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1.
Orv Hetil ; 160(48): 1915-1920, 2019 Dec.
Artigo em Húngaro | MEDLINE | ID: mdl-31760777

RESUMO

Introduction: Ménière's disease (MD) is a disorder that affects the inner ear, characterized by vertigo, tinnitus, hearing loss and vegetative symptoms. One of the main points of the management of the patients is the analysis of the vertigo diaries. Aim: To identify the typical characteristics of the symptoms and to highlight the importance of multidisciplinary approach. Material and method: 58 (12 male and 46 females, mean age 56.97 ± 10.45 SD) definite MD patients were enrolled in this investigation. The vertigo diaries filled out by the patients were analysed. The statistical analysis was performed using IBM SPSS V24 software. Since the parameters did not show normal distribution, non parametric test (Mann-Whitney U test) was used. Results: Based on the diaries, the most tormenting symptom is vertigo (mean power: 5.38 ± 2.06 SD), the second one is tinnitus (4.54 ± 2.81 SD), and last one is headache (2.77 ± 3.1 SD). Despite the frequent prevalence of associated headache, vestibular migraine could be ruled out in all of the cases. Another important outcome was that the attacks associated with headache were significantly stronger (p = 0.001). In the case of the vegetative symptoms, the association was even much stronger (p<0.01). According to the narrative analysis, the most frequent provocation factors of the attacks were the cold front and stress. Conclusion: Along with the treatment of vertigo, the management of the associated symptoms (headache, vegetative symptoms) is also of great importance. Monitoring the quality of life and psychiatric disorders suggests the importance of multidisciplinary approach. Orv Hetil. 2019; 160(48): 1915-1920.


Assuntos
Doença de Meniere/diagnóstico , Transtornos de Enxaqueca , Qualidade de Vida , Vertigem , Idoso , Feminino , Cefaleia , Perda Auditiva , Humanos , Masculino , Doença de Meniere/fisiopatologia , Pessoa de Meia-Idade , Zumbido
3.
Artigo em Chinês | MEDLINE | ID: mdl-31446722

RESUMO

Objective:The aim of this study is to evaluate the diagnostic value of vestibular-evoked myogenic potential (cVEMP and oVEMP), caloric test, and cochlear electrogram (EcochG) in patients with Meniere's disease (MD) and non-Meniere's disease. Method:Sixty-four patients (64 ears) with Unilateral Meniere's disease were enrolled in the study group (MD group), and 127 cases(254 ears) of non-Meniere's disease patients as non-MD group, including vertigo migraine in 40 cases, benign paroxysmal positional vertigo in 48 cases, benign recurrent vertigo in 13 cases, vestibular paroxysmia in 3 cases, vestibular neuritis in 5 cases and other undiagnosed vertigo in 18 cases. Both group undertake cVEMP, oVEMP, caloric test and ECochG. Use Medcale software to draw ROC curve of ECochG and calculate the area under curve(AUC), Jordan index and optimal diagnostic cut-off points. Make the cut-off point as the point of -SP/AP, then evaluate the sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) and diagnostic accuracy of cVEMP, oVEMP, caloric test and ECochG in MD group and non-MD group. Result:The AUC of ECochG ROC curve was 0.74, the Jordan index was 0.47 and the cut-off point was 0.4. The sensitivity and specificity of cVEMP(62% and 68%), oVEMP(61% and 53%) and caloric test(53% and 57%) were all below ECochG(65% and 78%). The positive predictive value and of ECochG was the highest(61.9%), the negative predictive value of cVEMP was highest(87.5%). The diagnostic accuracy of ECochG was highest(74%), followed with cVEMP(67%), oVEMP(55%) and caloric test(56%). Conclusion:Compared with the vestibular function tests, the sensitivity, specificity, diagnostic accuracy and NPV were all higher in ECochG, and the diagnostic benefit can be maximized when -SP/AP value>0.4. So the value of single vestibular function examination in the diagnosis of Meniere's disease is limited. The diagnosis of MD still requires a comprehensive evaluation in combination with medical history, audiological tests and vestibular function examinations.


