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The aim of the study was to describe the usefulness of the caloric directional preponderance in diagnosis of the peripheral and central vestibular disturbances. The examination was performed in 150 cases of the peripheral dysfunctions (labyrinth lesions in chronic otitis media, vestibular neuritis, Meniere's disease, temporal bone fracture) and the group of central vestibular disturbances (central nervous system tumors, multiple sclerosis, vestibular brainsteam insufficiency, epilepsy, arteriosclerosis). Vestistibular -- oculomotor reflexes were registered in electronytagmography and videonystagmography. Directional preponderance was done using Jongkees proposals. Directional preponderance was observed in 45.9 patients with peripheral lesions and in 51.5% of 'central cases'. Directional preponderance alone was present in 29.1% in peripheral and 43.2% in the central dysfunctions. The coexistence of directional preponderance and spontaneous or/and positional nystagmus was observed in 29.1% of peripheral cases and in 20.3% with central lesions. In the majority of cases directional preponderance, spontaneous and positional nystagmus directions were the same. The results of the study suggest the usefulness of directional preponderance in the evaluation of vestibular compensation, the directional preponderance is in accord with the direction of spontaneous and positional nystagmus in the peripheral lesions in the most cases, but opposite in central dysfunctions. But one must take into consideration that directional preponderance is present in peripheral and central vestibular disturbances -- it is the essential limitation of this phenomenon for determination of the vestibular dysfunction level. The directional preponderance mechanism is still unclear. [ABSTRACT FROM AUTHOR]

Migraine is a chronic disorder with episodic attacks, and patients with a migraine often report that certain factors can trigger their headache, with chocolate being the most popular type of food-based trigger. Many studies have suggested a link between chocolate and headaches; however, the underlying physiological mechanisms are unclear. As premonitory symptoms may herald migraine attacks, a question arises regarding whether eating chocolate before a headache is a consequence of a food craving or indeed a real trigger. Here, we aim to summarize the available evidence on the relationship between chocolate and migraines. All articles concerning this topic published up to January 2020 were retrieved by searching clinical databases, including EMBASE, MEDLINE, PubMed, and Google Scholar. All types of studies have been included. Here, we identify 25 studies investigating the prevalence of chocolate as a trigger factor in migraineurs. Three provocative studies have also evaluated if chocolate can trigger migraine attacks, comparing it to a placebo. Among them, in 23 studies, chocolate was found to be a migraine trigger in a small percentage of participants (ranging from 1.3 to 33), while all provocative studies have failed to find significant differences between migraine attacks induced by eating chocolate and a placebo. Overall, based on our review of the current literature, there is insufficient evidence that chocolate is a migraine trigger; thus, doctors should not make implicit recommendations to migraine patients to avoid it., Competing Interests: The authors declare no conflict of interest.

Some studies have suggested a link between vitamin D and headache; however, the underlying physiological mechanisms are unclear. We aimed to summarize the available evidence on the relationship between vitamin D and the various subtypes of primary headaches, including migraines and tension-type headaches. All articles concerning the association between primary headache and vitamin D published up to October 2019 were retrieved by searching clinical databases, including: EMBASE, MEDLINE, PubMed, Google scholar, and the Cochrane library. All types of studies (i.e., observational, cross-sectional, case-control, and clinical trials) were included. We identified 22 studies investigating serum vitamin D levels in association with headaches. Eight studies also evaluated the effect of vitamin D supplementation on the various headache parameters. Among them, 18 studies showed a link between serum vitamin D levels and headaches, with the strongest connection reported between serum vitamin D levels and migraine. Overall, there is not enough evidence to recommend vitamin D supplementation to all headache patients, but the current literature indicates that it may be beneficial in some patients suffering headaches, mainly migraineurs, to reduce the frequency of headaches, especially in those with vitamin D deficiency.

Headaches attributed to low cerebrospinal fluid (CSF) pressure are described as orthostatic headaches caused by spontaneous or secondary low CSF pressure or CSF leakages. Regardless of the cause, CFS leaks may lead to intracranial hypotension (IH) and influence cerebral blood flow (CBF). When CSF volume decreases, a compensative increase in intracranial blood volume and cerebral vasodilatation occurs. Sinking of the brain and traction on pain-sensitive structures are thought to be the causes of orthostatic headaches. Although there are many studies concerning CBF during intracranial hypertension, little is known about CBF characteristics during low intracranial pressure. The aim of this review is to examine the relationship between CBF, CSF, and intracranial pressure in headaches assigned to low CSF pressure., Competing Interests: The authors declare no conflict of interest.

