A quantitative analysis of postural control in elderly patients with vestibular disorders using visual stimulation by virtual reality.

INTRODUCTION: Postural instability is one the most common disabling features in vestibular disorders. OBJECTIVE: This study aimed to analyze the limit of stability and the influence of manipulation of visual, somatosensorial and visual-vestibular information on postural control in older adults with vestibular disorder, with and without a history of falls. METHODS: Cross-sectional study. Participants - 76 elderly patients with vestibular disorder (G1, without falls; G2, with falls) and 41 healthy elderly subjects (control group; CG). Using posturography, analyzed were limit of stability area, body center of pressure, and velocity of oscillation in the standing position in 10 conditions, including open/closed eyes, unstable surface with eyes closed, saccadic and optokinetic stimuli, and visual-vestibular interaction. RESULTS: Limit of stability area in CG was better compared with G1-2, and center of pressure values were worse in G1 than in CG. Center of pressure area in all conditions and velocity of oscillation in the following conditions: open/closed eyes, optokinetic stimulation, and visual-vestibular interaction showed worse values in G2 than in CG. Center of pressure area in the following conditions: open/closed eyes, saccadic and optokinetic stimuli, visual-vestibular interaction, and unstable surface with eyes closed showed worse values in G2 than in G1. CONCLUSION: Older adults with vestibular disorder presented reduced limit of stability and increased postural sway in the following conditions: conflict between visual and somatosensory information and visual-vestibular interaction. Deterioration in postural control was significantly associated with history of falls.

Immediate effects of an anchor system on the stability limit of individuals with chronic dizziness of peripheral vestibular origin.

INTRODUCTION: The symptoms associated with chronic peripheral vestibulopathy exert a negative impact on the independence and quality of life of these individuals, and many individuals continue to suffer from these symptoms even after conventional vestibular rehabilitation. OBJECTIVE: To evaluate the acute effect of an anchor system for balance evaluation of patients with chronic dizziness who failed to respond to traditional vestibular rehabilitation. METHODS: Subjects over 50 years of age, presenting with chronic dizziness and postural instability of peripheral vestibular origin, participated in the study. The limit of stability was evaluated in three positions using the Balance Master® system: Position 1, standing with the arms along the body; Position 2, standing with the elbows bent at 90° (simulating holding the anchors); and Position 3, with the elbows bent at 90° holding the anchors. The variables of movement latency, endpoint excursion and directional control of movement were evaluated. RESULTS: Using the anchor system, significant reduction of time in the response at the beginning of the movement compared to Position 1 (p<0.05); increased endpoint excursion in the left lateral direction compared to Position 1 (p<0.05); and more directional control of movement in the anterior and posterior directions (p<0.05) compared to the other positions, were found. CONCLUSION: While using the system anchor, individuals with chronic peripheral vestibulopathy showed an immediate improvement in the stability limit in relation to the movement latency, endpoint excursion, and directional control of movement variables, suggesting that the haptic information aids postural control.

Relationship between physical activity, feelings of disability, and quality of life in patients with peripheral vestibular dysfunction / Relação entre atividade física, sentimento de incapacidade e qualidade de vida em pacientes com disfunção vestibular periférica

ABSTRACT Purpose: to verify the association of self-reported feelings of disability and physical activity with the impact of vestibular symptoms on the quality of life of patients with vestibular dysfunction. Methods: a retrospective, cross-sectional, analytical, documentary study approved by the Research Ethics Committee (evaluation report no. 4.462.519), with 50 selected medical records of patients diagnosed with peripheral vestibular dysfunction, including a survey of their medical history and results of the Dizziness Handicap Inventory (DHI). Results: the sample's mean age was 55.38 years, and the majority were females (70%). The DHI revealed a moderate impact of dizziness. Physically active patients perceived less impact of the disease (p-value = 0.0167), while patients with feelings of disability, due to vestibular symptoms, had a greater damage of their quality of life (p-value = 0.0468). Conclusion: physical activity was associated with less damage of dizziness to the quality of life; also, a greater impact on the quality of life was associated with feelings of disability related to vestibular complaints.

RESUMO Objetivo: verificar a associação entre o sentimento de incapacidade autorrelatada e a prática de atividade física com o impacto dos sintomas vestibulares sobre a qualidade de vida em pacientes com disfunção vestibular. Métodos: estudo documental, analítico, transversal e retrospectivo, aprovado pelo Comitê de Ética em Pesquisa (parecer 4.462.519), no qual foram selecionados 50 prontuários de pacientes diagnosticados com disfunção vestibular periférica, analisada anamnese e os resultados do questionário Dizziness Handicap Inventory (DHI). Resultados: a amostra obteve média de idade de 55.38 anos e predomínio do sexo feminino (70%). O DHI evidenciou impacto moderado da tontura. Os pacientes que praticavam atividade física perceberam um menor impacto da doença (p-valor=0.0167) e, os pacientes que apresentavam sentimento de incapacidade, devido aos sintomas vestibulares, tiveram maior prejuízo na qualidade de vida (p-valor=0.0468). Conclusão: houve associação entre a prática de atividade física com o menor prejuízo da tontura na qualidade de vida e associação entre um maior impacto na qualidade de vida dos indivíduos que apresentavam sentimento de incapacidade relacionado às queixas vestibulares.

