[ACOUSTIC CR®-NEUROMODULATION -- FIRST EXPERIENCIES IN HUNGARY WITH A NOVEL METHOD IN THE THERAPY OF CHRONIC SUBJECTIVE TINNITUS]. / AKUSZTIKUS CR®-NEUROMODULÁCIÓ -- EGY ÚJ KEZELÉSI ELJÁRÁS MAGYARORSZÁGI BEVEZETÉSE SORÁN SZERZETT ELSO TAPASZTALATOK KRÓNIKUS SZUBJEKTIV FÜLZÚGÁSBAN SZENVEDO BETEGEKNÉL.

OBJECTIVE: Acoustic CR®-neuromodulation is a novel patented method for the therapy of chronic subjective tinnitus and has been tested in Hungary, as one of the first European countries introducing this procedure. It can be used for the treatment of monaural or binaural tonal tinnitus. Suitability of patients for this therapy was assessed by the help of an appropriate set of criteria. Aim of our study was to analyze 6-month therapy and related measurement data of patients first treated with this method in Hungary and evaluate the results. METHOD: 27 outpatients (20 males, seven females) with a minimum of 6-month long history of subjective tinnitus were assessed (four detected on the right side, six on the left side, 17 on both sides) who were treated for six months by Acoustic CR®-neuromodulation. On 44 treated ears (21 right, 23 left), changes of tinnitus frequency and loudness were measured and analysed, using Visual Analogue Scale (VAS) loudness/annoyance/pitch scores and Tinnitus Handicap Inventory tests, which were performed at defined intervals during the treatment period. RESULTS: During this 6-month treatment period, significant decrease was detected in tinnitus frequency and loudness by tinnitometry (irrespective of the affected side), and an improvement in VAS annoyance/pitch scores and THI test results. VAS loudness did not show any significant changes. CONCLUSION: Acoustic CR®-neuromodulation therapy may be a useful treatment of subjective chronic tinnitus, but its efficacy should be proved in controlled clinical trials.

Hungarian adaptation of the Tinnitus Handicap Inventory: reliability and validity.

The objective of this study was to determine the reliability and validity of the Hungarian version of the original Tinnitus Handicap Inventory (THI). In the study design the original THI (THI-US) was translated into Hungarian by three independent investigators. The final Hungarian version (THI-HUN) was constructed on the basis of these Hungarian interpretations and then administered to 72 patients suffering from chronic tinnitus. Construct validity was assessed using short version of Beck's Depression Inventory (BDI), Perceived Stress Scale (PSS4 version), Visual Analogue Scale (VAS) (loudness, annoyance and pitch of tinnitus), pure tone audiometry and tinnitometry. The 72 participants were 43 women and 29 men. Their mean age was 49.86 years with a mean tinnitus duration of 4.16 years. In the results THI-HUN and its subscales showed good internal consistency reliabilities (α = 0.95-0.74), with significant correlation between THI-HUN total score and subscales and the BDI, PSS4 and VAS annoyance. There was a high or moderate correlation between THI-HUN total score and VAS loudness, tinnitus duration, hearing loss and subjective perception of tinnitus loudness. The VAS pitch of tinnitus, the subjective perception of tinnitus pitch, age, gender and level of education did not show any correlation with THI-HUN total score. The test-retest reliability was high (r = 0.97). We conclude that a valid and reliable THI-HUN questionnaire was constructed.

Neurootological aspects of juvenile vertigo.

Pathologies from childhood to adolescence carry physical, cognitive, motor, linguistic, perceptual, social, emotional, and neurosensory characteristics. The ages between 8 and 14 or 15 especially carry very special traits of a rollover in data processing with respect to balance regulation. Data acquisition of neurootological function provides us with a network of information about the sensory status of our young patients. Major neurootological complaints leading to functional neurootological investigations are vertigo (including giddiness), dizziness, and nausea. These complaints may occur acutely but also are present in some patients at a young age as longer-lasting complaints. Physiological and clinical vertigo syndromes are commonly found as a combination of four principal phenomena: perceptual (vertigo), oculomotor (nystagmus), postural (dystaxia), and vegetative (nausea, vomiting). These four cardinal manifestations of vertigo are related to different levels of the vestibular analyzer and require different methods of investigation. The focus of our study is the phase of restructuring of equilibrium regulation in children between the ages of 8 and 15 years.

Neoadjuvant immunotherapy of oral squamous cell carcinoma modulates intratumoral CD4/CD8 ratio and tumor microenvironment: a multicenter phase II clinical trial.

PURPOSE: To investigate the clinicopathologic effects of local neoadjuvant Leukocyte Interleukin Injection (LI) regimen in oral squamous cell carcinoma (OSCC) patients. Treatment regimen included LI 800 IU/d as interleukin-2 (IL-2), administered half peritumorally and half perilymphatically five times per week for 3 weeks; low-dose cyclophosphamide; indomethacin; zinc; and multivitamins. PATIENTS AND METHODS: Thirty-nine patients diagnosed with T2-3N0-2M0 OSCC participated in the pathology portion of this phase II multicenter study (19 LI-treated patients and 20 historical controls). Clinical responses were determined by imaging. Paraffin-embedded tumor samples were obtained at surgery for all patients. Surgery for the LI-treated group was performed between days 14 and 54 after the end of treatment. Histologic evaluation, pathologic staging, necrosis, and American Joint Committee on Cancer grading were performed from hematoxylin and eosin sections. Immunohistochemistry and morphometry determined cellular infiltrate. RESULTS: Two pathologically complete, two major (> 50%), and four minor responses (> 30% but < 50%) resulted from LI treatment (overall response rate, 42%). Histopathology showed that the intratumoral CD4+:CD8+ ratio was low (< 1) in patients not treated with LI (controls). An increase in tumor-infiltrating CD4+ and a decrease of CD8+ T cells was observed in LI-treated patients, leading to a significantly (P < .05) higher intratumoral CD4+:CD8+ ratio (> 2.5). This was paralleled by dendritic cell transition from tumor surface toward stromal interface (P < .05), with macrophage decrease and neutrophil accumulation, multifocal microscopic necrosis, and significant (P < .05) increase in tumor stroma of LI-treated patients compared with controls. CONCLUSION: LI-treated OSCC patients were characterized by a markedly altered composition of tumor-infiltrating mononuclear cells, increased CD4+:CD8+ ratio, and increased tumor stroma to epithelial ratio, all of which were distinct from controls.

