Long-term evaluation of the effect of middle ear effusion on the vestibular system in children.

BACKGROUND: Otitis media with effusion (OME) is one of the most common clinical conditions in childhood. Fluid accumulation in the middle ear may impact inner ear. OBJECTIVES: The purpose of this random sample cohort study was to investigate whether the past history of middle ear effusion has a long-term negative impact on the vestibular system in children. MATERIAL AND METHODS: The study was carried out on 22 children aged 7-15 years who had undergone drainage of the middle ear 5 years before evaluation. The control group consisted of 29 healthy children aged 4-17 years. Vestibular function was examined using sway posturography and electronystagmography (ENG). RESULTS: The stabilogram parameters of the study group and the control group were compared. The field of developed area (FDA) and the average body sway velocity (ASV) were analyzed. Elevated stabilogram parameters of FDA and ASV, both with eyes open and eyes closed, were found in the study group. Statistically significant values (p < 0.05) were present for ASV with eyes open and with eyes closed. The ENG recordings were analyzed in both groups. In the study group, spontaneous nystagmus was observed in 40.9% of the children and positional nystagmus occurred in 63.6% of the children. According to tests, eye tracking test was impaired in 27.3% of cases. Rotatory chair testing revealed asymmetry in 18.2% of the children. CONCLUSION: The presence of effusion in the middle ear in the past has a negative impact on the vestibular part of the inner ear. Clinicians should be aware of the possible negative impact of middle ear effusion on the vestibular function in children with a history of otitis media with effusion. With seeimingly asymptomatic children clinicians should inquire parents about symptoms of dysequlibrium and imbalance.

Dynamics of pure tone audiometry and DPOAE changes induced by glycerol in Meniere's disease.

The purpose of this study is to follow up the dynamics of pure tone threshold and DPOAE amplitude changes induced by glycerol with reference to its activity in the inner ear. Selection was made among 38 patients with Meniere's disease for those having positive glycerol test. Pure-tone audiometry and DP-gram were performed in four series: as an initial examination before glycerol intake, 1, 2 and 3 h after. Audiometric changes formed distinct biphasal pattern at all frequencies between 250 and 4,000 Hz. The most dynamic pure tone threshold decrease occurred during the first hour. Between the first and second hour after glycerol ingestion there was a phase of no significant hearing changes. Further pure tone threshold decrease went on within the third hour reaching its top. Observing DPOAE changes, the highest DP amplitude growth occurred after the second and the third hour at DP-gram frequencies 2, 3 and 4 kHz. The fastest DP-amplitude increase was registered as well during the first hour after glycerol ingestion. In 11 persons with both audiometry and DPOAE positive glycerol test, parallel dynamics in the course of the glycerol test was observed. Biphasal glycerol test dynamics suggests the possibility of two mechanisms of glycerol activity in the inner ear.

DPOAE in estimation of the function of the cochlea in tinnitus patients with normal hearing.

OBJECTIVE: The most probable place generating tinnitus in the auditory pathway is the outer hair cells (OHCs) inside the cochlea. Otoacoustic emissions are used to assess their activity. The objective of the investigation was to measure the features of distortion product otoacoustic emissions (DPOAE) in a group of tinnitus patients without hearing loss, estimate the diagnostic value of the parameters for the analysis of cochlear function in the patients, emphasizing those most useful in localizing tinnitus generators, and determine the hypothetical influence of hyperacusis and misophony on DPOAE parameters in tinnitus patients. PATIENTS AND METHODS: The material consisted of 44 patients with tinnitus and without hearing loss. In the control group were 33 patients without tinnitus with the same state of hearing. The tinnitus patients were divided into three subgroups: those with hyperacusis, those with misophonia, and those with neither. After collecting medical history and performing clinical examination of all the patients, tonal and impedance audiometry, ABR, and discomfort level were evaluated. Then DPOAE were measured using three procedures. First the amplitudes of two points per octave were assessed, second the "fine structure" method with 16-20 points per octave (f2/f1=1.22, L1=L2=70 dB), and the third procedure included recording the growth function in three series for input tones of f2=2002, 4004, and 6006Hz (f2/f1=1.22) and L1=L2 levels increasing by increments of 5 dB in each series. RESULTS AND CONCLUSIONS: Hyperacusis was found in 63% and misophonia in 10% of the tinnitus patients with no hearing loss. DPOAE amplitudes in recordings with two points per octave and the fine structure method are very valuable parameters for estimating cochlear function in tinnitus patients with normal hearing. Function growth rate cannot be the only parameter in measuring DPOAE in tinnitus patients, including subjects with hyperacusis and misophonia. The markedly higher DPOAE amplitudes in the group of tinnitus patients without hearing loss suggest that tinnitus may be caused by increased motility of the OHCs induced by decreasing efferent fiber activity, and not by OHC failure. Hyperacusis significantly increases the amplitude of DPOAE in tinnitus patients with no hearing loss.

