[Investigation of vestibular function in patients with vestibular neuritis]. / Issledovanie vestibulyarnoi funktsii u patsientov s vestibulyarnym neironitom.

Vestibular neuritis occupies the third place in terms of prevalence in the structure of peripheral vestibulopathies, therefore, the choice of optimal diagnostic and differential diagnostic tactics at different stages of the disease is an urgent task. OBJECTIVE: To optimize the diagnostic algorithm for vestibular neuritis based on an assessment of the sensitivity of clinical methods for studying vestibular function in the recovery period of the disease. MATERIAL AND METHODS: A comprehensive assessment of the sensitivity of clinical methods for the study of vestibular function in the acute (up to 14 days: at the time of initial treatment, on the 7th and 14th day) and subacute (up to 3 months: on the 28th and 90th day) periods of the disease in 52 patients with upper vestibular neuritis was carried out. RESULTS: The timing of the processes of restoration of vestibular function after a transferred vestibular neuritis is individual: after 14 days, restoration of vestibular function was recorded in 52% (n=27) patients, after 1 month - in 62% (n=32), after 3 months - in 71% (n=37) patients with upper vestibular neuritis. Statocoordination, statokinetic, oculomotor tests under visual control have the highest sensitivity in the acute period of vestibular neuritis, within up to 7 days from the onset of symptoms. In the subacute period of vestibular neuritis, the study of spontaneous nystagmus and nystagmus in the head shaking test retains high sensitivity only when using special tools (Frenzel goggles or videonystagmography). A decrease in the sensitivity of the head rotation test and the dynamic visual acuity test in the subacute period of vestibular neuritis is associated with the processes of central compensation and the formation of a latent saccade. CONCLUSION: The sensitivity of clinical tests in patients with vestibular neuritis depends on the timing of the examination.

[Features of olfactory impairment connected with trigeminal nerve system]. / Osobennosti narusheniya obonyaniya v aspekte sistemy troinichnogo nerva.

Data on the state of sense of smell in patients who had a new coronavirus infection caused by the SARS-CoV-2 virus are currently reduced because of the impairment of the olfactory nerve system. There are practically no results in studies of disorders in the trigeminal nerve system. OBJECTIVE: Qualitative assessment of olfactory disorders after COVID-19 according to the system of olfactory and trigeminal nerves with a targeted assessment of the functional component of olfactory disorders. MATERIAL AND METHODS: We examined 40 patients aged 19 to 66 who had a coronavirus infection. All patients underwent neurological, otorhinolaryngological examinations, olfactometry, filled out the hospital anxiety and depression scale. RESULTS: Anosmia was diagnosed in 5 (12.5%) patients, hyposmia in 21 (52.5%) patients, and normosmia in 14 (35%) patients. Formed: the 1st group - 14 patients (35%) with normogram according to olfactometry; the 2nd group - 26 patients (65%) with anosmia/hyposmia. In the 1st group, disorders of the anxiety-depressive spectrum were significantly more common. In the 2nd group, a low identification of odors was found, lying in the spectrum of fresh, sharp, unpleasant, irritating, compared with sweet and pleasant or neutral, which indicates a predominant lesion of the trigeminal system. CONCLUSION: In patients with complaints of impaired sense of smell after undergoing COVID-19, the possible functional nature of anosmia/hyposmia should be taken into account, which requires the referral of such patients to psychotherapeutic specialists, and the possible entry of olfactory disorders into the 'trigeminal' spectrum.

[Rehabilitation in bilateral vestibulopathy: trends and perspectives]. / Reabilitatsiya patsientov s dvustoronnei vestibulopatiei: tendentsii i perspektivy razvitiya.

A review of the literature on rehabilitation methods for bilateral vestibulopathy is presented using RSCI, Scopus and PubMed databases. The principles and effectiveness of physical vestibular rehabilitation, vestibular implants, galvanic vestibular stimulation, and biofeedback-based sensory substitution and augmentation systems are described. The advantages and disadvantages of each method and perspectives for their improvement are presented.

[Involvement of the trigeminal nerve system in the sense of smell]. / Uchastie sistemy troinichnogo nerva v obonyanii.

A systematic review of literature on the issue of involvement in the sense of smell, as well as the interaction between the trigeminal and olfactory nerves, was carried out. The article discusses the features of the chemical perception systems, as well as the treatment of olfactory disorders using transcranial electrical stimulation of the trigeminal nerve.

