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1.
Acta otorrinolaringol. esp ; 71(5): 289-295, sept.-oct. 2020. graf, ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-195215

RESUMO

ANTECEDENTES Y OBJETIVO: El mareo visual surge cuando la compensación de la lesión vestibular se ve interferida por una alta dependencia visual, lo que lleva a una intolerancia en situaciones de conflicto visual. El Visual Vertigo Analogue Scale (VVAS) es un cuestionario autoadministrado, válido y confiable que evalúa específicamente el mareo visual. El uso de cuestionarios en culturas y lenguas diferentes requiere que los ítems sean traducidos y adaptados culturalmente. No existe una versión del VVAS en Argentina. Los objetivos del trabajo fueron traducir y adaptar transculturalmente el VVAS al castellano para su uso en la población argentina, en pacientes con trastornos vestibulares. MATERIALES Y MÉTODOS: Se llevó a cabo desde noviembre de 2015 y enero de 2016 en el Servicio de Kinesiología de un Hospital público de la Ciudad de Buenos Aires con pacientes argentinos mayores de 18 años que presentaban algún trastorno vestibular. El proceso de traducción y adaptación transcultural se basó en la guía del proceso de adaptación transcultural de mediciones autoadministradas de Beaton et al. RESULTADOS: Se incluyeron 39 pacientes para la adaptación transcultural del VVAS. Todas las decisiones de los cambios realizados por el comité de expertos fueron para asegurar la equivalencia semántica, idiomática, experimental y conceptual entre las versiones. CONCLUSIÓN: Se ha traducido y adaptado con éxito la versión original del VVAS al castellano para ser utilizado en la población argentina con trastornos vestibulares


BACKGROUND AND OBJECTIVE: Visual dizziness occurs when high visual dependence interferes with compensation for a vestibular lesion and leads to intolerance in situations of visual conflict. The Visual Vertigo Analogue Scale (VVAS) is a self-administered, valid and reliable questionnaire that serves to assess visual dizziness. The use of questionnaires in different cultures and languages requires that they be translated and adapted to the local culture. There is no version of the VVAS in Argentina. The objectives of this study were to translate and carry out a cross-cultural adaptation of the VVAS into Spanish for use with vestibular patients in Argentina. MATERIALS AND METHODS: This study was carried out from November 2015 to January 2016 in the Kinesiology Service of a public hospital in the city of Buenos Aires. Patients were Argentines older than 18 years who suffered from a vestibular disorder. The translation and cross-cultural adaptation were based on the guide to the process of cross-cultural adaptation of self-administered measurements by Beaton et al. RESULTS: 39 patients were included in the VVAS cross-cultural adaptation process. All changes made by the committee of experts were for the purpose of ensuring the semantic, idiomatic, experimental and conceptual equivalence of the two versions. CONCLUSION: The original version of the VVAS has been translated into Spanish and adapted for use in the Argentine population with vestibular disorders


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Traduções , Escala Visual Analógica , Autorrelato/normas , Vertigem/diagnóstico , Estatísticas não Paramétricas , Comparação Transcultural , Fatores de Tempo , Reprodutibilidade dos Testes , Tontura/diagnóstico , Argentina
2.
Artigo em Chinês | MEDLINE | ID: mdl-33040507

RESUMO

Objective:To analyze the clinical characteristics of patients with Meniere's disease and vestibular migraine, improve the understanding of such diseases for accurate treatment. Method:Eighteen patients with MD and VM were reviewed and the clinical characteristics of the patients were evaluated. Result:There were 4 males and 14 females whose average age was 55.2 years old. The average onset age was 36.5 years meanwhile the headache occured 7.5 years earlier than the vertigo. The average time of vertigo attacks was 30 min-24 h; The mainly kind of headache was unilateral pulsatile headache with or without vertigo attacks; All patients showed the characteristics of photophobia or phonophobia, 7 of them showed visual aura and 9 of them experienced vertigo attacks with headache but without auditory symptoms; 11 patients experienced motion sickness and 10 patients had a related family history. Electrocochleogram abnormal was 11 ears; c-VEMP abnormal was 11 cases; Caloric test abnormal was 13 cases; Velocity step test abnormal was 4 cases. Conclusion:MD and VM shows recurrent vertigo, There are evidences of hearing loss and abnormal changes of electrocochleogram、c-VEMP and lateral semicircular canal function in MD; VM experienced migraine attacks with the characteristics of photophobia、phonophobia and visual aura; The patients can be diagnosed with overlap syndrome when they fulfill the diagnostic criteria of MD and VM at the same time and the two diseases should be treated at the same time.


