Posturographic profile of patients with persistent postural-perceptual dizziness on the sensory organization test.

BACKGROUND/OBJECTIVE: Persistent postural-perceptual dizziness (PPPD) was defined by expert consensus for the forthcoming International Classification of Diseases, 11th edition. Its diagnostic criteria were derived from phobic postural vertigo and chronic subjective dizziness. Two key symptoms are postural unsteadiness and visually induced dizziness. We observed that patients with PPPD tended to perform poorly on multiple conditions of the EquiTest® Sensory Organization Test (SOT) and sought to investigate this phenomenon systematically. METHODS: We examined cross-sectional, pair-wise group differences in mean scores from SOT conditions 1-6 and composite scores among 20 patients with PPPD, 15 patients recovered from acute vestibular syndromes, and 15 normal individuals (all female, 43 ± 9 years old). We also compared proportions of patients in each group with abnormal sensory analyses, and poor performance across multiple conditions. RESULTS: Patients with PPPD had significantly lower mean scores than normal individuals on conditions 2-6 and the composite, and lower than recovered patients on conditions 2-3. Recovered patients had significantly lower mean scores than normal individuals on conditions 4-6 and the composite. Patients with PPPD had the greatest likelihood of abnormal sensory analyses. CONCLUSIONS: Patients with PPPD had difficulties with postural control across multiple sensory challenges, consistent with postulated neurophysiologic mechanisms of this condition.

Caloric test as a predictor tool of postural control in CI users.

CONCLUSIONS: Balance was improved at 365 days after CI in all patients. Caloric test findings were important determinants of balance outcomes over a year after CI. Pre-operative vestibular assessment findings should be documented because postural recovery over time depends on this information. OBJECTIVE: To verify the importance of the caloric test as a pre-operative predictor tool of postural control after CI surgery. METHODS: Prospective observational study made with 24 post-lingual deafness patients who underwent unilateral CI surgery. Vestibular assessments: questionnaire assessing vertigo, caloric tests, rotary chair (RC) testing, and computerized dynamic posturography (CDP), were sequentially performed for all patients before and 60, 120, 180, and 365 days after CI. RESULTS: Thirteen patients (54.2%) reported dizziness before CI. At the end of the study, dizziness remained unchanged in one (7.7%) patient, ameliorated in 11 (84.6%), and worsened in one (7.7%). Baseline caloric tests identified 29.2% patients with normal reflexes, 33.3% with unilateral areflexia or hyporeflexia, 12.5% with bilateral hyporeflexia, and 25% with bilateral vestibular loss (BVL). Most patients exhibited objective improvements in postural stability. At 365 days, the CDP condition (particularly C5) and CS were higher for caloric tests responders at baseline than for those with BVL at baseline.

Deletion of the entire POU4F3 gene in a familial case of autosomal dominant non-syndromic hearing loss.

In 20% of cases, hereditary non-syndromic hearing loss has an autosomal dominant inheritance (ADNSHL). To date, more than 50 loci for ADNSHL have been mapped to different chromosomal regions. In order to verify whether genomic alterations contribute to the hearing loss etiology and to search for novel deafness candidate loci, we investigated probands from families with ADNSHL by oligonucleotide array-CGH. A deletion in the 5q32 region encompassing only one gene, POU4F3, which corresponds to DFNA15, was detected in one family. POU4F3 protein has an important role in the maturation, differentiation and survival of cochlear hair cells. Defects in these cells may therefore explain sensorineural hearing loss. Mutations in this gene have already been associated with autosomal dominant hearing loss but this is the first description of a germline POUF4F3 deletion associated with hearing impairment.

Vestibular rehabilitation therapy in children.