Assuntos
Testes Calóricos , Doença de Meniere/diagnóstico , Potenciais Evocados Miogênicos Vestibulares , Humanos , Sensibilidade e Especificidade , Testes de Função Vestibular
4.
Acta Otolaryngol ; 139(9): 739-746, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31274039

RESUMO

Background: Endolymphatic sac drainage (ELSD) may have a positive effect on endolymphatic hydrops (EH) and may help to preserve inner ear function. However, the relationship between changes in EH volumes and hearing function after ELSD has not been described. Objectives: We aimed to reveal the factors related to changes in hearing and EH following ELSD. Material and Methods: Twenty-one patients who received ELSD were enrolled. Pure tone audiometry and 3-T magnetic resonance imaging (MRI) 4 h after intravenous injection of gadolinium enhancement were performed just before surgery and 2 years later. To characterize the endolymphatic space (ELS), we measured the volume of the total fluid (TFS) and ELS and calculated the ratio of ELS to TFS (ELS ratio). Results: The ELS ratio of the patients who showed hearing improvement was 18.5 ± 11.4% before surgery and 23.9 ± 14.3% after. For those with no change, it was 29.7 ± 10.8% before and 29.4 ± 9.5% after, and in patients with worsened hearing function it was 22.7 ± 7.5% before and 27.2 ± 13.4% after. Conclusion: We found no correlation between the changes in hearing function and the volume of EH after ELSD.


Assuntos
Drenagem/métodos , Hidropisia Endolinfática/diagnóstico , Hidropisia Endolinfática/terapia , Imagem Tridimensional , Imagem por Ressonância Magnética/métodos , Doença de Meniere/terapia , Adulto , Análise de Variância , Audiometria de Resposta Evocada , Audiometria de Tons Puros , Estudos de Coortes , Meios de Contraste , Saco Endolinfático/diagnóstico por imagem , Saco Endolinfático/patologia , Feminino , Gadolínio , Humanos , Masculino , Doença de Meniere/diagnóstico , Pessoa de Meia-Idade , Prognóstico , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
5.
Acta Otolaryngol ; 139(9): 747-752, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31271345

RESUMO

Background: Elder Meniere's disease (MD) patients ultimately lose their vestibular function. Objective: This study utilized an inner ear test battery to investigate evolution of MD. Methods: Total 278 elder MD patients aged >65 years were divided into three groups. Ninety-four patients with bilateral MD (188 ears) were assigned to Group A. The remaining 184 patients with unilateral MD were further divided into two groups. Group B consisted of 20 affected ears with normal vestibular function on the opposite ears, while Group C indicated 184 unaffected ears. All patients underwent an inner ear test battery. Results: Inner ear deficits in Group B declined from the cochlea via the saccule, utricle to semicircular canals. In contrast, Groups A and C did not significantly differ in the abnormality rates of cervical vestibular-evoked myogenic potential (cVEMP), ocular VEMP and caloric tests, indicating that Group C (unaffected ears) may partly share the same mechanism like Group A (affected ears), namely aging and hydropic effects. Conclusion and significance: Evolution of MD may progress from unilateral MD (MD 1.0), via unilateral MD coupled with asymptomatic hydrops on opposite ear (MD 1.5), toward bilateral MD (MD 2.0), where the number 1.0-2.0 means the number of clinically affected ears.


Assuntos
Progressão da Doença , Hidropisia Endolinfática/diagnóstico , Doença de Meniere/fisiopatologia , Potenciais Evocados Miogênicos Vestibulares/fisiologia , Idoso , Idoso de 80 Anos ou mais , Audiometria/métodos , Testes Calóricos , Estudos de Coortes , Hidropisia Endolinfática/fisiopatologia , Feminino , Seguimentos , Avaliação Geriátrica/métodos , Humanos , Masculino , Doença de Meniere/diagnóstico , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo
6.
Artigo em Chinês | MEDLINE | ID: mdl-31163516

RESUMO

Objective: To explore composition and characteristics of vertigo in children. Method:The diagnosis, medical history and examinations of 46 patients (≤17 years old) with vertigo were studied retrospectively. Result:Of the 46 children patients with vertigo enrolled in this study, 19 patients were with BPVC(41.3%), 11 patients with VM(23.9%),4 patients with BPPV(8.7%), 3 patients with unclassifiable vestibular syndrome(6.5%), 2 patients with Meniere's disease (4.3%), 1 patient with sudden deafness with vertigo, 1 patient with labyrinthitis, 1 patient with vestibular paroxysmal, 1 patient with vestibular neuritis, 1 patient with head trauma, 1 patient with light cupula, 1 patient with benign paroxysmal torticollis (2.2%, respectively). The statistical analysis was conducted among 4 kinds of the most common causes of vertigo in children. There was no significant differences in sex composition among different groups(P>0.05). The mean age and mean age of onset in patients with BPVC were the youngest(P<0.05). Headache was complained more often in patients with VM(P<0.05) and there was no difference in other accompanying symptoms (such as nausea, vomiting and tinnitus) among each groups(P>0.05).Most patients with VM had family history of vertigo or migraine, but not in patients with VM and patients with BPVC(P>0.05). Conclusion:The most common vertigo in children were BPVC, VM and BPPV. The medical history, physical examinations and vestibular function tests can help doctors to diagnose more correctly.


