Maurício Malavasi Ganança

The therapeutic effects of cyclacillin in acute sinusitis: in vitro and in vivo correlations in a placebo-controlled study.

SummaryIn 50 adults with bacterial sinusitis, cyclacillin (1500 mg. per day for 7 days) proved significantly more effective than placebo in eliminating the signs and symptoms and in eradicating the causative microorganisms, (Staphylococcus aureus, Proteus mirabilis, and Staph, epidermidis were most frequently isolated in this series). Sixty percent of the cultures in the cyclacillin series were sterilized, compared with only 10% in the placebo series. Globally, 93% of the cyclacillin-treated patients and only 55 % of the placebo-treated patients were considered improved. Of the P. mirabilis strains encountered, 72% were eradicated by cyclacillin (only 40% by placebo) despite the relatively high cyclacillin M.I.C.s for this microorganism (50 to 100 μg/ml.). Cyclacillin was much more effective in treating human sinusitis than would have been anticipated from the M.I.C.s alone.

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.

Factors relating to depressive symptoms among elderly people with chronic vestibular dysfunction

OBJECTIVE To identify factors relating to depressive symptoms among elderly people with chronic vestibular dysfunction. METHOD This was a cross-sectional study in which 120 elderly people with chronic vestibular dysfunction answered the Geriatric Depression Scale questionnaire. Multivariate linear regression analysis was performed (p<0.05 and 95% CI). RESULTS The patients presented a mean score of 12.86 +/- 6.39 points on the Geriatric Depression Scale, and 67 of them (55.8%) scored above the cutoff of 11 points. The predictive model for worsening of depressive symptoms was composed of female gender, memory and concentration disorders, insomnia, hearing disorders, poor sight, nonuse of walking aids and greater emotional impact of dizziness. CONCLUSION Greater numbers of depressive symptoms among elderly people with chronic vestibular disease were related to the presence of memory and concentration disorders, insomnia, hearing disorders, very poor sight, greater emotional impact of dizziness, female gender and nonuse of walking aids.

Betahistine in the treatment of tinnitus in patients with vestibular disorders

UNLABELLED Betahistine is a medicine used to treat vestibular disorders that has also been used to treat tinnitus. AIM To assess the effects of betahistine on tinnitus in patients with vestibular disorders. MATERIAL AND METHOD Retrospective data were collected from patient records for individuals presenting with vestibular dysfunction and tinnitus. Patients included had received betahistine 48 mg/day and clinical outcomes were compared with a control group comprising individuals who were unable to receive betahistine due to gastritis, ulcers, pregnancy, asthma or hypersensitivity to the drug. Patients underwent control of any aggravating factors and also standard vestibular exercises as a basis for treatment. The intensity, frequency and duration of tinnitus were assessed on the first day of dosing and after 120 days of treatment. Clinical improvement was defined as a total or partial reduction of tinnitus after treatment. RESULTS Clinical improvement was observed in 80/262 (30. 5%) of patients treated with betahistine and 43/252 (17. 1%) of control patients. Betahistine significantly (p<0. 0001) improved tinnitus in treated individuals. CONCLUSIONS The daily dosage of 48 mg of betahistine during 120 consecutive days is useful to reduce or eliminate tinnitus in patients with vestibular disorders.

Disability rank in vestibular older adults

Aim:  To analyze the hierarchical structure of activities of daily living (ADL) among vestibular older adults, according to its power to discriminate disability.

Achados à prova calórica e canal semicircular acometido na vertigem posicional paroxística benigna

PURPOSE: To characterize caloric test results in benign paroxysmal positional vertigo patients, according to the damaged semicircular canal. METHODS: The data of 1033 patients submitted to Dix-Hallpike testing, positional nystagmus and electronystagmography were analyzed. Caloric test results were compared to the damaged semicircular canals and were submitted to statistical analysis. RESULTS: In cases with posterior canal damage, there was prevalence of normal responses compared to abnormal results (p<0.0001); hypo activity was more prevalent than hyperactivity (p<0.0001) and directional preponderance (p<0.0001), and hyperactivity more prevalent than directional preponderance (p<0.0001). In cases with lateral canal damage, normal responses were more prevalent than hypo activity (p<0.0001) and hyperactivity (p<0.0001); there was a tendency of prevalence of hypo activity over hyperactivity (p=0.0771), and directional preponderance was not observed. In cases with anterior canal damage, normal responses were more prevalent than hypo activity (p<0.0001); hyperactivity and directional preponderance were not observed. CONCLUSION: In the caloric test of benign positional paroxysmal vertigo patients, normal responses, hypo activity, hyperactivity or directional preponderance of post-caloric nystagmus occur in decreasing order of prevalence when the posterior canal is damaged; normal responses are more prevalent than hypoactive or hyperactive caloric responses, and there is a tendency of prevalence of hypoactive over hyperactive caloric responses when the lateral canal is damaged; normal responses are more prevalent than hypoactive caloric responses when the anterior canal is damaged.

Controversies and outlooks on Vestibular Rehabilitation

Brazilian Journal of otorhinolaryngology 77 (2) March/april 2011 http://www.bjorl.org / e-mail: revista@aborlccf.org.br Vestibular rehabilitation (Vr) is well accepted today as an efficacious treatment option for body balance disorders. in order to enjoy its full efficacy, it must be employed within criteria based on the patient’s diagnosis and clinical situation. The department of neurotology of the Brazilian Association of Otorhinolaryngology and neck and Facial Surgery has been receiving numerous questions about the current status of Vr. The questions are basically associated with treatment: who is responsible for indicating it; who does it; which is the best method for a given disorder, etc. in our view, it is only the patient’s physician who can consider and indicate the best treatment option for his/her patient – Vr, in this case. The medical professional who is following the patient must master the physiology of posture and movement and, also, how the central nervous system coordinates body balance when facing the tasks presented to the individual. There is no specific field in charge of Vr. Today, different fields of medicine and paramedicine have been dedicating studies to body balance. Among the specialists who work with this topic, the otorhinolaryngologist plays a fundamental role, because he/she is the professional who has the anatomo-physiological knowledge concerning the system responsible for movement perception and integration – the vestibular system. The enT is also the professional who has the necessary skills to surgically approach the temporal bone. Given the growing interest of our members, in 2011 our department of neurotology intends to host a symposium with the goal of presenting and discussing current views on Vr, considering all its aspects. The “Controversies and Outlooks of Treatment in neurotology” is scheduled for november of the present year, in a venue yet to be defined, in the city of São paulo.

