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1.
Otol Neurotol ; 42(5): e573-e578, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33967250

RESUMO

OBJECTIVE: Highlight the importance of establishing a differential diagnosis to identify and treat multiple origins of dizziness in a patient following traumatic brain injury (TBI). PATIENT: 73-year-old man with TBI and temporal bone fracture developed posttraumatic bilateral multiple canal benign paroxysmal positional vertigo (BPPV). INTERVENTION: Multi-disciplinary diagnostic evaluation and vestibular rehabilitation (VR) treatment focused on canalith repositioning maneuvers (CRMs) and central adaptation. MAIN OUTCOME MEASURES: Diagnostic imaging, audiometric testing, clinical evaluation including video recordings of patterns of nystagmus, Dizziness Handicap Inventory (DHI). RESULTS: Systematic clinical examination identified multiple semicircular canal BPPV in addition to a suspected underlying unilateral hypofunction. Treatment focused on the appropriate CRMs and adaptation exercises. DHI scores improved significantly and patient returned to work and recreational activities. CONCLUSION: This Clinical Capsule Report highlights the importance of a comprehensive clinical evaluation of the TBI patient with dizziness when making an accurate diagnosis and treatment plan. Due to the complexity of differentiating between multiple canal BPPV in addition to other central and vestibular disorders, it is imperative for the clinician to have a clear understanding of nystagmus patterns for multicanal BPPV as well as other vestibular pathology.


Assuntos
Nistagmo Patológico , Vestíbulo do Labirinto , Idoso , Vertigem Posicional Paroxística Benigna , Tontura/diagnóstico , Tontura/etiologia , Tontura/terapia , Humanos , Masculino , Canais Semicirculares
2.
Complement Ther Clin Pract ; 43: 101387, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33892386

RESUMO

PURPOSE: The purpose of this study was to assess physical therapist's beliefs, practice patterns, and barriers of incorporation of mindfulness meditation into the management of individuals with chronic dizziness. METHODS: An electronic survey was sent to physical therapists with experience treating individuals with dizziness and vestibular disorders. Descriptive statistics and chi-square analysis were conducted. RESULTS: The majority of respondents agree that anxiety limits functional and participation outcomes with individuals with chronic dizziness and adoption of a mindfulness meditation practice could be helpful to address this. However, a much smaller percentage of respondents reported currently using these techniques a majority of time during their clinical practice. CONCLUSION: Barriers exist that prevent the widespread implementation of meditation and mindfulness in physical therapy practice. Potential limiting factors highlight that further research is needed to explore these barriers and evaluate the outcomes of patients with chronic dizziness when meditation is applied in practice.


Assuntos
Meditação , Atenção Plena , Fisioterapeutas , Tontura/terapia , Humanos , Vertigem
3.
MMW Fortschr Med ; 163(Suppl 4): 11-18, 2021 04.
Artigo em Alemão | MEDLINE | ID: mdl-33844180

RESUMO

BACKGROUND: The treatment of elderly patients with dizziness/vertigo/balance disorders (VDB) can be challenging for their general practitioner. Patient-centered care with a focus on self-management support could be a possible approach. Primary objective of this study was to investigate the correlations between quality of primary care and health-related quality of life (HRQOL) from the patient's perspective. METHOD: Data had been collected in the area of Munich and in the area of Dresden between 2017 and 2019. Questionnaires of n = 157 elderly patients from primary care practices in Munich and Dresden were evaluated. Multiple linear regression was used to analyse quality of care, physical activity, depression, and their correlations with HRQOL. RESULTS: In this cohort of patients aged 65 to 94 no significant correlation between quality of care and HRQOL could be detected. Depression correlated negatively with HRQOL, whereas physical activity showed a positive correlation with HRQOL. CONCLUSIONS: Physical activity can be beneficial for elderly dizzy patients' HRQOL. Additionally, a potential depression should be taken into account when treating patients with dizziness to improve their HRQOL. The results can be well transferred to elderly patients with VDB. Analysing more patients however, could increase the significance of the results.


