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The aims of this study were to follow recovery during the first 6 months after acute unilateral vestibular loss (AUVL) and to determine predictors for self-rated remaining symptoms.Forty-two subjects were included less than 10 days after AUVL. Static and dynamic clinical balance tests, visual analogue scales, University of California Los Angeles Dizziness Questionnaire, Dizziness Beliefs Scale, European Quality of Life questionnaire, Dizziness Handicap Inventory, and Hospital Anxiety and Depression Scale were performed at inclusion and at 7 follow-ups over 6 months. Subjects rated their symptoms on visual analogue scales daily at home. Videonystagmography was performed in the acute stage and after 10 weeks.Decrease of symptoms and improvement of balance function were larger during the first compared with the latter part of the follow-up period. Visual analogue scale ratings for balance problems were higher than those for dizziness. A prediction model was created based on the results of 4 tests in the acute stage: standing on foam with eyes closed, standing on 1 leg with eyes open, visual analogue scale rating of vertigo at rest, and European Quality of Life questionnaire rating of health-related quality of life. The prediction model identified subjects at risk of having remaining symptoms after 6 months with a sensitivity of 86% and a specificity of 79%.Recovery mainly takes place during the first weeks after AUVL. Subjects rate more balance problems than dizziness. Self-rated remaining symptoms after 6 months may be predicted by clinical balance tests and subjective ratings in the acute stage.

Physical inactivity is a risk factor for osteoporosis and fractures. The aim of the study was to see if supervised training would improve health-related quality of life (HRQL), reduce pain and fall ...

The industrial solvents xylene, styrene, trichloroethylene and methylchloroform administered to rabbits caused a positional nystagmus and disturbances in the nystagmus response to rotatory acceleration. The positional nystagmus had a beat direction the opposite to positional alcohol nystagmus, which was in similar experiments elicited by methanol, ethanol and propanol. The three alcohols needed a ten times higher blood concentration to cause a nystagmus than the solvents did.

Objective: To evaluate the influence of asymmetry of vestibular caloric response and age on balance and perceived symptoms after acute unilateral vestibular loss.Design: Prospective study.Setting: Ear, nose and throat departments in three hospitals.Subjects: Fifty-four patients (mean age 52 years) with acute unilateral vestibular loss participating in a randomized controlled training study were included.Main measures: Electronystagmography testing was performed within one week after onset of symptoms and after 10 weeks. The outcome measures clinical static balance tests (sharpened Romberg's test with eyes closed, standing on foam with eyes closed, and standing on one leg with eyes open and closed) and subjective symptom ratings on a visual analogue scale were done after one week, 10 weeks and six months. The correlation between age and asymmetry of vestibular caloric response, respectively, and the outcome measures were analysed.Results: Greater caloric asymmetry correlated with poorer performance at the sharpened Romberg's test and standing on one leg with eyes closed at all three follow-ups (rho=-0.31 to -0.54), and with higher symptom ratings at the 10-week and six-month follow-ups (rho=0.30-0.60). Higher age was associated with poorer performance on the sharpened Romberg's test and standing on one leg at all three follow-ups (rho=0.31-0.64), but did not change over time. Higher age was also associated with higher ratings of vertigo at the six-month follow-up, and less reduction of vertigo between the 10-week and six-month follow-ups (rho=0.29-0.48).Conclusions: A higher degree of asymmetry of vestibular caloric response and high age seem to be associated with poor outcome in balance and perceived symptoms after acute unilateral vestibular loss.

Purpose In a previous study we noticed that P6 acupressure ecreased postoperative nausea and vomiting (PONV) more markedly after discharge. As motion sickness susceptibility is increased by, for example, opioids we hypothesized that P6 acupressure decreased PONV by decreasing motion sickness susceptibility. We studied time to nausea by a laboratory motion challenge in a group of volunteers, during P6 and placebo acupressure.

In a questionnaire study detailed side effects after snoring surgery were examined in 415 individuals 2–8 years after surgery. Three years later a new questionnaire was answered by those with side effects affecting taste, smell and voice (n = 74). At the first follow-up 255 had side effects of globus, regurgitation, taste, smell and voice. The globus was the most common (40%). In all spheres except the globus, a significant improvement was seen 3 years later. However, pharyngeal dryness and phlegm had a reported frequency of nearly 60%. No significant differences were seen between the uvulopalatopharyngoplasty and laser uvulopalatoplasty methods. Taste disturbances might be due to surgical damage to the nerves or oral dryness. The olfactory impairment present in 7 patients still needs to be explained.

A follow-up study was performed with the aim to evaluate all individuals surgically treated by the uvulopalatopharyngoplasty (UPPP) or laser uvulopalatoplasty (LUPP) method from a whole county in Sweden, 1–8 years after surgery, by assessing snoring occurrence and daytime sleepiness, as experienced by the patients and their cohabitants. Questionnaires were mailed to all operated people (n = 457) and were returned by 91% (346 men, 69 women) preoperatively diagnosed as habitual snorers (n = 255), cases of obstructive sleep apnea syndrome (n = 110) and unspecified snorers (n = 48). In addition 345 bedpartners participated. For outcome of surgery, no significant differences in diagnoses or sex were found. Improvement in snoring occurrence was reported by 89.6% of the patients, confirmed by 92% of the cohabitants (r = 0.84, p < 0.01). The remaining snoring occurrence was significantly dependent on the surgical method and the time after operation. Excessive daytime sleepiness (EDS) was experienced by 73.3% of the patients compared to 67% reported by the cohabitants. Of 415 patients operated on, 18% were free from snoring and 25% were free from EDS. Individuals with a shorter time since surgery reported less snoring. The UPPP method gave a significantly better result than LUPP for the symptom ‘snoring’.

