Sudden hearing loss as a first complication of long-standing Type 1 diabetes mellitus: a case report.

The term 'sudden hypoacusis' describes a hearing loss of a rapid onset and unknown origin that can progress to severe deafness. Its pathophysiology is still unknown, the proposed aetiological mechanisms being vascular disease or autoimmune reaction. We present the case of a 19-year-old woman with Type 1 diabetes mellitus who experienced sudden hearing loss on her right side. She had no complications related to diabetes. After being referred to the hospital she was diagnosed with sudden sensorineural right-sided hearing loss accompanied by high frequency tinnitus. After administration of vasoactive drugs, there was partial improvement after 7 days, followed by gradual improvement over the next 4 weeks to 5 months. The tinnitus did not disappear completely. We conclude that hearing organ disturbances can be present in Type 1 diabetes and represent an early complication.

Are there any disturbances in vestibular organ of children and young adults with Type I diabetes?

AIMS/HYPOTHESIS: The aim of the work was to evaluate the vestibular organ condition in children and young adults suffering from Type I (insulin-dependent) diabetes mellitus. METHODS: The group examined consisted of 95 children and young adults aged from 6 to 28 years with Type I diabetes diagnosed. The diabetic group was divided into subgroups according to duration of the disease, compensation of the disease, and presence and character of hypoglycaemic incidents, and presence of diabetic complications. The control group consisted of 44 healthy children and young adults aged 6 to 28 years. After collecting detailed medical history in each case an electronystagmographic test was performed using the computed two-canal electronystagmographer. RESULTS: Within the diabetic group 6 patients complained about vertigo and balance disorders. Spontaneous nystagmus occurred in 10 cases, positional one in 21 cases. Impaired optokinesis occurred in 36 cases and impaired eye tracking test in 33 cases. In caloric tests there was partial canal paresis in 4 cases and directional preponderance in 7 cases. CONCLUSION/INTERPRETATION: Metabolic disturbances present in Type I diabetes cause disturbances in different parts of vestibular organ but mostly in its central part. Comparing disturbances in the vestibular organ with clinical and biochemical parameters characterising diabetes, the range of vestibular organ impairment in diabetes mellitus type 1 seems to depend mainly on the presence and character of hypoglycaemic incidents and the duration of the disease and to some extent on the compensation of diabetes.

[Progress in rehabilitation of dizziness and equilibrium disorders]. / Postepy w rehabilitacji zawrotów glowy i zaburzen równowagi.

Physiopathological basics of vestibular rehabilitation are based on mechanisms of vestibular compensation. In the course of vestibular organ lesion compensation can be achieved sooner through increased activity of the patient in habituation process, with active contribution of the vision and proprioceptive organs. The criteria of qualification and preparation of the patients were presented. The role of creation of adequate motivation of the subject in the process of preparation was emphasised. The progresses that had been achieved in this treatment method were mentioned. The value of individual training programs, that is programs adapted to definite needs of the patients, was appreciated in recent years. It was revealed, that training programs directed to train certain system such as lower limbs strength, failure of vestibular receptor, gait disturbances bring significant improvement in such cases. However traditional exercises consisting in the whole body movements do not bring desirable effects in certain cases. The new methods of assessment of rehabilitation progress were presented. Those methods are based on receding of subjective symptoms during normal daily activities.

[Chemodectoma: tympanic tumor]. / Chemodectoma--postac pierwotnie bebenkowa.

Glomus tympanicum tumors are the most common benign tumors of middle ear. Initially the leading symptoms are hearing loss and tinnitus. Other complications such as facial nerve paresis reflect deeper structures involvement. Sometimes the disease is masked by chronic pyogenic otitis media. It delays the diagnosis what we observed in one of three cases of chemodectoma presented. We present 3 cases of glomus tumor tympanicus that occurred in three women aged 60-68 years by the time of diagnosis. Localisation, size of the tumor and relation to other structures of the ear was made on the basis of computer tomography. The patients were operated (atticoantrotomy). In one of the cases there was recidivation of the disease two years after operation, we have made reoperation with hearing improvement. All the three patients were cured in outpatient before the correct diagnosis for a few years, they all presented typical symptoms together with typical changes in tympanic membrane. It is important to stress, that chronic pyogenic otitis media which first occurred as the patient was over fifty should arouse suspicion of neoplastic disease.

