Vertical visual subjetiva com o método do balde em indivíduos brasileiros hígidos

Introduction: The capacity of a healthy individual to estimate the true vertical in relation to the Earth when a fluorescent line is aligned in a completely dark room is called the subjective visual vertical. Objective: To evaluate subjective visual vertical using the bucket method in healthy Brazilian individuals. Methods: Binocular subjective visual vertical was measured in 100 healthy volunteers, 50 females and 50 males. The volunteers indicated the estimated position in which a fluorescent line inside a bucket reached the vertical position. A total of ten repetitions were performed, five clockwise and five counterclockwise. Data were tabulated and analyzed statistically. Results: It was observed that the highest concentration of absolute values of vertical deviation was present up to 3, regardless of gender, and the vertical deviation did not increase with age. The analysis of the mean of the absolute values of deviations from the vertical of 90% of the sample showed a maximum value of 2.6, and at the analysis of 95%, the maximum value was 3.4 degrees deviation from the vertical. Conclusion: The bucket method is easy to perform and interpret when assessing the deviation of the subjective visual vertical in relation to the true vertical in healthy Brazilian individuals. (C) 2016 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda.Introdução: A capacidade que um indivíduo hígido tem em estimar a vertical verdadeira em relação à Terra, quando alinha uma linha fluorescente em uma sala completamente escura é denominada de Vertical Visual Subjetiva (VVS). Objetivo: Avaliar a VVS com o método do balde em indivíduos brasileiros hígidos. Método: A VVS binocular foi medida em 100 voluntários hígidos, 50 do gênero feminino e 50 do masculino. Os voluntários indicaram a posição estimada em que uma linha fluorescente no interior de um balde alcançou a posição vertical. Foram realizadas 10 repetições, cinco no sentido horário e cinco no anti-horário. Os dados foram tabulados e submetidos à análise estatística. Resultados: Observou-se que a maior concentração dos valores absolutos dos desvios da vertical esteve presente até 3º, independente do gênero e o desvio da vertical não aumentou conforme a idade. À análise da média dos valores absolutos dos desvios da vertical de 90% da amostra, foi encontrado o valor máximo de 2,6º e à análise de 95% o valor máximo foi de 3,4 de desvio da vertical. Conclusão: O método do balde é fácil de realizar e de interpretar na avaliação do desvio da vertical visual subjetiva em relação à vertical verdadeira de indivíduos brasileiros hígidos.Univ Fed Sao Paulo EPM UNIFESP, Escola Paulista Med, Postgrad Program Human Commun Disorders, Campo Fonoaudiol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo EPM UNIFESP, Escola Paulista Med, Otorhinolaryngol Sci, Sao Paulo, SP, BrazilUniv Fed Sao Paulo EPM UNIFESP, Escola Paulista Med, Sci, Sao Paulo, SP, BrazilUniv Fed Sao Paulo EPM UNIFESP, Escola Paulista Med, Sch Speech Therapy & Audiol Specializat, Sao Paulo, SP, BrazilUniv Fed Sao Paulo EPM UNIFESP, Escola Paulista Med, Otorhinolaryngol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo EPM UNIFESP, Escola Paulista Med, Discipline Otol & Neurotol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo EPM UNIFESP, Escola Paulista Med, Postgrad Program Human Commun Disorders, Campo Fonoaudiol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo EPM UNIFESP, Escola Paulista Med, Otorhinolaryngol Sci, Sao Paulo, SP, BrazilUniv Fed Sao Paulo EPM UNIFESP, Escola Paulista Med, Sci, Sao Paulo, SP, BrazilUniv Fed Sao Paulo EPM UNIFESP, Escola Paulista Med, Sch Speech Therapy & Audiol Specializat, Sao Paulo, SP, BrazilUniv Fed Sao Paulo EPM UNIFESP, Escola Paulista Med, Otorhinolaryngol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo EPM UNIFESP, Escola Paulista Med, Discipline Otol & Neurotol, Sao Paulo, SP, BrazilWeb of Scienc

Vertical visual subjetiva após tratamento da vertigem posicional paroxística benigna

