Analysis of pathogens and antimicrobial treatment in different groups of patients with chronic otitis media.

OBJECTIVE: Microbial infection plays an important role in exacerbation of chronic otitis media. The aim of this study was to analyse the microbiota in chronic otitis media in the context of local treatment. METHOD: In this prospective study, samples for microbiological examination were taken from 119 patients who underwent operation because of chronic otitis media. RESULTS: The results were compared between groups depending on the type of operation (none, tympanoplasty or radical), the presence of cholesteatoma or granulomatous tissue or discharge from the ear as a symptom of exacerbation. Antibiotic susceptibility of germs was analysed to define the strategy of treatment. A total of 209 samples were collected from 119 patients with chronic otitis media. CONCLUSION: Pseudomonas aeruginosa and Staphylococcus aureus were pathogens most frequently identified from the ear in the course of chronic otitis media. Pseudomonas aeruginosa was concerned with major pathology of the middle ear (radical surgery, cholesteatoma or granulomatous tissue, persisting discharge after treatment), whereas Staphylococcus aureus was obtained in dry perforations without other pathology in the middle-ear cavity. Ciprofloxacin was effective against Staphylococcus aureus, but Pseudomonas aeruginosa strains were ciprofloxacin resistant.

The effect of betahistine on vestibular habituation: comparison of rotatory and sway habituation training.

This study was designed to investigate the effect of histaminergic agonists and antagonists on the acquisition of vestibular habituation. The experimental animals, pigeons, were subjected to unilateral rotatory and sway habituation training sessions. The habituation of postural reflexes and post-rotatory head nystagmus was assessed. Vestibular habituation in the control group was achieved by adopting the kinetic reflex posture after approximately 9 training sessions, and after 10 and 14 training sessions, respectively for 50% reduction of the total number of beats (TNB) and the duration of post-rotatory head nystagmus. In the sway adaptation test control pigeons needed nearly 15 training sessions while pigeons receiving betahistine adapted after approximately 8 sessions. Administration of histamine and, most notably, betahistine accelerated the process, while both H1 and H2 antagonists (clemastine, cimetidine) tended to retard it, indicating a less significant contribution of H2 receptors. The cholinergic agent physostigmine strongly retarded habituation while the anticholinergic agent scopolamine markedly accelerated it. In addition the adrenomimetic agent ephedrine also accelerated habituation while the adrenolytic agent droperidol retarded reduction of nystagmus beats. The results indicate that histaminergic receptors play a significant role in the vestibular habituation mechanism but are intricately involved with other types of receptors. Betahistine is clearly the agent of choice for attenuating vestibular effects.

A comparative study of cefaclor vs. amoxicillin/clavulanate in tonsillopharyngitis.

BACKGROUND: Acute pharyngotonsillitis (APT) is one of the most common inflammatory processes of adults and children in an outpatient setting. Increasing failure rates, hypersensitivity to penicillin, the required multiple daily doses and common side effects lead to poor patients compliance and thus inadequate treatment duration, providing therefore ground for considering alternative antimicrobial agents. MATERIAL AND METHODS: This multicenter, randomized, single blind study was undertaken in order to compare efficacy and safety of cefaclor (375 mg BID) and amoxicillin/clavulanate (625 mg BID) in 10 days treatment regiment of ambulatory patients with APT. A total of 200 patients (age range between 12-65 years) with symptoms of APT and positive antigen strep test were enrolled into the study. Clinical and bacteriological responses were assessed after the end of treatment (14th-18th day) and at the follow-up visit (38th-45th day). All GABHS strains, isolated from throat cultures, were tested for in vitro sensitivity to the antibiotics used in the study and no strain was found resistant to both antibiotics. RESULTS: The results indicated that both antibiotics had high--almost 99% effectiveness at the post therapy visit. On the follow up visit an increased tendency of relapses was observed in the amoxicillin/clavulanate treated group, compared to cefaclor treated group (8.33% vs 3.29%). Relative risk of relapse in patients treated with amoxicillin/clavulanate was 2.6 greater compared to cefaclor. There were significantly higher rates of gastrointestinal adverse events in group treated with amoxicillin/clavulanate (29/97 patients; 29.89%) compared to cefaclor (16/95 patients; 16.84%) - p< 0.03. Frequency of other adverse events did not differ significantly between the groups. CONCLUSIONS: Cefaclor and amoxicillin/clavulonate provide a clinically and bacteriologically effective treatment for patients with pharyngotonsillitis caused by GABHS, but cefaclor treatment is significantly safer in regard to gastrointestinal side effects.