[Method of registration of vestibular myogenic evoked potentials in the diagnosis of diseases of the inner ear]. / Metod registratsii vestibulyarnykh miogennykh vyzvannykh potentsialov v diagnostike zabolevanii vnutrennego ukha.

The literature review is devoted to the practical application of the method of recording vestibular evoked myogenic potentials (VEMPs) in the diagnosis of the inner ear diseases: superior semicircular canal dehiscence syndrome, Meniere's disease, benign paroxysmal positional vertigo (BPPV), vestibular neuritis. Registration of VMEP is an electrophysiological research method that allows to assess objectively the functional state of the otolith receptors (sacculus and utriculus) and their pathways, which expands the diagnostic capabilities in diagnosis of the inner ear diseases.

[Vestibular evoked myogenic potentials in patients with recurrent benign paroxysmal positional vertigo]. / Vestibulyarnye vyzvannye miogennye potentsialy u patsientov s retsidiviruyushchim dobrokachestvennym paroksizmal'nym pozitsionnym golovokruzheniem.

Registration of ocular and cervical vestibular evoked myogenic potentials (oVEMPs and cVEMPs) reflects the function of otolith receptors: sacculus and utriculus. Benign paroxysmal positional vertigo (BPPV) is a disease of the inner ear as a result of the utriculus disfunction and migration of otoliths into semicircular channels. OBJECTIVE: To study the function of otolith receptors (sacculus and utriculus) with using VEMPs registration in patients with first-time and recurrent posterior semicircular canal BPPV before and after repositional maneuvers. MATERIAL AND METHODS: Registration and comparison of the results of oVEMPs and cVEMPs were performed in 50 patients with first-time posterior semicircular canal idiopathic BPPV and 26 patients with recurrent posterior semicircular canal BPPV before and after repositional treatment. RESULTS AND DISCUSSION: Clinically significant asymmetry of the amplitude of oVEMPs before treatment was recorded in 14 (38%) of patients with first-time BPPV and in 15 (57.7%) of patients with recurrent BPPV; cVEMPs - in 6 (12%) of patients with first-time BPPV and in 6 (23.1%) of patients with recurrent BPPV. Successful repositional treatment did not affect the amplitude of cVEMPs in any of the groups of patients, but led to a significant increase in the amplitude of oVEMPs on the affected side in patients with first-time BPPV. In patients with recurrent BPPV, despite the absence of symptoms of otolithiasis, the asymmetry of the amplitude of oVEMPs persisted during remission (p<0.05), which can be considered as a prognostically unfavorable factor of disease recurrence.

[Dissociation of the results of caloric and video head impulse tests as a marker of Meniere's disease]. / Dissotsiatsiya kaloricheskogo i videoimpul'snogo testov u patsientov s bolezn'yu Men'era.

The study of vestibular function in patients with Meniere's disease (MD) is an urgent task, since it influences the choice of treatment tactic. We evaluated the results of caloric and video head impulse (vHIT) tests in 76 patients who met the clinical criteria for significant Meniere's disease (AAO-HNS modified by the Barany Society, 2015). Dissociation of the results of caloric and vHIT tests is observed in the majority (74%) of patients with MD: at normal gain, according to vHIT data, hypofunction of peripheral vestibular structures is recorded according to the caloric test (KASL 47 ± 7.8%). In patients with MD, vestibular dysfunction is observed mainly at low frequencies (0.003 Hz), therefore vHIT, which allows assessing horizontal semicircular canal function at high frequencies (3-5 Hz), is not an optimal study for assessing the degree of vestibular dysfunction in patients with MD.

[A case of hearing preservation during surgical treatment of distributed fistula labyrinth in a patient with chronic purulent means otitis and cholesteatoma]. / Sluchai sokhraneniya slukha pri khirurgicheskom lechenii rasprostranennoi fistuly labirinta u bol'noi s khronicheskim gnoinym srednim otitom i kholesteatomoi.

