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1.
Auris Nasus Larynx ; 49(4): 571-576, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34802775

RESUMO

OBJECTIVE: To analyze the preoperative patterns of caloric test, eye tracking test (ETT), and optokinetic pattern (OKP) in patients with acoustic neuroma (AN) and compare them with the postoperative patterns of ETT and OKP results METHODS: A total of 166 patients with AN (102 women; mean age: 41 years, range: 11-79 years) who were being treated at our hospital between 2013 and 2016 were enrolled. Preoperatively, a detailed history was taken regarding the presence of subjective symptoms of equilibrium dysfunction, and the patients underwent caloric test, ETT, and OKP. They were classified into three groups based on the preoperative ETT and OKP results as follows: Group A, normal ETT and OKP; Group B, either ETT or OKP was abnormal; and Group C, both ETT and OKP were abnormal. All patients were evaluated for subjective symptoms of vestibular dysfunction and were also grouped based on the tumor size on imaging. All surgeries were performed by a neurosurgeon using the lateral suboccipital retrosigmoid approach. About one month later after surgery, postoperatively ETT was performed on 150 patients and OKP was performed on 148 patients. The preoperative and postoperative ETT and OKP results were compared. The same two specialists analyzed the postoperative ETT and OKP findings as improved, unchanged, or worse. Student t-test was used for statistical analysis and a P-value of <0.05 was considered to indicate a statistically significant difference. RESULTS: The average canal paresis(CP) % was 65.8%. No correlation was found between tumor size and CP%. The other side, the average tumor size in each group was 26.6 mm, 28.7 mm, and 37.8 mm in the Group A, B, and C, respectively. The average tumor size in Group C was significantly greater than those of Group A and B (P<0.01). The presence of gait disturbance in Group C was significantly higher than the other groups (P<0.01). The other side, abnormal ETT and OKP were seen in 32.5% and 31.9% of all patients, respectively. ETT and OKP results improved postoperatively in 67.4% and 68.9% of these patients. CONCLUSIONS: Abnormal ETT and OKP results showed positive correlations with the tumor size and presence of subjective symptoms. Further, dysfunction of cerebellum and brain stem owing to tumor compression was observed to recover in many cases after surgery.


Assuntos
Neuroma Acústico , Adolescente , Adulto , Idoso , Testes Calóricos , Criança , Eletronistagmografia , Feminino , Humanos , Pessoa de Meia-Idade , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/patologia , Neuroma Acústico/cirurgia , Período Pós-Operatório , Adulto Jovem
2.
Am J Otolaryngol ; 43(1): 103171, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34509078

RESUMO

PURPOSE: Cochlear implantation (CI) has been shown to reduce vestibular function postoperatively in the implanted ear. The objective of this study was to identify the prevalence of preoperative vestibular weakness in CI candidates and identify any risk factors for postoperative dizziness. STUDY DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Patients who underwent CI and had preoperative videonystagmography (VNG) at the Silverstein Institute from January 1, 2017 to May 31, 2020 were evaluated. The primary endpoint was dizziness lasting more than one month postoperatively. RESULTS: One hundred and forty nine patients were evaluated. Preoperative VNG revealed that 46 (30.9%) had reduced vestibular response (RVR) on one side and 32 (21.5%) had bilateral vestibular hypofunction (BVH). Postoperative dizziness occurred in 14 (9.4%) patients. Patients with postoperative dizziness were more likely to have abnormal preoperative VNG (RVR or BVH), compared to patients without postoperative dizziness (78.6% versus 49.6%, p = 0.0497). In cases of RVR, implantation of the weaker or stronger vestibular ear did not affect the postoperative dizziness (16.1% versus 6.7%, p = 0.38). Postoperative VNG in patients with dizziness showed decreased caloric responses in the implanted ear (28.4 to 6.4 degrees/s, p = 0.02). CONCLUSION: Preoperative caloric weakness is prevalent in CI candidates and abnormal preoperative vestibular testing may be a predictor of postoperative dizziness. CI has the potential to cause vestibular injury and preoperative testing may aid in both counseling and decision-making.