Uso da posturografia para identificação do risco de queda em idosos com tontura / Use of posturography to identify the risk of falling in elderly people with dizziness

RESUMO Objetivo avaliar se a posturografia, exame que avalia a habilidade de manter o equilíbrio em condições sensoriais conflitantes, pode identificar risco de queda em idosos com tontura. Métodos comparar os resultados posturográficos de idosos com e sem história de quedas, pareados por gênero, idade e diagnóstico etiológico da tontura. Resultados dezoito idosos com quedas - 4 com único episódio e 14 com história de 2 ou mais quedas no último ano - foram comparados com 18 idosos sem quedas, pareados por gênero, idade e diagnóstico etiológico. Pacientes com quedas apresentaram resultados piores para as análises de dependência visual (p=0,04, p=0,01, p=0,03). Pacientes com quedas recorrentes (2 ou mais episódios) apresentaram piores resultados em diversas condições sensoriais: somatossensorial, vestibular, dependências visuais e índice de equilíbrio composto. Conclusão a posturografia mostrou-se útil na identificação de idosos com quedas, principalmente em indivíduos com quadros recorrentes.

ABSTRACT Purpose the aim of this study is to determine whether posturography, an exam used to investigate the ability to maintain balance under conflicting sensory conditions, can identify the risk of falls in eldery patients with dizziness. Methods to compare the posturographic results of elderly people with falls vs elderly people with no falls, paired by sex, age and dizziness etiology. Results 18 fallers, and, of these, 14 with two or more falls in the last year were compared with 18 elderly people without falls. Comparing subjects without falls vs subjects with at least one fall in the last year, fallers obtain worse scores in conditions of visual dependence. Comparing non fallers with subjects with two or more falls, people with recurrent falls obtain worse score in several conditions: somatosensorial, vestibular, visual conflict, and in the main measure, the composite score. Conclusion posturography appears to be a useful tool to identify those at high risk of recurrent falls.

Combined ocular and cervical vestibular evoked myogenic potential in individuals with vestibular hyporeflexia and in patients with Ménière's disease.

INTRODUCTION: The vestibular evoked myogenic potential is a potential of mean latency that measures the muscle response to auditory stimulation. This potential can be generated from the contraction of the sternocleidomastoid muscle and also from the contraction of extraocular muscles in response to high-intensity sounds. This study presents a combined or simultaneous technique of cervical and ocular vestibular evoked myogenic potential in individuals with changes in the vestibular system, for use in otoneurologic diagnosis. OBJECTIVE: To characterize the records and analyze the results of combined cervical and ocular VEMP in individuals with vestibular hyporeflexia and in those with Ménière's disease. METHODS: The study included 120 subjects: 30 subjects with vestibular hyporeflexia, 30 with Ménière's disease, and 60 individuals with normal hearing. Data collection was performed by simultaneously recording the cervical and ocular vestibular evoked myogenic potential. RESULTS: There were differences between the study groups (individuals with vestibular hyporeflexia and individuals with Ménière's disease) and the control group for most of wave parameters in combined cervical and ocular vestibular evoked myogenic potential. For cervical vestibular evoked myogenic potential, it was observed that the prolongation of latency of the P13 and N23 waves was the most frequent finding in the group with vestibular hyporeflexia and in the group with Ménière's disease. For ocular vestibular evoked myogenic potential, prolonged latency of N10 and P15 waves was the most frequent finding in the study groups. CONCLUSION: Combined cervical and ocular vestibular evoked myogenic potential presented relevant results for individuals with vestibular hyporeflexia and for those with Ménière's disease. There were differences between the study groups and the control group for most of the wave parameters in combined cervical and ocular vestibular evoked myogenic potential.

O efeito dos exercícios vestibulares na qualidade de vida e na intensidade de tontura de idosos com hipofunção vestibular unilateral / The effect of vestibular exercises on quality of life and intensity of dizziness in the elderly with unilateral vestibular hypofunction

Objetivo: analisar o efeito dos exercícios vestibulares na qualidade de vida e na intensidade de tontura de idosos com hipofunção vestibular unilateral. Método: participaram do estudo idosos com sintomas de tontura. A qualidade de vida foi avaliada pela versão brasileira do Dizziness Handicap Inventory e a intensidade de tontura por uma escala visual analógica. Para cada participante foi desenvolvido um protocolo de exercícios personalizado de acordo com seus sintomas. Utilizou-se o teste t-Student para avaliar a intensidade de tontura e, para comparar os resultados da qualidade de vida, utilizou-se o teste não-paramétrico de Wilcoxon (p<0,05). O teste de correlação de Pearson averiguou associações entre intensidade de tontura e qualidade de vida. Resultados: verificou-se diferença estatisticamente significativa para a intensidade de tontura (p<0,0007) e para os domínios físico (p<0,0009), funcional (p<0,0009), emocional (p<0,03) e total (p<0,001) da qualidade de vida dos idosos com hipofunção vestibular unilateral. Referente à correlação, quanto mais intenso o sintoma de tontura, maiores foram os prejuízos na qualidade de vida. Conclusão: os exercícios vestibulares contribuíram para a diminuição da intensidade da tontura dos idosos com hipofunção vestibular unilateral e, consequentemente, para melhora da qualidade de vida e seus respectivos domínios. (AU)

