The number of procedures required to eliminate positioning nystagmus in benign paroxysmal positional vertigo

AIM: To evaluate the number of weekly canalith repositioning procedures needed to eliminate positioning nystagmus in patients with benign paroxysmal positional vertigo and to verify influences of canalithiasis or cupulolithiasis and/or semicircular canal involvement. STUDY DESIGN: clinical prospective with transversal cohort. MATERIAL AND METHOD: Sixty patients with benign paroxysmal positional vertigo were consecutively selected according to each combination of canalithiasis or cupulolithiasis with semicircular canal involvement. Patients were treated by means of canalith repositioning procedures repeated weekly until the elimination of the positioning nystagmus. Analysis of Variance was used to verify differences between the variables. RESULTS: An average of 2.13 procedures (from 1 to 8) was needed to eliminate the positioning nystagmus. Canalithiasis required an average of 1.53 procedures, while cupulolithiasis needed 2.92 procedures (p=0.0002). An average of two procedures was needed to eliminate the positioning nystagmus in cases with posterior canal involvement, 2.39 procedures in cases with anterior canal involvement and 2.07 procedures in cases with lateral canal involvement (p=0.5213). CONCLUSIONS: From one to eight weekly canalith repositioning procedures were needed, with an average of two, to eliminate positioning nystagmus in benign paroxysmal positional vertigo. Cupulolithiasis requires a greater number of procedures than canalithiasis to eliminate positioning nystagmus. Semicircular canal involvement didn't influence the number of therapeutic maneuvers.OBJETIVO: Avaliar o número de manobras necessárias para abolir o nistagmo posicional em pacientes com Vertigem Posicional Paroxística Benigna e verificar possíveis influências do substrato fisiopatológico e/ou canal semicircular acometido. FORMA DE ESTUDO: clínico prospectivo com coorte transversal. MATERIAL E MÉTODO: Sessenta pacientes com Vertigem Posicional Paroxística Benigna foram tratados por meio das manobras de reposicionamento de estatocônios, repetidas semanalmente até a abolição do nistagmo. A Análise de Variância foi aplicada para verificar diferenças entre as variáveis dos fatores substrato fisiopatológico e canal semicircular acometido. RESULTADOS: Foram necessárias de 1 a 8 manobras, em média 2,13 para abolir o nistagmo posicional. A cupulolitíase necessitou de um número maior de manobras que a ductolitíase (p=0,0002*) e não houve diferença entre os canais semicirculares (p=0,5213). Nos canais anterior e posterior, a ductolitíase precisou em média de uma a duas manobras e a cupulolitíase precisou em média de três manobras. No canal lateral, tanto a ductolitíase quanto a cupulolitíase precisaram de duas manobras, em média. CONCLUSÕES: São necessárias de uma a oito manobras semanais de reposicionamento de estatocônios, em média duas, para eliminar o nistagmo posicional na Vertigem Posicional Paroxística Benigna. A cupulolitíase necessita de maior número de manobras que a ductolitíase. O canal semicircular acometido não influencia o número de manobras terapêuticas.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Otorrinolaringologia e Cirurgia de Cabeça e PescoçoUNIFESP-EPMUNIFESP, EPM, Otorrinolaringologia e Cirurgia de Cabeça e PescoçoUNIFESP, EPMSciEL

Tissue response evaluation of the mucosa of the tympanic cavity of guinea pigs, when receiving biodegradable implant

