Roberta Ribeiro de Almeida

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.

Histologic Behavior of the Inflammatory Process in Autologous Fat Implantation in Rabbit Vocal Folds

Fat implantation in the vocal fold is described as a method of repairing vocal fold histostructural lesions that correlate with mucosal wave abnormalities. The aim of this study was to evaluate the histologic behavior of autologous fat implants. A fat block was implanted in pockets surgically created in the vocal folds of rabbits, and the inflammatory process induced was compared to the status of the contralateral vocal fold. Twenty-four rabbits were allocated into 3 groups to be sacrificed 1 week, 3 weeks, and 3 months after the implantation. The fat autograft did not cause any unexpected fibrosis, and we consider it a relatively safe material for implantation, with a low tendency to induce epithelial reaction and the ability to repair the histostructure of the vocal fold.

Memory Networks in Tinnitus: A Functional Brain Image Study

Tinnitus is characterized by the perception of sound in the absence of an external auditory stimulus. The network connectivity of auditory and non-auditory brain structures associated with emotion, memory and attention are functionally altered in debilitating tinnitus. Current studies suggest that tinnitus results from neuroplastic changes in the frontal and limbic temporal regions. The objective of this study was to use Single-Photon Emission Computed Tomography (SPECT) to evaluate changes in the cerebral blood flow in tinnitus patients with normal hearing compared with healthy controls. Methods: Twenty tinnitus patients with normal hearing and 17 healthy controls, matched for sex, age and years of education, were subjected to Single Photon Emission Computed Tomography using the radiotracer ethylenedicysteine diethyl ester, labeled with Technetium 99 m (99 mTc-ECD SPECT). The severity of tinnitus was assessed using the “Tinnitus Handicap Inventory” (THI). The images were processed and analyzed using “Statistical Parametric Mapping” (SPM8). Results: A significant increase in cerebral perfusion in the left parahippocampal gyrus (pFWE <0.05) was observed in patients with tinnitus compared with healthy controls. The average total THI score was 50.8+18.24, classified as moderate tinnitus. Conclusion: It was possible to identify significant changes in the limbic system of the brain perfusion in tinnitus patients with normal hearing, suggesting that central mechanisms, not specific to the auditory pathway, are involved in the pathophysiology of symptoms, even in the absence of clinically diagnosed peripheral changes.

Vestibular evoked myogenic potentials in affected and asymptomatic ears in unilateral Ménière's Disease

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 Ménières disease. STUDY DESIGN Transversal cohort. MATERIAL AND METHOD The vestibular evoked myogenic potentials of 20 patients with unilateral Ménières disease were analyzed. The selection of individuals was based on the history and in clinical evaluation suggestive of unilaterally defined Ménières 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 Ménières disease.

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.

Vestibulopathy in Childhood and Adolescence

Objective: Evaluate diagnosis and treatment aspects at a clinic for children with otoneurology disorders. Method: Retrospective case series, held in otoneurology pediatric service. We evaluated the charts of all patients seen from 2006 to 2010. Results: Eighty-eight patients were included. The average age was 9.87 years. There were 46 girls (52.27%). The most prevalent diagnosis was BPVC in 48 (54.54%) cases, followed by vestibular metabolic syndrome (VMS), 21 (23.86%), and vestibular migraine in 10 (11.36%) patients. The majority (77.27%) had poor eating habits. The majority, 48 (54.54%), complained of vertigo. The vectoelectronystagmography (VENG) showed no changes in 22 (41.51%). In 30 (43.47%) patients improvement was noted with vestibular rehabilitation and dietary counseling, and dietary counseling alone was administered in 27 (39.13%) patients. Conclusion: There was a predominance of the diagnosis of BPVC. Its close relationship with a history of migraine and its benign nature of evolution were noted. We noted the importance of monitoring, dietary counseling, and the role of vestibular rehabilitation on vestibular childhood and adolescence.