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

Disability rank in vestibular older adults

Aim:To analyze the hierarchical structure of activities of daily living (ADL) among vestibular older adults, according to its power to discriminate disability.Methods:An exploratory cross-sectional study was conducted comprising 235 elderly, aged 65 years and older, with chronic vestibular dysfunction. Functional capacity was assessed through the Brazilian version of OARS Multidimensional Functional Assessment Questionnaire which consists of 15 activities of daily living (ADL). the sample was classified in each ADL according to the difficulty level in performing the activity. A multiple correlation analysis technique and discriminant analysis was used to analyze the hierarchical structure of ADL.Results:The sample consisted of 75.3% women, with an average age of 73.55 +/- 5.94 years. the ADL and their respective discrimination measurements were: getting into and out of bed (0.293); eating (0.129); combing hair (0.150); walking on flat surfaces (0.270); having a bath/shower (0.512); getting dressed (0.325); getting to the toilet in time (0.107); climbing stairs (0.338); taking medicines on time (0.035); walking close to home (0.529); shopping (0.503); preparing meals (0.398); cutting toenails (0.242); getting off buses (0.452); and cleaning the house (0.408).Conclusion:The tasks that reflect a higher demand upon the vestibular system were the most impaired, in the following order: walking close to home, having a bath/shower, shopping, getting off buses, cleaning the house, preparing meals, climbing stairs, getting dressed, getting into and out of bed, walking on flat surfaces, cutting toenails, combing hair, eating, getting to the toilet in time, taking medicines on time. Geriatr Gerontol Int 2011; 11: 50-54.Universidade Federal de São Paulo, São Paulo, BrazilUniv Cidade São Paulo, São Paulo, BrazilUniv Bandeirante São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc