ISSN 1612-3352

Editors in Chief

Prof. Dr. Claus F. Claussen, Neurootological Research Institute of the Research Society for Smell, Taste, Hearing and Equilibrium Disorders at Bad Kissingen (4-G-F). Bad Kissingen, Germany.
Dr. med. Julia M. Bergmann,
Dr. med. Guillermo O. Bertora,
Otoneuroophthalmological Neurophysiology,
Buenos Aires, Argentina.

Production Managers

Dr. med. Julia M. Bergmann,
Dr. med. Guillermo O. Bertora,
Otoneuroophthalmological Neurophysiology,
Buenos Aires, Argentina.

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Neurootometric findings in 4062 combined tinnitus cases among 9173 neurootological patients


In neurootology the complaints of disturbances and failures of the stato-acoustic nerve play an important role. The major groups of complaints comprise vertigo, instability, falling, nausea, tinnitus, hearing loss etc. For this study we randomly have selected a major sample of 9173 neurootological patients. 4062 (44,28%) of the total group of our patients complained about an annoying form of tinnitus. The symptom of tinnitus was taken for separating this group of 4062 patients from the total groups of 9173 neurootological patients and thus creating two samples.

Neurootology basically forms a clinical speciality related to the diseases and the systematics of the disorders of the cranial senses, like hearing, vision, equilibrium, taste and smell. The major symptoms of all our patients include individually specified and manifested vertigo, dizziness, nausea, instability, double-vision, oscillopsia, hearing loss, deafness, tinnitus etc. As our objective and quantitative neurootological network analysis system produces lots of protocols from many different measurements, we arrive at much paperwork for the diagnostic evaluation and treatment planning. Therefore we have systematically to bind together all the data of inspection, exploration and experimental investigations into a description of the individual case.

By this study we want to present a gross survey what can be found in the general description group of tinnitus patients, when confronting it to the total of a major sample of neurootological patients. As we are dealing with the stato-acoustic system, which seemingly is disturbed in our patients suffering from tinnitus, as a single sign, but also in the major group of cases as tinnitus bound into a more diversified spectrum of stato-acoustic complaints, we have separated 4062 patients (44,28%) from the total sample of 9173 (100%) of neurootological patients.

Traditionally diagnosis has been defined as the art of identifying a disease from its signs and symptoms, which are different in any case with respect to a comparative sample, but where also the sample of various groups of patients with leading signs may differ. Therefore in this case we have started with our history NODEC for finding out, whether there are differences in the composition of the vertigo
It easily can be found, that there all the different vertigo signs occur more frequently in the group with tinnitus, than they do in the total sample of neurootological patients. The nausea symptoms are regularly and trend wise more frequent in the group of tinnitus cases, than in the total group of neurootological patients.

The trigger mechanisms have been questioned from the patients according to our system NODEC.

Within this section of specific history questions, we only find that airsickness occurs more frequently in the total group of neurootological patients, than within the group of tinnitus patients. Trend wise all the other vertigo trigger mechanisms are more frequently to be seen amongst the group of the tinnitus cases.

Complaints about visual disturbances besides of changes in visual acuity are also reported by our patients within the two groups.
It is remarkable that loss of visual acuity and also oscillopsia are more frequently found among the tinnitus cases.

Trend-wise all the complaints about disturbances of hearing are more frequent within the tinnitus group.

The two samples also were analysed with respect to general patho-mechanisms, laying in basic factors of gerneral diseases.
There is some more cardio-vascular pathology in the tinnitus group.
Within the field of modern neurootometry methods for measuring disorders in hearing are named audiometry and those for measuring dysfunctions in the field of equilibrium are named equilibriometry.