Assuntos
Doença de Meniere , Vertigem , Neuronite Vestibular , Adolescente , Criança , Humanos , Doença de Meniere/diagnóstico , Estudos Retrospectivos , Vertigem/complicações , Vertigem/diagnóstico , Testes de Função Vestibular
7.
Artigo em Chinês | MEDLINE | ID: mdl-31163517

RESUMO

Objective:To determine whether the preoperative results of glycerol test of electrocochleography and hearing stage have a prognostic value on the effects of endolymphatic sac decompression surgery in patients with unilateral Meniere's disease. Method:A retrospective study was conducted of 58 unilateral Meniere's disease patients who underwent endolymphatic sac decompression surgery. The correlation between the preoperative results of glycerol test of electrocochleography, hearing stage and vertigo control was analyzed by Kendall test. Result:Patients in the positive glycerol test of electrocochleography group had better vertigo control after the decompression of the lymphatic sac than the negative group(P=0.029). Preoperative hearing staging was significantly associated with vertigo control after endolymphatic sac decompression(P=0.028). The better the preoperative hearing, the higher the control rate of vertigo after endolymphatic sac decompression. The stage Ⅰ patients were 91.7%, the stage Ⅱ patients were 78.1%, and the third stage Ⅲ patients were 57.1%, respectively. Conclusion:Our findings suggested that the positive preoperative results of glycerol test of electrocochleography and better hearing stage may indicate a better effects of endolymphatic sac decompression surgery in patients with unilateral Meniere's disease.


Assuntos
Audiometria de Resposta Evocada , Saco Endolinfático , Doença de Meniere , Saco Endolinfático/cirurgia , Glicerol , Humanos , Doença de Meniere/diagnóstico , Doença de Meniere/cirurgia , Prognóstico , Estudos Retrospectivos
8.
J Laryngol Otol ; 133(6): 450-456, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31172892

RESUMO

BACKGROUND: Ménière's disease often presents with aural fullness, for reasons that are currently not well understood. Transtympanic ventilation tube insertion has been historically used for the management of this symptom, though the nature and mechanism of effectiveness is unclear. OBJECTIVE: To give an overview of the data available on the effects of ventilation tube insertion on aural fullness in Ménière's disease. METHODS: The databases PubMed, Embase, Medline, Scopus, Web of Science, Central and Google Scholar were searched to identify relevant records. Records were subsequently analysed and data extracted. RESULTS: Only two studies directly measured the effect of ventilation tube insertion on aural fullness, while three others measured it as a placebo to assess another treatment. Considerable heterogeneity was found amongst the studies, including conflicting conclusions. CONCLUSION: There is a paucity of evidence investigating the effect of grommet insertion on aural fullness in Ménière's disease. This work directs future research into this topic.


Assuntos
Doença de Meniere/cirurgia , Ventilação da Orelha Média/métodos , Qualidade de Vida , Membrana Timpânica/cirurgia , Adulto , Fatores Etários , Idoso , Orelha Média/fisiopatologia , Orelha Média/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Doença de Meniere/diagnóstico , Pessoa de Meia-Idade , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Resultado do Tratamento , Adulto Jovem
9.
J Int Adv Otol ; 15(1): 112-117, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31058600

RESUMO

OBJECTIVES: The aim of the present study was to investigate current treatment practices and self-reported effectiveness in Ménière's disease. MATERIALS AND METHODS: Members of two Italian Ménière's disease support (n=170) with ≥6-month history of Ménière's disease were administered an online survey about recent treatments. Vertigo episode count, work absenteeism, and limitations in family life, social life, work, or travel as included in the Social Life and Work Impact of Dizziness Questionnaire before and after recent treatments were queried. RESULTS: Twenty-four different treatments were reported for Ménière's disease, with dietary modifications (55%), diuretics (47%), and betahistine (41%) being the most common. The majority (71%) received multiple simultaneous treatments. Prior to the most recent treatments, 78%-89% of respondents indicated limitations in family or social life, work, or traveling. After their most recent treatment, respondents reported improvements in mean vertigo episode counts (5.7±7.6 vs. 2.6±4.6, p<0.001), days off work per month (10.1±9.2 vs. 4.2±6.7, p<0.001), and proportions indicating limitations in any functional measure assessed (p<0.05). These findings were consistent regardless of treatment approach (p<0.05 for all). Intratympanic gentamicin provided the greatest reductions in vertigo count, functional limitations, and work absenteeism (p<0.01 for all), as well as the fewest respondents reporting post-treatment functional limitations (16%-37%). CONCLUSION: Despite many treatment approaches targeting different proposed pathophysiology for Ménière's disease in this cross-sectional survey, all treatments are reported as effective by patients. These findings support a prominent placebo effect in Ménière's disease and highlight challenges in studying treatment outcomes; there is a critical need to better understand Ménière's disease.


