Cristiane Akemi Kasse

Resultados do Balance Rehabilitation Unit na Vertigem Posicional Paroxística Benigna

UNLABELLED Posturography is a useful new tool to study the influence of vestibular diseases on balance. AIM to compare the results from the Balance Rehabilitation Unit (BRU) static posturography in elderly patients with Benign Paroxysmal Positional Vertigo (BPPV), before and after Epleys maneuver. MATERIALS AND METHODS a prospective study of 20 elderly patients with a diagnosis of BPPV. The patients underwent static posturography and the limit of stability (LE) and ellipse area were measured. We also applied the Dizziness Handicap Inventory (DHI) questionnaire to study treatment effectiveness. RESULTS 80% were females, with a mean age of 68.15 years. After the maneuver, the LE increased significantly (p=0.001). The elliptical area of somatosensory, visual and vestibular conflicts (2,7,8,9 situations) in BRU and the DHI scores decreased significantly (p<0.05) after treatment. CONCLUSION the study suggests that elderly patients with BPPV may present static postural control impairment and that the maneuver is effective for the remission of symptoms, to increase in the stability and improvement in postural control in situations of visual, somatosensory and vestibular conflicts.

The value of prognostic clinical data in Bell's palsy

UNLABELLED Electroneurography (ENoG) and clinical staging are currently the methods of choice to indicate prognosis in Bells palsy, although ENoG is an electrophysiological test not universally available. AIM Identify other options of prognostic evaluation based upon clinical aspects and minimal electrical stimulation test allowing prognostic measurement in almost any circumstances. STUDY DESIGN Historic cohort. MATERIAL AND METHOD Chart review of 1,521 cases of IPFP, analyzing the following clinical aspects: gender, age, paralyzed side, installation mode, previous symptoms, associated symptoms and minimal electrical stimulation test (Hilger test) and its statistical correlation to facial palsy evolution after 6 months. RESULTS Data indicated that patients above 60 years old had worse prognosis in comparison with patients under 30 years old. A progressive mode of paralysis installation, absence of previous symptoms, concomitant vertigo and response superior to 3.5 mA at minimum electrical stimulation test were also related to worse prognosis. On the other hand, the absence of concomitant symptoms, diminished tearing and sudden onset were related to better prognosis. CONCLUSION Clinical factors and Hilgers test can accurately indicate the prognosis in cases of Bells palsy when ENoG is not available.

Valor prognóstico de dados clínicos em paralisia de Bell

Com o advento dos testes eletrofisiologicos, a avaliacao clinica parece ter perdido interesse na paralisia de Bell. A eletroneuronografia (ENoG) associada ao estadiamento clinico da doenca e o metodo mais frequentemente utilizado para mensurar o prognostico da paralisia de Bell. Entretanto, a ENoG constitui-se em um teste eletrofisiologico ainda nao universalmente disponivel, especialmente nos servicos de emergencia. OBJETIVO: Estudar a medida do prognostico da paralisia de Bell com base nos dados clinicos e no teste de estimulacao eletrica minima, teste de Hilger, permitindo assim uma previsao de prognostico segura e factivel na maioria dos servicos. FORMA DE ESTUDO: coorte historica. MATERIAL E METODO: Estudo coorte retrospectivo, analisando 1521 casos de paralisia de Bell, correlacionando-se os dados clinicos sexo, idade, lado da paralisia, modo de instalacao, sintomas previos, sintomas associados e os resultados do teste de estimulacao eletrica minima (Hilger), com a evolucao da paralisia apos 6 meses. RESULTADO: O estudo desses dados indicou que pacientes acima de 60 anos apresentaram prognostico pior em comparacao com pacientes com idade abaixo de 30 anos; o modo de instalacao progressiva, a ausencia de sintomas previos, a presenca de vertigem concomitante a paralisia e resposta acima de 3,5 mm no teste de Hilger estiveram relacionados com mau prognostico. Por outro lado, a ausencia de sintomas concomitantes, a diminuicao do lacrimejamento e o inicio subito foram relacionados com bom prognostico. CONCLUSAO: A analise de fatores clinicos, associada ao teste de Hilger, pode indicar o prognostico da paralisia facial com reduzida margem de erro, sendo uma alternativa bastante interessante especialmente quando nao ha disponibilidade da ENoG.

