Roseli Saraiva Moreira Bittar

Efficacy of a vibrotactile neurofeedback training in stance and gait conditions for the treatment of balance deficits: a double-blind, placebo-controlled multicenter study.

Objective Vestibular rehabilitation strategies mostly require a long-lasting training in stance conditions, which is finally not always successful. The individualized training in everyday-life conditions with an intuitive tactile neurofeedback stimulus seems to be a more promising approach. Hence, the present study was aimed at investigating the efficacy of a new vibrotactile neurofeedback system for vestibular rehabilitation. Study Design Double-blinded trial. Patients One hundred five patients who experience one of the following balance disorders for more than 12 months were included in the study: canal paresis, otolith disorder, removal of an acoustic neuroma, microvascular compression syndrome, Parkinson’s disease, and presbyvertigo. Interventions Vibrotactile neurofeedback training was performed daily (15 min) over 2 weeks with the Vertiguard system in those 6 tasks of the Standard Balance Deficit Test with the most prominent deviations from the normative values. Main Outcome Measures Trunk and ankle sway, dizziness handicap inventory, and vestibular symptom score were measured in the verum and placebo group before the training, on the last training day and 3 months later. Results A significant reduction in trunk and ankle sway as well as in the subjective symptom scores were observed in the verum group. Such an effect could not be found in any of the outcome parameters of the placebo group. Conclusion The vibrotactile neurofeedback training applied in the present study is a highly efficient method for the reduction of body sway in different balance disorders. Because the rehabilitation program is easy to perform, not exhausting, and time saving, elderly patients and those with serious, long-lasting balance problems also can participate successfully.

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.

Effects of electrotactile vestibular substitution on rehabilitation of patients with bilateral vestibular loss.

The present study evaluated the effectiveness of electrotactile tongue biofeedback (BrainPort((R))) as a sensory substitute for the vestibular apparatus in patients with bilateral vestibular loss (BVL) who did not have a good response to conventional vestibular rehabilitation (VR). Seven patients with BVL were trained to use the device. Stimulation on the surface of the tongue was created by a dynamic pattern of electrical pulses and the patient was able to adjust the intensity of stimulation and spatially centralize the stimulus on the electrode array. Patients were directed to continuously adjust head orientation and to maintain the stimulus pattern at the center of the array. Postural tasks that present progressive difficulties were given during the use of the device. Pre- and post-treatment distribution of the sensory organization test (SOT) composite score showed an average value of 38.3+/-8.7 and 59.9+/-11.3, respectively, indicating a statistically significant improvement (p=0.01). Electrotactile tongue biofeedback significantly improved the postural control of the study group, even if they had not improved with conventional VR. The electrotactile tongue biofeedback system was able to supply additional information about head position with respect to gravitational vertical orientation in the absence of vestibular input, improving postural control. Patients with BVL can integrate electrotactile information in their postural control in order to improve stability after conventional VR. These results were obtained and verified not only by the subjective questionnaire but also by the SOT composite score. The limitations of the study are the small sample size and short duration of the follow-up. The current findings show that the sensory substitution mediated by electrotactile tongue biofeedback may contribute to the improved balance experienced by these patients compared to VR.

Vestibular rehabilitation exercises in acute vertigo.

Objectives/Hypothesis: To evaluate the effect of vestibular rehabilitation exercises in the early stages of peripheral vestibular disorders.

Prevalência das alterações metabólicas em pacientes portadores de queixas vestibulares

STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD:The authors evaluated the prevalence of metabolic disorders among 325 patients with vestibular symptoms investigated by the Otoneurology Section, Otolaryngology Department of Hospital das Clinicas, Medical School, University of Sao Paulo. The patients were evaluated from January 1997 to January 2002, by a standard protocol which included, among other items, fast glucose levels, cholesterol, triglycerides and thyroid hormones, performed in the same laboratory. The results were compared to a standard population. Results showed higher levels of fast glucose, alteration in the thyroid hormones and also higher prevalence of diabetes in the studied population. CONCLUSION: The otolaryngologist should include the investigation of such medical problems in the routine evaluation in order to reverse them and to obtain better results in management of vestibular disorders.

