[Approach to patients with vertigo]. / Enfoque del paciente con vértigo.

Vertigo is defined as an abnormal sensation of body motion or of its surrounding objects. It is a common chief complaint in emergency departments comprising 2 to 3% of these consultations worldwide. Vertigo is classified as peripheral or central, according to its origin, and can also be occasionally mixed, the most common cause of peripheral involvement being benign paroxysmal positional vertigo. The initial findings on clinical evaluation of patients are the clues for making a correct diagnosis. The differentiation between central and peripheral vertigo can be optimized by analysing nystagmus, by using the skew test and the head impulse test (HINTS), as also by performing the appropriate tests to evaluate the integrity of the vestibular-cerebellar pathway. In addition, tonal threshold audiometry could raise the diagnostic sensibility from 71 to 89% on initial approach. Appropriate diagnosis is the principal key for managing this clinical condition.

Health-related quality of life and disability in patients with acute unilateral peripheral vestibular disorders / Qualidade de vida relacionada à saúde e incapacidade em pacientes com distúrbios vestibulares periféricos unilaterais agudos

Abstract Introduction: Health-related quality of life is used to denote that portion of the quality of life that is influenced by the person's health. Objectives: To compare the health-related quality of life of individuals with vestibular disorders of peripheral origin by analyzing functional, emotional and physical disabilities before and after vestibular treatment. Methods: A prospective, non randomized case-controlled study was conduced in the ENT Department, between January 2015 and December 2015. All patients were submitted to customize a 36 item of health survey on quality of life, short form 36 health survey questionnaire (SF-36) and the Dizziness Handicap Inventory for assessing the disability. Individuals were diagnosed with acute unilateral vestibular peripheral disorders classified in 5 groups: vestibular neuritis, Ménière Disease, Benign Paroxysmal Positional Vertigo, cochlear-vestibular dysfunction (other than Ménière Disease), or other type of acute peripheral vertigo (as vestibular migraine). Results: There was a statistical significant difference for each parameter of Dizziness Handicap Inventory score (the emotional, functional and physical) between the baseline and one month both in men and women, but with any statistical significant difference between 7 days and 14 days. It was found a statistical significant difference for all eight parameters of SF-36 score between the baseline and one month later both in men and women; the exception was the men mental health perception. The correlation between the Dizziness Handicap Inventory and the SF-36 scores according to diagnostics type pointed out that the Spearman's correlation coefficient was moderate correlated with the total scores of these instruments. Conclusion: The Dizziness Handicap Inventory and the SF-36 are useful, proved practical and valid instruments for assessing the impact of dizziness on the quality of life of patients with unilateral peripheral vestibular disorders.

Resumo Introdução: Qualidade de vida relacionada à saúde é usada para designar a parte da qualidade de vida que é influenciada pela saúde do indivíduo. Objetivos: Comparar a qualidade de vida relacionada à saúde de indivíduos com distúrbios vestibulares de origem periférica, analisar incapacidades funcionais, emocionais e físicas antes e após o tratamento vestibular. Método: Um estudo de caso-controle prospectivo, não randomizado, foi conduzido no Departamento de Otorrinolaringologia, entre janeiro de 2015 e dezembro de 2015. Todos os pacientes foram submetidos a uma pesquisa de saúde personalizada de 36 itens sobre qualidade de vida, ao formulário abreviado de avaliação de saúde 36 (SF-36) e ao Dizziness Handicap Inventory para avaliar a incapacidade. Os indivíduos foram diagnosticados com distúrbios vestibulares periféricos unilaterais agudos, classificados em cinco grupos: neurite vestibular, doença de Ménière, vertigem posicional paroxística benigna, disfunção cócleo-vestibular (exceto Doença de Ménière) ou outro tipo de vertigem periférica aguda (como enxaqueca vestibular). Resultados: Houve uma diferença estatisticamente significante para cada parâmetro de escore no Dizziness Handicap Inventory (emocional, funcional e físico) entre a avaliação basal e depois de um mês, tanto em homens quanto em mulheres, mas sem diferença estatística significativa entre sete dias e 14 dias. Foi encontrada uma diferença estatisticamente significante para todos os oito parâmetros do escore no SF-36 entre a avaliação basal e um mês mais tarde, tanto em homens quanto em mulheres; a exceção foi a percepção de saúde mental nos homens. A correlação entre Dizziness Handicap Inventory e o SF-36 de acordo com o tipo de diagnóstico mostrou que o coeficiente de correlação de Spearman foi moderado quando correlacionado com o escore total desses instrumentos. Conclusão: O Dizziness Handicap Inventory e o SF-36 demonstraram ser instrumentos úteis, práticos e válidos para avaliar o impacto da tontura na qualidade de vida de pacientes com distúrbios vestibulares periféricos unilaterais.

Health-related quality of life and disability in patients with acute unilateral peripheral vestibular disorders.

