[The otoneurological examination of a patient suffering from dizziness]

[Clinical diagnosis and treatment of chronic dizziness]

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.

[Benign paroxysmal positional vertigo associated with trauma, middle and inner ear diseases]

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.

[Recovery of vestibulo-ocular reflex in vestibular neuronitis depending on severity of vestibulo-ocular reflex damage]

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.

[Ramsay Hunt syndrome with hearing loss and vertigo]

The article contains literature review on etiology, natural history and treatment of Ramsay Hunt syndrome. Differential diagnosis in case of 8^th cranial nerve involvement is discussed. We present a case of the patient with Ramsay Hunt syndrome with hearing loss and vertigo is described. Clinical symptoms and diagnosis of sensorineural hearing loss and acute unilateral vestibulopathy are presented. The successful treatment of the patient resulted in complete facial nerve recovery, hearing improvement and partial recovery of vestibular function.

[Clinical and psychological features in patients with incident and recurrent cases of benign paroxysmal positional vertigo]

OBJECTIVE

To assess the clinical and psychological features in patients with incident and recurrent posterior canal BPPV.

PATIENTS AND METHODS

The study included 47 patients (mean age 49.1±10.9 years; 12.8% of men and 87.2% of women) with idiopathic BPPV, posterior canal. According to the anamnesis, the patients were divided into two groups: 27 (57.4%) patients with incident BPPV (iBPPV) and 20 (42.6%) patients with recurrent BPPV (rBPPV). All patients were treated with repositioning Epley and/or Semont maneuvers until resolution of canalolithiasis. After that, clinical and psychological testing was immediately carried out, including short version of Vertigo Symptom Scale (VSS), Dizziness Handicap Inventory (DHI), Visual analogue scale (VAS) for fear of vertigo spells, Depersonalization-Derealization Inventory (DDI), Social Readjustment Rating Scale (SRRS) of Holmes and Rahe, Anxiety Sensitivity Index (ASI), Generalized Anxiety Disorder Scale (GAD-7) and Patient Health Questionnaire (PHQ).

RESULTS

Patients with rBPPV compared with iBPPV had more severe symptoms of dizziness according to DHI (p=0.02) due to a functional and emotional subscales, as well as a more pronounced feeling of fear according to VAS (p=0.01). The data obtained on the remaining scales and questionnaires did not show statistically significant differences between the groups. The revealed results may indicate a greater predisposition of patients with rBPPV to the development of a special kind of mental disorders - functional dizziness or persistent postural-perceptual dizziness, which requires additional study and development of preventive measures.

[The enhanced efficiency of nystagmus detection using the modified Frenzel goggles with congenerous illumination]

The objective of the present study was to evaluate the efficiency and convenience of using the new modified Frenzel goggles in diagnostics of spontaneous nystagmus. It was shown that the modified Frenzel goggles provide more homogeneous lightening of the eyes and better diagnosis of peripheral latent spontaneous nystagmus in comparison with the traditional Frenzel goggles, available at the market. The questionnaire survey held among the doctors using both types of the goggles showed that the modified Frenzel goggles are more convenient for detecting spontaneous nystagmus in everyday practice.