[A rare case of metastatic meningitis with unknown primary focus and atypical symptoms]. / Rzadki przypadek przerzutowego zapalenia opon mózgowo-rdzeniowych z nieznanego ogniska pierwotnego o nietypowych objawach.

We have presented the diagnostic difficulties in the case of woman aged 59 who was admitted to the clinic with the suspicion of neurinoma of acoustic nerve. The patient was admitted to hospital with peripheral facial nerve paresis on the left side together with sudden surdity and peripheral vestibular impairment. Surdity of the other side occurred after two months. In terminal phase of the disease there was aseptic meningitis. Posthumous diagnosis was made on the basis of neuropathological examination of the brain. It was carcinomatous meningitis. But there was no primary focus found during autopsy. It is important to stress that CT and MRI was completely useless in this case. However pathological brain stem response together with lack of stapedial muscle reflex were much ahead of surdity and other central symptoms. We found only one case of carcinomatous meningitis with unknown primary focus in the literature. The course of the disease is very insidious and in every suspicious cases one should be aware of cancer of unknown primary site.

[Branchiogenic cysts registered at the Otolaryngology Clinic of Medical University in Wroclaw in years 1989-1998]. / Torbiele skrzelopochodne (cystis branchiogenes) w materiale Kliniki Otolaryngologicznej AM we Wroclawiu w latach 1989-1998 r.

Lateral branchiogenic cysts are relatively rare among neck tumours. However they belong to the most frequent developmental malformation in this area. Their etiology and pathogenesis is not fully explained yet. Over the period of ten years there were 76 patients hospitalized in our clinic with the diagnosis of the lateral branchiogenic cyst. Its prevalence was similar in both sexes and ranged from 3 months to 62 years of age. More than half of the patients were children. In 2 cases, a rare primary cancer rising from a branchiogenic cyst was diagnosed. Positive family history was observed in two children. Surgery was performed in 59 patients. Unsatisfactory results of the surgery were noted in 6 cases and 4 of them were reoperated because of the recurrence. In the case of brachiogenic cysts a full oncologic diagnostics should be performed, as it is done with neck tumour management. The procedures, which enable us to estimate character and extent of a lesion and determine the proper surgical treatment, should include ultrasonography, fine-needle biopsy or CT.

[Assessment of some biochemical factors of nasal mucosa in workers occupationally exposed to inhaled chemicals]. / Ocena niektórych czynników biochemicznych blony sluzowej nosa u pracowników narazonych zawodowo na wziewne substancje chemiczne.

The aim of the work was to assesses the selected biochemical markers in nasal lavages obtained from 101 workers employed at a paint and lacquer factory who were exposed to inhalation of toxic substances. The concentrations of total protein and glycoconjugates were measured. The relationship was found between the concentration of substances under study, the clinical symptoms, and length of exposure. The increased levels of total protein and glycoconjugates were observed in workers with shorter period of employment, whereas those employed for longer period of time showed lower concentrations of both markers. The concentrations of the markers were also correlated with the progress of clinical symptoms. Workers with short employment showed mainly congestional changes, but in workers with longer exposure, atrophical changes in mucous membrane were observed. The results confirmed the usefulness of these markers in the objective assessment of the nasal mucosa condition.

Soluble L-selectin and interleukin-8 in otitis media with effusion.

OBJECTIVE: adhesion of leukocytes to vascular endothelium and their invasion into local tissues are important steps in inflammation. L-selectin plays a crucial role in leukocyte rolling and adhesion on endothelial cell surface. Interleukin-8 (IL-8) is a potent chemotactic substance toward neutrophils and lymphocytes-T and mediate their migration to local inflammation. The levels of soluble L-selectin (sL-selectin) and IL-8 were measured in middle ear effusions (MEE) from children with otitis media (OM) to estimate their role in pathogenesis of inflammation in middle ear. METHODS: MEE were collected from 113 ears of 62 children during routine myringotomy. The entire specimen was diluted with phosphate-buffered saline (PBS) to 2 ml and centrifugated at 1500 rpm for 15 min to separate cellular components. Supernatants of MEE were stored frozen at -20 degrees C for sL-selectin and at -80 degrees C for IL-8 assessment. The concentration of sL-selectin and IL-8 were estimated with ELISA and compared with total protein concentration measured by Bradford assay. RESULTS: MEEs from children with chronic mucous otitis media contained significantly higher mean concentrations of IL-8 559.4 pg/mg total protein (TP) (+/-535.6) in comparison with normal serum 17.79 pg/mg TP (+/-10.9), serous OM 40.3 pg/mg TP (+/-28.1) and purulent OM 104.4 pg/mg TP (+/-128.6). High concentration of IL-8 was found in MEE from the children with early recurrence of OMS. The levels of sL-selectin were higher in purulent effusions 77.2 ng/mg TP (+/-67.4) than those of chronic mucoid 27.6 ng/mg TP (+/-36.7) and serous OM 26.3 ng/mg TP (+/-27.1). CONCLUSION: the results support a hypothesis that IL-8 can be responsible for prolongation of inflammatory process in middle ear, therefore long-term treatment and observation of children with the high levels of IL-8 in MEE may be necessary. Elevated level of sL-selectin in acute OM suggests the involvement of L-selectin in the acute phase of OM.