The article provides a brief overview of the epidemiology, diagnosis, clinical manifestations and surgical methods of treatment of labyrinthine fistulas (LF) in patients with chronic suppurative otitis media (CSOM) with cholesteatoma. The efficacy of various LF treatment techniques, their complications, and the principles of prevention of cochleovestibular disorders during surgical treatment are described. The prognostic criteria for the deterioration of bone conduction thresholds during LF surgery, which include a large LF size, the opening of the membranous labyrinth, and the extent of damage to the structures of the inner ear, are presented. A clinical case of surgical treatment of widespread LF in CSOM with cholesteatoma is presented, which proves the possibility of preserving the auditory and vestibular functions while observing the stages of sanitation, manipulations on the LF and obliteration of semicircular canals defects with auto tissues. Combined surgery of such a plan must certainly be accompanied by local instillation of solutions of hormonal preparations in case of a deficiency of perilymphatic fluid in the labyrinth and postoperative antibacterial and hormonal therapy.

[Neuroimaging of the endolymphatic hydrops of the labyrinth in severe and moderately severe Meniere's disease]. / Neirovizualizatsiya endolimfaticheskogo gidropsa labirinta pri tyazhelom i srednetyazhelom techenii bolezni Men'era.

The results of magnetic resonance imaging (MRI) of the inner ear 24 hours after intratympanic administration of 1 ml of diluted (1:7) contrast substance for gadolinium-based MRI in 43 patients with moderate and severe Meniere's disease course are presented. It has been revealed that in case of severe and moderate course of Meniere's disease endolymphatic hydrops is presented in all departments of labyrinth: cochlea, vestibule, semicircular canals, but is most pronounced in vestibular department of labyrinth: horizontal semicircular canal and vestibule. The neuroimaging method according to the presented protocol is safe and can be applied in a wide practice both to assess the presence and localization, and the degree of expression of the endolymphatic hydrops.

[Effects of cochlear implantation on vestibular function]. / Vozdeistvie kokhlearnoi implantatsii na vestibulyarnuyu funktsiyu.

The literature review is devoted to the effects arising from the effect of a cochlear implant on the vestibular system. Due to the pronounced anatomical proximity and physiological interaction of vestibular receptors with the cochlea, the installation of a cochlear implant and its electrical activity are associated with an effect on the vestibular system. The analysis of the works of foreign and domestic researchers who carried out monitoring of vestibular function in patients after cochlear implantation using modern objective methods was carried out.

[Clinical and diagnostic criteria and differential diagnosis in the first and second stages of the development of Ménière's disease - A modern view of the problem]. / Kliniko-diagnosticheskie kriterii i differentsial'naya diagnostika pri pervoi i vtoroi stadiyakh razvitiya bolezni Men'era: sovremennyi vzglyad na problemu.

The results of a comprehensive examination of 82 patients with clinical signs of definite Ménière's disease, unilateral lesion and confirmed by extratympanic electrocochleography endolymphatic hydrops are presented. The results of the study showed that only 38% of patients had cochleovestibular syndrome due to Ménière's disease. In 45% of patients, Ménière's disease was combined with other diseases: benign paroxysmal positional vertigo, vestibular migraine, persistent postural-perceptual dizziness, superior semicircular canal dehiscence. In 17% of patients cochleovestibular syndrome was due to other reasons: vestibular migraine, tumor of the posterior cranial fossa, superior canal dehiscence syndrome, Cogan's syndrome, enlarged vestibular aqueduct, otosclerosis. Complaints, medical history of the disease and life, brain MRI, temporal bone CT and pure tone audiometry in dynamics are important in suspected Ménière's disease. For 1 and 2 Ménière's disease stages the most important characteristic are: progressive unilateral sensorineural hearing loss and reduced slow faze velocity values of caloric nystagmus in dynamics, mainly in warm response if attacks of vertigo is maintain; normal head impulse test between vertigo attacks and pathological result of this test in attack of vertigo with the normalization of gain during the first day.

[Vertical downbeat nystagmus in benign paroxysmal positional vertigo]. / Vertikal'nyi nistagm vniz pri dobrokachestvennom paroksizmal'nom pozitsionnom golovokruzhenii.

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibulopathy. Ppatients with BPPV contact with otorhinolaryngologists in 25% of cases. Due to the polymorphism of this pathology, an urgent task is to asess differential diagnosis of BPPV with various variants of the central positional syndrome: vestibular migraine, myofascial cervical syndrome, organic changes in the structures of the cerebellum. OBJECTIVE: To distinguish atypical forms of BPPV with downbeating vertical nystagmus and the central positional syndrome.

