RESUMEN
Vestibular neuritis occupies the third place in terms of prevalence in the structure of peripheral vestibulopathies, therefore, the choice of optimal diagnostic and differential diagnostic tactics at different stages of the disease is an urgent task. OBJECTIVE: To optimize the diagnostic algorithm for vestibular neuritis based on an assessment of the sensitivity of clinical methods for studying vestibular function in the recovery period of the disease. MATERIAL AND METHODS: A comprehensive assessment of the sensitivity of clinical methods for the study of vestibular function in the acute (up to 14 days: at the time of initial treatment, on the 7th and 14th day) and subacute (up to 3 months: on the 28th and 90th day) periods of the disease in 52 patients with upper vestibular neuritis was carried out. RESULTS: The timing of the processes of restoration of vestibular function after a transferred vestibular neuritis is individual: after 14 days, restoration of vestibular function was recorded in 52% (n=27) patients, after 1 month - in 62% (n=32), after 3 months - in 71% (n=37) patients with upper vestibular neuritis. Statocoordination, statokinetic, oculomotor tests under visual control have the highest sensitivity in the acute period of vestibular neuritis, within up to 7 days from the onset of symptoms. In the subacute period of vestibular neuritis, the study of spontaneous nystagmus and nystagmus in the head shaking test retains high sensitivity only when using special tools (Frenzel goggles or videonystagmography). A decrease in the sensitivity of the head rotation test and the dynamic visual acuity test in the subacute period of vestibular neuritis is associated with the processes of central compensation and the formation of a latent saccade. CONCLUSION: The sensitivity of clinical tests in patients with vestibular neuritis depends on the timing of the examination.
Asunto(s)
Pruebas de Función Vestibular , Neuronitis Vestibular , Humanos , Neuronitis Vestibular/fisiopatología , Neuronitis Vestibular/diagnóstico , Neuronitis Vestibular/complicaciones , Pruebas de Función Vestibular/métodos , Adulto , Femenino , Masculino , Persona de Mediana Edad , Vestíbulo del Laberinto/fisiopatología , Diagnóstico Diferencial , Recuperación de la FunciónRESUMEN
A review of the literature on rehabilitation methods for bilateral vestibulopathy is presented using RSCI, Scopus and PubMed databases. The principles and effectiveness of physical vestibular rehabilitation, vestibular implants, galvanic vestibular stimulation, and biofeedback-based sensory substitution and augmentation systems are described. The advantages and disadvantages of each method and perspectives for their improvement are presented.
Asunto(s)
Vestibulopatía Bilateral , Humanos , Vestibulopatía Bilateral/rehabilitación , Vestibulopatía Bilateral/fisiopatología , Vestibulopatía Bilateral/diagnóstico , Terapia por Estimulación Eléctrica/métodos , Biorretroalimentación Psicológica/métodos , Resultado del TratamientoRESUMEN
Data on the state of sense of smell in patients who had a new coronavirus infection caused by the SARS-CoV-2 virus are currently reduced because of the impairment of the olfactory nerve system. There are practically no results in studies of disorders in the trigeminal nerve system. OBJECTIVE: Qualitative assessment of olfactory disorders after COVID-19 according to the system of olfactory and trigeminal nerves with a targeted assessment of the functional component of olfactory disorders. MATERIAL AND METHODS: We examined 40 patients aged 19 to 66 who had a coronavirus infection. All patients underwent neurological, otorhinolaryngological examinations, olfactometry, filled out the hospital anxiety and depression scale. RESULTS: Anosmia was diagnosed in 5 (12.5%) patients, hyposmia in 21 (52.5%) patients, and normosmia in 14 (35%) patients. Formed: the 1st group - 14 patients (35%) with normogram according to olfactometry; the 2nd group - 26 patients (65%) with anosmia/hyposmia. In the 1st group, disorders of the anxiety-depressive spectrum were significantly more common. In the 2nd group, a low identification of odors was found, lying in the spectrum of fresh, sharp, unpleasant, irritating, compared with sweet and pleasant or neutral, which indicates a predominant lesion of the trigeminal system. CONCLUSION: In patients with complaints of impaired sense of smell after undergoing COVID-19, the possible functional nature of anosmia/hyposmia should be taken into account, which requires the referral of such patients to psychotherapeutic specialists, and the possible entry of olfactory disorders into the 'trigeminal' spectrum.
