Skull vibration-induced nystagmus in vestibular neuritis.

BACKGROUND: As described by Dumas, an 80-100 Hz vibration applied to the mastoid produces a horizontal nystagmus, with quick phases beating away from the affected side in patients with unilateral vestibular loss (UVL). AIM/OBJECTIVES: To elucidate the characteristics of skull vibration-induced nystagmus (SVIN) in patients suffering from vestibular neuritis and how these characteristics are related to information provided by the video head impulse test (vHIT). MATERIAL AND METHODS: Sixty-three patients were enrolled to perform a vHIT to measure the gain in both ears. SVIN was induced with stimulation at 30 Hz, 60 Hz, and 100 Hz. The slow phase velocity (SPV) of the SVIN was measured. RESULTS: The SVIN test was positive in 25/63 patients at 30 Hz, 36/63 at 60 Hz and 46/63 at 100 Hz. Mean gain difference between both ears to obtain a positive SVIN at 30 Hz was observed to be 0.38 ± 0.25, decreasing to 0.35 ± 0.23 at 60 Hz, and 0.31 ± 0.24 at 100 Hz (p = .025). We found a significant positive linear correlation between the gain asymmetry measured using horizontal vHIT and SPV in SVIN at 100 Hz. CONCLUSIONS AND SIGNIFICANCE: There is a close relationship between the difference in the gains of both ears as measured using VHIT and the SPV of the nystagmus induced by SVIN at 100 Hz.

Educación inclusiva en Medicina: una experiencia formativa sobre personas con discapacidad / Inclusive education in Medicine: Awareness health care for persons with disabilities

FUNDAMENTO: La educación inclusiva universitaria trata de transformar y mejorar el rol competencial de los futuros médicos en relación con las personas con discapacidad (PcD), grupo poblacional vulnerable y prevalente que necesita una atención de calidad para hacer efectivo su derecho a la salud. OBJETIVO: Analizar y valorar la sensibilización y la formación de una experiencia desarrollada en Medicina en relación con la atención integral a las PcD. MÉTODO: Se ha realizado un estudio de intervención, tipo antes y después, sin grupo control, en 120 alumnos del grado de Medicina. RESULTADOS: Los estudiantes perciben que falta de formación en este tema y son conscientes de su rol sanitario y social en la reducción de desigualdades en las PcD. Entre los conocimientos profesionales que mejoran con la intervención, de manera significativa, están los relacionados con los derechos de las PcD, los factores de riesgo, el grado de discapacidad, el diseño universal, las medidas de acción positiva y las adaptaciones curriculares asociadas a la educación inclusiva. En relación con las competencias que deben ser adquiridas, se debe destacar su sensibilización sobre la necesidad de habilidades sociales y de comunicación, y la capacidad para emitir informes médicos sobre la incapacitación. CONCLUSIÓN: La intervención formativa se muestra efectiva en relación con la sensibilización sobre la importancia del rol del médico en relación con los pacientes con discapacidad y, en consecuencia, se valoran los conocimientos y competencias necesarias para conseguir una mejor atención sanitaria

BACKGROUND: Inclusive higher education aims to transform and improve the competence role of the future doctors in relation to people with disabilities (PwD), a vulnerable and prevalent population group which needs Quality Care to fulfil the right to health. AIM: To analyse and assess the awareness and training received of an experience developed in the School of Medicine related to the comprehensive care for PwD. METHOD: A before- and after-intervention, with no control group, of 120 students enrolled in the School of Medicine. RESULTS: Students perceive a lack of training on this topic and are aware of their health and social role to reduce inequalities in PwD. The professional knowledge that significantly improved with the intervention are the related with the rights of PwD, risk factors, degree of disability, universal design, positive action measures, and curriculum adaptations. As regards to the competences that must be acquired, the awareness of social and communications skills needed should be noted, as well as the ability to issue medical reports about disability. CONCLUSION: The training intervention is effective in terms of awareness about the importance of the medical role related to PwD, and consequently, the knowledge and skills needed to achieve a better Health Care are assessed

Vestibular function in cochlear implantation: Correlating objectiveness and subjectiveness.