Objective: to analyze vestibular exercise in quality of life and intensity of dizziness in the elderly with unilateral vestibular hypofunction. Method: elderly with symptoms of dizziness participated in the study. The quality of life was assessed by the Dizziness Handicap Inventory and the intensity of dizziness by a visual analogical scale. For each participant a personalized treatment protocol was developed according to their symptoms. The t-Student test was used to assess the intensity of dizziness and Wilcoxon's nonparametric test to analyze the quality of life (p <0.05). The Pearson correlation test was used to verify the associations between intensity of dizziness and quality of life. Results: a statistically significant difference was observed for the intensity of dizziness (p<0.0007) and to the physical (p<0.0009), functional (p<0.0009), emotional (p<0.03) domains and total (p<0.001) of the quality of life of the elderly with unilateral vestibular hypofunction. Concerning the correlation, the more intense the symptom of dizziness, the greater the impairment in quality of life. Conclusion: the vestibular exercises contributed to decrease the intensity of dizziness in the elderly with unilateral vestibular hypofunction and, consequently, to improve the quality of life and their respective domains. (AU)

Alterações auditivas e vestibulares associadas ao uso da mefloquina: uma revisão integrativa / Auditory and vestibular changes associated with the use of mefloquine: an integrative review

RESUMO Objetivo descrever, por meio de revisão da literatura, alterações auditivas e/ou vestibulares relacionadas ao uso em curto ou em longo prazo da mefloquina. Estratégia de pesquisa trata-se de uma revisão integrativa, realizada nas seguintes bases de dados: PubMed, Web of Science, SciELO, LILACS, Scopus, ScienceDirect, Cochrane Library, Embase, OpenGrey, DissOnline e OAlster. Critérios de seleção foram incluídos estudos com participantes a partir de 18 anos de idade, que fizeram uso de mefloquina e que foram submetidos à avaliação auditiva e/ou questionário referente à função auditiva e vestibular. Foram excluídas revisões de literatura, capítulos de livros e estudos que utilizaram a mefloquina combinada a outros medicamentos. Resultados foram identificados 1.267 estudos nas bases de dados utilizadas, sendo selecionados 28 artigos para leitura completa. Destes, 12 foram incluídos na revisão, de acordo com os critérios de elegibilidade. Quatro artigos apontaram a presença de alterações vestibulares e auditivas, 2 indicaram apenas alterações auditivas e 6 apenas desordens vestibulares. No que se refere às manifestações auditivas, zumbido e perda auditiva foram os sintomas mais frequentes. Vertigem/tontura e desequilíbrio corresponderam às alterações vestibulares comumente apresentadas. Conclusão manifestações auditivas e vestibulares foram referidas em curto e longo prazo, após o tratamento com a droga. A descontinuação de seu uso possibilitou a reversão das manifestações, porém, em alguns casos, foi observada a permanência das afecções. Considera-se importante a realização de acompanhamento audiológico e vestibular durante a ingestão da mefloquina, visto o seu perfil de toxicidade e possíveis manifestações colaterais de caráter auditivo e vestibular.

ABSTRACT Objective To describe through a literature review auditory and/or vestibular alterations associated with the short or long-term use of mefloquine. Research strategy Integrative review performed on the following databases: Pubmed, Web of Science, Scielo, Lilacs, Scopus, Science Direct, Cochrane Library, Embase, Open Grey, DissOnline, OAlster. Selection Criteria The articles selected included studies with participants that were 18 years old or over, who used mefloquine and who were submitted to an auditory evaluation and/or a questionnaire regarding auditory and vestibular function. Literature reviews, book chapters, and studies using mefloquine associated with other drugs were excluded. Results 1,267 studies were identified in the databases used, 28 articles were selected for full reading, and out of these, twelve were included in the review according to the eligibility criteria. Four articles pointed out the presence of vestibular and auditory diseases, two indicated only auditory disorders, and six solely vestibular disorders. Regarding auditory manifestations, tinnitus and hearing loss (HL) were the most frequent symptoms. Vertigo/dizziness and imbalance matched to the vestibular changes were commonly observed. Conclusion Auditory and vestibular manifestations were referred to in the short and long-term after treatment with the drug. The discontinuation of its use made it possible to reverse the manifestations; however, in some cases, the permanence of the disorders was reported. Audiological and vestibular follow-up during mefloquine use is considered important, given its toxicity profile and possible side manifestations of an auditory and vestibular nature.

Postural balance in children with Autism Spectrum Disorders / Equilíbrio postural em crianças com Transtorno do Espectro Autista

ABSTRACT Purpose: to characterize the performance of children with autism spectrum disorders in two postural balance assessment scales. Methods: an observational cross-sectional study with a descriptive, analytical profile. Seven to 11-year-old children with mild autism spectrum disorder, diagnosed by an interdisciplinary team, according to the DSM-5, were assessed. The protocols used were the Sensory Organization Test and Pediatric Balance Scale. Results: all the children obtained maximum performance in the Sensory Organization Test. As for the Pediatric Balance Scale, the participants had similar responses in 8 out of its 14 items; in the other 6, there was a standard deviation. Conclusion: the participants did not have difficulties performing the Pediatric Balance Scale and Sensory Organization Test, scoring quite close to the maximum value.

RESUMO Objetivo: caracterizar o desempenho de criança com Transtorno do Espectro Autista em duas escalas de avaliação do Equilíbrio Postural. Métodos: estudo de interferência observacional, com segmento transversal e de perfil descritivo analítico. Foram avaliadas crianças com diagnóstico de TEA de grau leve segundo o DSM-5, diagnosticadas por equipe interdisciplinar, com idade entre 7 e 11 anos. Os protocolos utilizados foram o Teste de Organização Sensorial e a Escala de Equilíbrio Pediátrica. Resultados: todas as crianças apresentaram desempenho máximo no Teste de Organização Sensorial. Na Escala de Equilíbrio Pediátrica, dos 14 itens presentes, os participantes apresentaram respostas semelhantes em oito deles, e nos seis demais houve desvio padrão. Conclusão: os participantes não demonstraram dificuldades na realização na EEP e no Teste de Organização Sensorial, mantendo escores muito próximos do valor máximo.

