Good health is not only a privilege of young generation but also of elderly people. Nowadays 13% of the population has reached the age of 65, and one third of them have vertiginous attack at least once in their life. 45-70% of the elderly has one or more drop attacks yearly.

In the Semmelweis University Otoneurological Department, 17% of the patients are more than 65 years old. Detailed audiological and otoneurological examination was performed.

The origin of vertigo was extravestibular, like depression and anxiety disorder in 28% of the patients and vascular in 42%. Only in 30% specific balance system disease was observed.

Together with presbyacousia a slight loss in balancing appears. Gradually, elderly patients start noticing some unsteadiness or fear to keep moving. The presbyvertigo and presbyataxia are caused by the slow degeneration of vestibular end organs and brainstem pathways. The deterioration of sensorial organs and the central signal processing problems mean that our brain is getting old due to age.

The reasons of the old age vertigo are the decreased physical activity, concomitant diseases, increasing occurrence of vascular risk factors, degeneration of the cervical mechanoreceptors, and anxiety disorders with depression. The possibilities of the treatment: vasoactive and neuroprotective drug administration, adequate treatment of the concomitant diseases. The early mobilization of patients with vertigo is very important so as to avoid sedative drug administration. 

By means of improving diagnostic procedures, successful prevention and therapy the disability can be avoided.

Due to the brainstem involvement we find a higher rate of vertigo complaints and of vertigo releasing factors in our randomly selected sample of 26 cases. The nausea complaints are lagging behind the vertigo complaints. The vertigo complaints are long-lasting. There also is an elevated percentage of oculomotor regulating disturbances with double vision and oscillopsia. The elevated percentage of anosmia must be explained by a contrecoup effect. Approximately half of the sample is suffering from tinnitus and subjective hearing losses.

In equilibriometry  by means of polygraphic ENG we found much elevation in spontaneous nystagmus in lying position more then in sitting position. By means of the trinary coded caloric Claussen butterfly we detected 55% of pathology. The trinary stepping CCG is not as sensitive as it only detected in 47,3% of pathology. The complaints about a subjective hearing loss are more intensively objectivated by speech audiometry than by pure tone audiometry.

dizziness, hearing loss and tinnitus. The neurootological differential diagnosis is the basis

for planning the mostly supportive treatment of vertigo patients. In planning the therapy, we

are utilizing a computerbased expert system CLAMEDEX for establishing the

neurootological diagnosis through history, ORL inspection, ENG, calorics, rotatory chair test,

cranio-corpo-graphy (CCG), optokinetics, psychophysical audiometry, acoustic brainstem

and late evoked potentials, visually evoked potentials etc.. On this knowledge base we are

designing an individually adapted case oriented drug therapy.

Nausea and vomitus are the important subjective complications of dysequilibrium states.

Therefore antivertiginous and antiemetic therapies have to be applied if necessary. Usually

the duration is of limited time.

Oher drugs being chosen for a supportive pharmaco therapy according to the functional

topodiagnostics of the lesions usually possess one or more of the following actions upon the

equilibrium regulating network:

1. increase of cerebral blood flow,

2. enhanced penetration through the blood brain barrier,

3. increase of neuronal metabolism and

4. stabilization of specific neurotransmitters.

The neurootological patients are treated and monitored by regular neurootometric follow up

investigations.

The aim of this study was to investigate the different caloric findings in the Claussen-Butterflies in tinnitus patients under the assumption of a closely interrelated stato-acoustic network and to correlate these findings with our different tinnitus types.

For this we used the NODEC IV data bank and searched for the most frequent types of butterflies in the tinnitus patients. From these patients we took a sample of 56, classified them into: endogenous tinnitus, exogenous tinnitus, combined tinnitus and bruit. Then we correlated each type with a closely related butterfly pattern. Only a minority suffered from objective and quantitative measurable peripheral vestibular lesions. However the majority revealed central vestibular lesions, more obvious together with endogenous tinnitus.

We report  one patient with headache and symptoms of cerebellum involvement.

MRI showed a cerebellar large mass compatible with hemangioblastoma.