Assuntos
Implante Coclear/efeitos adversos , Tontura/epidemiologia , Tontura/etiologia , Perda Auditiva Neurossensorial/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Doenças Vestibulares/epidemiologia , Doenças Vestibulares/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Testes Calóricos , Eletronistagmografia/métodos , Feminino , Perda Auditiva Neurossensorial/diagnóstico , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Período Pré-Operatório , Prevalência , Doenças Vestibulares/fisiopatologia , Testes de Função Vestibular , Vestíbulo do Labirinto/fisiopatologia , Gravação em Vídeo
3.
Phys Ther ; 101(10)2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34270771

RESUMO

OBJECTIVE: The purpose of this study was to assess the static balance of children with sensorineural hearing loss (SNHL) according to the degrees of SNHL and the function of the vestibular system. METHODS: This cross-sectional study was conducted in public schools located in Caruaru, Pernambuco state, Brazil, with 130 children (65 with normal hearing and 65 with SNHL as documented by air and bone conduction audiometry) of both sexes between 7 and 11 years old. Static balance was assessed by a stabilometric analysis using a force platform consisting of the circular area of center-of-pressure displacement of the children evaluated in 3 positions: bipedal support with feet together and parallel (PF), tandem feet (TF), and 1 foot (OF), carried out under 2 sensory conditions each, with eyes open and eyes closed. After balance assessments, the children with SNHL received examinations of auditory and vestibular functions-through audiometry and computerized vectoelectronystagmography, respectively-to compose the groups according to degrees of SNHL and vestibular function. RESULTS: The children with severe and profound SNHL demonstrated more static balance instabilities than the children with normal hearing in 5 positions assessed with eyes open (PF, TF, and OF) and eyes closed (PF and TF). The same phenomenon occurred in children with SNHL and associated vestibular dysfunction in all of the positions assessed with eyes open and eyes closed (PF, TF, and OF). CONCLUSION: The larger the degree of SNHL, the greater the balance instability of the children. The children with SNHL and associated vestibular dysfunction showed the highest balance instabilities in this study. IMPACT: Children with larger degrees of SNHL and associated vestibular dysfunction might require prolonged periods to rehabilitate their balance.


Assuntos
Perda Auditiva Neurossensorial/complicações , Transtornos das Habilidades Motoras/complicações , Equilíbrio Postural/fisiologia , Transtornos das Sensações/complicações , Transtornos das Sensações/etiologia , Doenças Vestibulares/complicações , Vestíbulo do Labirinto/patologia , Estudos de Casos e Controles , Criança , Estudos Transversais , Eletronistagmografia , Feminino , Perda Auditiva/complicações , Perda Auditiva Neurossensorial/terapia , Humanos , Masculino , Transtornos das Sensações/diagnóstico , Transtornos das Sensações/fisiopatologia , Doenças Vestibulares/diagnóstico , Testes de Função Vestibular
4.
Am J Otolaryngol ; 42(3): 102909, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33476974

RESUMO

PURPOSE: Whiplash injury is a frequent traumatic lesion occurring mainly in road accidents, which may also cause dizziness severe enough to impact everyday life. Vestibular examination is routinely performed on these patients, although the role of the neuro-otologist is still not clearly defined. The main endpoint of this study was to describe the videonystagmography (VNG) evidence in a large cohort of patients who underwent road traffic whiplash injury. METHODS: 717 consecutive patients who reported whiplash-associated disorders due to a road traffic accident underwent clinical examination and VNG. RESULTS: Patients with saccadic test latency anomalies more frequently complained of vertigo, nausea and cochlear symptoms after trauma (p = 0.031, 0.028 and 0.006), while patients with bilateral vestibular weakness at caloric stimulation more often displayed neck pain after trauma (p = 0.005). Patients complaining of positional or cochlear symptoms or with accuracy anomalies at the saccadic test were significantly older than those with no positional, no cochlear symptoms and without accuracy anomalies (p = 0.022, p = 0.034 and p = 0.001). Patients with bilateral vestibular hypofunction were significantly younger (p < 0.001). CONCLUSIONS: VNG evidence, particularly vestibular function and saccadic tests, may be related to damage in the cervical region due to whiplash trauma. These findings suggest that neuro-otologic examination may play a role in properly identifying those who suffer damage caused by whiplash trauma, and in characterizing the severity and prognosis of whiplash-associated disorders.