PURPOSE:To evaluate the tissue response of the mucosa of the tympanic cavity of guinea pigs, when receiving biodegradable implant.METHODS:A total of 20 male guinea pigs were divided into 2 groups. After paracentesis in both ears, a biodegradable polymer of poly lactic-co-glycolic acid was implanted in only one middle ear. Histological analysis using neutrophil exudate and vascular neoformation (acute inflammation) and fibroblast proliferation and mononuclear inflammatory cells (chronic inflammation) as parameters was performed after 10 and 30 days of survival (groups 1 and 2, respectively).RESULTS:Four ears in group 1 and 7 in group 2 had an increase of neutrophil exudate. Vascular neoformation occurred in ears with or without the implant, in both groups. Fibroblast proliferation and mononuclear inflammatory cells (lymphocytes and macrophages) increased in ears with implant in group 2.CONCLUSION:The tissue response by histological analysis of the mucosa of the tympanic cavity of guinea pigs, when receiving biodegradable implant, showed no statistically significant difference between ears with or without the implant.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Department of OtorhinolaryngologyFederal University of Minas Gerais Faculty of PharmacyFederal University of Minas GeraisUSP Faculty of Medicine of Ribeirao PretoUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Department of Otorhinolaryngology and Head and Neck SurgeryFederal University of São PauloFederal University of São Paulo Medical SchoolUNIFESP, EPM, Department of OtorhinolaryngologyUNIFESP, EPM, Department of Otorhinolaryngology and Head and Neck SurgeryUNIFESP, Medical SchoolSciEL

The number of procedures required to eliminate positioning nystagmus in benign paroxysmal positional vertigo

BV UNIFESP: Teses e dissertaçõe

Vestibular evoked myogenic potential in benign paroxysmal positional vertigo

Introduction: Benign Paroxysmal Positional Vertigo (BPPV) is a highly last longing disorder. Despite being benign, it may follow a chronic and resistive course. Therefore, it may lead to serious difficulties to patients’ quality of life. The study of the performance of otoliths organs by Vestibular Evoked Myogenic Potential (VEMP) testing may be the key to understand the involvement and recurrent function in BPPV. Objective: It is to determine if there is statistically meaningful difference in the saccule-collic reflex in a Control group when compared to patients with BPPV as well as between the recurrent and non recurrent form of BPPV. Method: The transversal study by VEMP diagnostic intervention, where the Control group and patients with recurrent or non-recurrent BPPV forms went through an assessment. Results: The frequency of changes in VEMP was significantly greater in the BPPV patient group than the Control group (p<0,001). Changes were found related to the lack of response, the asymmetric index (AI) and the latencies of p13 and n23, however, just the lack of responses (p<0,001) and asymmetric index (p<0,001) results showed statistically significant difference related to the Control group. There has been no statistic difference between the recurrent and non recurrent forms of BPPV associated with VEMP result (p=0,09). Conclusion: There has been statistically significant difference in the saccule-collic reflex behavior from the group with BPPV when related to the Control group. There has been no statistically significant difference in the saccule-cholic reflex behavior between the recurrent and non recurrent form of BPPV.Introdução: A Vertigem Posicional Paroxística Benigna (VPPB) é uma doença de alta prevalência e, apesar de benigna, pode seguir um curso crônico e recidivante, impondo prejuízos à qualidade de vida do paciente. O estudo do funcionamento dos órgãos otolíticos, por meio do potencial evocado miogênico vestibular (VEMP), pode ser a chave para a compreensão dos mecanismos de formação e recorrência na VPPB. Objetivos: Determinar se existe diferença estatisticamente significante no comportamento do reflexo sáculo-cólico no grupo Controle em relação aos pacientes com VPPB e entre as formas recorrente e não recorrente da VPPB. Método: Estudo transversal com intervenção diagnóstica por meio do VEMP, onde foram avaliados indivíduos distribuídos em grupo Controle e indivíduos com as formas recorrente e não recorrente da VPPB. Resultados: A frequência de alterações ao VEMP foi significantemente maior nos indivíduos do grupo VPPB do que nos indivíduos do grupo Controle (p<0,001). Foram encontradas alterações quanto à ausência de resposta, ao índice de assimetria (IA) e às latências de p13 e n23, no entanto apenas os parâmetros ausência de respostas (p<0,001) e o índice de assimetria (p<0,001) apresentaram diferença estatisticamente significante em relação ao grupo Controle. Não houve diferença estatística entre as formas recorrente e não recorrente da VPPB em relação ao resultado do VEMP (p=0,09). Conclusões: Houve diferença estatisticamente significante no comportamento do reflexo sáculo-cólico do grupo com VPPB em relação ao grupo Controle. Não houve diferença estatisticamente significante no comportamento do reflexo sáculocólico entre as formas recorrente e não recorrente da VPPB.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)TEDEBV UNIFESP: Teses e dissertaçõe

