Vestibular Syndromes in Childhood and Adolescence.

Introduction The prevalence of vestibular disorders in childhood ranges from 0.4% to 15%; they may be the result of several factors, but most of the time it's an episodic vestibular syndrome related to migraine equivalents. Objective To evaluate the diagnostic and therapeutic aspects of children with vestibular signs and symptoms. Methods The present cross-sectional study evaluated data from the records of patients treated in an outpatient pediatric neurotology clinic over a 10-year period. These data included sociodemographic and clinical variables, results of complementary examinations, the treatment provided, and the clinical evolution. Results The sample was composed of 117 patients, with 54.7% of female subjects with a mean age of 10 years. The most prevalent diagnosis was benign paroxysmal vertigo of childhood (BPVC) (41.9%), followed by vestibular migraine (16.2%). The most prevalent complaint was vertigo (53.9% of the cases). Most patients (66.7%) had inadequate eating habits. Improvement of symptoms was observed in 40.4% of the patients treated with dietary guidance alone. In 80% of the cases, dietary counseling in combination with vestibular rehabilitation therapy achieved therapeutic success without the need of a drug treatment. Conclusion The predominant diagnosis was of BPVC, and its close relationship with the personal and family history of migraine, its benign evolution, and the importance of dietary guidance and vestibular rehabilitation for therapeutic success were observed.

Neurotology: definitions and evidence-based therapies - Results of the I Brazilian Forum of Neurotology.

INTRODUCTION: Neurotology is a rapidly expanding field of knowledge. The study of the vestibular system has advanced so much that even basic definitions, such as the meaning of vestibular symptoms, have only recently been standardized. OBJECTIVE: To present a review of the main subjects of neurotology, including concepts, diagnosis and treatment of Neurotology, defining current scientific evidence to facilitate decision-making and to point out the most evidence-lacking areas to stimulate further new research. METHODS: This text is the result of the I Brazilian Forum of Neurotology, which brought together the foremost Brazilian researchers in this area for a literature review. In all, there will be three review papers to be published. This first review will address definitions and therapies, the second one will address diagnostic tools, and the third will define the main diseases diagnoses. Each author performed a bibliographic search in the LILACS, SciELO, PubMed and MEDLINE databases on a given subject. The text was then submitted to the other Forum participants for a period of 30 days for analysis. A special chapter, on the definition of vestibular symptoms, was translated by an official translation service, and equally submitted to the other stages of the process. There was then a in-person meeting in which all the texts were orally presented, and there was a discussion among the participants to define a consensual text for each chapter. The consensual texts were then submitted to a final review by four professors of neurotology disciplines from three Brazilian universities and finally concluded. Based on the full text, available on the website of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery, this summary version was written as a review article. RESULT: The text presents the official translation into Portuguese of the definition of vestibular symptoms proposed by the Bárány Society and brings together the main scientific evidence for each of the main existing therapies for neurotological diseases. CONCLUSION: This text rationally grouped the main topics of knowledge regarding the definitions and therapies of Neurotology, allowing the reader a broad view of the approach of neurotological patients based on scientific evidence and national experience, which should assist them in clinical decision-making, and show the most evidence-lacking topics to stimulate further study.

Prophylactic treatment of vestibular migraine.

INTRODUCTION: Vestibular migraine (VM) is now accepted as a common cause of episodic vertigo. Treatment of VM involves two situations: the vestibular symptom attacks and the period between attacks. For the latter, some prophylaxis methods can be used. The current recommendation is to use the same prophylactic drugs used for migraines, including ß-blockers, antidepressants and anticonvulsants. The recent diagnostic definition of vestibular migraine makes the number of studies on its treatment scarce. OBJECTIVE: To evaluate the efficacy of prophylactic treatment used in patients from a VM outpatient clinic. METHODS: Review of medical records from patients with VM according to the criteria of the Bárány Society/International Headache Society of 2012 criteria. The drugs used in the treatment and treatment response obtained through the visual analog scale (VAS) for dizziness and headache were assessed. The pre and post-treatment VAS scores were compared (the improvement was evaluated together and individually, per drug used). Associations with clinical subgroups of patients were also assessed. RESULTS: Of the 88 assessed records, 47 were eligible. We included patients that met the diagnostic criteria for VM and excluded those whose medical records were illegible and those of patients with other disorders causing dizziness and/or headache that did not meet the 2012 criteria for VM. 80.9% of the patients showed improvement with prophylaxis (p<0.001). Amitriptyline, Flunarizine, Propranolol and Topiramate improved vestibular symptoms (p<0.001) and headache (p<0.015). The four drugs were effective in a statistically significant manner. There was a positive statistical association between the time of vestibular symptoms and clinical improvement. There was no additional benefit in hypertensive patients who used antihypertensive drugs as prophylaxis or depressed patients who used antidepressants in relation to other prophylactic drugs. Drug association did not show statistically significant results in relation to the use of a single drug. CONCLUSIONS: Prophylactic medications used to treat VM improve the symptoms of this disease, but there is no statistically significant difference between the responses of prophylactic drugs. The time of vestibular symptom seems to increase the benefit with prophylactic treatment.