Assuntos
Tontura , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Tontura/terapia , Humanos , Atenção Primária à Saúde , Inquéritos e Questionários , Vertigem
4.
Medicine (Baltimore) ; 100(8): e24939, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663133

RESUMO

BACKGROUND: Manual therapy is a common technique for the treatment of (CCS) cervicogenic cephalic syndrome, but the efficiency is various. The aim of the study is to evaluate the evidence pertaining to the efficiency and safety of using manual therapy to treat patients with CCS. METHODS: We searched the electronic databases including PubMed, ScienceDirect, and the Cochrane Library. Only randomized controlled trials (RCTs) were enrolled in this systematic review and cumulative meta-analysis. RESULTS: A total of 8 RCTs with 395 patients were included for meta-analysis. Patients who underwent manual therapy showed lower scores of visual analog scale (VAS) (weighted mean difference) WMD = 1.7, 95% confidence interval CI = 0.74-2.65, P = .0005); dizziness handicap inventory (DHI) (WMD = 0.66, 95%CI = 0.31-1, P = .0002); and neck disability index (NDI) (WMD = 0.59, 95%CI = 0.23-0.96, P = .002) and better rotation range of motion (ROM) of the cervical spine (WMD = -6.54, 95%CI = -7.60 to -5.48, P < .0001). However, these patients did not show much benefit from manual therapy with respect to the frequency of CCS episodes and head repositioning accuracy (HRA). No serious adverse effects were reported in our included studies lasting longer than 24 hours. CONCLUSIONS: Manual therapy offers an effective and safe approach to treat CCS with lower VAS, DHI, and NDI scores and better cervical spinal movement. Further high-quality RCTs are required to provide more conclusive evidence. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO172740.


Assuntos
Dor Crônica/terapia , Tontura/terapia , Manipulação da Coluna/métodos , Cervicalgia/terapia , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Síndrome
5.
J Laryngol Otol ; 135(4): 320-326, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33726881

RESUMO

OBJECTIVE: This study aimed to examine the association between caloric asymmetry and response to treatment in patients with vestibular migraine. METHOD: Dizziness Handicap Inventory scores were compared between patients with less than and more than 25 per cent asymmetry (using Cohen effect size) in a cohort of definite vestibular migraine patients who underwent caloric testing between August 2016 and March 2019. RESULTS: A total of 31 patients (mean age: 48.7 ± 20.0 years; mean follow up: 9.1 ± 8.1 months) were included. Mean caloric asymmetry was 15.1 ± 15.6 per cent, with 6 (19.4 per cent) patients having asymmetry more than 25 per cent. Overall, patients experienced significant improvement in Dizziness Handicap Inventory total (d = 0.623 (95 per cent confidence interval, 0.007, 1.216)), emotional domain (d = 0.635 (95 per cent confidence interval, 0.019, 1.229)) and functional domain (d = 0.769 (95 per cent confidence interval, 0.143, 1.367)) but not physical domain (d = 0.227 (95 per cent confidence interval, -0.370, 0.815)) scores. Patients with more than 25 per cent asymmetry had no significant improvement in Dizziness Handicap Inventory scores, whereas those with less than 25 per cent asymmetry had significant improvement in Dizziness Handicap Inventory functional domain scores only (d = 0.636 (95 per cent confidence interval, 0.004, 1.244)). CONCLUSION: Vestibular migraine patients with peripheral vestibular weakness on caloric testing may be less likely to improve after treatment compared with those without.


Assuntos
Testes Calóricos/estatística & dados numéricos , Avaliação da Deficiência , Tontura/diagnóstico , Transtornos de Enxaqueca/diagnóstico , Doenças Vestibulares/diagnóstico , Tontura/etiologia , Tontura/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/terapia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento , Doenças Vestibulares/complicações , Doenças Vestibulares/terapia
6.
Medicine (Baltimore) ; 99(52): e22945, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350720

RESUMO

OBJECTIVES: To investigate the association between cognitive behavior therapy (CBT) and dizziness. METHODS: The databases including PubMed, Embase, Cochrane Library and Web of science will be searched for randomized controlled trials. Weighted mean difference and 95% confidence interval will be utilized to calculate the effect of CBT on dizziness between the 2 groups. CONCLUSIONS: This meta-analysis will provide a high-quality synthesis from existing evidence for the relationship between CBT and dizziness. OSF REGISTRATION NUMBER: 10.17605/OSF.IO/YNH5W.


