Heloisa Helena Caovilla

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.

Revisão sistemática sobre os efeitos da reabilitação vestibular em adultos de meia-idade e idosos

OBJECTIVE: To summarize the results of clinical trials on vestibular rehabilitation (VR) in middle-aged and elderly people with vestibular disorders. METHODS: A search for relevant trials was performed in the databases LILACS, EMBASE, MEDLINE, SciELO, Cochrane, ISI Web of Knowledge and virtual libraries of theses and dissertations. Randomized controlled trials published in the last 10 years and written in English, Portuguese or Spanish were included. The methodological quality of the studies was assessed by the PEDro scale. Results from the included studies were analyzed through a critical review of content. RESULTS: Nine studies were included in the review. Four studies reported on participants aged over 40 years (middle-aged and elderly) and five studies consisted exclusively of elderly subjects (over 60 years). Findings of vestibular dysfunction were diverse and the most common complaints were body imbalance or postural instability (3 studies), and vertigo or dizziness (3 studies). The Visual Analogue Scale (VAS) was the most commonly used instrument to assess subjective perception of symptoms of vestibular dysfunction (4 studies). According to the PEDro scale, four studies were considered to be of good quality. The most common experimental intervention was the Cawthorne & Cooksey protocol (4 studies). For most outcome measures, the studies comparing VR with another type of intervention showed no differences between the groups after the therapy. CONCLUSIONS: The studies included in this review provide evidence for the positive effects of VR in elderly and middle-aged adults with vestibular disturbances.

Electronystagmography versus videonystagmography

UNLABELLED Electronystagmography (ENG) and videonystagmography (VNG) are eye movement recording methods used for the evaluation of balance disorders. AIM To compare literature information on the similarities, differences, advantages e disadvantages between ENG and VNG. MATERIALS AND METHODS review of the scientific literature. RESULTS ENG and VNG are very helpful methods for evaluating balance disorders, due to their capacity to recognize signs of peripheral or central vestibular dysfunction and to pinpoint the side of the lesion. Major advantages of VNG are related to calibration, temporospatial resolution, and recording of horizontal, vertical and torsional eye movements. CONCLUSION VNG is a new technology that presents advantages in the evaluation of eye movements; however, despite its disadvantages, ENG is still considered a valuable test in the clinical setting.

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.

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.

Dos potenciais evocados miogênicos vestibulares nas orelhas comprometida e assintomática na Doença de Ménière unilateral

AIM: To verify whether vestibular evoked myogenic potentials can present abnormalities in the affected ear and in the asymptomatic ear in patients with diagnosis of unilateral Menieres disease. STUDY DESIGN: Transversal cohort. MATERIAL AND METHOD: The vestibular evoked myogenic potentials of 20 patients with unilateral Menieres disease were analyzed. The selection of individuals was based on the history and in clinical evaluation suggestive of unilaterally defined Menieres disease, and with electrocochleography abnormalities in the affected ear. Vestibular evoked myogenic potentials were evaluated in both ears of each patient through absolute latencies of p13 and n23, interaural difference of latency of peaks p13 and n23 and amplitude p13-n23 asymmetry rate. RESULTS: Vestibular evoked myogenic potentials were altered in 35.0% of the affected ears and in 25.0% of the asymptomatic ears. The alterations were: absence of responses in seven cases, prolongation of p13 latency in three cases, and increase in interaural amplitude difference ratio in one case. CONCLUSION: The vestibular evoked myogenic potentials can present abnormalities in the affected and asymptomatic ears in patients with diagnosis of unilaterally defined Menieres disease.

Vestibular rehabilitation with virtual reality in Ménière's disease

UNLABELLED Virtual reality technology can provide a wide range of sensory stimuli to generate conflicts of varying degrees of complexity in a safe environment. OBJECTIVE To verify the effect of a virtual realitybased balance rehabilitation program for patients with Menières disease. METHOD This observational clinical study included 44 patients aged between 18 and 60 years diagnosed with Menières disease submitted to a controlled randomized therapeutic intervention. The case and control groups took betahistine and followed a diet. Case group subjects underwent 12 rehabilitation sessions with virtual reality stimuli in a Balance Rehabilitation Unit (BRU TM). Patients were assessed based on DHI scores, the dizziness visual analogue scale, and underwent posturography with virtual reality before and after the intervention. RESULTS After the intervention, the case group showed significantly lower scores in DHI (p < 0,001) and in the dizziness visual analog scale (p = 0.012), and had significantly greater limit of stability areas (p = 0.016) than controls. CONCLUSION Virtual reality-based balance rehabilitation effectively improved dizziness, quality of life, and limit of stability of patients with Menières disease.

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.

Do nistagmo às provas calóricas com ar e com água

The caloric test is an important tool for the assessment of labyrinthine function. OBJECTIVE: To compare the nystagmus response in the caloric tests with air at 50oC and 24oC and with water at 44oC and 30oC. Study Design: Randomized crossover clinical trial. MATERIALS AND METHODS: 40 healthy individuals were submitted to a neurotological evaluation, including caloric tests with air at 50oC and 24oC and water at 44oC and 30oC. RESULTS: Comparing the air and water caloric tests, there were no significant differences among the post-caloric nystagmus slow-phase velocity in relation to the stimulation order, between ears and between the values of unilateral weakness and directional preponderance. The slow-phase velocity values were higher with water (p = 0.008, p < 0.001), and cold stimulation produced stronger responses (p < 0.001). CONCLUSION: Comparing 50oC and 24oC air caloric test and 44oC and 30oC water caloric test, we observed similar slow-phase velocity values for both ears, higher responses in the cold temperature and in the test with water, and similar results of unilateral weakness or directional preponderance for post-caloric nystagmus in both tests.

Effects of conventional versus multimodal vestibular rehabilitation on functional capacity and balance control in older people with chronic dizziness from vestibular disorders: design of a randomized clinical trial

BackgroundThere are several protocols designed to treat vestibular disorders that focus on habituation, substitution, adaptation, and compensation exercises. However, protocols that contemplate not only vestibular stimulation but also other components that are essential to the body balance control in older people are rare. This study aims to compare the effectiveness of two vestibular rehabilitation protocols (conventional versus multimodal) on the functional capacity and body balance control of older people with chronic dizziness due to vestibular disorders.Methods/designA randomized, single-blind, controlled clinical trial with a 3 months follow-up period will be performed. The sample will be composed of older individuals with a clinical diagnosis of chronic dizziness resulting from vestibular disorders. The subjects will be evaluated at baseline, post-treatment and follow-up. Primary outcomes will be determined in accordance with the Dizziness Handicap Inventory (functional capacity) and the Dynamic Gait Index (body balance). Secondary outcomes include dizziness features, functional records, body balance control tests, and psychological information. The older individuals (minimum sample n = 68) will be randomized to either the conventional or multimodal Cawthorne&Cooksey protocols. The protocols will be performed during individual 50-minute sessions, twice a week, for 2 months (a total of 16 sessions). The outcomes of both protocols will be compared according to the intention-to-treat analysis.DiscussionVestibular rehabilitation through the Cawthorne&Cooksey protocol has already proved to be effective. However, the addition of other components related to body balance control has been proposed to improve the rehabilitation of older people with chronic dizziness from vestibular disorders.Trial registrationACTRN12610000018011