A new treatment for cervical dizziness.

OBJECTIVES: To verify the rates of heat effectiveness generated by Carbon Nanotubes (CNT) in the resolution of dizziness in individuals diagnosed with Cervical Dizziness (CD). METHODS: Randomized clinical trial was performed and samples from volunteers diagnosed with CD, divided into a Study Group (SG) and Control Group (CG). Patches containing CNT with thermotherapeutic effect were used in SG and inert patches in the CG. Treatment was performed over 30 days and measures of pain, dizziness and asymmetry of cervical muscle tension were evaluated over 60 days. RESULTS: Pain, dizziness and asymmetry of cervical muscle tension were reduced in the SG. The variables analyzed in this study did not change in the CG. CONCLUSION: Our results show that the therapeutic effect of heat was effective in the treatment of patients diagnosed with CD. We could also observe a clear interrelationship between pain and dizziness symptoms with the asymmetry of cervical muscle tension. LEVEL OF EVIDENCE: 1B.

Individualized Vibrotactile Neurofeedback Training in Patients with Chronic Bilateral Vestibulopathy.

Patients with bilateral vestibulopathy (BVP) suffer from postural imbalance during daily life conditions, which in turn leads to a high frequency of falls. Unfortunately, vestibular rehabilitation has only modest and somewhat inconsistent effects in this patient group. Approximately 50% of BVP patients show an improved postural control after conventional vestibular rehabilitation training. New and more promising approaches are required. The individualized vibrotactile neurofeedback training (IVNT) in stance and gait conditions has already been described as highly effective in patients with various vestibular disorders. The purpose of the present multicenter study was to determine the efficacy of the IVNT in improving balance, reducing self-perceived disability, and improving gait in patients with confirmed BVP. In total, 22 patients performed the IVNT with the Vertiguard® system for 10 daily sessions. The dizziness handicap inventory (DHI), the stance stability score of the sensory organization test (SOT) and the score for everyday life mobility in stance and gait tasks (SBDT) were obtained immediately before and after the rehabilitation training period, as well as 3 and 12 months later. All measures improved significantly after the IVNT. Between 77.3% and 94.4% of patients showed an individual benefit (depending on outcome measure). The effect was not significantly reduced within the follow-up period of 12 months. The results demonstrate a high efficacy of the IVNT for vestibular rehabilitation in BVP patients.

A new treatment for cervical dizziness

Abstract Objectives: To verify the rates of heat effectiveness generated by Carbon Nanotubes (CNT) in the resolution of dizziness in individuals diagnosed with Cervical Dizziness (CD). Methods: Randomized clinical trial was performed and samples from volunteers diagnosed with CD, divided into a Study Group (SG) and Control Group (CG). Patches containing CNT with thermotherapeutic effect were used in SG and inert patches in the CG. Treatment was performed over 30 days and measures of pain, dizziness and asymmetry of cervical muscle tension were evaluated over 60 days. Results: Pain, dizziness and asymmetry of cervical muscle tension were reduced in the SG. The variables analyzed in this study did not change in the CG. Conclusion: Our results show that the therapeutic effect of heat was effective in the treatment of patients diagnosed with CD. We could also observe a clear interrelationship between pain and dizziness symptoms with the asymmetry of cervical muscle tension. Level of evidence: 1B.

Vestibular recruitment: new application for an old concept.

INTRODUCTION: Vestibular recruitment is a sign of hyperexcitability of central vestibular neurons and may be characteristic of peripheral vestibular damage. OBJECTIVE: To define the post-caloric recruitment index and its ability to predict the stage of vestibular compensation and peripheral lesion. METHODS: First of all, we demonstrated that larger values in the cold post-caloric stimulation compared to warm stimulation were equivalent to vestibular recruitment observed during the sinusoidal harmonic acceleration test. In the next step, patients with vestibular complaints and asymptomatic controls were submitted to the caloric test. We calculated post-caloric recruitment index for the control group. Among the study group, we analyzed the relation between post-caloric recruitment and unilateral weakness as well as the types of vestibular diagnoses. RESULTS: Mean post-caloric recruitment was 17.06% and 33.37% among the control and study group, respectively. The ratio between post-caloric recruitment and unilateral weakness was 1.3 in the study group. Among recruiting subjects, no significant difference of unilateral weakness from the lesioned or healthy side was observed. We found no differences in vestibular diagnoses between recruiting and non-recruiting subjects. CONCLUSION: Post-caloric recruitment index identified asymmetric vestibular tonus and central compensation. The normal value was established at 17.06%.

