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Progressive hearing loss is a major symptom in osteogenesis imperfecta (OI), a genetic brittle bone disease. Vertigo is frequently associated with otosclerosis in which the hearing loss clinically resembles that in OI. Vertigo is also common in basilar impression (BI) found in up to 25% of adult OI patients. In order to evaluate the cause, frequency, and characteristics of vertigo in OI, 42 patients were studied by interview, clinical examination, and audiological examination supplemented with electronystagmography (ENG) and lateral skull radiography. Audiometry showed hearing loss in 25 patients (59.5%). Nine patients (21%) displayed abnormal skull base anatomy in the forms of basilar impression, basilar invagination, or both, all designated here as BI. Twenty-two patients (52.4%) reported vertigo, mostly of floating or rotational sensation of short duration. Patients with hearing loss tended to have more vertigo than patients with normal hearing. Vertigo was not correlated with type of hearing loss or auditory brain-stem response (ABR) pathology. ENG was abnormal in 14 patients (33.3%). No dependency was found between vertigo and deviant ENG results. Patients with BI tended to have more vertigo than patients with normal skull base but the difference was not statistically significant. Neither ENG pathology, nor the presence or type of hearing loss showed correlation with BI. In conclusion, vertigo is common in patients with OI. In most cases, it may be secondary to inner ear pathology, and in only some patients does BI explain it. Since some OI patients without BI or hearing loss also suffer from vertigo, further clinical and neurological studies are needed to define the pathogenesis of vertigo in OI. © 2003 Wiley-Liss, Inc.

Cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzymes catalyze the initial step in the formation of prostaglandins, which have a role in the regulation of circulation and in inflammatory reactions. As hypoxia is reported to stimulate the expression of COX-2, we have investigated the effects of bypass circulation and cardioplegic arrest on the expression COX-1 and COX-2 in the myocardium of porcine hearts.

OBJECTIVES:To study the vertigo attacks known as Tumarkin attacks or drop attacks (DA). DA are characterized by sudden loss of balance with or without falls but with preserved consciousness, and they are supposedly triggered by changes in the otolith function of Meniere's disease (MD).STUDY DESIGN AND SETTING:Data from 243 consecutive MD patients were collected into a database of an otoneurologic expert system.RESULTS:DA was experienced by 72% (n = 173) of the patients with MD. It correlated with visually provoked vertigo. Gait difficulties, tinnitus, and anxiety were more common in the DA group. Long lasting vertigo attacks were more frequently provoked in the DA subjects by physical strain (58% vs 14%), head movements or changes in head position (71% vs 48%), pressure changes (54% vs 12%), or rapid movements in visual surroundings (65% vs 35%) than in the non-DA subjects.CONCLUSION:DA are common in MD patients. The abrupt occurrence of DA make them poorly tolerated.SIGNIFICANCE:DA are more common in advanced MD.

Objectives: To study the vertigo attacks known as Tumarkin attacks or drop attacks (DA). DA are characterized by sudden loss of balance with or without falls but with preserved consciousness, and they are supposedly triggered by changes in the otolith function of Meniere's disease (MD). Study Design and Setting: Data from 243 consecutive MD patients were collected into a database of an otoneurologic expert system. Results: DA was experienced by 72% (n = 173) of the patients with MD. It correlated with visually provoked vertigo. Gait difficulties, tinnitus, and anxiety were more common in the DA group. Long lasting vertigo attacks were more frequently provoked in the DA subjects by physical strain (58% vs 14%), head movements or changes in head position (71% vs 48%), pressure changes (54% vs 12%), or rapid movements in visual surroundings (65% vs 35%) than in the non-DA subjects. Conclusion: DA are common in MD patients. The abrupt occurrence of DA make them poorly tolerated. Significance: DA are more common in advanced MD. (Otolaryngol Head Neck Surg 2001;124:526-30.)

To study the vertigo attacks known as Tumarkin attacks or drop attacks (DA). DA are characterized by sudden loss of balance with or without falls but with preserved consciousness, and they are supposedly triggered by changes in the otolith function of Meniere's disease (MD). Data from 243 consecutive MD patients were collected into a database of an otoneurologic expert system. DA was experienced by 72% (n = 173) of the patients with MD. It correlated with visually provoked vertigo. Gait difficulties, tinnitus, and anxiety were more common in the DA group. Long lasting vertigo attacks were more frequently provoked in the DA subjects by physical strain (58% vs 14%), head movements or changes in head position (71% vs 48%), pressure changes (54% vs 12%), or rapid movements in visual surroundings (65% vs 35%) than in the non‐DA subjects. DA are common in MD patients. The abrupt occurrence of DA make them poorly tolerated. DA are more common in advanced MD.