Introduction: Otolith function can be studied by testing the subjective visual vertical, because the tilt of the vertical line beyond the normal range is a sign of vestibular dysfunction. Benign paroxysmal positional vertigo is a disorder of one or more labyrinthine semicircular canals caused by fractions of otoliths derived from the utricular macula. Objective: To compare the subjective visual vertical with the bucket test before and immediately after the particle repositioning maneuver in patients with benign paroxysmal positional vertigo. Methods: We evaluated 20 patients. The estimated position where a fluorescent line within a bucket reached the vertical position was measured before and immediately after the particle repositioning maneuver. Data were tabulated and statistically analyzed. Results: Before repositioning maneuver, 9 patients (45.0%) had absolute values of the subjective visual vertical above the reference standard and 2 (10.0%) after the maneuver; the mean of the absolute values of the vertical deviation was significantly lower after the intervention (p < 0.001). Conclusion: There is a reduction of the deviations of the subjective visual vertical, evaluated by the bucket test, immediately after the particle repositioning maneuver in patients with benign paroxysmal positional vertigo. (C) 2016 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda.Introdução: A função do otólito pode ser estudada por meio de testes da vertical visual subjetiva, porque a inclinação da linha vertical além da faixa normal é um sinal de disfunção vestibular. A vertigem postural paroxística benigna é um distúrbio de um ou mais canais semicirculares labirínticos causado por frações de otólitos derivados da mácula utricular. Objetivo: Comparar a vertical visual subjetiva com o teste do balde antes e imediatamente após a manobra de reposicionamento de partículas em pacientes com vertigem posicional paroxística benigna. Método: Foram avaliados 20 pacientes. A posição estimada, onde uma linha de fluorescência dentro de um balde atingia a posição vertical, foi medida antes e imediatamente após a manobra de reposicionamento de partículas. Os dados foram tabulados e analisados estatisticamente. Resultados: Antes da manobra de reposicionamento, nove pacientes (45%) apresentaram valores absolutos de vertical visual subjetiva acima da referência padrão e dois (10%) depois da manobra; a média dos valores absolutos do desvio vertical foi significativamente mais baixa depois da intervenção (p < 0,001). Conclusão: Há uma redução dos desvios da vertical visual subjetiva, avaliada pelo teste do balde, imediatamente após a manobra de reposicionamento de partículas em pacientes com vertigem posicional paroxística benigna.Univ Fed Sao Paulo Unifesp, EPM, Programa Posgrad Disturbios Comunicacao Humana, Campo Fonoaudiol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, EPM, Dept Otorrinolaringol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, EPM, Disciplina Otol & Otoneurol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, EPM, Programa Posgrad Disturbios Comunicacao Humana, Campo Fonoaudiol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, EPM, Dept Otorrinolaringol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, EPM, Disciplina Otol & Otoneurol, Sao Paulo, SP, BrazilWeb of Scienc

Effects of conventional versus multimodal vestibular rehabilitation on functional capacity and balance control in older people with chronic dizziness from vestibular disorders: design of a randomized clinical trial

Background: There are several protocols designed to treat vestibular disorders that focus on habituation, substitution, adaptation, and compensation exercises. However, protocols that contemplate not only vestibular stimulation but also other components that are essential to the body balance control in older people are rare. This study aims to compare the effectiveness of two vestibular rehabilitation protocols (conventional versus multimodal) on the functional capacity and body balance control of older people with chronic dizziness due to vestibular disorders.Methods/design: A randomized, single-blind, controlled clinical trial with a 3 months follow-up period will be performed. the sample will be composed of older individuals with a clinical diagnosis of chronic dizziness resulting from vestibular disorders. the subjects will be evaluated at baseline, post-treatment and follow-up. Primary outcomes will be determined in accordance with the Dizziness Handicap Inventory (functional capacity) and the Dynamic Gait Index (body balance). Secondary outcomes include dizziness features, functional records, body balance control tests, and psychological information. the older individuals (minimum sample n = 68) will be randomized to either the conventional or multimodal Cawthorne&Cooksey protocols. the protocols will be performed during individual 50-minute sessions, twice a week, for 2 months (a total of 16 sessions). the outcomes of both protocols will be compared according to the intention-to-treat analysis.Discussion: Vestibular rehabilitation through the Cawthorne&Cooksey protocol has already proved to be effective. However, the addition of other components related to body balance control has been proposed to improve the rehabilitation of older people with chronic dizziness from vestibular disorders.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Otoneurol Discipline, Dept Otorhinolaryngol & Head & Neck Surg, BR-04025002 São Paulo, BrazilUniversidade Federal de São Paulo, Otoneurol Discipline, Dept Otorhinolaryngol & Head & Neck Surg, BR-04025002 São Paulo, BrazilFAPESP: 2009/16908-6Web of Scienc

Vertebral artery dissection: an important differential diagnosis of vertigo

Univ Fed Sao Paulo UNIFESP, Dept Otorrinolaringol & Cirurg Cabeca & Pescoco, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dept Otorrinolaringol & Cirurg Cabeca & Pescoco, Sao Paulo, SP, BrazilWeb of Scienc

