Abordaje integral del vértigo: algoritmo diagnóstico, causas, tratamientos y criterios de derivación desde la perspectiva de atención primaria. Documento de consenso SEMERGEN / Comprehensive approach to vertigo: Diagnostic algorithm, causes, treatments, and referral criteria from the perspective of primary care. SEMERGEN consensus document

El vértigo es un síntoma común que puede tener diversas causas y requerir un enfoque integral para su diagnóstico y tratamiento desde atención primaria. Se propone un algoritmo de diagnóstico basado en la clasificación propuesta por la Comisión de Otoneurología de la SEORL-PCF, que facilita la clasificación de los diferentes tipos de vértigo y proporciona criterios de derivación de pacientes desde atención primaria hacia otras especialidades. Se realiza una revisión de los tratamientos disponibles basada en la causa subyacente para un manejo terapéutico adecuado. Se espera que este documento se convierta en una herramienta valiosa para los profesionales que atienden a pacientes con vértigo. El documento se basa en evidencia científica y en la experiencia de expertos en el campo de las diferentes especialidades médicas implicadas; y busca mejorar la comprensión y el abordaje clínico del vértigo agudo desde atención primaria.(AU)

Vertigo is a common symptom that can have various causes and may require a comprehensive approach for its diagnosis and treatment from primary care. A diagnostic algorithm based on the classification proposed by the Otoneurology Commission of the SEORL-PCF is suggested, which facilitates the classification of the different types of vertigo and provides referral criteria for patients from primary care to other specialties. A review of the available treatments based on the underlying cause is conducted for appropriate therapeutic management. This document is expected to become a valuable tool for professionals treating patients with vertigo. The document is based on scientific evidence and on the experience of experts in the field from various medical specialties; and seeks to improve the understanding and clinical approach to acute vertigo from primary care.(AU)

[Comprehensive approach to vertigo: Diagnostic algorithm, causes, treatments, and referral criteria from the perspective of primary care. SEMERGEN consensus document]. / Abordaje integral del vértigo: algoritmo diagnóstico, causas, tratamientos y criterios de derivación desde la perspectiva de atención primaria. Documento de consenso SEMERGEN.

Vertigo is a common symptom that can have various causes and may require a comprehensive approach for its diagnosis and treatment from primary care. A diagnostic algorithm based on the classification proposed by the Otoneurology Commission of the SEORL-PCF is suggested, which facilitates the classification of the different types of vertigo and provides referral criteria for patients from primary care to other specialties. A review of the available treatments based on the underlying cause is conducted for appropriate therapeutic management. This document is expected to become a valuable tool for professionals treating patients with vertigo. The document is based on scientific evidence and on the experience of experts in the field from various medical specialties; and seeks to improve the understanding and clinical approach to acute vertigo from primary care.

Neuralgia del pudendo: a propósito de 2 casos / Pudendal neuralgia. A report of 2 cases

La neuralgia del pudendo es una causa infradiagnosticada de dolor neuropático en la zona perineal. Se produce a raíz del atrapamiento del nervio pudendo en algún punto de su trayecto. Su diagnóstico de sospecha es fundamentalmente clínico y se confirma mediante electromiografía y/o la mejoría tras infiltraciones perineurales. El tratamiento recomendado es inicialmente conservador y, si fracasa, quirúrgico. La rehabilitacio¿n tanto precirugía como después de la intervención quirúrgica tiene un papel importante en esta patología, aunque la pauta a seguir no está bien establecida. Como médicos rehabilitadores debemos tener en cuenta el atrapamiento del nervio pudendo como posible causa de dolor crónico en la región genital. Presentamos los casos de 2 pacientes diagnosticadas de neuralgia del pudendo que fueron derivadas a nuestra consulta de rehabilitación ambulatoria para valoración de tratamiento (AU)

