Aída Regina Assunção

Laryngopharyngeal Reflux: Diagnosis, Treatment, and Latest Research

Introduction Laryngopharyngeal reflux (LPR) is a highly prevalent disease and commonly encountered in the otolaryngologists office. Objective To review the literature on the diagnosis and treatment of LPR. Data Synthesis LPR is associated with symptoms of laryngeal irritation such as throat clearing, coughing, and hoarseness. The main diagnostic methods currently used are laryngoscopy and pH monitoring. The most common laryngoscopic signs are redness and swelling of the throat. However, these findings are not specific of LPR and may be related to other causes or can even be found in healthy individuals. Furthermore, the role of pH monitoring in the diagnosis of LPR is controversial. A therapeutic trial with proton pump inhibitors (PPIs) has been suggested to be cost-effective and useful for the diagnosis of LPR. However, the recommendations of PPI therapy for patients with a suspicion of LPR are based on the results of uncontrolled studies, and high placebo response rates suggest a much more complex and multifactorial pathophysiology of LPR than simple acid reflux. Molecular studies have tried to identify biomarkers of reflux such as interleukins, carbonic anhydrase, E-cadherin, and mucin. Conclusion Laryngoscopy and pH monitoring have failed as reliable tests for the diagnosis of LPR. Empirical therapy with PPIs is widely accepted as a diagnostic test and for the treatment of LPR. However, further research is needed to develop a definitive diagnostic test for LPR.

Auto-rotação cefálica ativa em pacientes com tontura/ vertigem

Introducao: A auto-rotacao cefalica ativa e um teste rapido, de simples realizacao, nao invasivo, que nao causa desconforto ao paciente, pode ser realizado com facilidade em criancas e avalia o reflexo vestibulo-ocular nas frequencias fisiologicas de movimentacao da cabeca, utilizadas na vida cotidiana (de 1 a 4 Hz). Forma de estudo: clinico retrospectivo nao randomizado. Objetivo: Avaliar pacientes com queixas de tontura/vertigem atraves da auto-rotacao cefalica ativa comparando os sintomas com as alteracoes encontradas. Material e metodo: Um grupo de 1281 pacientes com queixa de tontura/vertigem foi submetido ao teste de auto-rotacao cefalica ativa horizontal com alvo fixo, como uma etapa da avaliacao otoneurologica. Resultados: As idades variaram de tres a 93 anos com media de 49,6 anos, sendo 946 (73,8%) do sexo feminino e 335 (26,2%) do sexo masculino. A queixa de vertigem foi relatada por 896 (69,9%) dos pacientes e a tontura por 385 (30,1%). A faixa de frequencia de resposta a prova de auto-rotacao cefalica variou de 1,5 a 7,5Hz com media de 3,5Hz. A prova de auto-rotacao cefalica ativa foi normal em 937 (73,1%) e alterada em 344 (26,9%) dos pacientes. As alteracoes mais frequentes foram as relacionadas ao ganho (aumento, reducao) isoladas ou associadas a alteracoes de fase e simetria, em 241 (19%) pacientes. O aumento do ganho isolado foi verificado em 92 pacientes (7,2%). Conclusao: Nao houve relacao entre as alteracoes na prova de auto-rotacao cefalica ativa horizontal e as queixas de tontura e vertigem.

Cervical vestibular evoked myogenic potentials in children.

INTRODUCTION Cervical vestibular evoked myogenic potential is a test used in neurotological examination. It verifies the integrity of vestibular function through a muscular response evoked by an acoustic stimulation which activates the saccular macula. Normal standards in adults have been established, however, there are few published data on the normal responses in children. OBJECTIVE To establish normal standards for vestibular myogenic responses in children without neurotological complaints. METHODS This studys design is a cohort with cross-sectional analysis. The sample consisted of 30 subjects, 15 females (50%) and 15 males (50%). RESULTS The age of the subjects ranged between 8 and 13 years, with a mean of 10.2 (± 1.7). P1 peak showed an average latency of 17.26 (± 1.78)ms and a mean amplitude of 49.34 (± 23.07)μV, and the N2 peak showed an average latency of 24.78 (± 2.18)ms and mean amplitude of 66.23 (± 36.18)μV. P1-N2 mean amplitude was 115.6 (± 55.7)μV. There were no statistically significant differences when comparing by gender or by laterality. CONCLUSION We established normal values of cervical myogenic vestibular responses in children between 8 and 13 years without neurotological complaints.Introduction Cervical vestibular evoked myogenic potential is a test used in neurotological examination. It verifies the integrity of vestibular function through a muscular response evoked by an acoustic stimulation which activates the saccular macula. Normal standards in adults have been established, however, there are few published data on the normal responses in children.

