Marzena Bielińska

Zastosowanie testu VHIT (Videonystagmography Head Impulse Test) w diagnostyce uszkodzeń kanałów półkolistych

Summary Introduction The aim of that work was to evaluate the usefulness of VHIT (Videonystagmography Head Impulse Test) in the diagnostics of injuries to the semicircular canals. Material and methods The tests covered 58 patients aged 20–27, including 34 women and 24 men. Any deviations within the vestibular organs was excluded in the interview, otorhinolaryngological examination and full videonystagmographic test. The tests checked functions of the semicircular canals in the following way: in a sitting position and the head leaned forward at 30° the patient was looking at a motionless point while quick movements to the left or right were performed to stimulate a particular lateral semicircular canal. When the vertical semicircular canals were tested the head was inclined laterally to the right side at 45°. Then similar movements were performed forwards (stimulation of the left anterior semicircular canal) and backwards (stimulation of the right posterior semicircular canal). When the head was leaned laterally to the left at 45° the right or left anterior semicircular canal was stimulated respectively. Functions of the canal were determined on the basis of gain (%). Results of the tests In 58 patients the gain value for particular semicircular canals was normal, and the mean values presented as follows: the lateral semicircular canal: 11.9%±10.2, the anterior semicircular canal: 17.5%±11.6 and the posterior semicircular canal: 19.2%±13.5, whereas on the left side: 10.3%±7.9, 18.1%±11.1, 15.1%±12.3 respectively. In one man the gain value for the right posterior semicircular canal was found significantly above the standard value – 71%. Conclusion VHIT showed much more sensitive than a full videonystagmographic test.

The use of videonystagmography head impulse test (VHIT) in the diagnostics of semicircular canal injuries in patients with vertigo

ObjectivesThe aim of the study was to assess the function of semicircular canal in videonystagmography head impulse test (VHIT) in the patients with vertigo and balance disorders.Material and MethodsThe study was performed in 135 patients (86 women and 49 men) aged 22–79 years, who were divided into 2 groups: I (study group) — 73 patients with vertigo of peripheral, central or mixed origin, II (control group) — 62 patients without vertigo (healthy individuals). The function of canal was determined on the basis of GAIN and expressed as DG/RH×100% (where DG is deviation of gaze and RH is rotation of head).ResultsIn the study group the semicircular canal injuries were found in 37 (50.69%) patients, including 24 (32.87%) patients with 1 injury and 13 (17.8%) patients with 2 or more injuries in semicircular canal. The injured anterior semicircular canal was reported 13 times; the lateral — 9 times and the posterior — 31 times.ConclusionsIn the study group, in the VHIT, injuries in semicircular canals were reported in peripheral vertigo, mixed vertigo with non-compensated and compensated function of the labyrinth in 50.68% cases, whereas in the caloric test dysfunction of the labyrinth was found in 58.49% cases.

Ocena skuteczności leczenia chorych z zawrotami głowy typu mieszanego za pomocą rehabilitacji ruchowej

INTRODUCTION The aim of this work was to evaluate the efficiency of kinesitherapy in the patients with mixed-type vertigo. MATERIAL AND METHODS The study was conducted on a randomized group of 35 patients, 21 women and 14 men aged 24-75 years (mean age 42.5 years), who were treated at the Department of Otolaryngology and Laryngological Oncology Medical University Teaching Hospital in Lodz for mixed-type vertigo. The inclusion criteria were an interview, physical and otorhinolaryngological examinations, laboratory investigations, complete audiological and otoneurological examinations, including BERA and VNG, USG examination of the blood vessels to the cranium, and CT of the cervical spine. Each patient underwent an individually selected set of habituation exercises, corrective exercises for posture and its orientation in space through 2 months. The efficiency of the implemented therapy was evaluated after two weeks, one month and two months with the use of the complete videonystagmographic test and Silvoniemis criteria. RESULTS The mean excitability of the labyrinths was 25.38 degrees/s before rehabilitation and 22.26 degrees/s after rehabilitation, absolute directional preponderance was 7.62 degrees/s and 1.92 degrees/s respectively, relative directional preponderance was 31.36 degrees/s and 12.57 degrees/s, and unilateral deficit 32.12 degrees/s and 14.34 degrees/s. The subjective evaluation of the vertigo intensification based on the 5 stages of Silvoniemis scale indicates that the mean point-based evaluation reported by the patients at the beginning of the therapy was 3.85 points, whereas after the therapy was 2.91 points after two weeks, 2.35 points after one month, and 1.2 points after two months. CONCLUSIONS Kinesitherapy is an alternative and very effective method for treating mixed-type vertigo.

