Vestibular rehabilitation therapy in children.

OBJECTIVES: Vestibular disturbances are underdiagnosed in children. However, balance impairment may compromise the normal development of affected children. The appropriate therapeutic approach has not been agreed on for this age group. Vestibular rehabilitation therapy has excellent results in adults, but very few data exist regarding its results in children. We evaluated through clinical assessment and computerized dynamic posturography the outcome of children with peripheral vestibular disturbances undergoing vestibular rehabilitation therapy and observed the influence of learning and of central nervous system maturation on posturography retest results. METHODS: Sixteen children (10 boys and 6 girls) with peripheral vestibular disorders (mean age, 8 yr 7 mo) constituted the cohort and were consecutively treated with vestibular rehabilitation therapy. Symptomatic children underwent pre- and posttreatment computerized dynamic posturography. Their outcome was clinically assessed. Another 16 asymptomatic children, paired by sex and age, underwent two computerized dynamic posturography procedures with the same time interval as that of the symptomatic group. RESULTS: All children completed the treatment. Total recovery of symptoms occurred in nine (56.3%) patients, whereas a dramatic partial recovery was observed in the remaining seven (43.7%) children. Posturography Conditions 5 and 6, the vestibular ratio of the sensory analysis, and the composite equilibrium score had a significant quantitative improvement after vestibular rehabilitation therapy. No adverse reactions occurred to the exercises. No statistically significant posturography changes were observed in the asymptomatic children. CONCLUSION: Vestibular rehabilitation therapy seems to be a safe and efficacious therapeutic option in children with peripheral vestibular disturbances.

Sudden deafness and Lyme disease.

OBJECTIVES/HYPOTHESIS: Otolaryngological manifestations are common in Lyme disease, affecting up to 75% of patients. One of these symptoms is sudden deafness. Hearing loss has been frequently described in Lyme disease; on the other hand, titers seropositive for, the causal agent of this disease, have been found in almost 20% of cases of sudden deafness. No consensual information exists on the outcome of Borrelia-seropositive patients or on the importance of determining Borrelia antibody titers. The present study aimed to determine the prevalence of seropositivity for Borrelia in sudden deafness, describing clinical characteristics and outcomes. STUDY DESIGN: This was a prospective observational study. METHODS: Forty-seven consecutive patients with sudden deafness were enrolled in the study. Demographic data, the presence of tinnitus and vertigo, and low- and high-frequency pure-tone averages were recorded. The percentage of hearing recovery was determined. Data obtained from Borrelia-seropositive patients were described and compared with those from the seronegative group. RESULTS: Titers positive for antibodies were present in 21.3% of the cases. Seropositive and seronegative groups of patients were homogeneous concerning age, sex distribution, the presence of tinnitus and vertigo, and high- and low-frequency hearing thresholds. Hearing outcome was not significantly different between the groups of patients. CONCLUSIONS: No distinctive clinical characteristic was found between seropositive and seronegative subjects. The hearing outcome of treated Borrelia-seropositive patients was similar to that of the seronegative group.

[Evaluation of the treatment of vestibular disorders in children with computerized dynamic posturography: preliminary results]. / Avaliação do tratamento dos distúrbios vestibulares na criança através da posturografia dinâmica computadorizada: resultados preliminares.

OBJECTIVE: This study aimed at evaluating dynamic posturography as an evaluation method in children with balance problems due to peripheral vestibulopathy, before and after treatment with vestibular rehabilitation, establishing its correlation with classical clinical evaluation. METHOD: Ten children (six boys and four girls) with vestibular symptoms of peripheral origin were evaluated through a complete clinical history and with dynamic computerized posturography after being treated by vestibular rehabilitation therapy. Posturographic data were analyzed and compared to standard clinical evaluation parameters. RESULTS: Dynamic posturography showed a significant improvement of condition 1 (orthostatic position, fixed support and open eyes) and 5 (orthostatic position, sway-referenced support and closed eyes) of the vestibular function and of the composite balance score. The data showed significant correlation with the clinical improvement observed. A significant reduction of proprioceptive influence was also observed. CONCLUSIONS: Data showed that the dynamic posturography adds important quantitative information to the conventional clinical evaluation of vestibular symptoms, especially in children.

Avaliaçäo do tratamento dos distúrbios vestibulares na criança através da posturografia dinâmica computadorizada: resultados preliminares / Evaluation of the treatment of vestibular disorders in children with computerized dynamic posturography: preliminary results

OBJETIVO: o objetivo desta investigaçäo foi avaliar a posturografia como método de acompanhamento de crianças com vestibulopatia periférica, tratadas com reabilitaçäo vestibular, estabelecendo sua correlaçäo com a evoluçäo clínica dos pacientes. MÉTODOS: dez crianças (seis meninos e quatro meninas) portadoras de afecções vestibulares periféricas, submetidas à reabilitaçäo vestibular como forma de tratamento, tiveram sua evoluçäo clínica avaliada através de uma anamnese detalhada de seus sintomas e da realizaçäo da posturografia dinâmica computadorizada. Os dados posturográficos foram analisados e comparados à evoluçäo clínica dos pacientes estudados. RESULTADOS: observou-se, após o tratamento, melhora significativa das condições 1 (paciente em posiçäo ortostática, plataforma fixa e olhos abertos) e 5 (paciente em posiçäo ortostática, plataforma em movimento e olhos fechados) da posturografia dinâmica, da funçäo vestibular e do índice do equilíbrio, que correlacionaram-se significativamente com a melhora clínica e diminuiçäo dos sintomas dos pacientes. Observou-se, também, reduçäo significativa da influência da funçäo somatosensorial sobre o equilíbrio final da criança. CONCLUSÄO: os dados obtidos mostram que a posturografia näo substitui a avaliaçäo clínica convencional, mas agrega dados quantitativos importantes para o acompanhamento da terapia destes pacientes.