Assuntos
Doença de Meniere/tratamento farmacológico , Doença de Meniere/fisiopatologia , Doença de Meniere/psicologia , Absenteísmo , Antibacterianos/uso terapêutico , beta-Histina/uso terapêutico , Estudos Transversais , Dietoterapia/métodos , Diuréticos/uso terapêutico , Feminino , Gentamicinas/administração & dosagem , Gentamicinas/uso terapêutico , Agonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Injeção Intratimpânica , Itália/epidemiologia , Masculino , Doença de Meniere/diagnóstico , Pessoa de Meia-Idade , Autoimagem , Inquéritos e Questionários , Resultado do Tratamento , Vertigem/tratamento farmacológico
10.
J Int Adv Otol ; 15(1): 135-140, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31058603

RESUMO

OBJECTIVES: The aim of the current study was to further collect evidence that would confirm the hypothesis that vestibular drop attacks (VDAs) could cause syncope in patients with Ménière's disease (MD). MATERIALS AND METHODS: A cross-sectional survey design was employed in the present study. An Internet-based survey was administered on 602 individuals with MD. The mean age of the participants was 56.7 (25-75) years, and the mean duration of the disease was 12.4 (0.5-35) years. RESULTS: VDAs with varying severity were present among 307 (50.7%) patients and led to fall in 92 patients, and syncope occurred in 45 patients with VDA. The overall percentage of syncope due to MD was 4.7%. Factors, such as duration of disease, age, and gender of the patient, did not explain attacks of syncope. Migraine and headache were not associated with syncope. Syncope was witnessed in 23 and self-reported by 22 patients. Syncope was associated with frequent VDA, duration of VDA, and falls that occurred during VDA. Patients with syncope reported the experience as frightening, had reduced general health-related quality of life, had higher anxiousness scores, and suffered more from fatigue. They also experienced problems with work, employment, and social restrictions. CONCLUSION: Approximately 5% of patients with MD suffer from syncope, and syncope occurs among patients with VDA. In vestibular syncope, the sympathetic tone is lost, and baroreflex feedback is inhibited leading to fall and syncope. The consequences of vestibular syncope are severe, and patients face injuries and a significantly reduced quality of life.


Assuntos
Doença de Meniere/diagnóstico , Síncope/diagnóstico , Doenças Vestibulares/complicações , Adulto , Idoso , Barorreflexo , Estudos Transversais , Feminino , Humanos , Masculino , Doença de Meniere/complicações , Doença de Meniere/fisiopatologia , Pessoa de Meia-Idade , Qualidade de Vida , Autorrelato/estatística & dados numéricos , Inquéritos e Questionários , Sistema Nervoso Simpático/fisiopatologia , Síncope/etiologia , Síncope/psicologia , Vestíbulo do Labirinto/fisiopatologia
11.
Neurology ; 92(24): e2743-e2753, 2019 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-31092626

RESUMO

OBJECTIVE: To facilitate the diagnosis of vestibular disorders by patient-initiated capture of ictal nystagmus. METHODS: Adults from an Australian neurology outpatient clinic reporting recurrent vertigo were recruited prospectively and taught to self-record spontaneous and positional nystagmus at home while symptomatic, using miniature video-oculography goggles. Consenting patients with ictal videorecordings and a final unblinded clinical diagnosis of Ménière disease (MD), vestibular migraine (VM), or benign paroxysmal positional vertigo (BPPV) were included. RESULTS: Ictal eye videos of 117 patients were analyzed. Of 43 patients with MD, 40 showed high-velocity spontaneous horizontal nystagmus (median slow-phase velocity [SPV] 39.7°/s; 21 showed horizontal nystagmus reversing direction within 12 hours [24 on separate days]). In 44 of 67 patients with VM, spontaneous horizontal (n = 28, 4.9°/s), upbeating (n = 6, 15.5°/s), or downbeating nystagmus (n = 10, 5.1°/s) was observed; 16 showed positional nystagmus only, and 7 had no nystagmus. Spontaneous horizontal nystagmus with SPV >12.05°/s had a sensitivity and specificity of 95.3% and 82.1% for MD (95% confidence interval [CI] 0.84-0.99, 0.71-0.90). Nystagmus direction change within 12 hours was highly specific (95.7%) for MD (95% CI 0.85-0.99). Spontaneous vertical nystagmus was highly specific (93.0%) for VM (95% CI 0.81-0.99). In the 7 patients with BPPV, spontaneous nystagmus was absent or <3°/s. Lying affected-ear down, patients with BPPV demonstrated paroxysmal positional nystagmus. Median time for peak SPV to halve (T50) was 19.0 seconds. Patients with VM and patients with MD demonstrated persistent positional nystagmus (median T50; 93.1 seconds, 213.2 seconds). T50s <47.3 seconds had a sensitivity and specificity of 100% and 77.8% for BPPV (95% CI 0.54-1.00, 0.64-0.88). CONCLUSION: Patient-initiated vestibular event monitoring is feasible and could facilitate rapid and accurate diagnosis of episodic vestibular disorders.


