Volume 03 Issue 04-2023
62
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
04
P
AGES
:
62-67
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
Betahistine dihydrochloride is a synthetic drug that has the ability to bind to H1 histamine receptors, which are
embedded in the neuroreceptor cells of the inner ear. It has a powerful stimulating effect by increasing the release of
neurotransmitters (histamine) from the nerve endings of the inner ear receptor cells into the synapse. The
neurotransmitter acts on the precapillary sphincters, causing vasodilation of the vessels of the inner ear, increasing
their permeability and thereby normalizing intralabyrinthine pressure, i.e. eliminating hydrops.
KEYWORDS
Betahistine dihydrochloride, neuroreceptor cells, nerve.
Research Article
USE OF BETASERCA IN PATIENTS WITH HD WITH COCHLEOVESTIBULAR
DISORDERS
Submission Date:
April 14, 2023,
Accepted Date:
April 19, 2023,
Published Date:
April 24, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue04-09
U.S. Khasanov
Researcher Tashkent Medical Academy, Uzbekistan
N.A. Akhunjhanov
Researcher Tashkent Medical Academy, Uzbekistan
G.S. Khaydarova
Researcher Tashkent Medical Academy, Uzbekistan
K.E. Shaykhova
Researcher Tashkent Medical Academy, Uzbekistan
U.P. Abdullaev
Researcher Tashkent Medical Academy, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 04-2023
63
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
04
P
AGES
:
62-67
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
INTRODUCTION
In addition to affecting the receptors of the inner ear,
betahistine has an effect on the H3 receptors of the
vestibular nuclei located in the medulla oblongata.
Experimental work on animals has shown an increase
in the level of serotonin in the medulla oblongata. This
leads to a decrease in the activity of the vestibular
nuclei, a decrease in their excitability and the cessation
of dizziness. Thus, a vestibulodepressive effect is
manifested.
The aim of our study was to determine the efficacy and
tolerability of Betaserc in the treatment of such clinical
symptoms of hypertension as dizziness, subjective
tinnitus, noise in the head, hearing loss. The tasks of
the work included studying the dynamics of the clinical
picture of the disease during therapy with Betaserc for
1 month.
MATERIAL AND METHODS
Under our observation were 23 patients with GB with
LCVR treated in the clinical bases of the Research
Institute of Cardiology of the Ministry of Health of the
Republic of Uzbekistan. GB was diagnosed according
to WHO criteria (1978). All examined were males,
whose age ranged from 25 to 60 years. The duration of
GB varied from 1 year to 20 years.
Regarding the research methods, it should be noted
that all patients underwent a general clinical
examination, which included: examination of the
somatic
(cardiological),
neurological
and
otoneurological status, rheoencephalography (REG),
electroencephalography (EEG), audiometry (AM) and
electronystagmography (ENG) according to generally
accepted methods.
Of the 23 patients with DCVR examined by us, 18
people (78.3%) complained of noises: of them, tinnitus
was localized in 6 patients (33.3%), in the head - 3
people (16.7%), in the head and ears 9 patients (50%).
Results and discussion. Of the above 18 patients with
GB with LCVR, 6 people noted constant noises, 12 -
periodic. Most patients noted a relationship between
the occurrence and intensity of noise with a
deterioration in general well-being, increased blood
pressure and increased headaches. These noises were
usually subjective in nature and were expressed in a
very diverse way: patients noted whistling, ringing,
buzzing, murmuring water, slight wind noise, etc.
Of the 23 examined, deterioration in the perception of
whispered speech was found in 17 (77.3%) patients, and
only in 3 it was unilateral, and in the rest it was bilateral.
In the majority of the surveyed, the hearing for
whispered speech is reduced from 3 to 6 meters.
The perception of colloquial speech was not impaired
in 9 (39.1%) of the examined, in 14 (60.9%) - the
perception of colloquial speech was reduced; with
NPNMK - in 3 out of 6 patients, GE - I st. in 5 out of 8,
with GE - II st. - in 3 out of 5, and in HE with PNMK in 3
out of 4 examined.