Vestibular recruitment: new application for an old concept / Recrutamento vestibular: nova aplicação para um conceito antigo

Abstract Introduction Vestibular recruitment is a sign of hyperexcitability of central vestibular neurons and may be characteristic of peripheral vestibular damage. Objective To define the post-caloric recruitment index and its ability to predict the stage of vestibular compensation and peripheral lesion. Methods First of all, we demonstrated that larger values in the cold post-caloric stimulation compared to warm stimulation were equivalent to vestibular recruitment observed during the sinusoidal harmonic acceleration test. In the next step, patients with vestibular complaints and asymptomatic controls were submitted to the caloric test. We calculated post-caloric recruitment index for the control group. Among the study group, we analyzed the relation between post-caloric recruitment and unilateral weakness as well as the types of vestibular diagnoses. Results Mean post-caloric recruitment was 17.06% and 33.37% among the control and study group, respectively. The ratio between post-caloric recruitment and unilateral weakness was 1.3 in the study group. Among recruiting subjects, no significant difference of unilateral weakness from the lesioned or healthy side was observed. We found no differences in vestibular diagnoses between recruiting and non-recruiting subjects. Conclusion Post-caloric recruitment index identified asymmetric vestibular tonus and central compensation. The normal value was established at 17.06%.

Resumo Introdução O recrutamento vestibular é um sinal de hiperexcitabilidade dos neurônios vestibulares centrais e pode ser característico de lesão vestibular periférica. Objetivo Definir o índice de recrutamento pós‐calórico e sua capacidade de predizer o estágio de compensação vestibular e lesão periférica. Método Em primeiro lugar, demonstramos que valores maiores na estimulação pós‐calórica fria em relação à estimulação quente foram equivalentes ao recrutamento vestibular observado durante o teste de aceleração harmônica sinusoidal. Na etapa seguinte, os pacientes com queixas vestibulares e controles assintomáticos foram submetidos à prova calórica. Calculamos o índice de recrutamento pós calórico para o grupo controle. No grupo de estudo, analisamos a relação entre o recrutamento pós‐calórico e predomínio labiríntico, bem como os tipos de diagnósticos vestibulares. Resultados O recrutamento pós‐calórico médio foi de 17,06% e 33,37% nos grupos controle e estudo, respectivamente. A razão entre o recrutamento pós‐calórico e o predominício labiríntico foi de 1,3 no grupo de estudo. Nos sujeitos com recrutamento, não foi observada diferença significativa de predominício labiríntico do lado lesionado ou saudável. Não encontramos diferenças de diagnóstico vestibular entre sujeitos com recrutamento e sem recrutamento. Conclusão O índice de recrutamento pós‐calórico identificou tônus vestibular assimétrico e compensação central. O valor normal foi estabelecido em 17,06%.

Cerebral Responses to Stationary Emotional Stimuli Measured by fMRI in Women with Persistent Postural-Perceptual Dizziness

Abstract Introduction Persistent postural-perceptual dizziness (PPPD) is a functional vestibular disorder characterized by chronic dizziness, unsteadiness, and hypersensitivity to motion. Preexisting anxiety disorders and neurotic personality traits confer vulnerability to PPPD. High anxiety during acute vertigo or dizziness incites it. A functional magnetic resonance imaging (fMRI) study of chronic subjective dizziness found unexpectedly hypoactive responses to vestibular stimulation in cortical regions that integrate threat assessment and spatial perception. Objective This fMRI study used non-moving, but emotionally charged visual stimuli to investigate the brain's activity of PPPD patients and control subjects. Methods The participants included 16 women with PPPD and 16 age-matched women who recovered completely from acute episodes of vertigo or dizziness capable of triggering PPPD. Brain responses to positive, neutral, and negative figures from the International Affective Picture System were measured with fMRI and compared between the groups. Dizziness handicap, anxiety, and depression were assessed with validated questionnaires. Results Between group analyses: Participants with PPPD showed reduced activity in anterior cingulate cortex and increased activity in left angular gyrus in response to negative versus positive stimuli, which was not observed in recovered individuals. Within group analyses: Participants with PPPD had increased activity in visuospatial areas (parahippocampal gyrus, intraparietal sulcus) in negative versus positive and negative versus neutral contrasts, whereas recovered individuals had increased activity in anxiety regions (amygdala, orbitofrontal cortex). Conclusion Patients with PPPD may be more attuned to spatial elements than to the content of emotionally charged visual stimuli.

