S Kowalska

Nofer Institute of Occupational Medicine, Łódź, Łódź Voivodeship, Poland

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Publications (34)12.39 Total impact

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    Wiesław J Sułkowski, Sylwia Kowalska
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    ABSTRACT: It has been decided to identify the most frequent diseases of the larynx in people occupationally exposed to a considerable voice load and to assess the feasibility of using videostroboscopy to diagnose voice disorders and their organic effects in order to improve the reliability of certification of occupational vocal organ diseases as well as to evaluate the functioning of new regulations on diagnosing and certifying occupational vocal organ diseases and to assay the conformity of clinical diagnoses made at voivodeship (provincial) centers (level I) with those made at scientific research institutes (level II). The study involved an analysis of 1261 cases (1042 women and 219 men) with the vocal organ disorders referred to the ENT Unit, Nofer Institute of Occupational Medicine, Lódź, by voivodeship centers during 1999-2004 for consultation or under the appeal procedure (if applicants were denied the right to be included in the category of patients with occupational disease of the vocal organ). The majority of the patients (65.7%) were primary school teachers, and those aged 51-60 years made 54.8%. Laryngological, phoniatric and videostroboscopic examinations, when necessary, supplemented with other testing procedures (paranasal sinus imaging, allergenic tests) were taken to assess the clinical state of the patients. As a result of these comprehensive examinations, organic changes in the larynx were detected in 161 (12.7%) cases, including 139 (11.0%) women and 22 (1.7%) men. According to current diagnostic/certifying criteria those pathologies could be classified into the category of occupational disease of the vocal organ. Paresis of vocal folds due to the insufficiency of vocal fold adductor and tensor muscles with permanent dysphonia was found in 97 (7.6%) patients, vocal nodules in 53 (4.2%) and secondary hypertrophy changes in vocal folds in 11 (0.87%) patients. The most frequent reasons for excluding the occupational etiology of the disease were functional disorders of the voice observed in 82.3% of patients in the form of hyperfunctional dysphonia (64.3%), hypofunctional dysphonia (17.0%) and dysfunctional dysphonia (about 1.0%). In 9.0% of patients, the functional disorders of the voice were accompanied by organic changes in the larynx caused by non-occupational factors. The analysis showed that due to new Polish regulations, the number of certified occupational disease of the vocal organ was reduced; videostroboscopic tests proved to be a very helpful tool for discriminating between the functional and organic disorders of the vocal organ; and good agreement between clinical diagnoses issued at both levels (I and II) was also revealed.
    International Journal of Occupational Medicine and Environmental Health 02/2005; 18(4):341-9. · 1.31 Impact Factor
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    ABSTRACT: The purpose of this studywas to compare the cellular and biochemical findings in the nasal lavage fluid (NALF) and nasal resistance changes due to a challenge with laboratory animal allergens in 25 patients with occupational asthma and rhinitis, in 22 patients with atopic asthma and rhinitis sensitized to house dust mite, and in 15 healthy subjects. Skin prick tests with common and occupational allergens, total serum IgE level, specific anti-allergens IgE, spirometry and nasal lavages were performed. In patients with occupational airway allergy, nasal symptoms of varying severity developed directly after specific nasal challenge. The total symptom score immediately and 24 h after specific challenge was significantly correlated with expiratory nasal resistance (ENR). The percentage of eosinophils and basophils in NALF increased significantly 5 and 24 h after specific challenge in patients with occupational asthma and it was correlated with ENR. The authors did not observe any significant increase in the percentage of eosinophils, basophils and in the level of albumin in NALF of patients with non-occupational allergy and healthy subjects at any time-point after specific challenge. None of the healthy subjects and patients with non-occupational allergy developed either allergic symptoms or increased ENR after the challenge with laboratory animal allergens and placebo. The prolonged increase in the percentage of eosinophils, basophils and in the level of albumin seems to reflect allergic inflammation. The intensity of inflammation during the specific reaction is related to the symptom score and to ENR in occupational allergics.
