In einer retrospektiven Studie wurden 119 Patienten mit Hörsturz auf die Aussagefähigkeit der Umfelddiagnostik bezüglich einer sekundären Prävention beim Hörsturz untersucht. Außerdem sollte anhand der vorliegenden Analyse die Hypothese überprüft werden, dass Störungen im Innenohr durch Veränderungen der Halswirbelsäule oder des Kardiovaskulären- und Zentralnervensystems hervorgerufen werden können. 57 % (68/119) der computertomographisch untersuchten Patienten waren neurologisch unauffällig, und 45,6 % der Patienten hatten physiologische Halswirbelsäulen-Veränderungen, die auch in der Normalbevölkerung festzustellen sind. Im internistischen Bereich wurden die häufigsten kardiovaskulären Risikofaktoren und die Wandbeschaffenheit der Halsgefäße auf hämodynamische Stenosen ausgewertet. Bei der doppler-sonographischen Untersuchung der Karotisgefäße fanden sich keine Hinweise auf hämodynamisch wirksame Stenosen. Aufgrund dieses Ergebnisses sollte die doppler-sonografische-Untersuchung der Karotisgefäße nicht obligat im Rahmen der Umfelddiagnostik durchgeführt werden. Im untersuchten Patientenkollektiv lassen sich folgende Risikofaktoren (RF) erheben: Hypertonie (19 %), Hypercholesterinämie (28 %), Hypertriglyceridämie (20 %), Adipositas (31 %), Nikotinabusus (26 %) und Diabetes mellitus (3,3 %). Dabei betrug der Anteil an keinem oder einem RF Belasteten 62 %, zwei bis drei RF besaßen 33 % der Untersuchten. 5 % der Hörsturzpatienten hatten vier bis fünf RF. Im Risikofaktorprofil zeigt sich im Vergleich der Hörsturzgruppe mit der Normalbevölkerung eine vermehrte Prävalenz für Cholesterin und Adipositas. Die restlichen Risikofaktoren haben ein geringeres oder gleich häufiges Vorkommen wie in einer unabhängigen Bevölkerungsuntersuchung. In Hinblick auf die Lebensqualität der Patienten und in einer Zeit von immer knapper werdenden Finanzressourcen ist ein rationaler Einsatz der verschiedenen Verfahren in der Umfelddiagnostik beim Hörsturz zu fordern. Auf kostenintensive und den Patienten belastende Untersuchungen, wie z.B. das HWS-Röntgen oder die interdisziplinären Konsiliar untersuchungen kann nach der vorliegenden Studie verzichtet werden. Es sollte zwischen der routinemäßigen Umfelddiagnostik und der gezielten Diagnostik unterschieden werden. Spezielle konsiliarische Untersuchungen sollten nur bei anamnestischem Hinweis erfolgen. / A retrospective study was conducted with involvement of 119 patients with sudden deafness who were investigated for the amount of information potentially obtainable from environmental diagnostics with regard to secondary prevention of sudden deafness. The analytical results were additionally used to check on the hypothesis according to which disorders to the inner ear might be caused by lesions to the cervical spine or cardiovascular and central nervous systems. The average age of the patients was 47.6 + 6.5 years (range: 20-87). Females accounted for 27 % (32/119) and males for 73 % (87/119). Computed tomography failed to reveal any neurological findings in 57 % (68/119), while 45.6 % of the patients exhibited physiological alterations of the cervical spine as were more or less common in the general population. In internist diagnosis, emphasis was laid on the most common cardiovascular risk factors and on the condition of cervical vessel walls. No signs indicative of haemodynamically relevant stenoses were recorded by Doppler sonography of carotid vessels. The following risk factors may be defined on the basis of results: hypertension (19 %), hypercholesterolaemia (28 %), adiposity (31 %), hypertriglyceridaemia (20 %), nicotine abuse (26 %) and diabetes mellitus (3.3 %). Not more than one risk factor was identified in the overwhelming majority of all patients (62 %), two or three risk factors in 33 % and more than three in 5 %. Higher prevalence of cholesterol and adiposity were the only factors by which patients differed from the general population. High-economy use of procedures in environmental diagnostics of sudden deafness has to be demanded to improve patients' quality of life and to cope with persistent shrinkage of financial resources. This study seems to suggest that cost-intensive and stressful examinations can be abandoned, such as X-ray of cervical spine, Doppler sonography or involvement of interdisciplinary consultant bodies. Routine environmental diagnostics should be replaced by targeted diagnostics. Specialised imaging and consultant-based investigations should not be conducted unless otherwise suggested by case history.

The Czech Republic is numer one in the mortality and morbidity due to cardio-vascular diseases. It is evidence that the incidence of cardio-vascular dieseases can be influenced positively by primary prevention as to the lifestyle of the population and that the secondary prevention can improve the lifequality of patiens, diminish thein mortality and morbidity and reduce the numer of recurrences and complications. The degree work on the subjekt {\clqq}Change in the lifestyle of men after an acute myocardial infarct`` is in its general part concentrated on risk factors connected with cardio-vascular diseases, on a self-contained system of rehabilitation, on prevention (primary, secondary, tertiary) and on the welfare system in the Czech Republic. The risk factors connected with cardio-vascular diseases can be dividend into influenceable ones (nutrition, smoking, lack of physical exercise, alkohol consumption, hypertension, dyslipoproteineme, diabetes mellitus, obesity), into uncontrollable ones, (age, sex, genetic factors) and into behavioural ones, among which count psychosocial and economic factors. The mail aim of the work was to establish the extent as to the occurrence of risk factors in relation to men, who underwent an acute myocardial infarct and to determine the posibility of involving them in an active change in the lifestyle. The research proceeded in the form of questionnaires distributed at cardiological out-patients` departments in the region of Příbram.The data collection was under way from November 2009 to February 2010. The research was quantitative, the questionnaire was anonymous, in printed form, contained 29 questions and the respondents answered in writing. One thousand questionnaire were distributed, where of 231 fully completed questionnaires came back. The return rate of questionnaires were destined only for men, who underwent an acute myocardial infarct (two fundamentals identifications marks). I arrived to two hypotheses. The first was that the education of population played an important role in occurrence of cardio-vascular diseases and in awareness of influence of the lifestyle on reducing the risks connected with the development of these diseases. The second hypothesis was that the secondary prevention of risk factors connected with cardio-vascular diseases was not effetively and regorously applied to men, who underwent myocardial infarct. Both hypothese of mine proved to be right. The doctors and the learned public are doubtless well informed of the prevention and therapy as to the cardio-vascular diseases. The question is how effectively the professional information and recommendations find their way into the subconsciousness of our population. The research results show that an imaginary gap arises between recommended advices relating to the change in the lifestyle and in the positive influencing of influenceable and behaviour risk factors, the doctors give in thein routine practice. It is neccessary to create programmes of intervention in the lifestyle within the scope of a self-contained rehabilitation system. This system is applied on the occasion of spa care in the Czech Republic. The effect of the spa care is shortterm, lasts half a year to one year and there is no direkt further contact of the patient with dietary centres and with specialized physiotherapists. The recommendations concerning the change in the lifestyle should be popularized in the society as a whole in order to find their way into the wide subconsciousness of our population.