What is the optimal number of treatment sessions of vestibular rehabilitation?

Vestibular rehabilitation is effective and safe in patients with instability. However, there is insufficient evidence for distinguishing between efficacies of different dosage of therapies. Therefore, the aim of the present study was to verify whether there were differences between two computerised dynamic posturography (CDP) therapies of different numbers of sessions, in order to establish the optimal strategy. We conducted a prospective, comparative study of two different dosage of CDP therapy (a 5-session group and another of 10-session group) in patients with instability due to chronic unilateral peripheral vestibular disorder. We used balanced block randomisation to include 13 patients in each group. Improvement was assessed using the Dizziness Handicap Inventory and the CDP with the sensorial organisation test (SOT) and limits of stability (LOS). We found a statistically significant improvement in both groups in composite score, visual and vestibular input (SOT); and in reaction time, distance and directional control (LOS). If we compare the groups regarding these improvements, we found that 10-session group showed a greater benefit in distance covered and directional control of LOS. Since significant improvement is obtained with only five sessions, we believe this to be the optimal number of treatment sessions for most patients with chronic unilateral peripheral vestibular disorder. Nevertheless, those patients with more reduced limits of stability, and consequently greater likelihood of falling as a result of their diminished base of support, are candidates for rehabilitation protocols with a greater number of sessions.

Frontal sinus obliteration and craniofacial reconstruction with platelet rich plasma in a patient with fibrous dysplasia.

Frontal sinus obliteration is accomplished with many materials such as fat, bone, muscle and alloplasts. Fat obliteration is very common but not devoid of morbidity. An alternative method of treatment with PRP platelet rich plasma and human bank bone or autogenous cortical shavings is presented for obliteration and craniofacial repair. A patient with severe symptomatic fronto-orbital fibrous dysplasia underwent reconstruction with PRP. After an uneventful recovery there was complete remission of the symptoms and early bone formation; 18 months after surgery the patient remains asymptomatic and free from sequels. PRP associated to an allograft or to cortical bone shavings seems to be a safe and simple treatment with the advantage of the absence of donor site surgery and morbidity.

[Video-nystagmography findings in healthy elderly subjects]. / Resultados videonistagmográficos en un grupo de sujetos sanos de edad avanzada.

This study investigated 44 healthy elderly subjects aged between 64 and 87, who were analysed with videonystagmoscopy and quantitative videonystagmography, for establishing new standards for normal limits into this new diagnostic tool. 15.9% of the subjects were found to have spontaneous and provoked nystagmus at least in one position studied. Vertical nystagmus in head hanging position was the most frequent finding. In the Dix-Hallpike test we found one case of torsional nystagmus. No subject had seated position nystagmus. Nystagmus after head shaking and evoked nystagmus were not found.

Resultados videonistagmográficos en un grupo de sujetos sanos de edad avanzada / Videonystagmographics finding in healthy elderly subjects

Se presentan los resultados obtenidos en una muestra de 44 sujetos sanos de edades comprendidas entre 64 y 87 años, estratificados en sexo y edad que fueron sometidos a un estudio protocolizado, utilizando como herramienta la videonistagmoscopia y su estudio cuantitativo mediante videonistagmografía, para buscar valores normales en ese grupo de población. En el 15,9 por ciento de los sujetos (7/44) se encuentran nistagmo espontáneo y provocado en alguna de las posiciones estudiadas. El nistagmo encontrado con más frecuencia fue el vertical, seguido del horizontal y la posición en la que aparecieron correspondió a la hiperextensión cervical y la prueba de Dix-Hallpike, en donde sólo encontramos un nistagmo torsional. En ninguno de los sujetos detectamos nistagmo en posición sentada, ni nistagmo evocado por la mirada, ni en la maniobra de agitación cefálica (AU)

This study investigated 44 healthy elderly subjects aged between 64 and 87, who were analysed with videonystagmoscopy and quantitative videonystagmography, for establishing new standards for normal limits into this new diagnostic tool. 15.9% of the subjects were found to have spontaneous and provoked nystagmus at least in one position studied. Vertical nystagmus in head hanging position was the most frequent finding. In the Dix-Hallpike test we found one case of torsional nystagmus. No subject had seated position nystagmus. Nystagmus after head shaking and evoked nystagmus were not found (AU)