Cristina Freitas Ganança

Quedas em idosos com Vertigem Posicional Paroxística Benigna

UNLABELLED Benign Paroxysmal Positional Vertigo (BPPV) can cause falls, especially in the elderly. AIM to study whether or not elderly patients with BPPV have a reduction on their falls after the particle repositioning maneuver (PRM). MATERIALS AND METHODS retrospective study including elderly with BPPV who had fall(s) during the last year. All patients were submitted to the PRM according to the affected semicircular canal (SCC). After the abolition of positioning vertigo and nystagmus, the patients were submitted to a 12 month follow-up and were investigated about the number of fall(s). Wilcoxons test was performed to compare the number of fall(s) before and after 12 months of the PRM. RESULTS One hundred and twenty one patients were included in the study. One hundred and one patients presented involvement of the posterior SCC, 16 of the lateral and four of the anterior. We noticed a reduction on the number of falls, with statistically significant difference when all the patients were analyzed together (p<0.001), the posterior canal BPPV patients (p<0,001) and the lateral canal VPPB patients (p=0.002). We also found a tendency of statistically significant difference for the anterior canal BPPV patients (p=0.063). CONCLUSION BPPV elderly patients had indeed a reduction on the number of falls after the PRM.

Clinical features of benign paroxysmal positional vertigo

A vertigem posicional paroxistica benigna (VPPB) e considerada a mais comum das vestibulopatias. OBJETIVO: Avaliar pacientes com VPPB quanto a idade, genero, tipo e localizacao da lesao, associacao com outras vestibulopatias, dados evolutivos e recorrencia. MATERIAL E METODO: Estudo de series retrospectivo. Foram analisados os prontuarios de 1271 pacientes consecutivos examinados nos ultimos seis anos com VPPB. RESULTADOS: A VPPB apresentou prevalencia de faixa etaria entre 41 e 60 anos (42,2%), genero feminino (62,8%), presenca de nistagmo e vertigem de posicionamento (81,3%), comprometimento do canal posterior (87,0%; p<0,001), unilateral (91,8%), do labirinto direito (60,2%; p<0,001), por ductolitiase (97,5%), forma idiopatica (74,8%), associacao com a doenca de Meniere em relacao a outras afeccoes (55,4%; p<0,001), cura ou melhora por meio de manobra de reposicionamento de particulas (77,9%); e pela possibilidade de recorrencia (21,8%, em um ano de acompanhamento). CONCLUSAO: A VPPB e caracterizada pela prevalencia de faixa etaria entre 41 e 60 anos, genero feminino, presenca de nistagmo e vertigem de posicionamento, comprometimento do canal posterior unilateral do labirinto direito por ductolitiase, forma idiopatica, associacao com a doenca de Meniere em relacao a outras afeccoes, cura ou melhora por meio de manobra de reposicionamento de particulas; e pela possibilidade de recorrencia.

Qualidade de vida de indivíduos submetidos à reabilitação vestibular

Balance disorders affect social, family and professional activities. Vestibular rehabilitation can reduce the impact of these disorders on the quality of lif...

Benign Paroxysmal Positional Vertigo: Concomitant Involvement of Different Semicircular Canals

Objectives: We evaluated the simultaneous ipsilateral or contralateral involvement of the posterior and lateral, anterior and lateral, or posterior and anterior semicircular canals in patients with benign paroxysmal positional vertigo (BPPV). Methods: The files of 2,345 patients with BPPV were analyzed. Results: Single-canal BPPV occurred in 2,310 cases (98.5%) — Unilaterally in 2,058 (89.1%) and bilaterally in 252 (10.9%). Multiple-canal BPPV occurred in 35 cases (1.5%). Of these 35 cases, there was simultaneous involvement of the posterior and lateral canals on the same side (23) or on opposite sides (9) in 32 cases (91.4%). Simultaneous involvement of the anterior canal on one side and the posterior canal on the opposite side occurred in 2 cases (5.7%), and that of the anterior canal on one side and the lateral canal on the opposite side occurred in 1 case (2.9%). All cases represented canalithiasis. Conclusions: Multiple-canal BPPV was rare, and usually involved canals on the same side; simultaneous involvement of the posterior and lateral canals was much more common than involvement of the anterior and posterior canals or the anterior and lateral canals. Trauma increased the risk for multiple-canal BPPV, but not the risk for bilateral single-canal BPPV. Cupulolithiasis was not a factor in multiple-canal BPPV.

