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.

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


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Endolymphatic hydrops patients with benign paroxysmal positioning vertigo

Abstract

Objective: Amongst the reasons causing the inner ear pathology being accompanied by fits of giddiness, the most frequently occurring are the endolymphatic hydrops & benign paroxysmal positioning vertigo (BPPV). In the whole number of scientific articles there may be found the mentioning of patients with the combination of BPPV & Menier’s Disease. The reasons & probably the mechanisms for both conditions’ origin are somewhat similar within the frameworks of known theories.
The purpose of the present research is the scrutiny of labyrinth hydrops occurrence amongst the patients suffering from BPPV.

Methods: Within the course of the present work to diagnose the disease we used the whole battery of tests & examinations performed by neurotologist & neurologist. The investigation of the vestibular system state & condition has been carried out with the use of VISUAL EYES – videonystamography complex with the infra-red registering of eyes’ movements (By Micromedical Technologies). The examination of hearing has been performed in audiological laboratory, whilst the endolymphatic hydrops has been registered by method of extratympanic electrocochleography upon the system BRAVO (by NICOLET) with the application of the generally accepted criteria.

Results: We have examined the patients’ group with BPPV – totaling 94 patients. Amongst them 28 patients (29,8%) with endolymphatic hydrops has been discovered. Distribution by gender: 2 males and 26 females. The average age within the examined group of patients with the combination of hydrops & BPPV – 49.75 years old. The duration of disease: from 1 month to 16 years.

Within the afore group of patients the following reasons for the development of disease has been discovered: idiopathic – 75%, virus infection -–10.7%, acute stress – 7.1%, trauma – 7.1%.

The outset of disease has been accompanied by the following symptoms:
Spinning-32.1%, positional spinning – 32.1%, dizzy – 46.6%, noise in ears – 10.7%, reduction of hearing – 2%, the loss of conscience – 3.6%.
From 28 patients of the said group – 2 has been diagnosed with the Menier’s disease, 26 – with the secondary hydrops.

Within the afore group of patients the pathology of only the posterior semicircular channels has been registered (from the right in 39.3%, from the left – in 57.1%, of both – 3.6%). The distribution of the hydrops localizing in relation towards the BPPV pathology side was the following: while with the otolithiasis of the right posterior semicircular channel the hydrops has been registered from the right in 14.3% of cases, from the left in 14,3% of cases, from both sides – in 10.7%. Whilst with the otolithiasis from the left – the hydrops has been registered in left ear in 28.6% of cases, from the right – in 7.1%, and in both ears – 21.4%.

Considering the presence of both pathological conditions, the following therapy tactics has been chosen by ourselves. Upon the first stage we have used the rehabilitation manoeuvres, exercises & their combinations designed for BPPV correction. Thus the Epley manoeuvre has been applied in 85,7% of cases. The exercises of Brandt-Daroff – in 42,9% of cases.

The significant element for the successful therapy within the afore group of patients as per our judgement – has been the complex therapy of the second stage. The above therapy consisted in the use of special diet, short course of diuretics, Betaserk & its combination with other medications depending upon the character of the attendant diseases. Some patients have been treated with the course of osteopathic correction, massage from the alterations in the cervical part of the vertebral spine.

Conclusion: Taking into account the frequently occurring combination of BPPV & labyrinth hydrops we strongly recommend the inclusion of EcoG into the programm for examination of patient with the positional vertigo, especially with the persisting dizzy symptoms after performing of the rehabilitational manoeuvre. We have not discovered the combination of inner ear hydrops & BPPV by the localizing side. The course specially designed to manage the said patient with the whole combination of diseases has to obligatorily include the rehabilitational treatment methods co-jointly with the medicational therapy.

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