[Rehabilitation of benign paroxysmal positional vertigo in the experience of the Wroclaw Clinics]. / Rehabilitacja lagodnego, napadowego polozeniowego zawrotu glowy (l.n.p.z.g.) w doswiadczeniu kliniki wroclawskiej.

Mechanical disturbances in inner ear in cupulo-utricular complex are the cause of Benign Paroxysmal Positional Vertigo (BPPV). Pharmacotherapy is ineffective in such cases. The results of rehabilitation with the use of Semont of Epley manoeuvres in 46 patients were presented. The regression of symptoms in 24 cases treated with the use of Semont manoeuvre was achieved in 62% and in 22 cases treated with the use of Epley manoeuvre in 73%. Theoretical assumptions of effectiveness of treatment applied were discussed on the basis of cupulolithiasis and canalolithiasis theories.

Content of trace elements in serum of patients with carcinoma of the larynx.

An examination of the content of arsenic, nickel, copper, selenium, zinc, and iron in the serum of 78 patients with carcinoma of the larynx was carried out. The patients were divided into 4 groups: I - patients before treatment, II - patients after surgical treatment, III - patients after radiotherapy, IV - patients after combined treatment (surgery treatment + radiotherapy). The control group was formed of 17 patients operated for deviation of the nasal septum. Higher concentrations of arsenic, nickel and copper were found in the serum of the patients with carcinoma of the larynx before treatment (group I) as compared with the control group, whereas the concentrations of selenium, zinc and iron were lower. In the groups of patients after treatment, the highest concentrations of iron and zinc were found after surgical treatment. The level of selenium in all groups of patients was considerably lower than in the control group.

Poststeroid balance disorder--a case report in a body builder.

The authors describe a case of poststeroid balance disorder in a 20-year-old athlete. Previous information of such a doping pathology among sportsmen taking anabolics was not found. That anabolic steroids had a harm to central activities and could be suspected especially on the basis of reported psychiatric sequels and cerebrovascular disorders. The case described is of a patient who had been given metandienone, oxymetholone, and nandrolone phenyloproprionate in two courses. Vertigo appeared twice just after introducing doping and persisted in spite of a 1.5 year break in taking anabolics. In the electronystagmography a positional nystagmus was detected, the eye-tracking test was distempered, and abnormal responses in the caloric tests were obtained. In the computed dynamic posturography the number and length of body sway were increased and, consequently, the field of the outspread area was enlarged. The moment of appearance and long-lasting vertigo as well as the results of laboratory examinations indicate a poststeroid permanent disorder of the central part of the equilibrium organ. Such a diagnosis seems to be most probable here.

[The content of some trace elements in tissue of laryngeal squamous cell carcinoma]. / Zawartosc niektórych pierwiastków sladowych w tkance raka plaskonablonkowego krtani.

The examination of the content of arsenic, nickel, copper, selenium, zinc, iron, cadmium, lead, cobalt, antimony and tin in the tissue of laryngeal squamous cell carcinoma was carried out. Material was taken from tumour of the larynx of 22 patients during laryngectomy. The control group was made up by healthy tissue of the larynx taken from 14 patients during diagnostic examinations. Trace elements were determined by means of BAIRD plasma spectrometer. Higher values of the concentration of arsenic, nickel, copper, cadmium, lead and cobalt were found in the tissue with carcinoma of the larynx as compared with the control group. The concentration of selenium, zinc, and iron in the carcinoma tissue was lower than in the healthy tissue. The concentration of antimony and tin was similar to that of the control group.