Ocena wyników leczenia zawrotów głowy pochodzenia szyjnego za pomocą kinezyterapii – doniesienie wstępne

Summary Introduction The work aimed at analyzing results of kinesitherapeutic procedures in patients with cervical vertigo as well as evaluating a mobility range of the cervical spine. Material and methods The study was conducted on 23 people, including 17 women and 6 men suffering from cervical vertigo, at the age of 23–73 (the average age of 49,5). All the patients had an individually selected cycle of kinesitherapeutic exercises through the period of 2 months. The objective efficiency evaluation of the applied therapy was made on the grounds of the videonystagmographic examination (VNG). Additionally, the range of active mobility of the cervical spine was analyzed and the evaluation of vertigo according to Silvoniemis criteria was performed. Study results After a 2-month therapy 4 patients (17,4%) out of the examined material showed a total lack of vertigo, 15 patients (65,2%) demonstrated a meaningful decrease in the vertigo intensity, also in the frequency of their occurrence in 14 cases (60,8%). Only 3 patients did not show any decrease in vertigo whereas in 1 patient a slight increase in the intensity was indicated. On the basis of a subjective evaluation of the vertigo increase according to the 5-stage Silvoniemis scale it was proved that a mean point assessment claimed by the patients at the beginning of the therapy amounts to 3,0 points whereas after the therapy it was as follows: 1,43 pt after 2 weeks, 1,17 pt after 1 month and 1,13 pt after 2 months of kinesitherapy. Conclusions It is extremely difficult to fully eliminate the symptoms of cervical vertigo (in the studied material in 4 cases – 17,3%) because the causes of their occurrence, which are connected with excessive tension and degeneration in the cervical spine, cannot usually be eradicated. Additionally, as a diagnostic means, the videonystagmographic examination (VNG) accompanied by the positioning tests and the cervical rotation test facilitates precise and objective monitoring of the progress in treatment and rehabilitation of vertigo.INTRODUCTION The work aimed at analyzing results of kinesitherapeutic procedures in patients with cervical vertigo as well as evaluating a mobility range of the cervical spine. MATERIAL AND METHODS The study was conducted on 23 people, including 17 women and 6 men suffering from cervical vertigo, at the age of 23-73 (the average age of 49.5). All the patients had an individually selected cycle of kinesitherapeutic exercises through the period of 2 months. The objective efficiency evaluation of the applied therapy was made on the grounds of the videonystagmographic examination (VNG). Additionally, the range of active mobility of the cervical spine was analyzed and the evaluation of vertigo according to Silvoniemis criteria was performed. STUDY RESULTS After a 2-month therapy 4 patients (17.4%) out of the examined material showed a total lack of vertigo, 15 patients (65.2%) demonstrated a meaningful decrease in the vertigo intensity, also in the frequency of their occurrence in 14 cases (60.8%). Only 3 patients did not show any decrease in vertigo whereas in 1 patient a slight increase in the intensity was indicated. On the basis of a subjective evaluation of the vertigo increase according to the 5-stage Silvoniemis scale it was proved that a mean point assessment claimed by the patients at the beginning of the therapy amounts to 3.0 points whereas after the therapy it was as follows: 1.43 pt after 2 weeks, 1.17 pt after 1 month and 1.13 pt after 2 months of kinesitherapy. CONCLUSIONS It is extremely difficult to fully eliminate the symptoms of cervical vertigo (in the studied material in 4 cases--17.3%) because the causes of their occurrence, which are connected with excessive tension and degeneration in the cervical spine, cannot usually be eradicated. Additionally, as a diagnostic means, the videonystagmographic examination (VNG) accompanied by the positioning tests and the cervical rotation test facilitates precise and objective monitoring of the progress in treatment and rehabilitation of vertigo.