Serotonin Reuptake Inhibitors in Auditory Processing Disorders in Elderly Patients: Preliminary Results

Objective/Hypothesis: One mechanism associated with degeneration in the elderly is the decrease of neurotransmitters. In the central auditory pathway serotonin, can be found from cochlear nucleus to the auditory cortex, and it constitutes one of the most important neuromodulatory circuits in hearing processing. The present study analyzed the action of citalopram, a selective inhibitor of serotonin reuptake, in aged patients with normal to moderate sensorineural hearing loss (HL) and low performance on auditory processing.

Efficacy of Surgical Treatment of Chronic Otitis Media

This article presents our results of surgical treatment of chronic otitis media (COM) and discusses its efficacy regarding the control of disease and hearing results. A retrospective chart review of 84 ears was performed. Forty-one ears with noncholesteatomatous COM underwent tympanomastoidectomy, 43 ears with cholesteatoma were managed according to the extension of the disease, closed mastoidectomy was indicated in 19 cases, and open mastoidectomy was performed in 24 ears. In the group without cholesteatoma, a stable ear with closed tympanic membrane was obtained in 85% of cases after the first procedure. The speech response threshold before and after surgery was 38 and 26 dB. In patients with cholesteatoma, a dry ear was achieved in 79% of cases on both techniques after the first intervention. The recurrence rate of cholesteatoma was 10% for the closed technique and 4% for the open technique. The mean preoperative and postoperative SRTs for the closed technique were 30 and 29 dB and for the open technique were 50 and 54 dB. The surgical treatment for COM can be a rewarding procedure if a correct technique is indicated. The surgery should be tailored regarding the clinical stage and intraoperative findings in each case.

Postural Control in Older Patients with Benign Paroxysmal Positional Vertigo

Objective. To evaluate the effectiveness of a canalith-repositioning procedure in postural control of older patients with idiopathic benign paroxysmal positional vertigo (BPPV). Study Design. Prospective clinical trial. Setting. A tertiary referral center. Methods. A 9-month follow-up survey with a prospective design was conducted among 33 older patients with BPPV. Patients underwent static posturography (Balance Rehabilitation Unit [BRU]) and were administered the Dizziness Handicap Inventory (DHI) before and after the maneuver. After the treatment, they were compared with 33 healthy older subjects. The posturography parameters were the limit of stability (LOS), the center of body-pressure area (COP), and the velocity of oscillation (VOS) under conditions of visual, somatosensory, and visual-vestibular conflict. Results. One canalith-repositioning procedure relieved most patients’ complaints (54.5%), and 100% were relieved with 1 to 3 maneuvers. Total DHI score and all subscales improved after treatment (P < .01). The LOS values pretreatment (mean [SD] 134.27 [55.32] cm2) and posttreatment (181.03 [47.79] cm2) were significantly different (P < .01). Comparative analysis of COP values showed a relevant statistical difference in 8 of 10 postmaneuver conditions (P < .01). The postmaneuver VOS showed a significant difference under 7 conflict conditions. There were no differences between the healthy older subjects and treated patients for all VOS values under all conditions and for COP values under 9 conditions. Conclusion. The canalith-repositioning procedure promotes remission of symptoms, an increase in LOS, and improvement in postural control under conditions of somatosensory and visual conflict and visual-vestibular interaction.