Comparing neurootological complaints in patients at the end of their professional lives (51-60 years) with those during the first phase of retirement (61-70 years).

Geriatrics defines the branch of medicine that treats all problems peculiar to old age and the aging, including the clinical problems of senescence and senility. In the full chain of years of the human life, a special period is humans' last decade of professional life (i.e., 51-60 years) and their first decade of retirement (i.e., 61-70 years). For this study aimed at comparing neurootological complaints of persons in this period of their lives, we examined large samples of European neurootological patients: Group A consisted of 1,965 persons aged 51-60 years, and group B consisted of 1,032 persons aged 61-70 years. Of the 11 vertigo and nausea symptoms evaluated, group A demonstrated 2.68 signs and group B 2.49 signs per individual. Acoustic subjective symptoms of tinnitus were exhibited in 55.42% of group A patients, and hearing loss was present in 63.92% of these patients. In group B, 52.62% of patients exhibited tinnitus, and 68.31% of patients had hearing loss. Our experimental neurootometric investigations exhibited the following rates of abnormal test findings in group A: butterfly calorigrams, 71.86%; stepping craniocorpography, 72.01%; and pure-tone audiometry of bone conduction, 37.66% in the right and 47.07% in the left ear. Among group B patients, abnormal test findings were noted as follows: butterfly calorigrams, 69.86%; stepping craniocorpography, 74.03%; and pure-tone audiometry of bone conduction, 44.57% in the right and 55.43% in the left ear.

Depressive disorders in relation to neurootological complaints.

Depression is a state of depressed mood characterized by feelings of sadness, despair, and discouragement. Depression ranges from normal feelings of "the blues" through dysthymia to major depression. Endogenous depression has been identified with a specific symptom complex: psychomotor retardation, early morning awakening, weight loss, excessive guilt, and lack of reactivity to the environment. Reactive depression is precipitated by a stressful life event. In the field of depression, we found an overlapping activity between psychiatry and neurootology. Our sample comprises 134 patients (53 [39.55%] male, 81 [60.45%] female) who were classified either by psychiatrists or by neurologists as suffering from depression. By evaluating our neurootological history data bank (Neurootological Data Evaluation-Claussen [NODEC]) as regards 6 important vertigo symptoms, we found that patients presented with a frequency of 2.10 signs per patient. When we extended the list to 11 vertigo and nausea signs, we found 2.93 signs per patients. All patients underwent an objective and quantitative neurootometric analysis. The following rates of abnormal findings were observed: butterfly calorigram of polygraphic electronystagmography, 69.40%; stepping craniocorpograms, 69.40%; and bone-conduction pure-tone audiometry of the right ear, 28.36%, and of the left ear, 36.57%.

Neurosensory deficits after myocardial infarction.

Cardiovascular diseases are extremely widespread and often cause vestibular system dysfunctions. They are related mainly to organic lesions of the brain. To investigate neurootological functional changes, we compared two samples from among our patients, of whom those in group A (42 persons: 92.86% male, 7.14% female) had experienced myocardial infarction within 1 year before our neurootometric investigation and those in group B had undergone infarction 1 year or more before examination (104 patients: 81.73% male, 18.27% female). Considering only the six most important vertigo symptoms experienced by patients, we found 1.48 symptoms per patient in group A and 2.02 symptoms per patient in group B. As regards acoustic symptoms, 45.24% of patients in group A experienced tinnitus and 52.38% reported hearing loss. In patients in group B, 48.08% were affected with tinnitus and 58.65% with hearing loss. Abnormalities in the neurootometric measurements were revealed as follows: in group A, butterfly calorigrams, 80.95%; stepping-test craniocorpography (CCG), 64.29%; and bone conduction audiometry on the right side, 40.48%, and on the left side, 52.38%; in group B, butterfly calorigrams, 78.85%; stepping-test CCG, 61.54%; bone conduction audiometry on the right side, 28.85%, and on the left side, 41.35%.

[Noninvasive testing of intracranial pressure changes due to body position in infants]. / A testhelyzetváltozás által kiváltott koponyauri nyomásváltozás noninvazív vizsgálata csecsemokön.

INTRODUCTION: The hydrostatic fluctuations of intracranial pressure are transmitted to the inner ear and then the tension of the anular ligament of the stapes changes. This causes a change of the impedance of the transmission apparatus in the oval window. This in turn can be shown by the measurement of otoacoustic emissions (OAE), since both the stimulus and the emissions travel through the oval window. It has been shown that in adults the phase of otoacoustic emissions changes due to changes in intracranial pressure (eg. during positioning from sitting to head-down (Trendelenburg) position). AIMS: The aim of their study was to examine if these phase changes can be elicited in infants and children. RESULTS: In young infants (between 2 and 4 months old) there was no reproducible phase shift during positioning into Trendelenburg position, in children (between 3 and 4 years old) there was a significantly smaller phase shift than in adults. According to their theory that difference is due to the smaller hydrostatic pressure change and the fact that the skull distents easily thereby compensating for the volume change.