Assuntos
Doença de Meniere , Transtornos de Enxaqueca , Tontura , Feminino , Cefaleia , Humanos , Masculino , Doença de Meniere/complicações , Doença de Meniere/diagnóstico , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Vertigem/diagnóstico
3.
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
4.
Artigo em Chinês | MEDLINE | ID: mdl-32791773

RESUMO

Objective: To explore the possible pathogenesis of central paroxysmal positional vertigo (CPPV) by analyzing its clinical manifestations and characteristics. Methods: The clinical data of 3 patients with CPPV, including 1 male and 2 females, aged 36, 14 and 70 years old respectively, were collected from the Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from June 2014 to June 2018. The clinical symptoms, nystagmus, other central ocular motor abnormalities, MRI, PET-CT, and laboratory findings were analyzed retrospectively. Results: All patients showed transient vertigo and nystagmus induced by head changes relative to gravity, but the characteristics of nystagmus did not conform to the typical characteristics of nystagmus in benign paroxysmal positional vertigo. None of patients response to repositioning maneuvers, and all patients presented with the signs of abnormal visual oculomotor system or other symptoms of central system. MRI, PET-CT and blood biochemical tests confirmed that the causes of CPPV in the patients were chronic hemorrhage, inflammation and paraneoplastic cerebellar degeneration. Although the etiology of the three cases is different, the lesion site is involved in the central velocity storage mechanism. Conclusion: The damage of central velocity storage mechanism may lead to the damage of feedback rotation signal correction pathway, and CPPV appears when the head position changes relative to gravity.


Assuntos
Nistagmo Patológico/diagnóstico , Nistagmo Patológico/etiologia , Vertigem/diagnóstico , Vertigem/etiologia , Adolescente , Adulto , Idoso , Encefalopatias/sangue , Encefalopatias/complicações , Encefalopatias/diagnóstico , Encefalopatias/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Nistagmo Patológico/sangue , Nistagmo Patológico/diagnóstico por imagem , Posicionamento do Paciente/efeitos adversos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Estudos Retrospectivos , Vertigem/sangue , Vertigem/diagnóstico por imagem
5.
J Stroke Cerebrovasc Dis ; 29(9): 105043, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807455

RESUMO

BACKGROUND AND PURPOSE: Acute vertigo (sense of motion) can be the sole manifestation of a posterior circulation stroke, and often gets missed in the emergency department (ED). The studies for evaluation of central vertigo have focused on physical exam findings, which require expertise and may not be suitable for rapid triage by a nurse in ED or by paramedics. METHODS: This cross sectional study included retrospective chart review of patients 18 years of age and older who presented to the Adult ED with acute dizziness or vertigo during the calendar year 2017. All the patients with a diagnosis of central or peripheral vertigo were included in the final analysis. Sensitivity, specificity, Likelihood Ratio of positive result (LR (+)) and Likelihood Ratio of negative result (LR (-)) for central and peripheral vertigo were calculated for risk factors, symptoms and physical examination features. Chi-squared test and univariate logistic regression were used to evaluate statistical correlation and to calculate the prevalence odds ratio (POR). RESULTS: Two hundred and forty nine out of 505 (49.3%) patients presenting with dizziness had vertigo. Of these, 14 had central vertigo and 163 had peripheral vertigo. Statistically significant variables were: constant symptoms of vertigo (p 0.000- POR 8.7, 95% confidence interval (CI) 2.3-33.1), no change in symptoms with head movement (p 0.000- POR 10.2, 95% CI 3.0-35.4), dysmetria (p 0.000- POR 56.8, 95% CI 5.8-557.1), and unsteady gait (p 0.000- POR 13.3, 95% CI 3.3-54.3). The sensitivity and specificity to detect central vertigo were 100% and 66.4% respectively if the patient had either unsteady gait, constant symptoms, or no change in symptoms with head movement, [VAIN triad (Vertigo- Ataxia, Incessant, or Non-positional)]. CONCLUSIONS: We suggest that triage with VAIN triad can be used to design prospective studies to develop a triage algorithm for the detection of central vertigo in the ED.