Cerebral Responses to Stationary Emotional Stimuli Measured by fMRI in Women with Persistent Postural-Perceptual Dizziness.

Introduction Persistent postural-perceptual dizziness (PPPD) is a functional vestibular disorder characterized by chronic dizziness, unsteadiness, and hypersensitivity to motion. Preexisting anxiety disorders and neurotic personality traits confer vulnerability to PPPD. High anxiety during acute vertigo or dizziness incites it. A functional magnetic resonance imaging (fMRI) study of chronic subjective dizziness found unexpectedly hypoactive responses to vestibular stimulation in cortical regions that integrate threat assessment and spatial perception. Objective This fMRI study used non-moving, but emotionally charged visual stimuli to investigate the brain's activity of PPPD patients and control subjects. Methods The participants included 16 women with PPPD and 16 age-matched women who recovered completely from acute episodes of vertigo or dizziness capable of triggering PPPD. Brain responses to positive, neutral, and negative figures from the International Affective Picture System were measured with fMRI and compared between the groups. Dizziness handicap, anxiety, and depression were assessed with validated questionnaires. Results Between group analyses: Participants with PPPD showed reduced activity in anterior cingulate cortex and increased activity in left angular gyrus in response to negative versus positive stimuli, which was not observed in recovered individuals. Within group analyses: Participants with PPPD had increased activity in visuospatial areas (parahippocampal gyrus, intraparietal sulcus) in negative versus positive and negative versus neutral contrasts, whereas recovered individuals had increased activity in anxiety regions (amygdala, orbitofrontal cortex). Conclusion Patients with PPPD may be more attuned to spatial elements than to the content of emotionally charged visual stimuli.

Neurotology: definitions and evidence-based therapies - Results of the I Brazilian Forum of Neurotology / Otoneurologia: definições e terapias baseadas em evidências - Resultados do I Fórum Brasileiro de Otoneurologia

Abstract Introduction: Neurotology is a rapidly expanding field of knowledge. The study of the vestibular system has advanced so much that even basic definitions, such as the meaning of vestibular symptoms, have only recently been standardized. Objective: To present a review of the main subjects of neurotology, including concepts, diagnosis and treatment of Neurotology, defining current scientific evidence to facilitate decision-making and to point out the most evidence-lacking areas to stimulate further new research. Methods: This text is the result of the I Brazilian Forum of Neurotology, which brought together the foremost Brazilian researchers in this area for a literature review. In all, there will be three review papers to be published. This first review will address definitions and therapies, the second one will address diagnostic tools, and the third will define the main diseases diagnoses. Each author performed a bibliographic search in the LILACS, SciELO, PubMed and MEDLINE databases on a given subject. The text was then submitted to the other Forum participants for a period of 30 days for analysis. A special chapter, on the definition of vestibular symptoms, was translated by an official translation service, and equally submitted to the other stages of the process. There was then a in-person meeting in which all the texts were orally presented, and there was a discussion among the participants to define a consensual text for each chapter. The consensual texts were then submitted to a final review by four professors of neurotology disciplines from three Brazilian universities and finally concluded. Based on the full text, available on the website of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery, this summary version was written as a review article. Result: The text presents the official translation into Portuguese of the definition of vestibular symptoms proposed by the Bárány Society and brings together the main scientific evidence for each of the main existing therapies for neurotological diseases. Conclusion: This text rationally grouped the main topics of knowledge regarding the definitions and therapies of Neurotology, allowing the reader a broad view of the approach of neurotological patients based on scientific evidence and national experience, which should assist them in clinical decision-making, and show the most evidence-lacking topics to stimulate further study.