[RANTES expression in nasal polyps fibroblasts; spontaneously and after stimulation with lipopolisaccharides (LPS) and phytohemagglutinin (PHA)]. / Ekspresja chemokiny RANTES w fibroblastach pochodzacych z polipów nosowych; samoistna i po stymulacji lipopolisacharydami (LPS) i fitohematoksylina (PHA).

INTRODUCTION: According to the results of research carried out by a number of authors, one of the main mechanisms of the generation of polyps is local inflammatory processes accompanied by immune system disorders. It has recently been shown that a number of differentiation factors and inflammatory mediators may be involved in the growth of nasal polyps. RANTES is a eosinophil chemoattractant factor likely could play an important role in a chronic inflammatory response in the nasal tissue that subsequently leads to the development of nasal polyps. OBJECTIVE: The objective of this study was detection of the chemokine RANTES in nasal polyps fibroblasts and researching influence of stimulation with lipopolisaccharides and phytohemagglutinin for RANTES expression in cultured nasal fibroblasts in vitro. METHODS: Nasal polyps were obtained from 17 subjects (9 atopic and 8 nonatopic) during polypectomy. RANTES was measured by immunofluorescence method. RESULTS: Intensive granular luminescence was observed in all cytoplasm of cells with the exception of nucleus. Immunoreactive RANTES was found to be present in 70% of cells. We not find increase percentage of positive RANTES fibroblasts after stimulation with lipopolisaccharides and phytohemagglutinin. RANTES expression was similar in the both: atopic and nonatopic polyps. CONCLUSIONS: This study demonstrates that cultured fibroblasts derived from both atopic and nonatopic patients release RANTES spontaneously and after stimulation with lipopolisaccharides and phytohemagglutinin. This observation and the finding that RANTES is present in nasal polyps fibroblasts suggest that this chemokine may be an important mediator of eosinophil in both atopic and nonatopic nasal polyposis. More research needs to expand on chemotactic factors such as RANTES and their interplay with other local cytokines.

[Malignant tumors of the nose and paranasal sinuses in the years 1992-2001]. / Nowotwory zlosliwe nosa i zatok przynosowych w latach 1992-2001.

On the base of retrospective analysis of 927 cases of malignant neoplasms of the nose and paranasal sinuses, diagnosed and treated in 10 clinical centers in Poland from 1992-2001, the assessment of basic epidemiological data, including the localization of tumor, and stage of local and clinical advancement of the disease at the time of diagnosis has been conducted. In analyzed period of 10 years the trends to change the mentioned above parameters has been examined. The index of morbidity in this period was constant and compareable with figures published earlier. In the analyzed material there is a predominance of males and the sex ratio was 1.45. The majority of cases were between 50-69 years (55%). The most common histopathological diagnosis was carcinoma (58%). The majority of cases of malignant tumors of the nose and paranasal sinuses was diagnosed in the advanced stage T3-T4 (72.3%) with the highest percentage in the middle region. 90% of all cases were treated surgically, but in about 30% it was the only treatment (also in cases of stage T2-T4). In 56% of all patients the surgical procedure was completed by radiotherapy. This data suggest that indications for additional irradiation should be extended.

[DPOAE in tinnitus patients with cochlear hearing loss considering hyperacusis and misophonia]. / Otoemisja DPOAE u osób z szumami usznymi i niedosluchem slimakowym z uwzglednieniem nadwrazliwosci na dzwieki i misophonii.