Pudendal neuralgia is an underdiagnosed cause of neuropathic pain in the perineal area. It is caused by pudendal nerve entrapment at some point. Diagnosis is mainly clinical, and confirmation is by electromyography and/or improvement after perineural infiltration. The recommended treatment is initially conservative and, if unsuccessful, surgery can be performed. Pre- and post-surgical rehabilitation plays an important role in this disease, although there is still no well-established protocol. Specialists in physical medicine and rehabilitation should consider pudendal nerve entrapment as a cause of chronic pain in the genital region. We present the cases of two patients diagnosed with pudendal neuralgia who were referred to our clinic for treatment evaluation (AU)

Amputación femoral por prótesis de rodilla infectada: serie de 4 casos clínicos / Femoral amputation after infected knee prosthesis: a series of 4 cases

Una de las posibles complicaciones después de la cirugía de la prótesis total de rodilla (PTR) es la infección. En ocasiones se debe tratar recurriendo a la amputación supracondílea de fémur. Hemos realizado una recopilación retrospectiva de 4 casos clínicos de pacientes después de la amputación supracondílea de fémur por infección de la PTR. Se han recogido las siguientes variables epidemiológicas: edad, sexo, índice de masa corporal (IMC), comorbilidades e índice de clasificación del estado físico según la American Society of Anesthesiology (ASA), extremidad afectada, cirugías y tiempo hasta la amputación, microorganismo aislado, complicaciones del muñón, presencia de síndrome del miembro fantasma, tiempo hasta la protetización y nivel funcional alcanzado. Hemos analizado los datos con el programa estadístico SPSS® v.19.0. Como conclusión, la protetización debe ser la principal opción a tener en cuenta para recuperar la funcionalidad de estos pacientes. En nuestro caso, la mitad de los pacientes han presentado un proceso de protetización satisfactorio (AU)

One of the possible complications after surgery for total knee replacement (TKR) is infection, which sometimes needs to be treated by an above knee amputation. We retrospectively reviewed 4 cases of patients with femoral amputation after infected knee prosthesis. We collected the following epidemiological variables: age, sex, body mass index (BMI), comorbidities and physical status classification according to the American Society of Anesthesiology (ASA), affected limb, surgery and time to amputation, microorganism isolated, stump complications, phantom limb syndrome, time to fitting the prosthetic limb, and functional level achieved. The data were analyzed with the SPSS® v.19.0 statistical program. To conclude, prosthetic fitting should be the primary consideration to recover functionality. The fitting process was satisfactory in half of our patients (AU)

Familial clustering and genetic heterogeneity in Meniere's disease.

The aims of this study were to estimate the prevalence of familial cases in patients with Meniere's disease (MD) and to identify clinical differences between sporadic and familial MD. We recruited 1375 patients with definite MD according to the American Academy of Otolaryngology-Head and Neck Surgery criteria, obtaining the familial history of hearing loss or episodic vertigo by direct interview or a postal survey in 1245 cases in a multicenter study. Familial clustering was estimated by the recurrence risk ratio in siblings (λs ) and offspring (λo ) using intermediate and high prevalence values for MD in European population. A total of 431 patients (34%) reported a familial history of hearing loss or recurrent vertigo and 133 patients had a relative with possible MD. After clinical reevaluation, 93 relatives in 76 families were diagnosed of definite MD (8.4%), including three pairs of monozygotic twins. λs and λo were 16-48 and 4-12, respectively. We observed genetic heterogeneity, but most families had an autosomal dominant inheritance with anticipation. No clinical differences were found between sporadic and familial MD, except for an early onset in familial cases. We may conclude that MD has a strong familial aggregation and that sporadic and familial MDs are clinically identical.

Hyperglycemia after intratympanic dexamethasone treatment in a diabetic patient.

The treatment of patients with idiopathic sudden sensorineural hearing loss must be performed as an emergency measure in order to prevent long term hearing deficit. Steroids in monotherapy provide the best outcome. There is some controversy regarding the most efficient route but in order to prevent side effects, intratympanic treatment is the preferred choice, especially in diabetic patients. We here present the case of a patient that developed hyperglycemia after systemic and intratympanic dexamethasone treatment for sudden hearing loss. We conclude that after intratympanic treatment great caution must be taken.

Otosclerosis among patients with dizziness.