Postural control assessment in students with normal hearing and sensorineural hearing loss.

INTRODUCTION: Children with sensorineural hearing loss can present with instabilities in postural control, possibly as a consequence of hypoactivity of their vestibular system due to internal ear injury. OBJECTIVE: To assess postural control stability in students with normal hearing (i.e., listeners) and with sensorineural hearing loss, and to compare data between groups, considering gender and age. METHODS: This cross-sectional study evaluated the postural control of 96 students, 48 listeners and 48 with sensorineural hearing loss, aged between 7 and 18 years, of both genders, through the Balance Error Scoring Systems scale. This tool assesses postural control in two sensory conditions: stable surface and unstable surface. For statistical data analysis between groups, the Wilcoxon test for paired samples was used. RESULTS: Students with hearing loss showed more instability in postural control than those with normal hearing, with significant differences between groups (stable surface, unstable surface) (p<0.001). CONCLUSIONS: Students with sensorineural hearing loss showed greater instability in the postural control compared to normal hearing students of the same gender and age.

Influence of sensory information on static balance in older patients with vestibular disorder.

INTRODUCTION: With aging, the sensory systems suffer an accumulation of degenerative, infectious and/or traumatic processes that may hinder the body balance maintenance. OBJECTIVE: To assess the influence of sensory information on static body balance of elderly individuals with vestibular disorders. METHODS: Cross-sectional study of elderly individuals with vestibular disorders. The Clinical Test of Sensory Interaction and Balance and posturography integrated with virtual reality (Balance Rehabilitation Unit) were used. Posturography parameters analyzed included center of pressure and velocity of body sway. RESULTS: 123 individuals with mean age of 73.11 were assessed. Worst performance was observed in the Clinical Test of Sensory Interaction and Balance condition of visual dome-unstable surface. Differences between conditions were: firm surface-open eyes/firm surface-closed eyes, unstable surface-open eyes/unstable surface-closed eyes (p<0.001), and unstable surface-closed eyes/unstable surface-visual dome. Considering center of pressure and velocity of body sway, significant differences were observed between the following conditions: firm surface-open eyes/firm surface-closed eyes: firm surface-saccadic stimulus/firm surface-vertical optokinetic stimulus; firm surface-optokinetic stimuli/firm surface-visual-vestibular interaction; and firm surface-visual-vestibular interaction/unstable surface. Worse performances were observed in conditions firm surface-closed eyes, firm surface-vertical optokinetic stimulus, F-visual-vestibular interaction, and unstable surface-closed eyes. There was a difference in the center of pressure between firm surface-closed eyes/firm surface-saccadic stimulus, with a worse performance in the condition of firm surface-closed eyes, and of velocity of body sway, between firm surface-saccadic stimulus/firm surface-horizontal optokinetic stimulus (p<0.001). CONCLUSION: Static body balance in elderly individuals with vestibular disorders is worse when the sensory conditions are more challenging, i.e. stable and unstable surfaces, visual stimuli, such as optokinetic and visual-vestibular interaction, and with the eyes closed.

Effects of vibrotactile vestibular substitution on vestibular rehabilitation - preliminary study.

INTRODUCTION: Some patients with severe impairment of body balance do not obtain adequate improvement from vestibular rehabilitation (VR). OBJECTIVE: To evaluate the effectiveness of Vertiguard™ biofeedback equipment as a sensory substitution (SS) of the vestibular system in patients who did not obtain sufficient improvement from VR. METHODS: This was a randomized prospective clinical study. Thirteen patients without satisfactory response to conventional VR were randomized into a study group (SG), which received the vibrotactile stimulus from Vertiguard™ for ten days, and a control group (CG), which used equipment without the stimulus. For pre- and post-treatment assessment, the Sensory Organization Test (SOT) protocol of the Computerized Dynamic Posturography (CDP) and two scales of balance self-perception, Activities-specific Balance Confidence (ABC) and Dizziness Handicap Inventory (DHI), were used. RESULTS: After treatment, only the SG showed statistically significant improvement in C5 (p=0.007) and C6 (p=0.01). On the ABC scale, there was a significant difference in the SG (p=0.04). The DHI showed a significant difference in CG and SG with regard to the physical aspect, and only in the SG for the functional aspect (p=0.04). CONCLUSION: The present findings show that sensory substitution using the vibrotactile stimulus of the Vertiguard™ system helped with the integration of neural networks involved in maintaining posture, improving the strategies used in the recovery of body balance.

A quantitative analysis of postural control in elderly patients with vestibular disorders using visual stimulation by virtual reality / Análise quantitativa do controle postural em pacientes idosos com disfunção vestibular utilizando a estimulação visual por realidade virtual

Abstract Introduction: Postural instability is one the most common disabling features in vestibular disorders. Objective: This study aimed to analyze the limit of stability and the influence of manipulation of visual, somatosensorial and visual-vestibular information on postural control in older adults with vestibular disorder, with and without a history of falls. Methods: Cross-sectional study. Participants - 76 elderly patients with vestibular disorder (G1, without falls; G2, with falls) and 41 healthy elderly subjects (control group; CG). Using posturography, analyzed were limit of stability area, body center of pressure, and velocity of oscillation in the standing position in 10 conditions, including open/closed eyes, unstable surface with eyes closed, saccadic and optokinetic stimuli, and visual-vestibular interaction. Results: Limit of stability area in CG was better compared with G1-2, and center of pressure values were worse in G1 than in CG. Center of pressure area in all conditions and velocity of oscillation in the following conditions: open/closed eyes, optokinetic stimulation, and visual-vestibular interaction showed worse values in G2 than in CG. Center of pressure area in the following conditions: open/closed eyes, saccadic and optokinetic stimuli, visual-vestibular interaction, and unstable surface with eyes closed showed worse values in G2 than in G1. Conclusion: Older adults with vestibular disorder presented reduced limit of stability and increased postural sway in the following conditions: conflict between visual and somatosensory information and visual-vestibular interaction. Deterioration in postural control was significantly associated with history of falls.