Resumo Introdução: A otoneurologia é uma área de conhecimento que tem se expandido muito rapidamente. O estudo do sistema vestibular tem avançado tanto que mesmo definições básicas, como o significado dos sintomas vestibulares, foram apenas recentemente padronizadas. Objetivo: Apresentar uma revisão dos principais assuntos da otoneurologia, inclusive conceitos, diagnóstico e tratamento da otoneurologia, definir a evidência científica atual para facilitar a tomada de decisões e demonstrar as áreas mais carentes de evidência para estimular novas pesquisas. Método: Este texto é fruto do I Fórum Brasileiro de Otoneurologia, que reuniu os principais pesquisadores brasileiros dessa área para uma revisão da literatura. Serão feitos três trabalhos de revisão a serem publicados. Este primeiro abordou as definições e as terapias, o segundo abordará as ferramentas diagnósticas e o terceiro definirá os principais diagnósticos. Cada autor fez um levantamento bibliográfico na base de dados da Lilacs, SciELO, Pubmed e Medline de um determinado assunto. O seu texto foi então submetido aos demais participantes do Fórum por 30 dias para análise. Um capítulo especial, da definição dos sintomas vestibulares, foi traduzido por serviço de tradução oficial e igualmente submetido às demais etapas do processo. Houve então uma reunião presencial em que todos os textos foram apresentados oralmente e houve uma discussão entre os participantes para a definição de um texto consensual para cada capítulo. Os textos consensuais foram então submetidos a uma revisão final por quatro professores de otoneurologia de três universidades brasileiras e, por fim, finalizado. A partir do texto completo, publicado no site da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, foi escrita esta versão-resumo como artigo de revisão. Resultado: O texto apresenta a tradução oficial para o português da definição dos sintomas vestibulares propostos pela Barany Society e agrupa as principais evidências científicas para cada um das principais terapias existentes para as doenças otoneurológicas. Conclusão: Este texto agrupou de forma racional os principais tópicos de conhecimento a respeito das definições e terapias da otoneurologia, permite ao leitor uma visão ampla da abordagem dos pacientes otoneurológicos baseada em evidências científicas e experiência nacional, que deverá auxiliá-lo na tomada de decisões clínicas, e mostra os assuntos mais carentes de evidência para estimular novos estudos.

Magnetic resonance angiography and transcranial Doppler ultrasound findings in patients with a clinical diagnosis of vertebrobasilar insufficiency.

OBJECTIVE: To evaluate the findings of magnetic resonance angiography (MRA) and transcranial Doppler ultrasound (TCD) in patients with a clinical diagnosis of vertebrobasilar insufficiency (VBI). METHOD: From our outpatient neurotology clinic, we selected patients (using the criteria proposed by Grad and Baloh) with a clinical diagnosis of VBI. We excluded patients with any definite cause for vestibular symptoms, a noncontrolled metabolic disease or any contraindication to MRA or TCD. The patients in the study group were sex- and age-matched with subjects who did not have vestibular symptoms (control group). Our final group of patients included 24 patients (study, n=12; control, n=12). RESULTS: The MRA results did not demonstrate significant differences in the findings between our study and control groups. TCD demonstrated that the systolic pulse velocity of the right middle cerebral artery, end diastolic velocity of the basilar artery, pulsatility index (PI) of the left middle cerebral artery, PI of the right middle cerebral artery, and PI of the basilar artery were significantly higher in the study group than in the control group, suggesting abnormalities affecting the microcirculation of patients with a clinical diagnosis of VBI compared with controls. CONCLUSION: MRA failed to reveal abnormalities in patients with a clinical diagnosis of VBI compared with controls. The PI of the basilar artery, measured using TCD, demonstrated high sensitivity (91%) and specificity (91%) for detecting clinically diagnosed VBI.

Neurotology: definitions and evidence-based therapies - Results of the I Brazilian Forum of Neurotology.

INTRODUCTION: Neurotology is a rapidly expanding field of knowledge. The study of the vestibular system has advanced so much that even basic definitions, such as the meaning of vestibular symptoms, have only recently been standardized. OBJECTIVE: To present a review of the main subjects of neurotology, including concepts, diagnosis and treatment of Neurotology, defining current scientific evidence to facilitate decision-making and to point out the most evidence-lacking areas to stimulate further new research. METHODS: This text is the result of the I Brazilian Forum of Neurotology, which brought together the foremost Brazilian researchers in this area for a literature review. In all, there will be three review papers to be published. This first review will address definitions and therapies, the second one will address diagnostic tools, and the third will define the main diseases diagnoses. Each author performed a bibliographic search in the LILACS, SciELO, PubMed and MEDLINE databases on a given subject. The text was then submitted to the other Forum participants for a period of 30 days for analysis. A special chapter, on the definition of vestibular symptoms, was translated by an official translation service, and equally submitted to the other stages of the process. There was then a in-person meeting in which all the texts were orally presented, and there was a discussion among the participants to define a consensual text for each chapter. The consensual texts were then submitted to a final review by four professors of neurotology disciplines from three Brazilian universities and finally concluded. Based on the full text, available on the website of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery, this summary version was written as a review article. RESULT: The text presents the official translation into Portuguese of the definition of vestibular symptoms proposed by the Bárány Society and brings together the main scientific evidence for each of the main existing therapies for neurotological diseases. CONCLUSION: This text rationally grouped the main topics of knowledge regarding the definitions and therapies of Neurotology, allowing the reader a broad view of the approach of neurotological patients based on scientific evidence and national experience, which should assist them in clinical decision-making, and show the most evidence-lacking topics to stimulate further study.