OBJECTIVE: The objective of this study was to identify patients with otosclerosis and to characterize its clinical presentation among patients examined at our hospital with vertigo as the primary and most distressing symptom. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary medical center. PATIENTS: This study involved 40 patients suffering from dizziness and diagnosed with otosclerosis. METHODS: At inclusion, the clinical status, as well as auditory (pure tone hearing level and speech audiometry, impedancemetry) and vestibular function (bedside, nystagmography, caloric test and rotator chair testing) were assessed. The results were analyzed using parametric and non-parametric tests, and the chi2 test. RESULTS: The clinical presentation was diverse: 12 patients with Menière's syndrome (30%); 11 patients with spontaneous recurrent vertigo without hearing fluctuation (27.5%); 13 patients with positional vertigo (32.5%); 3 patients with chronic unrelapsing imbalance (7.5%); and 1 patient with acute unilateral vestibulopathy (2.5%). There was a lag between the detection of hearing loss and the beginning of vertigo attacks or imbalance in all patients. When measured through bone conduction, hearing loss was significantly different in patients with Menière's disease, spontaneous recurrent vertigo and positional vertigo. CONCLUSIONS: Dizziness, although frequent in patients with otosclerosis is rarely a cause for specific clinical assessment. There is a lag between the patient's perception of hearing loss and the initiation of vestibular symptoms, and it is not associated with any specific clinical disorder Otosclerosis can be found as any one of the most common vestibular disorders and in general, vestibular function tests reveal a more severe vestibular dysfunction than in the idiopathic forms. LEVEL OF EVIDENCE: 2A.

Disability in patients with Menière's disease following the use of two different treatment modalities: betahistine and intratympanic gentamicin.

OBJECTIVE: The objective of this study was to assess the level of residual disability and handicap in patients with Menière's disease (MD) that were free of new vertigo spells 2 years after having been administered treatment with either oral medication or with intratympanic gentamcin. SETTING: University hospital. Tertiary medical center. MATERIAL AND METHOD: 40 patients with MD were included in this study, of which 20 were treated with oral medication (betahistine) and 20 with intratympanic gentamicin; intratympanic gentamicin was for patients considered failures for the oral medication treatment. All of them are free of new vertigo in the 16-24 month period after beginning the treatment. They were matched by age and disease duration. Disability and handicap were assessed with conventional questionnaires at the time of inclusion and 2 years after beginning oral medication or ended the intratympanic gentamicin treatment. According to the treatment two groups were created: oral medication treatment and intratympanic gentamicin treatment. RESULTS: The amount of disability before treatment was higher in patients treated with intratympanic gentamicin than in those under oral medication; However, after treatment when no more vertigo spells takes place, this disability is significantly reduced and becomes similar for both groups of patients. In patients treated with oral medication the items reflecting the intensity of vertigo spell, the impact of vertigo in daily activities, the perception of quality of life and level of somatization do not show a significant reduction. CONCLUSION: The number or frequency of vertigo spells are very relevant for the process of disability and handicap of patients with MD when that is low or when oral medication is sufficient to eliminate vertigo spells. However when that number is high and the only possibility to arrest those vertigo spells is the use of intratympanic gentamicin, fear of vertigo must be considered as an associated problem for the patient.

[Intratympanic gentamicin in patients with Ménière's disease: analysis of our protocol]. / Gentamicina intratimpánica para la enfermedad de Ménière: análisis de la técnica.

OBJECTIVE: The aim of this paper is to analyze the peculiarities of a protocol for treatment with intratympanic gentamicin in patients with Ménière's disease. MATERIAL AND METHODS: 71 patients with unilateral disabling Ménière's disease were followed for a period longer than two years after concluding the treatment. AAO-HNS criteria for reporting treatment results was followed. Gentamicin was applied weekly until of symptoms or signs of vestibular hypofunction were noticed. RESULTS: Control of vertigo was obtained in 83% of the patients while in 24% a second course was needed beacuse of vertigo recurrence. 66% of the patients developed a typical syndrome of unilateral vestibular hypofunction in the ear treated. CONCLUSIONS: Ending weekly injections of gentamicin for the treatment of patients with Ménière's disease when signs of vestibular hypofunction appear warrants a control of vertigo similar to that obtained in other series.