Resumo Introdução: Instabilidade postural é uma das características incapacitantes mais comuns nos distúrbios vestibulares. Objetivo: Analisar o limite de estabilidade e a influência da manipulação de informações visuais, somatossensoriais e visuais-vestibulares no controle postural em idosos com disfunção vestibular, com e sem histórico de quedas. Método: Estudo transversal. Participantes: 76 idosos com distúrbios vestibulares (G1, sem quedas; G2, com quedas) e 41 idosos saudáveis (grupo controle; GC). Com o uso da posturografia, foram analisadas a área do limite de estabilidade, centro de pressão e velocidade de oscilação na posição ereta em 10 condições, incluindo olhos abertos/fechados, superfície instável com olhos fechados, estímulos sacádicos e optocinéticos e interação visual-vestibular. Resultados: A área de limite de estabilidade no GC foi melhor comparada com o G1-2 e os valores do centro de pressão foram piores no G1 do que no GC. A área do centro de pressão em todas as condições e a velocidade de oscilação nas seguintes condições: olhos abertos/fechados, estímulo optocinético e interação visual-vestibular mostraram valores piores no G2 do que no GC. A área do centro de pressão nas seguintes condições: olhos abertos/fechados, estímulos sacádicos e optocinéticos, interação visual-vestibular e superfície instável com olhos fechados apresentou valores piores no G2 do que no G1. Conclusão: Idosos com disfunção vestibular apresentaram redução de limite de estabilidade e aumento da oscilação postural nas seguintes condições: conflito entre informação visual e somatossensorial e interação visual-vestibular. A deterioração no controle postural foi significantemente associada ao histórico de quedas.

Relationship between vestibular dysfunction and quality of life in climacteric women / Relação entre disfunção vestibular e qualidade de vida em mulheres climatéricas

Abstract The hormonal changes in climacteric women may affect the vestibular system; however, it is not clear in the literature whether the presence of vestibular dysfunction associated with climacteric is related to poorer quality of life. The study sample was composed of 374 women (40-65 years). Socioeconomic and demographic data, menopausal status, practice of physical exercises, presence or absence of vestibular dysfunction, hypertension and diabetes, anthropometric measurements and quality of life (using the Utian Quality of Life Scale - UQoL) were collected. Statistical analyses were performed using the Pearson test, Anova, T-test, and multiple regression considering a significance level of 5%. A significant relationship was found between vestibular dysfunction and health (p = 0.02) and emotional (p = 0.01) domains of the UQoL. In addition, physical activity, menopausal status, body mass index (BMI), waist-hip ratio (WHR), household income and diastolic blood pressure (DBP) mean also remained significantly related to quality of life. A relationship between vestibular dysfunction and quality of life for health and emotional domains in climacteric women was observed.

Resumo Mudanças hormonais em mulheres climatéricas podem afetar o sistema vestibular, porém, não está claro na literatura se a presença da disfunção vestibular associada ao climatério está relacionada à pior qualidade de vida. O objetivo deste artigo é analisar a relação entre disfunção vestibular e qualidade de vida em mulheres climatéricas. Amostra composta por 374 mulheres (40 a 65 anos). Foram coletados dados socioeconômicos e demográficos, status menopausal, prática de exercício físico, presença ou ausência de disfunção vestibular, hipertensão e diabetes, medidas antropométricas e qualidade de vida (por meio do Utian Quality of Life Scale - UQoL). Na análise estatística foi utilizado teste de Pearson, Anova, teste t e regressão múltipla, considerando nível de significância de 5%. Verificou-se relação significativa entre a disfunção vestibular e os domínios saúde (p = 0,02) e emocional (p = 0,01) do UQoL. Além disso, atividade física, status menopausal, IMC (índice de massa corporal), RCQ (relação cintura-quadril), renda familiar e média da PAD (pressão arterial diastólica) também permaneceram significantemente relacionadas à qualidade de vida. Observou-se relação entre disfunção vestibular e qualidade de vida para os domínios saúde e emocional em mulheres climatéricas.