UNLABELLED: The most probable place generating tinnitus in auditory pathway are outer hair cells (OHC) inside cochlea. To asses their activity otoacoustic emission is used. The goal of the investigation was estimation the features of otoemission DPOAE in groups with tinnitus patients with cochlear hearing loss, estimation of diagnostic value of DPOAE parameters for analysis of function of the cochlea in investigated patients emphasizing DPOAE parameters most useful in localizing tinnitus generators and estimation of hypothetic influence of hyperacusis and misophony on parameters of DPOAE in tinnitus patients with cochlear hearing loss. The material of the study were 42 tinnitus patients with cochlear hearing loss. In the control group there were 21 patients without tinnitus with the same type of hearing loss. Then tinnitus patients were divided into three subgroups--with hyperacusis, misophony and without both of them, based on audiologic findings. METHOD: after taking view on tinnitus and physical examination in all the patients pure tone and impedance audiometry, supratreshold tests, ABR and audiometric average and discomfort level were evaluated. Then otoemission DPOAE was measured in three procedures. First the amplitudes of two points per octave were assessed, in second--"fine structure" method-- 16-20 points per octave (f2/f1 = 1.2, L1 = L2 = 70 dB). Third procedure included recording of growth rate function in three series for input tones of value f2 = 2002, 4004, 6006 Hz (f2/f1= 1.22) and levels L1=L2, growing by degrees of 5dB in each series. RESULTS: DPOAE amplitudes in recording of 2 points per octave and fine structure method are very valuable parameters for estimation of cochlear function in tinnitus patients with cochlear hearing loss. Decreasing of DPOAE amplitudes in patients with cochlear hearing loss and tinnitus suggests significant role of OHC pathology, unbalanced by IHC injury in generation of tinnitus in patients with hearing loss of cochlear localization. DPOAE fine structure provides us the additional information about DPOAE amplitude recorded in two points per octave, spreading the amount of frequencies f2, where differences are noticed in comparison of two groups--tinnitus patients and control. Function growth rate cannot be the only parameter in estimation of DPOAE in tinnitus patients with cochlear hearing loss, also including subjects with hyperacusis and misophony. Hyperacusis has important influence on DPOAE amplitude, increases essentially amplitude of DPOAE in the examined group of tinnitus patients.

[Diagnostic and treatment in nasal polyps of children treated in Wroclaw ENT department in the years 1991-2001]. / Diagnostyka i leczenie polipów nosa u dzieci hospitalizowanych w Klinice otolaryngologii we Wroclawiu w latach 1991-2001.

BACKGROUND: Nasal polyposis is not often observed in children and usually follows general chronic diseases or disorders of cilliary structure or function and occurs mostly after 10 years of age. This is why in children clinical changes qualified as nasal polyposis should always be verified as congenital diseases or neoplasmatic changes. CASE REPORT: The population: of children treated in the years 1991-2001 in the Wroclaw ENT Department with initial diagnosis of nasal polyposis was presented. Material consisted of 52 children admitted in the years of 1991-2001 to Wroclaw ENT Department with already diagnosed nasal polyposis. In each case medical history was collected together with routine physical ENT examination complemented with fiberoendoscopic examination of the nose end epipharynx. In 7 children with initial diagnosis of nasal polyposis hypertrophy of pharyngeal tonsil with vasomotor rhinitis was diagnosed. Those children underwent adenectomy. Remaining group of 45 children aged from 2 to 16 years was analysed. Surgical treatment (polypectomy, FESS) was performed in 44 children. There was antrochoanal polyp in 10 cases (20,4%), monolateral choanal atresy in 1 case, foreign body of nasal cavity in 1 case and neoplasmatic tumour diagnosed in 5 cases. CONCLUSIONS: The diagnostic difficulties in nasal polyposis in children, except neoplasm, are reflected by the cases with initial diagnosis of nasal polyp and finally diagnosed as foreign body with inflammatory reaction or monolateral choanal atresy. Endoscopic examination of nasal cavity together with radiological diagnostic should be ordered routinely in the unclear cases.

[Malignant neoplasm of nose and paranasal sinuses in Lower Silesia in years 1992-2001]. / Nowotwory zlosliwe nosa i zatok przynosowych na terenie Dolnego Slaska w latach 1992-2001.