[Hyperlipidemia in patients with inner ear disturbances]. / Hiperlipoproteinemie w zaburzeniach funkcji ucha wewnetrznego.

The aim of this study was to evaluate the occurrence of hyperlipidemia in patients suffering from vertigo, and/or tinnitus and/or hearing loss of unknown origin. 48 patients (25 women and 23 men) were included into this study. All patients had a negative previous medical history of any metabolic, cardiovascular or neurological disorders. Our results were compared to the control group of 31 healthy persons (16 women and 15 men). All subjects had a complete neurootologic examination, appropriate audiometric and vestibular studies. In biochemical evaluation lipid phenotype studies were performed. Hyperlipidemia were classified according to Friedricson criteria. There were some differences in lipid phenotype and severity of hyperlipidemia between this two group.

Stabilometric evaluation of equilibrium in patients with damage to the cervical spine.

The purpose of the present article is the stabilometric evaluation of patients with disorders of the cervical spine. The research involved 106 persons with spinal damage in the cervical segment due either to degenerative disease or traumatic injury. The examinations, performed on a Freyss stabilometric platform, involved the evaluation of particular parameters of platform movement. Head torque was also measured by using a special attachment. Improvement in posture coordination was demonstrated in the period from one month to one year after surgical fixation of the spine, as was the negative impact of an orthopedic collar on vestibulospinal reflexes. The results here recorded are associated with changes in cervical proprioception, reliably evaluated by comparing traditional platform movement results with the parameters used to evaluate shifts is head position.

Visuoocular reflexes in presbyvertigo.

Using electronystagmography, we tested 100 patients (ages 65-80 years) manifesting the clinical signs of presbyvertigo, for the purpose of demonstrating their visuoocular reflexes. We administered not only simple optokinetic and eye-tracking stimuli but caloric modification of each one as well (with contrary directed optokinetic trace movement). The results were compared with those obtained in a group of 40 healthy subjects between the ages of 20 and 25 years. In the older group, we observed a statistically significant increased frequency of asymmetry of optokinetic nystagmus and pathological patterns revealed by the eye-tracking test and caloric modification of both the optokinetic and eye-tracking tests. We discuss the hypothetical predominant localization of age-dependent changes, with emphasis on the disturbances of visual-vestibular integration, on the basis of data obtained from anamnesis and other electronystagmographic findings.

Metabolic disorders in vertigo, tinnitus, and hearing loss.

Vertigo, tinnitus, and hearing loss are common complaints among populations of industrial countries, especially in persons older than 40 years. Numerous agents are known to incite vertigo, tinnitus, and hearing loss, among them hyperinsulinemia, diabetes mellitus, and hyperlipidemia. In this study, we proposed to assess the occurrence of hyperinsulinemia, diabetes mellitus, and hyperlipidemia in patients suffering from vertigo, tinnitus, or hearing loss of unknown origin. Results of various tests in 48 patients were compared to those in 31 control subjects. Assessments of body mass index, blood pressure, and laryngological, audiometric, and electronystagmographic parameters were performed in all study participants. An oral glucose tolerance test was used to evaluate insulin levels, and lipoprotein phenotyping served to determine cholesterol, triglyceride, and lipoprotein levels. Patients were found to be significantly more overweight (on the basis of body mass index) than were the control subjects. Hypertension was more common among patients than controls, but the difference was significant only between the men in the two groups. Disturbances of glucose metabolism were found in 27.1% of patients but in only 9.7% of controls. Diabetes mellitus was not present in any controls but was identified in four patients. Hyperinsulinemia was almost twice as common in patients as in controls. Only the occurrence of hyperlipoproteinemia seemed not to differ between patients and control subjects. We conclude that such disturbances of glucose metabolism as diabetes mellitus and hyperinsulinemia may be responsible for inner ear diseases, whereas the role of disturbances of lipid metabolism remains vague.

[Electronystagmographic and videonystagmographic studies in cerebello-pontine angle tumors]. / Diagnostyka elektronystagmograficzna i videonystagmograficzna w guzach kata mostowo-mózdzkowego.