Assuntos
Terapia Cognitivo-Comportamental , Tontura/terapia , Metanálise como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Humanos
7.
PLoS One ; 15(9): e0238436, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877426

RESUMO

Postural control is the ability to maintain equilibrium and orientation in a gravitational environment. Patients with chronic subjective dizziness have some troubles with their postural stability. The present study aimed to assess the benefit of home-based vestibular rehabilitation in patients with chronic subjective dizziness using computerized dynamic posturography. Therefore, 100 subjects, between 19 to 86 years, diagnosed with dizziness were included in the study. Computerized dynamic posturography was performed to assess postural stability. Vestibular rehabilitation programs included exercises tailored to the particular needs of each patient. After vestibular rehabilitation, patients were re-examined using the same tests. Posturographic data were analyzed and compared for before and after vestibular rehabilitation findings. The mean composite scores before the intervention (58,92 ±11,64) was significantly (p<0.01) lower than the mean composite scores after vestibular rehabilitation (73,83 ± 8,26). This result is found to be statistically significant. In conclusion it could be suggested that the effectiveness of vestibular rehabilitation could be verified by means of computerized dynamic posturography as a concrete method.


Assuntos
Tontura/terapia , Terapia por Exercício/métodos , Equilíbrio Postural/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Tontura/diagnóstico , Exercício Físico/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Postura/fisiologia , Resultado do Tratamento , Vertigem/diagnóstico , Vertigem/terapia , Doenças Vestibulares/patologia , Testes de Função Vestibular/métodos , Núcleos Vestibulares/metabolismo
9.
Ideggyogy Sz ; 73(7-08): 241-247, 2020 Jul 30.
Artigo em Húngaro | MEDLINE | ID: mdl-32750240

RESUMO

Background - Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose - The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods - 879 patients were examined at the Semmel-weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results - Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion - The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion - Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.


Assuntos
Tontura/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Qualidade de Vida , Vertigem/diagnóstico , Idoso , Tontura/etiologia , Tontura/terapia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neuro-Otologia , Vertigem/etiologia , Vertigem/terapia
10.
Zhongguo Zhen Jiu ; 40(7): 726-30, 2020 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-32648396

RESUMO

OBJECTIVE: To compare the therapeutic effect of electro-nape-acupuncture (ENA) combined with hyperbaric oxygen therapy (HBOT) and single HBOT on refractory flat descending idiopathic sudden sensorineural hearing loss (ISSNHL). METHODS: A total of 78 patients were randomized into an ENA combined with HBOT (ENA+HBOT) group and a HBOT group, 39 cases in each one. Patients in both groups were treated with oral extract of ginkgo biloba leaves and mecobalamin tablets. On the basis of the conventional medication treatment, HBOT was adopt in the HBOT group. On the basis of the treatment in the HBOT group, electro-nape-acupuncture was applied at Fengchi (GB 20), Gongxue (Extra), Zhongzhu (TE 3), Waiguan (TE 5) and Yifeng (TE 17), Tinggong (SI 19), Tinghui (GB 2) and the vertigo-auditory area of affected side in the ENA+HBOT group. Pulse acupuncture instrument was connected at Fengchi (GB 20) and Gongxue (Extra) for 30 min (with continuous wave, 2 Hz in frequency), the needles were retained for another 30 min after electroaupuncture. The treatment was given once a day, 6 times a week for 4 weeks in both groups. Before the treatment and 2,4 weeks into the treatment, the average auditory threshold, the scores of tinnitus handicap inventory (THI) and dizziness handicap inventory (DHI) were observed, and the therapeutic effect was evaluated in both groups. RESULTS: Compared before treatment, the average auditory threshold, the scores of THI and DHI of 2,4 weeks into the treatment were decreased in both groups (P<0.000 1). Compared with the HBOT group, the average auditory threshold, the scores of THI and DHI of 4 weeks into the treatment were lower in the ENA+HBOT group (P<0.000 1). The total effective rate was 69.2% (27/39) in the ENA+HBOT group and 51.3% (20/39) in the HBOT group, there was no statistical difference (P>0.05). CONCLUSION: Electro-nape- acupuncture can improve the mean auditory threshold and the symptoms of tinnitus and dizziness in patients with refractory flat descending idiopathic sudden sensorineural hearing loss.