[Vestibulo-visual interaction in peripheral lesion of vestibular organ]. / Wspóldzialanie przedsionkowo-wzrokowe w obwodowym uszkodzeniu narzadu przedsionkowego.

Studies were carried out on 32 persons between 38 and 54 years of age (average 45) with unilateral peripheral lesion function of the vestibular organ (among them 8 persons with complete lack of excitability) and 10 healthy persons between 23 and 42 years of age (average 32). All of the patients were examinated for vestibulo-visual interaction. With the help of electronystagmography, the eye movement was registered after visual stimulation, vestibular stimulation and simultaneous vestibulo-visual stimulation, with impulses evoking nystagmus of direction compatible and incompatible. Movement of black stripes on the white optokinetic screen with the velocity of 15 degrees/s, to the left and to the right, was visual stimulus. Vestibular organ was activated by cold water (30 degrees C), according to the Fitzgerald Hallpike's procedure. Nystagmus reaction was evaluated in the highest intensification on the basis of the mean velocity of the slow faze, amount of nystagmus deflexion, sum of amplitudes, as well as gain. We also took into account compatibility or incompatibility of the nystagmus directions which was induced by the simultaneous of the vestibulo-visual stimulation. It has been stated that the vestibulo-visual interaction in the unilateral peripheral lesion of vestibular organ does not differ in comparison with healthy persons. Besides, simultaneous vestibulo-visual stimulation induced by the impulses incompatible in their direction causes the decrease of the parameters value of the nystagmus in healthy persons and in persons with peripheral lesion of labyrinth. In the case of one-sided fall-out function of the vestibular organ an increase was observed of value gain of optokinetic nystagmus directed at the damaged side.

[Auditory evoked potentials from brain stem determined in acoustic nerve neurinomas]. / Badanie wywolanych potencjalów sluchowych z pnia mózgu (PSPW) w przypadkach nerwiaków nerwu sluchowego.

An analysis of the studies of Brain Stem Electric Response Audiometry of patients operated on Bachaumont Clinic or in Cochin hospital in Paris, because of acoustic neurinoma, was carried out. The studies comprised 88 patients divided into groups according to the size of tumour. A group of small intrameatal tumours, a group of up to 2 cm tumours, a group of between 2 and 3 cm tumours and a group of above 3 cm tumours. A control group of examined patients consisted of 20 persons with one-side acoustic impairment or two-side impairment but predominant on one side and patients with one-side tinnitus or two-side tinnitus but predominant on one side. Examinations of these patients made with CT and NMR did not show presence of acoustic neurinoma. BERA's tests did not show a response in case of 22 patients with acoustic neurinoma. In 71% of cases BERA's tests showed an extrahelix type, for which in 50% of cases a prolonged latency on the side of the tumour was found. In 4% of cases Brain Stem Electric Response Audiometry gave results within normal range both with respect to morphology and latency time of each wave. A slight correlation between the size of tumour and type of BERA change was found.

[Pediatric neoplasms: laryngological manifestations]. / Nowotwory wieku dzieciecego--objawy laryngologiczne.

Ten children with neoplasms of the head and neck were treated in the Clinic of Otolaryngology of Medical University in Wroclaw. In 4 children non-Hodgkin lymphoma-type B (NHL-B) primarily situated in tonsils or adenoids were diagnosed, 3 patients suffered from embryonal rhabdomyosarcoma (RMS)--2 in the nasal cavity and the paranasal sinuses and 1 in the middle ear. One boy presented histiocytosis (LCH) in the orbit. In 1 case Hodgkin disease (HD) in the preauricular lympho nodes was found and in 1 child neuroblastoma of retromandibular region was detected. Our analysis revealed unsufficient oncological awareness of the physician who had examined the children as the first one. The neoplasms were detected in advanced stage. The onset of the treatment was additionally delayed because of the long period of expecting for the histological diagnosis.

[The evaluation of the balance organ in workers occupationally exposed to organic solvents and tinctorial dusts]. / Narzad równowagi pracowników narazonych zawodowo na pary rozpuszczalników organicznych i pyly barwnikowe.