Vestibular migraine: clinical and epidemiological aspects.

INTRODUCTION: Vestibular migraine (VM) is one of the most often common diagnoses in neurotology, but only recently has been recognized as a disease. OBJECTIVE: To analyze the clinical and epidemiological profile of patients with VM. METHODS: This was a retrospective, observational, and descriptive study, with analysis of patients' records from an outpatient VM clinic. RESULTS: 94.1% of patients were females and 5.9% were males. The mean age was 46.1 years; 65.6% of patients had had headache for a longer period than dizziness. A correlation was detected between VM symptoms and the menstrual period. 61.53% of patients had auditory symptoms, with tinnitus the most common, although tonal audiometry was normal in 68.51%. Vectoelectronystagmography was normal in 67.34%, 10.20% had hyporeflexia, and 22.44% had vestibular hyperreflexia. Electrophysiological assessment showed no abnormalities in most patients. Fasting plasma glucose and glycemic curve were normal in most patients, while the insulin curve was abnormal in 75%. 82% of individuals with MV showed abnormalities on the metabolism of carbohydrates. CONCLUSION: VM affects predominantly middle-aged women, with migraine headache representing the first symptom, several years before vertigo. Physical, auditory, and vestibular evaluations are usually normal. The most frequent vestibular abnormality was hyperreflexia. Most individuals showed abnormality related to carbohydrate metabolism.

Vestibular migraine: comparative analysis between diagnostic criteria.

INTRODUCTION: There is a strong association between vertigo and migraine. Vestibular migraine (VM) was described in 1999, and diagnostic criteria were proposed in 2001 and revised in 2012. OBJECTIVE: To compare the diagnostic criteria for VM proposed in 2001 with 2012 criteria with respect to their diagnostic power and therapeutic effect of VM prophylaxis. METHODS: Clinical chart review of patients attended to in a VM clinic. RESULTS: The 2012 criteria made the diagnosis more specific, restricting the diagnosis of VM to a smaller number of patients, such that 87.7% of patients met 2001 criteria and 77.8% met 2012 criteria. Prophylaxis for VM was effective both for patients diagnosed by either set of criteria and for those who did not meet any of the criteria. CONCLUSIONS: The 2012 diagnostic criteria for VM limited the diagnosis of the disease to a smaller number of patients, mainly because of the type, intensity, and duration of dizziness. Patients diagnosed with migraine and associated dizziness demonstrated improvement after prophylactic treatment of VM, even when they did not meet diagnostic criteria.

Neurotology: definitions and evidence-based therapies - Results of the I Brazilian Forum of Neurotology / Otoneurologia: definições e terapias baseadas em evidências - Resultados do I Fórum Brasileiro de Otoneurologia

Abstract Introduction: Neurotology is a rapidly expanding field of knowledge. The study of the vestibular system has advanced so much that even basic definitions, such as the meaning of vestibular symptoms, have only recently been standardized. Objective: To present a review of the main subjects of neurotology, including concepts, diagnosis and treatment of Neurotology, defining current scientific evidence to facilitate decision-making and to point out the most evidence-lacking areas to stimulate further new research. Methods: This text is the result of the I Brazilian Forum of Neurotology, which brought together the foremost Brazilian researchers in this area for a literature review. In all, there will be three review papers to be published. This first review will address definitions and therapies, the second one will address diagnostic tools, and the third will define the main diseases diagnoses. Each author performed a bibliographic search in the LILACS, SciELO, PubMed and MEDLINE databases on a given subject. The text was then submitted to the other Forum participants for a period of 30 days for analysis. A special chapter, on the definition of vestibular symptoms, was translated by an official translation service, and equally submitted to the other stages of the process. There was then a in-person meeting in which all the texts were orally presented, and there was a discussion among the participants to define a consensual text for each chapter. The consensual texts were then submitted to a final review by four professors of neurotology disciplines from three Brazilian universities and finally concluded. Based on the full text, available on the website of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery, this summary version was written as a review article. Result: The text presents the official translation into Portuguese of the definition of vestibular symptoms proposed by the Bárány Society and brings together the main scientific evidence for each of the main existing therapies for neurotological diseases. Conclusion: This text rationally grouped the main topics of knowledge regarding the definitions and therapies of Neurotology, allowing the reader a broad view of the approach of neurotological patients based on scientific evidence and national experience, which should assist them in clinical decision-making, and show the most evidence-lacking topics to stimulate further study.

