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Depression is a state of depressed mood characterized by feelings of sadness, despair, and discouragement. Depression is a disease that belongs in the practices of psychiatrists, psychologists, and psychosomatically oriented family physicians. In contrast to normal sadness or the grief that accompanies the loss of a loved one, clinical depression is sadness without any apparent reason and is persistent and severe. From our neurootological data bank and from archives of the Neurootologisches Forschungsinstitut der 4-G-Forschung e.V. All patients included in this study underwent systematic neurootometric and equilibriometric analyses.
The equilibriometric measurements were experimental neurophysiological investigations in which ENG represents only the recording part.
For establishing comparisons between various stimulus intensities, the so-called vestibular stimulus response intensity comparison (VESRIC) was used.
The hearing pathways are analyzed by means of pure-tone audiometry of the hearing threshold in all patients. The results of the polygraphic ENG together with the three-channel ECG represented the experimental investigations using the caloric test (Table 3).
CCG served for objectively and quantitatively measuring the responses of the vestibular spinal standing test and stepping test (Table 4). In one form of dysthymic disorder, "masked depression," either the patient or the physician may not readily recognize the mood disturbance. By means of our special neurootological investigations and methods, we tried to control for various aspects of the characteristics of the selected 134 patients in relation to depressive disorders. Among the nausea symptoms, the weaker nausea signs, such as malaise without vomiting, is much more frequent than in average NODEC samples.
As regards visual disturbances, we noted an unusually high incidence of visual abnormalities, such as illusions of movements (oscillopsia) and, especially, double vision. An evaluation of the caloric vestibuloocular nystagmus test showed that the central nystagmus frequency (see Table 3) had a tendency toward higher values, indicating an increased lability of this vestibuloocular regulation process. In analyzing the cardiac responses during perrotatory and postrotatory stimulations with rotations toward the right and left, we again observe (Fig. In combining results of the caloric test with ipsidirectional test results of the rotatory intensity-damping during the perrotatory phase (see Fig.
Evaluation of the stepping CCG (see Table 4) exhibits a reduced displacement (a little lateral sway, as if the patients are afraid to move too much and too far). In summarizing the results of this study, we came to the conclusion that some prominent findings include a high occurrence rate for the subjective complaint of instability and the sensation of rocking in the field of vertigo and a very high score for malaise in nausea.
When taken together, the vestibuloocular nystagmus responses due to monaural (caloric) and binaural (perrotatory) stimulations, the so-called decruitment phenomena, are unusually frequent in our statistics, which suggests a central tendency in the tested persons to overshoot downregulations in their vestibuloocular nystagmus.
The CCG evaluation of the stepping test also exhibits a restriction in movement as to longitudinal displacements. This article is based on a lecture presented at the Thirtieth Annual Neurootological and Equilibriometric Society Congress, Porto, Portugal, April 3-5 ,2003. So, we here at GIMME TINNITUS world headquarters are very excited for a full length album by Buke And Gass. And if you want to know what all that hookworm talk is about, listen to THIS (if fact you should probably listen to it anyway). Sanchez and Dyer are getting ready to self-release their first full length album, and have released the following ditty in anticipation. Hopefully, we will get some more information about the album soon (title, artwork, any innovative packaging deets, etc).
Depression ranges from normal feelings of "the blues" through dysthymia to major depression. Depression also occurs among patients especially seeking help from a neurootologist when they present with vertigo or tinnitus.
Depression may be accompanied by a variety of related symptoms, including disturbances in sleep and eating, loss of initiative, self-punishment, withdrawal and inactivity, and loss of pleasurable feelings.
They contained a neurosensory network analysis through polygraphic five-channel electronystagmography (ENG) together with simultaneous electrocardiographic (ECG) recordings of the heart rhythm.
For this test, the caloric warm response is defined to be stimulated with the weaker stimulus acting on one inner-ear receptor. In this analysis, we always add the pure-tone analysis of the discomfort threshold for measuring the audiometric dynamics of the inner ear.
According to our statistics, we have complete individual descriptions within the patient files. Dynamic vestibular stimulus response intensity comparison (VESRIC) sorted according to the occurrences of the 12 most frequent patterns. The investigation of the hearing pathways was evaluated by speech audiometry with respect to the three most socially important audiometric parameters (Fig. Speech audiometry evaluated according to the three important parameters: recognition of numbers and of words and loss of discrimination for the left ear. In our study, we adopted the diagnosis from other physicians who investigated the patients prior to our evaluations. The term implies that some intrinsic biological process rather than environmental influences is the cause.
The patient complains of chronic symptoms of a somatic nature, insomnia, and loss of pleasure in everything. The same level of tinnitus may be described by one patient as intolerable and by another as barely noticeable.
Among the reported phobias, general anxiety occurred frequently, rivaling the occurrence of all the other subsymptoms.


