Rheoencephalography (REG) was used on 35 patients with Meniere's disease to determine tonus and perfusion of cerebral vessels. The analysis took account of age, duration of the disease and presence or absence of cervical osteochondrosis. Hypertensive symptoms in the vertebro-basilar system predominated in the under 45 age group, while for the over 45 patients and those suffering for more than 5 years, hypertensive symptoms were likewise noted in the internal carotid arterial system. Signs of angiospasm were revealed both for patients with cervical osteochondrosis and without it. Hypertensive signs were noted in 88.5% of patients with Meniere's disease and as a rule they were noted in the entire vertebro-basilar system without respect to the presence or absence of concurrent cervical osteochondrosis and uni- or bilateral affection of the labyrinth; in patients over 45 who had suffered more than 5 years this also applied to the internal carotid arterial system. Identification of the condition of cerebral circulation and the planning of more effective therapy that influences vascular tone is made possible by REG

Mertsalova, O. N.

Nikolayev, M. P.

English

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NASA TBMICAL M[WRANOM 	 NASA TM-76387
KMOENGEPHi'#IDGRAPHY IN MENIERE' S DISEASE
M. P. Niko ayev and 0. N. Mertsalova
Translation of "Feoentsefalographiya pri bolezni Men'yera",
Vestnik otorinolaringologii, No. 3 0 May-Jun 1979, pp 12-15.
(NASA-TM-76387) 11HEOENCEPNALOGRAPHY 111
	 $81-16727
MENIERE I S DISEASE ( National Aeronautics and
Space Administration) 7 p HC A02/MF A01
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1. Report 4akgrowmen ► Accession No. ;h	 Pociplant's Coteleg N•,
'NASA TM-76387
d.	 Title and Su`title S. Report Dole
RHDOENCEPH.ITAGRA 1W IN MMM" S DISEASE S tember 1980 ^r^„f. Per(Atminq Organisation Code
7. AuthgrW 8. Performing o ►oonliovi•n Report No.
M. P. Nikolayev and 0, N Mertsalova
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Translation of "Reoentsefaaografiya pri bolezni Men'yera", Vastnik Oto-
rinolaringologii,°
 No. 3,• May-Jun 1979, pp 12-15.
16, 4b s t ac tREG was used on 35 patients With Meniere 's disease'to determine
tones and'perhasion of cerebral vessels. The analysis took account of age,
duration of the disease and presence bf absence of oarvical osteochondrosis
Iypertensive symptoms in .
 the vertebro-b silar system predominated in the
under 45 group, while for,the over 45 patients and those suffering for rrore
than 5 years hypertensive symptom, were likewise noted in the int-*.rnal car-
otid arterial system. 	 Signs of arqiospasm were revealed hath for patients
with cervical osteochondrosis (12) and without j,,t (9).	 T3:ws, hypertensive
signs woke rioted in 88.5% of patients with Meni; re's disease and, as a rule
they were noted in the entire-vetre ro-basilar•'system without respect to
the presence or.absence of concurrent cervical osteochondrosis'and unit= or
bilateral affection of ` the labyrinth;	 in patients over 45-who had suffered
more than 5 Years this also applied to the internal carotid arterial system
RnG makes possible.not only identification-of the condition of cerebral
,circulation but also the planning of more effective therapy 'that influences
vascular tone.,
17. Key Words (Selected by Author(s)) 16.	 Dislribuli*n Statement
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R==JGE'PHALOGRAPHY IN ME NIEIE' S DISEASE
M. P. Nikolayev and 4. N. Mertsalova
Section of ORL (Head, M. P. Nikolayev) and Functional Diagnosis (Dead, S. S. Moe
oral) of fhe Botkin Clinical Hospital (Medical, Director, A. M. Sotvinov)
There is an opinion current (13, 12, 8,9 , ^ .7, , 5, et al. ] that Meniere I s disa%V,	 12*
is based upon a dysfunction of autonomic innervation of the vessels of the inner ear,
this dysfunctioning appearing as a spasm ax dilatation of the labyrinthine arterioles.
For the purpose of defining the nature of these disturbances it was suggested that
use be made of a subcutar r ous histamine test (1I,, plethy€iogra phy or capillarosoopy
[2, 111, inhalation of carbogen or oxygen [8].	 /13
After the appearance of the rheoeincephalographic method (REG) making it possi-
ble to objectify the mechanism of vascular regulation while determining the locali-
