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.

Patients of whiplash trauma report to a neurootologist with complaints of long standing duration like vertigo, instability, especially on neck movements, vegetative symptoms like nausea, and also auditory symptoms like tinnitus and hearing loss. In addition they complain of neck pain, strain and stiffness.

The mechanism of triggering vertigo from the neck is partly explained by work of Barre´ and Lieou. The trauma causes an over excitation of cervical proprioceptors resulting in hyper tonicity of gamma fibres and sympathetic nerves of the neck triggering thus the vertigo and vegetative symptoms. However there is also intracranial trauma due to movement of brain within the skull thus affecting the brainstem and the supratentorial structures.

In our study we studied the caloric responses in these patients by means of Claussen’s caloric test and the butterfly chart. With respect to the post traumatic vertigo due to whiplash mechanisms, the monaural caloric vestibulo-ocular test by means of butterfly chart could detect 33% of the cases as normal and 67% as pathological.The most frequent types of the 10 pathological butterflies show that the majority of the pathologies are related to brainstem dysfunctions like major and minor brainstem disinhibitions.

Specific chemical intoxications in the inner ear can arise from aminoglycosidic antibiotics. For this paper two samples of 485 patients after treatment with streptomycin and 23 patients after treatment of gentamycin have been randomly selected.

The amount of vertigo complaints was more than double as high in the group with gentamycin. This also kept on with the nausea complaints and with the so called vertigo releasing factors.

With respect to the hearing complaints the streptomycin group reported about tinnitus in 17,32%. This occurrence was double as high as with gentamycin, i.e. 37,48%. Subjective hearing loss was complained with streptomycin in 25,98% and with gentamycin in 34,78%.

The neurootological examination with an equilibriometric test battery unveiled a higher activity of the spontaneous nystagmus ENG in lying position with streptomycin and sitting position with gentamycin. The Claussen butterfly calorigrams nearly showed the same amounts of pathology with streptomycin as well as with gentamycin. This also holds for the VESRIC. The most sensitive equilibriometric test is the stepping CCG. But the stepping test recorded by the craniocorpogram (CCG) showed 63% of vestibular spinal pathology with streptomycin and 73% pathology with gentamycin.

Concerning the complaints about hearing disturbances speech audiometry approximately shows the same amount of pathology with streptomycin as with gentamycin.

But pure tone audiometry proves by the trend that all the threshold measurements are worse with gentamycin than with streptomycin.

 For measuring the disturbances it is most favourable to apply step test CCG for equilibriometry and the pure tone audiometry for dealing with hearing deficits.

Besides of vertigo, nausea and hearing loss tinnitus belongs to the most important symptoms in neurootology. We have to discriminate between an endogenous i.e. a maskable tinnitus, from an exogenous tinnitus, which is nonmaskable. However, both are spontaneous, subjective and annoying phenomena, which frequently still are listed amongst other diseases of the ear.

For this paper we investigated 284 patients with tinnitus amongst others by ENG, caloric and rotatory tests, ABEP, ALEP, VEP and CCG.

Through the vestibular stimulus response intensity comparison (VSRIC ) 

we found, that this  pattern in 40.49% showed a decruitment type and in 26.76% a recruitment type.

So, also the interactive statoacoustic function from several inner ear sensors was involved in these tinnitus patients.

Amongst our neurootological patients we frequently find multisensorial syndromes, for instance with combinations between tinnitus, hearing impairment, vertigo and nausea.

The statistical results are exhibiting that tinnitus is bound to a multifactorial disease background. The topodiagnostic analysis of the stato-acoustic data shows that there exists significantly more central than peripheral pathology.

With electro-cochleography, brainstem audiometry and cortical response audiometry it was possible to record potentials from the inner ear, the brainstem and the auditory cortex. This has significantly improved the analysis of auditory symptoms like tinnitus and assisted in the differential diagnosis of hearing disorders.

Since now, cortical projections of the vestibular system are known and as it has been proved since more than 20 years, that there exist the possibility of vestibular evoked potentials, which then leads to detect that the dwelling point of the tinnitus in the area 41 of the temporal lobe of human cortex.

The typical caloric butterfly patterns of «2002» or «0220» are pointing to the same area.  Thus the acoustic and the vestibular approaches towards tinnitus of the cortical type are clinically investigated by cases of the Bad Kissingen databanks NODEC.

The findings are presented with respect to case reports as well as with statistics.

 By comparing the per-rotatory and the caloric tests, we can get important information regarding the stato-acoustic system.  Considering the different behaviour of the stato-acoustic system under the influences of the changing dynamics of the shape and the intensity of the supraliminal vestibular stimuli in tinnitus patients, we are trying to find a correlation between the abnormal vestibular dynamic response and the topodiagnostics of tinnitus. The different behaviour may point to the site of the lesion, peripheral or central.

We have investigated 3352 tinnitus patients from the NODEC V database considering the caloric test and the rotatory test.

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

Results: 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.

Conclusions: 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 mobilisation 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.

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.

Therefore, other easier methods for prediction of vertigo attack should be desirable. Body signs such as chills, shoulder stiffness and so on were paid attention on.  In younger patients feelings of shoulder stiffness were one of good indicators for vertigo attack.

Using the Western blot immunoassay, we examined in thirtheen patients’ sera the reactivity to bovine inner ear antigen (anti-heat shock protein 70 [HSP70] antibodies) and the presence of viral antibodies and autoantibodies (Herpes simplex type 1-2, Herpes Zoster, Cytomegalovirus, Ebstein-Barr IgM and IgG. Cardiolipin, thyroglobulin and thyroperoxidase,antinuclear, antimythocondrial and anti-smooth cell antibodies). Aim of the study was to probe a possible relationship between the presence of anti-HSP70 antibodies and the antibody pattern. Reactivity to HSP70 was found only in 1/13 MD patients (7.7%) and occurred during a Herpes Zoster (VZV) reactivation.

The occurrence of anti- HSP70 antibodies concomitant to the VZV expression suggests it was probably due to an aspecific polyclonal expression during the infection. No relationship was found between the presence of antibodies to HSP-70 and the immunologic and viral testing.