Vestibular evoked myogenic potentials and digital vectoelectronystagmography's study in patients with benign paroxysmal positional vertigo

Introduction: Benign Paroxysmal Positional Vertigo (BPPV) is a very common vestibular disorder characterized by brief but intense attacks of rotatory vertigo triggered by simple rapid movement of the head. The integrity of the vestibular pathways can be assessed using tests such as digital vectoelectronystagmography (VENG) and vestibular evoked myogenic potentials (VEMP). Aim: This study aimed to determine the VEMP findings with respect to latency, amplitude, and waveform peak to peak and the results of the oculomotor and vestibular components of VENG in patients with BPPV. Method: Although this otoneurological condition is quite common, little is known of the associated VEMP and VENG changes, making it important to research and describe these results. Results: We examined the records of 4438 patients and selected 35 charts after applying the inclusion and exclusion criteria. Of these, 26 patients were women and 9 men. The average age at diagnosis was 52.7 years, and the most prevalent physiological cause, accounting for 97.3% of cases, was ductolithiasis. There was a statistically significant association between normal hearing and mild contralateral sensorineural hearing loss. The results of the oculomotor tests were within the normal reference ranges for all subjects. Patients with BPPV exhibited symmetrical function of the semicircular canals in their synergistic pairs (p < 0.001). The caloric test showed statistically normal responses from the lateral canals. The waveforms of all patients were adequate, but the VEMP results for the data-crossing maneuver with positive positioning showed a trend toward a relationship for the left ear Lp13. There was also a trend towards an association between normal reflexes in the caloric test and the inter-peak VEMP of the left ear. It can be concluded that although there are some differences between the average levels of the VENG and VEMP results, these differences were not statistically significant. Conclusion: In conclusion, the results of audiologic assessment, hearing thresholds, positioning maneuvers, and caloric tests have no effect on the quantitative results of VEMP. Additional research is warranted to establish the relationships among VENG, VEMP, and BPPV, especially as concerns the oculomotor tests

Aspectos clínicos e funcionais do equilíbrio corporal em idosos com vertigem posicional paroxística benigna Clinical and functional aspects of body balance in elderly subjects with benign paroxysmal positional vertigo

Vertigem Posicional Paroxística Benigna (VPPB) pode alterar o equilíbrio corporal em pacientes idosos. OBJETIVO: Observar os efeitos da manobra de Epley em idosos com VPPB, avaliando os aspectos clínicos e funcionais do equilíbrio corporal. Forma de estudo: clínico e prospectivo. MÉTODO: Após o diagnóstico da doença (teste de DixHallpike), os testes Time Up and Go (TUGT), Clinical test of Sensory Interaction and Balance (CTSIB) e o teste de membros inferiores (MMI) foram realizados antes e após a manobra de reposicionamento de Epley modificada. RESULTADOS: O gênero feminino foi o mais prevalente e a média etária foi de 70,10 anos (DP = 7,00). Todos os pacientes apresentaram ductolitíase de canal posterior. Os seguintes sintomas melhoraram após a manobra: a instabilidade postural (p = 0,006), náusea e vômito (p = 0,021) e zumbido (p = 0,003). Em relação ao TUGT e o escore do teste de MMII, observou-se diminuição significante do tempo pós-manobra de Epley (p < 0,001). Observou-se melhora no CTSIB pós-manobra de Epley nas condições 2 (p < 0,003), condição 3 (p < 0,001), condição 4 (p < 0,001), condição 5 (p < 0,001), e condição 6 (p < 0,001). CONCLUSÃO: Houve melhora nos aspectos clínicos e funcionais do equilíbrio corporal em idosos com VPPB após o tratamento com a Manobra de Epley modificada.<br>Benign paroxysmal positional vertigo (BPPV) may compromise the balance of elderly subjects. OBJECTIVE: To observe the effects of the Epley maneuver in elderly subjects with BPPV and assess clinical and functional aspects of body balance. METHOD: This is a prospective clinical study. Patients diagnosed with BPPV (Dix-Hallpike test) were submitted to the Timed Up & Go (TUG) test, the Clinical Test of Sensory Interaction and Balance (CTSIB), and lower limb testing before and after they were repositioned using the modified Epley maneuver. RESULTS: Most subjects were females, and the group's mean age was 70.10 years (SD = 7.00). All patients had canalithiasis of the posterior canal. The following symptoms improved after the maneuver: postural instability (p = 0.006), nausea and vomiting (p = 0.021), and tinnitus (p = 0.003). Subjects improved their times significantly in the TUG and lower limb tests after the Epley maneuver (p < 0.001). Patients performed better on the CTSIB after the Epley maneuver on condition 2 (p < 0.003), condition 3 (p < 0.001), condition 4 (p < 0.001), condition 5 (p < 0.001), and condition 6 (p < 0.001). CONCLUSION: Clinical and functional aspects of body balance in elderly with BPPV improved after treatment with the modified Epley maneuver