Asunto(s)
COVID-19 , Trastornos del Olfato , Nervio Trigémino , Humanos , COVID-19/complicaciones , Femenino , Masculino , Persona de Mediana Edad , Adulto , Trastornos del Olfato/etiología , Trastornos del Olfato/fisiopatología , Trastornos del Olfato/diagnóstico , Trastornos del Olfato/virología , Nervio Trigémino/fisiopatología , SARS-CoV-2 , Anciano , Olfato/fisiología , Olfatometría/métodos , Anosmia/etiología , Anosmia/fisiopatología , Federación de Rusia/epidemiología , Enfermedades del Nervio Trigémino/fisiopatología , Enfermedades del Nervio Trigémino/etiología , Enfermedades del Nervio Trigémino/diagnósticoRESUMEN
One of the main causes of the of the inner ear pathology is a viral infection including SARS-CoV-2 virus. On the other hand the psycho-emotional state of patients also affects patients with hearing loss, tinnitus and dizziness, and an increase in depression and anxiety was revealed during the period of self-isolation. Goal of our study was to analyze cochleovestibular pathology in patients with COVID-19. The study involved 84 patients and the leading complaint was hearing loss - in 70 patients, tinnitus - in 54 patients, dizziness - in 50 patients. In addition, an increased anxiety background was found in patients, as well as signs of depression. Thus, the 2020 pandemic period was a high risk period for patients with inner ear pathology, which may be associated not only with the actual pathological effect of the virus on the auditory and vestibular system, but also with changes in the psycho-emotional status of patients.
Asunto(s)
COVID-19 , Mareo , Acúfeno , Humanos , COVID-19/complicaciones , COVID-19/epidemiología , COVID-19/psicología , Masculino , Femenino , Acúfeno/etiología , Acúfeno/diagnóstico , Persona de Mediana Edad , Mareo/etiología , Mareo/fisiopatología , Adulto , SARS-CoV-2 , Pérdida Auditiva/etiología , Pérdida Auditiva/diagnóstico , Ansiedad/etiología , Ansiedad/diagnóstico , Depresión/etiología , Depresión/diagnóstico , Enfermedades Vestibulares/etiología , Enfermedades Vestibulares/diagnóstico , Enfermedades Vestibulares/fisiopatologíaRESUMEN
The literature review is devoted to the practical application of the method of recording vestibular evoked myogenic potentials (VEMPs) in the diagnosis of the inner ear diseases: superior semicircular canal dehiscence syndrome, Meniere's disease, benign paroxysmal positional vertigo (BPPV), vestibular neuritis. Registration of VMEP is an electrophysiological research method that allows to assess objectively the functional state of the otolith receptors (sacculus and utriculus) and their pathways, which expands the diagnostic capabilities in diagnosis of the inner ear diseases.
