Vestibulocochlear evaluation in fibromyalgia

BACKGROUND: fibromyalgia is a non-inflammatory musculoskeletal syndrome, with a chronic nature and unknown aetiology, characterized by widespread pain, increase in sensibility to palpation and by symptoms such as insomnia, stiffness, fatigue, psychological sickness, intolerance to cold and otologic complaints. PROCEDURES: two female patients diagnosed with fibromyalgia, aged 52 to 61 years, were evaluated in the Otoneurology sector of a institution, in September 2008, and consulted for: dizziness, paraesthesia, perception of movement of objects, imbalance on walking, falls, fatigue, depression, headaches, and difficulty in listening and moving the neck. They were submitted to the following procedures: anamnesis, otological inspection, audiologic evaluation and vestibular exam through vectoelectronystagmography. RESULTS: the following discoveries were noted: Patient 1 - hearing loss of the sensorineural type from 2 KHz in the left ear, normal hearing thresholds in the right ear and hypo-reflexia with an absolute value of 42ºC in the caloric test in the right ear. Patient 2 - normal hearing thresholds, bilaterally, and hyper-reflexia with an absolute value of 42ºC in the caloric test in the right ear with an intense neurovegetative manifestation. CONCLUSION: the submitted cases demonstrated the importance of audiologic evaluations and vestibular exams in the contribution to elaboration of strategies used in the therapeutic consolidation of fibromyalgia suggesting the performance of those exams as a clinical routine.TEMA: a fibromialgia é uma síndrome musculoesquelética não inflamatória, de caráter crônico, de etiologia desconhecida, caracterizada por dor generalizada, aumento da sensibilidade na palpação e por sintomas como insônia, rigidez, cansaço, doença psicológica, intolerância ao frio e queixas otológicas. PROCEDIMENTOS: avaliaram-se no setor de Otoneurologia de uma Instituição, em setembro de 2008, dois pacientes com diagnóstico de fibromialgia, idades entre 52 e 61 anos, sexo feminino, que referiram: tontura, zumbido, sensação de movimento de objetos, desequilíbrio à marcha, quedas, fadiga, depressão, cefaléia, dificuldade em escutar e em movimentar o pescoço, entre outros. Foram submetidos aos seguintes procedimentos: anamnese, inspeção otológica, avaliação audiológica e vestibular por meio da vectoeletronistagmografia. RESULTADOS: observaram-se os seguintes achados: Paciente 1 - perda auditiva do tipo neurossensorial a partir de 2KHz na orelha esquerda, limiares auditivos dentro dos padrões de normalidade na orelha direita e hipo-reflexia em valor absoluto à prova calórica 42ºC na orelha direita. Paciente 2 - limiares auditivos dentro dos padrões de normalidade bilateralmente e hiper-reflexia em valor absoluto à prova calórica 42ºC na orelha direita com intensa manifestação neurovegetativa. CONCLUSÃO: os casos apresentados demonstraram a importância das avaliações audiológica e vestibular na contribuição da elaboração de estratégias utilizadas no acompanhamento terapêutico da fibromialgia sugerindo a realização desses exames como rotina clínica.Universidade Federal de São Paulo (UNIFESP)Universidade Tuiuti do ParanáUNIFESP, EPM, São PauloSciEL