Postural control in underachieving students✩✩Please cite this article as: Tomaz A, Ganança MM, Garcia AP, Kessler N, Caovilla HH. Postural control in underachieving students. Braz J Otorhinolaryngol. 2014;80:105-10.

UNLABELLED Postural balance is a sensory-motor function resulting from a learning process. OBJECTIVE To evaluate the postural control of underachieving students through static posturography together with virtual reality stimulation. METHODS This was a controlled cross-sectional study of a group of 51 underachieving students and a control group of 60 students with good school performance, with no history of vestibular disorders or neurotological complaints, volunteers from the community, age- and gender-matched. The students were submitted to Balance Rehabilitation Unit (BRU™) posturography. RESULTS A total of 111 students aged 7 to 12 years old were evaluated. At posturography evaluation, there was no significant difference between the limit of stability area (cm2) of the control group and the experimental group. The comparison between groups demonstrated a statistically significant difference (p < 0.05) in the values of sway velocity (cm/s) and center of pressure area (cm2) in the ten sensory conditions evaluated. CONCLUSION Posturography with virtual reality stimulation, allows for the identification of incapacity to maintain postural control, with or without visual deprivation, and the assessment of visual, somatosensory, and vestibular-visual interaction conflict in underachieving students.Postural balance is a sensory-motor function resulting from a learning process. Objective: To evaluate the postural control of underachieving students through static posturography together with virtual reality stimulation. Methods: This was a controlled cross-sectional study of a group of 51 underachieving students and a control group of 60 students with good school performance, with no history of vestibular disorders or neurotological complaints, volunteers from the community, age- and gender-matched. The students were submitted to Balance Rehabilitation Unit (BRU(tm)) posturography. Results: A total of 111 students aged 7 to 12 years old were evaluated. At posturography evaluation, there was no significant difference between the limit of stability area (cm2) of the control group and the experimental group. The comparison between groups demonstrated a statistically significant difference (p < 0.05) in the values of sway velocity (cm/s) and center of pressure area (cm2) in the ten sensory conditions evaluated. Conclusion: Posturography with virtual reality stimulation, allows for the identification of incapacity to maintain postural control, with or without visual deprivation, and the assessment of visual, somatosensory, and vestibular-visual interaction conflict in underachieving students.

Otoneurological evaluation: current good practice✩✩Please cite this article as: Gonçalves DU, Ganança FF, Bottino MA, Greters ME, Ganança MM, Mezzalira R, et al. Otoneurological evaluation: current good practice. Braz J Otorhinolaryngol. 2014;80:95.

Atualmente, a otoneurologia é entendida como o estudo e avaliação do equilíbrio corporal. Sendo assim, as avaliações de outrora foram complementadas por uma série de exames e procedimentos que, em conjunto, avaliam o complexo sistema de equilíbrio. A audiometria e a imitanciometria são partes integrantes da avaliação otoneurológica, ao lado da avaliação vestibular. A avaliação vestibular clássica consta de três etapas: 1. Anamnese; 2. Testes de observação direta, que compreendem o equilíbrio estático e dinâmico, as provas de coordenação e os testes do reflexo vestíbulo ocular (impulso cefálico, desvio da linha do olhar, nistagmo espontâneo e semiespontâneo); 3. Oculografia, avaliação monitorizada por eletrodos ou óculos de infravermelho, que compreendem o nistagmo espontâneo, semiespontâneo e fixação ocular; a oculomotricidade (sacadas, rastreio e nistagmo optocinético); os testes posicionais e de posicionamento e a prova calórica (PC) bilateral quente e fria, com intervalos adequados entre as estimulações. A parte técnica da oculografia não possui significado clínico sem a anamnese e o exame físico do doente, pois a interpretação deste depende da avaliação conjunta e da interação entre sintoma e sinal oculográfico. Portanto, a participação do médico é condição necessária para uma conclusão adequada. A execução da avaliação otoneurológica completa tem a duração aproximada de uma hora, na ausência de intercorrências. A PC fornece informação a respeito do funcionamento do canal semicircular lateral após estímulo térmico e costuma estar alterada nos casos de falência vestibular periférica uni ou bilateral. O exemplo clássico de alteração da prova calórica é a neurite vestibular, em que observamos a hiporreflexia pós-estimulação. No entanto, a PC pode estar normal em várias vestibulopatias. Entre os diagnósticos otoneurológicos que podem apresentar PC normal estão a migrânea, a vertigem posicional paroxística benigna (VPPB), a tontura crônica subjetiva ou doenças em que ocorra flutuação da função vestibular (como a Doença de Menière em seu período de remissão). Portanto, a prova calórica como exame isolado pode não diagnosticar várias doenças do sistema vestibular. É necessária a avaliação médica para que sejam formuladas hipóteses claras e fundamentadas com a finalidade de emitir laudos e indicar exames complementares que confirmem a doença em questão. Entre esses outros exames estão a posturografia, os testes eletrofisiológicos, o videoteste do impulso cefálico, a cadeira pendular e os exames de imagem.