[Characterisation of the influence exerted by the visual factor in patients with balance disorders]. / Caracterización de la influencia del factor visual en los pacientes con alteraciones del equilibrio.

INTRODUCTION: Visual information provides data about the position and movement of the head with respect to objects and serves as a source of reference for the proper perception of verticality. It also plays a specific role in postural control by modifying the efficiency of the vestibular and proprioceptive responses. AIMS: Our aim was to determine how visual information interacts with the symptoms of patients with vertigo, dizziness or instability and to find out the degree of disability it produces. PATIENTS AND METHODS: A study was conducted in 200 patients who had visited because of dizziness, vertigo, instability or loss of balance. We analysed the aspects related to the clinical symptoms of the patients. First, we examined the influence visual stimuli have on the symptoms of vestibular disease itself and their repercussions on the situation between crises. Second, the degree of disability was evaluated on the specific DHI (Dizziness Handicap Inventory) questionnaire. RESULTS: As regards the influence exerted by visual stimulation on the main symptoms, 77.5% reported that it had no effect and 21% said that it made them worse. With regard to the influence of visual stimulation during the intercritical period, it was of no relevance in 53.5% of patients, 26.5% were unaffected, it had an exacerbating effect in 4% and in 7.5% it induced it. Different disorders were observed depending on the type of disease suffered by the patient, and disability was greater according to the influence exerted by the visual factor. CONCLUSIONS: Postural adjustments induced by visual stimuli are capable of triggering instability with serious consequences.

Caracterización de la influencia del factor visual en los pacientes con alteraciones del equilibrio / Characterisation of the influence exerted by the visual factor in patients with balance disorders

Introducción. La información visual aporta datos acerca de la posición y el movimiento de la cabeza con respecto a los objetos y es fuente de referencia para la adecuada percepción de la verticalidad. Además, desempeña un papel específico en el control postural modificando la eficiencia de las respuestas vestibulares y propioceptivas. Objetivo. Determinar en pacientes con vértigo, mareo o inestabilidad cómo interactúa la información visual sobre su sintomatología y conocer el grado de discapacidad que produce. Pacientes y métodos. Se realizó el estudio de 200 pacientes vistos por mareo, vértigo, inestabilidad o desequilibrio. Analizamos los aspectos relacionados con la clínica de los pacientes. En primer lugar, la influencia que el estímulo visual tiene en los síntomas propios de la enfermedad vestibular y su repercusión en la situación entre crisis. En segundo lugar, el grado de discapacidad valorado por el cuestionario específico DHI (del inglés dizziness handicap inventory). Resultados. Respecto a la influencia que la estimulación visual tiene sobre la sintomatología principal, el 77,5 por ciento refería que no le afectaba, y el 21 por ciento, que le agravaba; en cuanto a la influencia de la estimulación visual durante el período intercrítico, en el 53,5 por ciento de los pacientes no era relevante, en el 26,5 por ciento no la afectaba, en el 4 por ciento la agravaba y en el 7,5 por ciento la inducía. Se observó la existencia de una afectación diferente según el tipo de enfermedad que sufría el paciente, y una mayor discapacidad según la influencia del factor visual. Conclusiones. Los ajustes posturales inducidos por el estímulo visual son capaces de provocar una desestabilización con serias consecuencias (AU)