Concurrent ENG and VNG recording in healthy people – preliminary report

INTRODUCTION The aim of the study was to evaluate concurrent recording of ENG and VNG measurements in selected diagnostic tests in healthy subjects so as to explore potential sensitivity and applicability of this kind of testing in the diagnostics of vertigo. MATERIAL AND METHODS The study was carried out in 50 healthy subjects including 24 women and 26 men aged 20-22 (mean age of 20.5 years) reporting no otorhinolaryngological organ-related complaints and no history of any balance disorders or vertigo. Every patient underwent subjective and objective otoneurological tests, electronystagmographic (ENG) examination including calibration, head-tracking test, optokinetic nystagmus test, rotatory chair test, positional tests according to Cawthorne and Rosen, and Hallpike caloric test as well as videonystagmographic (VNG) examination which included calibration, spontaneous nystagmus evaluation, head-tracking test, positional tests according to Cawthorne and Rosen with neck rotation test, and Hallpike caloric test. At first, ENG and VNG examinations were carried out separately at a 24-hour interval. Concurrent ENG and VNG recording was carried out 48 hours following the last test, with calibration being performed again before both evaluations. The concurrent recording included the spontaneous nystagmus evaluation, positional tests according to Cawthrone and Rose with the neck rotation test, and Hallpike caloric test. RESULTS No negative mutual interference of the conducted tests has been observed. Both in the concurrent and in the separate recordings, the caloric test revealed lower values of the mean velocity of the nystagmus free phase in the ENG test as compared to the VNG test. No signs of spontaneous nystagmus, as well as no signs of optokinetic and positional nystagmus, were detected in any case. CONCLUSIONS The conducted tests did not reveal any mutual excludability between the selected ENG and VNG diagnostic tests upon concurrent recording. However, the concurrent use of both examinations in the diagnostics of balance disorders and vertigo requires further studies.

Comparative evaluation of the diagnostic value of the VHIT and Dix-Hallpike test in patients with balance system disorders in out-patient healthcare practice and expertise preparation

INTRODUCTION The aim of the paper was the comparative analysis of the diagnostic value of the Video Head Impulse Testing (VHIT) Ulmer I and Dix-Hallpike Test in patients with balance system disorders in out-patient practice and expertise preparation. MATERIAL AND METHODS The examination was performed in 63 patients aged 20-79, including 28 women aged 20-72 and 35 men aged 23-79, divided into two groups: Group I (study group) - 33 patients with mixed cause vertigo (on the basis of the Fitzgerald-Hallpike caloric test during the VNG examination), and Group II (reference group) - 30 healthy patients. After the ENT interview and physical examination, exclusion of pathological lesions in the external acoustic meatus and middle ear, each patient was subjected to a Fitzgerald-Hallpike caloric test during VNG examination, as well as a VHIT test and Dix-Hallpike test, with the evaluation of eyeball reaction during head rotation. RESULTS In the group of patients with mixed-cause vertigo (Group I), the Fitzgerald-Hallpike caloric test showed unilateral labyrinth deficiencies in 90.9% of the patients (with the average value of 41.8%) and relative directional preponderance with the average value of 19.0%, while in 9.1% of the patients, the detected values of labyrinth excitability were normal. In the examination of patients with vertigo, benign paroxysmal positional vertigo was diagnosed in 9.1% of cases. This diagnosis was based on the positive response to the Dix-Hallpike manoeuvre and indicative of damage to the posterior semicircular canal in the VHIT test (without signs of deficiency in the VNG examination). CONCLUSION The VHIT test and Dix-Hallpike test enable quick and precise detection of benign paroxysmal positional vertigo in out-patient practice and expertise preparation.

