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Biomedical subjects

O Spitzer

Publications and source records attributed to O Spitzer.

At least 19 recordsLinked to original sources
PubMed2001

Inner ear decompression sickness in sport compressed-air diving.

OBJECTIVE: We report our experience over the past 12 years with recreational diving-related inner ear decompression sickness (IEDCS). STUDY DESIGN: Retrospective, consecutive case series. METHODS: Twenty-four divers, representing 29 cases of IEDCS, are presented with regard to evaluation, treatment, and follow-up. RESULTS: These 29 cases represent 26% of the severe decompression sickness (DCS) cases treated in that period. The patient group includes 22 divers who had a single event of IEDCS, one diver who had two events, and one with five repeated episodes. The cause of injury in 23 cases (79%) was violation of the decompression schedule. The mean time from surfacing to appearance of symptoms was 47 +/- 65 minutes. In 83%, symptoms appeared within 1 hour of ascent, in 97% within 2 hours, and in only one diver after 5.5 hours. Ten divers (34%) had pure vestibular involvement, 4 (14%) had cochlear insult alone, and 15 (52%) had combined vestibulo-cochlear injury. Except for one patient who had central as well as peripheral vestibulo-cochlear DCS, all the remaining patients had end organ involvement only, as demonstrated by physical examination and laboratory test results. Fifteen (52%) had isolated IEDCS, whereas 14 had additional symptoms of DCS. Twenty-six cases were treated by hyperbaric oxygenation with supplementary daily hyperbaric sessions. Of the 25 cases with vestibular injury and the 19 with cochlear damage, only 7 (28%) and 6 (32%), respectively, made a full recovery, whereas the others remained with residual damage. Of the 17 treated within 6 hours of symptom appearance, 9 (53%) were cured, compared with one of the 9 treated later (P <.05). CONCLUSIONS: IEDCS related to compressed-air recreational diving is more common than previously thought, and might occur even when no decompression schedule violation took place. Prompt diagnosis leading to the early commencement of hyperbaric oxygen recompression therapy is the key to complete recovery of cochlear and vestibular function.

Adult↗
PubMed2001

Vestibular findings in professional divers.

The purpose of the present study was to investigate possible inner ear changes related to professional diving, by the documentation of auditory and vestibular function in 13 asymptomatic professional divers and 12 nondiver controls. A higher average pure tone hearing threshold, although of no clinical significance, was found in the study group (8.53 +/- 4.85 versus 6.67 +/- 3.54 dB hearing level, p = .04). In the vestibular evaluation, the smooth harmonic acceleration test phase leads for 0.01, 0.02, and 0.04 Hz were significantly lower in the divers (0.01 Hz, 38.46 degrees +/- 7.15 degrees versus 45.83 degrees +/- 9.02 degrees, p = .02; 0.02 Hz, 21.08 degrees +/- 5.19 +/- versus 25.17 degrees +/- 5.78 degrees, p = .05: 0.04 Hz, 12.38 degrees +/- 3.69 degrees versus 14.25 degrees +/- 3.14 degrees, p = .05). We suggest that the lower smooth harmonic acceleration phase values found in the professional divers, reflecting longer vestibulo-ocular reflex primary time constants and enhancement of the velocity storage mechanism, are the result of a habituation process that augments the low-frequency response of the canal-ocular system.

Adult↗
PubMed2001

The effects of dimenhydrinate, cinnarizine and transdermal scopolamine on performance.

We assessed the influence of dimenhydrinate, cinnarizine and transdermal scopolamine on the ability to perform simulated naval crew tasks. The effect of single doses of dimenhydrinate, 100 mg, cinnarizine, 50 mg, and one transdermal scopolamine patch on psychomotor performance was evaluated using a double-blind, placebo-controlled, randomized, crossover design in three separate studies. A total of 60 young naval crew (20 for dimenhydrinate, 15 for cinnarizine and 25 for transdermal scopolamine) underwent a battery of computerized and paper and pencil performance tests, and filled out a questionnaire on side-effects and well-being self-assessment. Dimenhydrinate significantly impaired decision reaction time and auditory digit span. Most of the subjects who took dimenhydrinate also reported a subjective decrease in well-being and general performance abilities. Cinnarizine and transdermal scopolamine did not affect performance abilities. Cinnarizine was free of significant side-effects. Dry mouth was the only significant side-effect of transdermal scopolamine. These findings could be explained by the well-known sedative properties of dimenhydrinate and not by a specific effect on any particular cognitive or motor function. Our results suggest that dimenhydrinate, 100 mg, adversely affects psychomotor function, whereas single doses of cinnarizine, 50 mg, and transdermal scopolamine appear to be free of side-effects on performance and seem to be a preferable anti-seasickness drug for use by a naval crew.

