Ricardo Schaffeln Dorigueto

Benign paroxysmal positional vertigo recurrence and persistence

UNLABELLED Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorders. AIM To study the recurrence and persistence of BPPV in patients treated with canalith repositioning maneuvers (CRM) during the period of one year. STUDY DESIGN longitudinal contemporary cohort series. MATERIALS AND METHODS One hundred patients with BPPV were followed up during 12 months after a treatment with CRM. Patients were classified according to disease evolution. Aquatic physiotherapy for vestibular rehabilitation (APVR) protocol was applied in cases of persistent BPPV. RESULTS After CRM, 96% of the patients were free from BPPVs typical nystagmus and dizziness. During the follow up period of 1 year, 26 patients returned with typical BPPV nystagmus and vertigo. Nystagmus and vertigo were persistent in 4% of the patients. Persistent BPPV presented improvement when submitted to APVR. CONCLUSION During the period of one year, BPPV was not recurrent in 70% of the patients, recurrent in 26% and persistent in 4%.

Blood glucose and insulin levels in patients with peripheral vestibular disease

Metabolic disorders can cause dizziness. Aim: to study the prevalence of glucose and glucose-insulin alterations in patients with peripheral vestibular disorders by studying the four-hour glucose-insulin curve; to check at what time there was the highest prevalence of altered cases and whether the glucose and insulin curves together are better than the isolate glucose curve and fasting glucose curve. Materials and Methods: retrospective study, analyzing 81 four-hour glucose-insulin curves in patients with peripheral vestibular dizziness. Results: Four-hour glucose-insulin curve alterations happened in 87.7% of the patients. Hypoglycemia was seen in 61.7% of the cases, hyperinsulinemia in 55.5%, hyperglycemia in 27.2%, glucose intolerance in 12.3% and hypoinsulinemia in 1.2%. Normal tests were seen in 12.3 % of the cases and altered fasting glucose in 23.5%. Conclusions: The fourhour glucose-insulin curve analysis showed that 87.7% of the patients with dizziness and suspicion of peripheral vestibular disorder had glucose or insulin metabolism disorders. The highest number of alterations was seen up to the third and fourth hour of the glucose-insulin curve. The glucose and insulin curves together overcame the glucose curve alone and fasting glucose curve in regards of the prevalence of altered cases.

Repeated Epley’s maneuver in the same session in benign positional paroxysmal vertigo

AIM To assess whether more than one Epleys maneuver in the same session, compared to a single one, decreases the number of sessions necessary to suppress positional nystagmus. METHODS Epleys maneuver was done in 123 patients with BPPV due to unilateral posterior semicircular canal canalolithiasis. The number of sessions for positional nystagmus suppression was compared in two groups of patients. Group I consisted of 75 patients submitted to a single Epleys maneuver on weekly sessions and group II consisted of 48 patients that were submitted to four Epleys maneuvers during the first session. RESULTS Group II showed greater nystagmus latency and duration than group I (p<0.05). The number of sessions and standard deviation showed by group I was greater than in group II (p=0.008). We observed a significant association between number of sessions and group (p=0.039) studied. Group II had 21.4% more nystagmus-free patients following only one session (CI95% [7.7% - 35.1%]). CONCLUSION Repeated Epleys maneuvers in less sessions rendered more positional nystagmus-free patients when compared to those submitted to more sessions of single maneuvers.

Recorrência e persistência da vertigem posicional paroxística benigna

Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorders. AIM: To study the recurrence and persistence of BPPV in patients ...

Tissue response evaluation of the mucosa of the tympanic cavity of guinea pigs, when receiving biodegradable implant

PURPOSE To evaluate the tissue response of the mucosa of the tympanic cavity of guinea pigs, when receiving biodegradable implant. METHODS A total of 20 male guinea pigs were divided into 2 groups. After paracentesis in both ears, a biodegradable polymer of poly lactic-co-glycolic acid was implanted in only one middle ear. Histological analysis using neutrophil exudate and vascular neoformation (acute inflammation) and fibroblast proliferation and mononuclear inflammatory cells (chronic inflammation) as parameters was performed after 10 and 30 days of survival (groups 1 and 2, respectively). RESULTS Four ears in group 1 and 7 in group 2 had an increase of neutrophil exudate. Vascular neoformation occurred in ears with or without the implant, in both groups. Fibroblast proliferation and mononuclear inflammatory cells (lymphocytes and macrophages) increased in ears with implant in group 2. CONCLUSION The tissue response by histological analysis of the mucosa of the tympanic cavity of guinea pigs, when receiving biodegradable implant, showed no statistically significant difference between ears with or without the implant.

