at least three adjacent audiometric frequencies occurring within a 72-h period of time. One of the causes of SSNHL could be the progressive inflammatory state caused by an infection. The aim of this study was to assess the prevalence of SSNHL caused by various factors, most importantly those potentially related to Lyme disease. MATERIAL AND METHODS: The study includes a group of 86 patients between the ages of 20 and 70 who were hospitalized due to SSNHL between 2017 and 2018. All of these patients underwent a detailed medical interview and an otolaryngological examination, including audiological and diagnostic tests. Additionally, ELISA and Western blot tests were performed to confirm the diagnosis of Lyme disease. RESULTS: In this group of 86 patients, nine patients presented with positive antibodies toward Borrelia burgdorferi sensu lato. This group was treated with antibiotics and experienced partial or complete regression of their deafness. This may suggest a relationship between SSNHL and Lyme disease. CONCLUSION: Infections caused by Borrelia burgdorferi may contribute to the development of inflammatory and angiopathic lesions, which are a possible cause of SSNHL. The longer the duration of the infection, the greater the likelihood of permanent and irreversible changes in the vessels of the cochlea or auditory nerve. Therefore, serological tests for Borrelia burgdorferi should be performed during the diagnosis of SSNHL as a possible cause of this illness.

Effects of Biofeedback Training on Esophageal Peristalsis in Amyotrophic Lateral Sclerosis Patients with Dysphagia.

Esophageal manometry (EM) could serve as an objective method for the detection of esophageal peristalsis in patients with amyotrophic lateral sclerosis (ALS). In this group of patients, biofeedback training (BT) using the EM procedure is a promising method for the rehabilitation of swallowing function. A total of 20 ALS patients with clinical evidence of dysphagia and who met WFN criteria were recruited for this study. The standard transnasal EM with solid-state transducers was performed, and swallows with water and saliva were initiated in all subjects and repeated at 30-s intervals. The median upper esophageal contractile amplitude, duration, and velocity results during the wet and dry swallows were evaluated and compared in both the ALS and the control groups. In ALS patients, in contrast to the control, significant abnormalities in all EM parameters were recorded, which implies a specific pattern of esophageal peristalsis. Twelve months after BT, the body mass index (BMI) of ALS patients who underwent BT (ALSBT) was compared to the BMI of those who did not (ALS1)-compared to the ALS1 group, ALSBT patients showed a slightly smaller drop in BMI value. We presume that BT using EM can be a promising tool for the improvement of the swallowing mechanism in ALS patients.

Esophageal Peristalsis Disorders in ALS Patients with Dysphagia.

To detect the variations of esophageal peristalsis in amyotrophic lateral sclerosis (ALS) patients with predominantly bulbar or predominantly pseudobulbar clinical presentation by using esophageal manometry (EM). Fifteen ALS patients with pseudobulbar clinical presentation (PBP) and 13 patients with bulbar presentation (BP), fulfilling WFN Criteria, were studied. EM was performed in all subjects using a flexible catheter with solid-state transducers. Swallowing was initiated with 5 to 10 mL of water (wet swallows) and saliva (dry swallows) and repeated at 30 s intervals. The manometric parameters were measured automatically and visualized by the computer system. The tracings were analyzed using Synectics software. In PBP patients, an increase of resting pressure value in the upper esophageal sphincter (UES) >45 mmHg, a wave-like course of resting pressure, and toothed peristaltic waves were observed. In BP patients, a low amplitude of peristaltic waves <30 mmHg (mean: 17 ± 5) was recorded, without signs of esophageal motility disturbance at onset or during progression. EM procedure allows objectively distinguishing dysphagia in ALS patients due to bulbar syndrome from the dysphagia due to pseudobulbar syndrome. It is important to identify PBP patients because of their high risk of aspiration.

Otolaryngological symptoms in patients treated for tick-borne diseases.

infections are borreliosis (Lyme disease) and tick-borne encephalitis (TBE). Lately there is growing incidence of Bartonella, Babesia, Anaplasma and Brucella co-infections. The similarity between the symptoms of tick-borne diseases and other pathologies causes serious diagnostic issues. MATERIAL AND METHODS: 216 patients aged 18-55, who presented to the outpatient clinic for tick-borne diseases in the years 2014-2016, were enrolled in the study. The patients had been diagnosed with Lyme disease and co-infections. The principal diagnostic tests to confirm the infections included ELISA, Western-Blot and circulating immune complexes (CIC). RESULTS: In the group of 216 patients, 162 presented with otolaryngological symptoms. The most common complaint was tinnitus (76,5%) accompanied by vertigo and dizziness (53,7%), headache (39%), unilateral sensorineural hearing loss (16,7%). The patients also had tick-borne coinfections, among them the most common was Bartonella henselae (33,4%) and Bartonella quintana (13%). CONCLUSIONS: Otolaryngological symptoms are a common manifestation of tick-borne diseases. They are most frequently observed in Lyme disease and Bartonella spp. infections. The symptoms in the head and neck region are usually occur in chronic Lyme disease with predominant IgG antibodies nad VlsE antigen.