Assuntos
Vertigem Posicional Paroxística Benigna/diagnóstico , Medições dos Movimentos Oculares , Doença de Meniere/diagnóstico , Transtornos de Enxaqueca/diagnóstico , Monitorização Ambulatorial/métodos , Nistagmo Patológico/diagnóstico , Adulto , Idoso , Vertigem Posicional Paroxística Benigna/complicações , Feminino , Humanos , Masculino , Doença de Meniere/complicações , Pessoa de Meia-Idade , Transtornos de Enxaqueca/complicações , Nistagmo Patológico/etiologia , Vertigem/complicações , Vertigem/diagnóstico
12.
HNO ; 67(6): 425-428, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30963222

RESUMO

Vestibular migraine probably represents the second most common cause of vertigo after benign positional vertigo, by far exceeding Ménière disease. There are still relatively few published reports on vestibular migraine management, despite its enormous importance in daily practice. In 2003 the first clinical definition of vestibular migraine was proposed. Studies published before 2003 used variable terms for vestibular migraine. Some authors recommend treating vestibular migraine using multiple drugs; others have focused on using only one drug. Although at present it is not possible to quantify the effects of the treatments proposed, some recommendations can be made.


Assuntos
Doença de Meniere , Transtornos de Enxaqueca , Doenças Vestibulares , Criança , Diagnóstico Diferencial , Tontura , Feminino , Cefaleia , Humanos , Doença de Meniere/diagnóstico , Doença de Meniere/tratamento farmacológico , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/tratamento farmacológico , Doenças Vestibulares/diagnóstico , Doenças Vestibulares/tratamento farmacológico
13.
Adv Otorhinolaryngol ; 82: 77-86, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30947172

RESUMO

This article reviews 3 aspects of Meniere's disease (MD), which have been recently revisited: namely, the pathologic mechanism causing the attacks of vertigo, the clinical diagnosis, and the medical and surgical treatments. The characteristic attacks of vertigo are unlikely to be due to membrane ruptures, so a hypothesis that the vertigo is caused by a volume of endolymph shifting suddenly from the cochlea into the pars superior is suggested. The definite diagnosis according to the American Academy of Otolaryngology HNS 1995 criteria [13] failed to exclude vestibular migraine sufficiently and a revision in 2015 [14] has partly addressed this problem but another method which stresses the interaction of the cochlear and vestibular symptoms is described. The treatment of MD has been updated, providing evidence for each popular therapy. Newer treatments using intratympanic medications including steroid solutions and gentamicin are discussed. Finally, the role of cochlear implants is mentioned.


Assuntos
Doença de Meniere , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Gentamicinas/uso terapêutico , Humanos , Doença de Meniere/diagnóstico , Doença de Meniere/fisiopatologia , Doença de Meniere/terapia , Procedimentos Cirúrgicos Otológicos , Guias de Prática Clínica como Assunto , Esteroides/uso terapêutico , Testes de Função Vestibular
14.
Acta otorrinolaringol. esp ; 70(2): 97-104, mar.-abr. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-178520