Benign paroxysmal vertigo in children is characterized by sudden attacks of vertigo lasting seconds or minutes. During the attack, the child has nystagmus and is unable to stand without support. Initially, the attacks are frequent, later slowly disappearing. Nineteen children who were diagnosed in 1975-1981 participated in a follow-up study. Sixteen of them were examined with audiometry and electronystagmography. Age at onset was from 5 months to 8 years, and the symptoms disappeared after 3 months to 8 years. The follow-up was performed 13 to 20 years after diagnosis. Twenty-one percent developed migraine which is somewhat more than in a normal population of this age. Thirty-nine percent had a family history of migraine which is a figure considerably lower than in a migraine population. None still had vertigo or a balance disorder. Our conclusion is that benign paroxysmal vertigo has a favorable outcome, and it is not a general precursor of migraine.

Sixty workers, consecutively admitted due to suspicion of solvent-induced chronic toxic encephalopathy (CTE), were investigated with pure-tone audiometry, determination of speech recognition of monosyllabic words and distorted speech and cortical response audiometry (CRA). Eighteen workers not exposed to occupational solvents and noise were also investigated. The scores in the distorted speech test were significantly lower and the CRA latencies were significantly longer in the solvent group than in the control group. There was no difference between the groups in the pure-tone and monosyllabic speech recognition tests. In the solvent group, 19 subjects had one or several pathological audiological test results (values exceeding the mean result of the control group by 2 SD). Independently of the audiological examination all the workers in the solvent group underwent the traditional clinical assessment of CTE, which is based on symptoms, history of exposure, clinical neurological examination and a neuropsychological investigation. They were classified in three groups--CTE, incipient CTE and non-CTE. There was no correlation between these groups and the audiological test results. A previous report on vestibular pathology in the same group of subjects and the present investigation on hearing deficits suggest that long-term exposure to solvents causes disturbances of the central pathways in the otovestibular system. Hitherto, no attention has been paid to these disturbances in the definition of the CTE syndrome.

Gentamicin given as local therapy for severe Menière's disease is of considerable value in the control of vertigo. The ototoxic antibiotic is instilled through the tympanic membrane causing a peripheral vestibular loss and possibly also diminished endolymph production. In order to achieve the best results with gentamicin treatment it is of utmost importance that the diagnosis is correct. Given to a patient with vertigo of other than peripheral origin, the outcome would be worsening of the existing symptoms and addition of new ones. The method should be used only by physicians who are very familiar with vertigo and otology, and only in patients with such a disturbing degree of vertigo that they are well motivated to receive treatment. Thorough information regarding the disease, the treatment procedure and the symptoms caused by a unilateral peripheral vestibular loss should be given to the patient. Vestibular rehabilitation, including movement therapy, should be given by the physician or preferably, a well trained physiotherapist on an individual basis or in patient groups together with written practice programmes for use at home. Vertigo attacks are usually relieved in 95% of patients. Twenty percent of patients experience an added hearing loss in the treated ear, although this number is reduced if the treatment is given as a single installment on consecutive days with extra installments given one month later if the vertigo remains.

Peripheral vestibular equilibrium disorders may originate in various parts of the labyrinth or the vestibular nerve. Traditionally, the function of the lateral semicircular canals has been assessed with caloric irrigation, and sometimes falsely been interpreted as a vestibular nerve lesion. The vertical semicircular canals are not easily assessed. Caloric testing with the head in different positions is not very helpful, but the canals may pairwise be tested using specific rotational techniques. Often the otolithic organs, capable of detecting linear acceleration forces, are forgotten as a source of vertigo and dizziness. We have implemented horizontal rotatory testing with the subject seated eccentrically facing the direction of rotation as a means of assessing otolithic function. The subject experiences a lateral tilt and is instructed in darkness to put a short light bar in the position he thinks a water surface would have, which is identical to his perceived tilt. In 39 normal subjects, a theoretical tilt of 24 degrees was estimated as approximately 19.5 degrees, and the standard deviation was 6 degrees. A side difference index was proposed to be normal if below 25%. The preliminary findings in a few patients with known labyrinthine lesions are presented. We propose that otolithic as well as lateral semicircular canal functions are useful to monitor in patients with suspected peripheral equilibrium disorders.

Borreliosis is known to be a common cause of peripheral facial palsy in Stockholm and its vicinity. The aim of the present study was to investigate the frequency and characteristics of borreliosis among patients with peripheral facial palsy in different parts of Sweden. All serological tests were performed in one laboratory. Ten Swedish Ear Nose and Throat clinics participated in a prospective 1-year study of patients seeking medical attention for acute peripheral facial palsy. Twenty-eight (6%) out of totally 446 patients fulfilled the criteria for the diagnosis of borreliosis. The frequency varied between 1 and 16% and was highest along the southeast coast of Sweden whereas no case was reported from the northern part of the country. Borreliosis was more common among children with facial palsy than among adults. The infection occurred during all seasons although it appears to be less frequent during the spring months. Only a minority of the borrelial patients had a history of a preceding tick bite or erythema migrans. The fairly low overall frequency of this secondary stage of borreliosis in the study may be a result of better knowledge of the disease and earlier treatment of its early manifestations. In Sweden's endemic areas borreliosis is a common cause of peripheral facial palsy, and therefore all patients with facial palsy in these regions should be examined for borrelial infection.