Assuntos
Terapia por Acupuntura , Perda Auditiva Neurossensorial/terapia , Perda Auditiva Súbita/terapia , Oxigenação Hiperbárica , Tontura/terapia , Humanos , Extratos Vegetais/uso terapêutico , Zumbido/terapia , Resultado do Tratamento , Vitamina B 12/análogos & derivados , Vitamina B 12/uso terapêutico
11.
Otolaryngol Head Neck Surg ; 163(5): 857-859, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32600170

RESUMO

As a result of the COVID-19 pandemic, telemedicine has been thrust to the forefront of health care. Despite its inherent limitations, telemedicine offers many advantages to both patient and physician as an alternative to in-person evaluation of select patients. In the near term, telemedicine allows nonpandemic care to proceed while observing appropriate public health concerns to minimize the spread of pandemic pathogens. Thus, it behooves practitioners to use telemedicine consultations for common otolaryngology complaints. Assessment of the dizzy patient is well-suited to an algorithmic approach that can be adapted to a telemedicine setting. As best practices for telemedicine have yet to be defined, we present herein a practical approach to the history and limited physical examination of the dizzy patient in the telemedicine setting for the general otolaryngologist. Indeed, once the acute crisis has abated, we suspect that this approach will continue to be an effective way to manage dizzy patients.


Assuntos
Algoritmos , Betacoronavirus , Infecções por Coronavirus/complicações , Tontura/terapia , Otolaringologia/métodos , Pneumonia Viral/complicações , Telemedicina/métodos , Infecções por Coronavirus/epidemiologia , Tontura/etiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia
12.
Health Qual Life Outcomes ; 18(1): 204, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590995

RESUMO

BACKGROUND: An important question influencing therapy for dizziness is whether the strengths of the relationships of emotional and functional aspects of dizziness to 1) anxiety and other mental states, 2) perceived state of health (SoH) and quality of life (QoL) are different in patients with and without normal balance control. We attempted to answer this question by examining these dimensions' regression strengths with Dizziness Handicap Inventory (DHI) scores. METHODS: We divided 40 patients receiving group cognitive behavioural therapy (CBT) and vestibular rehabilitation for dizziness, into 2 groups: dizziness only (DO) and normal balance control; dizziness and a quantified balance deficit (QBD). Group-wise, we first performed stepwise multivariate regression analysis relating total DHI scores with Brief Symptom Inventory (BSI) sub-scores obtained pre- and post-therapy. Then, regression analysis was expanded to include SoH, QoL, and balance scores. Finally, we performed regressions with DHI sub-scores. RESULTS: In both groups, the BSI phobic anxiety state score was selected first in the multivariate regression analysis. In the DO group, obsessiveness/compulsiveness was also selected. The correlation coefficient, R, was 0.74 and 0.55 for the DO and QBD groups, respectively. When QoL and SoH scores were included, R values increased to 0.86 and 0.74, explaining in total 74, and 55% of the DHI variance for DO and QBD groups, respectively. Correlations with balance scores were not significant (R ≤ 0.21). The psychometric scores selected showed the strongest correlations with emotional DHI sub-scores, and perceived QoL and SoH scores with functional DHI sub-scores. CONCLUSIONS: Our findings suggest that reducing phobic anxiety and obsessiveness/compulsiveness during CBT may improve emotional aspects of dizziness and targeting perceived SoH and QoL may improve functional aspects of dizziness for those with and without normal balance control.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Tontura/terapia , Terapia por Exercício/métodos , Qualidade de Vida , Adulto , Idoso , Ansiedade/complicações , Estudos de Casos e Controles , Tontura/complicações , Tontura/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/complicações , Equilíbrio Postural/fisiologia
13.
Rev. otorrinolaringol. cir. cabeza cuello ; 80(2): 201-208, jun. 2020.
Artigo em Espanhol | LILACS | ID: biblio-1115836