Assuntos
Acidentes de Trânsito , Eletronistagmografia/métodos , Movimentos Oculares , Náusea/diagnóstico , Náusea/etiologia , Vertigem/diagnóstico , Vertigem/etiologia , Gravação em Vídeo/métodos , Traumatismos em Chicotada/complicações , Traumatismos em Chicotada/fisiopatologia , Adolescente , Adulto , Idoso , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/fisiopatologia , Vertigem/fisiopatologia , Adulto Jovem
5.
Ann Otol Rhinol Laryngol ; 130(7): 718-723, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33124434

RESUMO

OBJECTIVE: Videonystagmography (VNG) is a commonly ordered test to evaluate patients with vestibular complaints. To date, there are no evidence-based guidelines for evaluating patients presenting with vestibular symptoms. This study evaluates the cost effectiveness of VNG and the impact of VNG findings on patient management. METHODS: Patient charts were reviewed from 3 institutions to collect the pre- and post-VNG ICD-9/10 diagnosis and treatment plan. VNG findings were recorded to calculate the incidence of abnormal findings and the incidence of change in diagnosis and/or treatment plan. The cost effectiveness of VNG was estimated based on these calculations. RESULTS: A total of 120 patient charts were reviewed. 69/120 (57.5%; 95% CI: 48.2%-66.5%) patients had abnormal findings on their VNG. A change in diagnosis was noted in 24/120 (20.0%; 95% CI: 13.3%-28.3%) patients. A change in treatment plan was noted in 62/120 (51.7%; 95% CI: 42.4%-60.9%) patients, and 11/120 (9.2%; 95% CI: 4.7%-15.8%) had a change in diagnosis that led to change in treatment plan. Using the average Medicare reimbursement for VNG, the cost effectiveness analysis showed a cost of $869.57 per VNG with abnormal findings and a cost of $5454.55 per VNG that lead to a change in diagnosis and treatment plan. CONCLUSIONS: VNG findings may not result in changes in clinical diagnosis. However, VNG is impactful at influencing treatment plan changes. VNG results are beneficial for counseling patients, guiding treatment plans, and managing patient expectations. When there is a clear indication, VNG testing can be cost effective in managing patients presenting with vestibular symptoms.


Assuntos
Análise Custo-Benefício , Eletronistagmografia/economia , Doenças Vestibulares/diagnóstico , Doenças Vestibulares/economia , Gravação em Vídeo/economia , Eletronistagmografia/métodos , Humanos , Estudos Retrospectivos
6.
Rev. CEFAC ; 23(3): e11420, 2021. tab
Artigo em Inglês | LILACS | ID: biblio-1155337

RESUMO

ABSTRACT Purpose: this study aimed to verify the occurrence of abnormal vectoelectronystagmography findings in patients with temporomandibular disorders (TMDs). Methods: in this cross-sectional study, patients diagnosed with TMDs underwent an otorhinolaryngological examination, audiological evaluation, and balance and vestibular function examinations, using vectoelectronystagmography. The tests performed were 1) spontaneous nystagmus, 2) saccadic movements, 3) pendular tracking, 4) optokinetic nystagmus gain and velocity, 5) rotational chair testing, and 6) post-caloric vertigo and the direction and velocity of the slow component of nystagmus. Results: thirty patients were selected (22 females and 8 males) with mean age of 30.8(14.9 years. Sensorineural hearing loss was seen in four patients (13.3%); the other patients (86.7%) had results within the normal range at all frequencies. Five patients (16.7%) showed abnormalities on the Romberg test and seven (23.3%) on the Tandem test. Abnormalities on the caloric test were seen in 40.0% of patients. More prevalence of headache (p<0.0001) and tinnitus (p<0.0001) was observed in patients with unilateral hyperreflexia, and dizziness, depression, anxiety, gait imbalance and falls in patients with bilateral hyperreflexia. Conclusion: patients with TMDs may present vectoelectronystagmography abnormalities characterized by unilateral or bilateral hyperreflexia and unilateral hyporeflexia of post-caloric nystagmus.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Transtornos da Articulação Temporomandibular/fisiopatologia , Eletronistagmografia/métodos , Estudos Transversais , Estudos de Coortes
7.
Acta Otolaryngol ; 140(8): 639-645, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32329666