Pulsatile tinnitus: treatment with clonazepam and propranolol

Pulsatile tinnitus synchronous with heartbeat is rare and normally has vascular origin: arterial (malformation, arterial anatomical variation) or venous (aberrant jugular bulb, glomus tumors, tympanic glomus tumor). Early etiology identification is essential for appropriate treatment to be established. Magnetic angioresonance makes the vascular identification possible and precise. We report a case of arterial anatomical variation in which the treatment was propranolol and clonazepam, showing tinnitus improvement.Pulsatile tinnitus synchronous with heartbeat is rare and normally has vascular origin: arterial (malformation, arterial anatomical variation) or venous (aberrant jugular bulb, glomus tumors, tympanic glomus tumor). Early etiology identification is essential for appropriate treatment to be established. Magnetic angioresonance makes the vascular identification possible and precise. We report a case of arterial anatomical variation in which the treatment was propranolol and clonazepam, showing tinnitus improvement.

Original articleCervical vestibular evoked myogenic potentials in childrenPotencial evocado miogênico vestibular cervical em crianças

INTRODUCTION Cervical vestibular evoked myogenic potential is a test used in neurotological examination. It verifies the integrity of vestibular function through a muscular response evoked by an acoustic stimulation which activates the saccular macula. Normal standards in adults have been established, however, there are few published data on the normal responses in children. OBJECTIVE To establish normal standards for vestibular myogenic responses in children without neurotological complaints. METHODS This studys design is a cohort with cross-sectional analysis. The sample consisted of 30 subjects, 15 females (50%) and 15 males (50%). RESULTS The age of the subjects ranged between 8 and 13 years, with a mean of 10.2 (± 1.7). P1 peak showed an average latency of 17.26 (± 1.78)ms and a mean amplitude of 49.34 (± 23.07)μV, and the N2 peak showed an average latency of 24.78 (± 2.18)ms and mean amplitude of 66.23 (± 36.18)μV. P1-N2 mean amplitude was 115.6 (± 55.7)μV. There were no statistically significant differences when comparing by gender or by laterality. CONCLUSION We established normal values of cervical myogenic vestibular responses in children between 8 and 13 years without neurotological complaints.Introduction Cervical vestibular evoked myogenic potential is a test used in neurotological examination. It verifies the integrity of vestibular function through a muscular response evoked by an acoustic stimulation which activates the saccular macula. Normal standards in adults have been established, however, there are few published data on the normal responses in children.

P130: Active Cephalic Auto-Rotation in Patients with Dizziness

OBJECTIVES: Evaluate patients with complaints of dizziness/vertigo through the active cephalic auto-rotation, comparing symptoms with alterations found. METHODS: A group of 1,281 patients with dizziness underwent the horizontal active cephalic auto-rotation test with fixed target, as a part of otoneurological evaluation to verify the alterations that showed up. RESULTS: Ages ranged from 3 to 93 years with an average of 49,6 years; there were 946 (73.8%) females and 335 (26.2%) males. The vertigo complaint was reported by 896 (69.9%) patients and dizziness by 385 (30.1%). The frequency answering rate to cephalic auto-rotation test ranged from 1.5 to 7.5Hz with an average of 3.5Hz. The active cephalic autorotation test was normal in 937 (73.1%) and abnormal in 344 (26.9%) patients. The most frequent alterations were those having to do with the gain (increase–reduction) isolated or associated to alterations of phase and symmetry in 241 (19%) patients. The increase of gain isolated was verified in 92 (7.2%) patients. CONCLUSIONS: There was no relation between alterations in the active cephalic auto-rotation test and the complaints of dizziness and vertigo.