    International Journal of Occupational Medicine and Environmental Health 02/2003; 16(2):125-32. · 1.31 Impact Factor
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    ABSTRACT: Of the 150 patients admitted in 2001 to the Tinnitus Center located at the Nofer Institute of Occupational Medicine, Łódź, Poland, 80 were subjected to complex examinations consisted of standardized questionnaire on medical history, psychological tests and audiological assessment. The diagnostic procedure was completed for 52 patients (23 females and 29 males; mean age: 53 years). In this group, five patients were found to have conductive hearing loss due to chronic eustachtis or otosclerosis. They were excluded from further studies. Among the other 47 patients, 26 showed normal hearing threshold and 21 suffered from uni- or bilateral sensorineural hearing loss. Hyperacusis was diagnosed in 16 cases. The measurements of brainstem evoked potentials revealed V wave latency asymmetry in 7 cases, which implied the necessity to perform CT or MNR. In neither of cases did this diagnosis confirm the suspected tumor development (n. VIII neurinoma or pontocerebral angle tumor. The preliminary assessment of treatment efficacy for subjective tinnitus with use of retraining therapy yielded the following conclusions: 1. The application of hearing aid brings about an immediate improvement in the patient's self-assessment of hearing and a better tolerance towards tinnitus. 2. A systematic all-day wear of noise generators contributes to the patient's increased tolerance towards tinnitus, improved mental condition and alleviated hyperacusis. 3. The efficacy of the tinnitus retraining therapy, following Jastreboff, depends on providing the patient with detailed information on the causes and mechanisms of tinnitus development. 4. The negative diagnostics for tumor within the cranial cavity has not only a soothing effect on the patient as it relieves his/her stress, but it can also be a good starting point for the tinnitus retraining therapy.
    Medycyna pracy 02/2002; 53(6):461-4. · 0.39 Impact Factor
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    ABSTRACT: Some clinical and laboratory studies indicate that industrial solvents such as toluene, styrene, xylene, trichloroethylene and carbon disulfide or their mixtures may affect the inner ear, although the mechanism of this process is still not well understood. The aim of this investigation was to assess the incidence of hearing and vestibular disorders (using modem audiological and vestibular tests) in 61 workers exposed to a mixture of organic solvents at the production of paints and varnishes; the control group included 40 age-matched non-exposed subjects. Environmental and biological monitoring revealed that the most significant exposure can be attributed to the following mixture constituents: ethylbenzene, xylene and trimethylbenzene isomers such as pseudocumene, mesitylene and hemimellitene. Electronystagmographic examinations showed the symptoms of vestibular dysfunction, as well as the decreased duration, amplitude and slow phase angular velocity of induced nystagmus in 47.5% of the subjects exposed versus 5% of controls. This was accompanied by sensorineural high frequency hearing loss, identified by means of pure tone audiometry in 42% of those exposed versus 5% controls, and reduced amplitudes of transiently evoked and distortion-product otoacoustic emissions. The findings closely correspond with the rate of the total exposure to the solvent mixture. A possible mechanism responsible for ototoxicity of solvents is discussed.
    International Journal of Occupational Medicine and Environmental Health 02/2002; 15(3):247-56. · 1.31 Impact Factor
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    ABSTRACT: Noise-induced hearing loss together with presbyacusis are the most frequent causes of the disorders of the inner ear among adults. The authors present briefly epidemiological, diagnostic and certification aspects of this issue. Their attention was mainly focused on the role of objective methods of hearing examinations (impedance audiometry, brainstem electric response audiometry, recording of otoacoustic emissions) in diagnostic procedures. A growing significance of these methods, especially in frequent cases of the aggravation and simulation among persons who claim for certification of occupational noise-induced hearing loss, was highlighted.
    Medycyna pracy 02/2002; 53(6):457-9. · 0.39 Impact Factor
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    ABSTRACT: The aim of the study was to estimate the usefulness of nasal lavage, rhinomanometry and rhynoscopy in diagnosing occupational allergic rhinitis and bronchial asthma. 26 subjects with suspected bronchial asthma and allergic rhinitis due to occupational allergens were examined. Each subject had medical history collected and underwent physical examination, skin prick tests (SPT) with common and occupational allergens, determination of total and specific IgE, specific bronchial or nasal provocation with determination of spirometric parameters, morphological and biochemical changes in nasal lavage fluid (NLF). Moreover the anterior rhinomanometry and rhynoscopy were performed before and after the provocation. A significant increase in the percentage of eosinophils and albumin was observed in NLF up till 24 hr after the specific challenge, but only in the group of 16 subjects with diagnosed occupational airway allergy. The authors observed also the presence of mucosal oedema and rhinorrhea in this group of patients more frequently than in the group of patients without diagnosed occupational airway disease. No significant changes were observed in the frequency of positive rhinomanometry test between the analysed groups of patients.