Within the series of equilibriometric tests we regularly apply the synoptic “Claussen-Butterfly-Chart” for evaluating the caloric test responses. The electronystagmographically recorded vestibular tests are performed in the manner of quantitative sensory motor investigations. Thus the nystagmus responses can be taken as a measure of the individual reactivity upon a standard test load. The caloric nystagmus frequency has been proved to be the primary nystagmus parameter, which is most representative for the whole test response. The individual characteristic of each of the partial four tests, right warm, right cold, left warm, left cold are charted in four representative quadrants of the caloric butterfly scheme. There they may be positioned within one of three different areas, which are related to normal activity, over activity or inhibition. The Claussen Butterfly Chart mainly provides the investigator with the four quantitative informations:

1.) Receptor sidet comparison
2.) The nystagmus beat direction comparison
3.) The comparison of the experimental nystagmus intensity with the spontaneous nystagmus activity and direction
4.) The comparison of the individual nystagmus reactions with collective normative data, being printed already into the butterfly scheme.

The caloric butterfly charts of the Claussen Butterfly is able to separate the caloric vestibular test responses into 81 different patterns, which can be divided into: normal responses, responses related to peripheral vestibular lesions, responses related to central vestibular ocular lesions and responses related to combined peripheral and central vestibular ocular dysfunctions. The occurrence rates of the combined peripheral and central caloric butterfly patterns occur more than 5% more frequent in the group of the tinnitus patients than in the total sample.

There is a certain evidence that the pathways from the inner ear periphery into the brainstem is disturbed more frequent in the group of tinnitus patients, than in the total sample. Above this there is more pathology in the sample of the tinnitus patients than in the sample of neurootological patients.

The second important equilibriometric test is cranio-corpo-graphy for analysing the vestibular spinal body axis. Here especially we apply the most sensitive vestibular test, the stepping test of Unterberger and Fukuda. Cranio-corpo-graphy (CCG) basically introduces a charting of the patients head and body axes when he performs the stepping test and other vestibular spinal tests. The operator’s use was modified over the time. Originally cranio-corpo-graphy was invented by Claussen in 1968 by means of an optical tracing procedure. The head axis is monitored, using a worker’s hardhat mounted with two light-bulbs, one above the forehead and the other above the occiput. Two similar light-bulbs are taped onto each shoulder, ensuring a body or coronal axis tracing. An instant camera captures the patient’s light racings and transforms them into a cranio-corpo-grahic pattern. The chart is looking similar like a radar image. The stepping during one minute with optimally 60 – 100 steps is recorded. The important 4 parameters for quantitatively evaluating the stepping test cranio-corpo-grams are:

1.) Longitudinal displacement from the starting to the endpoint in cm
2.) Lateral sway widths during the stepping cycle, measured in cm
3.) Angular deviation in degrees between the directions of the starting position towards the connection line with the end position.
4.) The body axis spin in angular degrees in the end position with respect to the starting position.

For the stepping test cranio-corpo-gram charts of normal ranges for the four parameters have been derived from evaluations of major patient samples. Therefore also the stepping test cranio-corpo-graphy charts can be separated into normal, peripheral, central or combined peripheral and central patterns
There is only a very slightly elevated pathology in all the three categories of pathological patterns in the group of the tinnitus patients.

With modern audiometry the frames of normal hearing can well be described objectively and quantitatively. The basic investigations for measuring the abilities in hearing are: the threshold audiometry with pure tones between 125 Hertz up to 8.000 or 12.00 Hertz. The hearing threshold with bone conduction has been measured for this special study up to 2 kHz and in another group up to 4Khz and then statistically evaluated. The results of the systematized and grouped pure tone audiometry analysis are displayed together with the result of speech audiometry in combination for the tests of the right and the left ear.

The greatest differences between the two samples, i.e. 9173 neurootological patients and the sub-group of 4062 tinnitus patients are unveiled, showing much more pathology in the group of the tinnitus patients in the basic hearing functions.

Still it is obvious, that the group of the tinnitus patients also exhibit more pathology in the history of vertigo, nausea and also in the vertigo releasing trigger mechanisms, than in the whole group of mixed vertigo and tinnitus patients. A higher incidence rate of complaints about hearing impairment is also seen in table 6. The difference amounts to 21,04%. However, there the subjective impression of hearing impairment can also include an overlay with the experience of tinnitus. This we also derive from table 10 where the differences maximally go up to 10,49%.



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