Maria Cecília Lorenzi

The Influence of Voluntary Muscle Contractions upon the Onset and Modulation of Tinnitus

Objective: To evaluate the frequency of tinnitus onset (in normal subjects) and modulation (in tinnitus patients) during muscle contractions, estimating possible risk factors. Material and Method: This case-control study enrolled 121 tinnitus patients and 100 healthy volunteers who underwent medical history, ENT examination and 16 maneuvers of muscular contraction (head, neck and limbs). Modulation data were compared between patients with and without normal audiometry, well-defined diagnosis and symptoms of craniomandibular disorders. Results: The ability to modulate tinnitus (65.3%) was significantly higher than that to originate tinnitus (14.0%). The head and neck musculature was significantly more efficient than that of the limbs. Audiometric pattern, well-defined etiology and symptoms of craniomandibular disorders showed no relation to tinnitus modulation. Conclusions: Somatic modulation is a characteristic aspect of tinnitus.

Somatic Modulation of Tinnitus: Test Reliability and Results after Repetitive Muscle Contraction Training:

Objectives: We sought to study the reliability of tinnitus modulation by muscle contractions and to observe the effect of their prolonged repetition. Methods: Thirty-eight patients with tinnitus underwent 9 maneuvers of muscle contractions in test and retest situations. After a 2-month training period of repeating the maneuvers, tinnitus modulation and daily perception were evaluated. Results: There was no difference between the occurrence of tinnitus modulation in test (57.9%) and retest (63.2%) situations. After 2 months, the occurrence of modulation during the maneuvers was similar (55.3%), but a new pattern showed an increase in tinnitus improvement and a decrease in tinnitus worsening. The daily perception of tinnitus was unchanged. Conclusions: Maneuvers of head and neck muscle contractions evoked tinnitus modulation in a frequent and reliable manner. Also, the repetition of such maneuvers for 2 months altered the pattern of modulation.

Sudden Deafness and Lyme Disease

Objectives/Hypothesis Otolaryngological manifestations are common in Lyme disease, affecting up to 75% of patients. One of these symptoms is sudden deafness. Hearing loss has been frequently described in Lyme disease; on the other hand, titers seropositive for Borrelia burgdorferi, the causal agent of this disease, have been found in almost 20% of cases of sudden deafness. No consensual information exists on the outcome of Borrelia‐seropositive patients or on the importance of determining Borrelia antibody titers. The present study aimed to determine the prevalence of seropositivity for Borrelia in sudden deafness, describing clinical characteristics and outcomes.

Pharyngeal dimensions in healthy men and women

INTRODUCTION Epidemiological studies reveal a high male prevalence of obstructive sleep apnea syndrome. A possible explanation for this male predominance is the existence of anatomical differences in the upper airway between men and women. METHODS The upper airways of 10 male and 10 female healthy volunteers were prospectively evaluated by magnetic resonance imaging. Anatomical pharyngeal and column cross-sectional linear measurements were made in sagittal T1 and axial T1 and T2 weighted fast spin-echo images. RESULTS Men had significantly greater mean sagittal pharyngeal structural dimensions compared to women for all structures with the exception of the craniocaudal length of the soft palate and the thickness of the submentonian fat. In contrast, cross-sectional linear dimensions were similar in men and women with the exception of the laterolateral tongue length, which was greater in men. All mean linear measurements of the pharyngeal air column were similar in men and women at all studied levels. CONCLUSIONS Men and women present pharyngeal air columns with similar dimensions, but in women this column is surrounded by smaller structures, which might imply a smaller effort to keep its patency. Our data suggest the existence of an anatomical protective factor in women against the upper airway collapse.

Vestibular Rehabilitation Therapy in Children

Objectives: Vestibular disturbances are underdiagnosed in children. However, balance impairment may compromise the normal development of affected children. The appropriate therapeutic approach has not been agreed on for this age group. Vestibular rehabilitation therapy has excellent results in adults, but very few data exist regarding its results in children. We evaluated through clinical assessment and computerized dynamic posturography the outcome of children with peripheral vestibular disturbances undergoing vestibular rehabilitation therapy and observed the influence of learning and of central nervous system maturation on posturography retest results. Methods: Sixteen children (10 boys and 6 girls) with peripheral vestibular disorders (mean age, 8 yr 7 mo) constituted the cohort and were consecutively treated with vestibular rehabilitation therapy. Symptomatic children underwent pre- and posttreatment computerized dynamic posturography. Their outcome was clinically assessed. Another 16 asymptomatic children, paired by sex and age, underwent two computerized dynamic posturography procedures with the same time interval as that of the symptomatic group. Results: All children completed the treatment. Total recovery of symptoms occurred in nine (56.3%) patients, whereas a dramatic partial recovery was observed in the remaining seven (43.7%) children. Posturography Conditions 5 and 6, the vestibular ratio of the sensory analysis, and the composite equilibrium score had a significant quantitative improvement after vestibular rehabilitation therapy. No adverse reactions occurred to the exercises. No statistically significant posturography changes were observed in the asymptomatic children. Conclusion: Vestibular rehabilitation therapy seems to be a safe and efficacious therapeutic option in children with peripheral vestibular disturbances.

Sensory organization test in elderly patients with and without vestibular dysfunction.