Administration, Cutaneous↗
PubMed2001

Scopolamine bioavailability in combined oral and transdermal delivery.

Transdermal therapeutic system scopolamine (TTS-S) is effective in preventing motion sickness for 72 h. However, by this route a prophylactic effect is obtained 6 to 8 h postapplication. By the oral route, scopolamine is effective within 0.5 h for a period of 6 h. To achieve safe as well as effective protection against seasickness during the first hours of a voyage until the TTS-S patch takes effect, the pharmacokinetics of scopolamine was investigated after patch application in combination with oral tablets, 0.6 mg, 0. 3 mg, or placebo. Subjects were 25 naval-crew volunteers, randomly divided into three groups: group 1 (n = 9), TTS-S patch + 0.6 mg of scopolamine per os (p.o.); group 2 (n = 8), TTS-S patch + 0.3 mg of scopolamine p.o.; and group 3 (n = 8), TTS-S patch + placebo tablet. Blood samples were collected before treatment and 0.5, 1, 1.5, 2.5, 3.5, 6, 8, and 22 h post-treatment, and were analyzed for scopolamine levels using radioreceptor assay. Significantly higher plasma scopolamine levels were found in group 1 at 0.5, 1, 1.5, and 2.5 h, and in group 2 at 1 and 1.5 h post-treatment, compared with group 3. Thereafter, plasma levels did not differ significantly between the groups. In all subjects of group 1 and seven subjects (88%) of group 2, therapeutic levels (>50 pg/ml) were measured during the first 2.5 h, compared with only two subjects (25%) of group 3 (P < 0.05). Heart rate, blood pressure, visual accommodation, performance test results, and subjective complaints of adverse effects did not differ significantly. The combination of transdermal and oral scopolamine (0.3 or 0.6 mg) provides the required plasma levels to prevent seasickness, starting as early as 0.5 h post-treatment, with no significant adverse effects.

Accommodation, Ocular↗
PubMed1999

Computerized dynamic posturography and seasickness susceptibility.

OBJECTIVE/HYPOTHESIS: The neural mismatch theory emphasizes the role of conflicting multimodal sensory interactions in producing both motion sickness and the rearrangement process that finally leads to habituation to the adverse motion conditions. If this theory is, indeed, correct, the patterns of the response to the integrated signal from simultaneous multisensory stimulation, characterized by unusual relationships between the senses responsible for spatial orientation, should differ according to motion sickness susceptibility. Computerized dynamic posturography (CDP) provides the opportunity to simultaneously change the interactions between visual, somatosensory, and vestibular inputs, thus giving an indication of the relative importance of these senses in maintaining balance. The objective was to investigate balance strategies in naval crew members with differing susceptibility to sea conditions using CDP. STUDY DESIGN: Cross-sectional, parallel-group design. METHODS: Twenty subjects susceptible to seasickness (SS) and 20 nonsusceptible subjects (NSS), healthy male volunteers aged 18 to 25, were tested using the EquiTest system (NeuroCom, Inc., Clackamas, OR). RESULTS: The SS group exhibited significantly less stability than the NSS group in condition 5 of the sensory organization test (SOT). The ratio of the SOT scores of conditions 5 to 1 (the vestibular organization pattern) was also found to be significantly lower in the SS group. CONCLUSIONS: The results suggest that SS might be more dependent on somatosensory and visual inputs and less on vestibular inputs for maintenance of balance compared with NSS. Higher susceptibility to seasickness might reflect abnormal weighting of sensory modalities during the integration process. This would result in disruption of the integration process required to maintain balance and a sense of orientation in space in conditions producing conflicting sensory inputs.