We conducted a tuning fork study of hearing in 23
patients. The perception of C128 from the middle of the
crown was reduced in 18 (78.2%) of the examined. The
perception of C128 from the mastoid processes in
hypertensive patients with LCVR was shortened in 17
(73.9%) people, in 6 (26.1%) examined patients - within
the normal range. The perception of bone-guided
sounds from the mastoid processes was impaired in all
stages of GE in the vast majority of the examined
patients. Most often, perception is reduced by 25-50%.
Perception of C128 through the air was impaired in 16
patients. In the majority of patients with PNMC, its
Volume 03 Issue 04-2023
64
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
04
P
AGES
:
62-67
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
perception was within the normal range; in the stage
of HE with PNMC, it was impaired in all examined
patients. Consequently, the impairment of C128
perception through the air increases with the
progression of the disease.
Audiometric examination in 17 (73.9%) patients on the
audiogram revealed damage to sound perception of
varying degrees, in 6 (26.1%) patients, tonal hearing
was within the normal range. If we consider the state
of tonal hearing according to the stages of HE, then
normal hearing was detected in 3 out of 6 patients with
NPLMC, with HE - Ist. in 2 out of 8, with GE - II st. in 1 out
of 5 patients and in HE with PNMK, normal hearing was
not detected.
In the course of the study, it turned out that for
damage to the organ of hearing in LCVR, a
predominant decrease in the perception of high tones
is characteristic. So, if during the perception of tones
of the speech zone, hearing loss of more than 30% was
detected in 3 (13.1%) patients, then with the perception
of tones of 3000-8000 Hz in 14, which is more than 4
times more often. In patients with NPLMC and HE-I
stage, a decrease in hearing acuity by more than 30%
was not detected in any of them, in patients with HE-II
stage. in 1 out of 5, and in those suffering from HE with
PNMK - in 2 out of 4 examined. Consequently, with the
aggravation of the disease, the volume of hearing for
high tones decreases.
Thus, to accurately determine the hearing acuity in
patients with LCVR, it is necessary to perform pure-
tone audiometry. With the latter, the majority of those
examined revealed a bilateral decrease in perception
both during air and bone conduction of sounds. The
curves are located almost at the same level, but the
volume of hearing acuity in the vast majority of sounds
examined during bone conduction decreases to a
much greater extent, especially for high tones. Normal
tonal hearing is quite rare. In the majority of the
examined patients, there is a lesion of sound
perception of varying degrees. The decrease in the
acuity of tonal hearing increases depending on the
stage of the disease, and not on age.
Studying the state of the vestibular analyzer in LCVR,
we, before the caloric study of the labyrinth, revealed
the presence or absence of spontaneous vestibular
reactions.
Of the 23 patients with DCVR examined by us, 18
people noted dizziness of various severity (from a
slight sensation of vibration of objects to seizures with
a clear sensation of rotation of surrounding objects)
and of a very different nature.
According to the nature of these dizziness, we divided
the patients into two groups. We assigned 11 patients
to the first group, who noted dizziness, characteristic
of damage to the peripheral part of the vestibular
analyzer, for which a sensation of rotational
movement of one's own div or surrounding objects
is typical. Another group of patients, numbering 7
examined, noted the so-called "tactile" dizziness, in
which patients feel the imaginary movement of
tangible objects, for example: the bed on which they
lie, or the floor on which they stand.
We noted imbalances in the Romberg position with
vision turned off in 6 people with a simple and 12 with
a sensitized posture, a fall backwards in 1 with a simple
and 3 with a sensitized posture. When the position of
the head changed, the direction of fall did not change.
A caloric test was performed for all 23 patients. All
patients underwent ENG assessment of the caloric
test.
According to the functional state of the vestibular
apparatus, patients can be divided into two groups:
Volume 03 Issue 04-2023
65
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
04
P
AGES
:
62-67
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
with
symmetrical
and
asymmetric
reactions.
Symmetrical changes were found in 17 (73.9%),
asymmetric - in 6 (26.1%) examined. A normal response
during the test was detected in 5 people (21.7%), a
change in the excitability of the vestibular apparatus
was detected in 18 (78.3%) patients. Of these,
hyporeflexia was in 5 (27.7%), asymmetric reactions in
6 (33.3%), hyperreflexia in 5 (27.7%), areflexia in 2 (11.3%)
patients.