RESUMO

Introduction: Immune Mediated Inner Ear Disease (IMIED) is a rare form of sensorineural bilateral hearing loss, usually progressing in weeks to months and responsive to immunosuppressive treatment. Despite recent advances, there is no consensus on diagnosis and optimal treatment. Methods: A review of articles on IMIED from the last 10 years was conducted using PubMed(R) database. Results: IMIED is a rare disease, mostly affecting middle aged women. It may be a primary ear disease or secondary to autoimmune systemic disease. A dual immune response (both cellular and humoral) seems to be involved. Cochlin may be the inner ear protein targeted in this disease. Distinction from other (core common) forms of neurosensory hearing loss is a challenge. Physical examination is mandatory for exclusion of other causes of hearing loss; audiometry identifies characteristic hearing curves. Laboratory and imaging studies are controversial since no diagnostic marker is available. Conclusion: Despite recent research, IMIED diagnosis remains exclusive. Steroids are the mainstay treatment; other therapies need further investigation. For refractory cases, cochlear implantation is an option and with good relative outcome


Introducción: La enfermedad inmunomediada del oído interno (EIMOI) es una forma rara de pérdida auditiva bilateral sensorineural, que progresa generalmente en semanas a meses y responde al tratamiento inmunosupresor. A pesar de los recientes avances, no hay consenso sobre el diagnóstico y el tratamiento óptimo. Métodos: Se realizó una revisión de artículos sobre la EAOI de los últimos 10 años utilizando la base de datos PubMed(R). Resultados: La EIMOI es una enfermedad rara que afecta principalmente a las mujeres de 2 a 50 años de edad. Puede ser una enfermedad del oído primaria o secundaria a una enfermedad sistémica autoinmune. Parece estar involucrada una respuesta inmune dual (tanto celular como humoral). La coclina parece ser la proteína del oído interno diana en esta enfermedad. La distinción de otras formas de pérdida de audición neurosensorial es un desafío. El examen físico es obligatorio para la exclusión de otras causas de pérdida de la audición; la audiometría identifica curvas características de pérdida de audición. Los estudios de laboratorio y de imágenes son controvertidos, ya que no hay marcador diagnóstico disponible. Conclusión: A pesar de la investigación reciente, el diagnóstico de la EAOI sigue siendo de exclusión. Los esteroides siguen siendo el pilar del tratamiento; otras terapéuticas necesitan más investigación. Para los casos refractarios, la implantación coclear es una opción con buen resultado relativo


Assuntos
Humanos , Feminino , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Doenças do Labirinto/diagnóstico , Doenças do Labirinto/terapia , Perda Auditiva Bilateral/diagnóstico , Perda Auditiva Neurossensorial/complicações , Doença de Meniere/diagnóstico , Doença de Meniere/terapia , Perda Auditiva Bilateral/terapia , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/terapia , Doenças Hereditárias Autoinflamatórias/diagnóstico , Doenças Hereditárias Autoinflamatórias/terapia
16.
Artigo em Chinês | MEDLINE | ID: mdl-30813689

RESUMO

Objective:To analyze the clinical features of secondary benign paroxysmal positional vertigo (BPPV) and provide evidence for its precise diagnosis and treatment. Method:There were 942 patients with vertigo related to BPPV, including 204 patients with primary BPPV, 592 patients with vestibular migraine (VM), 83 patients with Meniere's disease (MD), 48 patients with vestibular neuronitis (VN), and 15 patients with sudden sensorineural hearing loss (SSNHL) accompanied by vertigo.There were 127 patients with BPPV secondary to vertigo in MD, VN, VM, and SSNHL. All patients received otolith repositioning treatment by hand or instrument based on detailed medical history. Secondary BPPV patients are treated according to the principle of diagnosis and treatment of primary BPPV. The incidence of secondary BPPV in each related disease was counted, and the difference between primary and secondary BPPV in gender, age, affected semicircular canal, number of reductions, and vertigo control rate was compared. Result:①The incidence of MD, VN, sudden vertigo, and VM secondary BPPV were 36.1% (30/83), 35.4%(17/48), 33.3% (5/15), and 12.7% (75/592). ②In patients with BPPV secondary to MD, the proportion of multi-semicircular canals involved was higher than that of primary BPPV, the difference was statistically significant (P<0.05), and there was no significant difference in the distribution of semicircular canals involved among the remaining diseases. ③The vertigo control rate of BPPV secondary to MD and VM was lower than that of primary BPPV, and the difference was statistically significant (P<0.05). ④The repositioning time of BPPV secondary to VM (2.88±2.32) and MD (2.53±1.14) was higher than that of primary BPPV (2.37±1.77). The difference was statistically significant (P<0.05). There was no significant difference in the repositioning time between other secondary BPPV and primary BPPV. Conclusion:Common causes of secondary BPPV include MD, VN, SSNHL, and VM. Same as primary BPPV, the secondary BPPV was more common in women and the posterior semicircular canal was most affected. BPPV secondary to MD is more susceptible to multi-semicircular canals involvement than primary BPPV. Detailed medical history combined with targeted examination is conducive to the accurate diagnosis of BPPV. Secondary BPPV can also be treated by manipulation or instrument, however, the effect is worse than primary BPPV. Secondary BPPV should be treated according to the treatment principle of primary disease besides otolith repositioning.


