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Some Otoneurogical Findings in Women in Climax

*D. Medzhidieva, *Vl. Zahov, †G. Kolarov

*ORL and Otoneurology Department, “St. Ivan Rilski” University Hospital, Sofia, Bulgaria
†University Hospital for Obstetrics and Gynaecology “Maichin dom”, Sofia, Bulgaria

ABSTRACT

Objective: The aim of this survey was to outline the otoneurology deviations in women in climax.
Study design: Prospective case review.
Setting: The survey took place in the ORL-Otoneurology Department, “St. Ivan Rilski” University Hospital and in University Hospital for Obstetrics and Gynaecology “Maichin dom” – Sofia.
Patients: 41 women in early menopause with climax symptoms.
Intervention: Patients underwent full otoneurological and gynaecological examination before and after the hormonal substitutive therapy.
Main outcome measures:
Results: Dysharmonic statokinetic disturbances are predominant and 50% of the patients have improvement after the hormonal substitutive therapy.
Conclusions:
Key words: Otoneurology, Climax, Hormonal substitutive therapy
Pro Otology 2-3: 99-101, 2003

Introduction

The climax in women is a period of hormonal resetting, mainly due to the stopping of the ovulatory function of the ovary, as well as a sharp decrease in the sex steroidogenesis. The reduced levels of estrogene results in the appearance of a wide spectrum of somatic, psycho-emotional and sexual deviations, as well as development different ans sophisticated processes in the cortical areas of the central nervous system. All these have reflection upon the vestubular analyzer and cause abnormalities in the vestibular reactions.

The combination of climacteric symptoms and otoneurologic deviations cause significant adaptation problems to women in climax, in social, occupational and family aspect.

Materials and methods

We tested 41 women in early menopause with climax symptoms as well as otoneurological such, representing as rotational vertigo, dizziness, discrete balance impairments, subjective noise, symptoms from the vegetative nervous system, as sweating, headaches, vomiting and nausea.

In the course of the investigation, two women dropped out, because of present vertebrobasilar insufficiency, one with posttraumatic vestibular deviations, one with disease of the thyroid gland as well as three with medical contraindication for hormonal substitutuve therapy.

The otoneurological symptoms were objectified, using Barany`s scheme, with reading of the positivation of the spontaneous symtoms with the help of Frenzel`s glasses, tone treshold audiometry and over treshold specialised tests, rotary and caloric provovations of the vestibular analyzer. The otoneurological study was performed before and after a three months course of hormonal substitutive therapy.

The climacteric complaints were evaulated with the help of Cooperman scale, before and after the therapeutic course, blood pressure level was monitored, as well as eventual side effects of the treatment.

For the hormonal substitutive therapy, a medicament that provides 50 mcg per 24 hours beta-estradiol was used, employing a scheme: 2 plasters a week for three weeks, followed by a 7 day pause – three months in total. From the tenth day on, a peroral gestagene was added.

The otoneurological treatment included symptomatic medication – beta-histidine dihydrochlorid, an anti-vertigo medicament that has a vasodilatative effect on the pre-capillary sphincters of the internal ear, which results in the decrease of the endolymphatic pressure, as well as having an agonistic effect upon the H2 receptors. This medication was administered 2 mg, two times a day for two weeks, with one month rest between the therapeutic courses.

For data processing, we used variation analysis and an IBM personal computer.

 

FIG 1. Climactery complaints.
 

FIG 2. Dynamics of results from rotatory provocations of vertical semicercular canals. (Details in the text).

 

Results

After the three month therapeutic course, we found an improvement of the climacteric complaints, with the aid of Cooperman scale as follows: vasomotory manifestations (1) from 9.3 before the treatment to 2.7 after it; paraesthesias (2) from 3.9 to 2.5; insomnia (3) – 5.2 to 2.1; nervousness (4) – 4.7 to 2.1; depressive afective disorders (5) – from 1.2 to 0.6, vertigo (6) – from 4.8 to 0.8; tiredness (7) – from 3.2 to 1.4; pains in muscles and joints (8) – from 1.6 to 0.5; headache (9) – from 2.4 to 0.8, tachycardia (10) – from 2.1 to 0.6 (FIG. 1).

Total rating before the treatment 37.7, after the treatment - 13.1. All differences are statistically reliable (p= 0.001).

In the treatment course, 3 women (8.8%) were found to have elevated blood pressure to 150/90 mm Hg which lowered to normal after the end of treatment. In 4 women (11.8%) we found dermal erythema at the place of plaster application. 6 women (17.6%) had uncomfortable feelings in the breasts (tension). One of the women had a scarce pseudomenstrual bleeding. All above mentioned side effects didn’t impose stop of the hormonal substitative therapy.

FIG 3. Dynamics of results from rotatory provocations of horizontal semicercular canals. (Details in the text).

The otoneurological tests before and after the treatment showed the following results: Audiometric data for normal hearing levels, excluding the age-connected abnormalities; lack of statokinetic symptoms. 25 women (73.5%) with dysharmonic type of statokinetic deviations, from which only 10 (29.4%) remain after the treatment; deviation in the nose-indictive test showed 16 women (55.8%) before the treatment and after it 7 women (20.5%); 15 (44.1%) women before the treatment had deviations of the Barany test and after the treatment 6 (17.6%). With full test set deviations were 10 women (29.4%) before the treatment and after it – 4 (11.7%).

The rotatory provocations of the vestibular analyzer showed before and after the treatment: for vertical semicircular canals: normoreflexia (1) had 9 women (26.3%) before the treatment and 28 (82.1%) after the treatment; bilateral hyperreflexia (2) – from 22 women (64.5%) before – to 8 (23.4%) after the treatment and hyperreflexia bilaterally (3) there was no change – 3 (8.8%) women before and after the treatment (FIG. 2).

For horizontal semicircular canals normoreflexia (1) was found in 28 (82.1%) women before and 29 (84.9%) after the treatment; bilateral hyporeflexia (2) from 5 before (14.7%) to 6 (17.6%) after the treatment; bilateral hyperreflexia (3) 1 (2.9%) before and after the treatment (FIG. 3).

The water caloric provocations showed normoreflexia before and after the treatment.

DISCUSSION

1. A significant diminishing of the climacteric symptoms is found in the end of the second month, and especially significantly in the end of the third month, with better influencing the vasomotorial complaints, vertigo and insomnia. The side effects are insignificant and do not impose stopping the hormonal substitutive therapy.

2. The statokinetic deviations of dysharmonic type are predominant, that correspond to functional impairments, most possibly due to dysbalance in the affective-depressive processes at cerebral cortex level, in the aspect of the vestibular analyzer.

3. The rotatory provocations of the vertical semicircular canals show relative bilateral hyporeflexia that corresponds to affection of the brainstem representative areas of the vestibular analyzer (vestibular nuclei), influenced in 50 % of the cases from the administered complex treatment.

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