UNLABELLED: Malignant neoplasms of the nose and paranasal sinuses occur rarely but due to late diagnosis and poor treatment effects still remain a serious problem. The aim of the study was the analysis of all nose and paranasal sinus neoplasms treated at Lower Silesia in the years 1992-2001. MATERIAL AND METHODS: In the years 1992-2001 in Lower Silesia region there were 182 patients treated for malignant nose and paranasal sinus tumors. Males outnumbered females significantly with male : female ratio was 1.9:1. Principal management was combined therapy--surgery with radiotherapy in 84% of the cases. Radiotherapy alone was performed in 8.8% and chemotherapy as palliative treatment in 7.1%. Fifteen patients (8.2%) underwent radical neck dissection followed by radiotherapy. RESULTS: The analysed group constituted 79.6% patients with epithelial tumors and 20.4% with nonepithelial tumors. Cases T3-T4 predominated in the material in amount of 77.9% (113). There were 15 T2 cases (10.4%) and none of T1. Most of the tumors (57%) arose from middle segment of ethmomaxillary sinuses. Upper segment tumors constituted 18.6% of cases and lower segment--10.4%. Enlarged lymph nodes were diagnosed in 8.2%. Survival rate analysis in patient treated in the years 1992-2001 revealed 37.9% (69) of 3-year survival and 30.2% (55) of 5-year survival. CONCLUSIONS: Unsatisfactory results of treatment are an effect of a high advanced stage of the tumor while diagnosed. Its direct causes are: asymptomatic course of the disease, localization in complex anatomical structure, not enough experience among medical staff dealing with the disease very rarely.

[Usefulness of imaging in the diagnosis of salivary gland diseases]. / Przydatnosc badan obrazowych w diagnostyce chorób gruczolów slinowych.

UNLABELLED: The aim of this study was to evaluate the value of modern imaging modalities in the diagnosis and management of different salivary gland diseases. MATERIAL AND METHODS: Material comprised of 135 patients (79 women and 56 men) at the age 14-70 (mean aged 35, 7). Ultrasonography (US) was basic examination in every case. Results of US examinations were compared with sialography, CT and MR imaging. Final diagnosis was established on the basis of histopathologic examination. RESULTS: The big usefulness of new visualization techniques, especially modem ultrasonography in detecting neoplastic and inflammatory processes of salivary glands was stated. CONCLUSION: US is the first, precious imaging modality to evaluate a small lesions (in diameter above 5 mm) of the parotid and submandibular gland. CT and MR is better to evaluate large tumors and should be performed whenever a malignancy is strongly suspected or has been assessed.

[A case of bilateral oncocytomas of the submandibular gland and synchronous renal oncocytomas]. / Przypadek równoczesnego wystepowania guzów onkocytarnych slinianek podzuchwowych z onkocytoza nerek.

A case of 42 years-old man with bilateral big sized (12 x 5 cm and 10 x 4,5 cm) oncocytoma in submandibular glands was presented. Oncocytoma is a rare benign neoplasm observed in numerous of organs. In the case described besides submandibular glands tumours, accessory oncocytic tumours in both kidneys were diagnosed. It was the reason of earlier unilateral nephrectomy. Surgical treatment was applied. The comparison of the both tumours histology allowed to establish proper diagnosis. The case is presented because of the explicitly of the oncocytoma location especially in the both submandibular glands simultaneously with tumour of the same histology in distant organs.

[Nasal glioma--case report]. / Glioma nasi--doniesienie o przypadku.

Benign congenital lesions resulting from the deficient regression of neuroglial tissue in normal embryonic development are called gliomas. They are usually located in the nasofrontal region and are diagnosed in the postnatal period. They are included in the differential diagnosis of nasofrontal midline masses. We present a case of the 9-year-old boy treated in the ENT Department of Wroclaw Medical University with the initial diagnosis of nasal polyposis or tumour which appeared to be glioma in the postoperative histological evaluation. The tumour was removed endoscopically. We present magnetic resonance imaging of the case together with the review of the literature concerning gliomas. We conclude that each doctor has to be aware of possible neoplasm even in the youngest groups of the patients.

