Maria Elisabete Bovino Pedalini

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.

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.

Repercussão das medidas de correção das comorbidades no resultado da reabilitação vestibular de idosos

The aim of this study was to assess the impact of adequate treatment of concomitant diseases in the elderly undergoing Vestibular Rehabilitation (VR). METHOD: 52 elderly patients with complaints of vertigo and/or imbalance requiring VR participated in this prospective study. The trial was designed as an open clinical assay at the Ear Nose and Throat Department Geriatric Otoneurology Clinic, and was done between 2003 and 2005. Patients were compared with the total group of elderly individuals treated with VR during the same period. RESULTS: 65 diseases were diagnosed in the study group, an average 1.25 diseases per patient. After the treatment of these diseases, patients underwent VR. The effectiveness of VR (remission and partial improvement rates) was 84.5% in the study group against 81.8% in the control group, which was not significant. Remission of symptoms, however, was present in 69.2% of the study group against 43.18% of the control group, which was statistically significant. CONCLUSION:The difference in the effectiveness of VR in both groups highlights the importance of the etiological treatment of concomitant diseases in patients with vestibular disorders.

The treatment of diseases related to balance disorders in the elderly and the effectiveness of vestibular rehabilitation

UNLABELLED The aim of this study was to assess the impact of adequate treatment of concomitant diseases in the elderly undergoing Vestibular Rehabilitation (VR). METHOD 52 elderly patients with complaints of vertigo and/or imbalance requiring VR participated in this prospective study. The trial was designed as an open clinical assay at the Ear Nose and Throat Department Geriatric Otoneurology Clinic, and was done between 2003 and 2005. Patients were compared with the total group of elderly individuals treated with VR during the same period. RESULTS 65 diseases were diagnosed in the study group, an average 1.25 diseases per patient. After the treatment of these diseases, patients underwent VR. The effectiveness of VR (remission and partial improvement rates) was 84.5% in the study group against 81.8% in the control group, which was not significant. Remission of symptoms, however, was present in 69.2% of the study group against 43.18% of the control group, which was statistically significant. CONCLUSION The difference in the effectiveness of VR in both groups highlights the importance of the etiological treatment of concomitant diseases in patients with vestibular disorders.

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.

A eficácia do molde aberto para o controle do zumbido

Hearing aids may be a option to improve tinnitus and hearing loss. AIM: to evaluate tinnitus after one month use of BTE hearing aids with open molds and pressure vent molds in patients with symmetric sensorineural hearing loss. METHODS: 50 patients seen at our Tinnitus Clinic who presented bilateral tinnitus and hearing loss underwent a randomized blind crossover clinical trial: 26 first used BTE hearing aids with open molds, and the remaining 24 first used pressure vent molds. After 30 days using the first mold and a wash-out period, the type of earmold was changed and was applied for another 30-day-period. Tinnitus evaluation was done qualitatively (improved, unchanged and worsened) and quantitatively (variation on a numeric scale from 0 to 10). RESULTS: 82% of the cases reported improvement of tinnitus with at least one type of earmold; there was no significant difference in the reduction of discomfort due to tinnitus in the quantitative and qualitative evaluations. Although similar tinnitus control was obtained with both methods, 66% of the patients preferred the open mold. CONCLUSION: In a short-term evaluation improvement of tinnitus by the use of hearing aids does not depend on earmold ventilation.

Critical analysis of vestibular rehabilitation outcome according to dizziness etiology

UNLABELLED Vestibular rehabilitation (VR) is an excellent therapy for dizziness patients. However, despite well managed, sometimes results are not suitable. AIM evaluate VR outcome between patients according to dizziness etiology. STUDY DESIGN Retrospective review of medical records. METHOD Patients records were analyzed between January 2002 and December 2004. As for inclusion criteria, patients should have had finished VR therapy and an established diagnosis. Patients were included in three VR outcome groups and compared according to etiology. RESULTS according to VR outcome 13 patients had no improvement, 24 had partial improvement and 22 complete improvement. The main etiologies were cervical syndrome, trauma, metabolic disorders, central nervous system disorders, anxiety and mood disorders, autoimmune disease and orthostatic intolerance. Patients with metabolic disorders showed better VR outcome than the others. CONCLUSION VR therapy combined with clinical etiology treatment is an excellent approach for dizziness patients.

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.

The efficacy of open molds in controlling tinnitus

UNLABELLED Hearing aids may be a option to improve tinnitus and hearing loss. AIM to evaluate tinnitus after one month use of BTE hearing aids with open molds and pressure vent molds in patients with symmetric sensorineural hearing loss. METHODS 50 patients seen at our Tinnitus Clinic who presented bilateral tinnitus and hearing loss underwent a randomized blind crossover clinical trial: 26 first used BTE hearing aids with open molds, and the remaining 24 first used pressure vent molds. After 30 days using the first mold and a wash-out period, the type of earmold was changed and was applied for another 30-day-period. Tinnitus evaluation was done qualitatively (improved, unchanged and worsened) and quantitatively (variation on a numeric scale from 0 to 10). RESULTS 82% of the cases reported improvement of tinnitus with at least one type of earmold; there was no significant difference in the reduction of discomfort due to tinnitus in the quantitative and qualitative evaluations. Although similar tinnitus control was obtained with both methods, 66% of the patients preferred the open mold. CONCLUSION In a short-term evaluation improvement of tinnitus by the use of hearing aids does not depend on earmold ventilation.

Arreflexia pós-calórica bilateral: aplicabilidade clínica da reabilitação vestibular

Bilateral vestibular loss is a rare diagnosis among patients with dizziness and imbalance. Nevertheless, symptoms are often disabling and therapy is yet to be establish. AIM: To evaluate and describe the clinical outcome of patients with imbalance due to bilateral vestibular loss after caloric test, treated with An analog visual scale was used to evaluated clinical results. Vestibular Rehabilitation. STUDY DESIGN: Retrospective case report. METHOD: Pre and post treatment outcomes were evaluated in 8 individuals suffering from post caloric bilateral vestibular paresis whose were submitted to vestibular rehabilitation. RESULTS: After Vestibular Rehabilitation, 7 (87,5%) of 8 patients had clinical improvement. CONCLUSION: Although is not expected entirely compensation for bilateral vestibular loss, the vestibular rehabilitation may be use as a therapeutic method for these patients.