zatian side of the process, some autbnrs (6, 9, 10] used this method in cases of
Meniere ' s disease and expressed ther. elves satisfied with its reliability for the
discovery of vagospast:ic or vasr"ralytic fo" of the disease and the assign ent of
appropriate therapy.
We have used the RBG to determine the tonus and perfusion of vessels of the
brain in 35 cases of Meniere's disease.
As we know, the principle of the ROG is the recording of changes in electrical
resistance of tissues for a determined segment of HF current based on differences in
vascular perfusion that are caused by the cyclic action of the heart which evokes
synchronous fluctuations in the. brain's electric conductivity. For the REG we used
the Fast German type 6 NEC-3 polygraph with a 4 channel Soviet rheographic attachment
type 4 RG-lA. We calibrated the rheograph with a standard resistance of 0.1 ohms,
the patient being hooked up in parallel. The calibrating signal was adjusted to 10
mm.
Record was made with symmetrical frontomastoidal (FM) leads showing the type of
Numbers in the margin indicate pagination in the foreign text.
1
2 .y
s
4",
s
Fig. 1. REG of patient M. with high
vascular tonus. 1 - FM right, 2 —
FM left, 3 - OM right, 4 OM left,
5 ,after nitroglycerin test. Under
each RUG curve differential curve.
2
3
4
Fig. 2. RUG of patient S. with low
vascular tons left side. Rest as above.
blood circulation in the system of intern-
al carotid artmries and with the occipito-
mastoidal (CM) leads showing blood circula-
tion in the system of the vertebrobasi:lar
arteries.
1MG makes it possible to discover the
special features of cerebral blood flow
and to assess the tones of cerebral, vessels.
For the evaluation of blood perfusion ii
the cerebral hem sphesms and the tonnus of
the cerebral vess'als we took into mount:
1) the shape of the rheographic curve as
an .index of the tons of the vascular wall.;
2) the rheographic index value (RI) show-
ing the intensity of arterial perfusion irk
the brain area under study; 3) length of
the anacrotic phase of the RMG curve in
seoonds,reflecting the elastic capability
of the vascular wall; 4) the presence of
asymmetrical intensity of blood perfusion
in the system of internal carotid and
vertebrobasilar arteries.
In the control group the average val-
ue for the RI of the hemisphere RUG was
1.2+0.1, for the occipital tracings 0.9+
J•0.1 and length of the anacrotic phase
was 0.10+0.01 and 0.10+0.01 sec respect-
ively.
There were the following signs of angiospasm: slower rise of the anacrotic
peak, rounded off peaks, at times a plateau or arclike peak, indistinct incisure,
a weak dicrotic notch. The principal finding from the quantitative indices was a
reliable drop in the RI. The nitroglycerin test was followed by an increase in the
amplitude of the curve, normalization of the shape of RDG attendant upon the decline
2
F
iof vascular tones. Fig. 1 shows the PM of patients with Meniere's disease and
symptoms of angiospasm.
14
i
aa,
jrhe patients studied (24 women and 11 men.) ranged in .age from 32 to 60. All of
them in the clinicoaudiological and vestibulametric examination presented a triad cf
symptoms (vertigo, diminished auditory acuity and noise in the ears, equilibrium dis-
turbanoe) typical of Meniere's disease. 25 patients presented unilateral impairment
of the peripheral eochleavestibular apparatus. 12 under X-ray stxmW signs of cer-
vical osteochondrosis.
17 patients presented signs of angiospasm both in the system. of internal carotid
arteries and in the vertebrobasilar systeir, in 2 of these cases on the same side as
the impairment; in 12 patients these symptoms were revealed only in the vertebro-
basilar system bilaterally, in 2 cases only on the iixpairmmit side, in 3 cases there
were no signs of hypertonus and 1 female patient presented reduced vascular tones
(Fig. 2) .
In analyzing the RM we took into acmmt the patient's age, length of illness
and the presence or absence of cervical osteochondrosis.
The patients up to age 45 presented a MG with predominant symptoms of hyperton-
us in the vertebrobasilar system, whereas older patients showed signs of kypertonus
not only in .the vertebrobasilar system but also in the system of internal carotid