Adolescent↗
PubMed1999

Inner ear decompression sickness following altitude chamber operation.

Decompression sickness (DCS) is a known hazard of altitude chamber operation. The musculoskeletal, dermal, neurological and pulmonary manifestations of DCS are well recognized, but inner ear injury has not been reported. We present the unusual case of a medical corpsman suffering from vestibular DCS after an altitude chamber exposure to 25,000 ft. The patient had a good clinical response to hyperbaric treatment, but there was laboratory evidence of mild residual vestibular damage with full compensation. This case suggests that aviation medical personnel should be more aware of the possible occurrence of inner ear DCS among subjects exposed to altitude.

Adult↗
PubMed1997

Alterations in R-R variability associated with experimental motion sickness.

Motion sickness is a complex integration of responses from multiple physiological systems. Whether the changes that occur during the time course of motion sickness are mediated by the sympathetic or parasympathetic systems is still controversial. The present study evaluates alterations in R-R variability during experimental motion sickness in motion sick and non-motion sick subjects. Ten motion sick subjects and 7 non-motion sick subjects participated in the study. Power spectrum analysis of R-R variation was conducted for all subjects 10 min before a brief vestibular disorientation test (BVDT), for 5-10 min of the test, and 10 min after the test. Subjects were also asked to report their symptoms during the test. The motion sick group showed a significant reduction in the power spectrum density of the R-R interval at the mid and high frequencies during the BVDT test period (BVDT), in comparison with the rest period (Rest). These changes probably indicate a decrease in parasympathetic activity during the time course of motion sickness. The non-motion sick group did not show significant differences at any of the frequencies during BVDT. Power spectrum analysis of the R-R interval provides an objective measure of the autonomic response to experimental motion sickness.

Adolescent↗
PubMed1996

Nonspecific vertigo with normal otoneurological examination. The role of vestibular laboratory tests.

Vestibular laboratory tests are not generally necessary in the diagnosis of patients with a clear description of vertigo accompanied by positive otoneurological examination findings. The purpose of the study was to investigate the role of conventional vestibular laboratory tests in the diagnosis of patients complaining of nonspecific vertigo, despite their having a documented normal otoneurological examination. The results of the standard electronystagmography (ENG) and sinusoidal harmonic acceleration (SHA) tests of 52 patients referred for ambulatory vestibular laboratory tests due to a nonspecific illusion of movement, but with a normal otoneurological examination, were reviewed. Abnormalities were found in the vestibular tests of 35 patients (67 per cent), 22 of whom (63 per cent) were finally diagnosed as having a unilateral peripheral vestibular lesion, and 13 (37 per cent) benign positional vertigo. These results suggest that a high percentage of patients with nonspecific vertigo and a normal otoneurological examination probably suffer from peripheral vestibular dysfunction, which can be objectively documented by the ENG and SHA tests.

Adult↗
PubMed1995

[Vestibular function in acoustic trauma].

Histological and functional derangement of the vestibular system has been reported in laboratory animals exposed to high levels of noise. However, reports of clinical series give contradictory results with regard to vestibular disturbances in industrial workers and military personnel suffering from noise-induced hearing loss (NIHL). This study evaluates vestibular function in 22 men with documented NIHL and in 21 matched controls, using electro-nystagmography (ENG) and the smooth harmonic acceleration (SHA) test. There was a significantly lower vestibulo-ocular reflex gain (p = 0.05), and a tendency towards decreased caloric response in the patients. There were no differences between patient and control groups in: incidence of vertigo and of spontaneous, positional and positioning nystagmus; directional preponderance and canal paresis in the ENG; or in phase and asymmetry parameters in the SHA test. These results demonstrated a symmetrical, centrally compensated decrease in vestibular end-organ response associated with symmetrical hearing loss in the patients. Statistically significant correlations were found between average hearing loss, and decrease in average vestibulo-ocular reflex gain (p = 0.01) and ENG caloric lateralization (p = 0.02). These correlations might indicate a single mechanism for both cochlear and vestibular NIHL. The results imply subclinical, well compensated malfunction of the vestibular system associated with NIHL.