Recorrência e persistência da vertigem posicional paroxística benigna

Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorders. AIM: To study the recurrence and persistence of BPPV in patients treated with canalith repositioning maneuvers (CRM) during the period of one year. STUDY DESIGN: longitudinal contemporary cohort series. MATERIALS AND METHODS: One hundred patients with BPPV were followed up during 12 months after a treatment with CRM. Patients were classified according to disease evolution. Aquatic physiotherapy for vestibular rehabilitation (APVR) protocol was applied in cases of persistent BPPV. RESULTS: After CRM, 96% of the patients were free from BPPV's typical nystagmus and dizziness. During the follow up period of 1 year, 26 patients returned with typical BPPV nystagmus and vertigo. Nystagmus and vertigo were persistent in 4% of the patients. Persistent BPPV presented improvement when submitted to APVR. Conclusion: During the period of one year, BPPV was not recurrent in 70% of the patients, recurrent in 26% and persistent in 4%.A vertigem posicional paroxística benigna (VPPB) é das vestibulopatias mais comuns. OBJETIVO: Verificar a recorrência e a persistência da VPPB no período de um ano em pacientes que foram tratados com manobras de reposicionamento de estatocônios (MRE). FORMA DE ESTUDO: coorte contemporânea longitudinal. MATERIAL E MÉTODO: Cem pacientes com VPPB foram acompanhados durante 12 meses após o tratamento com MRE. Os pacientes foram classificados de acordo com a evolução da doença no período de um ano. O protocolo de fisioterapia aquática para reabilitação vestibular (FARV) foi aplicado nos pacientes com VPPB persistente. RESULTADOS: Após as MRE, 96% dos pacientes aboliram o nistagmo e a vertigem de posicionamento. Destes pacientes, 26 apresentaram recorrência da VPPB, no período de um ano. Em 4% dos pacientes, a VPPB foi persistente. Os pacientes com VPPB persistente apresentaram melhora clínica após a realização da FARV. CONCLUSÃO: No período de um ano, a VPPB foi não recorrente em 70% dos pacientes, recorrente em 26% e persistente em 4%

O ENVELHECIMENTO E O SISTEMA VESTIBULAR

As principais alterações decorrentes do processo de envelhecimento nos sistemas de controle postural humano são apresentadas, com ênfase no sistema vestibular. Tais alterações quando associadas às doenças crônicas no idoso podem provocar disfunção do equilíbrio corporal, com prejuízo da capacidade funcional. A Reabilitação do Equilíbrio no idoso com alterações vestibulares deve incluir a Reabilitação Vestibular, sendo particularmente importante na manutenção da independência, prevenção de incapacidades e melhora da qualidade de vida destes pacientes