OBJECTIVES: To determine long-term clinical outcome in children with confirmed Lyme neuroborreliosis (LNB) and to evaluate persistent subjective symptoms compared with a control group. METHODS: After a median of 5 years, 84 children with confirmed LNB underwent a neurologic re-examination, including a questionnaire. Medical records were analyzed, and a control group (n = 84) was included. RESULTS: The total recovery rate was 73% (n = 61). Objective neurologic findings, defined as “definite sequelae,” were found in 16 patients (19%). The majority of these children had persistent facial nerve palsy (n = 11), but other motor or sensory deficits occurred (n = 5). Neurologic signs and/or symptoms defined as “possible sequelae” were found in another 7 patients (8%), mainly of sensory character. Nonspecific subjective symptoms were reported by 35 patients (42%) and 32 controls (38%) (nonsignificant). Affected daily activities or school performance were reported to the same extent in both groups (23% vs 20%, nonsignificant). CONCLUSIONS: The long-term clinical recovery rate was 73% in children with confirmed LNB. Persistent facial nerve palsy occurred in 13%, whereas other motor or sensory deficits were found in another 14%. Neurologic deficits did not affect daily activities or school performance more often among patients than controls and should be considered as mild. Furthermore, nonspecific subjective symptoms such as headache, fatigue, or memory or concentration problems were reported as often among patients as controls and should not be considered as sequelae after LNB.

Subjects exposed to industrial solvents may experience vertigo and nausea. Solvents are usually volatile hydrocarbon compounds, which are important parts of everyday life in a modern society. They may also cause neurastenia, personality changes, and reduced intellectual capacity. The syndrome that may develop was formerly named psycho-organic syndrome (POS), but in modern terminology it is called chronic toxic encephalopathy (CTE). The syndrome develops slowly, and during the first years no pathological findings will be found using various test batteries. Somewhat later, when the syndrome still might be reversible, psychometric, auditory, and otoneurologic testing may well unveil disturbances within the posterior fossa structures. Animal experiments suggest one site of effect for solvents to be within the cerebellum and brainstem regions with close relationship to the gamma-amino-butyric acid (GABA) transmission. In the otoneurologic test battery, visual suppression and smooth pursuit are of extreme value, as are some auditory tests such as discrimination of interrupted speech and cortical response audiometry using frequency glides as stimuli. Dynamic posturography and magnetic resonance imaging (MRI) have recently proved valuable in the diagnosis. Research is needed concerning the most efficient test battery for early detection of solvent-induced lesions. During further research it is important to unveil other toxic agents, like heavy metals and alcohol, and their damage to the central nervous system and to make comparisons between these substances and the lesions caused by hydrocarbon solvents.

Different medical and surgical methods have been tried in attempting to reduce endolymphatic pressure in MΘniΦre's disease. Pressure treatment has a role on the treatment staircase, after pharmacological treatment and before destructive methods. Pressure chamber treatment has shown that some patients respond well to the treatment with diminishing inner ear symptoms and also some hearing improvement. Earlier studies have shown that electrocochlear measurements improve after local pressure treatment in the ear. The present study was a prospective randomized placebo controlled, multicentre clinical trial. 56 patients with active MΘniΦre's disease, age 20-65 years, with a hearing loss of 20-65 dB PTA participated. A total of 31 patients completed 2 weeks use with an active apparatus (Meniett) and 25 patients completed the 2 weeks with the placebo gadget. Both machines were produced by Pascal Medical, Halmstad, Sweden. Two weeks before the start of treatment a grommet was placed in the tympanic membrane. A significant improvement concerning frequency and intensity of vertigo, dizziness, aural pressure and tinnitus was reported by the active group on the visual analogue scales (VAS) questionnaire. In the placebo group no change was the most common finding, followed by worsening of the symptoms and a few improvements. The function in professional and family life improved during active treatment and did not during placebo treatment. Pure-tone audiometry did not improve after placebo treatment, but improved at the frequencies 500 Hz and 1,000 Hz after active treatment. The study showed an improvement in the inner ear symptoms after Meniett treatment. The mechanism may be explained by the influence on the round window membrane pressure receptors or an endolymphatic flow out through the pressure release points, such as the endolymphatic duct and sac, thus activating the longitudinal flow. Other mechanisms are also possible.

All persons aged 70 through 75 years (N = 457) in a Swedish community were invited to participate in a 9 week balance training study. Out of 55 interested subjects, 15 were chosen at random for a study group; 15 matched controls were also selected. Before and after the investigation period the balance function was assessed by clinical balance tests and dynamic posturography. In the clinical balance tests, the training group significantly improved their balance standing on one leg with eyes closed as well as standing on one leg while shaking the head; they also walked 15 m back and forth faster. In the dynamic posturography the training group significantly improved their equilibrium scores in the 3 most difficult test conditions. The results of the control group were unchanged except for one test condition in the dynamic posturography. The differences in one-leg standing with head shaking, walking 2 × 15 m, and the equilibrium score using sway-referenced platform in dynamic posturography were proved to be attributable to the training. The first investigation in all 29 subjects formed normative dynamic posturography data for the age group 70 through 75 years. The normative posturographic data of this age group differed from previously obtained data in the age groups 20 through 59 and 60 through 69 years. It is concluded that elderly may improve their balance by regular balance training exercises for as short a period as 9 weeks. This might prove to be of great value in improving balance and thereby preventing accidental falls and subsequent fractures in elderly.

An otoneurological test battery was administered to 18 workers with long-term exposure (6-15 years) to styrene at levels well below the current Swedish limit (110 mg/m3). The results were compared with those of a reference group. Disturbances were found in the central auditory pathways of seven workers. Tests reflecting central processing of impulses from different sensory equilibrium organs were abnormal for 16 workers. The most relevant tests seemed to be static posturography and the rotatory visual suppression test. In the posturography the styrene group had a significantly larger sway area than the reference group. In the visual suppression test, the styrene workers displayed a significantly poorer ability to suppress vestibular nystagmus than the reference group. It was concluded that styrene exposure in industrial environments at moderate or low levels causes central nervous system disturbances which are not always diagnosable with psychometric tests but can be apparent in special otoneurological tests.