The aim of the study was to evaluate the balance organ in persons occupationally exposed to organic solvent vapours. The study was performed in a group of 35 workers employed for eight years on average in two departments of the Polifarb S.A. factory of patients and lacquers, Wroclaw. The control group consisted of 53 healthy persons. Static and dynamic posturography was used to assess the condition of the balance organ. In the persons exposed static posturography tests revealed statistically significant increase in the field of spread area and extent of sways, and dynamic posturography tests indicated an increased radius. It was shown that posturography ensure an objective assessment of balance disorders and can be applied in the screening of persons exposed to toxic substances. It is also useful in recording functional condition of the balance organ.

[Histological and histochemical investigation of pathological laryngeal mucosa with papillomatosis in children and adults]. / Badania histologiczne oraz histochemiczne brodawczaków krtani u dzieci i doroslych.

Papillomas of the larynx are the subject of numerous studies. They occur in two forms (multiple and singular). The authors presented the results of histological and histochemical investigations of larynx papillomas in 9 adults and 16 children. The studies comprised patients treated in the Clinic of Otolaryngology in Wroclaw. Surgically removed lesions constituted the material for estimation. Peculiar attention was paid to the degree of differentiation of tumours under the microscope. The interdependence between intensification of reaction and degree of epithelhyperplasia and strict connection of intensification of reaction with quantity of dysplastic changes of epithelium were indicated by estimation of enzymatic reactions. Histological studies disclosed marked morphological differences between papillomas in children and adults. The correlation of reactions to lactic dehydrogenase and NADH2-tetrazole reductase can be treated as an expression of hyperplastic changes in the epithelium. What is more, the reaction to lactic dehydrogenase may be regarded as a metabolic index of malignancy.

[Vestibular evoked potentials in people]. / Wywolane potencjaly przedsionkowe u ludzi.

In the article had been presented the structure and functioning of a prototype system for stimulation and registration vestibular evoked potentials, and the first recording of evoked vestibular potentials (VsEPs) in human beings. This system consist of a original stimulator accelerated for the stimulation of vestibular organ, modul registratory VsEPs as well as string elements and synchronizing stimulation with recording. IMB PC 486 is quickly process of investigation with help of standard interface and a original computer programme. Vestibular organ had been evoked by 200 to 500 cyclicly repealed angular decelerations of 4000 degrees/s2. During investigation white noise was used for masking to avoid the evoking of auditory potentials. Seven of the examined healthy persons (including one deaf person whose vestibular organ was not damaged) had registered a response consisting of several waves with vertex positive peaks. The first two waves P1 and P2 with the mean value 2.02 ms and 5.6 ms are most often during in the 10 ms. The registered deaf persons response does not differ from the record of healthy persons.

[Congenital nystagmus with sensory disorder: reaction to the caloric and optokinetic stimulation]. / Wrodzony oczoplas sensoryczny: reakcja na bodziec kaloryczny i optokinetyczny.

The purpose of this study was to estimate the response on vestibular caloric and optokinetic stimulation in patients with congenital nystagmus and serious congenital anomalies of visual system. 58 patients, aged 11-20 (21 female, 37 male) underwent this stimulation with ENG registration. The patients had visual acuity from 0.04 to 0.4, caused by visual system diseases e.g. congenital cataract, optic atrophy, hypoplasia maculae, high refractive error, albinism ect. The correct response was observed with 15.5% of the patients on vestibular caloric stimulation. There was no statistically significant relationship between visual acuity or visual system disease and the correct response. 28% of the patients responded correctly on optokinetic stimulation. There was statistically significant relationship between visual system anomaly and correct OKN: 80% of this reaction was in the group of optic atrophy, 54% in the group of high refractive error. Statistically significant relationship was no observed between visual acuiy and correct OKN. High level of the incorrect response on the caloric and optokinetic stimulation in the persons with congenital nystagmus and congenital disorder of visual system limits using of this tests for diagnostic purpose.

[Experimental laser stapedectomy. Scanning electron microscopy studies]. / Doswiadczalna stapedotomia laserowa. Badania w mikroskopie elektronowym.

The results of experimental tests performed upon 16 human stapes taken from cadavers were presented. The aim of the experiment was to define optimal parameters of laser stapedotomy. The less harmful range of argon laser energy for making the hole 0.6 mm diameter in the stape footplate was determined. There were two zones of tissue damage around the footplate's hole seen in scanning microscope. The internal area was made of carbonized tissue. The osseous tissue of the external zone had cavernous-cystic structure and lamellar stratification.