Association between hearing loss and vestibular disorders : a review of the interference of hearing in the balance

Dizziness is very prevalent and makes a great impact on people’s life. Because of anatomical and functional similarities of hearing and vestibular systems, it is noted that there is a big relation between hearing loss and vestibular disorders. Depending on the age onset of hearing loss, it can cause even delay on motor development. Objective: To find literature that demonstrates the relation between hearing and balance. Confirming that hearing loss or even intervention to improve quality of hearing can interfere on vestibular system. Methodology: Revision of literature was carried out, preferring recent research only in English. Conclusion: Cochlea and vestibular systems have a close relationship; changes in one of them can cause big damage in the other. So, a complete evaluation of vestibular system is recommended before ear surgeries. Video Head Impulse Test is a new procedure able to evaluate high frequency movements of the head. It was an additional exam of vestibular status and came to help detect problems that were not diagnosed before. Efforts must be directed in order to protect the balance

The potential use of melatonin for preventing cisplatin ototoxicity : an insight for a clinical approach

Cisplatin, one of the most effective and potent anticancer drugs, is used in the treatment of a wide variety of both pediatric and adult malignancies. However, the chemotherapeutic use of cisplatin is limited by its serious side effects, such as nephrotoxicity and ototoxicity. Ototoxicity produced by cisplatin is usually persistent, depending on the age of the patient, the cumulative number of doses, the number of chemotherapy cycles, the history of noise exposure, and deteriorating renal function. The mechanism of the ototoxicity caused by cisplatin is based on the generation of reactive oxygen species, which interfere with the antioxidant protection of the organ of Corti. Thus, protecting the cochlea with antioxidants ameliorates ototoxicity from cisplatin. In this context, melatonin appears as a therapeutic option for preventing the ototoxic effects of cisplatin, since the research in the last decade has proven its ability to be both a direct free radical scavenger and indirect antioxidant. In this sense, some of the evidence suggesting that melatonin is efficient for combating cisplatin-induced ototoxicity is summarized and discussed in this paper

Hearing preservation in cochlear implant surgery

In the past, it was thought that hearing loss patients with residual low-frequency hearing would not be good candidates for cochlear implantation since insertion was expected to induce inner ear trauma. Recent advances in electrode design and surgical techniques have made the preservation of residual low-frequency hearing achievable and desirable. The importance of preserving residual low-frequency hearing cannot be underestimated in light of the added benefit of hearing in noisy atmospheres and in music quality. The concept of electrical and acoustic stimulation involves electrically stimulating the nonfunctional, high-frequency region of the cochlea with a cochlear implant and applying a hearing aid in the low-frequency range. The principle of preserving low-frequency hearing by a “soft surgery” cochlear implantation could also be useful to the population of children who might profit from regenerative hair cell therapy in the future. Main aspects of low-frequency hearing preservation surgery are discussed in this review: its brief history, electrode design, principles and advantages of electric-acoustic stimulation, surgical technique, and further implications of this new treatment possibility for hearing impaired patients

Nasal involvement in obstructive sleep apnea syndrome

Numerous studies have reported an association between nasal obstruction and obstructive sleep apnea syndrome (OSAS), but the precise nature of this relationship remains to be clarified. This paper aimed to summarize data and theories on the role of the nose in the pathophysiology of sleep apnea as well as to discuss the benefits of surgical and medical nasal treatments. A number of pathophysiological mechanisms can potentially explain the role of nasal pathology in OSAS. These include the Starling resistor model, the unstable oral airway, the nasal ventilatory reflex, and the role of nitric oxide (NO). Pharmacological treatment presents some beneficial effects on the frequency of respiratory events and sleep architecture. Nonetheless, objective data assessing snoring and daytime sleepiness are still necessary. Nasal surgery can improve the quality of life and snoring in a select group of patients with mild OSAS and septal deviation but is not an effective treatment for OSA as such. Despite the conflicting results in the literature, it is important that patients who are not perfectly adapted to CPAP are evaluated in detail, in order to identify whether there are obstructive factors that could be surgically corrected