Often causing gradual hearing loss, tinnitus  and dizziness.If the tumor becomes large, it can interfere with the facial nerve, causing partial paralysis, and eventually pressing against brain structures, becoming life-threatening,

The diagnosis must be early, an hemangioblastoma is key to preventing its serious consequences. Unfortunately, early detection of the tumor is sometimes difficult, because the symptoms may be subtle and may not appear in the beginning stages of growth. Also, hearing loss, dizziness, and tinnitus are common symptoms of any middle and inner ear problems. Therefore, once the symptoms appear, a thorough ear examination and hearing test are essential the study the vestibular function through of vestibuloespinal, retinalocular, vestibuloocular systems in the Cranio-Corpo-Graphy (CCG), the Test of Balance(TOB) and the Computarized Electronystagmography (CNG).  in order to determine and orientate a better vestibular diagnosis. Computerized tomography(CT) and magnetic resonance imaging (MRI) are helpful in determining the location and size of a tumor and also in planning its removal.

The diagnosis must be early, an acoustic neurinoma is key to preventing its serious consequences. Unfortunately, early detection of the tumor is sometimes difficult, because the symptoms may be subtle and may not appear in the beginning stages of growth. Also, hearing loss, dizziness, and tinnitus are common symptoms of any middle and inner ear problems. Therefore, once the symptoms appear, a thorough ear examination and hearing test are essential the study the vestibular function through of vestibuloespinal, retinalocular, vestibuloocular systems in the Cranio-Corpo-Graphy (CCG), the Test of Balance(TOB) and the Computarized Electronystagmography (CNG). In order to determine and orientate a better vestibular diagnosis. Auditory Evoked Potentials, Computerized tomography(CT) and magnetic resonance imaging (MRI) are helpful in determining the location and size of a tumor and also in planning its removal.

Gleichgewichtsfunktionsstörungen können an den verschiedensten Orten der genannten Rezeptoren, wie auch innerhalb des Zentralnervensystemes entstehen. Für die diagnostische Suche nach den Läsionsorten, wie auch nach der Art der Störung bedient man sich verschiedener Kopfsinnesbahnen, die objektiv und quantitativ vermessen werden. Die klassischen objektiven und quantitativen äquilibriometrischen Verfahren sind die der sensomotorischen Augenbewegungskontrolle mittels Elektronystagmographie bzw. die der motorischen Kopf-Körper-Bewegungskontrolle mittels der Cranio-Corpo-Graphie u.a.m.. Für die synoptische Auswertung des Bárány’schen Kalorisationsversuches benutzen wir das Schmetterlingskalorigramm. Für die Steh- und Tretversuchanalyse bedienen wir uns der radarbildähnlichen Cranio-Corpo-Gramme. Neu hinzugetreten ist die kortikale Reaktionsauswertung mittels Brain Electrical Activity Mapping (BEAM) und vestibulär evozierter Hirnpotentiale (VbEP).

Alle genannten Verfahren werden miteinander vernetzt angewendet. Sie dienen nicht nur der Diagnostik, sondern auch der Steuerung einer modernen Differentialtherapie von Vertigo- und Nauseazuständen.

The displacement and rotation of the two rigid bodies head and trunk were analyzed to introduce new parameters with respect to the 2D dCCG. So 6 markers were adopted: three were put on an helmet placed on the head, two on the left shoulder and one on the right shoulder.

Subjects were asked to step on the spot in a more natural way and to standardize the length of the tasks, the test finished after almost 60 steps and 35 seconds.

Whiplash people executed four tests: open eyes, closed eyes, with and without the carpet on the floor. The considered parameters were extrapolated and generalized starting from those generally obtained by the 2D analysis, but trying to assess more the behaviour of the head and trunk (thought as two rigid bodies), than considering the trajectory of each marker. In particular the Index of Coordination, speeds (global with its lateral, vertical and longitudinal components), rotation angles (in the frontal, horizontal and sagittal plane) and displacements of the head and trunk were analyzed and compared with the normalcy databases.