[Clinical features of BPPV and their influence on the choice of the doctor's tactics]. / Dobrokachestvennoe paroksizmal'noe pozitsionnoe golovokruzhenie: osobennosti klinicheskoi kartiny i ikh vliyanie na vybor taktiki vracha.

OBJECTIVES: BPPV is the most common cause of recurrent vertigo. Except vertigo attacks main clinical symptoms of BPPV can include autonomic symptoms and imbalance, which sometimes complicate the diagnosis of BPPV.Purpose To evaluate clinical symptoms and management of patients with BPPV before the setting of correct diagnose. MATERIAL AND METHODS: A total of 640 patients (504 (78.8%) women) aged from 20 to 86 years old, mean age 56.43±0.54 years with BPPV were included and diagnosed by roll and Dix-Hallpike tests. Among them 144 (22.5%) patients were inpatient and 496 (77.5%) patients were outpatient. The detailed patient intake comprised the disease onset, the type of dizziness, vertigo triggers, autonomic symptoms, similar attacks in the past and previously made definite diagnosis of BPPV. The period from the appearance of the first symptoms to the correct diagnosis was assessed. RESULTS: The majority of patients (75.3%) consult a neurologist at the initial visit. Only 30.6% of patients had a correct diagnosis within a week of the onset of the disease. Initial BPPV symptoms included persistent dizziness that increased with head turns (38.8%), nausea and vomiting (21.6%), significant increase in blood pressure (13.4%), persistent imbalance while walking (73.4%). Inpatients more frequently had constant continuous dizziness, high blood pressure, severe nausea and vomiting, and the onset of symptoms in the morning when getting out of bed (p<0.05). CONCLUSION: Initial BPPV symptoms may be similar to other diseases. Focusing on medical history and complaints leads to frequent diagnostic errors, unnecessary hospitalization and prolonged treatment of patients. Positional tests are necessary for the correct diagnosis of BPPV.

[Various types of vertigo and balance disorders in patients with Meniere's disease]. / Razlichnye formy golovokruzheniya i narusheniya ravnovesiya pri bolezni Men'era.

Vertigo and balance disorders in Meniere's disease (MD) may have various etiology. The aim of the review is discussing pathogenetic mechanisms of the typical vertiginous paroxysms in MD, resulting from endolymphatic hydrops as well as analysis of etiology, pathogenesis, clinical course and basic treatment of paroxysmal and permanent forms of vertigo and balance disorders, caused by other conditions, associated with MD. We discussed the course of MD complicated by vestibular migraine, benign positional paroxysmal vertigo, functional dizziness, bilateral vestibulopathy and vestibular drop-attacks.

[Benign paroxysmal positional vertigo associated with trauma, middle and inner ear diseases]. / Dobrokachestvennoe paroksizmal'noe pozitsionnoe golovokruzhenie, assotsiirovannoe s travmaticheskim vozdeistviem, zabolevaniyami srednego i vnutrennego ukha.

OBJECTIVE: The aim of the study is to compare clinical symptoms and treatment of posttraumatic benign paroxysmal positional vertigo (BPPV), BPPV associated with middle and inner ear diseases and idiopathic BPPV (iBPPV). PATIENTS AND METHODS: 640 patients with BPPV of various canals were enrolled in the study. 455 (71.1%) patients had iBPPV, 185 (28.9%) had secondary BPPV. Among patients with secondary BPPV in 16 (2.5%) patients it was associated with Meniere's disease (MD), in 34 (5.3%) patients - with sudden sensorineural hearing loss (SSHL), in 14 (2.2%) patients - with vestibular neuritis (VN), in 19 (2.9%) patients - with acute and chronic otitis media (OM) and in 75 (11.7%) patients - with chronic sensorineural hearing loss (CSHL). Posttraumatic BPPV was observed in 27 (4.2%) patients. All patients were treated with repositioning maneuvers and observed for recurrences the following 3 years. RESULTS: IBPPV is the most frequent type in population and has the most favorable prognosis. Combined involvement of posterior and horizontal canals is more frequent in BPPV associated with MD, SSHL and OM in comparison with iBPPV (p<0.01). BPPV associated with BM, SSHL and VN is more resistant to treatment with repositioning maneuvers in comparison with iBPPV: successful treatment with one performed maneuver is more rarely and more follow-up visits to the doctor are needed (p<0.01). BPPV associated with MD has higher recurrence rate (p=0.04). The clinical course of BPPV associated with CSHL and posttraumatic BPPV is most similar to iBPPV.