Migrânea vestibular: aspectos clínicos e epidemiológicos

Introduction: Vestibular migraine (VM) is one of the most often common diagnoses in neurotology, but only recently has been recognized as a disease. Objective: To analyze the clinical and epidemiological profile of patients with VM. Methods: This was a retrospective, observational, and descriptive study, with analysis of patients' records from an outpatient VM clinic. Results: 94.1% of patients were females and 5.9% were males. The mean age was 46.1 years65.6% of patients had had headache for a longer period than dizziness. A correlation was detected between VM symptoms and the menstrual period. 61.53% of patients had auditory symptoms, with tinnitus the most common, although tonal audiometry was normal in 68.51%. Vectoelectronystagmography was normal in 67.34%, 10.20% had hyporeflexia, and 22.44% had vestibular hyperreflexia. Electrophysiological assessment showed no abnormalities in most patients. Fasting plasma glucose and glycemic curve were normal in most patients, while the insulin curve was abnormal in 75%. 82% of individuals with MV showed abnormalities on the metabolism of carbohydrates. Conclusion: VM affects predominantly middle-aged women, with migraine headache representing the first symptom, several years before vertigo. Physical, auditory, and vestibular evaluations are usually normal. The most frequent vestibular abnormality was hyperreflexia. Most individuals showed abnormality related to carbohydrate metabolism. (C) 2015 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda.Introdução: Migrânea vestibular (MV) corresponde a um dos mais frequentes diagnósticos em otoneurologia, o que justifica a importância de seu estudo, embora tenha sido apenas recentemente reconhecida como entidade nosológica. Objetivo: Analisar os perfis clínico e epidemiológico dos pacientes atendidos em um ambulatório de migrânea vestibular. Método: Estudo retrospectivo, observacional e descritivo, com análise de prontuários dos pacientes do ambulatório de MV. Resultados: O ambulatório é composto por 94,1% de mulheres e 5,9% de homens, com média de idade 46,1 anos. O tempo de cefaleia foi superior ao de vertigem em 65,6% dos pacientes. Observou-se correlação entre os sintomas e o período menstrual. A maioria (61,53%) dos indivíduos apresentou algum sintoma auditivo, sendo o zumbido o mais frequente, embora a audiometria tenha sido normal em 68,51%. A vectoeletronistagmografia apresentou-se normal em 67,34%, enquanto 10,20% apresentaram hiporreflexia e 22,44% hiperreflexia vestibular. Exames eletrofisiológicos não mostraram alterações na maioria dos pacientes. Glicemia dejejum e curva glicêmica foram normais para a maioria dos pacientes, enquanto a curva insulinêmica mostrou-se alterada em 75% dos indivíduos. 82% dos indivíduos com MV apresentaram alguma alteração relativa ao metabolismo dos carboidratos. Conclusão: Migrânea vestibular acomete, predominantemente, mulheres de meia idade, com cefaleia migranosa e vertigem, sendo a primeira de instalação mais precoce. O exame físico no período intercrise, bem como as avaliações auditiva e vestibular, mostram-se, geralmente, normais. O tipo de alteração vestibular mais observado foi a hiperreflexia labiríntica. A maioria os indivíduos avaliados apresentou alterações relativas ao metabolismo dos carboidratos.Univ Fed Sao Paulo UNIFESP, Dept Otorhinolaryngol & Head & Neck Surg, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dept Otorhinolaryngol & Head & Neck Surg, Sao Paulo, SP, BrazilWeb of Scienc

Vestibular function in carotid territory stroke patients

Stroke patients may present otoneurological symptoms.Objective: To assess the vestibular function of subjects with a history of carotid territory stroke.Method: This historical cohort cross-sectional study enrolled 40 patients; subjects answered the Dizziness Handicap Inventory, were interviewed and submitted to ENT examination and vector electronystagmography.Results: Mild saccadic movement anomalies were seen in 20 patients (50.0%); nine complained of imbalance and dizziness. Abnormal smooth pursuit gain was seen in 17 cases (42.5%); six subjects reported imbalance and one complained of dizziness. Abnormal directional preponderance during rotational nystagmus was seen in two cases (5.0%), who also reported imbalance. Three patients (7.5%) and two subjects (5.0%) were found to have abnormal labyrinthine predominance and abnormal nystagmus directional preponderance respectively; all five individuals reported imbalance. Ten of the 11 patients without complaints of disordered balance had altered saccadic and smooth pursuit eye movements, while one had unaltered vestibular function.Conclusion: Patients with a history of carotid territory stroke may suffer from dizziness or imbalance and present signs of compromised eye motility and vestibular function.Univ São Paulo, Paulista Med Sch, BR-05508 São Paulo, BrazilUniversidade Federal de São Paulo, Paulista Med Sch, São Paulo, BrazilUniversidade Federal de São Paulo, Paulista Med Sch, São Paulo, BrazilWeb of Scienc