Asunto(s)
Enfermedades del Laberinto , Enfermedad de Meniere , Potenciales Vestibulares Miogénicos Evocados , Vestíbulo del Laberinto , Humanos , Vértigo Posicional Paroxístico Benigno/diagnóstico , Enfermedades del Laberinto/diagnóstico , Enfermedad de Meniere/diagnóstico , Potenciales Vestibulares Miogénicos Evocados/fisiologíaRESUMEN
Registration of ocular and cervical vestibular evoked myogenic potentials (oVEMPs and cVEMPs) reflects the function of otolith receptors: sacculus and utriculus. Benign paroxysmal positional vertigo (BPPV) is a disease of the inner ear as a result of the utriculus disfunction and migration of otoliths into semicircular channels. OBJECTIVE: To study the function of otolith receptors (sacculus and utriculus) with using VEMPs registration in patients with first-time and recurrent posterior semicircular canal BPPV before and after repositional maneuvers. MATERIAL AND METHODS: Registration and comparison of the results of oVEMPs and cVEMPs were performed in 50 patients with first-time posterior semicircular canal idiopathic BPPV and 26 patients with recurrent posterior semicircular canal BPPV before and after repositional treatment. RESULTS AND DISCUSSION: Clinically significant asymmetry of the amplitude of oVEMPs before treatment was recorded in 14 (38%) of patients with first-time BPPV and in 15 (57.7%) of patients with recurrent BPPV; cVEMPs - in 6 (12%) of patients with first-time BPPV and in 6 (23.1%) of patients with recurrent BPPV. Successful repositional treatment did not affect the amplitude of cVEMPs in any of the groups of patients, but led to a significant increase in the amplitude of oVEMPs on the affected side in patients with first-time BPPV. In patients with recurrent BPPV, despite the absence of symptoms of otolithiasis, the asymmetry of the amplitude of oVEMPs persisted during remission (p<0.05), which can be considered as a prognostically unfavorable factor of disease recurrence.
Asunto(s)
Vértigo Posicional Paroxístico Benigno , Potenciales Vestibulares Miogénicos Evocados , Humanos , Vértigo Posicional Paroxístico Benigno/diagnóstico , Potenciales Vestibulares Miogénicos Evocados/fisiología , Canales Semicirculares , Membrana Otolítica , Sáculo y UtrículoRESUMEN
The study of vestibular function in patients with Meniere's disease (MD) is an urgent task, since it influences the choice of treatment tactic. We evaluated the results of caloric and video head impulse (vHIT) tests in 76 patients who met the clinical criteria for significant Meniere's disease (AAO-HNS modified by the Barany Society, 2015). Dissociation of the results of caloric and vHIT tests is observed in the majority (74%) of patients with MD: at normal gain, according to vHIT data, hypofunction of peripheral vestibular structures is recorded according to the caloric test (KASL 47 ± 7.8%). In patients with MD, vestibular dysfunction is observed mainly at low frequencies (0.003 Hz), therefore vHIT, which allows assessing horizontal semicircular canal function at high frequencies (3-5 Hz), is not an optimal study for assessing the degree of vestibular dysfunction in patients with MD.
Asunto(s)
Prueba de Impulso Cefálico , Enfermedad de Meniere , Humanos , Prueba de Impulso Cefálico/métodos , Enfermedad de Meniere/diagnóstico , Estudios Retrospectivos , Pruebas Calóricas/métodos , Canales SemicircularesRESUMEN
Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibulopathy. Ppatients with BPPV contact with otorhinolaryngologists in 25% of cases. Due to the polymorphism of this pathology, an urgent task is to asess differential diagnosis of BPPV with various variants of the central positional syndrome: vestibular migraine, myofascial cervical syndrome, organic changes in the structures of the cerebellum. OBJECTIVE: To distinguish atypical forms of BPPV with downbeating vertical nystagmus and the central positional syndrome.
Asunto(s)
Trastornos Migrañosos , Nistagmo Patológico , Vértigo Posicional Paroxístico Benigno/diagnóstico , Diagnóstico Diferencial , Humanos , Trastornos Migrañosos/diagnóstico , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/etiología , Canales SemicircularesRESUMEN
The results of magnetic resonance imaging (MRI) of the inner ear 24 hours after intratympanic administration of 1 ml of diluted (1:7) contrast substance for gadolinium-based MRI in 43 patients with moderate and severe Meniere's disease course are presented. It has been revealed that in case of severe and moderate course of Meniere's disease endolymphatic hydrops is presented in all departments of labyrinth: cochlea, vestibule, semicircular canals, but is most pronounced in vestibular department of labyrinth: horizontal semicircular canal and vestibule. The neuroimaging method according to the presented protocol is safe and can be applied in a wide practice both to assess the presence and localization, and the degree of expression of the endolymphatic hydrops.