Consequently, when conducting a caloric test, the
majority of hypertensive patients showed altered
responses to calorization, and only 5 had normal
excitability. Asymmetric reactions prevailed, which
were expressed in differences in the duration of
nystagmus, in amplitude, and in vegetative and
protective reactions.
REG study was performed in all 23 patients. In the visual
analysis of rheoencephalograms, the waveform was
most often "double-humped" or "hump-shaped", or
biphasic of the "plateau" type. The apex had a rounded
configuration, the additional wave and incisura were
displaced towards the apex and were weakly
expressed, which indicated a high tone of the cerebral
vessels and difficulty in venous outflow from the
cranial cavity. In patients with SPNMK, the normotonic
type was found in 3 examined patients. The rest had
mild changes in the REG of the hypertonic type, 1
patient had a moderate form of hypertonicity. In
patients with GE-I st. in most cases, there was a REG
picture of a moderate increase in the tone of large and
small vessels of the brain. In persons GE-II Art.
normotonic type was found only in 1 case. The REG
picture of a moderate and pronounced increase in the
tone of the cerebral vessels was mainly observed. In
persons with GE with PNMK, the normotonic type did
not occur at all. In all patients of this group, an increase
in the tone of cerebral vessels of varying degrees was
noted, but mostly a pronounced form. Signs of
obstruction of venous outflow increased as the disease
progressed. So, if in case of SLIMC, RVO was observed
in 33.3% of patients with a change in the tone of the
cerebral vessels, then in HE with MIMC, it was already
in 100%, and the REG picture was qualitatively different:
the number and severity of presystolic waves
increased in comparison with SICM.
An electroencephalographic study was also performed
in all 23 patients. As our studies have shown, violations
of the functional activity of the brain, according to
electroencephalography, are detected in 21 (91.3%) of
the examined.
Analyzing encephalograms according to CVR forms, it
can be noted that mild and moderate changes in
bioelectrical activity (BEA) predominate in NLUMC,
while HE-Ist. and GE-IIst. more moderate and
pronounced changes in BEA. The aggravation of
neurological pathology is naturally accompanied by a
corresponding aggravation of the EEG state. Thus,
there is a shift towards an increase in the severity class:
with HE with PNMK, mild EEG changes are extremely
rare, the frequency of occurrence of pronounced ones
increases sharply, in addition, in cases with the
development of acute cerebrovascular accidents, focal
EEG changes are noted in 10.5%, which indicate the
development local vascular pathology.
In conclusion, it can be noted that LCVR, being
complicated by disorders of cerebral circulation, has
not only a pronounced clinical, but also a
corresponding paraclinical picture: spasm of cerebral
vessels with impaired pulse blood filling, difficulty in
venous outflow from the cranial cavity with symptoms
of secondary cerebrospinal fluid hypertension,
disorders of bioelectrical activity various degrees of
expression. Moreover, the degree of the above
Volume 03 Issue 04-2023
66
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
04
P
AGES
:
62-67
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
changes is directly dependent on the severity of the
systemic and cerebral vascular process.
Achieving high clinical efficacy in therapy of patients
with cochleovestibular disorders is possible due to the
use of the optimal scheme of complex treatment,
developed for patients individually. The plan of
therapeutic measures was compiled on the basis of the
analysis of the results of a multifaceted examination.
The analysis showed the prevalence of polymorbidity
in patients, i.e. the presence of two or more diseases,
especially in elderly patients. Therefore, drug therapy
included, in addition to betaserc and antihypertensive
drugs, also nootropic, diuretic, antianginal drugs, and
vitamins. An increase in the clinical effectiveness of the
pharmacological correction of cochleovestibular
disorders was facilitated by the use of non-drug
methods: physical therapy and massage of the collar
region in osteochondrosis of the cervical spine,
reflexology, etc.
As a result of the complex treatment, positive clinical
dynamics was registered in the vast majority of cases.
After treatment, the noise disappeared or significantly
decreased in 15 (83.3%) patients. When examining
hearing with whispered speech, improvement in
perception was noted by 15 people (83.3%), and the
perception of spoken speech improved in 12 patients
(85.7%), and these indicators improved in all patients
with NPLMC and GE-1st, and with HE- 11st and HE with
PNMK improvement was noted not in everyone.