[Clinical diagnosis and treatment of chronic dizziness]. / Khronicheskoe golovokruzhenie: podkhody k diagnostike i lecheniyu.

Chronic dizziness is defined as a complex of symptoms lasting months or years, including oscillopsia, nystagmus, and postural instability. Diagnostic search includes peripheral vestibulopathy - chronic unilateral vestibulopathy resulting from vestibular neuronitis, schwannoma of the 8th pair of cranial nerves, medical or surgical ablation of the labyrinth, and bilateral vestibulopathy; central vestibulopathy - syndromes accompanied by central vertical nystagmus, small vessel disease in patients with chronic cerebral ischemia; general somatic diseases, peripheral polyneuropathy, side-effects of medications as well as persistent postural-perceptual dizziness. Often, when collecting an anamnesis, it is not possible to identify specific features of dizziness and instability, therefore, clinical and instrumental examination of the patient is of particular importance. In the otoneurological examination, the greatest attention is paid to static/coordination tests, oculomotor tests aimed at identifying signs of damage to the vestibulo-ocular reflex. The principles of treatment depend on the diagnosed cause of dizziness and instability and can, to varying degrees, combine pharmacotherapy, vestibular rehabilitation and psychotherapy, as well as correction of therapy for the underlying disease that caused vestibulopathy.

[Repositioning maneuver for self-performing by patients in cupulolithiasis of horizontal canal BPPV]. / Repozitsionnyi manevr pri kupulolitiaze gorizontal'nogo polukruzhnogo kanala dlya samostoyatel'nogo vypolneniya patsientami doma.

OBJECTIVE: The aim of the study is to evaluate the efficiency of the new repositioning maneuver for patients with horizontal canal cupulolithiasis benign paroxysmal positional vertigo (BPPV) to perform independently at home between doctor's sessions. MATERIALS AND METHODS: 28 patients with isolated horizontal canal cupulolithiasis BPPV were enrolled. In all of them treatment with Gufoni maneuver was not successful after first session. They were divided in M«-¼ group (17 patients), M«-¼ group (11 patients). M«-¼ group performed forced prolong prositionig on the side with less dizziness between sessions. M«-¼ group performed forced prolong prositionig on the side with less dizziness and 3-5 repetitions of new repositioning maneuver 2-3 times a day between sessions. Repositioning maneuver consists of head shaking, then moving to one side-lying position with maintaining it until dizziness stops and resuming the upright sitting position, then without a pause performing head shaking and moving to the other side-lying position with maintaining it until dizziness stops and resuming the upright sitting position. The patients visited doctor once a week. Before treatment and 1 week after treatment dizziness handicap inventory (DHI) was administrated. RESULTS: After 2 and 3 weeks of treatment more patients in M«-¼ group than in M«-¼ group were cured (p<0.05). After 4 weeks of treatment the number of recovered patients did not significantly differ in both groups. After 1 week of treatment according to DHI scores in M«-¼ group there were less patients with mild dizziness and more patients with moderate dizziness than in M«-¼ group (p<0.05). CONCLUSION: Recovery from horizontal canal cupulolithisis BPPV could be achieved at an early date with self-performing of new repositioning maneuver. Patient-perceived disability in persisting horizontal canal cupulolithiasis could be less if the new repositioning maneuver is performed.

[Symptomatic approach to diagnosis and treatment of inflammatory diseases of the outer ear]. / Simptomaticheskii podkhod k diagnostike i lecheniiu vospalitel'nykh zabolevanii naruzhnogo ukha.

The article presents a modern approach to the diagnosis and treatment of inflammatory diseases of the outer ear. The authors consider the main predisposing factors that determine the development of external otitis: traumatic injury, water ingress, use of in-the-ear headphones, occupational hazards and others. The role of various microorganisms, including Pseudomonas aeruginosa, Staphylococcus aureus, bacteria of Enterobacteriaceae family and fungi of genera Aspergillus, Candida, Penicillium, Mucor in the genesis of inflammatory pathology of the outer ear is discussed. For the purpose of effective treatment of external otitis the authors suggest to use a local combined preparation Candibiotic, which contains antibacterial, fungicidal, hormonal and analgesic components that affect the main factors of pathogenesis of the disease.

[Vascular mechanisms in Meniere's disease]. / Sosudistye mekhanizmy v razvitii bolezni Men'era.