Body balance in elderly patients, 12 months after treatment for BPPV

UNLABELLED Benign Paroxysmal Positional Vertigo is highly prevalent in the elderly population, triggering major changes in body balance. OBJECTIVE To compare the results obtained from static posturography in the elderly before and after otoliths repositioning maneuvers and 12 months after treatment onset. DESIGN longitudinal, descriptive and analytical study. METHOD Elderly patients with clinical diagnosis of BPPV submitted to Balance Rehabilitation Unit static posturography in 10 sensory conditions at three time intervals: before and after the repositioning maneuver and12 months after the treatment RESULTS We studied 23 subjects with a mean age of 68.74 years. Posturography revealed that the stability limit was not significantly different when the three time intervals were compared (p = 0.405). The center of pressure (CoP) showed a significant change in condition 2 (stable surface and closed eyes), because after the repositioning maneuver, the CoP significantly differed vis-à-vis the results before and 12 months after the treatment (p = 0.003). The values of body velocity sway (BVS) were significantly different in six sensory conditions in these three time intervals. CONCLUSION 12 months after the treatment for BPPV, the static posturography showed balance abnormalities similar to those found before treatment.

Tinnitus treatment with Trazodone.

UNLABELLED Tinnitus is a common symptom, defined as a sound perception in absence of a sound stimulus. AIM Evaluate if Trazodone, an antidepressant drug, which modulates serotonin at central neuronal pathways, is effective in controlling tinnitus. STUDY DESIGN Prospective, double blind, randomized, placebo-controlled. MATERIALS AND METHODS Study performed with patients presenting tinnitus. 85 patients were analyzed between February and June of 2005. 43 received trazodone and 42 placebo, for 60 days. The clinical criteria of analysis were tinnitus intensity, discomfort and life quality impact by tinnitus, using an analogue scale varying between 0 and 10, scored by patients before and after drug or placebo use. RESULTS There was a significant improvement in intensity, discomfort and life quality in both groups after treatment; however, there was no significant difference between the drug and placebo groups. Patients with age equal or over 60 years presented better results after treatment. CONCLUSION Trazodone was not efficient in controlling tinnitus in the patients evaluated under the doses utilized.

The use of Maytenus ilicifolia to prevent cisplatin-induced ototoxicity

UNLABELLED Maytenus ilicifolia is a native plant from South America, with several medicinal properties including antioxidant effects. AIM using an original cisplatin induced ototoxicity model, we evaluated a possible otoprotection caused by Maytenus ilicifolia extract. MATERIALS AND METHODS clinical and experimental study design with female albino guinea pigs divided in groups as follows: 9 animals receiving cisplatin only (three doses of 7.5mg/kg/day), 4 animals receiving the plant extract only, 10 animals receiving the cisplatin protocol and 1g/kg/day of extract for 8 days, 5 animals with cisplatin and 3g/kg/day of extract for 8 days, and 5 animals receiving extract for 3 weeks and cisplatin in the last week. The tests were distortion product otoacoustic emissions, brainstem auditory response, before and after medication and scanning electron microscopy. RESULTS the animals receiving cisplatin plus plant extract, had alterations in all the tests, showing lesions on the basal cochlear region under electron microscopy. CONCLUSIONS Despite of the plant extracts antioxidant effect, it was not sufficient to protect the cochlea against cisplatin ototoxicity.

O uso de Maytenus ilicifolia na prevenção da ototoxicidade induzida pela cisplatina

Maytenus ilicifolia is a native plant from South America, with several medicinal properties including antioxidant effects. AIM: using an original cisplatin induced ototoxicity model, we evaluated a possible otoprotection caused by Maytenus ilicifolia extract. MATERIALS AND METHODS: clinical and experimental study design with female albino guinea pigs divided in groups as follows: 9 animals receiving cisplatin only (three doses of 7.5mg/kg/day), 4 animals receiving the plant extract only, 10 animals receiving the cisplatin protocol and 1g/kg/day of extract for 8 days, 5 animals with cisplatin and 3g/kg/day of extract for 8 days, and 5 animals receiving extract for 3 weeks and cisplatin in the last week. The tests were distortion product otoacoustic emissions, brainstem auditory response, before and after medication and scanning electron microscopy. RESULTS: the animals receiving cisplatin plus plant extract, had alterations in all the tests, showing lesions on the basal cochlear region under electron microscopy. CONCLUSIONS: Despite of the plant extracts antioxidant effect, it was not sufficient to protect the cochlea against cisplatin ototoxicity.