Hearing Loss, Noise-Induced↗
PubMed1994

Cinnarizine in the prophylaxis of seasickness: laboratory vestibular evaluation and sea study.

Cinnarizine was evaluated for the prevention of seasickness in a laboratory and sea study. The effects of 25 mg cinnarizine on the vestibulo-ocular reflex were investigated in 13 subjects. Significant reduction of the gain in response to sinusoidal oscillations at 0.02, 0.08, and 0.16 Hz (p < 0.05) and increased phase lead at 0.16 Hz (p < 0.01) were observed. The effect of 25 and 50 mg cinnarizine on seasickness severity was examined in 95 subjects during a voyage in rough seas. Seasickness symptoms were improved in 69% of the subjects by 50 mg cinnarizine versus 35% and 31% in the groups receiving 25 mg cinnarizine and placebo (p < 0.05 and p < 0.01, respectively). The percentage of vomiting protection provided by 50 mg cinnarizine was 63% (p < 0.05). We conclude that 50 mg cinnarizine is an effective drug for the prevention of seasickness. The reduction in vestibular sensitivity observed even after administration of 25 mg cinnarizine may explain the potency of cinnarizine in the prevention of seasickness.

Adolescent↗
PubMed1994

Vestibular findings associated with chronic noise induced hearing impairment.

Histological and functional derangements of the vestibular system have been reported in laboratory animals exposed to high levels of noise. However, clinical series describe contradictory results with regard to vestibular disturbances in industrial workers and military personnel suffering from noise induced hearing loss (NIHL). The purpose of the present study was to evaluate vestibular function in a group of subjects with documented NIHL, employing electronystagmography (ENG) and the smooth harmonic acceleration (SHA) test. Subjects were 22 men suffering from NIHL and 21 matched controls. Significantly lower vestibulo-ocular reflex gain (p = 0.05), and a tendency towards decreased caloric responses were found in the study group. No differences in the incidence of vertigo symptoms, spontaneous, positional and positioning nystagmus, directional preponderance and canal paresis in the ENG, or the SHA test phase and asymmetry parameters were observed between the groups. These results demonstrated a symmetrical centrally compensated decrease in the vestibular end organ response which is associated with the symmetrical hearing loss measured in the study group. Statistically significant correlations were found between the average hearing loss, the decrement in the average vestibulo-ocular reflex gain (p = 0.01), and ENG caloric lateralization (p = 0.02). These correlations might indicate a single mechanism for both cochlear and vestibular noise-induced injury. The results imply subclinical, well compensated malfunction of the vestibular system associated with NIHL.

Adolescent↗
PubMed1994

Effect of cinnarizine in the prevention of seasickness.

In a double-blind, placebo-controlled study, we evaluated the effect of two different doses of cinnarizine in the prevention of seasickness in very rough seas. We divided 95 healthy male subjects into 3 groups which received: cinnarizine 50 mg, cinnarizine 25 mg, and placebo. Seasickness susceptibility and severity were evaluated by a standard questionnaire concerning the subject's condition on previous voyages (seasickness susceptibility), and the subject's condition immediately after a 4-6-h voyage in very rough seas with 3.5 m waves (seasickness severity). Possible side effects of the drug were also evaluated by filling in a further questionnaire. Of the 31 subjects who received cinnarizine 50 mg, 65% felt better during the present voyage than on previous voyages, compared to 41% of the 32 subjects who received cinnarizine 25 mg and 31% of the 32 who received placebo. A significant difference (p < 0.05) was found between the cinnarizine 50 mg and placebo groups, while cinnarizine 25 mg was no more effective than placebo. No notable side effects were found for any drug group. In conclusion, cinnarizine 50 mg was found to be effective in the prevention of seasickness in rough seas.

Adolescent↗
PubMed1994

Seasickness susceptibility, personality factors, and salivation.