Resumo Introdução: A otoneurologia é uma área de conhecimento que tem se expandido muito rapidamente. O estudo do sistema vestibular tem avançado tanto que mesmo definições básicas, como o significado dos sintomas vestibulares, foram apenas recentemente padronizadas. Objetivo: Apresentar uma revisão dos principais assuntos da otoneurologia, inclusive conceitos, diagnóstico e tratamento da otoneurologia, definir a evidência científica atual para facilitar a tomada de decisões e demonstrar as áreas mais carentes de evidência para estimular novas pesquisas. Método: Este texto é fruto do I Fórum Brasileiro de Otoneurologia, que reuniu os principais pesquisadores brasileiros dessa área para uma revisão da literatura. Serão feitos três trabalhos de revisão a serem publicados. Este primeiro abordou as definições e as terapias, o segundo abordará as ferramentas diagnósticas e o terceiro definirá os principais diagnósticos. Cada autor fez um levantamento bibliográfico na base de dados da Lilacs, SciELO, Pubmed e Medline de um determinado assunto. O seu texto foi então submetido aos demais participantes do Fórum por 30 dias para análise. Um capítulo especial, da definição dos sintomas vestibulares, foi traduzido por serviço de tradução oficial e igualmente submetido às demais etapas do processo. Houve então uma reunião presencial em que todos os textos foram apresentados oralmente e houve uma discussão entre os participantes para a definição de um texto consensual para cada capítulo. Os textos consensuais foram então submetidos a uma revisão final por quatro professores de otoneurologia de três universidades brasileiras e, por fim, finalizado. A partir do texto completo, publicado no site da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, foi escrita esta versão-resumo como artigo de revisão. Resultado: O texto apresenta a tradução oficial para o português da definição dos sintomas vestibulares propostos pela Barany Society e agrupa as principais evidências científicas para cada um das principais terapias existentes para as doenças otoneurológicas. Conclusão: Este texto agrupou de forma racional os principais tópicos de conhecimento a respeito das definições e terapias da otoneurologia, permite ao leitor uma visão ampla da abordagem dos pacientes otoneurológicos baseada em evidências científicas e experiência nacional, que deverá auxiliá-lo na tomada de decisões clínicas, e mostra os assuntos mais carentes de evidência para estimular novos estudos.

Prophylactic treatment of vestibular migraine / Tratamento profilático da migrânea vestibular

Abstract Introduction: Vestibular migraine (VM) is now accepted as a common cause of episodic vertigo. Treatment of VM involves two situations: the vestibular symptom attacks and the period between attacks. For the latter, some prophylaxis methods can be used. The current recommendation is to use the same prophylactic drugs used for migraines, including β-blockers, antidepressants and anticonvulsants. The recent diagnostic definition of vestibular migraine makes the number of studies on its treatment scarce. Objective: To evaluate the efficacy of prophylactic treatment used in patients from a VM outpatient clinic. Methods: Review of medical records from patients with VM according to the criteria of the Bárány Society/International Headache Society of 2012 criteria. The drugs used in the treatment and treatment response obtained through the visual analog scale (VAS) for dizziness and headache were assessed. The pre and post-treatment VAS scores were compared (the improvement was evaluated together and individually, per drug used). Associations with clinical subgroups of patients were also assessed. Results: Of the 88 assessed records, 47 were eligible. We included patients that met the diagnostic criteria for VM and excluded those whose medical records were illegible and those of patients with other disorders causing dizziness and/or headache that did not meet the 2012 criteria for VM. 80.9% of the patients showed improvement with prophylaxis (p < 0.001). Amitriptyline, Flunarizine, Propranolol and Topiramate improved vestibular symptoms (p < 0.001) and headache (p < 0.015). The four drugs were effective in a statistically significant manner. There was a positive statistical association between the time of vestibular symptoms and clinical improvement. There was no additional benefit in hypertensive patients who used antihypertensive drugs as prophylaxis or depressed patients who used antidepressants in relation to other prophylactic drugs. Drug association did not show statistically significant results in relation to the use of a single drug. Conclusions: Prophylactic medications used to treat VM improve the symptoms of this disease, but there is no statistically significant difference between the responses of prophylactic drugs. The time of vestibular symptom seems to increase the benefit with prophylactic treatment.