Asunto(s)
Hidropesía Endolinfática , Enfermedad de Meniere , Vestíbulo del Laberinto , Medios de Contraste , Hidropesía Endolinfática/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Enfermedad de Meniere/diagnóstico por imagen , NeuroimagenRESUMEN
The results of a comprehensive examination of 82 patients with clinical signs of definite Ménière's disease, unilateral lesion and confirmed by extratympanic electrocochleography endolymphatic hydrops are presented. The results of the study showed that only 38% of patients had cochleovestibular syndrome due to Ménière's disease. In 45% of patients, Ménière's disease was combined with other diseases: benign paroxysmal positional vertigo, vestibular migraine, persistent postural-perceptual dizziness, superior semicircular canal dehiscence. In 17% of patients cochleovestibular syndrome was due to other reasons: vestibular migraine, tumor of the posterior cranial fossa, superior canal dehiscence syndrome, Cogan's syndrome, enlarged vestibular aqueduct, otosclerosis. Complaints, medical history of the disease and life, brain MRI, temporal bone CT and pure tone audiometry in dynamics are important in suspected Ménière's disease. For 1 and 2 Ménière's disease stages the most important characteristic are: progressive unilateral sensorineural hearing loss and reduced slow faze velocity values of caloric nystagmus in dynamics, mainly in warm response if attacks of vertigo is maintain; normal head impulse test between vertigo attacks and pathological result of this test in attack of vertigo with the normalization of gain during the first day.
Asunto(s)
Hidropesía Endolinfática , Enfermedad de Meniere , Audiometría de Respuesta Evocada , Vértigo Posicional Paroxístico Benigno , Diagnóstico Diferencial , Humanos , Enfermedad de Meniere/diagnósticoRESUMEN
The results of treatment of 38 patients suffering from sensorineural hearing loss with the Gliatilin (solution 3 ml intravenously for 10 days, capsules 400 mg 3 times a day or solution for ingestion 600 mg 2 times a day for 3 months) are presented. All patients in dynamics were given a comprehensive audiological, neurological examination, as well as an assessment of psycho-emotional status and cognitive function. Subjective improvement of ear noise tolerance by patients by 40 days of observation and continuation of this trend during the whole period (100 days) outside of the form of the medicinal preparation is noted. A reliable improvement in the 50% speech intelligibility threshold by day 100 of observation was established in patients of both groups, with a tendency towards earlier (on day 70 of the study) onset of this effect when taking the drug inside as a solution. The Gliatilin has been proven to reduce anxiety and depression, as well as reliably improve cognitive function. Thus, Gliatilin (injection solution, ingestion solution, capsules) can be used to improve the subjective tolerance of ear noise, speech intelligibility and quality of life of patients in chronic sensorineural hearing loss.
Asunto(s)
Pérdida Auditiva Sensorineural , Acúfeno , Umbral Auditivo , Pérdida Auditiva Sensorineural/tratamiento farmacológico , Humanos , Calidad de Vida , Inteligibilidad del Habla , Acúfeno/tratamiento farmacológicoRESUMEN
Headache is not infrequently one of the major complaints in the patients visiting the otorhinolaryngologist's office. It was estimated to occur in 24% of the patients presenting with chronic sinusitis. The cause of headache may be pathological processes either in the nasal cavity or in the paranasal sinuses as well as a primary disorder in the nervous system. The present article is concerned with the peculiar features of rhinogenic headache and that of a different etiology. It was shown that the patients suffering from headache are in need not only of the obligatory otorhinolaryngological examination including endoscopy of the nasal cavity, X-ray study and, sometimes, specialized tests but also of neurological counseling. However, the surgical treatment does not always results in the elimination or relief of the rhinogenic headache. Hence, the importance of the evaluation of the risks and benefits of such treatment for an individual patient. The formation of the contact points in the nasal mucosa is considered to be one of the possible causes of rhinogenic headache. However, this opinion needs to be confirmed by the results of large-scale comparative clinical studies.