    Otolaryngologia polska. The Polish otolaryngology 02/2001; 55(3):279-86.
  • S Kowalska, W Sułkowski
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    ABSTRACT: The analysis of the epidemiological data indicates that exposure to noise is widespread and it is one of the most common causes of tinnitus, estimated at about 20.7% according to Hazell; 28% according to Axelsson; and 42% according to Palmer. Bearing in mind the scantiness of reliable data on the incidence and nature of tinnitus in persons exposed to industrial noise, and especially the need for the objectivity of this subjective symptom, the authors have decided to undertake the study aimed at assessing the interrelation between tinnitus, the magnitude and kind of hearing impairment, and otoacoustic emission. The study group included 191 persons aged 42.5 +/- 7.6 years (range, 25 to 65), occupationally exposed to noise at the levels of 88-92 dB(A) for 26.9 +/- 4.6 years (range, 9 to 30) who had reported hearing disorders and tinnitus. The control group, matched by similar age and duration of employment, consisted of 80 persons with perceptive hearing impairment induced by industrial noise who had not complained of tinnitus. The results of the study revealed that in 59.7% of the study subjects, noise proved to be one of the most probable factors responsible for the development of tinnitus. The presence of tinnitus was found in 22.5% and in 46% of the study subjects after 10 years and 11-20 years of noise exposure, respectively. In 95.8% of workers, tinnitus was associated with hearing loss, and only in 4.2% of cases it occurred in ears with normal hearing. In persons exposed to noise, tinnitus was most frequently (59.2%) bilateral and permanent. Following the audiologic examinations, verified by objective audiometry (tympanometry, ABR), cochlear hearing impairment was found in 68.6%; retrochochlear in 8.37%; mixed and other forms of impairment, e.g. presbyacousis, in 19.4% of subjects. The audiologic assessment of tinnitus demonstrated that in 62.3% of persons, tinnitus occurred at high frequencies and correlated with the magnitude of hearing impairment in the tonal audiogram. The tinnitus intensity ranged between 10-15 dB and 45 dB. In 40.3% of those under study, noise was not the only tinnitus-risk factor. In this group of persons, the presence of predisposing diseases was also observed, e.g. hypertension, diabetes, atherosclerosis, disturbed lipid metabolism and other etiologic factors that might have impact on the tinnitus incidence, ototoxic drugs, for example. The measurements of evoked otoacoustic emission (EOAE and DPOAE) revealed in 58.63% of persons significant differences (p < 0.01) in the amplitude and spectrum of EOAE in the ears with tinnitus as compared to the ears without tinnitus with a similar hearing threshold. Whereas in 27.74% of subjects, no differences in the EOAE measurements in the ears with or without tinnitus were observed. The results of DPOAE measurements showed in 62% of subjects significant differences in DP-grams in the ears with tinnitus as compared to the ears without tinnitus (p < 0.01). Interestingly, the differences in measurements of both types of evoked emissions (EOAE and DPOAE), expressed by the lowered amplitude, narrowed spectrum, reduction of emission or its complete fading in a limited area of high frequencies, were demonstrated in the ears with tinnitus only in retrocochlear hearing impairment, as compared to those free from tinnitus. The evaluation of the EOAE and DPOAE measurements seems to prove that this method may be useful in assessing the contribution of the cochlear mechanisms to the incidence of tinnitus and in distinguishing between tinnitus generated in cochlea and tinnitus with the source at other levels of the hearing organ or beyond it. Our study failed to determine the interrelation between tinnitus and spontaneous emissions as the emission was registered only in about 12% of persons exposed to noise, including 2% of those with normal hearing.