RESUMO

Background: Generally, vertical component of the skull vibratory nystagmus (VCN) is ignored in the clinical practise. Thus, the relative contribution of the vestibular organs in the presence of VCN remains unknown.Objectives: To determine the association between vertical semicircular canal (vSCC) function and the presence of VCN.Material and methods: Comparisons were made between Video Head Impulse Test and SVINT (100 Hz) results at the time of the acute peripheral vestibular lesion (PVL) and at the post-acute phase in patients diagnosed PVL. Later on, a paired analysis was performed restricting the assessments to patients with vestibular explorations in both the acute and post-acute phases.Results: In an univariable analysis, larger mean total gain differences (TGD) between vSCC VOR gains, significantly related with the appearance of VCN in nystagmography in the acute phase (p = .001), unlike the post-acute phase (p = .46). After a multivariate analysis, mean TGD was the only predictive factor of the VCN (p = .013). In the paired analysis, we found an increase in the post-acute phase mean TGD, approaching zero value.Conclusions and significance: Global relation between all vertical canals has at least a contributory role in the presence of the vertical component of nystagmus in SVINT.


Assuntos
Nistagmo Fisiológico/fisiologia , Canais Semicirculares/fisiologia , Doenças Vestibulares/fisiopatologia , Testes de Função Vestibular , Adulto , Estudos Transversais , Eletronistagmografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Reflexo Vestíbulo-Ocular/fisiologia , Estudos Retrospectivos
8.
Am J Otolaryngol ; 41(4): 102497, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32345445

RESUMO

PURPOSE: Whiplash is a type of trauma typically caused by a rear end collision in a road accident. About one in two patients who experience whiplash report dizziness and balance problems, which can severely affect their activities in daily life. In industrialized countries, the number of elderly people with a driving license has increased in recent years. The aims of the present study were to describe the video-nystagmographic features in a consecutive series of elderly patients experiencing whiplash injury in a road accident, comparing them with similar injuries in a group of young adults. METHODS: Twenty-seven patients aged 65 years or more and a control group of 32 young adults between 18 and 21 years old were retrospectively selected. All patients underwent oto-vestibular assessment and video-nystagmography. RESULTS: After whiplash trauma, vertigo was more common in elderly patients with decreased peak velocity during the saccadic ocular motricity test (p = 0.017) and with evidence of bilateral vestibular hypofunction after caloric stimulation (p = 0.033). Comparing the two age groups, neck pain after the trauma was reported significantly more by young adults (p = 0.003), who also showed more frequently bilateral vestibular hypofunction (p = 0.025). CONCLUSION: Clinical and instrumental findings seem to support the hypothesis of a functional lesion to the brainstem regions after a whiplash injury. There is an undeniable need, however, for tools capable of objectively assessing the functional or anatomical damage resulting from whiplash-associated disorders, for both clinical and medico-legal reasons.


Assuntos
Acidentes de Trânsito , Eletronistagmografia , Gravação em Vídeo , Traumatismos em Chicotada/diagnóstico por imagem , Adolescente , Idoso , Feminino , Humanos , Masculino , Cervicalgia/etiologia , Equilíbrio Postural , Traumatismos em Chicotada/complicações , Adulto Jovem
9.
Auris Nasus Larynx ; 47(6): 1070-1073, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32269002