INTRODUCTION: Health-related quality of life is used to denote that portion of the quality of life that is influenced by the person's health. OBJECTIVES: To compare the health-related quality of life of individuals with vestibular disorders of peripheral origin by analyzing functional, emotional and physical disabilities before and after vestibular treatment. METHODS: A prospective, non randomized case-controlled study was conduced in the ENT Department, between January 2015 and December 2015. All patients were submitted to customize a 36 item of health survey on quality of life, short form 36 health survey questionnaire (SF-36) and the Dizziness Handicap Inventory for assessing the disability. Individuals were diagnosed with acute unilateral vestibular peripheral disorders classified in 5 groups: vestibular neuritis, Ménière Disease, Benign Paroxysmal Positional Vertigo, cochlear-vestibular dysfunction (other than Ménière Disease), or other type of acute peripheral vertigo (as vestibular migraine). RESULTS: There was a statistical significant difference for each parameter of Dizziness Handicap Inventory score (the emotional, functional and physical) between the baseline and one month both in men and women, but with any statistical significant difference between 7 days and 14 days. It was found a statistical significant difference for all eight parameters of SF-36 score between the baseline and one month later both in men and women; the exception was the men mental health perception. The correlation between the Dizziness Handicap Inventory and the SF-36 scores according to diagnostics type pointed out that the Spearman's correlation coefficient was moderate correlated with the total scores of these instruments. CONCLUSION: The Dizziness Handicap Inventory and the SF-36 are useful, proved practical and valid instruments for assessing the impact of dizziness on the quality of life of patients with unilateral peripheral vestibular disorders.

Visual gravitational vertical perception in peripheral vestibular hypofunction.

CONCLUSIONS: Rise time in the estimation of the gravitational vertical in the head tilt response (HTR) test is increased in patients with peripheral vestibular lesions and residual chronic dizziness. OBJECTIVE: Assessment of the perception of the gravitational vertical in patients with peripheral vestibular lesions through the HTR. METHODS: HTR was studied in 12 patients with peripheral vestibular lesion, 8 clinically with chronic dizziness and 4 without it; 23 normal subjects were studied as control group. Two parameters of the HTR were assessed, rise time and steady-state error to characterize a dynamical system step response. The Kolmogorov-Smirnov test (alpha = 5%) was used to verify normal distribution (steady-state error, p = 0.53; rise time, p = 0.88). The three sigma ellipse was calculated for the control group. ROC curves were used to measure the sensitivity and specificity of these parameters. RESULTS: Rise time showed increased values in peripheral vestibular lesion patients with chronic dizziness. Two-dimensional analysis (rise time vs steady-state error) allows a better discrimination between patients with peripheral vestibular hypofunction with chronic dizziness and the rest of the studied population.

Electromyographic activity of sternocleidomastoid and masticatory muscles in patients with vestibular lesions.

This study evaluated the electromyographic characteristics of masticatory and neck muscles in subjects with vestibular lesions. Surface electromyography of the masseter, temporalis and sternocleidomastoid muscles was performed in 19 patients with Ménière's disease, 12 patients with an acute peripheral vestibular lesion, and 19 control subjects matched for sex and age. During maximum voluntary clenching, patients with peripheral vestibular lesions had the highest co-contraction of the sternocleidomastoid muscle (analysis of covariance, p=0.02), the control subjects had the smallest values, and the patients with Ménière's disease had intermediate values. The control subjects had larger standardized muscle activities than the other patient groups (p=0.001). In conclusion, during maximum voluntary tooth clenching, patients with vestibular alterations have both more active neck muscles, and less active masticatory muscles than normal controls. Results underline the importance of a more inclusive craniocervical assessment of patients with vestibular lesions.

Electromyographic activity of sternocleidomastoid and masticatory muscles in patients with vestibular lesions

This study evaluated the electromyographic characteristics of masticatory and neck muscles in subjects with vestibular lesions. Surface electromyography of the masseter, temporalis and sternocleidomastoid muscles was performed in 19 patients with Ménière's disease, 12 patients with an acute peripheral vestibular lesion, and 19 control subjects matched for sex and age. During maximum voluntary clenching, patients with peripheral vestibular lesions had the highest co-contraction of the sternocleidomastoid muscle (analysis of covariance, p=0.02), the control subjects had the smallest values, and the patients with Ménière's disease had intermediate values. The control subjects had larger standardized muscle activities than the other patient groups (p=0.001). In conclusion, during maximum voluntary tooth clenching, patients with vestibular alterations have both more active neck muscles, and less active masticatory muscles than normal controls. Results underline the importance of a more inclusive craniocervical assessment of patients with vestibular lesions.

Vestibular function interferes in cardiovascular reflexes [corrected].

BACKGROUND: Experimental work indicates that the vestibular system participates in autonomic reflexes during body movement and postural changes. However, there are no studies of cardiovascular reflexes during vertigo due to human acute vestibular lesions. METHODS: We assessed the response to active change of posture and hand immersion in cold water in seven patients with unilateral peripheral vestibular failure (vestibular neuritis) and seven age/sex-matched healthy subjects in acute phase (72 h from vertigo onset) and at 2 weeks of follow-up. RESULTS: During acute phase, patients showed decreased blood pressure response during cold hand test (p < 0.05). Upright stance induced deficient decrease of the respiratory component of heart rate variability (p < 0.05) with lack of increase in low frequency/high frequency (LF/HF) ratio. At 2 weeks of follow-up, these abnormalities improved. CONCLUSIONS: Results suggest that acute vestibular lesions can interfere with cardiovascular autonomic responses in humans. This may reflect disruption of normal vestibulo-autonomic reflexes.