Resumo Introdução: A migrânea vestibular (MV) é aceita atualmente como uma causa comum de vertigem episódica. O tratamento da MV envolve duas situações: as crises de sintomas vestibulares e o período intercrise. Para esse último, pode-se usar algum método de profilaxia. A recomendação atual é que se usem os mesmos medicamentos profiláticos usados para a enxaqueca, o que inclui os β-bloqueadores, antidepressivos e anticonvulsivantes. A recente definição diagnóstica da migrânea vestibular torna escasso o número de estudos sobre seu tratamento. Objetivo: Avaliar a eficácia do tratamento profilático usado em pacientes em um ambulatório de MV. Método: Revisão de prontuários de pacientes com MV pelos critérios da Bárány Society/International Headeache Society de 2012. Foram pesquisados os medicamentos usados e resposta ao tratamento obtida através da escala visual analógica (EVA) para tontura e cefaleia. Foram comparados os escores da EVA pré e pós-tratamento (a melhoria foi avaliada em conjunto e individualmente por droga usada). Também foram pesquisadas relações com subgrupos clínicos dos pacientes. Resultados: De 88 prontuários estudados, 47 foram elegíveis. Incluíram-se os pacientes que preenchiam os critérios diagnósticos para MV, foram excluídos os prontuários ilegíveis e aqueles de pacientes com outro distúrbio causador de tontura e/ou cefaleia que não preenchiam critérios de 2012 para MV. Apresentaram melhoria com a profilaxia 80,9% dos pacientes (p < 0,001). Amitriptilina, flunarizina, propranolol e topiramato apresentaram melhoria para sintomas vestibulares (p < 0,001) e para cefaleia (p < 0,015). Os quatro medicamentos foram eficazes de forma estatisticamente significante. Houve relação estatística positiva entre tempo de sintoma vestibular e melhoria clínica. Não houve benefício adicional para hipertensos que usaram anti-hipertensivos como profilaxia ou para os deprimidos que usaram antidepressivos em relação ao uso dos outros profiláticos. A associação de medicamentos não mostrou resultados estatisticamente significantes do uso de um medicamento isolado. Conclusões: Os medicamentos profiláticos usados para MV melhoram os sintomas dessa doença, porém não há diferença estatisticamente significante entre as respostas dos medicamentos profiláticos. O tempo de sintoma vestibular parece aumentar a melhoria obtida com o tratamento profilático.

Vestibular migraine: clinical and epidemiological aspects / Migrânea vestibular: aspectos clínicos e epidemiológicos

ABSTRACT INTRODUCTION: Vestibular migraine (VM) is one of the most often common diagnoses in neurotology, but only recently has been recognized as a disease. OBJECTIVE: To analyze the clinical and epidemiological profile of patients with VM. METHODS: This was a retrospective, observational, and descriptive study, with analysis of patients' records from an outpatient VM clinic. RESULTS: 94.1% of patients were females and 5.9% were males. The mean age was 46.1 years; 65.6% of patients had had headache for a longer period than dizziness. A correlation was detected between VM symptoms and the menstrual period. 61.53% of patients had auditory symptoms, with tinnitus the most common, although tonal audiometry was normal in 68.51%. Vectoelectronystagmography was normal in 67.34%, 10.20% had hyporeflexia, and 22.44% had vestibular hyperreflexia. Electrophysiological assessment showed no abnormalities in most patients. Fasting plasma glucose and glycemic curve were normal in most patients, while the insulin curve was abnormal in 75%. 82% of individuals with MV showed abnormalities on the metabolism of carbohydrates. CONCLUSION: VM affects predominantly middle-aged women, with migraine headache representing the first symptom, several years before vertigo. Physical, auditory, and vestibular evaluations are usually normal. The most frequent vestibular abnormality was hyperreflexia. Most individuals showed abnormality related to carbohydrate metabolism.