Expert systems have been applied in medicine as diagnostic aids and education tools. The construction of a knowledge base for an expert system may be a difficult task; to automate this task several machine learning methods have been developed. These methods can be also used in the refinement of knowledge bases for removing inconsistencies and redundancies, and for simplifying decision rules. In this study, decision tree induction was employed to acquire diagnostic knowledge for otoneurological diseases and to extract relevant parameters from the database of an otoneurological expert system ONE. The records of patients with benign positional vertigo, Meniere's disease, sudden deafness, traumatic vertigo, vestibular neuritis and vestibular schwannoma were retrieved from the database of ONE, and for each disease, decision trees were constructed. The study shows that decision tree induction is a useful technique for acquiring diagnostic knowledge for otoneurological diseases and for extracting relevant parameters from a large set of parameters.

An interactive database has been developed to assist the diagnostic procedure for vertigo and to store the data. The database offers a possibility to split and reunite the collected information when needed. It contains detailed information about a patient's history, symptoms, and findings in otoneurologic, audiologic, and imaging tests. The symptoms are classified into sets of questions on vertigo (including postural instability), hearing loss and tinnitus, and provoking factors. Confounding disorders are screened. The otoneurologic tests involve saccades, smooth pursuit, posturography, and a caloric test. In addition, findings from specific antibody tests, clinical neurotologic tests, magnetic resonance imaging, brain stem audiometry, and electrocochleography are included. The input information can be applied to workups for vertigo in an expert system called ONE. The database assists its user in that the input of information is easy. It not only can be used for diagnostic purposes but is also beneficial for research, and in combination with the expert system, it provides a tutorial guide for medical students. (OTOLARYNGOL HEAD NECK SURG 1995;112:383-90.)

In connection with several recent studies of medical informatics, the usefulness and use of expert systems have been both criticized and defended. We have examined the issue of the inference power of expert systems compared to that of human experts. At an abstract level we have shown that there is no doubt that expert systems could successfully complement human experts within strictly limited and well-defined specialties, and actually be of reasonable aid in diagnosis, provided that the expert systems have been correctly and effectively elaborated. Also practical experiments were conducted with our recently implemented expert system.

An interactive database has been developed to assist the diagnostic procedure for vertigo and to store the data. The database offers a possibility to split and reunite the collected information when needed. It contains detailed information about a patient's history, symptoms, and findings in otoneurologic, audiologic, and imaging tests. The symptoms are classified info sets of questions on vertigo (including postural instability), hearing loss and tinnitus, and provoking factors. Confounding disorders are screened. The otoneurologic tests involve saccades, smooth pursuit, posturography, and a caloric test. In addition, findings from specific antibody tests, clinical neurotologic tests, magnetic resonance imaging, brain stem audiometry, and electrocochleography are included. The input information can be applied to workups for vertigo in an expert system called ONE. The database assists its user in that the input of information is easy. It not only can be used for diagnostic purposes but is also beneficial for research, and in combination with the expert system, it provides a tutorial guide for medical Students.

An interactive database has been developed to assist the diagnostic procedure for vertigo and to store the data. The database offers a possibility to split and reunite the collected information when needed. It contains detailed information about a patient's history, symptoms, and findings in otoneurologic, audiologic, and imaging tests. The symptoms are classified info sets of questions on vertigo (including postural instability), hearing loss and tinnitus, and provoking factors. Confounding disorders are screened. The otoneurologic tests involve saccades, smooth pursuit, posturography, and a caloric test. In addition, findings from specific antibody tests, clinical neurotologic tests, magnetic resonance imaging, brain stem audiometry, and electrocochleography are included. The input information can be applied to workups for vertigo in an expert system called ONE. The database assists its user in that the input of information is easy. It not only can be used for diagnostic purposes but is also beneficial for research, and in combination with the expert system, it provides a tutorial guide for medical Students.

An interactive database has been developed to assist the diagnostic procedure for vertigo and to store the data. The database offers a possibility to split and reunite the collected information when needed. It contains detailed information about a patient's history, symptoms, and findings in otoneurologic, audiologic, and imaging tests. The symptoms are classified info sets of questions on vertigo (including postural instability), hearing loss and tinnitus, and provoking factors. Confounding disorders are screened. The otoneurologic tests involve saccades, smooth pursuit, posturography, and a caloric test. In addition, findings from specific antibody tests, clinical neurotologic tests, magnetic resonance imaging, brain stem audiometry, and electrocochleography are included. The input information can be applied to workups for vertigo in an expert system called ONE. The database assists its user in that the input of information is easy. It not only can be used for diagnostic purposes but is also beneficial for research, and in combination with the expert system, it provides a tutorial guide for medical Students.