[Vertical nystagmus]. / Vertikal'nyi nistagm.

The review article provides a definition and classification of different nystagmus types, a comparative description of the central and peripheral vestibular nystagmus. The pathogenetic patterns of up-beating and down-beating nystagmus are accurately described. The features of nystagmus formation in various diseases are discussed, such as Wernicke encephalopathy, Arnold-Chiari anomaly, spinocerebellar ataxia and vestibular migraine. The authors provide their own data on oculomotor disorders in 100 patients with vestibular migraine and migraine with a brain stem aura. This article considers approaches to treatment: surgical and conservative. In conclusion, was noted the possibility of differentiating the central and peripheral vestibular nystagmus by means of clinical study. As well, the differences between vertical nystagmus associated with organic lesions of the brain stem or cerebellum and transient nystagmus with vestibular migraine are highlighted. The authors note the need for in-depth studies of nystagmus in vestibular migraine patients and methods of dealing with it.

[Positional vertigo variant]. / Variant pozitsionnogo golovokruzheniya.

The article describes case history and multiphase treatment of the patient with attacks of vertigo, initially regarded as the onset of Meniere's disease, but later qualified as secondary positional attacks with combined musculoskeletal pathology of the craniovertebral region and temporomandibular joint. Medicinal, local and surgical treatment led to the perfect result. Thus, the team work of neurologist, otolaryngologist, maxillofacial surgeon and orthodontist led to the successful elimination of vertigo attacks.

[Etiology and clinical symptoms of bilateral vestibulopathy]. / Etiologiya i klinicheskie proyavleniya dvustoronnei vestibulopatii.

OBJECTIVE: To identify etiology, clinical symptoms of bilateral vestibulopathy (BV) depending on etiology. RESULTS: Idiopathic BV was identifies in one third of patients. The most common identified reasons are Meniere's disease, meningitis and ototoxicity. BV develops more often without incidental hearing loss in case of idiopathic, autoimmune etiology, ototoxicity and bilateral vestibular neuronitis. BV after neuroinfection is characterized by prompt symptoms development, bilateral severe hearing loss, Gain reduction in vHIT lower 0.4 and loss of more than 8 lines in DVA test. CONCLUSION: BV after bilateral Meniere's disease is characterized by Gain higher than 0.4 and typical clinical picture of the primary disease.

[The use of Gliathiline in patients with sensorineural hearing loss]. / Ispol'zovanie preparata Gliatilin u bol'nykh neirosensornoi tugoukhost'iu.

The results of treatment of 38 patients suffering from sensorineural hearing loss with the Gliatilin (solution 3 ml intravenously for 10 days, capsules 400 mg 3 times a day or solution for ingestion 600 mg 2 times a day for 3 months) are presented. All patients in dynamics were given a comprehensive audiological, neurological examination, as well as an assessment of psycho-emotional status and cognitive function. Subjective improvement of ear noise tolerance by patients by 40 days of observation and continuation of this trend during the whole period (100 days) outside of the form of the medicinal preparation is noted. A reliable improvement in the 50% speech intelligibility threshold by day 100 of observation was established in patients of both groups, with a tendency towards earlier (on day 70 of the study) onset of this effect when taking the drug inside as a solution. The Gliatilin has been proven to reduce anxiety and depression, as well as reliably improve cognitive function. Thus, Gliatilin (injection solution, ingestion solution, capsules) can be used to improve the subjective tolerance of ear noise, speech intelligibility and quality of life of patients in chronic sensorineural hearing loss.

[The compensation of the vestibulo-ocular reflex during rehabilitation of the patients presenting with vestibular neuritis]. / Kompensatsiia vestibulookuliarnogo refleksa pri reabilitatsii u patsientov s vestibuliarnym neironitom.