In sinus empyema, H. influenzae is the most prevalent pathogen in some subpopulations and in case of therapeutic failure. Cefixime, the first oral cephalosporin of the 3rd generation, is highly potent in vitro against H. influenzae. To study the efficacy and safety of cefixime in adults with acute sinusitis, a coordinated, double-blind multicenter trial was designed for purulent cases, as confirmed by antral aspiration. A total of 364 patients were enrolled in the study with 125 cases randomized to the reference group, assigned to treatment with cefaclor. Evaluation was based on clinical outcome and on antral reaspiration (86% of the cases). No significant differences between the treatment groups were found, as regards short-term or long-term clinical outcome. However, the clinical examination overestimated the therapeutic results. Only 4% of the patients were considered as failures, but the re-aspiration demonstrated remaining suppuration in 14% of all cases (p less than 0.001). Based on re-aspiration, the failure rate among patients with initial growth of pathogens was lower for cefixime (8%) than for cefaclor (20%) (p less than 0.05). Such a difference was not found among patients with growth of H. influenzae. No serious adverse reactions were recorded, but loose stools and diarrhoea were significantly more frequent in the cefixime treatment group. Five patients (2%) in the cefixime treatment group discontinued their treatment due to adverse events.

Fifteen voluntary subjects with a mean age of 26 years (17–39), participated in two rotatory experiments. The rotatory test used was sinusoidal harmonic acceleration (SHA) test at frequencies of 0.01–0.32 Hz. Compensatory eye movements were measured by means of EOG. Experiment A included rotation in darkness during alerting tasks (day 1), rotation in darkness with no tasks (day 2) and rotation in darkness during alerting tasks (day 3). In the altertness tests, the gain varied between 0.5 and 0.77. Phase values decreased with increasing frequency. The alertness results between days 1 and 3 did not differ in gain or phase. The gain of day 2 (no tasks) displayed significantly reduced gain at all frequencies, and a more pronounced decrease in phase than in the alertness tests. Experiment B compared testing with eyes open (day 1) and eyes closed (day 2) during alerting tasks. These tests displayed significantly decreased gain at all frequencies with eyes closed compared with eyes open and with more negative ph...

The scientific workshop, organized under the 6th European Framework Programme, the Marie Curie Host Fellowship for the Transfer of Knowledge "NoiseHear" Project, by the Nofer Institute of Occupational Medicine (Łódź, Poland, 15-16 November 2006), gathered world specialists in noise, chemicals, and ototoxicity, including hearing researchers, toxicologists, otolaryngologists, audiologists and occupational health physicians.The workshop examined the evidence and the links between isolated exposure to organic solvents, combined exposure to noise and solvents, and effects on the auditory system. Its main purpose was to review the key scientific evidence to gather the necessary knowledge for developing adequate occupational health policies. This paper summarizes the workshop sessions and subsequent discussions.

About half of the subjects in this study reported remaining symptoms 3-6 years after acute unilateral vestibular loss. Differences could be seen between subjects with and without remaining symptoms regarding health-related quality of life, anxiety and depression.To evaluate the presence of self-rated remaining symptoms 3-6 years after acute unilateral vestibular loss, and to compare subjects with and without such symptoms.Firstly, 51 subjects answered a questionnaire which included the EuroQol EQ-5D, the Hospital Anxiety and Depression Scale, the University of California Los Angeles Dizziness Questionnaire, visual analogue scales and the Dizziness Handicap Inventory. Secondly, nine subjects with and nine without remaining symptoms participated in an extended testing procedure, including electronystagmography (ENG), determination of vestibular-evoked myogenic potentials (VEMPs) and clinical balance tests.In the first part of the study, 27 subjects reported remaining symptoms, 3 reported 1 additional period of symptoms and 21 had not experienced any symptoms at all in the 3-6 years since acute unilateral vestibular loss. In the second part, the group with remaining symptoms rated a lower health-related quality of life and a higher level of anxiety and depression. There were no differences between the two groups in terms of ENG tests, VEMPs or clinical balance tests.

Objective: To evaluate the effects of additional physical therapy on recovery after acute unilateral vestibular loss given to patients receiving home training.Design: Randomized controlled trial.Setting: Ear, nose and throat departments in three hospitals.Subjects: Fifty-four patients (mean age 52 years) with acute unilateral vestibular loss within the last week confirmed with electronystagmography testing were included. Patients with central neurologic or auditory symptoms or other vertigo disease were excluded.Interventions: Home training with or without additional physical therapy 12 times during 10 weeks.Main measures: Electronystagmography testing was performed before and after the training period. Clinical static (Romberg?s test, sharpened Romberg?s test, standing on foam and standing on one leg) and dynamic (walking forward and backward on a line) balance tests and subjective ratings of vertigo and balance problems on a visual analogue scale were done one week, 10 weeks and six months after the start of training.Results: Similar changes were seen in the two training groups.Conclusions: No significant differences in outcome regarding balance function or perceived symptoms were found between home training with or without additional physical therapy.

Objectives: To evaluate the efficacy of a new device, the Meniett, in the treatment of Meniere’s disease. The device delivers pressure pulses to the middle ear through a ventilating tube in the tympanic membrane at a frequency of 6 Hz for 0.6 second. After rising to a pressure level of 1.2 kPa, the pressure oscillates between 0.4 and 1.2 kPa. It is believed that the pressure changes are conveyed to the inner ear, inducing a transport of fluids via the pressure outlets and thus reducing the endolymphatic hydrops. Study Design: A clinical, randomized, multicenter, doubleblind, placebo-controlled study. A total of 40 patients were included that had active Meniere’s disease according to American Academy of Otolaryngology–Head and Neck Surgery criteria, aged between 20 and 65 years, with a history of at least eight attacks during the past year. After insertion of the ventilation tube, the patients should have had attacks of vertigo for 2 months before entering the study. Outcome Measures: Primary study endpoints were change in frequency of vertigo, change of functionality profile, and change in patient perception of vertigo (visual analogue scale); secondary endpoints were perception of tinnitus, aural pressure, and hearing, as well as an audiologic evaluation of hearing before and after the treatment period. Results: The functionality level improved statistically significantly in the active group compared with the placebo group (p 0.0014), as did the visual analogue scale evaluation of vertigo (p 0.005). There was a trend toward a reduction of the frequency of vertiginous attacks that was not significant (p 0.090). With regard to the secondary endpoints, there was no statistical difference between active and placebo groups. Conclusion: Local overpressure treatment is a novel treatment that is noninvasive, nondestructive, and safe. It significantly reduces vestibular symptoms in patients with Meniere’s disease. The Meniett was cleared by the Food and Drug Administration in 2000. Key Words: Meniere’s disease— Noninvasive—Pulsed local overpressure—Vertigo. Otol Neurotol 26:68–73, 2005.

