Vestibular rehabilitation exercises in acute vertigo.

OBJECTIVES/HYPOTHESIS: To evaluate the effect of vestibular rehabilitation exercises in the early stages of peripheral vestibular disorders. STUDY DESIGN: Prospective, randomized trial. Patients were blinded to assignment groups. METHODS: The study group (45 patients) performed exercises for adaptation of the vestibulo-ocular reflex; the control group (42 patients) performed placebo exercises. Both groups were instructed to use dimenhydrinate (up to 150 mg/d) if symptomatic, irrespective of exercises. Patients were evaluated by visual analogue scale, physical examination, and need to use the medication. All patients were adults and symptomatic for less than 5 days. RESULTS: The study and control groups were comparable in terms of demographics data and duration and intensity of symptoms. Study group patients recovered faster than controls and used less medication. By 10 to 14 days after the intervention, 43% of study group and 5% of control group patients had no significant symptoms (P < .001), and 67% of study group and 3% of control group patients needed no medication (P < .001). Although both groups had no significant symptoms by the end of the follow-up period (21 days), 14% of the study group patients were still using medication, compared with 83% of the placebo group patients (P < .001). CONCLUSIONS: Vestibular exercises are effective in reducing the duration of symptoms and the need of medication of patients in the early stages of peripheral vestibular disorders.

Benzodiazepines and GABAergics in treating severe disabling tinnitus of predominantly cochlear origin.

Severe disabling tinnitus (SDT) refers to a symptom severe enough to disrupt affected patients' routine and keep them from performing their daily activities. SDT of a predominantly central origin has been treated successfully with benzodiazepines and GABAergic drugs. Our aim was to test the control of SDT of predominantly cochlear origin by benzodiazepines and GABAergic drugs. We followed the format of a prospective, randomized, single-blind clinical trial at an academic tertiary-care hospital. We studied 30 patients, all with SDT of clear cochlear origin. We treated 10 patients with placebo (group 1), 10 with benzodiazepine drugs (group 2), and 10 with benzodiazepine and GABAergic drugs (group 3). We recorded a decrease in the annoyance and intensity of SDT as measured by a visual analog scale ranging from 1 (negligible) to 10 (unbearable). We found statistically significant improvement in comparing groups 2 and 3 with group 1 but found no significant difference when groups 2 and 3 were compared. Addition of GABAergic to benzodiazepine drugs does not modify the treatment results in SDT of a predominantly cochlear origin.

Long-term follow-up of tinnitus in patients with otosclerosis after stapes surgery.

We prospectively studied 48 otosclerosis patients over a 2-year interval. Forty-four had stapedotomy, and four had stapedectomy. Demographics, clinical history, and pre- and postoperative audiometry results were recorded. A questionnaire asking about tinnitus (intensity, pitch) and including a visual analog scale quantifying the degree (1-10) of annoyance caused by the tinnitus was completed pre- and postoperatively (4-10 months and 14-48 months, respectively). Ninety-one percent of the otosclerosis patients reported the presence of tinnitus, and 39.58% reported severe disabling tinnitus (SDT; 7-10 on the visual analog scale). High-pitch (whistle) tinnitus was present in most patients, and white noise (radio static, waterfall, rain) was present in others. No patient described the tinnitus as a low-tone noise (buzzing). Ninety-one percent of patients reported tinnitus reduction or total remission after surgery. Ten of 19 patients with SDT reported complete remission of tinnitus, 7 reported improvement postoperatively, and 2 reported no change. No patient reported worsening of tinnitus. Small postoperative air-bone gaps (four tonal average) correlated with remission or reduction of tinnitus in SDT patients. Tinnitus pitch, gender, and age of patients were not related to decrease of tinnitus postoperatively. A larger preoperative air-bone gap correlated with larger reduction of tinnitus after successful surgery. A lower preoperative bone conduction level correlated with more intense tinnitus before surgery and greater reduction postoperatively. We contacted 25 patients from 14 to 48 months after surgery, and all reported that their tinnitus status had not changed since the early follow-up. Tinnitus is very prevalent in otosclerosis patients; almost one-half of patients have SDT preoperatively, and stapes surgery improves this symptom in 91% of cases. Preoperative air-bone gap and bone conduction level and a postoperative airbone gap seem to influence the degree of postoperative tinnitus reduction.

Palatal and middle-ear myoclonus: a cause for objective tinnitus.

The cause of objective tinnitus provoked by palatal and middle-ear myoclonus may be identified by magnetic resonance imaging of the central nervous system in the Guilliain-Mollaret triangle or it may be idiopathic. The idiopathic cases are rare. From the literature, one can perceive the following unanswered questions: (1) Are palatal and middle-ear myoclonus different entities or do they usually appear together? (2) Are the clicks being produced by the palatal myoclonus (walls of the eustachian tube slapping together) or by the tensor tympani muscle contractions or by both? (3) Is stapedius muscle myoclonus important in the production of the clicks? (4) What should be the treatment for palatal and middle-ear myoclonus? We present two cases of idiopathic palatal and middle-ear myoclonus and discuss these cases in light of the literature and of some ideas of our own.

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