RESUMO

El vértigo posicional paroxístico benigno (VPPB) es reconocido como la principal causa de vértigo de origen periférico en adultos, ya que, si bien la etiología del VPPB aún no se ha demostrado plenamente y se clasifica como la mayoría de los casos, se puede identificar el desprendimiento de otolitos y su desplazamiento en uno de los tres canales semicirculares. Una anamnesis cuidadosa puede abordar el diagnóstico clínico del VPPB, pero la confirmación se obtendrá por medio de maniobras de diagnóstico especificas de acuerdo a cuál de los canales está involucrado. Este trastorno altera la capacidad de llevar a cabo actividades de la vida cotidiana que determinan un aumento significativo en el riesgo de caídas y las consiguientes lesiones. La mayoría de los pacientes se recuperan después del tratamiento, sin embargo, hasta dos tercios de éstos pueden percibir inestabilidad prolongada, aturdimiento y malestar definidos como mareo residual. Esta sintomatología residual después de la resolución del VPPB es variable entre los pacientes, siendo el tiempo de duración de los síntomas residuales de aproximadamente de 1 a 3 semanas, existiendo algunos pacientes que pueden recuperarse más tardíamente. En esta revisión analizaremos el mareo residual, describiendo su expresión clínica, diagnóstica, fisiopatológica y tratamientos actuales de esta entidad clínica.


Benign paroxysmal positional vertigo (BPPV) is recognized as the main cause of peripheral vertigo in adults, although the etiology of BPPV has not yet been fully demonstrated and is classified as idiopathicin most cases, detachment of otoliths and their displacement in one of the three semicircular canals can be identifie. A careful history can address the clinical diagnosis of BPPV, but confirmation will be obtained through specific diagnostic maneuvers according to which canal is involved. This disorder alters the ability to carry out activities of daily living that determine a significant increase in the risk of falls and consequent injuries. Most patients recover after treatment, however, up to two thirds of these patients may perceive prolonged instability, dizziness and discomfort defined as residual dizziness. This residual symptomatology following BPPV resolution is variable among patients, the duration of residual symptoms can last 1 to 3 weeks, with some patients may recover later on. In this review, we will analyze residual dizziness, describing its clinical presentation, diagnosis, pathophysiology and current treatments of this clinical entity.


Assuntos
Humanos , Tontura/fisiopatologia , Tontura/terapia , Posicionamento do Paciente , Tontura/etiologia , Vertigem Posicional Paroxística Benigna/fisiopatologia , Vertigem Posicional Paroxística Benigna/terapia
14.
Emerg Med Clin North Am ; 38(2): 523-537, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32336338

RESUMO

A careful history and thorough physical examination are necessary in patients presenting with acute neurologic dysfunction. Patients presenting with headache should be screened for red-flag criteria that suggest a dangerous secondary cause warranting imaging and further diagnostic workup. Dizziness is a vague complaint; focusing on timing, triggers, and examination findings can help reduce diagnostic error. Most patients presenting with back pain do not require emergent imaging, but those with new neurologic deficits or signs/symptoms concerning for acute infection or cord compression warrant MRI. Delay to diagnosis and treatment of acute ischemic stroke is a frequent reason for medical malpractice claims.


Assuntos
Serviço Hospitalar de Emergência , Doenças do Sistema Nervoso/diagnóstico , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Dor nas Costas/terapia , Tontura/diagnóstico , Tontura/etiologia , Tontura/terapia , Cefaleia/diagnóstico , Cefaleia/etiologia , Cefaleia/terapia , Humanos , Imperícia , Doenças do Sistema Nervoso/terapia , Gestão de Riscos , Convulsões/diagnóstico , Convulsões/etiologia , Convulsões/terapia
17.
Ann Emerg Med ; 75(4): 459-470, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31866170