Meniere's disease (MD) is chronic multifactorial medical condition caused by endolymphatic hydrops, which etiology is unclear. This review highlights possible vascular mechanisms of MD. Impairment of vascular regulation, further ischemic damage of labyrinth and venous drainage pathology could lead to endolymphatic hydrops. Epidemiologic studies reveal high comorbidity of MD and migraine. Both diseases could be the result of trigeminovascular dysfunction. Betahistine, the medication with vascular effect, is widely used in treatment of MD, the effectiveness of calcium channel blockers is evaluated. Keywords: vertigo, Meniere's disease, endolymphatichydrops, migraine, vascular mechanisms, betahistine.

[Clinical features and treatment of multi-canal benign paroxysmal positional vertigo]. / Mul'tikanal'noe dobrokachestvennoe paroksizmal'noe pozitsionnoe golovokruzhenie: osobennosti diagnostiki i lecheniia.

OBJECTIVE: To reveal clinical features of natural history, diagnosis and treatment of multi-canal benign paroxysmal positional vertigo (m-BPPV). PATIENTS AND METHODS: 640 patients with BPPV are evaluated. 80 (12.5%) patients had m-BPPV, 560 (87.5%) patients had single-canal BPPV. The analyses of involved canals and comparison of the course of the disease and effectiveness of treatment in m-BPPV and single-canal BPPV was done. RESULTS: m-BPPV accounts for 12.5% of all patients with BPPV. In m-BPPV mostly unilateral involvement of posterior and horizontal canals are involved, in bilateral BPPV often both posterior canals are involved. M-BPPV is more often associated with middle and inner ear diseases. Recurrences are more often observed in m-BPPV. For m-BPPV it is typical to have more severe clinical symptoms: constant dizziness, balance problems, intensive nausea and vomiting, frequent falls. M-BPPV is often resistant to treatment with repositioning maneuvers: more maneuvers, more follow-up consultations, carrying out home-based vestibular exercises by patients and use of mechanical chair in some cases are necessary to achieve successful treatment. In patients with m-BPPV residual dizziness after successful treatment often takes place, so that additional diagnosis and assessment is needed.

[Recovery of vestibulo-ocular reflex in vestibular neuronitis depending on severity of vestibulo-ocular reflex damage]. / Osobennosti vosstanovleniia vestibulookuliarnogo refleksa pri razlichnoi stepeni ego porazheniia u patsientov s vestibuliarnym neironitom.

AIM: The aim of this study is to evaluate clinical symptoms and recovery of vestibule-ocular reflex (VOR) in patients with vestibular neuronitis (VN) in dependence on severity of VOR damage according to video head impulse test (vHIT). PATIENTS AND METHODS: 45 patients with VN and superior or both superior and inferior vestibular nerves involvement were recruited and horizontal gain was measured with vHIT. According to gain asymmetry the patients were divided in three groups: 11 patients with 8-19% gain asymmetry, 10 patients with 20-39% gain asymmetry and 24 patients with more than 40% gain asymmetry. RESULTS: Coexisting chronic heart and endocrinological diseases could contribute to greater damage of VOR in VN. In patients with less gain asymmetry the full recovery of gain on the affected side was more often. When gain asymmetry was more than 40%, only 10% of patients demonstrated full recovery of gain in 8-12 months. Dynamic visual acuity (DVA) could normalize in patients with clinically significant gain asymmetry. DVA stays decreased more often in patients with in the most gain asymmetry even after vestibular rehabilitation. Benign paroxysmal positional vertigo appeared in 8.9% of patients with VN and had no correlation with VOR asymmetry. Steroid treatment didn't show significant impact on VOR recovery in patients with VN.

[Dizziness and vertigo associated with vestibular neuronitis: the approaches to the diagnostics and treatment]. / Golovokruzhenie pri vestibuliarnom neironite: podkhody k diagnostike i lecheniiu.

This article is focused on the peculiar features of diagnostics and treatment of dizziness and vertigo in the patients presenting with vestibular neuronitis. The authors present the detailed overview of various theories concerning etiology and pathogenesis of this condition, describe the methods for its clinical and instrumental diagnostics (including its differential diagnostics from other diseases associated with acute dizziness and vertigo). Special attention is given to the methods of pharmacological and physical rehabilitation of the patients suffering from vestibular neuronitis.

[The specific pathogenetic features of the development of chronic tonsillar pathology]. / Patogeneticheskie osobennosti formirovaniia khronicheskoi tonzilliarnoi patologii.

