Hyperinsulinemia in vertigo,tinnitus and hearing loss

48 patients (25 woman, mean age 42 +/- 9.9 years and 23 men, mean age 46.6 +/- 8.3 years) suffering from vertigo, tinnitus and hearing loss of unknown origin were included into this study. The occurrence and coexistence of symptoms was measured. Insulin levels were measured fasting and at the second hour of OGTT. Results were compared with the control group of 31 healthy persons (16 women, mean age 41.3 +/- 5.6 years and 15 men, mean age 47.6 +/- 9.4 years). The character of vertigo, localization of hearing loss and electronystagmographic findings showed the pathology of the inner ear. The occurrence of hyperinsulinemia was significantly more common in the patients group--43.8%, comparing to the control group--22.6%. Also the insulin levels in the second hour of OGTT, were statistically significantly higher in patients that in the control group.     

The efficacy of Arlevert therapy for vertigo and tinnitus

We were interested in determining the efficacy of Arlevert therapy in vertigo and tinnitus patients, especially as it compared to the efficacy of the drug's two component agents, dimenhydrinate and cinnarizine. We conducted a comparative, randomized, double blind, multicenter, parallel group study involving a group of patients (n = 122) with vertigo and tinnitus of peripheral or central origin. The three test groups, nearly equal in size, were administered three times daily for 4 weeks one of the three agents being evaluated. To evaluate therapeutic success, we studied patients' vertigo symptoms, concomitant vegetative symptoms, CCG parameters, and electronystagmographic and audiometric parameters. We also obtained subjective assessments of outcomes from the test patients. Our results led us to conclude that Arlevert is more effective than either of its component drugs alone in treating vertigo and tinnitus. The drug also was well tolerated.     

重视循证医学研究促进眩晕及耳鸣疾病诊疗技术发展

作为耳科常见病症,眩晕疾病及耳鸣疾病的临床诊疗工作近年来受到国内外耳鼻咽喉头颈外科学界的高度关注.由于常见眩晕疾病及耳鸣疾病的发病机制尚未完全阐明,常缺乏客观而有效的检查与诊断方法,故眩晕及耳呜疾病的诊断与治疗是耳鼻咽喉头颈外科学界一大难点.近年来眩晕及耳鸣疾病的基础研究、临床诊断与治疗研究等均取得了许多进展,本期重点号论著亦报道了国内学者在眩晕和耳鸣疾病临床诊断与治疗研究领域内的研究结果.     

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.     

Neurally mediated syncope presenting with paroxysmal positional vertigo and tinnitus

A 72-year-old man with positional vertigo and tinnitus was referred to us. He did not want to perform provoking test except once due to his fear. No positional nystagmus was provoked. He found that his attacks usually occurred when he lay on his right ear. From his clinical history, benign paroxysmal positional vertigo was suspected. Conventional pharmacotherapy as well as non-specific physical therapy did not have significant effect. His feeling of positional vertigo with pyrosis was actually presyncope. We suspected cardiovascular disorders, and referred him to a cardiologist. Portable cardiogram monitoring revealed paroxysmal bradycardia. He was diagnosed with neurally mediated syncope, and a pacemaker was implanted. His paroxysmal dizziness soon disappeared. It is important to study the clinical history of the patients in detail, as they are not always able to accurately explain their symptoms. We should carefully rule out cardiovascular disorders, especially when we see the patients with suspected BPPV without the characteristic positional nystagmus.     

Temporomandibular joint dysfunction in whiplash injuries: association with tinnitus and vertigo

Temporomandibular joint dysfunction in whiplash injuries is usual. The author describes the mechanism of this joint dysfunction and the physiopathology of tinnitus and associated balance disorders.     

New pharmacological strategies to restore hearing and treat tinnitus

Recent advances in molecular pharmacology of the cochlea have lead to a much better understanding of the physiology, and especially the pathophysiology, of the sensorineural structures of the organ of Corti. Knowledge of the intimate molecular mechanisms of cellular dysfunction is of considerable use in the development of new therapeutic strategies. Herein, we summarize the mechanisms of sensory hair cell death after various injuries. Based on these molecular mechanisms, we propose novel therapeutic strategies to restore hearing. In addition to permanent hearing loss, exposure to noise or ototoxic drugs also induces tinnitus. We thus review recent findings obtained from a behavioral model of tinnitus in rats. In addition to providing evidence for the site and mechanism of generation of tinnitus induced by salicylate, these results support the idea that targeting cochlear N-methyl-D-aspartate receptors may represent a promising therapeutic strategy for treating tinnitus.     

New pharmacological strategies to restore hearing and treat tinnitus

Recent advances in molecular pharmacology of the cochlea have lead to a much better understanding of the physiology, and especially the pathophysiology, of the sensorineural structures of the organ of Corti. Knowledge of the intimate molecular mechanisms of cellular dysfunction is of considerable use in the development of new therapeutic strategies. Herein, we summarize the mechanisms of sensory hair cell death after various injuries. Based on these molecular mechanisms, we propose novel therapeutic strategies to restore hearing. In addition to permanent hearing loss, exposure to noise or ototoxic drugs also induces tinnitus. We thus review recent findings obtained from a behavioral model of tinnitus in rats. In addition to providing evidence for the site and mechanism of generation of tinnitus induced by salicylate, these results support the idea that targeting cochlear N-methyl-D-aspartate receptors may represent a promising therapeutic strategy for treating tinnitus.     

Angiomatous malformation of the inner auditory canal with the leading symptoms of vertigo and tinnitus

A case of a rare arteriovenous malformation in the internal auditory canal is reported. It caused unilateral tinnitus, facial weakness, trigeminal hypesthesia, and vertigo with lateropulsion. The audiological and otoneurological findings together with air-cisternography a CT scan had indicated an intrameatal tumor. An extended trans-temporal exposure of the internal auditory canal demonstrated an angiomatous lesion compressing the adjacent seventh and eighth cranial nerves. It could be removed safely by a second-stage lateral suboccipital approach to the cerebello-pontine angle.     

天眩清治疗眩晕、耳鸣的临床观察

目的 观察天眩清注射液对周围性眩晕、神经性耳鸣的治疗效果。方法 眩晕患者120例，耳鸣患者80例，各随机分为实验组及对照组，按观察项目、评定标准进行系列临床观察。结果 两实验组病例中，眩晕者总有效率93．3％，耳鸣者总有效率77．5％。结论 天眩清注射液对周围性眩晕、神经性耳鸣有显著疗效，为一种安全有效的制剂。     

Flunarizine in the treatment of vertigo

Experience with flunarizine, a selective calcium-entry blocker, in the treatment of dizziness is reviewed. Clinical efficacy was predicted in pharmacological studies both in rabbits and humans: torsion swing or caloric induced nystagmus were significantly suppressed by flunarizine. Open therapeutic findings, using clinical and electronystagmographic or audiographic assessments as well, showed that flunarizine is of benefit to patients with vertigo of labyrinthine as well as of cerebrovascular origin. These results were confirmed in double-blind controlled trials. Flunarizine, either started with a loading dose gradually decreased thereafter, or given at a fixed 10 mg. dose schedule was proven to produce rapid improvement of dizziness and unsteadiness and to be tolerated very well.