Assuntos
Vertigem Posicional Paroxística Benigna , Doença de Meniere , Neuronite Vestibular , Vertigem Posicional Paroxística Benigna/complicações , Vertigem Posicional Paroxística Benigna/diagnóstico , Feminino , Humanos , Masculino , Doença de Meniere/diagnóstico , Estudos Retrospectivos , Canais Semicirculares , Neuronite Vestibular/diagnóstico
17.
Artigo em Chinês | MEDLINE | ID: mdl-30813690

RESUMO

Objective:To study acoustic absorbance characteristics of wideband tympanometry in patients with unilateral Meniere's disease. Method:Acoustic absorbance were detected using wideband tympanometry in 36 patients with unilateral Meniere's disease and 39 control subjects excluding inner ear and middle ear disease. All patients with Meniere's disease underwent electrocochleography, gadolinium contrast internal auditory canal MRI, pure tone test. The integral area formed by the absorbance curve on peak pressure and x-axis(frequency) was calculated. Student's t-test was used to compare integral areas difference of 2 ears in Meniere's disease patients and control group. Result:The integral area of absorbance was greater in affected side than unaffected side and there was no difference in peak values of absorbance between 2 ears in Meniere's disease patients. There was no significant difference in areas between Meniere's disease in different grade(P>0.05). Peak value of absorbance and difference value of absorbance were not significant between Meniere's disease patients and normal control. Only 61.11% Meniere's disease patients showed -SP/AP>0.4 and 95.24% showed endolymphatic hydrops in affected side. Conclusion:Affected side in patients with Meniere's disease showed higher integral area of absorbance than other side,which is high sensitive but not specific.


Assuntos
Testes de Impedância Acústica , Orelha Interna , Hidropisia Endolinfática , Doença de Meniere , Audiometria de Resposta Evocada , Humanos , Doença de Meniere/diagnóstico
18.
Artigo em Chinês | MEDLINE | ID: mdl-30813691

RESUMO

Objective:This study was designed to distinguish vestibular migraine(VM) from Meniere's disease(MD) by comparing age, sex, family history, audiological and vestibular test results in patients with VM or MD. Method:Forty-six patients with suspected VM, 60 patients with confirmed VM, and 60 patients with confirmed MD were studied. All patients were asked for detailed medical history, and then underwent bithermal caloric test and audiological test. The hearing function and vestibular function were analyzed. Result:①General conditions: the sex ratio with suspected VM, confirmed VM and confirmed MD was 1∶4.75, 1∶5.67 and 1∶1. Family history in these three groups was 80.43%(37/46),66.67%(40/60),6.67%(4/60), respectively. ②In the three groups, the abnormal rates of caloric test were 50.00% (23/46), 31.67% (19/60) and 78.33%(47/60), respectively.③The rate of pure tone audiometry abnormality in the three groups was 60.87% (28/46), 63.33% (38/60) and 100.00% (60/60), respectively. Of 46 suspected VM patients, 18 (39.13%) had high frequency hearing loss, 7 (15.22%) had full frequency hearing loss, and 3 (6.52%) had low frequency hearing loss. Among 60 confirmed VM patients, 18 (30.00%) had high frequency hearing loss, 15 (25.00%) had full frequency hearing loss, 4 (6.67%) had low frequency hearing loss, and 1 case (1.67%) with low frequency and high frequency hearing loss. Among 60 confirmed MD patients, 56 (93.33%) had full frequency hearing loss, and 4 (6.67%) had low frequency hearing loss. ④The difference of audiological test between patients with confirmed VM and patients with suspected VM was not statistically significant(P>0.05). The difference of bithermal caloric test between patients with confirmed VM and patients with suspected VM was not statistically significant(P>0.05).Compared with MD patients, the incidence of hearing loss and the incidence of abnormal bithermal caloric test in VM patients is lower(P<0.05). Conclusion:The abnormality rate of caloric test and the incidence of hearing loss in MD patients were higher than VM. The confirmed and suspected VM patients can be accompanied by hearing loss mainly with high hearing frequency decline. There was no difference in clinical characteristics between confirmed and suspected VM patients.