Assuntos
Técnicas de Apoio para a Decisão , Serviço Hospitalar de Emergência , Acidente Vascular Cerebral/diagnóstico , Vertigem/diagnóstico , Adulto , Idoso , Tomada de Decisão Clínica , Estudos Transversais , Diagnóstico Precoce , Feminino , Marcha , Movimentos da Cabeça , Humanos , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Triagem , Vertigem/etiologia , Vertigem/fisiopatologia , Vertigem/terapia
6.
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
7.
Z Gerontol Geriatr ; 53(6): 577-589, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32666157

RESUMO

The clinical symptom dizziness encompasses a broad range of complaints. The prevalence among older adults is high. Over the course of 1 year 50% of people over 80 years old, 30% of those between 70-80 years old and 20% between 60-70 years old contact a physician as a result of dizziness. The diagnostic process has to be well organized. The medical history and clinical examination are frequently underestimated but in many cases are crucial. Extensive investigations should only be carried out in cases of a firmly suspected diagnosis. A good interdisciplinary cooperation can positively influence the diagnostic process. The awareness of red flags also helps to detect emergency patients with dizziness. This article discusses the differential diagnosis of dizziness in older adults and provides appropriate recommendations for the diagnostic process.


Assuntos
Tontura , Vertigem , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Tontura/diagnóstico , Serviço Hospitalar de Emergência , Humanos , Exame Físico , Vertigem/diagnóstico
8.
Expert Opin Pharmacother ; 21(14): 1753-1763, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32539493

RESUMO

INTRODUCTION: The term Meniere disease (MD) gathers a set of rare diseases involving the inner ear characterized by episodic vertigo associated with fluctuating auditory symptoms. Five clinical subgroups of patients have been defined, including familial MD, autoimmune MD, and MD with migraine. The diagnosis is based on clinical criteria as no biomarker is available, but genetic factors have a significant contribution in familial and non-familial MD. AREAS COVERED: In this review, the authors summarize the pharmacological treatment for vertigo in MD, providing evidence from preclinical and clinical studies. However, evidence supporting the efficacy for betahistine, diuretics, and intratympanic administration of corticosteroids or gentamicin is limited. EXPERT OPINION: Randomized clinical trials should consider stratification by MD clinical subgroups. The treatment plan should be personalized according to the clinical subgroup, hearing stage, duration of the disease, vertigo attack profile, and comorbidities. The treatment should include therapeutic counseling, sodium-free diet, high-water intake, and a diary of vertigo attacks with symptoms during the episodes to improve phenotyping. Migraine or autoimmune comorbidities will also require pharmacotherapy. Genetic testing by exome/genome sequencing should be discussed with the patient for familial MD and individuals with an early onset for genetic counseling and future gene therapies.


Assuntos
Doença de Meniere/tratamento farmacológico , Transtornos de Enxaqueca/tratamento farmacológico , Vertigem/tratamento farmacológico , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , beta-Histina/administração & dosagem , beta-Histina/uso terapêutico , Ensaios Clínicos como Assunto , Diuréticos/administração & dosagem , Diuréticos/uso terapêutico , Feminino , Gentamicinas/administração & dosagem , Gentamicinas/uso terapêutico , Humanos , Doença de Meniere/complicações , Doença de Meniere/diagnóstico , Transtornos de Enxaqueca/complicações , Resultado do Tratamento , Vertigem/complicações , Vertigem/diagnóstico
9.
Orv Hetil ; 161(25): 1050-1058, 2020 06.
Artigo em Húngaro | MEDLINE | ID: mdl-32516123