    Medycyna pracy 01/2001; 52(5):305-13. · 0.39 Impact Factor
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    ABSTRACT: Epidemiological studies carried out in the years 1984-1993 revealed carbon disulfide (CS2) to be one of the major chemical occupational hazards. Whereas among physical factors, noise was found to be the most common threat. Industrial workers very often face a combined exposure of two or more factors, like CS2 and noise, responsible for significant biological risk to the human health, although health effects of such an exposure have not as yet been thoroughly recognized and explored. The aim of this study was to assess changes in the hearing system in people exposed to toxic effect of CS2, recognized as characteristic of an overall clinical history of chronic poisoning by this solvent, in cases of concomitant exposure to noise exceeding maximum allowable levels. The study covered 80 workers aged 44-65 years (mean = 44.9 +/- 5.1), employed in a spinning mill of viscose fibre for 20.3 years on average (+/- 5.4 years) with clinically observed chronic CS2 poisoning, and a group of 40 people (mean age = 56.8 years) exposed to CS2 but without subjective or objective symptoms indicating chronic poisoning by the solvent. Both groups of subjects at similar age and with almost the same duration of employment were exposed to CS2 in concentrations changing in time between 10 and 35 mg/m3 (mean concentration = 25.8 mg/m3), and to continuous noise with the level ranging from 88 to 92 dB(A) for six hrs per one shift. The control group was composed of 40 workers (mean age = 52.0 +/- 5.3 years) employed in the cotton industry plant, without contact with CS2 or other chemicals and working in the acoustic environment with similar level of exposure to noise (86-93 dB(A)). Audiological and electronystagmographic examinations revealed bilateral retrocochlear hearing impairment associated with symptoms of the central vestibular syndrome in 97.5 subjects with diagnosed chronic CS2 poisoning. In workers free from clinical symptoms of chronic CS2 poisoning, perceptive hearing impairment of various degrees was found, including retrocochlear in 45% of subjects and cochlear in 32.5%, while in 22.5% of those under study normal hearing was observed. In the control group of subjects exposed to noise without contact with CS2, sensorineural cochlear hearing loss, typical of chronic acoustic trauma without concomitant vestibular disorders, was revealed. The results of the study show that in subjects with diagnosed chronic CS2 poisoning and exposed to noise, hearing impairment and vestibular disorders occur in the form of central changes which suggests a dominating CS2 toxic effect on the hearing system. But in some people exposed to both CS2 and noise, the hearing impairment in localised in cochlea like in acoustic trauma damage. This probably depends on individual susceptibility to harmful effect of these factors.
    Medycyna pracy 02/2000; 51(2):123-38. · 0.39 Impact Factor
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    ABSTRACT: Tinnitus is frequently accompanied by noise-induced hearing losses, and perhaps as it is assumed--particularly with those arising from exposure to impulsive types of noise. In order to explain it and to estimate a prevalence of tinnitus in the industrial, impulse noise workers the group of 261 drop-forge operators exposed to impulses with peak levels of 135 dB versus 169 age-matched controls was subjected to otological and audiometric examination, and then the complaints for tinnitus in both groups have been analysed. The prevalence of tinnitus, highest in operators with longer exposure duration (> 10 years) was found in 184 individuals (70.4%) versus 6 (3.5%) in controls. The findings closely corresponded with the degree of impulse noise-induced hearing loss. As the maximum audiometric notch was mostly localised at 6 kHz and rarely at 4 kHz, consequently the approximate pitch of the tinnitus was related to the frequencies where hearing was most affected. It is concluded that impulse noise-induced tinnitus may be sometimes more severe in its effects than is hearing loss, thus it creates an additional reason for strict hearing conservation programmes.
    International Journal of Occupational Medicine and Environmental Health 01/1999; 12(2):177-82. · 1.31 Impact Factor
  • S Kowalska, W Sułkowski
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    ABSTRACT: In most industrialised countries exposure to noise is one of major health problems which, because of its social and economic dimension has been given priority in the area of preventive activities. It is estimated that only in Europe about 25-30 million people are employed in conditions under exposure to noise at excessive levels, harmful to the hearing organ, generating the risk of hearing loss (disability), and in consequence limiting the possibility of active life. Acknowledging the significance of the problem and its consequences the World Health Organization (WHO) in cooperation with the International (ISA) and European Federation of Audiological Society (EFAS) has developed the programme for the protection against noise. The prime aims of the programme are to establish the cooperation between scientists, health services and technicians in order to promote knowledge and exchange of experience, to improve workers' health, and to identify the biological, neuropsychological and psycho-social effect of noise exposure on the hearing ability. The authors discuss basic objectives and adopted strategies of experimental and clinical studies carried out in countries of the European Union, participating in the implementation of the programme. The WHO guidelines for the reduction in noise exposure in the working, municipal and recreation environments are also presented.