Zumbido e intolerância a sons : evidência e experiência de um grupo brasileiro

Introdução Zumbido e intolerância a sons são queixas frequentes e subjetivas que podem ter impacto na qualidade de vida do paciente. Objetivo Apresentar uma revisão dos principais pontos, inclusive conceitos, fisiopatologia, diagnóstico e abordagem do paciente com zumbido e sensibilidade a sons. Método Revisão da literatura com levantamento bibliográfico na base de dados da LILACS, SciELO, Pubmed e MEDLINE. Foram selecionados artigos e capítulos de livros sobre zumbido e sensibilidade a sons. Os diversos tópicos foram discutidos por um grupo de profissionais brasileiros e as conclusões, descritas. Resultado A prevalência de zumbido tem aumentado ao longo dos anos, muitas vezes associado a perda auditiva, fatores metabólicos e erros alimentares. A avaliação médica deve ser feita minuciosamente no sentido de orientar a solicitação de exames subsidiários. Os tratamentos disponíveis atualmente variam de medicamentos ao uso de sons com características específicas e técnicas de meditação, com resultados variáveis. Conclusão Foi apresentada uma revisão sobre os temas que permitindo ao leitor uma visão ampla da abordagem dos pacientes com zumbido e sensibilidade auditiva baseada em evidências científicas e experiência nacional.Introduction Tinnitus and sound intolerance are frequent and subjective complaints that may have an impact on a patient's quality of life. Objective To present a review of the salient points including concepts, pathophysiology, diagnosis and approach of the patient with tinnitus and sensitivity to sounds. Methods Literature review with bibliographic survey in LILACS, SciELO, Pubmed and MEDLINE database. Articles and book chapters on tinnitus and sound sensitivity were selected. The several topics were discussed by a group of Brazilian professionals and the conclusions were described. Results The prevalence of tinnitus has increased over the years, often associated with hearing loss, metabolic factors and inadequate diet. Medical evaluation should be performed carefully to guide the request of subsidiary exams. Currently available treatments range from medications to the use of sounds with specific characteristics and meditation techniques, with variable results. Conclusion A review on tinnitus and auditory sensitivity was presented, allowing the reader a broad view of the approach to these patients, based on scientific evidence and national experience