AIM: The objective of the present study was to elucidate the mechanisms behind the compensation of the vestibular ocular reflex and evaluate the effectiveness of vestibular rehabilitation in the patients presenting with vestibular neuritis (VN) with the application of the video head-impulse test (vHIT) and the dynamic visual acuity test (DVAT). METHODS: The study included 26 patients with vestibular neuritis whose condition was assessed by scoring based on the dizziness handicap inventory, the dynamic visual acuity test, and the video head-impulse test with the evaluation of saccades and the degree of eye-head movement coordination (gain) before and after the course of vestibular rehabilitation. RESULTS: The study has demonstrated that the course of vestibular rehabilitation of the patients presenting with vestibular neuritis resulted in a significant decrease in the scores of dizziness estimated based on the dizziness handicap inventory and an improvement of dynamic visual acuity in the case of the complete gain recovery as well as in the case of persisting impairment of the gain and the development of sufficient 'covert' saccade. Vestibular rehabilitation was unsuccessful in the patients with persistereduced gain and simultaneous development of 'covert' and 'overt' saccades.

[The importance of vestibular evoked myogenic potentials for the assessment of the otolith function in the patients presenting with benign paroxysmal positional vertigo]. / Vestibuliarnye miogennye vyzvannye potentsialy v otsenke otolitovoi funktsii u patsientov s dobrokachestvennym paroksizmal'nym pozitsionnym golovokruzheniem.

The objective of the present study was to evaluate the otolith function in the patients presenting with idiopathic benign paroxysmal positional vertigo (pBPPV) attributable to the occlusion of the posterior semicircular canal (PSCC) of the inner ear with the use of vestibular evoked myogenic potentials (VEMP). Cervical (cVEMP) and ocular VEMP (oVEMP) were measured in 34 patients with idiopathic pBPPV before and 7 days after the treatment by means of reposition maneuvers. The results of the repeated Dix-Hallpike test performed 7 days after the repositioning maneuver were negative in 27 patients and positive in 7 patients. There was no statistically significant difference in the amplitude of cervical VEMP between the healthy and affected ears either before or after the repositioning treatment. The measurement of oVEMP revealed a reduction of the response amplitude on the affected side. The average values of the plnl on the healthy side were 12.84±1.09 and those on the affected side 4.62±0.69 (p<0,05). The successful repositioning treatment resulted in a significant increase of the oVEMP amplitude on the affected side (p<0,05). In the patients presenting with the persistent symptoms of pBPPV, the repositioning maneuvers did not cause an appreciable increase in the amplitude of oVEMP on the affected side (p<0.05). The results of the present study give evidence that pBPPV of the posterior semicircular canal is associated with the impairment of the function of the receptor structures of the utriculus and the preserved function of the succulus as suggested by the reduction of the oVEMP amplitude and clinically significant asymmetry of ocular VEMP on the affected side with intact cervical VEMP on both sides. The successful treatment of pBPPV of PSCC with the use of the liberatory maneuver results in the increase of the oVEMP amplitude on the affected side increases while the response asymmetry between both sides significantly decreases which indicates the repair of the utriculus otolith function.

[Cervical vertigo from the perspective of an otorhinolaryngologist]. / Sheinoe golovokruzhenie: vzgliad otorinolaringologa.

At present, the skeptical attitude toward the term 'cervical vertigo' (CV) predominates in the ENT-community. Such point of view is attributable to the absence of specific CV symptoms and well-defined diagnostic criteria. The present literature review was designed to consider the results of the clinical observations and experimental investigations obtained during the past 150 years that give evidence of the possibility to regard cervical vertigo as a separate nosological entity. The characteristic signs of this condition are analyzed and systematized. Four CV variants are currently distinguished. The principles of diagnostics and treatment of cervical vertigo are discussed and general concept of CV is formulated.

[The influence of Memoplant monotherapy on the dizziness]. / Vliianie preparata Memoplant v rezhime monoterapii na golovokruzhenie.

The objective of the present work was to study the influence of the dry extract from the leaves of Ginkgo biloba EGb 761 (used as monotherapy at a dose of 120 mg twice daily during 4 months) on the vestibular function of the patients presenting with cochleovestibular pathology of peripheral and mixed genesis. We present the results obtained by the objective and subjective methods for the evaluation of the vestibular function as well as the neurological and psychoemotional state of the 40 patients that was carried out during the four months of memoplant monotherapy. It is concluded that monotherapy with the use of the dry extract from Ginkgo biloba leaves can be applied for the purpose of improvement of static and dynamic balancing state. Moreover, this memoplant preparation can be used as a means of prophylaxis of recurrent dizziness that in addition reduces the severity of anxiety and depression without producing adverse side effects.