ECG analysis revealed that downregulation of the ECG under the influence of caloric vestibuloocular stimulation is very low, if not abolished, in comparison to the situation during spontaneous recording (see Table 3). 4) that downregulation of the heart rate is incomplete or lacking with respect to the sitting spontaneous situation. Per- and postrotatory electrocardiogram (ECG) analysis during the experimental vestibuloocular investigation rotatory intensity-damping test of 134 patients suffering from depressive disorders.
2) in the VESRIC, we find only 22.39% of normal reactions within the tests of the vestibuloocular nystagmus-regulating system. The subjective impressions of oscillopsia and double vision are also higher than in other groups of patients with neurootological complaints.
There, we find only minor incidences of broad sway patterns of the cerebellar pontomedullary dysregulation type. Untersuchungen uber den vom Vestibularapparat des Ohres retlektorisch ausgelosten rhythmischen Nystagmus und seine Begleiterscheinung. Das Frequenzmaximum des kalorisch ausgelosten Nystagmus I als Kennlinienfunktion des gepriiften Vestibularorgans. Die quantitative Vestibularisprufung-Eine audiogrammanaloge Auswertung von Nystagmusbefunden (Schmetterlingsschema). Uber eine Gleichgewichtsfunktionsprufung mit Hilfe der Cranio-Corpo- Graphie (CCG) und Polarkoordinaten im Raume. Forschungsbericht Cranio-Corpo- Graphie (CCG)-Ein einfacher, objektiver und quantitativer Gleichgewichtstest fur die Praxis. Das impulsmarkierte Cranio-Corpo-Gramm, ein differenzierter vestibulospinaler Test mit besonderer Bedeutung fur die Arbeitsmedizin.
Uber eine Systematik der mittels der Cranio-Corpo-Graphie aufgezeichneten Kopf-Korper-Bewegungsmuster [inaugural dissertation].
Die Darstellung per- und postrotatorischer Vestibularisreaktionen mittels des Brain Electrical Activity Mapping. Uber die Registrierung des Nystagmus und anderer Augenbewegungen vermittels des Seitengalvanometers. Neue objektive registrierbare Vestibulariskorperdrehreaktionen, erhalten durch Treten auf der Stelle.
Department of Otorhinolaryngology Head and Neck Surgery, Semmelweis University, Budapest, Hungary. The duo of Aron Sanchez and Arone Dyer play highly customized instruments to create a truly unique audio experience. Endogenous depression has been identified with a specific symptom complex: psychomotor retardation, early morning awakening, weight loss, excessive guilt, and lack of reactivity to the environment.
More generally, modern medicine acknowledges depression as a mental disorder characterized by feelings of worthlessness, guilt, sadness, helplessness, and hopelessness, experienced either as individual symptoms or in combination with others. These electrophysiological data were recorded within our neurootometric vestibular laboratories. The maximum responses to the four caloric partial tests and the spontaneous nystagmus were plotted onto the Claussen butterfly chart. The patient is also connected to seven electrodes around the eyes for a five-channel ENG and electrodes at the limbs for a three-channel ECG and then is connected to amplifiers and the recording devices. A NODEC comprising a list and a statistical analysis of the entire sample of 134 patients has been established. The results of the VESRIC are shown in Figure 2 with respect to the 12 most frequent patterns (of 81 possible VESRIC codes) describing the cybernetic status of vestibuloocular pathway regulation. Combining the caloric with the perrotatory part of the rotatory intensity-damping test (RIDT) with the caloric warm response, we can establish the so-called VESRIC. Many patients presenting with repeated complaints of physical symptoms to physicians who are not psychiatrists are, in fact, suffering from chronic depression. Neurootological experience shows that persons with severe tinnitus experience excessive stress. Comparison of height and weight revealed a tendency toward a slight overweight (see Table 1).
The duration of single vertigo attacks shows a tendency to longer episodes; the vertigo does not occur as a momentary flash. Thus, tinnitus together with vertigo are important subjective complaints within this group of 134 patients complaining of depressive disorders. This tendency is underscored in Figure 1, in evaluating the 12 most frequent caloric butterfly patterns in trinary coding. Conversely, upregulation in the sense of a sympathetic tonus during the postrotatory nystagmus phase is much too small.
During the standing test, the longitudinal head sways are much longer than the lateral sways.
In comparing this with vestibuloocular nystagmus dysregulation, we were led to conclude that the majority of pathological processes must occur in the upper brainstem together with supratentorial structures. Observation on the directional preponderance of caloric nystagmus resulting from cerebral lesions. Additionally, the vestibular spinal pathways were analyzed by means of ultrasound computerized craniocorpography (US-COM-CCG), recording head and shoulder movements from above. This chart allows for the discrimination of 81 different test responses, of which some occur in frequencies of more than 1% and some in frequencies of less than 1%; several never have been found among our patients. The perrotatory stimulus, however, is a step-shaped stimulus and is applied simultaneously to the right and to the left inner-ear vestibular apparatus. The test results of the RIDT are measured from the registration and thereafter are plotted numerically and graphed into the L-chart of the RIDT. The social hearing of the test persons is investigated by means of standard speech audiometry, with hearing threshold for numbers and monosyllable words.