Efficacy of vestibulo-ocular reflex exercises in the treatment of acute vertigo

Introdução: Desde sua primeira descrição na década de 40 o espectro de aplicação da reabilitação vestibular vem crescendo, tornando-se opção de tratamento em disfunções vestibulares periféricas, incluindo as uni e bilaterais, e em doenças do sistema nervoso central. O presente estudo avalia a eficácia de exercícios que estimulam a adaptação do reflexo vestíbulo-ocular em indivíduos com quadro agudo de vertigem. Métodos: neste estudo clínico prospectivo foram avaliados indivíduos aleatoriamente alocados em um grupo de estudo, que realizou exercícios para adaptação do reflexo vestíbulo-ocular, e em um grupo controle, que realizou exercícios placebo. Os critérios de inclusão foram história de pelo menos um episódio de vertigem nos últimos cinco dias, idade acima de 18 anos, e alteração em pelo menos dois dos testes objetivos de equilíbrio (teste de Romberg, teste de Fukuda e \"head-shaking\" nistagmo) e/ou presença de nistagmo espontâneo. Os pacientes de ambos os grupos foram orientados a utilizar dimenidrato na dose máxima de 150 mg ao dia, divididas em três doses, podendo auto-regular a dose conforme a intensidade dos sintomas apresentados. Foram excluídos indivíduos que tivessem utilizado medicação com ação no sistema vestibular nos últimos sete dias, com presença de alterações sugestivas de doença do sistema nervoso central, diagnóstico de vertigem posicional paroxística benigna ou de fístula perilinfática. Os pacientes foram avaliados, no início do estudo e em três visitas subseqüentes, realizadas nos períodos de três a cinco dias, sete a dez dias e dezoito a vinte e um dias após o início da pesquisa. Em todas as visitas a avaliação foi realizada por meio de notas atribuídas à intensidade dos sintomas (escala analógica visual), quantidade de medicação utilizada e resultados dos testes de equilíbrio. Resultados: Foram analisados 87 xxxv indivíduos, 45 no grupo de estudo e 42 no grupo controle. Na avaliação inicial os grupos eram semelhantes do ponto de vista estatístico em relação ao sexo e idade dos pacientes, tempo decorrido entre o início dos sintomas e a primeira avaliação, intensidade dos sintomas e achados de exame físico. O grupo de estudos apresentou intensidade de sintomas inferior ao grupo controle nas segunda e terceira avaliações; na quarta e última avaliação ambos os grupos apresentaram sintomatologia semelhante. A quantidade de medicação utilizada pelos pacientes do grupo de estudos foi inferior à utilizada pelo grupo controle em todos as avaliações realizadas. Não houve diferença entre os grupos em relação ao desaparecimento do nistagmo espontâneo exceto na terceira avaliação. A proporção de pacientes com teste de Romberg alterado foi menor no grupo de estudo quando comparada ao grupo controle nas segunda (tendência à significância estatística) e terceira avaliações, não havendo diferença entre os grupos na última avaliação. Nos testes de Fukuda e de \"head-shaking\" nistagmo não houve diferença entre os grupos em relação à proporção de testes alterados nas primeira e segunda avaliações, entretanto nas terceira e quarta avaliações o grupo de estudos teve menor proporção de testes alterados. Conclusões: O grupo submetido aos exercícios para adaptação do reflexo vestíbulo-ocular obteve melhora clínica mais rápida, fez uso de quantidade menor de dimenidrato e apresentou normalização dos testes clínicos de equilíbrio mais precocemente quando comparado ao grupo controleIntroduction: Since its first description in 1940 decade, the spectrum of use of vestibular rehabilitation has broadened and nowadays comprises unilateral, bilateral and even central vestibular disorders. The objective of this study is to evaluate the effect of exercises for adaptation of the vestibuloocular reflex in patients with acute vertigo. METHODS: Study design: prospective randomized trial, patients blinded to assignment groups. The study population had the following characteristics: = 18 years of age, at least one episode of vertigo in the last five days, negative results in at least two objective vestibular tests and/or presence of spontaneous nystagmus. The exclusion criteria were: use of any medication interfering with the vestibular system in the past seven days, clinical history or physical findings indicative of central nervous system disorders, clinical diagnosis of benign paroxysmal positional vertigo or perilymphatic fistula. Patients were randomly allocated to the intervention and placebo controlled groups. Intervention group performed exercises for adaptation of the vestibulo-ocular reflex; control group performed placebo exercises. Both groups were instructed to use dimenhydrinate and self-adjust the dose according to the intensity of their symptoms (up to 150mg/day). Patients evaluated by the assessment of the intensity of symptoms, by analogue visual scale, neuro-otological examination (presence of spontaneous nystagmus, Romberg test, Fukuda test and head-shaking nystagmus) and need to use the medication. There were three appointments in the follow-up period: three to five days, seven to ten days and eighteen to twenty one days after the initial evaluation. Results: There were 87 patients eligible for the study, 45 in the intervention group and 42 in the control group. At the initial evaluation, there was no statistically significant difference between the intervention and control groups in terms of sex, age, interval from onset of symptoms to inclusion in the study, intensity xxxvii of symptoms and neuro-otological tests results. Intensity of symptoms: the mean of the patients\' analogue visual scale score was similar for the intervention and control groups at the initial evaluation. At the second and third evaluations the mean score of the intervention group was significantly smaller. At the fourth and final evaluation, the groups were similar again. In the intervention group the amount of medication used by patients was always smaller than in the control group. Presence of spontaneous nystagmus was similar in between the groups at all but the third evaluation. As to the Romberg test results, the proportion of patients with a positive test was smaller for the intervention group at the second and third evaluations (borderline significant for the second intervention). At the fourth and final evaluation, the groups were similar again. As to the Fukuda and headshaking nystagmus tests, results were similar, at the third and forth evaluations the intervention group performed better than the control group. Conclusions: Vestibular exercises for adaptation of the vestibulo-ocular reflex have beneficial effects on treatment of patients with acute vertigo. The intervention group recovered faster, used a reduced amount of medication and performed better on balance tests as compared to the control grou