Introduction. Visual information provides data about the position and movement of the head with respect to objects and serves as a source of reference for the proper perception of verticality. It also plays a specific role in postural control by modifying the efficiency of the vestibular and proprioceptive responses. Aims. Our aim was to determine how visual information interacts with the symptoms of patients with vertigo, dizziness or instability and to find out the degree of disability it produces. Patients and methods. A study was conducted in 200 patients who had visited because of dizziness, vertigo, instability or loss of balance. We analysed the aspects related to the clinical symptoms of the patients. First, we examined the influence visual stimuli have on the symptoms of vestibular disease itself and their repercussions on the situation between crises. Second, the degree of disability was evaluated on the specific DHI (Dizziness Handicap Inventory) questionnaire. Results. As regards the influence exerted by visual stimulation on the main symptoms, 77.5% reported that it had no effect and 21% said that it made them worse. With regard to the influence of visual stimulation during the intercritical period, it was of no relevance in 53.5% of patients, 26.5% were unaffected, it had an exacerbating effect in 4% and in 7.5% it induced it. Different disorders were observed depending on the type of disease suffered by the patient, and disability was greater according to the influence exerted by the visual factor. Conclusions. Postural adjustments induced by visual stimuli are capable of triggering instability with serious consequences

Estudio epidemiológico de la incontinencia urinaria femenina en edad laboral / Epidemiological study of feminine urinary incontinence in work age

La Sociedad Internacional para la Continencia (ICS) define la incontinencia urinaria como la pérdida involuntaria de orina a través de la uretra, objetivamente demostrable y de tal magnitud que constituye un problema higiénico o social. Clínicamente, puede clasificarse en: incontinencia de esfuerzo, de urgencia y mixta. Llevados por el interés de este tema nos planteamos como objetivo principal estudiar la prevalencia de la incontinencia urinaria en mujeres en edad laboral en nuestro ámbito más cercano, el hospital. Material y métodos. Durante los meses de octubre de 2002 a enero de 2003 había censadas 1.705 mujeres en nuestro hospital. Diseñamos una encuesta tomando como guía el IU-4, que incluía un primer bloque de preguntas para conocer los datos sociodemográficos y, otro bloque para evaluar la pérdida involuntaria de orina, el tipo de incontinencia y el grado de repercusión en la calidad de vida de la mujer (tabla 1).La distribución de cuestionarios se realizó de forma personalizada dejando urnas para su recogida. Resultados. Recuperamos 751 cuestionarios contestados. La edad media de la población fue de 43 años con una desviación estándar de 8,98. La estimación de prevalencia para la población fue del 33,2 por ciento, afectando en mayor porcentaje a las mujeres que se encontraban entre los 45 y 49 años (30,5 por ciento).De los posibles factores de riesgo asociados a incontinencia urinaria encontramos una asociación estadísticamente significativa (p < 0,05), con la edad, la menopausia, los embarazos, los partos por vía vaginal y las infecciones de repetición, no encontrándose relación con el resto de parámetros estudiados. En cuanto a la forma clínica, el 15,4 por ciento pertenecía a la categoría de esfuerzo, el 39 por ciento, a la de urgencia y el 45,6 por ciento, a la mixta. Un 74,1 por ciento consideró que la incontinencia no repercutía de forma importante en su calidad de vida, el 23,55 por ciento se vio afectada de forma moderada y el 2,5 por ciento, de forma importante (AU)

[Sensory interaction in posturography]. / Caracterización de la interacción sensorial en posturografía.

OBJECTIVE: The aim of this work is to show the results obtained with a dynamic posturography on a stabilometric platform and to create relative parameters of study. MATERIAL AND METHODS: The study was performed on 127 patients with dizziness of a peripheral vestibular origin and the results analyzed in a dynamic posturography under six conditions of stimulation. RESULTS: The values obtained under the studied conditions of dynamic posturography are significantly different when the conditions of test increases sensorial conflicts. We could create 15 news relatives parameters which are in normal distribution. CONCLUSIONS: Dynamic posturography over stabilometric platform could be considered as a good test in the evaluation of vertiginous patients. Different stimulations introduce more sensibility to the test.

