Dynamic stabilometric findings in equilibrium disorders of the elderly.

Equilibrium disorders are frequent symptoms of aging, both on account of the so-called "multisensorial decay" and age-related diseases. Aim of the study was to evaluate the functional integrity of static-dynamic postural control related subsystems (visual, somatosensorial, vestibular), the fundamental postural strategies effected and adaptation to destabilizing inputs, in elderly subjects with otoneurological disorders. From January to November 2003, 40 elderly patients (19 male, 21 female, mean age +/- SD: 69.5 +/- 4.3 years; range: 65-83), with balance disorders, consisting in dizziness or vertigo, have been observed. Otoneurologic and internal case history was collected in all patients, all of whom were submitted to otoscopy, otoneurologic examination, pure-tone audiometry, as well as a specific examination called Equi test. The sensorial analysis, as often occurs in elderly subjects without unbalance, revealed marked impairment of the somatosensorial (85%), compared to vestibular (60%) and visual (40%), subsystems. Longer latencies of motor responses to forward platform translations than to backward translations were observed, even if the symmetry of movements was more evident in the former. Postural adaptation was more frequently impaired during raising of the support (70%) than during lowering. Therefore, in elderly people, somatosensorial impairment, combined with flexor muscle dysfunction, exists. Indeed, extensor responses, although slower than flexor responses, are more correctly performed.

Falls in the elderly: the development of a risk questionnaire and posturographic findings.

In elderly people, owing to a perturbation at several levels, including the motor, sensory and cognitive levels, a condition of dizziness and unsteadiness complicated by frequent falls often appears. In this article, we review the most recent information about clinical and instrumental tools available for preventing mobility-related accidents and report the results of a comparative study of postural control, carried out through tetraataxiometry (by Tetrax, Tel Aviv, Israel), in two samples of elderly women belonging to two different populations: 24 Italian women (11 reporting falls and 13 without falls) having a mean age of 73.1 years, and 37 Israeli women (12 with falls and 25 without falls) having a mean age of 72.5 years. The posturographic findings show that the falling subjects, to maintain postural control, are highly dependent on somatosensory inputs and have a weaker "systeme postural fin" (fine postural system), according to Gagey. They also show that an elderly subpopulation exists that, for unknown reasons, is immune to destabilization and falls.

[Otolaryngologic disorders caused by esophageal reflux]. / Molestias otorrinolaringológicas del reflujo gastro-esofágico.

The authors through an accurate analysis of the literature make a synthesis of the most recent knowledge about the correlation existing between the distal and proximal gastroesophageal reflux (GER) and a series of common otolaryngologic symptoms whose aetiology is doubtful, in order to explain its most significative physiopathological and clinic aspects. The diagnostic modalities able to reveal the presence of the correlation and the adequacy therapy to cure the disease are also discussed.

Vertigo and multiple sclerosis: aspects of differential diagnosis.

Equilibrium disorders caused by involvement of brainstem and cerebellar structures are common in patients with multiple sclerosis (MS), but peripheral conditions such as benign paroxysmal positional vertigo (BPPV) can be sometimes confused with those of a central origin. Therefore, an accurate otoneurologic investigation paying attention to differential diagnosis aspects should be performed in these subjects. Among available diagnostic tools, electro-oculography, posturography and vestibular evoked myogenic potentials (VEMPs) are especially suited to assess vestibulo-oculomotor and vestibulospinal systems. This paper briefly describes the most recent otoneurologic diagnostic strategies for MS patients and the results of initial clinical experiences, and finally provides suggestions for differentiating MS-related vestibular disorders from other common otoneurological conditions.