An evaluation of postural stability and the effects of middle-ear drainage on vestibulo-spinal reflexes of children with chronic otitis media with effusion.

OBJECTIVE: Many authors agree that chronic otitis media with effusion (OME) are the main causes of vertigo and balance disturbances in children. The aim of this work was the stabilometric evaluation of postural stability and the influence of middle ear drainage on vestibulo-spinal reflexes in children with OME. METHODS: Fifteen children with OME (5-14 years old, 13 males and two females) were selected for bilateral drainage of the middle ear after conservative treatment proved ineffective. The control group consisted of 15 healthy children of an analogous age range. Static and quasi-dynamic posturography was performed to evaluate balance. The tests were performed three times: 1 day before drainage, 1 day after drainage and 4 weeks after drainage. Parameters including the field of the developed area and the average velocity of body deflection were analysed. RESULTS: There was statistically significant elevation of stabilogram parameters in almost all the tests in children with OME as compared to the control group. The changes in the stabilogram parameters were analysed with reference to the timing of the evaluation. Significant improvement was noted after the fluid was removed from the ear, although recovery was not complete after 4 weeks. CONCLUSIONS: The presence of fluid in the middle ear impairs the functioning of the balance system in children. Postural stability and the quantity of vestibulo-spinal reflexes seem to depend on the functional condition of the middle ear. Prolonged cases of OME could potentially handicap a child's motor development.

[Vertigo in women in menopausal period]. / Zawroty glowy u kobiet w okresie menopauzy.

UNLABELLED: The aim of the work was an evaluation of vestibular organ as well as static and dynamic balance condition in menopausal women. We have examined 107 women aged 46 to 55 years, 47 among them with complaints of vertigo (Group I), 30 women aged 45 to 50 years with symptoms of menopause diagnosed in Outpatient of Endocrinology Clinic (Group II) and 30 healthy women aged 45-54 (control Group). Blood concentration of sexual hormones (estradiol, LH, FSH, progesterone), sodium and potassium blood level, electronystagmography (ENG), optokinesis, eye tracking test, static and dynamic posturography and radiography of cervical part of vertebral column were applied in each case. The intensification of the symptoms was assessed according to Blatt-Kupperman scale. RESULTS: There were disturbances of central type in ENG in 70% of the patients from Group I, in 12.7% of the patients from the Group I there were disturbances typical for cervical and (12,7%) positional origin. There were moderate qualitative disturbances in ENG in 50% of the patients from the Group II. No peripheral vestibular lesion as well as no disturbances in optokinesis and eye tracking test were diagnosed in any woman form all the groups. There was significant elevation of stabilogram parameters in the Group I (in comparison to the control Group) in the tests without vision control (static balance) and in all the tests in dynamic posturography. There was significant increase of the velocity of sways to the right and left in the test with eyes closed in the Group II (dynamic posturography). Vertigo in women in menopausal period are not connected with the lesion of the peripheral part of vestibular organ, they are mostly of central origin. Simultaneous posturographic tests reveal worse central co-ordination in vestibular organ, especially after vision control cancellation.

[Experimental joint incus-stapedial injuries in scanning electron microscopy]. / Doswiadczalne uszkodzenia stawu kowadelkowo-strzemiaczkowego w skaningowej mikroskopii elektronowej.

Because all machines and vibration devices also produce noise, the combined activities of both factors are usually examined together. The opinion dominates that vibration exerts only a weak, additionally traumatic influence on the hearing organ. The aim of our investigation was to determine the influence of long-term, whole-body vibration on the incudo-stapedial joint which integrity is indispensable for the protection of the inner ear from the effect of noise. To realize the experimental conditions, sinusoidal vertical shaking (10 Hz, 5 mm, 1.4 g rms), an own noiseless apparatus was consisted. The experiment was carried out on 30 young, healthy, colored guinea pigs. They were subjected to vibration over 1, 3, and 6 months (132, 396, and 792 hours). The investigation was based on examination of the structures of the incudo-stapedial joint in the scanning electron microscopy. Among experimental animals two kinds of changes were ascertained which can be attributed to the activity of vibration. One was an extensive damage to the surfaces of the incudo-stapedial joint itself. The other was an often observed thickening of the bursa of the joint. The frequencies of occurrence and stages of advancement of both were in direct relationship to the duration of the experiment. The evaluation of the observed changes permits an explanation of the mechanism of the damage to hearing of persons subjected to noise and vibration. Whole-body vibration damages the incudo-stapedial joint, making its separation difficult. This may, than, facilitate the transfer of noise and its injurious influence to the inner ear.