Prophylactic treatment of vestibular migraine

Introduction: Vestibular migraine (VM) is now accepted as a common cause of episodic vertigo. Treatment of VM involves two situations: the vestibular symptom attacks and the period between attacks. For the latter, some prophylaxis methods can be used. The current recommendation is to use the same prophylactic drugs used for migraines, including beta-blockers, antidepressants and anticonvulsants. The recent diagnostic definition of vestibular migraine makes the number of studies on its treatment scarce. Objective: To evaluate the efficacy of prophylactic treatment used in patients from a VM outpatient clinic. Methods: Review of medical records from patients with VM according to the criteria of the Barany Society/International Headache Society of 2012 criteria. The drugs used in the treatment and treatment response obtained through the visual analog scale (VAS) for dizziness and headache were assessed. The pre and post-treatment VAS scores were compared (the improvement was evaluated together and individually, per drug used). Associations with clinical subgroups of patients were also assessed. Results: Of the 88 assessed records, 47 were eligible. We included patients that met the diagnostic criteria for VM and excluded those whose medical records were illegible and those of patients with other disorders causing dizziness and/or headache that did not meet the 2012 criteria for VM. 80.9% of the patients showed improvement with prophylaxis (p < 0.001). Amitriptyline, Flunarizine, Propranolol and Topiramate improved vestibular symptoms (p < 0.001) and headache (p < 0.015). The four drugs were effective in a statistically significant manner. There was a positive statistical association between the time of vestibular symptoms and clinical improvement. There was no additional benefit in hypertensive patients who used antihypertensive drugs as prophylaxis or depressed patients who used antidepressants in relation to other prophylactic drugs. Drug association did not show statistically significant results in relation to the use of a single drug. Conclusions: Prophylactic medications used to treat VM improve the symptoms of this disease, but there is no statistically significant difference between the responses of prophylactic drugs. The time of vestibular symptom seems to increase the benefit with prophylactic treatment. (C) 2016 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda.Univ Fed Sao Paulo UNIFESP, Dept Otorrinolaringol & Cirurgia Cabeca & Pescoco, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dept Otorrinolaringol & Cirurgia Cabeca & Pescoco, Sao Paulo, SP, BrazilWeb of Scienc

Emerging pharmacotherapy of tinnitus

Tinnitus, the perception of sound in the absence of an auditory stimulus, is perceived by about 1 in 10 adults, and for at least 1 in 100, tinnitus severely affects their quality of life. Because tinnitus is frequently associated with irritability, agitation, stress, insomnia, anxiety and depression, the social and economic burdens of tinnitus can be enormous. No curative treatments are available. However, tinnitus symptoms can be alleviated to some extent. The most widespread management therapies consist of auditory stimulation and cognitive behavioral treatment, aiming at improving habituation and coping strategies. Available clinical trials vary in methodological rigor and have been performed for a considerable number of different drugs. None of the investigated drugs have demonstrated providing replicable long-term reduction of tinnitus impact in the majority of patients in excess of placebo effects. Accordingly, there are no FDA or European Medicines Agency approved drugs for the treatment of tinnitus. However, in spite of the lack of evidence, a large variety of different compounds are prescribed off-label. Therefore, more effective pharmacotherapies for this huge and still growing market are desperately needed and even a drug that produces only a small but significant effect would have an enormous therapeutic impact. This review describes current and emerging pharmacotherapies with current difficulties and limitations. In addition, it provides an estimate of the tinnitus market. Finally, it describes recent advances in the tinnitus field which may help overcome obstacles faced in the pharmacological treatment of tinnitus. These include incomplete knowledge of tinnitus pathophysiology, lack of well-established animal models, heterogeneity of different forms of tinnitus, difficulties in tinnitus assessment and outcome measurement and variability in clinical trial methodology. © 2009 Informa UK Ltd.Fil: Langguth, Berthold. Universitat Regensburg; AlemaniaFil: Salvi, Richard. State University of New York; Estados UnidosFil: Elgoyhen, Ana Belen. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; Argentin