RESUMO

INTRODUCTION: About 25-30% of patients present themselves in general practice and specialized healthcare with medically unexplained somatic symptoms. The prevalence of these symptoms is the highest among the elderly, children and adolescents. Approximately 20% of patients in primary care and 47% of them in specialized clinics are children between the age of 7-12 who seem to have somatic symptom disorder (SSD). Somatization disorder most frequently occur with symptoms of headache, stomach ache or various kinds of pain in the limbs that show high comorbidity with other mental disorders, predominantly with anxiety. SSDs are always multicausal issues where biological, social-environmental and psychological factors are interconnected in a complex manner. According to our experience, somaziting patients are often drifting in the healthcare system for years, and instead of getting adequate treatment, they only receive medication, thus their symptoms may easily become chronic. Aim, method: Our aim was to review the current literature and guidelines concerning evidence-based treatments for SSD in childhood. Furthermore, to underline the importance of psychotherapy in SSD, we present the cognitive behavior therapy of a 16-year-old adolescent with vertigo, gastrointestinal symptoms and insomnia over a 8-month period. DISCUSSION: The results of effectiveness studies unequivocally recommend cognitive behavioral therapy in the treatment of SSD patients, accompained by family therapy or family consultation. The therapy should focus on reducing psychosocial stressors, health anxiety and catastrophizing thinking style in the family, while developing adequate coping and communication skills as well as maintaining the patient's age-appropriate activity level. CONCLUSION: Cognitive behavior therapy is the treatment of choice in SSD for children and young people. Applying the biopsychosocial approach is a key issue in the assessment of predisposing and maintaining factors, ensuring that only methods based on scientific evidence will be applied to help these children. Orv Hetil. 2020; 161(25): 1050-1058.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Sintomas Inexplicáveis , Transtornos Somatoformes/psicologia , Transtornos Somatoformes/terapia , Adolescente , Idoso , Transtornos de Ansiedade/terapia , Medicina Baseada em Evidências , Humanos , Psicoterapia , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/terapia , Transtornos Somatoformes/diagnóstico , Resultado do Tratamento , Vertigem/diagnóstico , Vertigem/terapia
10.
J Headache Pain ; 21(1): 56, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448118

RESUMO

BACKGROUND: Vestibular symptoms and balance changes are common in patients with migraine, especially in the ones with aura and chronic migraine. However, it is not known if the balance changes are determined by the presence of vestibular symptoms or migraine subdiagnosis. Therefore, the aim of this study was to verify if the migraine subdiagnosis and/or the presence of vestibular symptoms can predict balance dysfunction in migraineurs. METHODS: The study included 49 women diagnosed with migraine with aura, 53 without aura, 51 with chronic migraine, and 54 headache-free women. All participants answered a structured questionnaire regarding migraine features and presence of vestibular symptoms, such as dizziness/vertigo. The participants performed the Modified Sensory Organization Test on an AMTI© force plate. The data were analysed using a linear mixed-effect regression model. RESULTS: The presence of vestibular symptoms did not predict postural sway, but the subdiagnosis was a significant predictor of postural sway. Migraine with aura patients exhibited more sway than migraine patients without aura when the surface was unstable. Additionally, we found high effect sizes (ES > 0.79) for postural sway differences between patients with chronic migraine or with aura compared to controls or migraine without aura, suggesting that these results are clinically relevant. CONCLUSIONS: The subdiagnosis of migraine, instead of the presence of vestibular symptoms, can predict postural control impairments observed in migraineurs. This lends support to the notion that balance instability is related to the presence of aura and migraine chronicity, and that it should be considered even in patients without vestibular symptoms.