Vestibular evoked myogenic potential in unilateral vestibular hypofunction

Abstract Conclusion: The patients with unilateral chronic vestibular hypofunction detected by caloric test demonstrated at least some sort of altered vestibular evoked myogenic potential (VEMP) in 63.63% of the cases. The VEMP altered side was the same as the unilateral vestibular hypofunction side in 54.54% of the cases and was the opposite side in 24.24%. The VEMP test improved functional vestibular assessment in patients with unilateral caloric hypofunction. Objectives: To analyze VEMP in patients with chronic dizziness and unilateral vestibular hypofunction and verify findings according to the side and structures involved. Methods: This was an observational study. In all, 66 subjects were evaluated by VEMP (tone bursts/1000 Hz/100 dBnHL/bandpass filtered 10–1500 Hz/4.3 Hz rate), 33 with unilateral vestibular hypofunction, detected by caloric test and clinical data, and 33 control subjects, matched by gender and age. Amplitude of the p13-n23, asymmetry index of the amplitude, p13 and n23 latencies, p13 and n23 interaural difference and threshold were analyzed. Simple descriptive analysis was carried out using the t test, Shapiro-Wilks test, and Mann-Whitney test, p < 0.05. Results: VEMP was altered in patients with unilateral vestibular hypofunction in 63.63% of cases. Thirteen of them were ipsilateral to the vestibular hypofunction and three were contralateral to the vestibular hypofunction. In five cases, VEMP were bilaterally altered.

Vestibular evoked myogenic potentials and digital vectoelectro- nystagmography's study in patients with benign paroxysmal positional vertigo

Summary Introduction: Benign Paroxysmal Positional Vertigo (BPPV) is a very common vestibular disorder characterized by brief but intense attacks of rotatory vertigo triggered by simple rapid movement of the head. The integrity of the vestibular pathways can be assessed using tests such as digital vectoelectronystagmography (VENG) and vestibular evoked myogenic potentials (VEMP). Aim: This study aimed to determine the VEMP findings with respect to latency, amplitude, and waveform peak to peak and the results of the oculomotor and vestibular components of VENG in patients with BPPV. Method: Although this otoneurological condition is quite common, little is known of the associated VEMP and VENG changes, making it important to research and describe these results. Results: We examined the records of 4438 patients and selected 35 charts after applying the inclusion and exclusion criteria. Of these, 26 patients were women and 9 men. The average age at diagnosis was 52.7 years, and the most prevalent physiological cause, accounting for 97.3% of cases, was ductolithiasis. There was a statistically significant association between normal hearing and mild contralateral sensorineural hearing loss. The results of the oculomotor tests were within the normal reference ranges for all subjects. Patients with BPPV exhibited symmetrical function of the semicircular canals in their synergistic pairs (p < 0.001). The caloric test showed statistically normal responses from the lateral canals. The waveforms of all patients were adequate, but the VEMP results for the data-crossing maneuver with positive positioning showed a trend toward a relationship for the left ear Lp13. There was also a trend towards an association between normal reflexes in the caloric test and the inter-peak VEMP of the left ear. It can be concluded that although there are some differences between the average levels of the VENG and VEMP results, these differences were not statistically significant. Conclusion: In conclusion, the results of audiologic assessment, hearing thresholds, positioning maneuvers, and caloric tests have no effect on the quantitative results of VEMP. Additional research is warranted to establish the relationships among VENG, VEMP, and BPPV, especially as concerns the oculomotor tests.Introduction:  Benign Paroxysmal Positional Vertigo (BPPV) is a very common vestibular disorder characterized by brief but intense attacks of rotatory vertigo triggered by simple rapid movement of the head. The integrity of the vestibular pathways can be assessed using tests such as digital vectoelectronystagmography (VENG) and vestibular evoked myogenic potentials (VEMP). Aim:  This study aimed to determine the VEMP findings with respect to latency, amplitude, and waveform peak to peak and the results of the oculomotor and vestibular components of VENG in patients with BPPV. Method:  Although this otoneurological condition is quite common, little is known of the associated VEMP and VENG changes, making it important to research and describe these results. Results:  We examined the records of 4438 patients and selected 35 charts after applying the inclusion and exclusion criteria. Of these, 26 patients were women and 9 men. The average age at diagnosis was 52.7 years, and the most prevalent physiological cause, accounting for 97.3% of cases, was ductolithiasis. There was a statistically significant association between normal hearing and mild contralateral sensorineural hearing loss. The results of the oculomotor tests were within the normal reference ranges for all subjects. Patients with BPPV exhibited symmetrical function of the semicircular canals in their synergistic pairs (p  Conclusion:  In conclusion, the results of audiologic assessment, hearing thresholds, positioning maneuvers, and caloric tests have no effect on the quantitative results of VEMP. Additional research is warranted to establish the relationships among VENG, VEMP, and BPPV, especially as concerns the oculomotor tests.