Gentamicina intratimpánica para la enfermedad de Ménière: análisis de la técnica / Intratympanic gentamicin in patients with Ménière's disease: analysis of our protocol

Objetivo: Estudiar las características y los resultados de un protocolo de tratamiento con gentamicina intratimpánica para la Enfermedad de Ménière. Material y métodos: Se estudiaron 71 con enfermedad de Ménière unilateral seguidos por un período superior a 2 años después de finalizado el tratamiento. Se utilizaron los criterios de la AAO-HNS para el diagnóstico y seguimiento de estos pacientes. La gentamicina se aplicó hasta la aparición de síntomas o signos de hipofunción vestibular unilateral. Resultados: Se obtuvo un control del vértigo en el 83 por ciento de los enfermos si bien en un 24 por ciento fue necesario repetir el tratamiento por recurrencia de los síntomas. El 66 por ciento de los pacientes presentaron un cuadro clínico, vestíbulo-espinal y oculomotor típico de la desaferentización periférica unilateral aguda. Conclusiones: El protocolo de tratamiento con gentamicina intratimpánica resulta eficaz en el control de los síntomas siendo comparable a otras series de tratamiento a dosis única o semanales también (AU)

OBJECTIVE: The aim of this paper is to analyze the peculiarities of a protocol for treatment with intratympanic gentamicin in patients with Ménière's disease. MATERIAL AND METHODS: 71 patients with unilateral disabling Ménière's disease were followed for a period longer than two years after concluding the treatment. AAO-HNS criteria for reporting treatment results was followed. Gentamicin was applied weekly until of symptoms or signs of vestibular hypofunction were noticed. RESULTS: Control of vertigo was obtained in 83% of the patients while in 24% a second course was needed beacuse of vertigo recurrence. 66% of the patients developed a typical syndrome of unilateral vestibular hypofunction in the ear treated. CONCLUSIONS: Ending weekly injections of gentamicin for the treatment of patients with Ménière's disease when signs of vestibular hypofunction appear warrants a control of vertigo similar to that obtained in other series (AU)

Caracterización de la interacción sensorial en posturografía / Sensory interaction in posturograhy

Objetivo: El objetivo de este estudio es describir los resultados obtenidos al realizar en una población de pacientes con trastornos del equilibrio una posturografía dinámica (PD) con una plataforma estabilométrica y crear una serie de parámetros relativos normalizados que interrelacionan todas las posibilidades de estimulación. Material y Métodos: Este estudio descriptivo se realizó con 127 pacientes que acudieron a la consulta de Otorrinolaringología refiriendo problemas de equilibrio, a los que se realizó una posturografía dinámica bajo 6 diferentes condiciones de estimulación. Resultados: Analizando los valores obtenidos se observa cómo la longitud del estatokinesigrama (LSKG) y el área de estatokinesigrama (SSKG) aumentan a medida que las diferentes condiciones de estimulación aumentan el conflicto sensorial pudiéndose crear 15 parámetros relativos de estudio que siguen una distribución normal. Conclusiones: Podemos concluir que la PD realiza un adecuado acercamiento diagnóstico en los pacientes con trastornos del equilibrio, observándose cómo diferentes situaciones de estimulación sensorial parecen introducir una mayor sensibilidad en la prueba (AU)

OBJECTIVE: The aim of this work is to show the results obtained with a dynamic posturography on a stabilometric platform and to create relative parameters of study. MATERIAL AND METHODS: The study was performed on 127 patients with dizziness of a peripheral vestibular origin and the results analyzed in a dynamic posturography under six conditions of stimulation. RESULTS: The values obtained under the studied conditions of dynamic posturography are significantly different when the conditions of test increases sensorial conflicts. We could create 15 news relatives parameters which are in normal distribution. CONCLUSIONS: Dynamic posturography over stabilometric platform could be considered as a good test in the evaluation of vertiginous patients. Different stimulations introduce more sensibility to the test (AU)

[Disability in patients with benign paroxysmal positional vertigo with posterior semicircular canal involvement]. / Discapacidad en pacientes con vértigo posicional paroxístico benigno del canal semicircular posterior.