Analysis of risk factors for oral cavity and oropharynx cancer in the authors’ own material

INTRODUCTION The aim of the study was to analyse the risk factors for oral cavity and oropharynx cancer in peopled examined under the Head and Neck Cancer Awareness Week in 2016, Lodz. MATERIAL AND METHODS In Lodz, 21st September 2016, under the Head and Neck Cancer Awareness Week, 106 people, including 67 women aged 29-77 and 39 men aged 23-84, underwent preventive examinations in the hospital department. Prior to the laryngological examination, the patients were asked to answer questions that referred to their education, medical case history, symptoms, smoking habits with the number of cigarettes per day, alcohol intake, the number of lifetime sexual partners, oral sex engagement, incidents of head and neck cancer in the family history. RESULTS The major part of the examined patients were women and men with the secondary and high level of education, 47,76% and 35,82%, and 58,97% and 35,91% respectively. The patients were informed by mass media about the planned preventive medical examinations - 80,60% women and 79,49% men. The most common symptoms reported by women were: hoarse voice in 61,19% cases, dysphagia in 32,84% cases and burning sensation and/or pain in the oral cavity in 29,85% cases. The examined male patients mainly showed hoarse voice (46,15%), other symptoms (43,59%) and dysphagia (25,64%). 28,35% women and 28,20% men smoked cigarettes, while passive smokers were 22,38% and 25,64% respectively. Alcohol consumption was reported by 67,16% women and 82,05% men, rather occasionally. Having oral sex was noted in 25,37% women and 38,46% men, mostly with multiple sexual partners. Among the studied patients, 13,43% women and 5,12% men suffered from malignant cancer, including 2,98% women and 2,56% men who reported head and neck carcinoma in the medical interview. On the basis of the interview and ENT examination, 11,94% women and 17,94% men were qualified for the extended oncological diagnostics. Conclussion. The Fourth Head and Neck Cancer Awareness Week shows the increased interest in preventive screening, especially oncological screening, and thus the necessity of such preventive activities in the future.

Diagnostic evaluation of neck torsion test in objective examination in patients with vertigo and/or hearing-impairment.

INTRODUCTION INTRODUCTION The aim of the study was to evaluate the neck torsion test in objective examinations of patients with vertigo and/or hearing loss. MATERIAL AND METHODS The study was conducted in 100 patients, including 54 women and 46 men aged 17-79 years, who were divided into two groups: I - 50 patients, including 30 women and 20 men aged 17-79 years (mean age 49.92 years) with dizziness and/or hearing impairments, and confirmed asymmetry of intracranial vessels, II - 50 patients - control group, including 24 women and 26 men aged 20-71 years without dizziness and/or hearing disorders and without disturbance in the construction of intracranial vessels. For each patient, the following tests were carried out: subjective, objective otorhinolaryngological, Doppler ultrasound specifying diameter of vertebral and carotid arteries and the velocity of blood flow in these vessels, audiological diagnostics, including the examination of latency of waves I, III, V of the auditory evoked potentials of the brain stem, otoneurological diagnostics with used the neck torsion test. RESULTS It appears from the analysis of the material presented that the application of the neck torsion test in the Doppler ultrasound results in the fact that the difference in the mean systolic velocity of blood flow in vertebral artery is higher on the side opposite to the turning of the neck, and the increase in the average diastolic blood flow velocity in the vertebral artery on the side of the test being performed and its reduction on the opposite side in the study group, when compared to the control group. The value of the wave I, II, V latency in the ABR test during the neck torsion test is extended more in the study group than in the controls, on the side of the performed test. The performed neck torsion test in the VNG test increases the occurrence of both, square waves and nystagmus (much higher in the study group than in the controls). Conclussion. The application of the neck torsion test in the Doppler ultrasound, ABR and VNG test in patients with vertigo and/or hearing loss means that these tests become functional, thereby increasing their diagnostic value and may be used to monitor the rehabilitation of inner ear disorders.