Hearing: a pediatrician s approach

Hearing plays a fundamental role in a child s global development; however, some professionals do not realize how much they may contribute to mitigate the sequelae caused by hearing impairment. AIM: to collect data on pediatricians approaches in a city in the country side of Santa Catarina State, regarding the early detection of hearing impairment and identify the methodology utilized for its diagnosis. STUDY DESING: Historical Cohort with Cross-Sectional Cohort. MATERIALS AND METHODS: Analysis of questionnaires with nine multiple choice questions and ten open questions. RESULTS: 62% reported that their training in hearing disorders happened during their medical course; high risk patients are referred to the otorhinolaryngologist (92%); 83% said they are aware of the evaluation techniques; 55% stated they were not aware of the different types of hearing loss; only 25% reported they knew about the levels of hearing loss and 42% of the interviewees believe a child may have fruitful use of a hearing aid before six months of age. CONCLUSION: There is the need of more information about the importance of early diagnosis, as well as the methods used for this end.A audição exerce fundamental importância no desenvolvimento global da criança, porém, alguns profissionais desconhecem a contribuição que podem dar para reduzir ou minimizar as seqüelas deixadas por uma perda auditiva. OBJETIVO: Coletar dados referentes à conduta dos pediatras, de uma cidade do interior de Santa Catarina, frente à detecção precoce da deficiência auditiva e identificar a metodologia utilizada para o diagnóstico. FORMA DE ESTUDO: Coorte histórico com corte transversal. MATERIAL E MÉTODO: Análise de questionários, com dez questões abertas e nove fechadas. RESULTADOS: 62% informaram que sua formação sobre deficiência auditiva ocorreu durante a graduação; conduta nos casos de alto risco (92%) é o encaminhamento ao otorrinolaringologista; 83% referem conhecer as técnicas de avaliação, 55% afirmam desconhecer os tipos de perda auditiva, apenas 25% mencionam conhecer os graus de perda auditiva e 42% dos entrevistados acreditam que uma criança pode fazer uso da prótese auditiva antes dos seis meses. CONCLUSÃO: A necessidade de mais informações sobre a importância do diagnóstico precoce, bem como dos métodos utilizados para realização deste, mostrou-se evidente neste estudo.Universidade Tuiuti do ParanáUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM)Universidade Tuiuti do Paraná Programa de Mestrado em Distúrbios da ComunicaçãoUniversidade Federal do ParanáUniversidade Tuiuti do Paraná Programa de Pós-Graduação em Distúrbios da ComunicaçãoUNIFESP, EPMSciEL

Vestibular rehabilitation in elderly patients with dizziness

BACKGROND: the aging of the population is a natural process and is manifested by a decline in the functions of several organs. Vestibular rehabilitation (VR) is a therapeutic process that seeks to promote a significant reduction in the symptoms of the labyrinth. AIM: to verify the benefits of VR exercises through the application of the Dizziness Handicap Inventory (DHI) questionnaire - Brazilian version - pre and post rehabilitation. METHOD: participants of this study were eight elderly patients with dizziness, ages between 63 and 82 years, three male and five female. The following procedures were carried out: medical history, otologic inspection, vestibular evaluation with vectoelectronystagmography (VENG), application of the DHI questionnaire and of the Cawthorne (1944) and Cooksey (1946) VR exercises. RESULTS: regarding the auditory and vestibular complaints which were referred to in the medical history, the following was observed: presence of tinnitus, hearing loss, postural vertigo and of unbalance. In the evaluation of the vestibular function alterations were observed for all of the participants, mainly in the caloric test, with a prevalence of unilateral and bilateral hypofunction. In the vestibular exam the following was observed: three cases of unilateral peripheral vestibular deficit syndrome, three cases of bilateral peripheral vestibular deficit syndrome, one case of bilateral central vestibular deficit syndrome and one case of irritating bilateral central vestibular syndrome. There was a statistically significant improvement of the following aspects after VR: physical (p=0.00413), functional (p=0.00006) and emotional (p=0.03268). CONCLUSION: the VR protocol favored the improvement of life quality of the participants and was of assistance in the process of vestibular compensation.TEMA: o envelhecimento populacional é um processo natural, manifesta-se por um declínio das funções de diversos órgãos. A reabilitação vestibular (RV) é um processo terapêutico que visa promover a redução significativa dos sintomas labirínticos. OBJETIVO: verificar os benefícios dos exercícios de RV por meio da avaliação pré e pós-aplicação do questionário Dizziness Handicap Inventory (DHI) - adaptação brasileira. MÉTODO: participaram deste estudo oito idosos com queixa de tontura, na faixa etária de 63 a 82 anos, três do sexo masculino e cinco do sexo feminino. Realizaram-se os seguintes procedimentos: anamnese, inspeção otológica, avaliação vestibular por meio da vectoeletronistagmografia (VENG), aplicação do questionário DHI e dos exercícios de RV de Cawthorne (1944) e Cooksey (1946). RESULTADOS: com relação as queixas auditivas e vestibulares, observou-se a incidência do zumbido, da hipoacusia, da vertigem postural e do desequilíbrio; na avaliação da função vestibular, constataram-se alterações em todos os idosos; as alterações foram na sua maioria na prova calórica com predomínio da hiporreflexia uni e bilateral; constataram-se, no exame vestibular, três casos de síndrome vestibular periférica deficitária unilateral, três casos de síndrome vestibular periférica deficitária bilateral, um caso de síndrome vestibular central deficitária bilateral e um caso de síndrome vestibular central irritativa bilateral; houve melhora significativa dos aspectos físico (p = 0,00413), funcional (p = 0,00006) e emocional (p = 0,03268) após a realização dos exercícios de RV. CONCLUSÃO: o protocolo utilizado de RV promoveu melhora na qualidade de vida dos idosos e auxiliou no processo de compensação vestibular.Universidade Tuiuti Faculdade Integrada EspíritaEscola Paulista de MedicinaUniversidade Tuiuti Programa de Mestrado em Distúrbios da ComunicaçãoUniversidade Tuiuti Programa de MestradoUniversidade Federal do ParanáUniversidade TuiutiUNIFESP, EPMSciEL