Magnetic resonance angiography and transcranial Doppler ultrasound findings in patients with a clinical diagnosis of vertebrobasilar insufficiency

OBJECTIVE: To evaluate the findings of magnetic resonance angiography (MRA) and transcranial Doppler ultrasound (TCD) in patients with a clinical diagnosis of vertebrobasilar insufficiency (VBI). METHOD: From our outpatient neurotology clinic, we selected patients (using the criteria proposed by Grad and Baloh) with a clinical diagnosis of VBI. We excluded patients with any definite cause for vestibular symptoms, a noncontrolled metabolic disease or any contraindication to MRA or TCD. The patients in the study group were sex- and age-matched with subjects who did not have vestibular symptoms (control group). Our final group of patients included 24 patients (study, n=12; control, n=12). RESULTS: The MRA results did not demonstrate significant differences in the findings between our study and control groups. TCD demonstrated that the systolic pulse velocity of the right middle cerebral artery, end diastolic velocity of the basilar artery, pulsatility index (PI) of the left middle cerebral artery, PI of the right middle cerebral artery, and PI of the basilar artery were significantly higher in the study group than in the control group, suggesting abnormalities affecting the microcirculation of patients with a clinical diagnosis of VBI compared with controls. CONCLUSION: MRA failed to reveal abnormalities in patients with a clinical diagnosis of VBI compared with controls. The PI of the basilar artery, measured using TCD, demonstrated high sensitivity (91%) and specificity (91%) for detecting clinically diagnosed VBI.

Caloric test and video head impulse test sensitivity as vestibular impairment predictors before cochlear implant surgery.

OBJECTIVES: Currently, cochlear implant procedures are becoming increasingly broad and have greatly expanded. Bilateral cochlear implants and cochlear implants are more frequently applied in children. Our hypothesis is that the video head impulse test may be more sensitive than the caloric test in detecting abnormal vestibular function before cochlear implant surgery. The objective of this study was to compare the video head impulse test and caloric test results of patients selected for cochlear implant procedures before surgery. METHODS: The patients selected for cochlear implant surgery were submitted to a bithermal caloric test and video head impulse test. RESULTS: By comparing angular slow phase velocity values below 5° in the bithermal caloric test (hypofunction) and video head impulse test with a gain lower than 0.8, we identified 37 (64.9%) patients with vestibular hypofunction or canal paresis and 21 (36.8%) patients with abnormal video head impulse test gain before the cochlear implant procedure. Of the 37 patients with caloric test vestibular hypofunction, 20 (54%) patients exhibited an abnormal gain in the video head impulse test. CONCLUSION: The caloric test is more sensitive than the video head impulse test (Fisher's exact test, p=0.0002) in detecting the impaired ear before cochlear implant delivery. The proportion of caloric test/video head impulse test positive identification of abnormal vestibular function or caloric test/video head impulse test sensitivity was 1.8:1.

Video head impulse test relevance in the early postoperative period after cochlear implantation.

BACKGROUND: Cochlear implantation (CI) is the gold standard therapy for profound or severe sensorineural hearing loss. It is a safe surgical procedure but, because of the proximity of the cochlea and vestibule, postoperative vestibular disorder may occur. Our hypothesis is that the video head impulse test (vHIT) may be a good tool to achieve a topographic diagnosis of dizziness in the early postoperative period after CI. AIMS/OBJECTIVES: To evaluate patients with instability, imbalance and vertigo between 7 and 14 days after CI procedure. MATERIAL AND METHODS: A total of 31patients scheduled for unilateral CI were included in this study. vHIT for horizontal semicircular canal was performed before CI and between days 7 to 14 after the surgery. RESULTS: Six subjects had dizziness complaints after CI: instability (N = 2), imbalance (N = 2) and vertigo (N = 2). The postoperative vHIT test turned abnormal only in subjects with vertigo as compared to the preoperative vHIT test results. CONCLUSION AND SIGNIFICANCE: vHIT is a good vestibular function test during the first 2 weeks after CI surgery when vertigo is the main complaint.