The authors discuss the mechanisms underlying the development of chronic tonsillar pathology confirmed by the methods of histological, autoradiographic, and bacteriological diagnostics. The new aspects of vital activity of microorganisms in the parenchymal tissue of the palatine tonsils are highlighted that account for the low effectiveness of the conservative therapy of chronic tonsillitis and give evidence of the necessity of the surgical treatment of this condition.

[The pedagogical activities at the Department of Otorhinolaryngology of the Faculty of General Medicine]. / Pedagogicheskaia deiatel'nost' kafedry otorinolaringologii lechebnogo fakul'teta Rossiiskogo natsional'nogo issledovatel'skogo meditsinskogo universiteta im. N.I. Pirogova.

This article was designed to substantiate the main principles of the academic process as practiced at the Department of Otorhinolaryngology of the N.I. Pirogov Russian National Research Medical University under the current conditions of the ongoing modernization of the system of higher medical education. The authors emphasize the necessity of the combination of theoretical and practical training with special reference to the specific features of the curricular and extracurricular activities. The importance of the formation of the properly functioning teaching staff is underscored. To enhance the efficiency of the educational process, the wide application of the computer-assisted technologies is recommended that can be simultaneously used to improve the methods for diagnostics and treatment of various pathological conditions. The activities based at the specialized students' scientific circle may prove very helpful to facilitate the acquisition of the necessary theoretical knowledge and practical skills by the medical students and thereby to promote the formation of professional otorhinolaryngologists.

[The peculiar features of vestibular function disorders associated with Meniere's disease]. / Osobennosti porazheniia vestibuliarnoi funktsii pri bolezni Men'era.

AIM: The objective of the present study was to reveal the special aspects of vestibular dysfunction in the patients presenting with unilateral Meniere's disease (MD) during the attack-free intervals. METHODS: The study included 23 patients suffering from unilateral MD; all of them were examined with the use of tonal threshold audiometry, videonystagmography, the caloric test and video head-impulse test (vHIT). RESULTS: The study has demonstrated that the patients with MD are characterized, during the attack-free intervals, by the absence of latent spontaneous nystagmus in conjunction with the positive results of the head shaking test. Moreover, asymmetry of the results of the caloric test together with the normal results of the video head-impulse test is shown to be the characteristic feature of the patients with unilateral MD. The analysis of the degree of sensorineural hearing loss, the caloric test data, and coefficient of labyrinth asymmetry (CLAS) gave evidence of the tendency toward the elevation of the hearing threshold with increasing CLAS.

[The peculiar features of the clinical course of Meniere's disease associated with benign paroxysmal positional vertigo]. / Osobennosti klinicheskogo techeniia bolezni Men'era, assotsiirovannoi s dobrokachestvennym paroksizmal'nym pozitsionnym golovokruzheniem.

AIM: The objective of the present study was to evaluate the frequency of occurrence and clinical features of vertigo spells in the patients presenting with Ménière's disease (MD) associated with benign paroxysmal positional vertigo (BPPV). METHODS: A total of 104 patients with MD were available for the observation. All of them underwent the comprehensive examination that included the audiological study and vestibular tests, such as the Dix-Hallpike test and the roll-test for BPPV diagnostics. A structured questionnaire was used to calculate the average number of vertigo spells per month during the period of 6 months and the mean duration of the vertigo spells; the presence or the absence of changes in hearing ability during the spells as well as the severity of vertigo were determined with the use of the 10-point visual analogue scale. RESULTS: The patients suffering from BPPV associated with Meniere's disease presented with the following clinical features which distinguished them from the patients with idiopathic BPPV (p<0.05): (1) a higher percentage of female patients; (2) a longer duration of clinical symptoms; (3) the frequent involvement of the horizontal semicircular canal; (4) a greater incidence of canal paresis; (5) more therapeutic sessions needed for the recovery in conjunction with a higher rate of recurrence. CONCLUSION: The frequency of association of MD and BPPV was estimated at 14.4%. Such association of MD was more frequently observed in the elderly patients (older than 60 years) (p<0.05). The clinical manifestations of the vertigo spells in the patients having MD associated with BPPV occurred with an enhanced frequency; their mean duration was relatively short due to the presence of both long and short positional vertigo attacks characterized by the absence of hearing changes during the spells and the equal severity of vertigo (p < 0,05).

[The characteristics of broad-band tympanometry in the volunteers with the unaffected hearing]. / Pokazateli shirokopolosnoi timpanometrii u lits s normal'nym slukhom.