Hearing: a pediatrician s approach

Hearing plays a fundamental role in a child s global development; however, some professionals do not realize how much they may contribute to mitigate the sequelae caused by hearing impairment. AIM: to collect data on pediatricians approaches in a city in the country side of Santa Catarina State, regarding the early detection of hearing impairment and identify the methodology utilized for its diagnosis. STUDY DESING: Historical Cohort with Cross-Sectional Cohort. MATERIALS AND METHODS: Analysis of questionnaires with nine multiple choice questions and ten open questions. RESULTS: 62% reported that their training in hearing disorders happened during their medical course; high risk patients are referred to the otorhinolaryngologist (92%); 83% said they are aware of the evaluation techniques; 55% stated they were not aware of the different types of hearing loss; only 25% reported they knew about the levels of hearing loss and 42% of the interviewees believe a child may have fruitful use of a hearing aid before six months of age. CONCLUSION: There is the need of more information about the importance of early diagnosis, as well as the methods used for this end.A audição exerce fundamental importância no desenvolvimento global da criança, porém, alguns profissionais desconhecem a contribuição que podem dar para reduzir ou minimizar as seqüelas deixadas por uma perda auditiva. OBJETIVO: Coletar dados referentes à conduta dos pediatras, de uma cidade do interior de Santa Catarina, frente à detecção precoce da deficiência auditiva e identificar a metodologia utilizada para o diagnóstico. FORMA DE ESTUDO: Coorte histórico com corte transversal. MATERIAL E MÉTODO: Análise de questionários, com dez questões abertas e nove fechadas. RESULTADOS: 62% informaram que sua formação sobre deficiência auditiva ocorreu durante a graduação; conduta nos casos de alto risco (92%) é o encaminhamento ao otorrinolaringologista; 83% referem conhecer as técnicas de avaliação, 55% afirmam desconhecer os tipos de perda auditiva, apenas 25% mencionam conhecer os graus de perda auditiva e 42% dos entrevistados acreditam que uma criança pode fazer uso da prótese auditiva antes dos seis meses. CONCLUSÃO: A necessidade de mais informações sobre a importância do diagnóstico precoce, bem como dos métodos utilizados para realização deste, mostrou-se evidente neste estudo.Universidade Tuiuti do ParanáUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM)Universidade Tuiuti do Paraná Programa de Mestrado em Distúrbios da ComunicaçãoUniversidade Federal do ParanáUniversidade Tuiuti do Paraná Programa de Pós-Graduação em Distúrbios da ComunicaçãoUNIFESP, EPMSciEL

Análisis acústico de la deglución como método auxiliar para evaluar la disfagia en la enfermedad de Parkinson

Objective: To measure the accuracy of DeglutiSom as an auxiliary method to assess swallowing in patients with Parkinson's disease (PD). Methodology: Accuracy study. Among 248 individuals, 91 participants met the inclusion criteria, with a mean age of 64.9 years (SD 7.7), 53.8% male and 46.2% female, with a mean disease duration of 12.6 years (SD 3.8 years). Two instrumental studies were performed: An acoustic analysis with Sonar Doppler via the DeglutiSom Software, and a videofluoroscopic swallow study. Three judges analyzed the swallowing sounds in the DeglutiSom software and the instrumental examination findings. Results: The inter-rater reliability was 90.1%, with 4.4% degree of partial agreement and 5.5% disagreement. Sensitivity resulted in 90.0% and specificity in 90.0%. A sensitivity of 97.0% and specificity of 91.0% are indicators of a high validity for the dysphagia screening method, with predictive value (+) of 97.0% and predictive value (-) of 91.0%, with an accuracy method of 96.0%. The validity indicator values for screening aspiration were also high, with a sensitivity of 90.0%, specificity of 90.0%, predictive value (+) of 82.0%, predictive value (-) of 95% , 0% and 90.0% accuracy. Conclusion: The method proposed is considered appropriate for oropharyngeal dysphagia and tracheal aspiration screening in patients with Parkinson's Disease.info:eu-repo/semantics/publishedVersio