Resumo Introdução: Migrânea vestibular (MV) corresponde a um dos mais frequentes diagnósticos em otoneurologia, o que justifica a importância de seu estudo, embora tenha sido apenas recentemente reconhecida como entidade nosológica. Objetivo: Analisar os perfis clínico e epidemiológico dos pacientes atendidos em um ambulatório de migrânea vestibular. Método: Estudo retrospectivo, observacional e descritivo, com análise de prontuários dos pacientes do ambulatório de MV. Resultados: O ambulatório é composto por 94,1% de mulheres e 5,9% de homens, com média de idade 46,1 anos. O tempo de cefaleia foi superior ao de vertigem em 65,6% dos pacientes. Observou-se correlação entre os sintomas e o período menstrual. A maioria (61,53%) dos indivíduos apresentou algum sintoma auditivo, sendo o zumbido o mais frequente, embora a audiometria tenha sido normal em 68,51%. A vectoeletronistagmografia apresentou-se normal em 67,34%, enquanto 10,20% apresentaram hiporreflexia e 22,44% hiperreflexia vestibular. Exames eletrofisiológicos não mostraram alterações na maioria dos pacientes. Glicemia dejejum e curva glicêmica foram normais para a maioria dos pacientes, enquanto a curva insulinêmica mostrou-se alterada em 75% dos indivíduos. 82% dos indivíduos com MV apresentaram alguma alteração relativa ao metabolismo dos carboidratos. Conclusão: Migrânea vestibular acomete, predominantemente, mulheres de meia idade, com cefaleia migranosa e vertigem, sendo a primeira de instalação mais precoce. O exame físico no período intercrise, bem como as avaliações auditiva e vestibular, mostram-se, geralmente, normais. O tipo de alteração vestibular mais observado foi a hiperreflexia labiríntica. A maioria os indivíduos avaliados apresentou alterações relativas ao metabolismo dos carboidratos.

Vestibular migraine: comparative analysis between diagnostic criteria / Migrânea vestibular: análise comparativa entre critérios diagnósticos

ABSTRACT INTRODUCTION: There is a strong association between vertigo and migraine. Vestibular migraine (VM) was described in 1999, and diagnostic criteria were proposed in 2001 and revised in 2012. OBJECTIVE: To compare the diagnostic criteria for VM proposed in 2001 with 2012 criteria with respect to their diagnostic power and therapeutic effect of VM prophylaxis. METHODS: Clinical chart review of patients attended to in a VM clinic. RESULTS: The 2012 criteria made the diagnosis more specific, restricting the diagnosis of VM to a smaller number of patients, such that 87.7% of patients met 2001 criteria and 77.8% met 2012 criteria. Prophylaxis for VM was effective both for patients diagnosed by either set of criteria and for those who did not meet any of the criteria. CONCLUSIONS: The 2012 diagnostic criteria for VM limited the diagnosis of the disease to a smaller number of patients, mainly because of the type, intensity, and duration of dizziness. Patients diagnosed with migraine and associated dizziness demonstrated improvement after prophylactic treatment of VM, even when they did not meet diagnostic criteria.

RESUMO Introdução: Há forte associação entre vertigem e enxaqueca. A migrânea vestibular (MV) foi descrita em 1999 e critérios diagnósticos foram propostos em 2001 e revisados em 2012. Objetivo: Comparar os critérios diagnósticos para MV propostos em 2001 com os de 2012, através de seu poder diagnóstico e efeito terapêutico da profilaxia da MV. Método: Revisão de prontuários de pacientes atendidos em uma clínica de MV. Resultados: Os critérios de 2012 tornaram o diagnóstico mais específico, restringindo a MV a um número menor de pacientes, sendo que 87,7% dos pacientes preencheram os critérios de 2001 e 77,8% preencheram os critérios de 2012. O tratamento profilático para MV foi eficaz tanto para pacientes diagnosticados por algum dos critérios quanto para aqueles que não se enquadravam em qualquer critério. Conclusões: Os critérios diagnósticos de 2012 para MV restringiram o diagnóstico da doença para um menor número de pacientes, principalmente por causa do tipo de tontura, a sua intensidade e duração. Pacientes com enxaqueca diagnosticada e tontura associada apresentaram melhora após o tratamento profilático da MV mesmo quando não preenchem critérios diagnósticos. (c) 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Publicado por Elsevier Editora Ltda. Todos os direitos reservados.