Caloric test and video head impulse test sensitivity as vestibular impairment predictors before cochlear implant surgery

OBJECTIVES: Currently, cochlear implant procedures are becoming increasingly broad and have greatly expanded. Bilateral cochlear implants and cochlear implants are more frequently applied in children. Our hypothesis is that the video head impulse test may be more sensitive than the caloric test in detecting abnormal vestibular function before cochlear implant surgery. The objective of this study was to compare the video head impulse test and caloric test results of patients selected for cochlear implant procedures before surgery. METHODS: The patients selected for cochlear implant surgery were submitted to a bithermal caloric test and video head impulse test. RESULTS: By comparing angular slow phase velocity values below 5° in the bithermal caloric test (hypofunction) and video head impulse test with a gain lower than 0.8, we identified 37 (64.9%) patients with vestibular hypofunction or canal paresis and 21 (36.8%) patients with abnormal video head impulse test gain before the cochlear implant procedure. Of the 37 patients with caloric test vestibular hypofunction, 20 (54%) patients exhibited an abnormal gain in the video head impulse test. CONCLUSION: The caloric test is more sensitive than the video head impulse test (Fisher's exact test, p=0.0002) in detecting the impaired ear before cochlear implant delivery. The proportion of caloric test/video head impulse test positive identification of abnormal vestibular function or caloric test/video head impulse test sensitivity was 1.8:1.

Preoperative vestibular assessment protocol of cochlear implant surgery: an analytical descriptive study / Protocolo de avaliação vestibular pré-operatória da cirurgia de implante coclear: estudo descritivo analítico

Abstract Introduction: Cochlear implants are undeniably an effective method for the recovery of hearing function in patients with hearing loss. Objective: To describe the preoperative vestibular assessment protocol in subjects who will be submitted to cochlear implants. Methods: Our institutional protocol provides the vestibular diagnosis through six simple tests: Romberg and Fukuda tests, assessment for spontaneous nystagmus, Head Impulse Test, evaluation for Head Shaking Nystagmus and caloric test. Results: 21 patients were evaluated with a mean age of 42.75 ± 14.38 years. Only 28% of the sample had all normal test results. The presence of asymmetric vestibular information was documented through the caloric test in 32% of the sample and spontaneous nystagmus was an important clue for the diagnosis. Bilateral vestibular areflexia was present in four subjects, unilateral arreflexia in three and bilateral hyporeflexia in two. The Head Impulse Test was a significant indicator for the diagnosis of areflexia in the tested ear (p = 0.0001). The sensitized Romberg test using a foam pad was able to diagnose severe vestibular function impairment (p = 0.003). Conclusion: The six clinical tests were able to identify the presence or absence of vestibular function and function asymmetry between the ears of the same individual.

Resumo Introdução: Os implantes cocleares (IC) são indiscutivelmente um método eficaz de recuperação da função auditiva de pacientes surdos. Objetivo: Descrever o protocolo de avaliação vestibular pré-operatória em sujeitos que serão submetidos ao IC. Método: Nosso protocolo institucional prevê o diagnóstico vestibular por meio de seis testes simples: testes de Romberg e Fukuda, nistagmo espontâneo, Head Impulse Test, Head Shaking Nistagmus, prova calórica. Resultados: Foram avaliados 21 pacientes com média de 42,75 ± 14,38 anos. Apenas 28% da amostra apresentaram todos os testes normais. A presença de informação vestibular assimétrica foi documentada pela prova calórica em 32% da amostra e o nistagmo espontâneo mostrou-se pista importante para seu diagnóstico. A arreflexia vestibular bilateral foi diagnosticada em quatro sujeitos; arreflexia unilateral em três e hiporreflexia bilateral em dois. O Head Impulse Test mostrou-se indicador significante (p = 0,0001) para diagnosticar arreflexia da orelha testada. O teste de Romberg sensibilizado em almofada foi capaz de diagnosticar os comprometimentos severos da função vestibular (p = 0,003). Conclusão: Os seis testes clínicos foram capazes de identificar a presença ou não de função vestibular e assimetria da função entre as orelhas de um mesmo indivíduo.

