Jurkiewicz Dariusz, Kantor Ireneusz, Usowski Jacek
Wojskowy Instytut Medyczny, Klinika Otolaryngologiczna CSK MON w Warszawie.
Pol Merkur Lekarski. 2006;21 Suppl 1:3-12.
In balance system assessment there is no single set of tests applicable for all patients. A comprehensive medical history plays a main role in balance assessment. Patients often describe the same disorders in different ways. The aim of our work was to analyze effectiveness of betahistine hydrochloride (Betaserc) treatment on vertigo, nausea, vomiting, tinnitus and progressive hearing loss basing on the medical assessment (interview) performed by doctors and patient's personal questionnaires as well as to collect and accumulate data about balance system disorders. We prepared questionnaires for both doctors and patients. The doctor's questionnaire was divided into three sections. In the first section we included questions about direct cause of visit at the doctor's office. Questions were covering problems regarding balance system disorders (difficulty to keep erect position), vertigo, tinnitus, hearing impairment and other problems. The second section of the questionnaire included assessment of treatment effectiveness through the first 14 days and on the 28th day (a control visit). A third section of the questionnaire was focused on estimation of intensity of balance system disturbances. Patient's questionnaire included everyday self observations of intensity of disturbances within the 14 days observation period. We analyzed data of 980 patients, of the age between 16 and 96 years (mean age--54.1). There were 57.8% females and 42.2% males. From the group of 980 patients we separated a group of patients under 40 and over 60 years of age for additional analysis. Having analyzed doctors questionnaires we noted that the most frequent cause of patients' visits were: vertigo--in 770 people (78.57%), tinnitus--in 708 people (72.24%), disturbance of balance system--in 612 people (62.45%), hearing loss--in 607 people (61.94%) and other problems--in 72 people (7.35%). Patients over 60 years of age described vertigo as rolling and falling (38.92%). Patients under 40 years of age described vertigo as a body rotation and they were able to indicate direction of rotating movement (53.78%) in this group balance disturbances were intensified by moving of the head (56.49%). Both doctors and patients noticed higher percentage of answers "none" and "minimal difficulty in everyday life" on 14th and 28th day of observation in all analyzed groups, especially in people under 40 years of age. Properly prepared questionnaire for doctors and patients is very helpful not only at initial interview but also at reviewing the current condition of patient as well as at monitoring effects of treatment. Aliments and symptoms self noticed by patients are more serious and troublesome than those noticed by doctors. Ailments linked to disturbances of balance system noticed by group of patients under 40 years of age are usually sudden and shorter in duration and more intensive than in group of patients over 60 years of age. Betaserc used in treatment of balance system disorders lessens the insensitivity of vertigo, gait disturbances and nausea/vomiting. It does not affect hearing loss or tinnitus. The first therapeutic goals are achieved (especially in patients under 40 years of age) after 14 days of treatment.
在平衡系统评估中,没有一套适用于所有患者的单一测试方法。全面的病史在平衡评估中起主要作用。患者常常以不同方式描述相同的病症。我们这项工作的目的是,基于医生进行的医学评估(问诊)以及患者的个人问卷,分析盐酸倍他司汀(敏使朗)治疗眩晕、恶心、呕吐、耳鸣和进行性听力损失的有效性,并收集和积累有关平衡系统紊乱的数据。我们为医生和患者都准备了问卷。医生问卷分为三个部分。在第一部分,我们纳入了关于患者到医生办公室就诊直接原因的问题。问题涵盖了与平衡系统紊乱(难以保持直立姿势)、眩晕、耳鸣、听力障碍及其他问题相关的情况。问卷的第二部分包括对治疗前14天及第28天(复查)治疗效果的评估。问卷的第三部分着重于平衡系统紊乱强度的评估。患者问卷包括在14天观察期内对紊乱强度的日常自我观察。我们分析了980例年龄在16至96岁(平均年龄54.1岁)患者的数据。其中女性占57.8%,男性占42.2%。从980例患者中,我们分离出年龄在40岁以下和年龄在60岁以上的患者组进行进一步分析。分析医生问卷后我们注意到,患者就诊最常见的原因是:眩晕——770人(78.57%),耳鸣——708人(72.24%),平衡系统紊乱——612人(62.45%),听力损失——607人(61.94%),其他问题——72人(7.35%)。60岁以上的患者将眩晕描述为翻滚和跌倒(38.92%)。40岁以下的患者将眩晕描述为身体旋转,并且他们能够指出旋转运动的方向(该组中为53.78%),在这组中,头部移动会加剧平衡紊乱(56.49%)。医生和患者都注意到,在所有分析组中,观察的第14天和第28天,回答“无”和“日常生活中困难极小”的比例更高,尤其是在40岁以下的人群中。为医生和患者精心准备的问卷不仅在初次问诊时非常有用,而且在复查患者当前状况以及监测治疗效果时也很有帮助。患者自己注意到的病症和症状比医生注意到的更严重、更麻烦。40岁以下患者组注意到的与平衡系统紊乱相关的病症通常突发、持续时间短且比60岁以上患者组更严重。用于治疗平衡系统紊乱的敏使朗可减轻眩晕、步态障碍及恶心/呕吐的不适感。它不影响听力损失或耳鸣。治疗14天后实现了首要治疗目标(尤其是在40岁以下的患者中)。