Electrophysiological tests of the hearing organ in Hashimoto's disease.

Thyroid gland diseases resulting from an autoimmunological process may influence the hearing organ. The aim of this study was to assess peripheral and central parts of the hearing organ in children with Hashimoto's thyroiditis. Thirty children (mean age 14.9 years) with Hashimoto's thyroiditis were examined. Patients were euthyroid, and presented high blood concentration of antithyroperoxidase (ATPO) antibodies. Pure tone audiometry, tympanometry, otoacoustic emissions (DPOAEs), and brain auditory evoked potentials (BAEPs) were performed. None of the patients had any complaints about hearing acuity; pure tone audiometry, tympanometry, and DPOAEs were normal in all patients. There were considerable disturbances in auditory nerve and brainstem neural conduction in BAEPs. There was positive correlation between the blood concentration of ATPOA and the extent of the disturbances in the central part of the hearing organ. One should consider the possible presence of subclinical Hashimoto's encephalopathy affecting the central part of the auditory organ.

[Inverted papilloma of the nose and paranasal sinuses: diagnosis and treatment]. / Brodawczak odwrócony nosa i zatok przynosowych--diagnostyka i leczenie.

The authors present a retrospective study of 6 patients with inverted papilloma, which appeared in the material of ENT Clinic in Wroclaw in years 1996-2001. In the group of treated patients, we can recognize 5 men and one woman at the age between 42 to 82. Average age amounted to 62 years. At all the patients the papilloma inversum was diagnosed completely accidentally, during histopathological examination, after having polypectomy or Calwell-Luca operation. Operating treatment was proceeded by performing the CT or NMR test. In four cases the Denker's operation was done, in one case More's and in another one we performed the endoscopy operation (limited changes to ethmoidal labyrinth). The patients stay under the observation for 8 months to even 5 years. In one case we observed a relapse, which occurred after 8 months (patient after the Moure's operation). In all the rest cases a relapse was not identify.

[Role of cytokines in pathomechanism of otitis media]. / Rola cytokin w patomechanizmie zapalenia ucha srodkowego.

Otitis media is one of the most common diseases in children. A variety if cytokines, potent inflammatory mediators, play a crucial role in the initiation and maintenance of the immunological response in otitis media. We discussed a profile of cytokines in various forms of otitis media (otitis media acute, chronic otitis media with effusion) and we underlined the differences between these types. We also described the influence of the most common pathogens of otitis media (S. pneumoniae and H. influenzae) on the cytokine panel in middle ear effusion. We discussed the current data supporting the hypothesis that in some cases the middle ear may act as a target organ for allergic inflammation. Since numerous authors demonstrated that the cytokine profiles are relevant for the evolution of otitis media it has been proposed that measurement of some proinflammatory cytokines in the middle ear effusion may be used in order to monitor the inflammatory process. It has been also proposed using cytokines as a target for pharmacological manipulation in the treatment of otitis media.

[Electrophysiologic tests of the auditory apparatus and vestibular organ in Usher syndrome]. / Badania elektrofizjologiczne narzadu sluchu i przedsionkowego w zespole Ushera.

Usher syndrome is a congenital autosomal dominant inherited disease characterised by hearing, balance and vision problems. The aim of the work was an evaluation of hearing and vestibular organ in the chosen group of patients with Usher syndrome diagnosed. Material consisted of 10 persons (5 males and 5 females) aged from 16 to 46 years with Usher syndrome diagnosed. All the patients have been in constant ENT and Ophthalmology Clinics' care. Complex hearing and balance organ, including posturography, as well as complex ophthalmologic examination were performed in each case. Medium or severe perceptive cochlear hearing loss, proper function of vestibular organ and slight elevation of stabilograms parameters were found in 6 cases. In 4 cases there were severe bilateral hearing loss, lack of vestibular function and considerable worsening of stabilograms parameters. In ophthalmologic examination in all the cases there was bilateral symmetrical dystrophy of the retina of various intensification. We concluded that hearing and balance organ examination in Usher syndrome can state accessory diagnostic aspect that might help to distinguish subtypes of the syndrome. In this way audiologic and otoneurologic tests could help to define prognosis of the disease in the individual cases. A necessity of close co-operation of genetics, ophthalmologists and ENT doctors as well as psychologists was stressed.