Conclusions. Elderly subjects without vestibular dysfunction had an overall worse performance as compared with the group of normal adults, confirming that age has a negative impact on balance. The group of elderly subjects with vestibular dysfunction had more important balance alterations than those without, confirming that vestibular dysfunction has a major impact on balance control in the elderly. The visual and vestibular systems presented more important functional changes with ageing than the somatosensory system. Objective. The main sensory input comes from the visual, vestibular and somatosensory systems; all of them may present changes due to ageing. This study aimed to investigate the performance of vestibular, visual and somatosensory systems in aged subjects with or without vestibular dysfunction, as compared to normal adults. Subjects and methods. Dynamic posturography was used in 60 elderly subjects without vestibular dysfunction (Gaa), 60 with vestibular dysfunction (Gas) and 58 normal adults (Gn). Results. For condition 1 and 2 Gn performed significantly better than Gaa and Gas, with no difference between the latter. In conditions 4, 5 and 6 the performance of Gn was statistically superior to that of Gaa, which in turn, was better than that of Gas. The somatosensory responses showed no significant differences between the three groups. The performance of visual and vestibular systems showed progressive dysfunction: Gn did better than than Gaa, and Gaa did better than Gas.

Magnetic resonance imaging of the temporal bone in patients with Ménière's disease.

Menieres disease (MD) is still controversial in several aspects. The vestibular aqueduct, the osseous channel that carries the endolymphatic duct and sac, has previously been studied by tomography and computed tomography, with shortening and narrowing of this structure observed. These findings are apparently correlated to the development of the endolymphatic hydrops present in MD and related to its episodic symptoms. In studying the endolymphatic duct, the key structure in the pathology of this disease, magnetic resonance imaging (MRI) studies of the temporal bone were performed in 12 patients with unilateral MD and in 9 bilateral cases; the results were compared with images obtained from 30 normal ears. The endolymphatic duct appeared to be statistically less visible in MD patients, with no difference between symptomatic and asymptomatic ears in the presence of unilateral disease. No relationship was found between visualization of the endolymphatic duct and time of evolution or response to clinical treatment in these cases. The distance from the posterior semicircular canal to the posterior temporal border was found to be bilaterally reduced in MD. The authors conclude that although the demonstration of endolymphatic hydrops ?in vivo? is not yet possible by MRI, some features can be observed that can support a clinical hypothesis of MD.

Evaluation of the treatment of vestibular disorders in children with computerized dynamic posturography: preliminary results

OBJECTIVE This study aimed at evaluating dynamic posturography as an evaluation method in children with balance problems due to peripheral vestibulopathy, before and after treatment with vestibular rehabilitation, establishing its correlation with classical clinical evaluation. METHOD Ten children (six boys and four girls) with vestibular symptoms of peripheral origin were evaluated through a complete clinical history and with dynamic computerized posturography after being treated by vestibular rehabilitation therapy. Posturographic data were analyzed and compared to standard clinical evaluation parameters. RESULTS Dynamic posturography showed a significant improvement of condition 1 (orthostatic position, fixed support and open eyes) and 5 (orthostatic position, sway-referenced support and closed eyes) of the vestibular function and of the composite balance score. The data showed significant correlation with the clinical improvement observed. A significant reduction of proprioceptive influence was also observed. CONCLUSIONS Data showed that the dynamic posturography adds important quantitative information to the conventional clinical evaluation of vestibular symptoms, especially in children.

Efeitos da pressão positiva contínua em vias aéreas sobre os sintomas nasofaríngeos em pacientes com a síndrome da apnéia obstrutiva do sono

BACKGROUND: Nasal and pharyngeal symptoms are common in patients with obstructive sleep apnoea (OSA) treated with nasal continuous positive airway pressure (CPAP). However, these symptoms are common in OSA patients even before the treatment. OBJECTIVE: Determine the impact of nasal CPAP on nasal and pharyngeal symptoms in OSA patients. METHOD: Thirty-five adult patients (28 males), age 54±10 years old, with OSA diagnosed by polissonography. All patients answered to a questionnaire about the presence and quantification of sneezing, rhinorrhea, nasal pruritus, obstruction and bleeding, nasal and pharyngeal dryness. The questionnaire was answered before and after at least three months of CPAP therapy. RESULTS: The apnea-hypopnea index was 50±25 events per hour. Twenty six patients (74%) presented at least one naso-pharingeal symptom before treatment. Nasal obstruction was the most common symptom, being referred by 18 patients (51%). Among the patients that were initially assymptomatic (n=9), 78% developed adverse nasal reactions to CPAP. In contrast, among the patients that presented nasal symptoms before treatment, there was a significant reduction in nasal obstruction, nasal and throat dryness scores as well as nasal bleeding after CPAP therapy. CONCLUSION: Nasal na pharyngeal symptoms are frequent in OSAS patients. CPAP therapy may originate nasal symptoms in patients previously assymptomatic, as well as reduce the intensity of these symptoms in patients that are previously symptomatic.

Treatment Comparison Between Dexamethasone and Placebo for Idiopathic Facial Palsy

Idiopathic facial palsy (Bell’s palsy) was first described by Charles Bell in 1883 [1]. Since then, the treatments employed have been empirical in some way, as no etiological cause has been well established. Some theories are widely accepted such as viral, ischemic, and autoimmune origin [2–4]. All of them are based on vascular changes causing edema with neural compression and then neuropraxia. The drug most commonly used is cortisone, with the finality of aging on the edema. In the literature we have found no citations about the use of dexamethasone, although it is known to have an excellent effect in acute processes of the central nervous system because of its fast efficacy and aggregation on neuronal membrane. We observed that many patients treated with different drugs had a good evolution too. The aim of this study is to find out the real advantage of treating patients with dexamethasone by analyzing the final evolution of the paralysis and the recuperation time.