    Medycyna pracy 02/1997; 48(6):703-12. · 0.39 Impact Factor
  • S Kowalska, W Sułkowski
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    ABSTRACT: Measurement results of click evoked otoacoustic emissions (EOAE) and distortion products otoacoustic emissions (DPOAE) in a case of sensorineural hearing loss in a case of sensorineural hearing loss in a patient with a history of oticus zoster with nerve VII palsy are presented. Feasibility of using otoacoustic emissions measurements for hearing loss type identification is discussed.
    Otolaryngologia polska. The Polish otolaryngology 02/1997; 51(4):396-401.
  • S Kowalska, W Sułkowski
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    ABSTRACT: Click-evoked otoacoustic emission (c-EOAE) was analysed in a group of 122 males (= 244 ears) occupationally exposed to industrial noise levels of 89-94 dB (A). The highest intensity of cochlear responses was observed at 1 and 2 kHz, while at the higher frequencies (3-4 kHz), c-EOAE spectrum was contracted proportionally to the level of the hearing loss and duration of occupational exposure to noise. If hearing loss in pure-tone audiometry exceeded 30 dB HL at 1 kHz and 40 dB at 2 and 4 kHz, c-EOAE was absent. The analysis of the relationship between c-EOAE spectrum and hearing threshold in pure-tone audiogram showed correlation (R = 0.43 to 0.48, at p < 0.01) between distribution of emission energy and hearing threshold at the same range of frequencies. It was found that the c-EOAE amplitudes as well as the values of c-EOAE energy in the noise-exposed people were lower by about 3 dB SPL than in the controls, especially at 4 kHz even in cases of pure-tone hearing thresholds < or = 20 dB HL. This study indicates that, owing to c-EOAE, it is possible to detect a slight noise-induced cochlear lesion which may be overlooked in pure-tone audiometry.
    International Journal of Occupational Medicine and Environmental Health 01/1997; 10(4):441-59. · 1.31 Impact Factor
  • S Kowalska, W Sułkowski
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    ABSTRACT: Measurement results of click evoked otoacoustic emissions (EOAE) and distortion product otoacoustic emissions (DPOAE) obtained in two cases of inner ear pathology are presented. One case involved unilateral perceptive deafness in a 18 year old male with a history of heavy mumps, and the other concerned early hearing loss due to 5-year exposure to industrial noise in a 23 year old male. Feasibility of using otoacoustic emission measurements to determine the extent and type of hearing loss is discussed.
    Otolaryngologia polska. The Polish otolaryngology 02/1996; 50(4):417-27.
  • S Kowalska, W Sułkowski
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    ABSTRACT: Measurement results of click evoked otoacoustic emissions (EOAE) and distortion products otoacoustic emissions (DPOAE) in two perceptive deafness cases of different severity resulting from long years of exposure to industrial noise are presented. Agreement of emissions measurements with pura tone audiogram is evaluated and their feasibility for hearing loss type identification is discussed.
    Otolaryngologia polska. The Polish otolaryngology 02/1996; 50(5):542-7.
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    ABSTRACT: The use of impedance audiometry for determining hearing threshold and locating hearing impairments was investigated in 112 people exposed to occupational noise. Tympanometry and the stapedius reflex threshold measurements (ART) were made using Madsen ZO 2020 set. The comparison of ART findings, particularly the interval between tonal audiometric threshold and stapedius reflex threshold, helped to diagnose cochlear location of hearing impairment in 17 subjects (15.2%) and extracochlear in 70 (62.5%) out of all the examined subjects. The analysis of the study results has confirmed the usefulness of impedance audiometry also when patients' simulation has to be excluded in the case of their claiming compensation for occupational hearing loss.