AIM: The objective of the present work was to elucidate the characteristics of broad-band tympanometry in the healthy subjects with the unaffected hearing ability. The study involved 54 volunteers (27 men and 27 women) at the age from 21 to 55 years exhibiting no pathologic changes in the ear system as confirmed by the tone threshold audiometry, otoacoustic emission, tympaometry at a frequency of 226 Hz, and reflexometry. All the participants of the study underwent absorbance measurements by broad-band tympanometry within the frequency range from 226 to 8,000 Hz at an ambient pressure. Five parameters have been detected which reflected the major characteristics of the absorbance curve, such as the maximum sound power absorbance ratio; the frequency at which the ear structures absorbed the maximum sound power; the frequency at which the absorbance ratio bounces off the plateau; the frequency at which the absorbance ratio plummets to plateau; and the frequency range within which the absorbance ratio underwent the most pronounced changes. The results obtained in the present study give evidence of response stability and the absence of the statistically significant differences in the absorbance parameters between the men and women obtained by their analysis for the ipsilateral and contralateral ears.

[The modern approaches to the evaluation of the importance of chronic inflammation in the mucous membrane of the middle ear]. / Sovremennye podkhody k otsenke znachimosti khronicheskogo vospaleniia v slizistoi obolochke srednego ukha.

Despite the ever growing progress in antibiotic therapy and the advent of the new methods for this purpose, the number of patients suffering from chronic focal infection of the ENT organs has not decreased during the last decades which turns the problem of chronization of inflammation into a serious challenge for the physicians as exemplified by chronic inflammation in the mucous membrane of the middle ear. Pathological changes in the middle ear make up a large fraction of ENT diseases of importance not only for otorhinolaryngologists but also for the specialists in the related medical disciplines. The present article is an overview of etiological, pathogenetic, and pathomorphological aspects of chronization of the inflammation process that are known to occur in the mucous membrane of the middle ear. In the overwhelming majority of the cases, the main cause of the conversion of acute inflammation in the middle ear into the chronic condition is the inadequate (incorrect), inopportune or incomplete treatment of the acute inflammatory process in the middle ear.

[The basic principles underlying the provision of the urgent and emergency medical assistance in otorhionolaryngology]. / Osnovnye printsipy okazaniya neotlozhnoi i skoroi pomoshchi v otorinolaringologii.

The peculiarities of the clinical course of ENT pathologies are considered with special reference to the associated life-threatening conditions. The basic principles underlyi ng the provision of the urgent and emergency medical assistance in the otorhionolaryngological practice are discussed.

[The place of otorhinolaryngology in modern medicine].

This publication is devoted to the peculiar features of the development of otorhinolaryngology as an integral component of modern medical science and practice and the place it now occupies among other disciplines. Much attention is given to the formation of the scientific views of focal infections with special reference to tonsillitis, the role of immune pathology an allergic reactions in etiology and pathogenesis of ENT diseases. Also considered is the problem of the elaboration of the new surgical methods and their application for the treatment of ENT pathology.

[Focal infections in otorhinolaryngology].

This publication is focused on the mechanisms underlying the clinical course of acute focal infections concomitant with ENT pathology, factors responsible for their chronization and the development of complications. Also discussed are the methods for the early adequate conservative and surgical treatment of these conditions. Special emphasis is placed on the principles of management of chronic tonsillitis.

[The specific clinical features of acute sensorineural loss of hearing associated with vertigo].

The objective of the present study was to estimate the prevalence of vertigo and to determine the type of the lesion of the vestibular analyzer in the patients presenting with acute sensorineural loss of hearing (ASNLH). The secondary objective was to evaluate the possibility of the restoration of the auditory thresholds. The results of the examination and treatment of 94 patients suffering from ASNLH are presented. It was shown that the development of acute sensorineural loss of hearing was accompanied by unilateral peripheral vestibulopathy in 22.3% of the patients. In 5.3% of these cases, dizziness could be attributed to benign paroxysmal positional vertigo and canalolythias is of the posterior semicircular canal on the side of hearing impairment. It is concluded that the presence of the clinical signs of lesions of the vestibular analyzer and peripheral vestibular dysfunction in the form of latent spontaneous nystagmus without gaze fixation and/or asymmetric nystagmus with unilateral weakness in the caloric test is a negative prognostic factor for the restoration of the auditory thresholds in the patients presenting with acute sensorineural loss of hearing.