arteries and this is apparently explained by the incipient formation of a hypertonic
syndrome or by sclerotic changes in the vessels.
Patients who had been ill more than 5 years also showed a MG with a predominance
of hypertonic symptoms in both systems (12 patients).
Symptoms of angiospasm were presented both by patients with cervical osteochon
drosis (12 patients) and by 19 patient;.; without such symptoms.
An anlysis of the literature data bears witness to the fact that the EBG of pa-
tients with Meniere's disease are interpreted variously despite the fact that the
method is ackixjvledged to be valuable and reliable in the assessment of the condi-
tion of cerebral, circulation. Thus, V. V. M trofanov, in 45 out of 50 patients with
3
r	 #	 ^
Meniere l s disease, found a difference in the intensity of blood perfusion and a dif-
ferenoe in the ;anacrotic phase in the vertebrobasilar system on the impairment side
without substantial changes of perfusion in the system of the internal carotid ar-
teries, A. N. PomMina and N. N. Filimonov in noting similar changes explain them
as due to irritation of the periarterial syApathetic plexus of the spinal artery in
trice osteochondritic process. in contradistinction to this V. N. Prokhor v found in
most patients (9 out of 12) a healthy symretrical blood flow in the vertebsabasi.lar
system.
WE know that the RUG shows the quality not only of pulse fluctuation but also
of changes in elasticity and tonus of the cerebral vessles [141, so that in our o- 15
pinion it is important to take into account tht* patient's age, length of illness,
frequency and intensity of vertigo attacks, presence or absence of conocxmitant cer-
vical osteoctosis and its clinical severity.
We have had under observation patients with frequent vertigo attacks repeated
monthly or even oftener; the attendant cervical osteochondrosis did not appear with
clinical synptams that were typical Zzltd caused by osseous growths in the bodies or
processes of cervical vertebrae. we discovered signs of hypertonus in 88.5% of pa-
tients with Meniere's disease, as a rule, in the entire vertebrobasi,lar system with-
out reference to the presence or absence of acoonVanying cervical osteochondrosis
and likewise in the system of internal carotid arteries in patients older than 45
who had suffered from the disease more than 5 years.
More intensive changes in cerebral blood circulation, it would appear, are due
to the spread of dysfunction in the autonomic nervous system, which is the root of
Men ere I s disease [13, 12, 8, 3, 4 et al.] with vasarotor impairment not only in
the vertebrobasilar system but also in the system of internal carotid artier es and
likewise with sclerotic vascular changes or incipient manifestations of a hyperten-
sive syndrome.
Thus the FaG makes it possible not only to discover the condition of cerebral
circulation but also to determine the extent to which it has changed and to indicate
a m.re effective use of conservative therapy affecting vascular tones.
4
1. Atkinson, M., xs_cholaryng. 55, 434-444 (1952).
2. Balkovskaya, N. A., K voprosu patogeneza, raspoznavaniya i ledImiya bolezni
Men'yera (Pathogenesis, Diagnosis and Treatmer t of Meniere's Disease), Doc-
toral candidate's dissertation, Leningrad, 1958.
°3. Beickert# P., Z. Laryng. 41, 828-838 (1962).
4. Hanicke, 0, HNO (Berlin) 16, 298-302 (1968).
S. House, W. F., Arch. Otolar m. 79, 338-354 (1964)..
U. M trofanov, V V. r Vest"Arm ,., 3, 50-56 (1972)
7. Neveu, M., Ann. OW-laryng. (Paris) 79, 726-751 (1962).
8. Olisov, V. S. , Zabiri.ntopatii [Cases of Lubyrinthopathy) , Leningrad, 1973.
9. Pnmukhina, A. N. and N. N. Filinonov, v kn: Aktual'n ew o otorinolarin-
ii (Current Problems in ORL), Rostov-na-Dony, 	 , pp	 .
10. Prokhorov, V. N., v kn: Negnoynyye zabolcvaniya ukha (Nonpurulent Diseases of
the Bar), Moscow, 1975,E -30.
11. Ryndina, A. M., Zh. ushn. nos. i gorl. bol., 4, 28-33 (1961).
12. Soldatov, I. B., Trudy Mask. NII ukha, go;,:2a i. nosa, 14, 137-145 (1966).
13. Undrits,p V. F., Vestn. otorinolar., 6, 57-65 (1958)0
14. Yarullin, Kh, Kh.,Kliniccheska a reoentsefal a hi a [clinical Rheoencephalo-
graphylr Leningr 9 •
P
, IL,
a5


Rheoencephalography in Meniere's disease

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