In a repeated audiometric study, 13 patients (76.5%) out
of 17 showed an improvement in sound perception,
only 1 patient with HE-11st and 2 patients with HE with
MIMC did not show a clear improvement.
We observed the most striking positive dynamics with
the use of betaserc when such a symptom of the
disease as dizziness was detected. If 18 patients noted
attacks of dizziness before treatment, then after using
the drug for 10 days, 17 patients (94.4%) noted the
absence or significant decrease in dizziness.
The results of electronystagmography during a caloric
test before and after treatment also showed a good
efficiency of using this drug. So, if before treatment a
change in the excitability of the vestibular apparatus
was detected in 18 (78.3%) patients, and asymmetric
reactions prevailed, then after treatment, altered
responses were determined only in 6 examined (26.1%),
and asymmetric reactions were only in 1 patient.
Thus, our observations showed that the inclusion of
betaserc in the treatment regimen for patients with
cochleovestibular disorders reduces the time for the
onset of compensation of the vestibular function in
comparison with patients who did not use betahistine
dihydrochloride in similar basic therapy.
CONCLUSION
In conclusion, we believe that an integrated approach
to the treatment of HD patients with CVD is the key to
its high clinical efficacy. The use of betahistine-
dihydrochloride
in
the
complex
therapy
of
cochleovestibular disorders can stop dizziness,
normalize statics and coordination, and improve
hearing. In addition, given the possibility of recurrence
of chronic diseases, it seems appropriate to conduct a
long-term course maintenance monotherapy with
betaserc, or its combined use with other drugs.
REFERENCES
1.
Vokhidov
U.
N.
STATE
OF
COCHLEOVESTIBULAR
DISORDERS
IN
PATIENTS WITH ARTERIAL HYPERTENSION
//Oriental
Journal
of
Medicine
and
Pharmacology.
–
2022.
–
Т. 2. –
№. 06. –
С. 7
-20.
Volume 03 Issue 04-2023
67
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
04
P
AGES
:
62-67
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
2.
Kari E. et al. A de novo SIX1 variant in a patient
with a rare nonsyndromic cochleovestibular
nerve abnormality, cochlear hypoplasia, and
bilateral sensorineural hearing loss //Molecular
genetics & genomic medicine.
–
2019.
–
Т. 7. –
№. 12. –
С. e995.
3.
Mei C. et al. Genetics and the individualized
therapy of vestibular disorders //Frontiers in
neurology.
–
2021.
–
Т. 12. –
С. 633207.
4.
Vilchez‐Madrigal L. D. et al. Children with
unilateral cochlear nerve canal stenosis have
bilateral cochleovestibular anomalies //The
Laryngoscope.
–
2019.
–
Т. 129. –
№. 10. –
С.
2403-2408.
5.
Ekobena P. et al. Four cases of audio-vestibular
disorders related to immunisation with SARS-
CoV-2 mRNA vaccines //International Journal of
Audiology.
–
2022.
–
С. 1
-5.
6.
Daneshi A. et al. Cochlear implantation in
children with inner ear malformation: a
multicenter study on auditory performance
and
speech
production
outcomes
//International
Journal
of
Pediatric
Otorhinolaryngology.
–
2020.
–
Т. 132. –
С.
109901.
7.
McNeill A. et al. SLC12A2 variants cause a
neurodevelopmental
disorder
or
cochleovestibular defect //Brain.
–
2020.
–
Т.
143.
–
№. 8. –
С. 2380
-2387.
8.
Lemasson J. et al. Cochleovestibular toxicity
induced by immune checkpoint inhibition: a
case series //European Journal of Cancer.
–
2019.
–
Т. 117. –
С. 116
-118.
9.
Sluydts M. et al. The relationship between
cochleovestibular
function
tests
and
endolymphatic hydrops grading on MRI in
patients with Menière’s disease //European
Archives of Oto-Rhino-Laryngology.
–
2021.
–
С.
1-11.
10.
Khoza-Shangase K. Cochleovestibular findings
linked to COVID-19: A scoping review for clinical
care planning in South Africa //South African
Journal of Communication Disorders.
–
2022.
–
Т. 69. –
№. 2. –
С. 899.