Otoneurological investigations were carried out in 24 patients with cerebello-pontine angle tumors demonstrated in computed tomography. Standardized history taking was followed by electronystagmographic and videonystagmographical tests. In no case correct electrophysiological results were obtained. Eye-tracking test and gaze nystagmus were most frequently abnormal and together with other data these abnormalities indicated the location of the process. A more extensive use of videonystagmography was postulated.

[Risk factors for inner ear diseases]. / Czynniki ryzyka w chorobach ucha wewnetrznego.

The aim of this study was to evaluate the occurrence of obesity and arterial hypertension in patients suffering from vertigo, and/or tinnitus and/or hearing loss of unknown origin. 48 patients (25 women and 23 men) were included into this study. All patients had a negative previous medical history of any metabolic, cardiovascular or neurological disorders. Our results were compared to the control group of 31 healthy persons (16 women and 15 men). All subjects had a complete neurootologic examination, appropriate audiometric and vestibular studies. In most cases inner ear pathology was recognised. BMI, systolic and diastolic blood pressure were measured in all cases. Patients were overweight significantly more often comparing to the control group. Systolic and diastolic hypertension was found significantly more often in men from the patients than control group.

[The vestibular system and migraine in children]. / Uklad przedsionkowy a migrena u dzieci.

Migraine in childhood is relatively common disease. Although clinical practice and scientific publications recognize frequent association of migraine and vestibular disorders, relationships have yet to be well defined. In present study the vestibular function was extensively tested in 20 children suffering from migraine. All the patients underwent complete neurootological examination including tonal threshold audiometry, testing of vestibulo-spinal reflexes--Romberg and Unterberger-Fukuda tests, Dix-Halpike test for BPPV, videonystagmography. On videonystagmography each patient was evaluated regarding: calibration, spontaneous nystagmus, gaze nystagmus, eye tracking test, optokinetic and positional nystagmus, and caloric testing. The same procedure have been performed regarding control group comprised of 15 healthy. All the patients with migraine presented abnormalities in vestibular testing. Analysis of the results showed that: functional state of structures forming both visuo-ocular and vestibulo-ocular structures was altered in all the migraine patients evaluated in the study, pathological findings suggest mainly central localisation of vestibular dysfunction in children suffering from migraine, the number of pathological VNG findings seems not to be correlated with the type of migraine.

Electronystagmographic study in chronic schizophrenia.

The authors reached the neurological and psychiatric diagnosis of chronic schizophrenia in 20 patients after examination of both vestibulooculomotor and visuooculomotor reflexes on electronystagmography. The type and intensity of the disease were established on adequate scales, and the entire group was tested in the remission stage, during the absence of psychotic signs. Electronystagmographic study, particularly the eye-tracking test with caloric modification, revealed the significant pathology of optokinetic nystagmus. The disturbances of the suppression effect of fixation on caloric nystagmus were observed in one-half the cases. Caloric stimulation demonstrated no case of canal paresis and a very small amount of directional preponderance.

[Vestibular findings in children's epilepsy]. / Badania narzadu przedsionkowego u dzieci z padaczka.

20 children between ages 6 and 15 who suffered from epilepsy classified according to suggestions of International League Against Epilepsy to partial seizures evolving to generalized seizures were tested otoneurologically. The aim of the study was to estimate the frequency and location of vestibular disturbances coexisting with the disease. Subjective and objective (using electronystagmography--ENG--and videonystagmography--VNG) otoneurological study was performed. Dizziness was noted in most cases. Nobody demonstrated normal ENG/VNG recordings and the character of the pathology suggested its central origin. Eye-tracking proof and optokinetic nystagmus (cortical and subcortical) revealed to be most helpful during diagnostic procedures. No correlation between the location of EEG pathological patterns and ENG pathological signs was proved.

[Electrophysiological examination (ENG, EEG) in Alzheimer's disease]. / Badania elektrofizjologiczne (ENG, EEG) w chorobie Alzheimera.

The aim of the study was the electronystagmographic and electroencephalographic examination in patients with clinical diagnosis of Alzheimer's disease. The results showed that visual-oculomotor and vestibulo-oculomotor disturbances have had the central origin. ENG and EEG examination showed the lesions of both frontal and temporal cortes in these patients.