Background:Intramuscular scopolamine plus morphine pre‐medication is traditionally used when prominent sedative or antisialogogue effect is needed. Knowledge of the pharmacokinetics of scopolamine is limited due to low plasma concentrations found after therapeutic doses. This investigation compares the pharmacokinetics and the clinical responses of this drug combination injected into two commonly used injection sites.

Artificial intelligence donates new possibilities to neurotologic research. Neural networks are a computer-based reasoning method which can be applied in expert systems created for clinical decision support. Neural networks have been used in medical imaging, in medical signal processing and to analyze both clinical and laboratory data. Principally, neural networks simulate the function of the brain. They have to be taught to make correct decisions from the input data. This learning process can be either supervised or unsupervised. The decision making is based on mathematical transformations and it occurs on a hidden level. Calculations are made on parallel manner and the decision making simulates pattern recognition method. Neural networks suit well in medical problems which cannot be defined in simple rules. A drawback of neural networks is that the decisions are irrational and cannot be motivated to the user. Another problem is neural networks difficulty to handle incomplete input data, i.e., how to define some default or expected values for unknown input parameters. In a complex medical area, which would require multilayered neural networks, the neural networks require a large amount of solved cases for the learning process. In our experience neural networks seem not suitable for diagnosing vertigo and a better choice would be either case-based reasoning or possibly genetic algorithms or a combination of these.

The etiology of many diseases involving vertigo is still unknown although the same etiologic factors have been suggested for several diseases. In most cases the diseases are diagnosed on the basis of exclusion - other possible causes being ruled out before the diagnosis can be confirmed. Benign recurrent vertigo (BRV) has been defined as spells of vertigo characteristic of Menieres disease without auditory or clinical neurologic symptoms and signs. The etiology of this condition is also unknown. BRV has been linked to migraine and viral diseases. In a prospective study we collected the clinical history and the signs and results of neurotologic and audiologic tests from 33 patients with a BRV diagnosis. The clinical characteristics truly mimicked the vertigo seen in Menieres disease. The concept of vestibular Menieres disease is not widely accepted, and without auditory signs BRV is the only diagnosis that can be given to these patients. In other studies up to 25% of the patients initially diagnosed with BRV subsequently developed another peripheral vestibular disorder. Until the etiology of diseases involving vertigo is more clearly understood, artificial diagnoses like BRV, must be accepted.

An otoneurological expert system (ONE) was developed to help collect data and diagnose the work-up of vertigo of both central and peripheral diseases causing vertigo. Patient history and otoneurological and other examination results are used in the reasoning process. The history is interactively collected and is complemented with clinical examination results. The case history data can be either mandatory or supportive. Mandatory questions are used to confirm a diagnosis, and conflicting answers are used to reject an unlikely disease. Supportive questions support or suppress a diagnosis, but their presence is not obligatory. The reasoning procedure of ONE scores every question independently for different diagnoses, depending on how well they agree with the symptom entity of a disease. Diagnostic criteria are set for each disease, in Meniere's disease, for example, the full triad is required. Graphic displays illustrate the linear and nonlinear correlation between the symptoms and diseases. For instance, both second-long Tumarkin-type attacks and attacks lasting hours give a high score while intermediately long attacks score much lower in Meniere's disease. To be able to take even rare diseases into consideration we try to diminish the possibility of a wrong decision rather than maximize the likelihood of reaching only one right decision.

We have developed an interactive database for vertigo than can be used to assist in the diagnostic procedure and to store the data in a form of a database. The database offers the possibility to split and reunite the collected information in a desired way. The database contains detailed information about patient history, symptoms and findings in neurotological, audiological and imaging tests. The symptoms are classified into three sets of questions: vertigo (including postural instability). hearing loss and tinnitus, and provoking Factors. Confounding disorders are screened. The neurotological tests involve saccades. smooth pursuit, posturography and caloric test. In addition. findings in specified antibody testing. clinical neurotological tests, MRI, brain stem audiometry and electrocochleography are included. The input information can be applied in an expert system ONE for vertigo work-up. The database is user-friendly. Besides diagnostic purposes the database is excellent for research purposes. and combined with the expert system it works as a tutorial guide for medical students.