Sensitivity of caloric test and video head impulse as screening test for chronic vestibular complaints.

OBJECTIVE:: This study compared the results of the caloric test with those of the video head impulse test obtained during the same session and evaluated whether the former can be used to screen for non-acute vestibular dysfunction. METHODS:: A total of 157 participants complaining of dizziness with vestibular characteristics of varying durations and clinical courses completed the caloric test and video head impulse test. RESULTS:: Significantly more caloric test results than video head impulse test results were abnormal. CONCLUSIONS:: The results of the caloric test and video head impulse test are distinct but complement each other. Within our sample, the caloric test was more sensitive for vestibular dysfunction. Therefore, the video head impulse test is not a suitable screening tool of the vestibular system in patients with chronic complaints.

Sensitivity of caloric test and video head impulse as screening test for chronic vestibular complaints

OBJECTIVE: This study compared the results of the caloric test with those of the video head impulse test obtained during the same session and evaluated whether the former can be used to screen for non-acute vestibular dysfunction. METHODS: A total of 157 participants complaining of dizziness with vestibular characteristics of varying durations and clinical courses completed the caloric test and video head impulse test. RESULTS: Significantly more caloric test results than video head impulse test results were abnormal. CONCLUSIONS: The results of the caloric test and video head impulse test are distinct but complement each other. Within our sample, the caloric test was more sensitive for vestibular dysfunction. Therefore, the video head impulse test is not a suitable screening tool of the vestibular system in patients with chronic complaints.

Hearing performance as a predictor of postural recovery in cochlear implant users / Desempenho auditivo como preditor de recuperação postural em usuários de implante coclear

Abstract Objective This study aimed to evaluate if hearing performance is a predictor of postural control in cochlear implant (CI) users at least six months after surgery. Methods Cross-sectional study including (CI) recipients with post-lingual deafness and controls who were divided into the following groups: nine CI users with good hearing performance (G+), five CI users with poor hearing performance (G−), and seven controls (CG). For each patient, computerized dynamic posturography (CDP) tests, a sensory organization test (SOT), and an adaptation test (ADT) were applied as dual task performance, with first test (FT) and re-test (RT) on the same day, including a 40–60 min interval between them to evaluate the short-term learning ability on postural recovery strategies. The results of the groups were compared. Results Comparing the dual task performance on CDP and the weighted average between all test conditions, the G+ group showed better performance on RT in SOT4, SOT5, SOT6, and CS, which was not observed for G− and CG. The G− group had significantly lower levels of short-term learning ability than the other two groups in SOT5 (p = 0.021), SOT6 (p = 0.025), and CS (p = 0.031). Conclusion The CI users with good hearing performance had a higher index of postural recovery when compared to CI users with poor hearing performance.

Resumo Objetivo O presente estudo teve por objetivo avaliar se o desempenho auditivo é preditor de controle postural em usuários de IC pelo menos seis meses após a cirurgia. Método Estudo transversal que consistiu em recipientes de implante coclear (IC) com surdez pós-lingual e controles, que foram divididos nos seguintes grupos: nove usuários de IC com bom desempenho auditivo (G+), cinco usuários de usuários de IC com desempenho auditivo insatisfatório (G-) e sete controles (GC). Aplicamos os testes de posturografia dinâmica computadorizada (PDC), de organização sensitiva (TOS) e de adaptação (TAd) como desempenho de dupla tarefa, primeiro teste (PT) e reteste (RT) no mesmo dia, com intervalo de 40-60 minutos entre testes, com o objetivo de avaliar a capacidade de aprendizado em curto prazo nas estratégias de recuperação postural. Comparamos os resultados dos testes. Resultados Na comparação do desempenho de dupla tarefa no teste PDC e a média ponderal entre todas as condições de teste, o grupo G+ demonstrou melhor desempenho no RT nos TOS4, TOS5, TOS6 e EC, o que não foi observado para os grupos G- e GC. O grupo G- obteve níveis significantemente mais baixos de capacidade de aprendizado em curto prazo vs. outros dois grupos no TOS5 (p = 0,021), TOS6 (p = 0,025) e EC (p = 0,031). Conclusão Usuários de IC com bom desempenho auditivo tiveram índice melhor de recuperação postural, quando comparados com usuários de IC com desempenho auditivo insatisfatório.