Headache is a common complication after diagnostic lumbar puncture (DLP). We aimed to check whether hydration before puncture influences the incidence of post-lumbar puncture headache (PLPH) and affects cerebral blood flow. Ninety-nine patients enrolled for puncture were assigned to a group with ( n = 40) or without hydration ( n = 59). In the hydration group, 1000 mL 0.9% NaCl was infused and a minimum of 1500 mL oral fluids was recommended within the 24 h before puncture. A Transcranial Doppler (TCD) was performed before and after DLP. Mean velocity (Vm) and pulsatility index (PI) were measured in the middle cerebral arteries (MCAs). PLPH occurred in 28 patients (28.2%): six (15.4%) from the hydrated and 22 (37.3%) from the non-hydrated group ( p < 0.023). Patients with PLPH were younger ( p < 0.014) and with headaches in their histories ( p < 0.036) compared with the non-headache group. Vm values in both MCAs after puncture were significantly lower than before puncture in all patients. In the PLPH group, Vm in MCAs before puncture were significantly higher and the PI was lower than in the non-headache group. Our findings suggest that hydration of patients within 24 h before puncture prevented PLPH. Twenty-four hours after puncture, significant decreases in Vm were observed in the MCAs of all patients. Low baseline values of PI and high Vm predisposed patients to PLPH.

Background: Tinnitus is defined as a phantom auditory perception, i.e., sound experience despite the lack of acoustic stimuli in the environment. The aim of this study was to assess the state of the natural antioxidant barrier of a body in patients complaining about the presence of tinnitus., Material and Methods: The study included a total of 51 patients aged from 20 to 62 years with diagnosed idiopathic tinnitus and 19 healthy subjects as a control group. All patients underwent the audiometric tone test, speech audiometry, distortion otoacoustic emission product testing, study of evoked auditory potentials of short latency, and biochemical analysis of venous blood concerning values of activity or concentration of glutathione, glutathione peroxidase, S-transferase, glutathione reductase superoxide dismutase, malondialdehyde, and ceruloplasmin as the selected parameters of oxidative stress., Results: Disorders of the auditory pathway were not only limited to the cochlea but also covered its further episodes. Mean values of activity or concentration of the selected parameters of oxidative stress in the study and control groups showed reduced effectiveness of the body's natural antioxidant barrier., Discussion: Patients complaining about the presence of tinnitus showed reduced effectiveness of the body's natural antioxidant barrier compared to the control group., Conclusions: The main indication to undertake further research on the functioning of the antioxidant barrier in people suffering from ailments in the form of tinnitus is to determine a suitable therapy aimed at improving the quality of life of these patients, which might be the administration of antioxidant medications.

Aim: Our goal was to determine the expression levels of p16 in the cohort of the OPSCC patients and evaluation of the pathological and clinical differences between these two groups including patients' survival., Background: HPV infection is the main causative factor of oropharyngeal cancer (OPSCC). Identification of HPV status in OPSCC requires positive evaluation of viral DNA integration into host cell however, p16 accumulation in the proliferating cell layers has been accepted as an alternative marker for HPV infection., Material and Methods: The IHC staining for p16 has been performed in tumor tissue from 382 OPSCC patients. The sample was considered positive based on more than 70% of carcinoma tissue showing strong and diffused nuclear and cytoplasmic immunostaining. The clinicopathological characteristics of the patients including site, age, gender, tumor grade, tumor stage, the nodal status, smoking and survival have been analyzed when comparing p16 positive and p16 negative tumors., Results: Out of our cohort in 38.2% cases positive staining for p16 has been recorded. Our analysis did not indicate significant differences in the distribution of the p16 positive patients and age of the patients, stage of the disease. Among the patients who have presented with the N+ neck, there were significantly more p16 positive tumors than in the group with N0 neck ( p  = 0.0062). There was highly significant correlation between the expression of p16 and smoking ( p  < 0.0001). The significant difference in survival ( p  < 0.0001) with more favorable prognosis in the p16 positive group has been observed., Conclusions: Overexpression of p16 is accepted as a surrogate diagnostic marker for detecting HPV infection in oropharyngeal cancer. However, one should remember about existence of the small subgroups of p16 positive but HPV negative tumors, with relatively worse prognosis. Immunostaining for p16, however useful on everyday basis, should be complemented with other techniques in terms of reliable identification of the HPV infection.