Efficacy of vestibulo-ocular reflex exercises in the treatment of acute vertigo

Introdução: Desde sua primeira descrição na década de 40 o espectro de aplicação da reabilitação vestibular vem crescendo, tornando-se opção de tratamento em disfunções vestibulares periféricas, incluindo as uni e bilaterais, e em doenças do sistema nervoso central. O presente estudo avalia a eficácia de exercícios que estimulam a adaptação do reflexo vestíbulo-ocular em indivíduos com quadro agudo de vertigem. Métodos: neste estudo clínico prospectivo foram avaliados indivíduos aleatoriamente alocados em um grupo de estudo, que realizou exercícios para adaptação do reflexo vestíbulo-ocular, e em um grupo controle, que realizou exercícios placebo. Os critérios de inclusão foram história de pelo menos um episódio de vertigem nos últimos cinco dias, idade acima de 18 anos, e alteração em pelo menos dois dos testes objetivos de equilíbrio (teste de Romberg, teste de Fukuda e \"head-shaking\" nistagmo) e/ou presença de nistagmo espontâneo. Os pacientes de ambos os grupos foram orientados a utilizar dimenidrato na dose máxima de 150 mg ao dia, divididas em três doses, podendo auto-regular a dose conforme a intensidade dos sintomas apresentados. Foram excluídos indivíduos que tivessem utilizado medicação com ação no sistema vestibular nos últimos sete dias, com presença de alterações sugestivas de doença do sistema nervoso central, diagnóstico de vertigem posicional paroxística benigna ou de fístula perilinfática. Os pacientes foram avaliados, no início do estudo e em três visitas subseqüentes, realizadas nos períodos de três a cinco dias, sete a dez dias e dezoito a vinte e um dias após o início da pesquisa. Em todas as visitas a avaliação foi realizada por meio de notas atribuídas à intensidade dos sintomas (escala analógica visual), quantidade de medicação utilizada e resultados dos testes de equilíbrio. Resultados: Foram analisados 87 xxxv indivíduos, 45 no grupo de estudo e 42 no grupo controle. Na avaliação inicial os grupos eram semelhantes do ponto de vista estatístico em relação ao sexo e idade dos pacientes, tempo decorrido entre o início dos sintomas e a primeira avaliação, intensidade dos sintomas e achados de exame físico. O grupo de estudos apresentou intensidade de sintomas inferior ao grupo controle nas segunda e terceira avaliações; na quarta e última avaliação ambos os grupos apresentaram sintomatologia semelhante. A quantidade de medicação utilizada pelos pacientes do grupo de estudos foi inferior à utilizada pelo grupo controle em todos as avaliações realizadas. Não houve diferença entre os grupos em relação ao desaparecimento do nistagmo espontâneo exceto na terceira avaliação. A proporção de pacientes com teste de Romberg alterado foi menor no grupo de estudo quando comparada ao grupo controle nas segunda (tendência à significância estatística) e terceira avaliações, não havendo diferença entre os grupos na última avaliação. Nos testes de Fukuda e de \"head-shaking\" nistagmo não houve diferença entre os grupos em relação à proporção de testes alterados nas primeira e segunda avaliações, entretanto nas terceira e quarta avaliações o grupo de estudos teve menor proporção de testes alterados. Conclusões: O grupo submetido aos exercícios para adaptação do reflexo vestíbulo-ocular obteve melhora clínica mais rápida, fez uso de quantidade menor de dimenidrato e apresentou normalização dos testes clínicos de equilíbrio mais precocemente quando comparado ao grupo