Clinical and epidemiological study of vertigo at an outpatient clinic.

OBJECTIVES: The main goal of this study was to set up a database of vertigo patients that could serve as a reference for other ENT services treating these pathologies. We present a clinical and epidemiological study of vertigo in an ENT outpatient clinic in 2001 and describe our diagnosis protocol. MATERIAL AND METHODS: This was a prospective study of 591 patients (18% of the total number of 3283 first visits) controlled and treated at the ENT service of the Hospital Clinic in Barcelona. The main variables studied were sex, age, clinical characteristics and the results of physical and basic instrumental examinations. RESULTS: After obtaining a clinical history and performing a physical examination, pure-tone audiometry, impedance audiometry and electronystagmography, 394 patients were discharged with a medical report, diagnosis and prescription for treatment. The other 197 patients whom the standard examination was unable to diagnose were referred to a multidisciplinary committee for re-evaluation. CONCLUSION: A correct diagnosis is essential to ensure adequate treatment and attain an acceptable balance between cost and effectiveness.

Hearing and diabetes.

The results of the audiological evaluation of 47 diabetics are presented. The patients were divided into two groups: A (17/47), type I early diabetics, and B (30/47), type I chronic diabetics. The evaluation included puretone audiometry, high-frequency audiometry and auditory brainstem response. There was a control group consisting of 30 healthy subjects. In group 1 the audiological assessment was normal in all cases. In group 2 hearing loss was found in 30% of cases (9/30). Hearing loss was significantly correlated with age (p = 0.0019) and duration of diabetes (p = 0.0143), but not with diabetic microangiopathy (p = 0.1506). The authors conclude that hearing loss is not a usual feature in diabetic patients. When present, hearing loss should be attributed to the effect of diabetes on the age-related physiological impairment of the inner ear. The pathogenic mechanisms remain obscure.

[Ototoxicity of deferoxamine]. / Ototoxicidad de la deferoxamina.

Deferoxamine or desferrioxamine (DFO) is a chelating agent, largely used in patients with chronic renal failure, although it has many side effects, being ototoxicity one of them. In this paper we studied the eventually adverse otologic effects of DFO in 20 patients receiving haemodialysis. A complete audiological evaluation, including pure-tone audiometry, brainstem auditory evoked potentials and high-frequency audiometry, was performed. The results showed a sensorineural hearing loss of retrocochlear origin in 3/20 cases (15%). We can accept that ototoxic effects of DFO are minimal, but no inexistent. Because of these we considered highly recommendable an accurate control of hearing in patients with renal disease receiving DFO.

Auditory function in young patients with type 1 diabetes mellitus.

Comprehension of the effect of diabetes mellitus on auditory function has been hindered by the fact that previous studies have evaluated hearing function in heterogeneous groups of patients with diabetes mellitus, thus giving conflicting results. We have performed audiometric studies in 46 consecutive patients. 13 with newly diagnosed type 1 diabetes mellitus (group 1) and 33 with type 1 diabetes mellitus of more than 3 years of duration (group 2), of 14 to 40 years of age. The results were compared to an age-matched control group. Pure-tone auditory thresholds were significantly higher in all frequencies 250-8,000 Hz in both groups when compared to the control subjects. Ten patients, all of which belonged to group 2, had auditory thresholds above 30 dB in at least one frequency, showing a conversational hearing loss that ranged between 11 and 44%. However, none of them referred subjective hypoacusia. Univariate analysis revealed significant associations between auditory thresholds and age, duration of disease as well as retinopathy, but not with neuropathy, HbA1c or hypoglycaemic episodes. Only age and duration of disease independently correlated with an auditory threshold using multiple regression. We conclude that type 1 diabetes mellitus can cause mild sensorineural hearing impairment which correlates with age and duration of disease.

Asymptomatic electronystagmographic abnormalities in patients with type I diabetes mellitus.

Only a few studies have investigated vestibular function in diabetes mellitus (DM), showing contradictory results. We have performed an electronystagmographic (ENG) evaluation of 46 individuals with type I DM and 37 healthy controls. No patient reported subjective vestibular symptoms. Duration of caloric-induced nystagmus (DN) was significantly lower (2.1 +/- 0.7 vs. 2.6 +/- 0.4 min, p less than 0.01), and central nystagmus frequency of caloric response also nonsignificantly tended to be decreased (37.4 +/- 16.5 vs. 41.7 +/- 12.7 beats/30s, p = 0.21) in DM patients, as compared to controls. The latter comparison achieved significance after exclusion of newly diagnosed diabetic patients (33.4 +/- 16.1 vs. 41.6 +/- 12.7 beats/s, p less than 0.05). Depressed caloric reactions were seen in 21.8% of patients. DN was lower in patients with microalbuminuria and retinopathy, but this was not observed after exclusion of newly diagnosed diabetic patients, all of whom had normal ENG responses and no chronic diabetic complications. The existence of a lower DN and central nystagmus frequency should be borne in mind when interpreting ENG tracings in patients with long duration type I diabetes mellitus.

[Primary care in otorhinolaryngology]. / Asistencia primaria en otorrinolaringología.

A report on the otolaryngological diseases diagnosed in an out patients Clinic of Barcelona (Social security) during a one-year term, is presented. The commonest entities (chronic pharyngitis, ceruminosis, vertigo, otitis) are studied and classified according to age, sex and other etiologic factors.

Measurement of nasal mucociliary transport rate in normal man.

After reviewing the main methods existing to calculate the rate of the mucociliary transport, the authors describe their personal technique. A 99mTechnetium Sulphur Colloid drop is deposited in the nasal fossa, which is carried away by the cilia down to the rhinopharynx and followed by a gamma camera. To calculate the transport rate, a new method of quantification has been introduced, based on the formation of a parametric image. A study was carried out in 14 males without any pathology of the upper airways, obtaining a mean velocity of 5.3 mm per min (range 3.3.-8.2).

Nasal mucociliary transport in laryngectomees.

A study has been carried out to assess the mucociliary function of nasal mucosa in 30 patients: 16 had undergone surgery due to larynx malignancy and the remaining 14 were divided in two groups. The first group was composed of seven patients suffering from larynx cancer but not operated, and the second group of seven had pathology not related to the airways (control group). The method used a 99mtechnetium sulphur colloid drop deposited on the nasal mucosa of one nostril. To calculate the rate of transport, a new method of quantification has been introduced, based on the formation of a parametric image. The mean velocity in laryngectomees was 3.6 mm/min (range 1.1-6.4). It was compared with the group of 14 patients without tracheostomy (mean 5.3, range 3.3-8.2). An impaired Student's-t-test gave a significant difference between both groups (P less than 0.005). The comparison between patients with nonoperated larynx cancer and normals gave a nonsignificant difference. The 16 operated patients were arbitrarily divided into two groups as per the time elapsed from laryngectomy; seven were studied within the first 3 years of operation and seven other patients after this term. The comparison between them was not significant.