OBJECTIVES: Vestibular disturbances are underdiagnosed in children. However, balance impairment may compromise the normal development of affected children. The appropriate therapeutic approach has not been agreed on for this age group. Vestibular rehabilitation therapy has excellent results in adults, but very few data exist regarding its results in children. We evaluated through clinical assessment and computerized dynamic posturography the outcome of children with peripheral vestibular disturbances undergoing vestibular rehabilitation therapy and observed the influence of learning and of central nervous system maturation on posturography retest results. METHODS: Sixteen children (10 boys and 6 girls) with peripheral vestibular disorders (mean age, 8 yr 7 mo) constituted the cohort and were consecutively treated with vestibular rehabilitation therapy. Symptomatic children underwent pre- and posttreatment computerized dynamic posturography. Their outcome was clinically assessed. Another 16 asymptomatic children, paired by sex and age, underwent two computerized dynamic posturography procedures with the same time interval as that of the symptomatic group. RESULTS: All children completed the treatment. Total recovery of symptoms occurred in nine (56.3%) patients, whereas a dramatic partial recovery was observed in the remaining seven (43.7%) children. Posturography Conditions 5 and 6, the vestibular ratio of the sensory analysis, and the composite equilibrium score had a significant quantitative improvement after vestibular rehabilitation therapy. No adverse reactions occurred to the exercises. No statistically significant posturography changes were observed in the asymptomatic children. CONCLUSION: Vestibular rehabilitation therapy seems to be a safe and efficacious therapeutic option in children with peripheral vestibular disturbances.

[Evaluation of the treatment of vestibular disorders in children with computerized dynamic posturography: preliminary results]. / Avaliação do tratamento dos distúrbios vestibulares na criança através da posturografia dinâmica computadorizada: resultados preliminares.

OBJECTIVE: This study aimed at evaluating dynamic posturography as an evaluation method in children with balance problems due to peripheral vestibulopathy, before and after treatment with vestibular rehabilitation, establishing its correlation with classical clinical evaluation. METHOD: Ten children (six boys and four girls) with vestibular symptoms of peripheral origin were evaluated through a complete clinical history and with dynamic computerized posturography after being treated by vestibular rehabilitation therapy. Posturographic data were analyzed and compared to standard clinical evaluation parameters. RESULTS: Dynamic posturography showed a significant improvement of condition 1 (orthostatic position, fixed support and open eyes) and 5 (orthostatic position, sway-referenced support and closed eyes) of the vestibular function and of the composite balance score. The data showed significant correlation with the clinical improvement observed. A significant reduction of proprioceptive influence was also observed. CONCLUSIONS: Data showed that the dynamic posturography adds important quantitative information to the conventional clinical evaluation of vestibular symptoms, especially in children.

Avaliaçäo do tratamento dos distúrbios vestibulares na criança através da posturografia dinâmica computadorizada: resultados preliminares / Evaluation of the treatment of vestibular disorders in children with computerized dynamic posturography: preliminary results

OBJETIVO: o objetivo desta investigaçäo foi avaliar a posturografia como método de acompanhamento de crianças com vestibulopatia periférica, tratadas com reabilitaçäo vestibular, estabelecendo sua correlaçäo com a evoluçäo clínica dos pacientes. MÉTODOS: dez crianças (seis meninos e quatro meninas) portadoras de afecções vestibulares periféricas, submetidas à reabilitaçäo vestibular como forma de tratamento, tiveram sua evoluçäo clínica avaliada através de uma anamnese detalhada de seus sintomas e da realizaçäo da posturografia dinâmica computadorizada. Os dados posturográficos foram analisados e comparados à evoluçäo clínica dos pacientes estudados. RESULTADOS: observou-se, após o tratamento, melhora significativa das condições 1 (paciente em posiçäo ortostática, plataforma fixa e olhos abertos) e 5 (paciente em posiçäo ortostática, plataforma em movimento e olhos fechados) da posturografia dinâmica, da funçäo vestibular e do índice do equilíbrio, que correlacionaram-se significativamente com a melhora clínica e diminuiçäo dos sintomas dos pacientes. Observou-se, também, reduçäo significativa da influência da funçäo somatosensorial sobre o equilíbrio final da criança. CONCLUSÄO: os dados obtidos mostram que a posturografia näo substitui a avaliaçäo clínica convencional, mas agrega dados quantitativos importantes para o acompanhamento da terapia destes pacientes.

Sudden deafness and Lyme disease.