controleIntroduction: Since its first description in 1940 decade, the spectrum of use of vestibular rehabilitation has broadened and nowadays comprises unilateral, bilateral and even central vestibular disorders. The objective of this study is to evaluate the effect of exercises for adaptation of the vestibuloocular reflex in patients with acute vertigo. METHODS: Study design: prospective randomized trial, patients blinded to assignment groups. The study population had the following characteristics: = 18 years of age, at least one episode of vertigo in the last five days, negative results in at least two objective vestibular tests and/or presence of spontaneous nystagmus. The exclusion criteria were: use of any medication interfering with the vestibular system in the past seven days, clinical history or physical findings indicative of central nervous system disorders, clinical diagnosis of benign paroxysmal positional vertigo or perilymphatic fistula. Patients were randomly allocated to the intervention and placebo controlled groups. Intervention group performed exercises for adaptation of the vestibulo-ocular reflex; control group performed placebo exercises. Both groups were instructed to use dimenhydrinate and self-adjust the dose according to the intensity of their symptoms (up to 150mg/day). Patients evaluated by the assessment of the intensity of symptoms, by analogue visual scale, neuro-otological examination (presence of spontaneous nystagmus, Romberg test, Fukuda test and head-shaking nystagmus) and need to use the medication. There were three appointments in the follow-up period: three to five days, seven to ten days and eighteen to twenty one days after the initial evaluation. Results: There were 87 patients eligible for the study, 45 in the intervention group and 42 in the control group. At the initial evaluation, there was no statistically significant difference between the intervention and control groups in terms of sex, age, interval from onset of symptoms to inclusion in the study, intensity xxxvii of symptoms and neuro-otological tests results. Intensity of symptoms: the mean of the patients\' analogue visual scale score was similar for the intervention and control groups at the initial evaluation. At the second and third evaluations the mean score of the intervention group was significantly smaller. At the fourth and final evaluation, the groups were similar again. In the intervention group the amount of medication used by patients was always smaller than in the control group. Presence of spontaneous nystagmus was similar in between the groups at all but the third evaluation. As to the Romberg test results, the proportion of patients with a positive test was smaller for the intervention group at the second and third evaluations (borderline significant for the second intervention). At the fourth and final evaluation, the groups were similar again. As to the Fukuda and headshaking nystagmus tests, results were similar, at the third and forth evaluations the intervention group performed better than the control group. Conclusions: Vestibular exercises for adaptation of the vestibulo-ocular reflex have beneficial effects on treatment of patients with acute vertigo. The intervention group recovered faster, used a reduced amount of medication and performed better on balance tests as compared to the control grou

Sucesso no tratamento do zumbido com terapia em grupo Group therapy for patients with tinnitus at the University of Brasilia Medical School