Assuntos
Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/fisiopatologia , Equilíbrio Postural/fisiologia , Doenças Vestibulares/diagnóstico , Doenças Vestibulares/fisiopatologia , Adulto , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Transtornos de Enxaqueca/epidemiologia , Valor Preditivo dos Testes , Inquéritos e Questionários , Vertigem/diagnóstico , Vertigem/epidemiologia , Vertigem/fisiopatologia , Doenças Vestibulares/epidemiologia , Adulto Jovem
11.
Am J Otolaryngol ; 41(4): 102503, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32402694

RESUMO

OBJECTIVES: Vertigo in sudden sensorineural hearing loss (SSNHL) is hypothesized as an extension of the disease caused by the anatomical proximity of the cochlea and vestibule. The present study aimed to demonstrate the association of vestibular function test (VFT) results with SSNHL disease severity and prognosis. MATERIALS AND METHODS: This study assessed clinical records of 263 SSNHL patients admitted to our hospital, between January 2010 and October 2017. Steroid treatment comprised high-dose intravenous dexamethasone (16 mg/d) or oral methylprednisolone (64 mg/d) for 4 days and tapered oral methylprednisolone for 8 days after discharge. Caloric tests were performed in all patients, and cervical vestibular-evoked myogenic potential (c-VEMP) and ocular VEMP (o-VEMP) tests were performed in 209 and 144 patients, respectively. RESULTS: Ninety six patients had vertigo, and caloric abnormalities were observed in 119 patients. Initial PTA in patients with vertigo were worse than in those without vertigo (63.0 dB vs 72.7 dB, P = .002). Initial PTA in patients with abnormal o-VEMP was worse than in those with normal o-VEMP (61.4 dB vs 73.0 dB, P = .004). PTA improvement after steroid treatment in patients with vertigo was lower than in those without vertigo (25.0 dB vs 20.9 dB, P = .028). PTA improvement after treatment in patients with abnormal caloric results was lower than in those with normal caloric results (26.0 dB vs 18.4 dB, P = .013). CONCLUSION: The functions of vestibular organs, particularly the utricle and lateral semicircular canal, are associated with disease severity and hearing outcome in SSNHL patients.


Assuntos
Perda Auditiva Neurossensorial/etiologia , Vertigem/etiologia , Vestíbulo do Labirinto/fisiopatologia , Administração Oftálmica , Adolescente , Adulto , Idoso , Testes Calóricos , Dexametasona/administração & dosagem , Potenciais Evocados , Feminino , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/tratamento farmacológico , Perda Auditiva Neurossensorial/fisiopatologia , Humanos , Infusões Intravenosas , Masculino , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Vertigem/diagnóstico , Vertigem/tratamento farmacológico , Vertigem/fisiopatologia , Adulto Jovem
12.
J Laryngol Otol ; 134(4): 302-310, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32241307

RESUMO

BACKGROUND: Recent developments in magnetic resonance imaging have enabled demonstration of endolymphatic hydrops, and the clinical application of these imaging studies in Ménière's disease is being explored. OBJECTIVE: To evaluate our centre's experience to date of hydrops magnetic resonance imaging in patients with episodic vertigo. METHODS: Magnetic resonance imaging was performed using a high-resolution three-dimensional fluid-attenuated inversion recovery sequence on a 3 Tesla scanner at 4 hours following double-dose gadolinium administration. RESULTS: The study included 31 patients, 28 of whom had a clinical diagnosis of Ménière's disease. In unilateral Ménière's disease, magnetic resonance imaging was able to lateralise endolymphatic hydrops to the clinically symptomatic ear in all cases. Mild hydrops was often seen in clinically asymptomatic ears. CONCLUSION: There is a good correlation between the clinical symptoms and lateralisation of hydropic changes on magnetic resonance imaging. Further refinements of imaging techniques and grading system will likely improve the diagnostic accuracy and clinical utilisation of hydrops magnetic resonance imaging.


Assuntos
Hidropisia Endolinfática/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Doença de Meniere/diagnóstico , Adulto , Idoso , Feminino , Gadolínio/administração & dosagem , Humanos , Imageamento Tridimensional/métodos , Masculino , Doença de Meniere/classificação , Doença de Meniere/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Reino Unido/epidemiologia , Vertigem/diagnóstico , Vertigem/epidemiologia
13.
Otolaryngol Head Neck Surg ; 162(2_suppl): S1-S55, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32267799

RESUMO

OBJECTIVE: Ménière's disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid (endolymph) volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Conventional imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many and typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies. PURPOSE: The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.