OBJECTIVES/HYPOTHESIS: Otolaryngological manifestations are common in Lyme disease, affecting up to 75% of patients. One of these symptoms is sudden deafness. Hearing loss has been frequently described in Lyme disease; on the other hand, titers seropositive for, the causal agent of this disease, have been found in almost 20% of cases of sudden deafness. No consensual information exists on the outcome of Borrelia-seropositive patients or on the importance of determining Borrelia antibody titers. The present study aimed to determine the prevalence of seropositivity for Borrelia in sudden deafness, describing clinical characteristics and outcomes. STUDY DESIGN: This was a prospective observational study. METHODS: Forty-seven consecutive patients with sudden deafness were enrolled in the study. Demographic data, the presence of tinnitus and vertigo, and low- and high-frequency pure-tone averages were recorded. The percentage of hearing recovery was determined. Data obtained from Borrelia-seropositive patients were described and compared with those from the seronegative group. RESULTS: Titers positive for antibodies were present in 21.3% of the cases. Seropositive and seronegative groups of patients were homogeneous concerning age, sex distribution, the presence of tinnitus and vertigo, and high- and low-frequency hearing thresholds. Hearing outcome was not significantly different between the groups of patients. CONCLUSIONS: No distinctive clinical characteristic was found between seropositive and seronegative subjects. The hearing outcome of treated Borrelia-seropositive patients was similar to that of the seronegative group.

Reabilitaçäo vestibular na criança: estudo preliminar / Vestibular rehabilitation in children: preliminary study

Forma de estudo: Clínico prospectivo. Objetivo: O estudo analisa prospectivamente os resultados da Reabilitaçäo Vestibular pelo método de Cawtorne & Cooksey em 22 crianças, portadoras de vestibulopatia periférica, associada ou näo a sintomas centrais, com idade média de 8,6 anos. Material e método: Os exames quantitativos da funçäo vestibular utilizados para quantificar a vestibulopatia foram a eletronistagmografia e a prova rotatória pendular decrescente (PRPD), mas a história clínica altamente sugestiva de processo vestibular foi considerada diagnóstica mesmo na presença de exames normais. Resultado: Os resultados apontam a Reabilitaçäo Vestibular como uma opçäo válida no tratamento das vestibulopatias na infância, uma vez que näo houve casos näo responsivos ao tratamento

Nistagmo de privaçäo vértebro-basilar e doppler no diagnóstico de insuficiência vértebro-basilar / Nistagmus of vertebrobasilar privation and doppler in the diagnosis of vertebrobasilar insufficiency

Introduçäo: A insuficiência vértebro-basilar (IVB) é causa freqüente de vertigem, especialmente em idosos, que comumente sofrem de aterosclerose e espondiloartrose cervical. Nos últimos 10 anos, temos utilizado o nistagmo de privaçäo vértebro-basilar (NPVB) para diagnosticar IVB. O objetivo do nosso estudo é avaliar a utilidade do método duplex scan para detectar compressäo da artéria vertebral em pacientes com sintomas de IVB e NPVB positivo. Material e método: Um total de 21 pacientes com sintomas de IVB e NyPVB positivo foi avaliado. Exames com duplex scan (7,5 MHz, SD 800 Philips) foram realizados para avaliar as artérias vertebrais (21 pacientes) e artérias carótidas (15 pacientes). Resultados: Compressäo de artéria vertebral foi encontrada em quatro (19 por cento) pacientes: três compressöes extrínsicas e uma intrínseca. O diagnóstico foi baseado na diminuiçäo ou ausência de fluxo evidenciada pelo duplex scan após uma rotaçäo de cabeça do paciente. Conclusäo: O NPVB e relativamente freqüente em pacientes com sintomas de IVB. Apesar da história e do exame físico, o método: duplex scan mostrou poucos casos de IVB (19 por cento), o que pode ser explicado pela limitaçäo dele em avaliar regiöes anatômicas de difícil acesso, como as artérias vertebrais. Concluímos que o NPVB é mais útil que o duplex scan no diagnóstico de IVB

Surdez súbita pós uso de contraceptivo injetável: relato de caso / Sudden deafness following contraceptive use: case report

Muitas etiologias já foram atribuídas à surdez súbita, algumas näo completamente elucidadas. Os autores relatam o caso de uma paciente jovem com surdez súbita unilateral com história pregressa de uso de anticoncepcional injetável de progestágeno. Embora näo tivesse apresentado melhora de quadro durante o período de internaçäo hospitalar, a mesma apresentou reversäo total tardia da disacusia após suspender o uso do medicamento. Assim, os autores concluem que as alteraçöes hormonais podem justificar o quadro de surdez súbita nesta paciente