OBJECTIVE: The aim of this work is to analyze the vestibular function and level of disability in two populations of patients with positional vertigo but with different results in the Dix-Hallpike test. MATERIAL AND METHODS: 114 patients were assessed. In 65 the Dix-Hallpike test was positive (DH+) and in 49 negative (DH). The caloric test was performed as well as the assessment of disability with the pertinent questionnaires for vestibular disability. RESULTS: Patients in the DH+ group showed a higher level of disability in the physical subscale of the DHI and a higher perception of a deteriorated quality of life. Patients in the DH- group showed a more severe disability in the emotional subscale of the DHI. CONCLUSIONS: Once the phenomenon of nystagmus fatigability is ruled out, patients with positional vertigo and DH- must not be considered a minor form of positional vertigo.

Discapacidad en pacientes con vértigo posicional paroxístico benigno del canal semicircular posterior / Disability in patients with benign paroxysmal positional vertigo with posterior semicircular canal involvement

Objetivo: En este trabajo se analizan la función vestibular y grado de discapacidad en dos poblaciones de pacientes con historia congruente de vértigo posicional y resultado dispar en la maniobra de Dix-Hallpike. Material y Métodos: Se estudiaron 114 pacientes con vértigo posicional. En 65 el Dix-Hallpike fue positivo (DH+) y en 49 fue negativo (DH-). Se realizó prueba calórica y se determinó el grado de discapacidad vestibular utilizando diferentes cuestionarios.Resultados: Los pacientes del grupo DH+ manifestaron un mayor nivel de discapacidad en la subescala física del DHI y una percepción de mayor deterioro en su calidad de vida. Los pacientes del grupo DHmanifestaron un mayor nivel de discapacidad en la subescala emocional del DHI. Conclusiones: Descartado el fenómeno de fatigabilidad del nistagmo en el VPPB, los pacientes del grupo DH- no representan una forma menor del VPPB (AU)

OBJECTIVE: The aim of this work is to analyze the vestibular function and level of disability in two populations of patients with positional vertigo but with different results in the Dix-Hallpike test. MATERIAL AND METHODS: 114 patients were assessed. In 65 the Dix-Hallpike test was positive (DH+) and in 49 negative (DH). The caloric test was performed as well as the assessment of disability with the pertinent questionnaires for vestibular disability. RESULTS: Patients in the DH+ group showed a higher level of disability in the physical subscale of the DHI and a higher perception of a deteriorated quality of life. Patients in the DH- group showed a more severe disability in the emotional subscale of the DHI. CONCLUSIONS: Once the phenomenon of nystagmus fatigability is ruled out, patients with positional vertigo and DH- must not be considered a minor form of positional vertigo (AU)

Enfermedad de Menière: criterios diagnósticos, criterios para establecer estadios y normas para la evaluación de tratamientos. Revisión bibliográfica y actualización / Meniere's disease: diagnostic criteria, criteria to stablish stages and rules to evaluate treatments. Bibliographic revision and updates

Si los médicos utilizáramos los mismos conceptos al referirnos a la definición de Enfermedad de Menière (EM) y las mismas escalas para establecer los estadios o las valoraciones de un tratamiento podríamos contrastar nuestros resultados. Ello redundaría en beneficio de los enfermos porque permitiría facilitarles información más correcta sobre la evolución de la enfermedad y la eficacia de los posibles tratamientos. Con la incorporación de la informática surge un nuevo interés sobre estos principios porque se pueden conseguir bases de datos muy amplias aunando las que utiliza cada centro, siempre y cuando las normas de recogida de datos se hayan estandarizado previamente. En este trabajo valoramos las propuestas del "Committee on Hearing and Equilibrium" de la Academia Americana de Otolaringología (AAO) y de otros autores respecto a los planteamientos anteriores (AU)

If all doctors would use the same concepts to define Meniere's Disease (MD) and the same scale to either establish the different steps of the disease or to evaluate a specific treatment, it would be easy to compare our results. This would be beneficial for patients because of the possibility of giving them a more accurate information about the follow-up of their disease and the advantages of the different possibilities of treatment. Since the introduction of informatic systems a new goal appeared: large databases could be achieved, as a result of being able to gather the different database that are independently used in each hospital, provided that rules to establish data would be previously standardized. The purpose of this paper is to evaluate the proposal of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology and those proposed by other authors according to the stated courses of action (AU)