Assuntos
Doença de Meniere/diagnóstico , Doença de Meniere/terapia , Audiometria , Aconselhamento , Diagnóstico Diferencial , Diuréticos/uso terapêutico , Orelha Interna/cirurgia , Gentamicinas/uso terapêutico , Glucocorticoides/uso terapêutico , Humanos , Doença de Meniere/epidemiologia , Transtornos de Enxaqueca/diagnóstico , Educação de Pacientes como Assunto , Qualidade de Vida , Vertigem/diagnóstico , Doenças Vestibulares/diagnóstico
14.
J Laryngol Otol ; 134(4): 293-301, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32301406

RESUMO

BACKGROUND: Ménière's disease is a debilitating chronic peripheral vestibular disorder associated with psychiatric co-morbidities, notably depression. METHODS: Database searches were performed to identify studies that assessed depression in Ménière's disease. Metrics used to diagnose depression were extracted, along with the prevalence of depression in each study. RESULTS: Fifteen studies from 8 different countries reported on 6587 patients. The weighted average age was 55.3 years (range, 21-88 years). Depression was measured by eight different scales, with Zung's Self-Rating Depression Scale used most often. A weighted proportion of 45.9 per cent of patients (confidence interval = 28.9-63.3) were depressed. Weighted averages (± standard deviations) of Beck's Depression Inventory and the Illness Behavior Questionnaire - Dysphoria were 8.5 ± 7.9 and 2.4 ± 1.7, respectively. CONCLUSION: The prevalence of depression in patients with Ménière's disease is nearly 50 per cent. Treating otolaryngologists should have a low threshold to screen and refer appropriately. Identifying and treating depression should allow for improvement of overall quality of life in patients with Ménière's disease.


Assuntos
Depressão/epidemiologia , Depressão/psicologia , Doença de Meniere/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Depressão/diagnóstico , Depressão/etiologia , Feminino , Perda Auditiva/diagnóstico , Perda Auditiva/etiologia , Humanos , Masculino , Doença de Meniere/complicações , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida , Índice de Gravidade de Doença , Zumbido/diagnóstico , Zumbido/etiologia , Vertigem/diagnóstico , Vertigem/etiologia
16.
Rev Med Liege ; 75(3): 171-175, 2020 Mar.
Artigo em Francês | MEDLINE | ID: mdl-32157842

RESUMO

After a reminder of the semiology and pathophysiology of balance disorders (vertigo and dizziness), the author considers the disabilities and incapacities that result from these disturbances.


Assuntos
Tontura , Vertigem , Tontura/diagnóstico , Tontura/etiologia , Humanos , Vertigem/diagnóstico , Vertigem/etiologia
17.
Acta otorrinolaringol. esp ; 71(1): 3-8, ene.-feb. 2020. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-192429

RESUMO

BACKGROUND AND OBJECTIVE: Migrainous dizziness is one of the most frequent complaints. Dizziness associated with migraine may be the result of abnormal eye movements. Brain imaging and changes in eye movements may explain the dizziness and highlight possible pathophysiological substrates in migraine dizziness. Our aim is to evaluate eye movement using videonystagmography (VNG) and video head impulse test (vHIT) and to study the occipital lobe metabolic profile in vestibular migraine patients (VM). MATERIALS AND METHODS: There were 2 groups enrolled in the study; the first group consisted of 25 vestibular migraine patients (VM) according to the recent criteria of Barany society. The second group consisted of 20 age matched healthy subjects. Both groups underwent the following: (1) A detailed history, VNG test protocol, vHIT in three planes. (2) Magnetic resonance imaging (MRI) for the brain and inner ear using 1.5 T magnet and proton magnetic resonance spectroscopy (H1-MRS). RESULTS: Sixty eight percent of the patients complained of spontaneous vertigo and 28% complained of positional vertigo. Non-paroxysmal positional nystagmus was recorded in 92% during their dizzy spell. The brain MRI was unremarkable in 72% of the cases. Chemical shift in the occipital lobe was found in 92% of VM. Lactate peaks were statistically significant related with the presence of non-paroxysmal positional nystagmus. CONCLUSIONS: A statistically significant relationship exists between non-paroxysmal positional nystagmus and presence of lactate peaks in the occipital lobe in VM patients