Balance Rehabilitation with Virtual Games in Elderly with Vestibular Disorders

Objectives: Evaluate the effectiveness of balance rehabilitation protocol with virtual games in elderly with vestibular disorders. Method: Pilot prospective clinical trial at a university center for balance disorders. Nine older patients of both genders diagnosed with vestibular disorder were elected. Their symptoms, static posturography parameters (functional reserve and velocity of oscillation (VOS) in ten visual-vestibular interaction and somatosensory conflicts) and the Dynamic Gait Index were evaluated before and after vestibular rehabilitation. The virtual games rehabilitation program used the Wii Balance Board. Patients were put in situations causing dizziness and postural instability, such as walking with eyes open and closed on a stable and unstable surface, beyond optokinetic stimuli, saccadic, and pursuit eye visuovestibular interaction. Sessions lasted 60 minutes, two times per week for eight weeks. Results: After treatment, there was significant reduction of the following symptoms: dizziness (P < 0.01), motion sickness (P < 0.05), postural instability (P < 0.01), and fear of falling (P < 0.05).The Dynamic Gait Index increased in all subjects and was above the cutoff score for high risk of falling. Mean values of functional reserve and VOS improved in all conditions after vestibular rehabilitation (P < 0.05), exception in conditions 2,4,9, and 10 of VOS. Conclusions: Preliminary results suggest that balance rehabilitation program using virtual games is effective in improving symptoms and clinical parameters related to static and dynamic balance in older patients with balance disorders.

Gait Speed Seems to Predict Body Balance in Elderly Women

Objectives: Determine the influence of body fat distribution, functional capacity, gait speed, and peak oxygen uptake on body balance of elderly women. Methods: Prospective clinical trial: at a university medical center. The sample consisted of 41 healthy elderly women aged from 61 to 77 years-old (68.1 ± 0.7 years). Body fat distribution was assessed by subcutaneous central body adiposity and waist girth. Functional capacity was determined by time taken to move from seated to standing position (TSSP) and time to tie sneakers. Gait speed was assessed by the time to walk 3.33 m. Peak oxygen uptake (VO2peak) was measured during cardiopulmonary exercise testing. Body balance was assessed by the time to maintain an unipodal position during 30 seconds. Results: There were no significant prediction power for subcutaneous central body adiposity (adjusted R2=.01; P =.471), waist girth (adjusted R2=.01; P =.355), TSSP (adjusted R2=.04; P=.107), time to tie sneakers (adjusted R2 =.01; P = .413) or VO2peak (adjusted R2=.03; P = .747) with body balance. Nevertheless, it was observed that the time to walk 3.33 m significantly predicted the body balance (adjusted R2 =.08; P = .047). Conclusions: Our results suggest that gait speed seems to be an important variable to predict body balance in elderly women. The prediction power of this association was very low, but appears to be a biological phenomenon because their impact was significant even in this small sample size.

Comparative Study between Epley and Semont Maneuvers to Treat Benign Paroxysmal Positional Vertigo

Objective: Compare the efficacy of Epley and Semont maneuvers to treat benign paroxysmal positional vertigo (BPPV). Method: Retrospective study conducted by analysis of medical records of 139 patients with a diagnostic hypothesis of ductolithiasis of posterior semicircular canal. Patients were treated by maneuvers repeated weekly until the abolition of nystagmus. Results: It took an average of 1.29 Epley maneuvers and 1.13 Semont maneuvers to eliminate the positional nystagmus (P = .086). Conclusion: Semont maneuver tended to a lower average number of therapy sessions.