[The role of the histaminergic receptor in the vestibular habituation: an experimental study]. / Znaczenie receptora histaminergicznego w habituacji przedsionkowej--badania doswiadczalne.

The aim of the study was to determine the role of histaminergic H1, H2 and H3 transmission on the acquisition of vestibular habituation in pigeons. Rotatory training was used and the intraperitoneal injections of the agonists and antagonists of receptors described above were performed before each training. The results showed that agonists of H1 and H2, and H3 antagonist facilitate vestibular habituation. On the other hand, H1 and H2 antagonists restrain this process.

Experimental hemispherectomy and hemicerebellectomy and their influence on vestibular habituation.

The aim of the study was to estimate the influence of hemispherectomy and hemicerebellectomy on acquisition and retention of vestibular habituation in pigeons. The habituation training was performed using a rotatory test. The frequency of head nystagmus and postural reflexes was examined before and after acquisition of habituation and some days later, for the evaluation of the retention process. Our results suggested that the hemispherectomy did not inhibit the acquisition of habituation but retention of this phenomenon was shorter at that time. The hemicerebellectomy made it impossible to reveal the vestibular habituation.

[The role of neurotransmitters in the vestibular habituation: an experimental study]. / Rola przekazników synaptycznych w mechanizmie habituacji przedsionkowej--badania doswiadczalne.

The aim of the study was an evaluation of the influence that agonists and antagonists of the cholinergic and adrenergic transmission have on the acquisition and retention of habituation in a pigeon. Habituation training was performed by a rotatory test, under specific drugs influencing cholinergic and adrenergic transmission. The results show that after injection of a cholinergic antagonist or adrenergic agonist the acquisition of habituation is quicker; on the contrary, cholinergic agonists or adrenergic antagonists make this process slower. These drugs do not have any influence on the retention of habituation.

Vestibular habituation--the effect of cholinergic, adrenergic and histaminergic agents on the process.

Vestibular habituation-the effect of cholinergic, adrenergic and histaminergic agents on the process. The role of cholinergic, adrenergic and histaminergic transmission on the acquisition of vestibular habituation in pigeons is reported. 1. Cholinolytic, adrenomimetic and histaminergic agents probably clear the way for vestibular habituation in pigeons. 2. The cholinomimetic, adrenolytic and antihistaminergic effects probably inhibit the acquisition of habituation in these animals.

[The study of visual-oculomotor disturbances in otoneurological diagnosis]. / Badanie zaburzen wzrokowo-okoruchowych w diagnostyce otoneurologicznej.

The subject of work was the evaluation of diagnostic value of optokinetic nystagmus in inhibition of caloric nystagmus. Examination was performed in healthy subjects and in the peripheral and central vestibular pathology. The results of investigations show that this inhibition test is useful for differentiation peripheral and central vestibular pathology, especially supra- and subtentorial CNS lesions. Pathological result of this test in cerebellar lesions and brain-stem lesions suggest the role of these structures in the mechanism of optokinetic nystagmus.

[The influence of experimental hemispherectomy and hemicerebellectomy on the acquisition and retention of habituation in pigeon]. / Wplyw doswiadczalnej hemisferektomii oraz hemicerebellektomii na nabywanie i zapamietywanie habituacji u golebia.

The subject of investigation was the analysis of the acquisition and retention of the vestibular habituation in pigeons after hemispherectomy or hemicerebellectomy. The habituation training was performed using rotatory test. The frequency of head nystagmus and postural reflexes were examined before and after acquisition of habituation and some days later, for evaluation of retention. Our results suggests that hemispherectomy does not inhibit acquisition of habituation but retention of this phenomenon is shorter at that time. The hemicerebellectomy makes impossible the vestibular habituation.

[Experimental investigation of habituation transfer]. / Badania doswiadczalne zjawiska przekazywania habituacji.

The subject of investigation was the possibility of the transfer of habituation. In 20 pigeons frequency of optokinetic and postrotatoric head nystagmus was established. Then in 10 birds optokinetic habituation training and in 10 remaining pigeons rotatoric habituation training were performed. After acquisition of habituation in the first group, frequency of postrotatoric head nystagmus and in the second group frequency of optokinetic head nystagmus were defined. The transfer of optokinetic habituation to the rotatoric test was confirmed. The inverted process was not observed.