ANTECEDENTES Y OBJETIVO: El mareo migrañoso es una de las quejas más frecuentes. Las pruebas de imagen del cerebro y los cambios en los movimientos oculares pueden explicar los mareos y destacar los posibles sustratos fisiopatológicos en la migraña vestibular. Nuestro objetivo fue evaluar el movimiento ocular utilizando videonistagmografía (VNG) y la prueba de impulso cefálico por vídeo (vHIT), y estudiar el perfil metabólico del lóbulo occipital en pacientes con migraña vestibular (VM). MATERIALES Y MÉTODOS: Se incluyeron dos grupos en el estudio; el primer grupo consistió en 25 pacientes con VM según los criterios recientes de la sociedad Bárány. El segundo grupo consistió en 20 sujetos sanos emparejados por edad. Ambos grupos se sometieron a lo siguiente: 1) Una historia detallada, protocolo de prueba de VNG y vHIT en 3 planos, y 2) Imágenes de resonancia magnética (IRM) para el cerebro y el oído interno con el imán de 1,5 tesla y la espectroscopía de resonancia magnética de protones (H1-MRS). RESULTADOS: El 68% de los pacientes se quejó de vértigo espontáneo, y el 28% de vértigo posicional. El nistagmo posicional no paroxístico se registró en el 60% de los pacientes durante su mareo. La resonancia magnética cerebral no mostró alteraciones en el 72% de los casos. El cambio químico en el lóbulo occipital se encontró en el 92% de los casos de VM. Los picos de lactato fueron estadísticamente significativos con relación a la presencia de nistagmo posicional no paroxístico. CONCLUSIONES: Existe una relación estadísticamente significativa entre el nistagmo posicional no paroxístico y la presencia de picos de lactato en el lóbulo occipital en pacientes con VM


Assuntos
Humanos , Movimentos Oculares/fisiologia , Transtornos de Enxaqueca/diagnóstico por imagem , Doenças Vestibulares/diagnóstico , Testes Calóricos/métodos , Nistagmo Fisiológico/fisiologia , Transtornos de Enxaqueca/fisiopatologia , Testes de Função Vestibular/métodos , Eletronistagmografia , Imagem por Ressonância Magnética , Cérebro/diagnóstico por imagem , Orelha Interna/diagnóstico por imagem , Espectroscopia de Ressonância Magnética , Vertigem/diagnóstico
18.
Wien Klin Wochenschr ; 132(17-18): 521-525, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31997063

RESUMO

BACKGROUND: Menière's disease (MD) is a symptom complex which is characterized by episodes of vertigo, tinnitus and fluctuating sensorineural hearing loss, which worsens during the course of the disease. OBJECTIVE: Vertigo attacks (MD functional level scale) before compared to after cochlear implantation in patients with end-stage MD. DESIGN AND PATIENTS: In this questionnaire-based cross-sectional study eight patients with end-stage MD, who received a cochlear implant (CI) were analyzed. MAIN OUTCOME MEASURE: The effect of the CI on vertigo was measured preoperatively and postoperatively with the Menière's disease functional level scale and the Menière's disease outcome questionnaire. The primary outcome parameter influence of vertigo attacks on daily living was analyzed using the non-parametric Wilcoxon signed rank test before and after CI. SETTING: Department of otolaryngology of a medical university. RESULTS: The primary outcome measure influence of vertigo attacks on daily living as measured by the MD functional level scale improved significantly after CI. CONCLUSION: A CI can be an adequate treatment for vertigo attacks in patients with end-stage MD; however, due to the small sample size additional (multicenter) trials are necessary to confirm the findings.