Asunto(s)
Cefalea , Procedimientos Quírurgicos Nasales , Enfermedades Nasales , Enfermedades de los Senos Paranasales , Diagnóstico Diferencial , Endoscopía/métodos , Cefalea/diagnóstico , Cefalea/etiología , Humanos , Procedimientos Quírurgicos Nasales/efectos adversos , Procedimientos Quírurgicos Nasales/métodos , Enfermedades Nasales/complicaciones , Enfermedades Nasales/diagnóstico , Enfermedades de los Senos Paranasales/complicaciones , Enfermedades de los Senos Paranasales/diagnóstico , Medición de Riesgo , Tomografía Computarizada por Rayos X/métodosRESUMEN
At present, the skeptical attitude toward the term 'cervical vertigo' (CV) predominates in the ENT-community. Such point of view is attributable to the absence of specific CV symptoms and well-defined diagnostic criteria. The present literature review was designed to consider the results of the clinical observations and experimental investigations obtained during the past 150 years that give evidence of the possibility to regard cervical vertigo as a separate nosological entity. The characteristic signs of this condition are analyzed and systematized. Four CV variants are currently distinguished. The principles of diagnostics and treatment of cervical vertigo are discussed and general concept of CV is formulated.
Asunto(s)
Vértigo , Diagnóstico Diferencial , Humanos , Trastornos Migrañosos/diagnóstico , Equilibrio Postural , Trastornos de la Sensación/diagnóstico , Vértigo/clasificación , Vértigo/diagnóstico , Vértigo/fisiopatología , Enfermedades Vestibulares/diagnósticoRESUMEN
The objective of the present work was to study the influence of the dry extract from the leaves of Ginkgo biloba EGb 761 (used as monotherapy at a dose of 120 mg twice daily during 4 months) on the vestibular function of the patients presenting with cochleovestibular pathology of peripheral and mixed genesis. We present the results obtained by the objective and subjective methods for the evaluation of the vestibular function as well as the neurological and psychoemotional state of the 40 patients that was carried out during the four months of memoplant monotherapy. It is concluded that monotherapy with the use of the dry extract from Ginkgo biloba leaves can be applied for the purpose of improvement of static and dynamic balancing state. Moreover, this memoplant preparation can be used as a means of prophylaxis of recurrent dizziness that in addition reduces the severity of anxiety and depression without producing adverse side effects.
Asunto(s)
Mareo , Ginkgo biloba , Fitoterapia/métodos , Extractos Vegetales , Calidad de Vida , Enfermedades Vestibulares , Adulto , Mareo/tratamiento farmacológico , Mareo/etiología , Mareo/psicología , Monitoreo de Drogas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Examen Neurológico/métodos , Extractos Vegetales/administración & dosificación , Extractos Vegetales/efectos adversos , Resultado del Tratamiento , Enfermedades Vestibulares/complicaciones , Enfermedades Vestibulares/diagnóstico , Enfermedades Vestibulares/tratamiento farmacológico , Enfermedades Vestibulares/fisiopatología , Pruebas de Función VestibularRESUMEN
The present article is focused on the detailed analysis of the history of a patient suffering from combined dizziness including the entire course of the disease, the complicating complex of complaints, and the increasing number of abnormal components of the patient's condition. The specific features of various nosological forms of the disease are described as arising from different clinical entities causing vertigo. The special emphasis is laid on the diagnostic algorithm for the elucidation of these disorders.
Asunto(s)
Mareo , Calidad de Vida , Vértigo , Audiometría/métodos , Diagnóstico Diferencial , Manejo de la Enfermedad , Mareo/diagnóstico , Mareo/etiología , Mareo/fisiopatología , Mareo/psicología , Mareo/terapia , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Examen Neurológico/métodos , Evaluación de Síntomas/métodos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vértigo/diagnóstico , Vértigo/etiología , Vértigo/fisiopatología , Vértigo/psicología , Vértigo/terapiaRESUMEN
The objective of the present study was to improve diagnostics of basilar type migraine (BTM) based on the results of neurological, vestibulometric, and audiological studies of 11 patients. Peculiarities of the clinical picture of this disease and the medical histories of these patients are described. The pathogenetic role of labyrinthine hydrops and the difficulties encountered in diagnostics of Meniere's disease are discussed.