Purpose: To use MR to examine patients with CNS symptoms indicating chronic intoxication. Material and Methods: Thirty-two subjects exposed to industrial solvents for 5 to 28 years and 40 age-matched, healthy controls were examined. Results: All patients showed decreased signal in the basal ganglia on T2-weighted images. In 11 of the patients the white matter showed diffuse hyperintensity with loss of the grey-white matter discrimination and with distinct periventricular hyperintensities in 5 of the patients. The controls had no pathological changes in the brain. Conclusion: Although the relatively small number of patients may obscure the significance, findings observed on T2-weighted images were patchy periventricular hyperintensities and hypointensities in the basal ganglia. Fast spin-echo is a good technique with fast acquisition of images with true spin-echo contrast features.

The effects of classical sedating antihistamines on cognitive and perceptual functions are well known. Loratadine is a new antihistamine without sedative effects. In this study, loratadine 10 and 40 mg daily, clemastine 2 mg twice daily and placebo were evaluated in 8 healthy subjects in terms of effects on equilibrium as measured with dynamic posturography. Dynamic posturography comprises a sensory organization part in which the support surface and visual surround are either stable or referenced to the patient's sway, with eyes open or closed. In a movement coordination part, the platform makes active movements. Analysis of variance showed no effects on equilibrium attributable to loratadine. Comparing substances pairwise, however, a significant difference between loratadine and clemastine was displayed in 2 out of 6 sensory test conditions. In conclusion, loratadine can be considered safe regarding balance functions.

Acute facial palsy in children is believed to be a rather benign neurological condition. Follow-up-studies are sparse, especially including a thorough otoneurological re-examination. The aim of this study was to examine children with a history of facial palsy in order to register the incidence of complete recovery and the severity and nature of sequelae. We also wanted to investigate whether there was a correlation between sequelae and Lyme Borreliosis, treatment or other health problems.Twenty-seven children with a history of facial palsy were included. A re-examination was performed by an Ear-Nose-Throat (ENT) specialist 1-2.9 years (median 2) after the acute facial palsy. The otoneurological examination included grading the three branches of the facial nerve with the House-Brackman score, otomicroscopy and investigation with Frenzel glasses. A paediatrician interviewed the families. Medical files were analysed.The incidence of complete recovery was 78% at the 2-year follow-up. In six out of 27 children (22%), the facial nerve function was mildly or moderately impaired. Four children reported problems with tear secretion and pronunciation. There was no correlation between sequelae after the facial palsy and gender, age, related symptoms, Lyme neuroborreliosis (NB), treatment, other health problems or performance.One fifth of children with an acute facial palsy get a permanent dysfunction of the facial nerve. Other neurological symptoms or health problems do not accompany the sequelae of the facial palsy. Lyme NB or treatment seems to have no correlation to clinical outcome. Factors of importance for complete recovery after an acute facial palsy are still not known.

Subjects with neck problems, such as whiplash injuries, often complain of disturbed equilibrium and, in some instances, provocation of the neck position can elicit such problems. The importance of neck proprioceptors for maintaining balance is gaining increased interest, moreover the function or malfunction of the otoliths may disturb equilibrium in certain head positions. The aim of the study was to create a reference material for postural control and its dependence on head position in healthy subjects and to compare this with a set of patients with known neck problems and associated vertiginous problems. A total of 32 healthy subjects (16 men, 16 women, age range 21-58 years) as well as 10 patients age range 27-62 years (mean 44 years) with neck problems and associated balance problems since a whiplash injury were tested for postural control using the EquiTest dynamic posturographic model. The normal subjects were initially split into four age groups in order to estimate the effects of age on performance. The postural stability was evaluated for dependence of support surface conditions (stable or sway-referenced), visual input (eyes open or closed) and head position (neutral, left rotated, right rotated, extended backwards or flexed forward) using analysis of variance (ANOVA) with Tukey's post hoc test in case of a significant factor effect. As expected, visual cues as well as stable support surface improve postural stability (p0.001). Postural stability is statistically different in the head extended backwards condition compared with the other four head positions (p0.001 in all cases) in both patients and controls. Eliminating this test condition from the analysis, only a slight (p0.05) difference between head forwards and head turned left remained. This pattern of results remained if the normal subjects were only split into two age groups instead of four. Finally, the patient group exhibited significantly lower postural performance than all the groups of normal subjects (p0.01), but none of the normal groups differed significantly from each other. It is concluded that the postural control system is significantly challenged in the head extended backwards condition in both normal subjects and patients with previous whiplash injury and persistent neck problems. The patient group differed statistically from all groups of normal subjects. This suggests that neck problems impair postural control, and that the head extended position is a more challenging task for the postural system to adapt to. Whether this is due to utricular malpositioning, central integrative functions or cervical proprioceptive afferents is not within the scope of this study to answer.