The present study investigates the possible relationship between motion sickness susceptibility, personality factors and salivation. Personality factors, as evaluated by the Eysenck Personality Questionnaire, and salivary composition and flow were measured in a group of 29 subjects highly susceptible to seasickness and in a group of 25 non-susceptible subjects. The non-susceptible group had significantly higher psychoticism scores and significantly lower salivary amylase levels compared to the highly susceptible group. A significant positive correlation was found between psychoticism scores and the amount of the increase in salivary flow in response to gustatory stimulation. These results provide more data in support of a connection between motion sickness susceptibility, personality, and the autonomic nervous system.

Adolescent↗
PubMed1993

Vestibulo-ocular reflex in migraine patients: the effect of sodium valproate.

We studied vestibulo-ocular reflex measurements in a group of 12 patients suffering from migraine without aura and evaluated the effect of sodium valproate given as prophylactic migraine therapy. The study was randomized, double blind and placebo controlled, with a crossover design. The horizontal vestibulo-ocular reflex was evaluated by the Sinusoidal Harmonic Acceleration test at 0.01, 0.02, 0.04, 0.08 and 0.16 Hz using a computerized rotatory chair system. No abnormalities were found for the vestibulo-ocular reflex gain, phase and asymmetry at each of the frequencies examined during the placebo treatment. These normal vestibulo-ocular reflex measurements contrasted with the repeated complaints of dizziness, vertigo and unsteadiness reported by 7 patients (58%). Sodium valproate affected neither vestibulo-ocular responses nor vestibular complaints but was effective in reducing migraine attacks in 8 of the 12 patients. These results demonstrate that the low frequency vestibulo-ocular reflex measurements are normal in patients suffering from migraine without aura.

Adult↗
PubMed1992

Salivary secretion and seasickness susceptibility.

The salivary flow rate and composition of 2 groups of 31 subjects, one group at each extreme of the seasickness susceptibility scale, were compared. No significant differences were found between the two groups in flow rates and electrolyte concentrations of whole resting and stimulated saliva. Amylase activity and rate of secretion in resting saliva were significantly higher in subjects susceptible to seasickness as compared with nonsusceptible subjects. Also, the total protein rate of secretion in resting saliva was significantly higher in the susceptible group. The present findings could be explained in terms of higher sympathetic tone in subjects susceptible to seasickness, and salivary amylase levels might be recommended as an additional parameter in the evaluation of seasickness susceptibility.

Adult↗
PubMed1991

Recurrent classic migraine attacks following transdermal scopolamine intoxication.

A 20 year old male naval crew-member suffering from sea sickness was treated with transdermal scopolamine (TS). After 5 months of continuous treatment, he developed scopolamine intoxication followed by the appearance of recurrent classic migraine attacks. He had never suffered from headache or migraine prior to TS intoxication. The migraine attacks comprised a prodrome of apathy, bad mood and loss of appetite lasting several hours. An aura of scintillating spots, left arm numbness and paresthesias lasting several minutes was followed by a severe throbbing unilateral headache with photophobia, sonophobia and nausea. After one year of repeated follow-up examination, he continued to suffer from the attacks once every 10 to 14 days, with no identified precipitating factors. We are not aware of similar cases in the medical literature. Although it is not possible to establish TS intoxication as a causal effect of the appearance of classic migraine in our patient, the temporal association and clinical course are very supportive of this assumption. Central nervous system neurotransmitter imbalance of cardiovascular alterations may possibly be implicated.

Administration, Cutaneous↗
PubMed1991

Diving-related inner ear injuries.

Diving-related inner ear barotrauma (IEB) and inner ear decompression sickness (IEDS) most often result in permanent severe cochleovestibular deficits, unless immediate diagnosis is reached and the correct treatment is commenced early. Nine cases of sport-diving-induced inner ear injuries that were referred to the Israeli Naval Hyperbaric Institute between October 1987 and September 1989 are presented with regard to evaluation, treatment, and follow-up. The diagnosis was IEB in five divers and IEDS in four. Explorative tympanotomy was carried out with remarkable results in two patients with IEB, while the remaining three were relieved by bed rest alone. Three of the four IEDS patients were recompressed according to the extended US Navy Table 6 with good short-term results. The role of complete otoneurological evaluation in the decision-making process leading to the correct diagnosis and treatment is emphasized.

Adolescent↗