Objective: The goal of this study was to observe spontaneous cortical activity and cortical activity modulated by tinnitus-matched sound in tinnitus patients and healthy subjects with no otoneurologic symptoms., Method: Data were prospectively collected from 50 tinnitus patients and 25 healthy subjects. Cortical activity was recorded in all subjects with eyes closed and open and during photostimulation, hyperventilation and acoustic stimulation using 19-channel quantitative electroencephalography. The sound applied in the tinnitus patients was individually matched with the ability to mask or equal the tinnitus. The maximal and mean amplitude of the delta, theta, alpha and beta waves and the type and amount of the pathologic EEG patterns were noted during each recording. Differences in cortical localization and the influence of sound stimuli on spontaneous cortical activity were evaluated between the groups., Results: The tinnitus group exhibited decreased delta activity and increased alpha and beta activity. Hyperventilation increased the intensity of the differences. The tinnitus patients had more sharp-slow waves and increased slow wave amplitude. Sound stimuli modified the EEG recordings; the delta and beta wave amplitudes were increased, whereas the alpha-1 wave amplitude was decreased. Acoustic stimulation only slightly affected the temporal region., Conclusion: Cortical activity in the tinnitus patients clearly differed from that in healthy subjects, i.e., tinnitus is not a "phantom" sign. The changes in cortical activity included decreased delta wave amplitudes, increased alpha-1, beta-1 and beta-h wave amplitudes and pathologic patterns. Cortical activity modifications occurred predominantly in the temporal region. Acoustic stimulation affected spontaneous cortical activity only in tinnitus patients, and although the applied sound was individually matched, the pathologic changes were only slightly improved.

The aim of this study was to compare the frequency of pathological types of smooth-pursuit and saccadic movements in different localizations of vestibular lesions. We tested 112 patients using videonystagmography. The smooth pursuit was appreciated qualitatively on the basis of Malecki's patterns. We analyzed the saccadic movements taking three parameters into consideration: latency, velocity, and accuracy. The patients suffered from posterior cranial fossa lesions, supratentorial damage, and peripheral vestibular disorders. We discovered that testing of smooth pursuit and saccades was very helpful in pointing to the localization of the damage in the posterior fossa. The frequency of the pathological saccadic and eye-tracking movements was similar for the different sites of deficit inside the posterior fossa, so recognizing the precise localization of lesion in this anatomical region was difficult.

The aim of this study was to search for the reason for vertigo in children who complain of it. We tested 30 children who had been treated by a pediatrician for various diseases. We performed the detailed protocol of anamnesis, videonystagmography, posturography, and additional tests ordered by the pediatrician and then compared the results of these procedures with those of a group of 30 healthy children. Respiratory system infections, gastritis, and spondylosis were diagnosed most often by pediatricians in young people with vertigo. From videonystagmography results, we observed only four types of pathological reactions: positional nystagmus, cervical nystagmus, abnormal eye-tracking test results, and square wave abnormalities. Only 40% of children demonstrated objective signs of vertigo. Posturography results did not provide specific findings as compared with those from the healthy children. We discussed the probable reasons for vertigo, among which psychogenic origin, side effect of medications, hormonal disturbances, spondylosis, and diet errors had to be taken into consideration.

The origin of the generation of saccadic and smooth-pursuit eye movements has not been proved. The goal of the study reported here was to search for the connection of visuooculomotor reactions--saccades and eye-tracking test--with cerebellar damage. Using electronystagmography, we tested 11 patients treated with aminoglycosides because of pneumonia. After a mean of 21 days of pharmacological therapy, a neurological examination revealed cerebellar disability in all cases. On the basis of our previous studies, we suspected cortical Purkinje cell damage. In all tested patients, saccadic movements were disturbed: We observed overshoot, undershoot, and prolonged latencies. In seven patients, eye-tracking test results were not correct: We noted the degradation of the sinusoidal pattern most often. The results pointed to a connection between the generation of these two tested visuooculomotor reactions with cerebellar diseases possibly located in the cortex.

The aim of this study was to observe the usefulness of betahistine dihydrochloride--Betaserc--in therapy for vestibular disorders in patients with vertebrobasilar insufficiency. Two groups of patients, in each of which were 150 patients (mean age, 52.2 years), were tested on the basis of videonystagmography and stabilometry. Betaserc was administrated in two separate doses: 8 mg three times daily and 16 mg three times daily for 120-180 days (mean, 132 days). In every case before and after therapy, visuo-oculomotor and vestibulo-oculomotor reflexes were tested, and amplitude and velocity of the sway were measured during dynamic posturographic testing. After Betaserc treatment, pathological visuo-oculomotor reactions and pathological cervical test results disappeared in most cases: Smooth pursuit improved in 59.9% of cases and saccadic movements in 55.9% of patients, and cervical nystagmus disappeared in 62.2% of tested people. During stabilometry, mean and maximal platform amplitude and mean head velocity decreased as compared with results from tests performed before treatment. These observations were significant after the greater dose of Betaserc; nonetheless, improvement was noted after both doses. The usefulness of Betaserc in vertebrobasilar insufficiency was proved, 4-6 months' therapy was sufficient, and the effect on central compensation seemed to be most probable.