RESUMO

Major earthquakes occasionally cause vertiginous attacks or persistent dizziness, which may be related to the effects of autonomic stress on equilibrium function and/or psychological factors. We present the case of a 73-year-old woman who suffered from persistent dizziness for 1 year, during which she lived in a house tilted by the great 2011 Tohoku earthquake. An electronystagmogram demonstrated leftward horizontal and downbeat nystagmus in the sitting and supine positions with eyes closed. Caloric testing and cervical vestibular-evoked myogenic potentials showed normal responses in both ears. Posturography indicated no involvement of psychological factors or autonomic stress. After moving into a new apartment, both the dizziness and nystagmus completely disappeared within 10 weeks. We speculate that the gravity-related linear acceleration with vertical and horizontal components in the tilted house may have chronically stimulated the otoliths, inducing the symptoms and nystagmus via the velocity storage mechanism.


Assuntos
Tontura/etiologia , Terremotos , Gravitação , Nistagmo Patológico/etiologia , Membrana dos Otólitos/fisiopatologia , Idoso , Eletronistagmografia , Feminino , Humanos , Decúbito Dorsal
10.
Rev. otorrinolaringol. cir. cabeza cuello ; 80(1): 54-62, mar. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1099202

RESUMO

La vestibulopatía bilateral es poco frecuente, se caracteriza principalmente por inestabilidad al caminar o al estar de pie, visión borrosa inducida por el movimiento u oscilopsia al caminar o al realizar movimientos rápidos de la cabeza o del cuerpo, empeoramiento de la estabilidad en la oscuridad o terrenos irregulares, reducción de los síntomas al estar en condiciones estáticas, ganancia del reflejo vestíbulo-ocular angular reducida de forma bilateral, entre otros. Existen múltiples causas. Dentro de las causas identificables, se describen principalmente medicamentos ototóxicos, meningitis y enfermedad de Ménière. Se presenta el caso de una paciente de 64 años diagnosticada con vestibulopatía bilateral posterior a tratamiento intramuscular con gentamicina por sobreinfección bacteriana cutánea de las manos. La evaluación vestibular complementada con videonistagmografía y prueba de impulso cefálico asistida por video confirman el diagnóstico y se inicia tratamiento con rehabilitación vestibular enfocada en promover la compensación central a través de estrategias de sustitución principalmente; además de habituación y adaptación vestibular, favoreciendo la estabilización de la mirada, mantención del equilibrio, control postural, marcha y reducción de los síntomas.


Bilateral vestibulopathy is infrequent, and it is characterized mostly by unstable walking or when standing, blurred vision induced by movement, or oscillopsia when walking or performing fast movements; worsening of the stability in darkness or uneven ground, but with lack of symptoms in static conditions. Other symptoms may include bilateral reduction of the oculo-vestibular reflex. Among the identifiable causes, there is the use of ototoxic medication, meningitis, Ménière's disease, although it can be idiopathic or have a neurological cause. We hereby describe the case of a 64-year-old woman, diagnosed with bilateral vestibulopathy secondary to intramuscular treatment with gentamicin due to a bacterial hand infection. Vestibular assessment was complemented with video-nystagmography and video head impulse test which confirmed the diagnosis, and therapy was started with vestibular rehabilitation focused on promoting central compensation mainly, through substitution strategies. Also, habituation exercise and vestibular adaptation strategies were used, thus promoting sight stabilization, balance maintenance, postural control, walking, and reduction of the symptoms.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Gentamicinas/efeitos adversos , Vestibulopatia Bilateral/induzido quimicamente , Vestibulopatia Bilateral/reabilitação , Antibacterianos/efeitos adversos , Audiometria , Superinfecção , Eletronistagmografia , Teste do Impulso da Cabeça , Vestibulopatia Bilateral/diagnóstico , Vestibulopatia Bilateral/fisiopatologia
11.
Artigo em Chinês | MEDLINE | ID: mdl-32086931

RESUMO

Vertical nystagmus is a vertical nystagmus caused by structural abnormalities and/or dysfunction of the central vestibular system and observed in situ in the center of the eyeball. There are two kinds of nystagmus (UBN) and downbeat nystagmus (DBN) according to the direction of nystagmus. The diagnosis of UBN is mainly made by naked eye or electronystagmography/viewer. It is a common neuro-ophthalmologic sign in the field of vestibular medicine. In this paper, the mechanism of vertical nystagmus formation and the location of lesions were briefly introduced, in order to provide help for the diagnosis and treatment of Vertigo.