RESUMO

STUDY OBJECTIVE: We evaluated a strategy to increase use of the test (Dix-Hallpike's test [DHT]) and treatment (canalith repositioning maneuver [CRM]) for benign paroxysmal positional vertigo in emergency department (ED) dizziness visits. METHODS: We conducted a stepped-wedge randomized trial in 6 EDs. The population was visits with dizziness as a principal reason for the visit. The intervention included educational sessions and decision aid materials. Outcomes were DHT or CRM documentation (primary), head computed tomography (CT) use, length of stay, admission, and 90-day stroke events. The analysis was multilevel logistic regression with intervention, month, and hospital as fixed effects and provider as a random effect. We assessed fidelity with monitoring intervention use and semistructured interviews. RESULTS: We identified 7,635 dizziness visits during 18 months. The DHT or CRM was documented in 1.5% of control visits (45/3,077; 95% confidence interval 1% to 1.9%) and 3.5% of intervention visits (159/4,558; 95% confidence interval 3% to 4%; difference 2%, 95% confidence interval 1.3% to 2.7%). Head CT use was lower in intervention visits compared with control visits (44.0% [1,352/3,077] versus 36.9% [1,682/4,558]). No differences were observed in admission or 90-day subsequent stroke risk. In fidelity evaluations, providers who used the materials typically reported positive clinical experiences but provider engagement was low at facilities without an emergency medicine residency program. CONCLUSION: These findings provide evidence that an implementation strategy of a benign paroxysmal positional vertigo-focused approach to ED dizziness visits can be successful and safe in promoting evidence-based care. Absolute rates of DHT and CRM use, however, were still low, which relates in part to our broad inclusion criteria for dizziness visits.


Assuntos
Vertigem Posicional Paroxística Benigna/diagnóstico , Vertigem Posicional Paroxística Benigna/terapia , Serviço Hospitalar de Emergência , Prática Clínica Baseada em Evidências , Posicionamento do Paciente , Adulto , Vertigem Posicional Paroxística Benigna/diagnóstico por imagem , Tontura/etiologia , Tontura/terapia , Feminino , Fidelidade a Diretrizes , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente/efeitos adversos , Posicionamento do Paciente/métodos , Modelos de Riscos Proporcionais , Acidente Vascular Cerebral/epidemiologia
18.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(12): 131-137, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33459553

RESUMO

Chronic dizziness is defined as a complex of symptoms lasting months or years, including oscillopsia, nystagmus, and postural instability. Diagnostic search includes peripheral vestibulopathy - chronic unilateral vestibulopathy resulting from vestibular neuronitis, schwannoma of the 8th pair of cranial nerves, medical or surgical ablation of the labyrinth, and bilateral vestibulopathy; central vestibulopathy - syndromes accompanied by central vertical nystagmus, small vessel disease in patients with chronic cerebral ischemia; general somatic diseases, peripheral polyneuropathy, side-effects of medications as well as persistent postural-perceptual dizziness. Often, when collecting an anamnesis, it is not possible to identify specific features of dizziness and instability, therefore, clinical and instrumental examination of the patient is of particular importance. In the otoneurological examination, the greatest attention is paid to static/coordination tests, oculomotor tests aimed at identifying signs of damage to the vestibulo-ocular reflex. The principles of treatment depend on the diagnosed cause of dizziness and instability and can, to varying degrees, combine pharmacotherapy, vestibular rehabilitation and psychotherapy, as well as correction of therapy for the underlying disease that caused vestibulopathy.


Assuntos
Nistagmo Patológico , Doenças Vestibulares , Tontura/diagnóstico , Tontura/etiologia , Tontura/terapia , Humanos , Reflexo Vestíbulo-Ocular , Vertigem , Doenças Vestibulares/complicações , Doenças Vestibulares/diagnóstico , Doenças Vestibulares/terapia , Testes de Função Vestibular
19.
Rev. ORL (Salamanca) ; 11(1): 43-50, 2020.
Artigo em Espanhol | IBECS | ID: ibc-193120