    Otolaryngologia polska. The Polish otolaryngology 02/1995; 49(3):243-51.
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    ABSTRACT: The paper reports results of measurement of spontaneous and click-evoked otoacoustic emissions in 44 subjects (male and female) with normal hearing capacity confirmed by tonal audiometry. Otoacoustic responses were recorded separately for each ear. Altogether 176 measurements were made; their results being subject to detailed quantitative and qualitative analysis. Then mean EOAE values were calculated as the function of frequency and intensity of the stimulating agent. The statistical analysis of results revealed insignificant differences in EOAE values in males and females and in responses from the right and left ear. The results should be regarded as a statistical probability of the standard in view of the significant differences between individual recordings of otoacoustic emissions. It is anticipated that EOAE measurements will be useful for identifying frequency range of normal hearing in healthy ears and in cases of pathology.
    Otolaryngologia polska. The Polish otolaryngology 02/1994; 48(4):353-62.
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    ABSTRACT: With the current epidemic of compensation claims for occupational noise-induced hearing loss, the number of claimants in whom hearing test results do not reflect the true hearing status still inexorably increase. The incidence of a such cases with feigned hearing loss is reported at between 20 and 25 per cent of all patients being tested. Searching for any reliable indicators useful in uantifying a valid hearing thresholds the authors present their own experience with the electric response audiometry (ERA) by the use of the Amplaid MK 10 system a series of 56 malingerers. A suggested test protocol including the click-evoked auditory brainstem responses (ABR) and the 40 Hz logon-evoked middle latency responses (MLR) is discussed as a promising method for determining a frequency-specific threshold.
    Otolaryngologia polska. The Polish otolaryngology 02/1994; 48(4):370-4.
  • S Kowalska, W Sułkowski
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    ABSTRACT: The authors present views, selected from the literature, on the development and significance of impedance audiometry as well as on the clinical application of this objective method in audiological and otoneurological diagnosis. Special attention is paid to the usefulness of impedance audiometry in objectivization of the hearing threshold and detection of simulation in the diagnosis of occupational hearing impairments.
    Medycyna pracy 02/1994; 45(4):333-41. · 0.39 Impact Factor
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    ABSTRACT: The paper discusses the results of DPOAE measurement in 44 young subjects with normal hearing capacity. The measurements were carried out separately for each ear (88 measurements altogether). Otoacoustic responses to continuous two-tone stimulation (f1 and f2) with an intensity range of 46-71 dB SPL were recorded. Mean DPOAE values from 2f1-f2 measurement for the right ear in males and females varied from 2.6 +/- 5.6 to1 5.4 +/- 6.9 (within the range 0.7-6.0 kHz). For the left ear the respective values were 3.9 +/- 4.7 to 19.1 +/- 4.0. In most of subjects an increase in DPOAE values for frequencies higher than 3 kHz was found, which is characteristic of middle ear emission. The statistical analysis of DPOAE measurements in males and females did not reveal significant differences except for a few parameters. In both sexes the intensity of f1 and f2 stimuli at the frequency of 1.5 kHz was found to be significantly different at p = 0.48. The results of DPOAE measurements can be regarded as a statistical probability of standard. In view of the lack of approved calibration standards, the data obtained from the study will be considered a local set of standard values and will be used for clinical interpretation of pathological cases.
    Otolaryngologia polska. The Polish otolaryngology 02/1994; 48(6):572-82.
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    ABSTRACT: In the group of 37 patients with chronic carbon disulphide (CS2) intoxication manifested by encephalopathy, polyneuropathy or psycho-organic syndrome and complaining for vertigo, a statokinesiometric test was performed with open and closed eyes, and with visual stimulation. Basic test parameters of stabilograms and statokinesiograms were compared with standard values of the control group. Results of the test were additionally verified by electronystagmography with the recording of spontaneous, positional, optokinetic and post-rotatory nystagmus as well as the eye-tracking test. The statokinesiometry revealed postural stability disorder in 72.9% of patients. Balance disorders detected by means of this test showed high compatibility with results of electronystagmography which confirmed damage of the central part of vestibular system due to CS2 intoxication.
    Polish journal of occupational medicine and environmental health 02/1992; 5(3):265-76.