To assess whether estrogen treatment given to postmenopausal women without vasomotor symptoms improves balance more than placebo.Forty healthy postmenopausal women without vasomotor symptoms were randomized to transdermal 17beta-estradiol (E2) 50 microg/day for 14 weeks or identical transdermal placebo patches. Postural balance was measured with dynamic posturography before and after 4, 12, and 14 weeks of therapy. In this test, the visual, vestibular, and somatosensory systems were provoked with increasing difficulty and body sway was measured with a dual forceplate. A low score showed large sway and a score of 100 showed no sway at all.Thirty-eight women completed the study. Both groups had normal balance for their ages and near maximum scores in the three easier balance tests at baseline. In the most difficult test, both groups improved their postural balance significantly (from 13 to 32 and from 22 to 39, respectively) after 4 weeks. Thereafter, no change was seen. One problem was low statistical power, but the relative change in balance did not differ between groups. The comparison did not show even a minute advantage of E2 over placebo, so a study with higher power would probably not have shown a more pronounced effect of estrogen than placebo. The change over time did not differ between groups, which indicates a significant learning effect.In women without vasomotor symptoms, estrogen therapy did not seem to increase postural balance significantly more than placebo. However, we could not rule out that estrogens affect postural balance in women with vasomotor symptoms.

Objectives The diagnosis of solvent-induced chronic toxic encephalopathy is commonly based on case histories of exposure to solvents, symptoms, and deficits on psychometric tests. It has previously been demonstrated that long-term solvent-exposed workers have disturbances of the equilibrium system. The correlation between these disturbances and the diagnosis of chronic toxic encephalopathy has been analyzed in the present study. Materials and methods Sixty men, consecutively admitted due to the suspicion of this syndrome, were investigated and classified into 3 groups -- solvent-induced chronic toxic encephalopathy, incipient chronic toxic encephalopathy and nonchronic toxic encephalopathy. They were all examined using an otoneurological test battery, including analysis of saccades, smooth pursuit, visual suppression of the vestibular ocular reflex, and dynamic posturography. Results Compared with healthy referents several of the subjects, even in the nonchronic toxic encephalopathy group, showed a reduced visual suppression ability, a prolonged latency of saccades, and pathological posturographic results. Some otoneurological tests correlated with the duration of exposure and the results of psychometric tests representing memory and perceptual skills. Nevertheless, there was no significant group correlation between the otoneurological findings and the diagnosis of chronic toxic encephalopathy. Conclusion Disturbances revealed by an otoneurological investigation have so far not been considered in the diagnosis of chronic toxic encephalopathy. Our results indicate that an otoneurological test battery adds worthwhile information about lesions within the brainstem-cerebellar complex not revealed by a psychometric investigation.

In the diagnostic procedure for patients with symptoms and signs indicating VIIIth nerve or brain stem disturbances, the possible presence of tumors, infarcts, bleedings or microvascular loops are taken into account. Ten patients with vertigo, balance disorders, tinnitus or unilateral hearing loss proved to have a similar cause underlying the disturbances. They ranged in age from 51 to 80 years and had a duration of their symptoms of 1-10 years. In the test battery audiology, electronystagmography, broad-frequency rotatory testing and dynamic posturography were used. No uniform pattern was present. The results showed VIIIth nerve as well as CNS signs. Trigeminal neuralgia and hemifacial spasm were observed. CT, NMR or angiography were performed. The common finding for these patients were ectatic vertebral and/or basilar arteries. The size and position of the vessels indicated that compression of the VIIIth nerve or brainstem was the cause underlying their disturbances. To exclude that macrovessels appear in patients without neurotological symptoms and signs 300 consecutive NMR investigations in patients referred for other than neurotogic indications were scrutinized. In these patients no macrovessels were found. The findings indicate that ectatic vessels may cause disturbances mimicking a pontine angle tumor, Meniere's disease and other peripheral or central conditions with inner ear symptoms, vertigo and balance disorders. Arterial loops in the pontine angle may give indications for microvascular surgery, but the big ectatic vertebral and basilar arteries may offer surgical decompression possibilities, though with large risks.

Twenty-one patients with unilateral sudden deafness and 16 patients with vestibular neuritis, all with typical clinical history and findings, were investigated for a possible borrelia-cause. Only one patient, a patient with vestibular neuritis, had evidence of active borreliosis in terms of high antibody-titers in CSF, increased cell count and disturbed albumin ratio. To gain more knowledge about the etiological role of Borrelia burgdorferi in patients with hearing and vestibular symptoms, it is, despite this sparse finding, motivated to perform Borrelia testing in patients from tick-frequent areas. A reliable testing includes both serum and CSF analysis.

Little is known about the long-term effects of Borrelia burgdorferi (Bb) infection in untreated patients with peripheral facial palsy. We investigated 12 patients with elevated serum Bb antibody levels, with a median follow-up time of 11 years, during which 3 of the 12 still exhibited intrathecal antibody production of antibodies against Bb flagellar antigen, and 2 of the 3 had normal serum Bb antibodies. Four of the 12 had elevated serum antibody titres at the late follow-up examination. Arthralgia, reported by 7 patients, was the single most common complaint. Four patients showed extensive oculomotor disturbances, which were not correlated to antibody titres or intrathecal antibody synthesis. In 1 of the patients with intrathecal Bb antibody production, most symptoms were eradicated by antibiotic treatment 6 years after the initial infection. We conclude that even several years after a Bb infection, intrathecal Bb antibody production can still occur in serum Bb IgG antibody negative patients with a history of facial palsy.