Déficits vestibulares e vertigem posicional paroxística benigna em adultos jovens assintomáticos: um estudo transversa / Vestibular deficits and benign paroxysmal positional vertigo in young asymptomatic adults: a transversal study

Introdução: O equilíbrio corporal pode ser afetado por déficits visuais, proprioceptivos e/ou vestibulares centrais ou periféricas. Dentre as afecções vestibulares periféricos, a Vertigem Postural Paroxística Benigna apresenta grande interesse em pesquisas que buscam responder suas apresentações clínicas em adultos e sua associação com a integralidade dos demais sistemas corporais. Objetivo: Analisar as respostas de adultos jovens assintomáticos submetidos à semiologia do sistema vestibular. Metodologia: Estudo quantitativo, transversal analítico e descritivo, onde foram utilizados os testes de equilíbrio estático, dinâmico e a manobra de DixHallpike, com amostra de 30 voluntários assintomáticos recrutados em uma instituição de ensino superior do município de Parnaíba/PI. Resultados: O teste de apoio unipodal (1,87 ± 0,346) foi negativo (p < 0,001) e no teste de Fukuda (1,20 ± 0,407) grande parte tiveram resultados positivos (p < 0,001). Os testes de Romberg (2,00 ± 0,000), Romberg-Barré (1,50 ± 0,509) e Babinski-Weil (1,37 ± 0,490) não foram significantes (p = 0,001). Para a Manobra de Dix-Hallpike observamos que os movimentos de sedestação para decúbito dorsal esquerdo e de decúbito dorsal para sedestação direito e esquerdo foram significativos (p < 0,001). Conclusão: Os adultos jovens assintomáticos podem apresentar resultados positivos em teste de equilíbrio e sintomas na manobra de Dix-Hallpike, confirmando a Vertigem Postural Paroxística Benigna.(AU)

Introduction: Body balance can be affected by visual deficits, proprioceptive and/or central or peripheral vestibular. Among the peripheral vestibular disorders, the Benign Paroxysmal Positional Vertigo presents great interest in research seeking to answer clinical presentations in adults and its association with the completion of other body systems. Objective: To analyze the responses of asymptomatic young adults with symptoms of the vestibular system. Methods: This was a quantitative, descriptive analytical cross-sectional, where we used the tests of static balance, dynamic and Dix-Hallpike, with a sample of 30 asymptomatic volunteers recruited in a higher education institution in the city of Parnaíba/PI, Brazil. Results: The one-leg supporting roll 1.87 ± 0.346) was negative (p < 0.001) and the test Fukuda (1.20 ± 0.407) were largely positive (p < 0.001). The Romberg test (2.00 ± 0.000) Romberg-Barré (1.50 ± 0.509) and Babinski-Weil (1,37 ± 0.490) were not significant (p = 0.001). For the Maneuver Dix-Hallpike we observed that the movements of the sitting position to the left supine and supine to right and left sedestation were significant (p < 0.001). Conclusion: Asymptomatic young adults may have positive results on balancing test and symptoms in the Dix-Hallpike, confirming the Benign Paroxysmal Positional Vertigo. (AU)

Evaluation of postural control in unilateral vestibular hypofunction.

INTRODUCTION: Patients with vestibular hypofunction, a typical finding in peripheral vestibular disorders, show body balance alterations. OBJECTIVE: To evaluate the postural control of patients with vertigo and unilateral vestibular hypofunction. METHOD: This is a clinical cross-sectional study. Twenty-five patients with vertigo and unilateral vestibular hypofunction and a homogeneous control group consisting of 32 healthy individuals were submitted to a neurotological evaluation including the Tetrax Interactive Balance System posturography in eight different sensory conditions. RESULTS: For different positions, vertiginous patients with unilateral vestibular hypofunction showed significantly higher values of general stability index, weight distribution index, right/left and tool/heel synchronizations, Fourier transformation index and fall index than controls. CONCLUSION: Increased values in the indices of weight distribution, right/left and tool/heel synchronizations, Fourier transformation and fall risk characterize the impairment of postural control in patients with vertigo and unilateral vestibular hypofunction.

Efeito da realidade virtual na intensidade de tontura e qualidade de vida de idosos com hipofunção vestibular unilateral / Effect of virtual reality on intensity of dizziness and quality of life in elderly living with unilateral vestibular hypofunction

Este estudo teve por objetivo verificar a eficácia da realidade virtual na intensidade de tontura e qualidade de vida de idosos com hipofunção vestibular unilateral. A amostra foi constituída por 12 indivíduos com idade média de 70,16 ± 6,86 anos, de ambos os gêneros, referindo sintoma de tontura por dois meses e apresentaram positividade para hipofunção vestibular unilateral. Foram excluídos do estudo pacientes que apresentaram positividade para VPPB. Para avaliação da qualidade de vida foi utilizado o Dizziness Handicap Inventory - versão brasileira, para a avaliação do sintoma de tontura foi utilizado a Escala Visual Analógica (EVA). Os participantes foram avaliados e divididos em dois grupos, grupo A - exercícios vestibulares convencionais - e grupo B - tratamento com realidade virtual através do Xbox 360 Kinect® da Microsoft. Ao término da última sessão, foi realizada a reavaliação. Para a análise dos dados foi utilizado estatística descritiva, os testes de Wilcoxon para a variável EVA e T de Student para as o DHI de ambos os grupos. O nível de significância foi de 5%. Ao término do programa, apenas o grupo B mostrou diferença significativa nos quesitos avaliados. Conclui-se que a realidade virtual é adequada no tratamento de idosos com hipofunção vestibular unilateral. (AU)

This study aimed to verify the efficacy of virtual reality on intensity of dizziness and quality of life in elderly with unilateral vestibular hypofunction. The sample consisted of 12 individuals with a mean age of 70.16 years (± 6.86) of both genders, who reported dizziness symptoms for at least two months and presented positivity for unilateral vestibular hypofunction. Patients who were positive for BPPV were excluded. The Dizziness Handicap Inventory - Brazilian version was used to evaluate quality of life, and Visual Analog Scale (VAE) was used for evaluation of dizziness symptoms. Participants were assessed and then divided into two groups; in group A the intervention was performed through conventional vestibular exercises; and group B underwent a treatment with use of virtual reality through the Xbox 360 Kinect® of Microsoft. At the end of last session, the revaluation was carried out. For data analysis, descriptive statistics were used, and Wilcoxon, Student's T and Shapiro-Wilk tests were used to compare variables of groups A and B. The level of significance was 5%. At the end of the program, only group B showed a significant difference in the evaluated items, we concluded that virtual reality is an adequate to treatment of elderly patients with unilateral vestibular hypo function. (AU)