Assuntos
Doença de Meniere , Transtornos de Enxaqueca , Vestíbulo do Labirinto , Audiometria de Tons Puros , Testes Calóricos , Humanos , Doença de Meniere/diagnóstico , Transtornos de Enxaqueca/diagnóstico , Vertigem
19.
Otolaryngol Head Neck Surg ; 160(5): 894-901, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30665325

RESUMO

OBJECTIVE: To analyze acute vertigo showing spontaneous nystagmus with negative video head impulse test (vHIT). STUDY DESIGN: Retrospective chart analysis. SETTING: Tertiary referral hospital. SUBJECTS AND METHODS: Over 16 months, 155 patients were identified with acute vertigo with spontaneous nystagmus. Of these 155, 30 (19.4%) were enrolled in this study because they did not show gain loss or catch-up saccades in both sides of the horizontal vHIT. Results of vestibular function tests (videonystagmography, horizontal vHIT, caloric test, and cervical vestibular-evoked myogenic potential [cVEMP]) and pure tone audiometry were analyzed. For all cases, magnetic resonance imaging with diffusion-weighted imaging was checked. RESULTS: Patients consisted of 17 with Ménière's disease and 7 with sudden sensorineural hearing loss with vertigo (SSNHL_V), and only 3 patients were finally diagnosed as having acute vascular stroke. Except for the loss of hearing on the lesion side, the direction of nystagmus or cVEMP asymmetry showed very different results. All 7 patients with SSNHL_V did not have canal paresis in the caloric test, but cVEMP amplitude was smaller on the lesion side for 6 patients. CONCLUSIONS: For patients with acute vertigo presenting spontaneous nystagmus with negative horizontal vHIT, it is important not only to focus on the diagnosis of acute vascular stroke but also to evaluate hearing because of the high possibility of Ménière's disease or SSNHL_V.


Assuntos
Perda Auditiva Neurossensorial/diagnóstico , Doença de Meniere/diagnóstico , Nistagmo Patológico/etiologia , Vertigem/etiologia , Neuronite Vestibular/diagnóstico , Adulto , Idoso , Audiometria de Tons Puros , Feminino , Teste do Impulso da Cabeça , Perda Auditiva Neurossensorial/complicações , Humanos , Masculino , Doença de Meniere/complicações , Pessoa de Meia-Idade , Estudos Retrospectivos , Potenciais Evocados Miogênicos Vestibulares , Testes de Função Vestibular , Neuronite Vestibular/complicações , Vestíbulo do Labirinto , Adulto Jovem
20.
Eur Arch Otorhinolaryngol ; 276(4): 993-1000, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30694377

RESUMO

PURPOSE: To help clinicians to further understand the significance of vestibular-evoked myogenic potential (VEMP) examinations to diagnose MD and the quantitative relationship between VEMP and MRI in assessing the location and degree of endolymphatic hydrops (EH) in definite Meniere's disease (MD) patients. METHODS: Fifty-six patients with unilateral definite MD participated in this study, which used MRIs through intravenous gadolinium administration (IV-Gd), audiometry, caloric tests and VEMP tests. The VEMP results of 26 healthy volunteers were used as a normal reference value. RESULTS: The participants were found through MRI to have differing degrees of vestibular and cochlear EH. Quantitative comparison of MRI and VEMP results found that the response rates of oVEMP decreased with cochlear EH increasing; the asymmetry ratio (AR) of oVEMP can be used to find whether cochlear EH or not, and the P1-N1 amplitude was lower in the extreme cochlear EH group (P < 0.01). The AR of cVEMP was larger in severe vestibular EH group than that of the mild or no vestibular EH group (P < 0.01). The correlation between the degree of cochlear EH and the mean PTA threshold was statistically significant (P < 0.05). The duration of MD correlated positively with vestibular EH (P < 0.05). The abnormal rate of caloric tests was higher in severe vestibular EH group than that of the mild or no vestibular EH group (P < 0.05). CONCLUSIONS: The advantages of MRIs by IV-Gd administration were obvious in assessing the location and degree of EH. oVEMP and PTA can be indirectly used to evaluate the extent of cochlear EH, cVEMP and caloric tests can be used to assess the extent of vestibular EH on the condition of absent MRIs.


Assuntos
Imagem por Ressonância Magnética , Doença de Meniere/diagnóstico , Potenciais Evocados Miogênicos Vestibulares , Administração Intravenosa , Adulto , Testes Calóricos , Cóclea/diagnóstico por imagem , Hidropisia Endolinfática/diagnóstico , Feminino , Gadolínio , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Doença de Meniere/diagnóstico por imagem , Doença de Meniere/fisiopatologia , Pessoa de Meia-Idade , Potenciais Evocados Miogênicos Vestibulares/fisiologia , Vestíbulo do Labirinto
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