Introduction: The causes for peripheral facial palsy remain obscure in many patients. Evidence exists suggesting viruses, especially those belonging to the herpesvirus group, may be causative. This study was developed to evaluate this theory. Methods: One hundred forty-seven patients with acute peripheral facial palsy of primarily unknown origin were studied. All were examined within 1 week of onset. Subsequent follow-up was undertaken until the palsy had recovered or become static. Paried cerebral spinal fluid and serum samples were obtained for serological evaluation to detect herpes simplex, varicella zoster, cytomegalovirus, measles, mumps, rubella, tick-borne encephalitis, adenovirus, Epstein-Barr virus, and human immunodeficiency virus, as well as the antibodies to Borrelia burgdorferi . Results: Elevated antibiotic titers to Borrelia burgdorferi were observed in 11% of patients, whereas 9% of patients demonstrated elevated viral titers. Antibody pattern consistent with Epstein-Barr virus reactivation was present in 13%. A total of 67% were classified as idiopathic. Conclusion: Patients with reactivated Epstein-Barr virus were characterized by having a higher incidence of auricular pain and displayed diabetes mellitus in a higher frequency than in other groups. In the Borrelia group, neck/back pain was more common. Healing was less favorable in the Borrelia group despite an equal rate of palsy at onset and adequate antibiotic treatment. Corticosteroid treatment used in 44% of the patients did not significantly improve the functional outcome.

Seven male patients previously exposed to industrial solvents and diagnosed with chronic toxic encephalopathy (aged 38 to 69 years; mean age, 56 years) were investigated by dynamic posturography and compared with healthy, age-matched male control patients. Dynamic posturography comprises two phases: a sensory organization (SO) phase, in which the support surface and visual surround are either stable or referenced to the patient's sway, with eyes open or closed, and a movement coordination (MC) phase, in which the platform makes active movements. In SO testing, the patient group showed significantly impaired equilibrium performance compared with the control group in most test conditions. The MC test revealed no differences between groups. A relationship was found between the equilibrium score resulting from SO testing with stable support and visual surround and the sway area of the confidence ellipse elicited 3 years previously by static posturography with eyes open. We conclude that patients with chronic toxic encephalopathy have impaired equilibrium, as demonstrated by dynamic posturography testing.

Cervical vertigo, the entity of neck disorder and associated vestibular symptoms, was investigated in 15 suspected subjects and results were compared with 15 age-matched controls. A modified dynamic posturography investigation with different head positions was used. Head position was recorded 3-dimensionally with electrogoniometry. Differences on a sway-referenced forceplate were found.

CSF and serum were examined in acute and convalescence phase from 56 patients with acute idiopathic peripheral facial palsy. CSF protein analysis, viral and borrelia serology were performed. Borrelia infection was found in 9/56 cases and was often associated with inflammatory CSF findings. One patient each had serological evidence for a recent or ongoing infection with herpes simplex, varicella zoster, adeno, influenza B, echo and Epstein-Barr virus, but none had specific intrathecal antibody synthesis; 11 patients had a serological pattern compatible with a reactivated Epstein-Barr virus infection. Eleven patients displayed mononuclear CSF pleocytosis. Four of them had a borrelia infection. A disturbed blood-brain barrier was observed in 19 patients. Intrathecal immunoglobulin synthesis as indicated by elevated IgM-indices was found in 16 patients and by IgG indices in three. Nine patients had oligoclonal IgG bands in serum and CSF, three exclusively in CSF. It is concluded that patients with facial palsy often have inflammatory CSF findings, indicating a generalised central nervous system affection, and not only a mononeuritis. The importance of viral infections in the pathogenesis is still obscure. Borrelia is the most common infectious cause of facial palsy.

Two groups of 10 healthy volunteers each with a mean age of 28 years (17-39) were tested in low-frequency rotatory experiments (sinusoidal harmonic acceleration, SHA), at frequencies of 0.01-0.32 Hz. The purpose was to ascertain whether voluntary enhancement and reduction of gain and phase occurred with voluntary performances. The different tests were alertness in darkness, stationary and moving targets, imaginary stationary and moving targets in darkness, proprioceptive moving targets and acoustic stationary and moving targets. Alertness tests in darkness demonstrated a gain increase (0.5-0.7) at 0.01-0.32 Hz, and a decreasing phase lead (40-2 degrees) with increasing frequency. The alertness tests served as a reference for the other tests. In tests with stationary targets, the gain reached unity and the phase was almost 0 degrees. In imaginary stationary target tests, gain and phase were significantly increased compared with alertness. Stationary acoustic targets in darkness significantly enhanced the gain. An increased phase lead was also found. In visual suppression tests (moving target), the gain was near 0. In imaginary moving target tests, the gain decreased significantly. In darkness the gain was significantly more depressed with a proprioceptive moving target than during imaginary moving target. Testing with proprioceptive + acoustic moving target in darkness, displayed an additional gain depression and negative phase at 0.08 Hz. The conclusion is that the influence of non-vestibular mechanisms substantially affects low frequency sinusoidal rotatory testing.

Twenty-eight patients with polyneuropathy aged 49–82 years (mean 67 years) were assessed by dynamic posturography. The patient group was compared to a control group comprising 29 healthy controls aged 70 through 75 years (mean 73 years). The dynamic posturography method comprises a sensory organization part in which the platform and visual surround are either stable or referenced to the patient’s sway; furthermore, the eyes are open or closed. In a movement coordination part the platform makes active movements. In the sensory organization part of the dynamic posturography the patient group showed significantly lower equilibrium performance compared to the control group in the test conditions with absent vision, sway-referenced surrounding, and, finally, sway referenced platform and surrounding. In these conditions the influx of somatosensory information is of paramount importance for stable posture. In the movement coordination test, the patient group showed prolonged muscular response latencies in both forward and backward platform perturbations compared to the control group. It is concluded that dynamic posturography is a valuable diagnostic tool in assessment of the dynamic equilibrium performance in patients with polyneuropathy.

In patients with vertigo, with unilateral auditory problems, or for whom there is a suspicion of a posterior fossa lesion, vestibular testing is mandatory. After anamnesis, and clinical investigation, it should be decided what parts of the vestibulo-oculomotor and auditory test batteries are to be used. Apart from auditory brain stem responses, the most fruitful tests seem to be the broad-frequency rotatory tests, which are of considerably greater diagnostic value than the visual suppression test and the smooth pursuit test.