Such statistics as age, height, and weight have been recorded to describe the group of persons within the study (Table 1). When combining the right beating nystagmus and the left beating nystagmus characteristics, we get the charts of the VESRIC, which can be graphed or expressed by trinary coding (0 = normal , I = inhibited, 2 = disinhibited) with four digits (pos. Even a reactivated depression is characterized by a sad or hopeless mood, pessimistic thinking, a loss of enjoyment and interest in one's usual activities and pastimes, reduced energy and vitality, increased fatigue, slowness of thought and action, loss of appetite, and disturbed sleep and insomnia. As a result, patients may demonstrate a cluster of hysterical defenses or a serious degree of depression.
Among the vertigo symptoms, the feeling of instability is the leading subsymptom, occurring in more than 55%, followed by the feeling of rocking (as if the patient were in a boat) in approximately 53%. Of 81 possible caloric butterfly patterns, the most frequent is the normal pattern in approximately 30%. All this points to a significantly reduced vegetative reactivity within this group of patients. Such an accumulation of decruitment phenomena in a ranking of the most frequent VESRIC patterns is very unusual.
Speech audiometry shows in the right and in the left ear a major spread for the loss of discrimination.
We saw a high incidence of home accidents in this study group, which is contrary to the usual occurrence of traffic accidents. In C-F Claussen, MV Kirtane, K Schlitter (eds), Vertigo, Nausea, Tinnitus and Hypoacusia in Metabolic Disorders. In the field of depression, we found an overlapping activity between psychiatry and neurootology. For this purpose, test persons were marked on the head and shoulders with ultrasound markers. The results of our investigations of depressive patients are transferred into the spreadsheets of the Microsoft Excel program. The subjective history of the patients in this study having depressive disorders in relation to their aforementioned neurootological complaints and the duration of their vertigo attacks, visual disturbances, hearing loss, and tinnitus were systematically catalogued.
Remarkable is that the subsymptom of a lifting sensation (as if riding on a flying carpet and the like) statistically occurs nearly twice as frequently in average neurootological data banks (8.2%). This means, conversely, that 7 of 10 patients have a pathologically dysregulated vestibuloocular caloric response.
It points toward a labile regulation disturbance within central pathways, which easily can fall into states of blockades.
Neurootologists know that many people thus afflicted, when feeling specific vertigo sensations or tinnitus, also seek the help of a neurootologist. The images received had the appearance of a radar picture of a head and trunk floating through time and space. In comparing the test results of the weaker supraliminal caloric warm test with a stronger supraliminal perrotatory nystagmus response, an individual VESRIC can be established. There the data are analyzed according to the capabilities of modern Excel programs, using numerical statistics and graphical displays.
Also, we evaluated basic mechanisms of underlying pathology, such as former traumas and cardiovascular disorders and reports about phobias. Often, it engenders feelings of low self-esteem, guilt, and somatic symptoms, such as eating and sleep disturbances. Just as a state of stress can be responsible for the onset or exacerbation of a tinnitus episode or even of disequilibrium, tinnitus can incite or exacerbate stress.
In the details of the list, we find in first position the normals (sOOOO), followed by s0002, s2222, s0022, s2000, and si001, five patterns with typical central disturbances mainly of dysregulations within the brainstem.
The vestibuloocular nystagmus tests exhibited a high rate of occurrence of centrally deregulated caloric butterfly patterns and, at the same time, a rigidity with respect to the usually occurring vagal heart-regulating reflexes. By evaluating our neurootological history data bank (Neurootological Data Evaluation-Claussen [NODEC]) as regards 6 important vertigo symptoms, we found that patients presented with a frequency of 2.10 signs per patient. Therefore, we selected for our study a sample of typical patients who presented also with a diagnosis of depression, a diagnosis that had been made externally by both psychiatrists and family physicians. The stimulus procedures underlying this investigation were the standing test of Romberg [1] and the stepping test of Unterberger [2] and Fukuda [3]. By doing so, we can find out how individual vestibuloocular circuitries respond to a change of stimulus intensity. Thus, affected patients can get into a vicious cycle: This applies also to patients suffering from vertigo or hearing loss. Pattern s2002, lying in pathological position eight in the ranking, points toward a supratentorial dysregulation in the temporal lobe. When we extended the list to 11 vertigo and nausea signs, we found 2.93 signs per patients.
Data for this group of 134 patients were collected for this sample in a special study in which the objective was to determine how much vertigo, dizziness, hearing loss, and tinnitus occur in combination with significant objective and quantitative findings within our neurootometric tests. The most frequent combinations of the VESRIC patterns for both ears are also given for the patients in this study in a table of trinary test results. The test results can be categorized into three groups with three subdivisions within each group.



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