Otoneurological findings prevalent in hereditary ataxias / Alterações otoneurológicas prevalentes nas ataxias hereditárias

ABSTRACT Objective To describe and compare the vestibular findings most evident among the hereditary ataxias, as well as correlate their clinical features with the nervous structures affected in this disease. Methods Seventy-five patients were evaluated and underwent a case history, otorhinolaryngological and vestibular assessments. Results Clinically, the patients commonly had symptoms of gait disturbances (67.1%), dizziness (47.3%), dysarthria (46%) and dysphagia (36.8%). In vestibular testing, alterations were predominantly evident in caloric testing (79%), testing for saccadic dysmetria (51%) and rotational chair testing (47%). The presence of alterations occurred in 87% of these patients. A majority of the alterations were from central vestibular dysfunction (69.3%). Conclusion This underscores the importance of the contribution of topodiagnostic labyrinthine evaluations for neurodegenerative diseases as, in most cases, the initial symptoms are otoneurological; and these evaluations should also be included in the selection of procedures to be performed in clinical and therapeutic monitoring.

RESUMO Objetivo Descrever e comparar os achados vestibulares mais evidentes entre a ataxia hereditária, bem como correlacionar seus aspectos clínicos com o estudo das estruturas nervosas afetadas nesta doença. Métodos 75 pacientes foram avaliados e submetidos aos seguintes procedimentos: anamnese, avaliação otorrinolaringológica e vestibular. Resultados Clinicamente, os pacientes apresentaram sintomas de distúrbios da marcha (67,1%), tonturas (47,3%), disartria (46%) e disfagia (36,8%). No teste vestibular, as alterações foram predominantemente evidentes no teste calórico (79%), dismetria sacádicas (51%) e no teste rotatório (47%). A presença de alterações ocorreu em 87% dos pacientes. A maioria das alterações observadas foram da disfunção vestibular central (69,3%). Conclusão O estudo ressalta a importância da contribuição da avaliação labiríntica no topodiagnóstico para doenças neurodegenerativas, uma vez que, na maioria dos casos, os sintomas iniciais são otoneurológicos, e essas avaliações também devem ser incluídas na seleção de procedimentos a serem realizados no monitoramento clínico e terapêutico.

Vectoelectronystagmography in children with dyslexia and learning disorder / Vectoeletronistagmografia em crianças com dislexia e transtorno de aprendizagem

ABSTRACT Objective: to describe and compare the results of ocular (saccadic, screening, and optokinetic) tests of vectoelectronystagmography among the groups with dyslexia, learning disorder and control. Methods: 28 male and female students aged 8 to 11 years participated in this study. They were divided into three groups: Group I, 10 students with dyslexia, Group II, 9 students with learning disorders and Group III, 9 students with no learning disorders. In this research, digital vectoelectronystagmography - ocular test - was performed. Results: saccadic movement, optokinetic nystagmus, and pendular tracking tests were found to show subtle differences among the three groups. Comparing the saccadic eye movements and the optokinetic nystagmus tests, it was observed that the movement in the left eye was slower for Group I, and even slower for Group II. It was also observed that GI and GII were slower for the pendular tracking of luminous stimulus in relation to the control group. Conclusion: in general, there are differences among the groups in the vectoelectronystagmography, which indicated slower tracking and vestibulo-ocular reflex in children with dyslexia and learning disorders.

RESUMO Objetivo: descrever e comparar os resultados das provas oculares (sacádicos, rastreio, e optocinético) da vectoeletronistagmografia entre os grupos com dislexia, transtorno de aprendizagem e controle. Métodos: participaram deste estudo 28 estudantes do sexo masculino e feminino, com idade entre 8 e 11 anos. Foram divididos em três grupos, sendo Grupo I: Dez escolares com Dislexia, Grupo II: Nove escolares com Transtornos de Aprendizagem e Grupo III: Nove escolares sem dificuldades de aprendizagem. Nesta pesquisa foi realizada avaliação da vectoeletronistagmografia digital: provas oculares (sacádicos, rastreio, e optocinético). Resultados: verificou-se que as provas de movimento sacádico, nistagmo optocinético e rastreio pendular mostraram diferenças sutis entre os três grupos. Na comparação das provas de movimentos sacádicos dos olhos e pesquisa do nistagmo optocinético foi observada que a velocidade do movimento do olho esquerdo que se mostrou mais lento para o Grupo I, e ainda mais lentos para o Grupo II. Foi observado também que os grupos GI e GII foram mais lentos para o rastreio em pêndulo do estímulo luminoso em relação ao grupo controle. Conclusão: de modo geral, foi observada diferença entre os grupos para a medida da vectoeletronistagmografia, que indicam rastreios e reflexo vestibular-ocular mais lentos nas crianças com dislexia e transtornos de aprendizagem.