Assuntos
Olho/patologia , Nistagmo Patológico/diagnóstico , Eletronistagmografia , Humanos , Vertigem
12.
J Otolaryngol Head Neck Surg ; 49(1): 7, 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32024552

RESUMO

BACKGROUND: Vestibular symptoms such as vertigo and imbalance are known to occur in some cochlear implant patients during the immediate postoperative period; however, acute vertigo in implanted children occurring remotely from the postoperative period has not been previously well-described. CASE PRESENTATION: A three-year-old girl with a history of bilateral sequential cochlear implantation presented with acute labyrinthitis associated with sudden onset of vertigo, balance impairment, and decline in right cochlear implant function 2 years after her most recent implant surgery. We describe her audiological and vestibular testing results during both the acute phase and following medical management and recovery. CONCLUSION: Acute labyrinthitis should be considered when sudden onset vertigo and/or imbalance presents in children with cochlear implants outside of the perioperative period. Such symptoms should prompt early assessment of cochlear implant function, so that the device can be reprogrammed accordingly.


Assuntos
Implante Coclear , Implantes Cocleares , Labirintite/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Pré-Escolar , Eletronistagmografia , Feminino , Humanos , Imageamento por Ressonância Magnética , Vertigem/fisiopatologia , Testes de Função Vestibular , Vestíbulo do Labirinto/fisiopatologia
13.
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 , Imageamento por Ressonância Magnética , Cérebro/diagnóstico por imagem , Orelha Interna/diagnóstico por imagem , Espectroscopia de Ressonância Magnética , Vertigem/diagnóstico
14.
Strabismus ; 28(1): 3-6, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31889465

RESUMO

Purposes: To establish a relation between pendular low amplitude high frequency (PLAHF) components and congenital retinal disorders.Methods: Patients who showed PLAHF components in their eye-movement recording between January 2016 to January 2019 were included. Best corrected visual acuity (BCVA), refraction, strabismus assessment, fundus photograph, spectral domain-optical coherence tomography (SD-OCT), full-field electroretinography (f-ERG), clinical ophthalmological examination, and gene tests were used to determine their clinical conditions, especially their retina conditions in all patients.Results: Among 136 patients there were 76 males and 60 females with mean age of 11.4.5 ± 4.5 years. Pure PLAHF waveforms were found in 38 patients (28%), the amplitude of the PLAHF was 2°±1.6° and frequency was 5-10 Hz. Superimposed PLAHF waveforms were found in 98 patients (72%). BCVA was worse than Log MAR1.0 in 94 patients (69%), between LogMar 0.5-1.0 (20/63-20/200) in 30 cases (22%); higher than LogMar 0.5 (20/63) in 12 cases (9%). Fifty-eight patients were diagnosed with exotropia and six patients with esotropia. Abnormal Fundus were found in 71 cases (52%), fovea hypoplasia was identified with OCT in 95 cases (70%) and retinal thinning in 92 cases (68%). Abnormal on-off VEP were found in 116 cases (85%). The f-ERG responses were reduced in all patients. In 46 patients, gene mutations were found to related to retinal disease, including 3 congenital stationary night blindness (CSNB), 14 achromatopsia (ACHM), 5 Aland Island eye disease (AIED), 7 Alstrom syndrome (AS), 11 Leber congenital amaurosis (LCA), 6 cone-rod dystrophy (CRD).Conclusions: Patients presenting with PLAHF usually had retinal disorders.