Assuntos
Implante Coclear , Doença de Meniere , Vertigem , Idoso , Estudos Transversais , Humanos , Doença de Meniere/diagnóstico , Doença de Meniere/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Vertigem/diagnóstico
19.
Otolaryngol Head Neck Surg ; 162(2): 241-247, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31689154

RESUMO

OBJECTIVES: Understand the prevalence of vestibular symptoms in US children. STUDY DESIGN: Cross-sectional analysis. SETTING: 2016 National Health Interview Survey. SUBJECTS AND METHODS: Responses from the 2016 National Health Interview Survey for children ages 3 to 17 years were examined to determine the prevalence of vestibular symptoms and provider-assigned diagnoses. RESULTS: Dizziness or imbalance was reported in 3.5 (95% confidence interval, 3.1-3.9) million patients (5.6%) with a mean age of 11.5 years. Dizziness was reported in 1.2 million patients (2.0%) with a mean age of 12.7 years and balance impairment in 2.3 million patients (3.7%) with a mean age of 10.6 years. Prevalence of dizziness and imbalance did not vary by sex (P = .6, P = .2). Evaluation by a health professional was reported for 42% of patients with dizziness and 43% of patients with imbalance, with diagnoses reported in 45% and 48% of patients with dizziness and imbalance, respectively. The most common diagnoses reported for dizziness were depression or child psychiatric disorder (12%), side effects from medications (11%), head/neck injury or concussion (8.4%), and developmental motor coordination disorder (8.3%). The most common diagnoses reported for imbalance were blurred vision with head motion, "bouncing" or rapid eye movements (9.1%), depression or child psychiatric disorder (6.2%), head/neck injury or concussion (6.1%), and side effects from medications (5.9%). CONCLUSION: The national prevalence of childhood vestibular symptoms is more common than previously thought. Reported diagnoses varied greatly from the literature, suggesting a need for increased awareness of causes of vestibular symptoms in children.


Assuntos
Tontura/epidemiologia , Equilíbrio Postural/fisiologia , Vertigem/complicações , Vestíbulo do Labirinto/fisiopatologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Tontura/etiologia , Tontura/fisiopatologia , Feminino , Humanos , Masculino , Prevalência , Estados Unidos/epidemiologia , Vertigem/diagnóstico , Vertigem/fisiopatologia
20.
Am J Otolaryngol ; 41(2): 102287, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31761408

RESUMO

PURPOSE: This study was performed to evaluate the effectiveness and impact on quality of life in patients undergoing plugging of superior semicircular canal dehiscence using the transmastoid approach. MATERIALS AND METHODS: Retrospective chart review with prospective outcomes assessment, using validated quantitative scoring systems, was performed on 10 patients (23-76 years) who underwent transmastoid plugging of superior semicircular canal dehiscence between February 2014 and February 2018 at a tertiary referral center. Pre-operative and post-operative autophony and vertigo were measured by The Autophony Index and the Dizziness Handicap Index. Overall quality of life following intervention was measured by the Glasgow Benefit Inventory. Subjective improvement, audiological changes, and subjective quality of life changes were also recorded. RESULTS: A significant reduction in the total Dizziness Handicap Index was seen following transmastoid repair of superior semicircular canal dehiscence (p = 0.0078). This was also evident when subgroup analysis of the Dizziness Handicap Index was performed, as physical (p = 0.0273), emotional (p = 0.0078), and functional subgroups were all significantly reduced (p = 0.0117). Autophony was also significantly reduced following intervention (p = 0.0312). Overall quality of life was seen to be improved following surgery as measured by the Glasgow Benefit Inventory (p = 0.0345). CONCLUSION: Our data suggest that transmastoid plugging of a dehiscence in the superior semicircular canal is a safe and effective means of improving autophony, dizziness and overall quality of life in these patients. We believe that these results should be taken into consideration in discussions regarding surgical approach for patients who are contemplating this procedure.


Assuntos
Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Qualidade de Vida , Canais Semicirculares/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Processo Mastoide , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Vertigem/diagnóstico , Vertigem/prevenção & controle , Adulto Jovem
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