Reabilitação vestibular personalizada: levantamento de prontuários dos pacientes atendidos no ambulatório de otoneurologia da I.S.C.M.S.P.

The objective of this research study was to verify the efficiency of the personalized vestibular rehabilitation (PVR) in different otoneurologic clinical diseases, as well as set the best protocol option in each case. STUDY DESIGN: clinical retrospective. MATERIAL AND METHOD: A retrospective study was conducted based on the description of the vestibular rehabilitation program of 37 patients aged 21 to 87 years, twenty-six females and eleven males, with different clinical diseases seen in the Otoneurologic Ambulatory of Otolaryngology, department of Irmandade da Santa Casa de Misericordia de Sao Paulo, from 2002 to 2003. Those patients went through otoneurologic evaluation and after diagnosis they were referred to vestibular rehabilitation. Each patient followed a specific program based on diagnosis, clinical disease and symptoms. We performed an individual analysis of the evaluation of each patient and group analysis in order to verify the efficiency of the PVR. CONCLUSION: It was possible to conclude that the PVR program is an effective resource in the treatment of otoneurologic symptoms of patients, consequently improving their quality of life.

Quality of life of individuals submitted to vestibular rehabilitation

UNLABELLED Balance disorders affect social, family and professional activities. Vestibular rehabilitation can reduce the impact of these disorders on the quality of life of individuals with vertigo. AIM to study the influence of vestibular rehabilitation on the quality of life of individuals, correlating it with gender, age, results from computerized vectoelectronystagmography and vertigo. STUDY TYPE Retrospective. MATERIALS AND METHODS Twenty-two individuals were submitted to customized vestibular rehabilitation and the Brazilian Dizziness Handicap Inventory - DHI before and after vestibular rehabilitation. Results from this questionnaire were correlated with gender, age, vestibular assessment and the presence of vertigo. RESULTS all the DHI scores reduced significantly after vestibular rehabilitation. There were no differences among genders; adults and elderly patients; irritative peripheral vestibular syndromes; deficiency syndromes and normal exams; the presence or absence of vertigo. CONCLUSION all the individuals had improvements in their quality of life after customized vestibular rehabilitation.

Comparação de diferentes protocolos de reabilitação vestibular em pacientes com disfunções vestibulares periféricas

PURPOSE: To compare the therapeutic efficacy of two protocols for vestibular rehabilitation in several vestibular disordes. METHODS: Twenty patients with chronic peripheral disorders of both genders (prevalence of females, with 60% of the sample) and mean age of 55 years and 9 months participated in this study. Group 1 carried out exercices based on stimulation of vertical and horizontal vestibulocular reflex, and Group 2 carried out exercices based on a protocol of personalized vestibular rehabilitation. Data analysis considered the complaint manifested during anamnesis and the clinical evolution of the patient during the execution of the exercises. The results obtained from the application of the Dizziness Handicap Inventory questionnaire (DHI) and the dizziness visual analog scale (VAS), both before and after vestibular rehabilitation, were also considered in the analysis. RESULTS: Differences were found in the values obtained in VAS and DHI (physical and functional scales and total score), in both groups. However, the comparison of the groups after rehabilitation showed that Group 2 obtained better scores than Group 1, both in VAS and DHI (functional scale and total value). CONCLUSION: Vestibular rehabilitation allowed significant improvement in otoneurological clinical profile and in self-perception of dizziness, regardless the therapeutic method used. Personalized vestibular rehabilitation was more efficient than the vestibulocular reflex stimulation protocol in improving quality of life of individuals with chronic periferal disorders