Assuntos
Nistagmo Patológico/diagnóstico , Distrofias Retinianas/diagnóstico , Adolescente , Adulto , Criança , Pré-Escolar , Eletronistagmografia , Eletrorretinografia , Feminino , Humanos , Lactente , Masculino , Nistagmo Patológico/fisiopatologia , Distrofias Retinianas/fisiopatologia , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia , Adulto Jovem
15.
J Vestib Res ; 29(6): 309-314, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31707380

RESUMO

OBJECTIVE: To measure the time required in patients with tympanic perforation to reverse paradoxical stimulation (reverse pseudo-nystagmus) and to create a physical model of the process. METHOD: An analytical, observational, cross-sectional study with vestibular evaluation (electronystagmography) of 52 individuals with tympanic membrane perforation without otorrhea or concomitant disease. Increased duration of caloric stimulation in the presence of paradoxical stimulation (reverse pseudo-nystagmus) reverses nystagmic responses. RESULTS: Reversal of nystagmus was observed in 90.9% of patients. The average reversal time was 105.5 seconds. The physical model we prepared provided supporting evidenced for the effects seen in these individuals: warm stimulation in a moist environment initially caused a decrease in temperature (nystagmus to the unexpected side, which characterizes paradoxical stimulation in the warm caloric test); but, as time passed by, the moisture evaporated, and the temperature gradually increased (reversal of nystagmus). CONCLUSIONS: Increasing the stimulation time can be used as a strategy to differentiate reverse nystagmus from paradoxical stimulation. Confusion is thus avoided in diagnostic findings, allowing peripheral alterations to be distinguished from central ones.


Assuntos
Testes Calóricos/métodos , Nistagmo Patológico/fisiopatologia , Nistagmo Fisiológico/fisiologia , Perfuração da Membrana Timpânica/fisiopatologia , Estudos Transversais , Eletronistagmografia , Humanos
16.
Comput Biol Med ; 114: 103448, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31577963

RESUMO

Symptoms of dizziness or imbalance are frequently reported by people over 65. Dizziness is usually episodic and can have many causes, making diagnosis problematic. When it is due to inner-ear malfunctions, it is usually accompanied by abnormal eye-movements called nystagmus. The CAVA (Continuous Ambulatory Vestibular Assessment) device has been developed to provide continuous monitoring of eye-movements to gain insight into the physiological parameters present during a dizziness attack. In this paper, we describe novel algorithms for detecting short periods of artificially induced nystagmus from the long-term eye movement data collected by the CAVA device. In a blinded trial involving 17 healthy subjects, each participant induced nystagmus artificially on up to eight occasions by watching a short video on a VR headset. Our algorithms detected these short periods with an accuracy of 98.77%. Additionally, data relating to vestibular induced nystagmus was collected, analysed and then compared to a conventional technique for assessing nystagmus during caloric testing. The results show that a range of nystagmus can be identified and quantified using computational methods applied to long-term eye-movement data captured by the CAVA device.


Assuntos
Eletronistagmografia/métodos , Movimentos Oculares/fisiologia , Nistagmo Patológico/diagnóstico , Processamento de Sinais Assistido por Computador , Algoritmos , Tontura/diagnóstico , Desenho de Equipamento , Humanos , Monitorização Ambulatorial/instrumentação
17.
Eur Arch Otorhinolaryngol ; 276(12): 3513-3517, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31494697

RESUMO

OBJECTIVE: Vertigo is a complex symptom which imposes diagnostic and treatment challenges. Laboratory evaluation of vertigo includes video-nystagmography (VNG) and computerized dynamic posturography (CDP) for the evaluation of different aspects of this complaint. There are vague indications for each test and potential disagreements between them. The aim of this study is to examine the association between the test results of the VNG and sensory organization test (SOT) of CDP in patients referred for both vestibular tests. METHODS: Retrospective data regarding 56 patients age 17-82 years were collected. Patients suffered vestibular complaints and were referred for VNG and CDP evaluation on the same day. The level of agreement between VNG (including caloric test) and the vestibular input of the SOT for each patient was calculated. RESULTS: Among the study group, 10 showed abnormal caloric test results, of which 3 (5.4%) had normal vestibular input in the SOT, and 7 (12.5%) had impaired input (p = 0.724). Spontaneous nystagmus was recorded in 13 patients by VNG, of which 2(3.6%) had normal vestibular input and 11(19.6%) had impaired vestibular input (p = 0.056). CONCLUSIONS: This study shows no statistically significant association between the VNG test and SOT test results. Our results emphasize the difference between the tested aspects in each laboratory test, and the need to define specific indications for each of them. There is a marginally significant association between impaired vestibular input and spontaneous nystagmus, demonstrating the non-localizing nature of this sign.