Asunto(s)
Enfermedades del Laberinto/fisiopatología , Trastornos Migrañosos/fisiopatología , Adulto , Anciano , Hidropesía Endolinfática/etiología , Hidropesía Endolinfática/fisiopatología , Femenino , Humanos , Enfermedades del Laberinto/etiología , Masculino , Enfermedad de Meniere/etiología , Enfermedad de Meniere/fisiopatología , Persona de Mediana Edad , Trastornos Migrañosos/complicaciones , Migraña con Aura/complicaciones , Migraña con Aura/fisiopatologíaRESUMEN
A systematic review of literature on the issue of involvement in the sense of smell, as well as the interaction between the trigeminal and olfactory nerves, was carried out. The article discusses the features of the chemical perception systems, as well as the treatment of olfactory disorders using transcranial electrical stimulation of the trigeminal nerve.
Asunto(s)
Trastornos del Olfato , Estimulación Transcraneal de Corriente Directa , Humanos , Olfato , Trastornos del Olfato/etiología , Nervio TrigéminoRESUMEN
The review of literature considers the correlation between hearing loss and dementia. Hearing loss is one of the few potentially modifiable factors in terms of dementia prevention, and the research highlighted in this article confirms the need to continue studying this correlation to better understand the benefits of treating hearing loss in order to improve cognitive function. It should be kept in mind that hearing loss also has social consequences in the form of reduced daily activity, communication function, isolation, loss of independence, impaired ability to drive vehicles, and this once again confirms the importance of timely treatment of hearing loss. This article also addresses the problem of late diagnosis, lack of treatment and rehabilitation of hearing loss in elderly people.
Asunto(s)
Demencia , Audífonos , Pérdida Auditiva , Actividades Cotidianas , Anciano , Audición , Pérdida Auditiva/diagnóstico , Pérdida Auditiva/epidemiología , Pérdida Auditiva/etiología , HumanosRESUMEN
The review of domestic and foreign literature was conducted to identify the current terminology, diagnostic criteria, mechanisms of ethiopathogenesis, and the methods of treatment of psychogenic vertigo. The article covers the questions of combined approach to treatment, including vestibular rehabilitation combined with cognitive behavioral therapy.
Asunto(s)
Mareo , Trastornos Psicofisiológicos , Vértigo , Terapia Cognitivo-Conductual , Mareo/psicología , Mareo/terapia , Humanos , Trastornos Psicofisiológicos/terapia , Vértigo/psicología , Vértigo/terapiaRESUMEN
AIM: To explore the possibility of cerebral hemodynamic reserve (CHR) normalization in patients with obstructive sleep apnea syndrome (OSAS), aged over fifty, who received continuous positive airway pressure (CPAP) therapy. MATERIAL AND METHODS: The main group (20 patients, aged 50-65 years, with severe OSAS) and the control group (20 volunteers without snoring and OSAS matched for age and physical status) were studied. Diagnosis included cardio-respiratory monitoring of nocturnal sleep and ultrasound examination of cerebral blood flow with functional tests (breath holding and hyperventilation) and calculating the coefficient of vasomotor reactivity (CVMR) before the start of CPAP-therapy and after one month therapy. RESULTS: The significant CVMR decrease in vertebral (VA) and basilar arteries (BA) in patients with OSAS compared to the control group was identified: 38.9±8.5 and 55.7±11.3 for VA, 36.8±15.7 and 54.0±5.4 for BA. After one month CPAP-therapy, no significant coefficient gains was observed: 38.9±8.5 and 42.3±9.1 for VA, 36.8±15.7 and 37.2±7.7 for BA. CONCLUSION: The reduction of CVMR in patients older than 50 years with severe OSAS suggests the disturbance of CHR. The absence of its recovery within one month of CPAP-therapy may be indicative of the irreversible damage of the cerebral blood flow regulation mechanisms. Continued observations for a longer period are needed.