Embora os tratamentos em grupos para o zumbido sejam uma área bem documentada na literatura internacional, até onde sabemos nunca foram realizados no Brasil. Este estudo apresenta uma experiência bem-sucedida de um tratamento em grupo para zumbido baseado na terapia de retreinamento do zumbido aliada com as técnicas cognitivo-comportamentais. O objetivo deste estudo é avaliar pacientes com zumbido antes e depois do tratamento em grupo estruturado baseado da terapia de retreinamento do zumbido e na terapia cognitivo comportamental. MATERIAL E MÉTODO: Estudo coorte prospectivo: 27 sujeitos aplicaram-se para a pesquisa. Responderam ao inventário do Handicap do Zumbido (THI) e à escala da Ansiedade e Depressão Hospitalar (HAD),antes e depois do tratamento. Foram realizadas 6 sessões estruturadas segundo os princípios da terapia de retreinamento do zumbido associada com técnicas cognitivo-comportamentais. RESULTADOS: 27 pacientes iniciaram e 19 terminaram o tratamento (8 excluídos). 47,4% homens, média das idades 47.6. O resultado do THI antes e depois do tratamento foi respectivamente: funcionais, 29 e 14; emocional, 24 e 10; e catastrófico, 12 e 5; a escala HAD: ansiedade, 12 e 9 e depressão, 10 e 6. CONCLUSÃO: O tratamento descrito é efetivo na melhora do zumbido.Although group therapy for tinnitus is a well documented field in the international literature, as far as we know it has never been held in Brazil. This study represents a successful experience of a group therapy for tinnitus based on the tinnitus retraining therapy associated with behavioral cognitive techniques. The goal of the present study is to assess patients with tinnitus before and after the group therapy based on the tinnitus retraining therapy and the behavioral cognitive therapy. MATERIALS AND METHODS: Prospective cohort study: 27 subjects signed in for the study, and answered the Tinnitus Handicap Inventory (THI) and the Hospital Depression and Anxiety Scale (HAD), before and after the treatment. We held six structured sessions according to the principles of tinnitus retraining therapy associated with behavioral cognitive techniques. RESULTS: 27 patients started and 19 finished the treatment (8 were taken off). 47.4% men, mean age of 47.6. THI results before and after treatment were respectively: functional: 29 and 14, emotional 24 and 10 and catastrophic 12 and 5 and the HAD scale: anxiety 2 and 9 and depression 10 and 6. CONCLUSION: The treatment described is effective in improving tinnitus symptoms

Nasal Involvement in Obstructive Sleep Apnea Syndrome

Numerous studies have reported an association between nasal obstruction and obstructive sleep apnea syndrome (OSAS), but the precise nature of this relationship remains to be clarified. This paper aimed to summarize data and theories on the role of the nose in the pathophysiology of sleep apnea as well as to discuss the benefits of surgical and medical nasal treatments. A number of pathophysiological mechanisms can potentially explain the role of nasal pathology in OSAS. These include the Starling resistor model, the unstable oral airway, the nasal ventilatory reflex, and the role of nitric oxide (NO). Pharmacological treatment presents some beneficial effects on the frequency of respiratory events and sleep architecture. Nonetheless, objective data assessing snoring and daytime sleepiness are still necessary. Nasal surgery can improve the quality of life and snoring in a select group of patients with mild OSAS and septal deviation but is not an effective treatment for OSA as such. Despite the conflicting results in the literature, it is important that patients who are not perfectly adapted to CPAP are evaluated in detail, in order to identify whether there are obstructive factors that could be surgically corrected

Hearing preservation in cochlear implant surgery

In the past, it was thought that hearing loss patients with residual low-frequency hearing would not be good candidates for cochlear implantation since insertion was expected to induce inner ear trauma. Recent advances in electrode design and surgical techniques have made the preservation of residual low-frequency hearing achievable and desirable. The importance of preserving residual lowfrequency hearing cannot be underestimated in light of the added benefit of hearing in noisy atmospheres and in music quality. The concept of electrical and acoustic stimulation involves electrically stimulating the nonfunctional, high-frequency region of the cochlea with a cochlear implant and applying a hearing aid in the low-frequency range. The principle of preserving lowfrequency hearing by a "soft surgery" cochlear implantation could also be useful to the population of children who might profit from regenerative hair cell therapy in the future. Main aspects of low-frequency hearing preservation surgery are discussed in this review: its brief history, electrode design, principles and advantages of electric-acoustic stimulation, surgical technique, and further implications of this new treatment possibility for hearing impaired patients