RESUMO

INTRODUCCIÓN Y OBJETIVO: Desde la aplicación de la rehabilitación vestibular como tratamiento del paciente con mareo, las indicaciones han ido ampliándose en función del avance de los procedimientos aplicados, pasando de una terapia puramente física a otra en la que además, se usan instrumentos que aporta el avance tecnológico. En este capítulo, vamos a presentar las distintas indicaciones que hoy en día se han demostrado eficaces y aquellas que aún no han sido validadas a pesar de que muchos autores las defienden. MÉTODO: revisión narrativa. RESULTADOS: Además de la utilidad de la rehabilitación vestibular en el déficit vestibular agudo, también lo es en diferentes patologías crónicas, aunque siguen quedando pendientes algunas cuestiones como conocer el momento idóneo de su aplicación. DISCUSIÓN Y CONCLUSIONES: la rehabilitación vestibular es fundamental en el tratamiento de muchos tipos de patología vestibular. Es importante tener en cuenta todas las indicaciones posibles para poder ofrecer al paciente un tratamiento adecuado que conlleve un mejor resultado terapéutico


INTRODUCTION AND OBJECTIVE: Since the application of vestibular rehabilitation as a treatment for patients with dizziness, the indications have been extended according to the progress of the procedures applied, going from a purely physical therapy to another in which, in addition, instruments that provide technological advancement are used. In this chapter, we will present the different indications that have proved effective today and those that have not yet been validated despite the fact that many authors defend them. METHOD: narrative review. RESULTS: In addition to the usefulness of vestibular rehabilitation in acute vestibular deficit, it is also useful in different chronic pathologies, although some issues remain pending, such as knowing the appropriate moment of its application. Discussion/conclusions: Vestibular rehabilitation is elementary in the treatment of many types of vestibular pathology. It is important to take into account all possible indications in order to offer the patient an appropriate treatment that leads to a better therapeutic result


Assuntos
Humanos , Doenças Vestibulares/reabilitação , Tontura/terapia , Doença de Meniere/reabilitação , Doença Crônica/reabilitação , Vertigem Posicional Paroxística Benigna/reabilitação , Qualidade de Vida
20.
Chiropr Man Therap ; 27: 65, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31867101

RESUMO

Background: Neck pain is a leading cause of individual and societal burden worldwide, affecting an estimated 1 in 5 people aged 70 years and older. The nature and outcomes of chiropractic care for older adults with neck pain, particularly those with co-morbid headaches, remains poorly understood. Therefore, we sought to ascertain: What proportion of Australian chiropractors' caseload comprises older adults with neck pain (with or without headache); How are these conditions treated; What are the reported outcomes? Methods: An online survey examining practitioner and practice characteristics, clinical patient presentations, chiropractic treatment methods and outcomes, and other health service use, was distributed to a random nationally representative sample of 800 Australian chiropractors. Quantitative methods were used to analyze the data. Results: Two hundred eighty-eight chiropractors (response rate = 36%) completed the survey between August and November 2017. Approximately one-third (M 28.5%, SD 14.2) of the chiropractors' patients were older adults (i.e. aged ≥65 years), of which 45.5% (SD 20.6) presented with neck pain and 31.3% (SD 20.3) had co-morbid headache. Chiropractors reported to combine a range of physical and manual therapy treatments, exercises and self-management practices in their care of these patients particularly: manipulation of the thoracic spine (82.0%); activator adjustment of the neck (77.3%); and massage of the neck (76.5%). The average number of visits required to resolve headache symptoms was reported to be highest among those with migraine (M 11.2, SD 8.8). The majority of chiropractors (57.3%) reported a moderate response to treatment in reported dizziness amongst older adults with neck pain. Approximately 82% of older adult patients were estimated to use at least one other health service concurrently to chiropractic care to manage their neck pain. Conclusion: This is the first known study to investigate chiropractic care of older adults living with neck pain. Chiropractors report using well-established conservative techniques to manage neck pain in older adults. Our findings also indicate that this target group of patients may frequently integrate chiropractic care with other health services in order to manage their neck pain. Further research should provide in-depth investigation of older patients' experience and other patient-reported outcomes of chiropractic treatment.


Assuntos
Quiroprática , Tontura/terapia , Cefaleia/terapia , Manipulação da Coluna , Cervicalgia/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Pessoal de Saúde/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Inquéritos e Questionários , Resultado do Tratamento
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