Lidocaine test in patients with tinnitus: rationale of accomplishment and relation to the treatment with carbamazepine

OBJECTIVES There is strong evidence in the literature about the effect of local anesthetics such as lidocaine in controlling tinnitus; these agents act by stabilizing hair cell membrane and cochlear nerve fibers. However, the effect of intravenous lidocaine is transient, and its oral analog (tocainide) does not have the same efficacy for long-term treatment in patients with tinnitus. Some oral anti-epileptic drugs (carbamazepine, for instance) have been used alternatively in several studies. The aim of this work is to evaluate the response to intravenous lidocaine in patients with intractable tinnitus and the effect of oral carbamazepine in long-term maintenance of tinnitus relief. PATIENTS AND METHODS We studied prospectively 50 patients (28 females and 22 males; mean age 50.9 years) who underwent the lidocaine test, performed by a 3-min intravenous infusion of 2% lidocaine chloridrate. The patients who experienced any relief after the test started treatment with oral carbamazepine in ascending dosages (50-600 mg/day). RESULTS The results were classified as tinnitus abolition (18%), marked relief (32%), partial relief (26%), unchanged (22%), or worsening (2%). The lidocaine test showed favorable results in 76% of patients, especially those with bilateral tinnitus (P < 0.001). Afterwards, 50% of patients treated with carbamazepine maintained the improvement of tinnitus (P = 0.0034). CONCLUSION The authors conclude that intravenous lidocaine is effective in reducing intractable tinnitus and that there is a close association between lidocaine and oral carbamazepine effects. Therefore, carbamazepine can be used for the treatment of tinnitus when the patient achieves improvement of symptom after the lidocaine test.

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.

Restrições posturais não interferem nos resultados da manobra de reposição canalicular

A Vertigem Posicional Paroxistica Benigna (VPPB) e uma das mais comuns doencas da orelha interna que cursam com tontura, porem o seu tratamento ainda e algo de inumeras controversias. OBJETIVO: Avaliar a influencia das orientacoes posturais na evolucao precoce de pacientes com diagnostico de VPPB de canal semicircular posterior, submetidos a manobra de Epley. FORMA DE ESTUDO: Prospectivo randomizado. MATERIAL E METODO: Foram avaliados 50 pacientes com diagnostico de VPPB de canal semicircular posterior submetidos a manobra de reposicao canalicular de Epley, divididos em Grupo de Estudo - 23 pacientes - que receberam orientacoes de restricao postural pos-manobra e Grupo Controle - 27 pacientes - que nao receberam orientacoes. RESULTADOS: Nao houve diferenca estatisticamente significante entre os grupos estudados quanto a resolucao dos sintomas da VPPB independentemente de sexo e idade. CONCLUSAO: A eficacia da Manobra de Reposicao Canalicular de Epley nao e influenciada pelo uso ou nao das restricoes posturais.

Population epidemiological study on the prevalence of dizziness in the city of São Paulo

UNLABELLED The epidemiology of dizziness is essential in clinical practice. OBJECTIVE To establish the prevalence of dizziness in the adult population of São Paulo, its clinical characteristics and level of discomfort. METHOD A prospective cross-sectional study ran from April to October of 2012 by a field questionnaire, totaling 1,960 interviews. The predictor variables assessed were age, gender, type of dizziness and the dizziness disability index. The statistical tools used to assess the significance between variables were the chi-square test, Students t-test and logistic regression. We used a 95% confidence interval for estimated values. RESULTS The prevalence of dizziness in the city of São Paulo was established at 42%. We found two peak of complaints, 49% in the range of 46-55 years and 44% in the elderly. Vestibular-related dizziness was estimated to affect 8.3% of the population, mainly women (p < 0.001). The symptoms caused disability in 27% of symptomatic interviewees and it is more bothersome to females (p < 0.001), who more frequently seek medical care (p < 0.001). CONCLUSION The prevalence of dizziness in São Paulo was found to be 42%. It affects daily activities in 67% of symptomatic patients, but only 46% of them seek medical help.

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.