OBJECTIVE: To evaluate vestibular function before and after cochlear implantation (CI) STUDY DESIGN: A prospective descriptive study. MATERIAL AND METHODS: Thirty consecutive patients with profound sensorineural hearing loss undergoing CI. Objective assessment of vestibular function was performed with the caloric test and video head impulse test (vHIT) in patients before and after CI. Dizziness Handicap Inventory (DHI) was used for subjective assessment before and after CI. RESULTS: Thirty patients received CI with 21 by round window approach and nine by anteroinferior cochleostomy. Vestibular results were categorized into four groups: no changes (20 patients), changes in the caloric test and vHIT (3 patients, all with DHI changes; P = 0.0001), changes in vHIT gain but not in caloric test (3 patients, all with DHI changes; P = 0.005), no changes in the caloric test and vHIT gain but only saccades appear (4 patients, all with DHI changes; P = 0.011). CONCLUSIONS: Although CI is a safe surgery with few major complications, it is a procedure that can produce dizziness. The vHIT reveals that 30% of patients demonstrate postoperative change in vestibular function. Therefore, when examining a CI patient with postoperative symptoms of dizziness, results of the vHIT test and gain as well as the presence of saccades, along with an increase DHI score, are parameters to consider in their evaluation. LEVEL OF EVIDENCE: 4.

"Seeing" cochlear implant misplacement without imaging test.

Electrode array misplacement is an infrequent complication in cochlear implant surgery. A case report of electrode array insertion into the posterior semicircular canal, and its effects on the vestibular function is described. Video head impulse test (vHIT) has become an exceptional diagnostic tool to study vestibular function. We present our experience using the vHIT to detect a misplaced electrode array after cochlear implant surgery.

The vestibulo-ocular reflex and subjective balance after vestibular schwannoma surgery.

OBJECTIVES/HYPOTHESIS: To evaluate the vestibulo-ocular reflex and its relationship with subjective balance in a long-term follow-up after vestibular schwannoma surgery. STUDY DESIGN: Retrospective cohorts study in a tertiary referral hospital. Forty-nine consecutive patients on which vestibular schwannoma surgery was performed at least 1 year before. METHODS: Patients are classified in accordance with the morphology of the vestibulo-ocular reflex (VOR) into two groups: Group A, in which covert and overt saccades always occur in an organized fashion; and group B, in which covert and overt saccades randomly occur during head impulse and once finished. We evaluate the presence of covert and overt saccades and the morphology of the VOR measured by the video head impulse test (vHIT) and its relationship with subjective balance measured by Dizziness Handicap Inventory (DHI). RESULTS: The group B patients returned a higher score in total DHI and all three subscales without any predominant subscale (P = 0,0002; t test). Group B patients were older than those in group A (P = 0,024; t test). No differences were found in sex distribution, tumor size, or side or time interval after surgery. Regarding the unaffected side, overt saccades were found to be more frequent in group B patients (P = 0.05; X(2)). CONCLUSIONS: Long-term follow-up after vestibular schwannoma surgery has shown that 22% of the patients display a particular abnormality in the VOR because refixation saccades occur in a random fashion after elicitation of the reflex in the HIT test. These patients report the higher level of vestibular disability and handicap. LEVEL OF EVIDENCE: 2b.

Vestibular compensation after vestibular schwannoma surgery: normalization of the subjective visual vertical and disability.

CONCLUSIONS: The degree of caloric weakness before surgery influences faster or slower recovery of patients undergoing vestibular schwannoma surgery. The Dizziness Handicap Inventory (DHI) is a good index to show the recovery of patients as it relates directly to an improvement or not of the subjective visual vertical (SVV). OBJECTIVE: To evaluate the process of recovery of patients as measured by the SVV and the DHI after surgical removal of vestibular schwannoma. METHODS: We studied 24 consecutive patients of the University Hospital of Salamanca who underwent vestibular schwannoma surgery. We assessed age, tumour size, degree of canalicular weakness and preoperative SVV, and their relationship with DHI and SVV at discharge and also at 1, 3 and 6 months postoperatively. RESULTS: Patients with lesser degrees of caloric weakness took longer to normalize SVV than those with a higher caloric weakness before surgery (p < 0.05). There was a significant correlation between DHI and improvements in SVV with time. The differences disappeared in 6 months where all patients, with greater or lesser degree of caloric weakness, had the same results.