The aim of this study was to evaluate the usefulness of ozone and pressure-pulse therapies in treating Ménière's disease. Using objective otoacoustic emissions and short-increment sensitivity index (SISI) tests together with subjective anamnesis, we tested 15 patients (8 men, 7 women) who had suffered from Ménière's disease for 1-3 years and had permanent sensorineural hypoacusis; we compared results before and after treatment. We performed ozone therapy and pressure-pulse treatments simultaneously for one 10-minute session each day for 10 consecutive days. After treatment, both otoacoustic-spontaneous and transiently evoked emissions and SISI test results exhibited no statistically significant changes. However, the subjective state of the patients was clearly improved. The frequency, severity of attacks, and tinnitus decreased. The mechanism of such an improvement is discussed.

Background: Acute pharyngotonsillitis (APT) is one of the most common inflammatory processes of adults and children in an outpatient setting. Increasing failure rates, hypersensitivity to penicillin, the required multiple daily doses and common side effects lead to poor patients compliance and thus inadequate treatment duration, providing therefore ground for considering alternative antimicrobial agents., Material and Methods: This multicenter, randomized, single blind study was undertaken in order to compare efficacy and safety of cefaclor (375 mg BID) and amoxicillin/clavulanate (625 mg BID) in 10 days treatment regiment of ambulatory patients with APT. A total of 200 patients (age range between 12-65 years) with symptoms of APT and positive antigen strep test were enrolled into the study. Clinical and bacteriological responses were assessed after the end of treatment (14th-18th day) and at the follow-up visit (38th-45th day). All GABHS strains, isolated from throat cultures, were tested for in vitro sensitivity to the antibiotics used in the study and no strain was found resistant to both antibiotics., Results: The results indicated that both antibiotics had high--almost 99% effectiveness at the post therapy visit. On the follow up visit an increased tendency of relapses was observed in the amoxicillin/clavulanate treated group, compared to cefaclor treated group (8.33% vs 3.29%). Relative risk of relapse in patients treated with amoxicillin/clavulanate was 2.6 greater compared to cefaclor. There were significantly higher rates of gastrointestinal adverse events in group treated with amoxicillin/clavulanate (29/97 patients; 29.89%) compared to cefaclor (16/95 patients; 16.84%) - p< 0.03. Frequency of other adverse events did not differ significantly between the groups., Conclusions: Cefaclor and amoxicillin/clavulonate provide a clinically and bacteriologically effective treatment for patients with pharyngotonsillitis caused by GABHS, but cefaclor treatment is significantly safer in regard to gastrointestinal side effects.

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.

Using electronystagmography, we tested 100 patients (ages 65-80 years) manifesting the clinical signs of presbyvertigo, for the purpose of demonstrating their visuoocular reflexes. We administered not only simple optokinetic and eye-tracking stimuli but caloric modification of each one as well (with contrary directed optokinetic trace movement). The results were compared with those obtained in a group of 40 healthy subjects between the ages of 20 and 25 years. In the older group, we observed a statistically significant increased frequency of asymmetry of optokinetic nystagmus and pathological patterns revealed by the eye-tracking test and caloric modification of both the optokinetic and eye-tracking tests. We discuss the hypothetical predominant localization of age-dependent changes, with emphasis on the disturbances of visual-vestibular integration, on the basis of data obtained from anamnesis and other electronystagmographic findings.

The authors reached the neurological and psychiatric diagnosis of chronic schizophrenia in 20 patients after examination of both vestibulooculomotor and visuooculomotor reflexes on electronystagmography. The type and intensity of the disease were established on adequate scales, and the entire group was tested in the remission stage, during the absence of psychotic signs. Electronystagmographic study, particularly the eye-tracking test with caloric modification, revealed the significant pathology of optokinetic nystagmus. The disturbances of the suppression effect of fixation on caloric nystagmus were observed in one-half the cases. Caloric stimulation demonstrated no case of canal paresis and a very small amount of directional preponderance.