Comparison of two VHIT software programs in diagnostics of semicircular canals

Introduction The aim of this work was to assess SCC function in VHIT test, using both versions of VHIT ULMER. Material and methods The study was performed in 57 subjects aged 22–33 years (48 women and 9 men) without vertigo in anamnesis. Patients did not complain of any “vertigo” ailments or any balance disorder incidents in the past. All tests using either VHIT I or VHIT II were performed by the same person. The function of lateral SCC in VHIT ULMER II was examined similarly like in VHIT ULMER I. In both methods was used the same sensitivity threshold parameters for horizontal and vertical accelerations (horizontal – 2500, vertical – 1600). Each of these sequences enables a parameter, called represented GAIN, to be calculated in form of a point on the canalogram. Results GAIN represents the deviation of the gaze in comparison to the deviation of the head between the first (t – 0 ms) and the fourth image (t = 120 ms). The calculation formula is: GAIN (in %) =100 x DG/RH. DG is deviation of the gaze (“gaze velocity in space”) and RH is rotation of the head (“head velocity or impulse canal paresis”). Normal GAIN value ranges 1–40%. Conclusions The examination using VHIT ULMER II appears to be a more sensitive diagnostic method than VHIT ULMER I. Improved software with automated functions such as camera adjustments, examination surface arrangement, of VHIT ULMER II, enables technician to shorten the time of examination, simultaneously providing a range of new information about the condition of oculo-vestibular system.

Acoustic neuroma as first sign of inner ear functional disorders.

INTRODUCTION The aim of this work was to describe acoustic neuromas as the first signs of inner ear functional disorders. MATERIAL AND METHODS The study covered 3,456 audiological and otoneurological patients, who were treated in the Department of Otolaryngology, Laryngological Oncology, Audiology and Phoniatrics Military Medical Academy University Teaching Hospital in Lodz within the period of 2011-2016. Among the studied subjects, an acoustic neuroma on the vestibulocochlear nerve was diagnosed in 13 cases (5,16%), including 9 women and 4 men. Each patient underwent a medical interview and an objective examination with static and dynamic tests, pure tone audiometry and speech audiometry tests, impedance audiometry tests, characteristics of tinnitus, videonystagmography and auditory brainstem evoked potentials (ABR) in crack. In each case of an incorrect ABR recording, contrast-enhanced MRI was performed. STUDY RESULTS The conducted tests showed an incorrect ABR recording in 252 patients (7,29%, including 54,37% women and 45,63% men). In the performed contrast-enhanced MRI, 13 patients (5,16%), including 3,57% women and 1,59% men, had an image typical to neuroma of the vestibulocochlear nerve. Each one of the studied patients showed signs and symptoms typical to an acoustic neuroma such as hypoacusia and balance disorders, tinnitus in 12 subjects, headaches in the temporal and occipital area in 4 subjects, trigeminal neuralgia symptoms in 2 subjects and vision problems like scotoma and blurred vision reported by 1 patient. CONCLUSION Each case of sensorineural hearing loss, particularly unilateral sensorineural hearing loss, requires expanded hearing tests and auditory brainstem evoked potentials tests. An incorrect brainstem evoked potentials recording such as: an elongated latency of the 5th wave, an elongated interlatency of 1-2-3 and 1-2-3-4 waves, requires a contract-enhanced magnetic resonance imaging to diagnose cerebellopontine angle tumours.