Assuntos
Equilíbrio Postural/fisiologia , Transtornos das Sensações/fisiopatologia , Vertigem/diagnóstico , Doenças Vestibulares/diagnóstico , Doenças Vestibulares/fisiopatologia , Vestíbulo do Labirinto/fisiopatologia , Gravação em Vídeo , Adolescente , Adulto , Idoso , Testes Calóricos , Técnicas e Procedimentos Diagnósticos , Técnicas de Diagnóstico Oftalmológico , Eletronistagmografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nistagmo Patológico/fisiopatologia , Estudos Retrospectivos , Transtornos das Sensações/complicações , Doenças Vestibulares/complicações , Testes de Função Vestibular , Adulto Jovem
18.
J Laryngol Otol ; 133(7): 554-559, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31196230

RESUMO

OBJECTIVE: To determine whether central findings from vestibular tests predict abnormal findings on magnetic resonance imaging. METHOD: This study was a retrospective case series at a tertiary referral centre. The main outcome measure of this diagnostic intervention study was the positive predictive value of central vestibular findings in relation to magnetic resonance imaging abnormalities. RESULTS: Central vestibular findings had a 50.9 per cent positive predictive value for magnetic resonance imaging abnormalities across all age groups although they varied according to age group. Optokinetic nystagmus (p < 0.05) and abnormal findings on videonystagmography tests (p < 0.05) were the main predictors of magnetic resonance imaging abnormalities. White matter lesions constituted the bulk of the central lesions on magnetic resonance imaging followed by cortical and cerebellar atrophy. CONCLUSION: Central vestibular findings had a 50.9 per cent positive predictive value for magnetic resonance imaging abnormalities across all age groups. Magnetic resonance imaging is medically justified to further evaluate patients with central findings on vestibular studies. Therefore, it is reasonable to request magnetic resonance imaging in these patients.


Assuntos
Encéfalo/diagnóstico por imagem , Eletronistagmografia/métodos , Imageamento por Ressonância Magnética/métodos , Nistagmo Patológico/diagnóstico por imagem , Vertigem/diagnóstico por imagem , Vestíbulo do Labirinto/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Centros de Atenção Terciária , Testes de Função Vestibular , Gravação em Vídeo , Adulto Jovem
19.
Adv Otorhinolaryngol ; 82: 32-38, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30947200

RESUMO

Videonystagmography (VNG) and posturography are two vestibular assessment techniques that are still in use today. VNG: VNG allows clinicians to observe and record eye movements in real-time. Compared with electronystagmography (ENG), VNG tracings are more detailed and can capture subtle clinical findings. The utility of the monothermal caloric screen has been proposed in various studies. When appropriate cut-offs are used, the monothermal screen can be completed with a low false-negative rate. Air is often used as a medium for caloric testing, though not without some controversy. When air and water are compared, the response magnitudes for air are consistently smaller than for water. However, the overall classification of the result appears to be generally the same regardless of the caloric medium used. Posturography: Concerns have been raised about the reliability and validity of posturographic measurements. Approaches and analysis techniques vary widely, and there is little consensus regarding the best approaches for assessment or interpretation. There is a need for standardized protocols. The portable and low-cost Nintendo Wii Balance Board (WBB) has inspired a surge in publications looking at the validity of the system for quantifying posturography and for balance training; preliminary findings are very promising.


Assuntos
Diagnóstico por Computador/métodos , Técnicas de Diagnóstico Neurológico , Eletronistagmografia/métodos , Equilíbrio Postural/fisiologia , Doenças Vestibulares/diagnóstico por imagem , Doenças Vestibulares/fisiopatologia , Gravação em Vídeo , Humanos , Jogos de Vídeo
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