[Evaluation of glycerol test in Meniere's disease with pure tone audiometry and distortion product otoacoustic emission]. / Ocena testu glicerolowego w chorobie Meniere'a przy zastosowaniu audiometrii tonalnej i otoemisji akustycznej produktów znieksztalcen nieliniowych DPOAE.

The purpose of the work was to follow up changes in the pure tone audiometry and distortion products otoacoustic emissions (DPOAE) after glycerol administration in Meniere's patients. Twenty patients with Meniere's disease and 16 with cochlear hearing loss without vestibular symptoms were subjected to the glycerol test following the complete audiological evaluation. Glycerol was administered orally 1.5 ml/kg of body weight dissolved in the equal amount of the physiological saline. The results of the glycerol test were analyzed with reference to changes in the pure tone threshold and DPOAE testing. Both investigations were performed in four series: as an initial testing before the glycerol intake and next--one, two and three hours after the glycerol administration. DPOAE included DP-gram registration (L1 = L2 = 70 dB; f2/f1 = 1.22; 1/2 octave) and input/output (I/O) function at 2, 4 and 6 kHz. The glycerol test was regarded as positive in the audiometry if the pure tone threshold improved at least 15 dB at minimum 3 frequencies. Positive result of the glycerol test in DPOAE was judged if DP amplitude increased more than 5dB at 2 or more frequencies in DP-gram and/or DP-threshold lowered at least 10dB in minimum two I/O registrations. In the subjects with Meniere's disease, 11 positive and 9 negative glycerol tests in audiometry and 10 positive and 10 negative DPOAE glycerol tests were obtained. In the reference group, one audiometric glycerol test and two DPOAE glycerol tests were regarded as positive. Much conformity, making 85%, between audiometric and DPOAE tests results is observed. The dynamics of the parameter changing in the consecutive test hours was also similar in both pure tone audiometry and DPOAE. These studies suggest that distortion product otoacoustic emission could be useful in diagnostics of Meniere's disease and would be a valuable diagnostic tool as an objective examination.

[DPOAE otoemission in patients with tinnitus and normal hearing]. / Otoemisja DPOAE u pacjentów z szumami usznymi i prawidlowym sluchem.

The goal of our study was analysis of characteristic interrogation, audiometry and distortion products otoacoustic emission in patients with normal hearing and complaining of tinnitus. We examined the group of 24 ill patients with hearing threshold up till 25 dB HL and with tinnitus and the control group of 18 with no audiological complains. All the patients were made tonal audiometry and the discomfort level as well as tinnitus frequency and intensity were evaluated. For each ear separately, we examined DPAOE of DP-gram function with resolving power of half the octave and the fine structure on the level of stimulation L1 = L2 = 70 dB. In the group of patients average time of tinnitus was 1.5 year. Average hearing threshold in patients with tinnitus was 18 dB HL for air conduction and 11 dB HL for bone conduction, average discomfort threshold--93 dB HL. In the control group hearing threshold was comparatively 16 dB and 10 dB HL and average discomfort threshold--95 dB HL. In the tinnitus group 8 patients (21%) complained of hyperacusis. The differences between the two groups in DP-gram were observed mainly in high frequencies (higher than 3000 Hz). In DP-gram fine structure in the group of patients with tinnitus we noted wider span of otoemission decreases (over the octave) compared to control group. In the tinnitus group among 20 examined ears with decreases of otoacoustic emission DP--fine structure only in 6 patients (30%) the frequency of tinnitus given by the patient was overlapping with the frequency for which decreases of otoemission were observed. In both groups we observed decreases of DPOAE for some frequencies but in the patients with tinnitus we noticed the lack of otoacoustic emission in wider span of frequencies, mainly in higher frequencies compared to controls.