The short-term effect of exposure to toluene on the vestibulo- and opto-oculomotor system in rats was investigated. Stimulation of the vestibulo- and opto-oculomotor system was either a constant rotatory acceleration, a sinusoidal oscillation, a randomized oscillation or an optokinetic stimulation. Eye movements in response to the different stimulations were recorded by EOG and fed into a computer for analysis. Due to toluene exposure the slow phase velocity gain during constant acceleration increased and the post-acceleratory nystagmus response was prolonged. The optokinetic gain at stimulation velocities above 10 deg/sec decreased during toluene exposure. Toluene also prolonged the duration of optokinetic after- and after-afternystagmus. The findings in this study strongly suggest an effect of toluene on the cerebellum.

Nine subjects with long-term (8-30 years) occupational exposure to industrial solvents and a confirmed diagnosis of psycho-organic syndrome (POS) have been studied with audiological and otoneurological test batteries. The results were compared to a matched control group of nine industrial workers not exposed to solvents and to normal data from healthy volunteers. In the clinical examination, the Romberg test identified 5/9 workers as pathologic and concurrently the stabilometry showed significantly larger sway areas in the POS-group. In the audiological test battery, the significantly pathologic tests were discrimination of interrupted speech and evoked cortical responses to frequency glides (CRA-delta-f). The saccade test disclosed abnormal findings in 5/9 workers. In the smooth pursuit test, abnormality was found at some test frequencies using pseudorandomized stimulus. The VOR-suppression test was significantly abnormal at all test frequencies. The test battery used strongly indicates CNS lesions due to industrial solvents.

Exposure to oil mist used in metal work sometimes gives symptoms from skin and airways. This study was performed to evaluate histological and functional respiratory tract disorders. Six male lathe workers aged 31-64 years exposed to oil mist for 4-29 years were examined and compared with matched controls. The investigation included case history, ENT examination, nasal mucociliary function, routine blood tests, IgE, RAST, X-ray of sinus and lungs and biopsy of the nasal mucosa. The mucociliary test showed no difference between the groups. However, all 6 exposed workers had pathological histology findings in the nasal mucosa including lack of cilia, basal cell hyperplasia, goblet cell hyperplasia, squamous metaplasia and subepithelial hyalinization. The biopsies from the controls were mainly normal. The remainder of the investigations revealed no pathology. The study shows that exposure to oil mist--even below the permitted threshold limit--may cause airway symptoms and histological signs comparable to a premature ageing.

The labyrinthine input to the vestibular nuclei was investigated in 24 awake cats. Stimulus consisted of electrical shocks given through bipolar silver wire electrodes, implanted in the utricular and lateral ampullar nerves. Throughout the vestibular nuclei, single units were recorded extracellularly with glass micropipettes filled with Fast Green. The tracts of the penetrating electrodes were identified histologically. In all four nuclei units responding to both labyrinths outnumbered unilaterally responding neurones with certain differences between the individual nuclei. Excitatory as well as inhibitory responses were observed, polysynaptic being more common than mono- or disynaptic ones. No monosynaptic contralateral responses were seen. The latency distribution of contralateral responses closely mirrored that of ipsilateral responses within each nucleus. Both excitatory and inhibitory responses fell into relatively segregated populations, based upon latency distribution. This implies separate pathways for labyrinthine input to the vestibular nuclei.

Twenty-nine patients seriously disabled by Meniere's disease due to frequent attacks were treated with Gentamicin administered in the middle ear once daily until first sign of an inner ear disturbance, usually a spontaneous nystagmus and a sensation of unsteadiness. All patients except one were relieved from their vertiginous attacks and returned to normal activities. Tinnitus was usually diminished or absent, as was the feeling of pressure in the ear. The hearing was slightly improved in 5 patients, worse in 9 patients and two treated ears became deaf. The indication for an intratympanal treatment with Gentamicin should be a disabling form of Meniere's disease not responding to medical treatment. The risk for the cochlea increases after 6 days of treatment. The advantage versus intracranial surgery is the absence of the surgical risks for complications. The mode of action exerted by the ototoxic drug is a destruction of the vestibular sensory epithelium and the endolymph producing cells.

Seven patients with bilateral vestibular dysfunction were investigated with a new broad frequency oscillatory test. The vestibular stimulation was of two types: a pseudo-random oscillation in the frequency range 0.5-4 Hz and a sinusoidal frequency sweep from 0.5 to 3.5 Hz. Compensatory eye movements were recorded by EOG. Gain and phase values between eye and head movements were extracted using power spectral analysis technique. Two different visual conditions were used: 1) fixating a stationary target and /) fixating a moving target (visual suppression test). At high frequencies all patients showed a reduced VOR gain compared to normal subjects. At low frequencies gain values were close to normal when using a predictable (sinusoidal) stimulation. With a non-predictable (pseudo-random) stimulation gain values were significantly reduced even at low frequencies. The patients with the most severe loss showed a phase lag at higher frequencies (condition 1). The results in the oscillatory test were compared to subjective symptoms and caloric responses. The new test appears to be better suited to assess the vestibular function in patients with suspected bilateral vestibular loss than the caloric test or other traditional procedures.

Fifteen children with a syndrome called benign paroxysmal vertigo are presented. This syndrome is characterized by attacks of vertigo of sudden onset lasting a few minutes and in extreme cases several hours or even up to 2 days. Additional symptoms are pallor, sweating, vomiting and nystagmus. Consciousness is not impaired. The attacks usually occur in the first 4 years of life. They are recurrent, the appearance varying from several times a week to once a year, and they may cease spontaneously after only months but usually years. The most important differential diagnoses are epilepsy and posterior fossa tumour. The etiology is unknown, but there may be a vascular disturbance affecting the posterior cerebral circulation with secondary disturbances of the vestibular nuclei.