Avaliação de resultados e complicações da cirurgia de colocação de tubos de ventilação em pacientes com otite media serosa / Evaluation of the results and complications of the ventilation tubes' setting surgery in patients with serous otitis media

Introdução: Timpanotomia para colocação de tubo de ventilação é uma das cirurgias mais frequentes realizadas em pacientes na faixa etária pediátrica. Objetivo: Esse estudo avalia indicações e complicações pós-operatórias mais frequentes nesta prática otorrinolaringológica em um hospital escola. Método: Foi realizado um estudo retrospectivo tipo série de casos no qual 109 pacientes pediátricos, que receberam tubos de ventilação, foram avaliados quanto à indicação e acompanhamento pós-operatório pelo setor de otorrinolaringologia da Escola Paulista de Medicina durante os anos de 2007 a 2008. Resultados: A idade média encontrada foi de 7,37 anos, sendo a maioria dos pacientes do sexo masculino (59,63%). Todos os casos tiveram como indicação cirúrgica otite média serosa. As taxas de complicações encontradas foram menores que as relatadas pela literatura com 3,43% de perfuração residual com necessidade de reintervenção cirúrgica e 5,47% não apresentaram melhora audiométrica, necessitando de nova inserção de tubo de ventilação. Conclusão: Os resultados encontrados sugerem que em nosso serviço há menores taxas de otorreia pós-operatória, reinserção de tubos, menor número de tubos removidos cirurgicamente e taxa semelhante de perfurações residuais que a descrita na literatura para a cirurgia de colocação de tubo de ventilação em pacientes com OMS.

Introduction: Tympanostomy for ventilation tube setting is one of the surgeries more frequent performed in patients in the pediatric age group. Objective: This study evaluates the indications and complications post operatives more frequents in this otorhinolaryngological practice in a school hospital. Method: It was realized a series type retrospective study of cases in which 109 pediatric patients, that have received ventilation tube were evaluated as for the post operative indication and attendance for the otorhinolaryngology sector of the Paulista Medicine School for 2007 to 2008. Results: The age' average found was 7,37 years, being the majority of the patients of the male sex (59,63%). All the cases have had as surgical indication serous otitis media. The taxes of complications found were lower than those related for the literature with 3,43% of residual perforation with necessity of surgical re intervention and 5,47% do not presented a audiometric improvement needing a new insertion of ventilation tube. Conclusion: The results found suggest that in our service there are lower rates of postoperative otorrhea, tube reinsertion, less tubes surgically removed and a similar rate of residual perforations that that one described in the literature for surgical placement of ventilation tubes in patients with SOM.

Labirintopatias / Vestibular disorders

A tontura é considerada um dos sintomas mais comuns em Medicina e a principal manifestação clínica das labirintopatias. No presente texto são revisados os aspectos clínicos mais relevantes das labirintopatias consideradas mais prevalentes em nosso meio. Os principais diagnósticos diferenciais são apresentados. As opções terapêuticas também estão descritas e incluem o tratamento etiológico, a correção dos hábitos prejudiciais ao sistema vestibular, os medicamentos, os exercícios de reabilitação vestibular, a psicoterapia e, em casos específicos, os procedimentos cirúrgicos.

Labirintopatias / Labyrinth disorders

A tontura é definida como sensação de perturbação do equilíbrio corporal. Trata-se de queixa bastante prevalente e que pode ocorrer devido a alterações de diversos sistemas do organismo humano, entre eles o sistema vestibular. A causa mais comum de tontura são as síndromes vestibulares periféricas e para seu diagnóstico são preponderantes a anamnese e o exame físico do paciente. Os exames otoneurológicos auxiliam na confirmação da lesão auditiva e/ou vestibular, na sua localização, na orientação terapêutica e no prognóstico. O tratamento otoneurológico é eficaz na grande maioria dos casos de tontura de origem vestibular periférica e seu objetivo é promover a recuperação do equilíbrio corporal e, também, controlar os sintomas e sinais associados. Para isso, podem ser necessárias orientações dietéticas, tratamento medicamentoso, exercícios de reabilitação vestibular e, eventualmente, procedimentos cirúrgicos.