Visuo-vestibular biofeedback in patients with peripheral vestibular disorders.

It is well known that diseases of the vestibular system can be compensated by increased spontaneous activity of other systems engaged in maintaining equilibrium, i.e. proprioceptive and visual systems. A complex approach using multisensory stimulation is the optimal way to achieve vestibular compensation. The aim of our study was to determine the effect of vestibular rehabilitation therapy as measured by posturography in a group of 72 patients suffering from vestibular disorders: Ménière's disease (n = 31), neuritis vestibularis (n = 21) and vertebrobasilar insufficiency (n = 20). Patients underwent the following examinations: electronystagmography; caloric, rotatory and optokinetic tests; computed posturography; craniocorpography; pure-tone audiometry; speech audiometry; and tinnitometry (tinnitus loudness, pitch). The instability in patients with Ménière's disease decreased 3 weeks after starting the therapy; nevertheless, the decrease in area (the surface formed by the movement of the patient's equilibrium point during a defined time) was transitory because of the increase in area values obtained between the 3rd and 6th weeks when measured with closed eyes. In the vestibular neuronitis patients, the measured values of area and the velocity of the patient's movement decreased continuously. The values measured in the patients suffering from vertebrobasilar insufficiency decreased continuously, the absolute values remaining pathological.

Combined laser-EGb 761 tinnitus therapy.

The treatment of patients with chronic tinnitus is very problematic and therefore otologists are trying to discover more suitable courses of therapy. In this study we wanted to evaluate the outcome of using a combination of EGb 761 and soft laser therapy. We examined 120 patients with an average duration of tinnitus of 10 years. The patients underwent pure-tone audiometry, speech audiometry and objective audiometry tests. The intensity and frequency of tinnitus was also determined. EGb 761 was administered 3 weeks before starting soft laser therapy. Patients underwent 10 sessions of laser therapy, each lasting for 10 min. An improvement in tinnitus was audiometrically confirmed in 50.8% of patients: 10 dB in 18; 20 dB in 22; 30 dB in 10; 40 dB in 6; and 50 dB in 5.

[Hearing and treatment of neonates with gentamycin]. / Sluch a lécba novorozencu Gentamycinem.

The authors examined two groups of children treated during neonatal period with high doses of Gentamycin. The reasons for Gentamycin treatment at the intensive care unit were infection of the CNS, pneumopaties, intracranial haemorrhagiae, cerebral oedema and other causes. The first group of children was treated in 1981, the second one in 1986. Both groups were examined in 1987. All children were evaluated to objective hearing tests, impedance audiometry by acoustically evoked potentials of the brain stem. Children of the first group examined during their fifth or sixth year were also submitted to a hearing test. The control group was formed by children born in 1986 treated at the intensive care unit with similar indications but who were not given Gentamycin. A total of 51 children were examined. Twenty-two children examined at the age of five had no hearing impairment. Acoustically evoked potentials of the brain stem have a wide variability which may be the manifestation of the disease which led to admission to the intensive care unit. Therefore it should be conceived as a screening examination and the revealed pathological findings should be verified by repeated examinations. Possible hearing disorders should be confirmed at a later age by conventional examinations.

[Treatment of tinnitus by Neolidocatone administered by iontophoresis into the middle ear]. / Ovlivnení tinnitu iontoforézou stredousí Neolidocatonem.

The authors describe a possible therapeutic approach mitigating tinnitus. It is not causal treatment but only symptomatic and extends the group of methods which influence tinnitus. The authors describe their own experience with iontophoresis of the middle ear with Neolidocatone-a derivate of Lidocaine which was done with a SANOMATIC apparatus, using galvanic current 1.5 mA. In one third of the patients it proved possible to mitigate the tinnitus permanently, in the remaining patients it persisted in the original intensity. The group of patients was heterogeneous from idiopathic tinnitus without impaired hearing, patients with otosclerosis, cervicocranial syndrome to those with Ménière's disease. The cause of tinnitus did not influence the therapeutic results.

[The tensor tympani muscle reflex in nasopharyngeal carcinoma]. / K problému reflexu m. tensoris tympani u karcinomu nosohltanu.

The initial stages of carcinoma of the nasopharynx may be manifested by different types of impaired hearing. The Eustachian tube may be obstructed by a tumour or its orifice compressed, sometimes the tumour penetrates into the middle ear. The authors discuss the position which may develop in infiltration of the semicanalis m. tensoris tympani and how functional disorders of this muscle may be manifested. They describe the provoked reflex of this muscle by trimolar acetic asid and investigate tympanometric reactions of this artificially provoked contraction of the m. tensor tympani in patients with carcinoma of the nasopharynx.

[Adenectomy and the status of the middle ear]. / Adenotomie a stav stredousí.

By tympanometric examination before and after adenotomy the authors confirmed the favourable effect of adenotomy on the condition of the middle ear. A marked decline of the tympanograms type B, almost to the level of the control group provides evidence to this effect. In the control group formed by children from a nursery school a great variance of tympanograms and their spontaneous dynamics was demonstrated. The authors consider tympanometric examinations fully indicated in children after adenotomy. Based on repeated pathological tympanograms and other examinations, we can easily differentiate children with a chronic secretory catarrh.

[Diagnostic contributions to the tympanometric study of malignant nasopharyngeal processes]. / Diagnostischer Beitrag zur tympanometrischen Untersuchung bei malignen Nasopharynxprozessen.

Extensive studies in areas of high prevalence of nasopharyngeal carcinoma have demonstrated that the most frequent site of origin is Rosenmuller's fossa. Even a small tumour may cause changes in the lumen of the orifice of the Eustachian tube either because of compression or because of a growth of the tumour directly into the lumen of the tube. This causes various wellknown disorders which are frequent initial signs and symptoms of the disease. Initially, subjective symptoms and signs are not accompanied by objective pathological findings except for a pathological tympanogram. The present method of tympanometric examination offers the possibility of detection of several initial stages of nasopharyngeal carcinoma, and combined with nasopharyngoscopy proves to be a very useful complementary examination to serology, biopsy and molecular-biological methods.