Impacto da tontura na qualidade de vida de idosos com vestibulopatia crônica

BACKGROUND: dizziness impact on the quality of life (QoL) of elderly patients with chronic vestibular dysfunction. AIM: to evaluate the association between the impact of dizziness on the QoL of elderly patients with chronic vestibular dysfunction and demographic and clinical variables. METHOD: a prospective study. A hundred and twenty elderly patients with chronic vestibular dysfunction underwent the Brazilian version of the Dizziness Handicap Inventory (DHI). In order to verify the association between the QoL and the demographic and clinical variables, the following testes were used: Mann-Whitney, Kruskal-Wallis and Spearmans correlation coefficient. RESULTS: there were significant associations between the presence of rotating and non-rotating dizziness with the total score of the DHI (p = 0.010) and physical (p = 0.049) and functional (p = 0.009) subscales; between recurrent falls with total DHI (p = 0.004) and physical (p = 0.045), functional (p = 0.010) and emotional (p = 0.011) subscales. Significant correlations were found between functional incapacity and total DHI (r = + 0,557; p < 0.001) and physical (r = + 0,326; p < 0.001), functional (r = + 0,570; p < 0.001) and emotional (r = + 0,521; p < 0.001) subscales. CONCLUSIONS: the impact of dizziness on the QoL is higher in elderly patients with rotating and non-rotating dizziness, recurrent falls and functional incapacity.

Epley’s maneuver in benign paroxysmal positional vertigo associated with Meniere’s disease

UNLABELLED The effects of Epleys maneuver in benign paroxysmal positional vertigo (BPPV) associated with Menières disease are controversial. AIMS To evaluate the progression of positional vertigo and nystagmus after one or more of Epleys maneuvers in BPPV associated with Menières disease, and the recurrence of BPPV. METHOD a retrospective study of 62 patients with BPPV associated with Menières disease, that underwent Epleys maneuver, and that were monitored during 12 months after elimination of positional nystagmus. RESULTS One Epleys maneuver was required to eliminate positional nystagmus in 80.7% of the patients, two in 16.1%, and three in 3.2%; after elimination of nystagmus, positional vertigo was suppressed in 71.0% of the patients, improved in 27.4% and remained unaltered in 1.6%. Four weeks after elimination of positional nystagmus, all patients were asymptomatic. Recurrence of BPPV was seen in 19.4% of the cases, with elimination of the positional vertigo and nystagmus by means of the specific maneuver for the involved canal. CONCLUSION In BPPV associated with Menières disease, vertigo and positioning nystagmus were eliminated with one, two or three Epley maneuvers. BPPV recurrence was resolved by using a specific maneuver for the affected canal.

Balance Rehabilitation Unit (BRU TM) posturography in relapsing-remitting multiple sclerosis

OBJECTIVE To evaluate balance control with Balance Rehabilitation Unit (BRU™) posturography in patients with multiple sclerosis (MS). METHOD A cross controlled study was performed including 39 relapsing-remitting multiple sclerosis patients with scores less than or equal to 4 in the Expanded Disability Status Scale (EDSS), and a homogeneous control group consisting of 65 healthy individuals, matched by the age and gender. The experimental group was distributed according to the EDSS scale scores in 0-2.5 and 3-4. To assess the vestibular system function, the patients underwent a neurotological evaluation, including posturography of the Balance Rehabilitation Unit (BRU™). RESULTS Statistically significant differences were observed when comparing the values of the sway velocity and the ellipse area of the MS 0-2.5 group with the control and the MS 3-4 group with the control. A statistically significant difference was verified between the MS 0-2.5 and the MS 3-4 groups in the condition 3 ellipse area values. CONCLUSION The evaluation of the balance control with posturography of Balance Rehabilitation Unit (BRU™) enables the identification of abnormalities of the sway velocity and confidential ellipse in patients with relapsing-remitting multiple sclerosis.