Vestibular dysfunction and postural balance in cochlear implant users: a narrative literature review / Disfunção vestibular e equilíbrio postural em usuários de implante coclear: revisão narrativa da literatura

ABSTRACT Cochlear implants directly stimulate nerve fibers and ganglion cells of the auditory nerve, which transform sound energy into low levels of electrical current, stimulating the remaining fibers of the auditory nerve in patients with severe to profound hearing loss, in order to provide the significant range of auditory sensation and speech comprehension. Due to the close relationship between cochlea and vestibular receptors, some patients may present vestibular and postural balance changes concomitantly after surgery. This study aimed to perform a narrative review of the main studies that relate vestibular symptoms in patients implanted in the last six years. The research was performed through the databases: SciELO, LILACS and PubMed, using associated descriptors for "cochlear implant", "vestibular dysfunction", "vertigo" and "balance", totalizing 21 studies that fitted the inclusion criteria. The results were described in a chronological order of publication, showing the main conclusions. Of the total studies analyzed, 18 related vestibular function to cochlear implant and only 3 studies did not find such a relationship. The literature characterize the effects of the cochlear implant on the vestibular system, however, the results are contradictory.

RESUMO O implante coclear estimula, diretamente, as fibras nervosas e as células ganglionares do nervo auditivo, que transformam a energia sonora em baixos níveis de corrente elétrica, estimulando as fibras remanescentes do nervo auditivo em pacientes com perda auditiva de grau severo a profundo, a fim de proporcionar o alcance significativo da sensação auditiva e compreensão da fala. Devido à estreita relação entre cóclea e os receptores vestibulares, alguns pacientes podem apresentar alterações vestibulares e do equilíbrio postural, concomitantemente, após a cirurgia. Este trabalho teve como objetivo realizar uma revisão narrativa dos principais estudos, que relacionam sintomas vestibulares, em pacientes implantados, nos últimos seis anos. A pesquisa foi realizada por meio dos bancos de dados: Scielo, LILACS e PubMed, utilizando descritores associados para "implante coclear", "disfunção vestibular", "vertigem" e "equilíbrio", totalizando vinte e um estudos, que se enquadraram nos critérios de inclusão. Os resultados foram descritos em ordem cronológica de publicação, mostrando as principais conclusões. Do total de estudos analisados, dezoito relacionaram função vestibular e implante coclear e apenas três estudos não encontraram tal relação. Estudos caracterizam os efeitos do implante coclear no sistema vestibular, no entanto, os resultados são contraditórios.

Immediate effects of an anchor system on the stability limit of individuals with chronic dizziness of peripheral vestibular origin / Efeitos imediatos de um sistema de âncoras no limite de estabilidade de indivíduos com tontura crônica de origem vestibular periférica

Abstract Introduction The symptoms associated with chronic peripheral vestibulopathy exert a negative impact on the independence and quality of life of these individuals, and many individuals continue to suffer from these symptoms even after conventional vestibular rehabilitation. Objective To evaluate the acute effect of an anchor system for balance evaluation of patients with chronic dizziness who failed to respond to traditional vestibular rehabilitation. Methods Subjects over 50 years of age, presenting with chronic dizziness and postural instability of peripheral vestibular origin, participated in the study. The limit of stability was evaluated in three positions using the Balance Master® system: Position 1, standing with the arms along the body; Position 2, standing with the elbows bent at 90º (simulating holding the anchors); and Position 3, with the elbows bent at 90º holding the anchors. The variables of movement latency, endpoint excursion and directional control of movement were evaluated. Results Using the anchor system, significant reduction of time in the response at the beginning of the movement compared to Position 1 (p < 0.05); increased endpoint excursion in the left lateral direction compared to Position 1 (p < 0.05); and more directional control of movement in the anterior and posterior directions (p < 0.05) compared to the other positions, were found. Conclusion While using the system anchor, individuals with chronic peripheral vestibulopathy showed an immediate improvement in the stability limit in relation to the movement latency, endpoint excursion, and directional control of movement variables, suggesting that the haptic information aids postural control.

Resumo Introdução Os sintomas associados à vestibulopatia periférica crônica têm impacto negativo na independência e qualidade de vida dos indivíduos e muitos deles continuam a sofrer desses sintomas, mesmo depois de ter passado pela reabilitação vestibular convencional. Objetivo Avaliar o efeito agudo de um sistema de ancoragem para avaliação do equilíbrio de pacientes com tontura crônica que não responderam à reabilitação vestibular tradicional. Método Participaram do estudo indivíduos com mais de 50 anos que se apresentaram com tontura crônica e instabilidade postural de origem vestibular periférica. O limite de estabilidade foi avaliado em três posições, com o uso do sistema Balance Master®: Posição 1, de pé com os braços pendentes ao longo do corpo; Posição 2, de pé com os cotovelos flexionados em 90º (simulando a posição de segurar as âncoras); e Posição 3, com os cotovelos flexionados em 90º e segurando as âncoras. Foram avaliadas as variáveis de latência de movimento, o ponto final da excursão e o controle direcional do movimento. Resultados Com o uso do sistema de âncoras, ocorreu redução significante no tempo de resposta no início do movimento em comparação com a Posição 1 (p < 0,05); aumento no ponto final da excursão na direção lateral esquerda, em comparação com a Posição 1 (p < 0,05); e mais controle direcional do movimento nas direções anterior e posterior (p < 0,05), em comparação com as demais posições. Conclusão Enquanto usavam o sistema de âncoras, os indivíduos com vestibulopatia periférica demonstraram melhoria imediata no limite da estabilidade em relação às variáveis latência de movimento, ponto final da excursão e controle direcional do movimento. Isso sugere que a informação háptica auxilia no controle postural.