Effects of sleep deprivation on central auditory processing

AbstractBackgroundSleep deprivation is extremely common in contemporary society, and is considered to be a frequent cause of behavioral disorders, mood, alertness, and cognitive performance. Although the impacts of sleep deprivation have been studied extensively in various experimental paradigms, very few studies have addressed the impact of sleep deprivation on central auditory processing (CAP). Therefore, we examined the impact of sleep deprivation on CAP, for which there is sparse information. In the present study, thirty healthy adult volunteers (17 females and 13 males, aged 30.75 ± 7.14 years) were subjected to a pure tone audiometry test, a speech recognition threshold test, a speech recognition task, the Staggered Spondaic Word Test (SSWT), and the Random Gap Detection Test (RGDT). Baseline (BSL) performance was compared to performance after 24 hours of being sleep deprived (24hSD) using the Student’s t test.ResultsMean RGDT score was elevated in the 24hSD condition (8.0 ± 2.9 ms) relative to the BSL condition for the whole cohort (6.4 ± 2.8 ms; p = 0.0005), for males (p = 0.0066), and for females (p = 0.0208). Sleep deprivation reduced SSWT scores for the whole cohort in both ears [(right: BSL, 98.4 % ± 1.8 % vs. SD, 94.2 % ± 6.3 %. p = 0.0005)(left: BSL, 96.7 % ± 3.1 % vs. SD, 92.1 % ± 6.1 %, p < 0.0001)]. These effects were evident within both gender subgroups [(right: males, p = 0.0080; females, p = 0.0143)(left: males, p = 0.0076; females: p = 0.0010).ConclusionSleep deprivation impairs RGDT and SSWT performance. These findings confirm that sleep deprivation has central effects that may impair performance in other areas of life

Análisis acústico de los sonidos de la deglución con el uso de Sonar Doppler en bebés prematuros durante la transición alimentaria

Objective: To define the acoustic parameters and the feasibility of using swallowing acoustic analysis as an auxiliary method for the transition from nasogastric or orogastric tube feeding to oral breastfeeding. Methodology: A cross-sectional study, which consisted of the following steps: 1. Data collection: Thirty-two newborns participated in this study (16 preterm and 16 full-term); 2. Clinical speech-language pathology evaluation: Clinical data were collected using Sonar Doppler used to assess the readiness of preterm infants to start oral feeding and swallowing sounds. Swallowing sounds were captured during breastfeeding and analyzed according to the frequency, intensity, and time of swallowing, as well as the pause time between swallows and the number of swallows. Results: The control and study groups presented significant differences in the mean wave time and swallowing per minute variables. Conclusion: Sonar Doppler, as an instrument used to capture sounds, is a viable auxiliary resource to evaluate the transition from nasogastric or orogastric tube to oral breastfeeding.info:eu-repo/semantics/publishedVersio

Efecto de la terapia respiratoria en pacientes con bruxismo del sueño y eventos respiratorios asociados: protocolo de estudio para un ensayo clínico controlado aleatorizado

Aim: The aim of this study will be to perform respiratory physiotherapy on patients with sleep bruxism and associated respiratory events (apnea and hypopnea). Methodology: The study will be a randomized, controlled, doubleblind, clinical trial with a sample of individuals with sleep bruxism and associated respiratory events. Respiratory (inspiratory and/or expiratory) physiotherapy will be performed using the THRESHOLD IMT and PEP and the results will be compared to a placebo group. Discussion: Regarding respiratory events, there is a broad variety of possible treatments for sleep apnea depending on the physiopathology, severity and patient preference, with CPAP considered the gold standard. However, data on CPAP are inconsistent, with adherence to therapy reported to be between 45 and 89%. Thus, other forms of treatment are proposed, including respiratory training. Understanding obstructive sleep apnea syndrome as the loss of the dilation strength of the pharynx and the inability to maintain the path open for air, respiratory muscle training could assist in increasing dilation strength, enabling the passage of air during sleep. Taking into consideration that sleep bruxism may be associated with events of apnea and hypopnea, the intervention to treat obstructive respiratory events related to sleep may have a positive impact on events related to sleep bruxism (rhythmic activity of the masticatory muscles). To determine this, we will measure the apnea/hypopnea index (AHI) and number of contractions of the masseter muscle (characteristic of the activity of bruxism) before and after the intervention using polysomnography.info:eu-repo/semantics/publishedVersio