[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.

[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.

[Glucocorticosteroids in the treatment of acute neurosensory hearing loss. The current state of the problem. Part 2]. / Glyukokortikosteroidy v lechenii ostroi neirosensornoi tugoukhosti. Sovremennoe sostoyanie problemy. Chast' 2.

Modern literature data are presented on the choice of a drug for hormonal therapy in acute neurosensory hearing loss of various origins, the doses used for systemic therapy, the features and methods of intratympanic administration of glucocorticosteroids, and the evaluation of the effectiveness of treatment with this group of drugs.

[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.

[Benign paroxysmal positional vertigo: modern concepts of its etiology and pathogenesis]. / Dobrokachestvennoe paroksizmal'noe pozitsionnoe golovokruzhenie: sovremennye predstavleniia ob étiologii i patogeneze.

The objective of the present review of the literature is the analysis of the currently available data concerning etiology and pathogenesis of benign paroxysmal positional vertigo (BPPV). The special emphasis is placed on the modern hypotheses of BPPV formation that collectively account for not more than 15% of all known cases of this condition. The best explored are the following causes of benign paroxysmal positional vertigo: vestibular neuronitis, head injuries, and disorders in the middle ear. During the recent years, much attention has been given to the role of disturbances of calcium metabolism and osteoporosis in etiology of benign paroxysmal positional vertigo. It is supposed that pathogenesis of vertiginous attacks can be explained in terms of the canalolithiasis and cupulolithiasis theories.