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Background: Feedback postural control depends upon information from somatosensation, vision, and the vestibular system that are weighted depending on their relative importance within the central nervous system. Following loss of any sensory component, the weighting changes, e.g., when suffering a vestibular loss, the most common notion is that patients become more dependent on visual cues for maintaining postural control. Dizziness and disequilibrium are common after surgery in schwannoma patients, which could be due to interpretation of the remaining sensory systems involved in feedback-dependent postural control and spatial orientation. Objective: To compare visual dependency in spatial orientation and postural control in patients suffering from unilateral vestibular loss within different time frames. Methods: Patients scheduled for schwannoma surgery: group 1 (n = 27) with no vestibular function prior to surgery (lost through years), group 2 (n = 12) with remaining vestibular function at the time of surgery (fast deafferentation), and group 3 (n = 18) with remaining function that was lost through gentamicin installations in the middle ear (slow deafferentation). All patients performed vibratory posturography and rod and frame investigation before surgery and 6 months after surgery. Results: Postural control improved after surgery in patients that suffered a slow deafferentation (groups 1 and 3) (p < 0.001). Patients that suffered fast loss of remaining vestibular function (group 2) became less visual field dependent after surgery (p ≤ 0.035) and were less able to maintain stability compared with group 1 (p = 0.010) and group 3 (p = 0.010). Conclusions: The nature and time course of vestibular deafferentation influence the weighting of remaining sensory systems in order to maintain postural control and spatial orientation.
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Neurilemoma/fisiopatologia , Equilíbrio Postural/fisiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurilemoma/cirurgia , Testes de Função VestibularRESUMO
OBJECTIVE: To evaluate auditory and vestibular function after presurgical treatment with gentamicin in schwannoma patients. BACKGROUND: The vestibular PREHAB protocol aims at diminishing the remaining vestibular function before vestibular schwannoma surgery, to ensure less acute symptoms from surgery, and initiate a more efficient vestibular rehabilitation already before surgery. However, the potential cochleotoxicity of gentamicin is a concern, since modern schwannoma surgery strives to preserve hearing. STUDY DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: Seventeen patients diagnosed with vestibular schwannoma between 2004 and 2011, and took part in vestibular PREHAB program. The patients were of age 21 to 66 years (mean 48.8), 9 females and 8 males. INTERVENTION: Intratympanic gentamicin installations before surgery as part of the vestibular PREHAB. MAIN OUTCOME MEASURES: Hearing thresholds, word recognition score, caloric response, subjective visual vertical and horizontal, cVEMP, and vestibular impulse tests. RESULTS: Combined analysis of frequency and hearing threshold showed a significant decrease after gentamicin therapy (p < 0.001). Pure-tone average decreased with 7.1 ± 8.5 dB (p = 0.004), and speech recognition with 10%. The treatment resulted in unilateral vestibular deafferentation with no notable reaction to bithermal caloric irrigation (reduction 64%, p < 0.001), loss of the vestibulo-ocular response measured by the head-impulse test, and deviation of subjective horizontal/vertical to the side of the lesion (+2.2 degrees, p = 0.010). CONCLUSIONS: Intratympanic installations of gentamicin, as part of the vestibular PREHAB, result in unilateral vestibular deafferentation, but constitute a definite risk for high-frequency hearing loss. The hearing results are in line with those reported upon when treating Menière's disease.
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Antibacterianos/efeitos adversos , Gentamicinas/efeitos adversos , Perda Auditiva de Alta Frequência/induzido quimicamente , Neuroma Acústico/cirurgia , Cuidados Pré-Operatórios , Potenciais Evocados Miogênicos Vestibulares/fisiologia , Doenças do Nervo Vestibulococlear/induzido quimicamente , Adulto , Idoso , Antibacterianos/administração & dosagem , Audiometria de Tons Puros , Limiar Auditivo , Testes Calóricos , Feminino , Gentamicinas/administração & dosagem , Humanos , Injeção Intratimpânica , Masculino , Pessoa de Meia-Idade , Reflexo Anormal , Reflexo Vestíbulo-Ocular/fisiologia , Estudos Retrospectivos , Doenças do Nervo Vestibulococlear/fisiopatologia , Adulto JovemRESUMO
PURPOSE: We wanted to explore the specific proprioceptive effect of cervical pain on sensorimotor control. Sensorimotor control comprises proprioceptive feedback, central integration and subsequent muscular response. Pain might be one cause of previously reported disturbances in joint kinematics, head on trunk orientation and postural control. However, the causal relationship between the impact of cervical pain on proprioception and thus on sensorimotor control has to be established. METHODS: Eleven healthy subjects were examined in their ability to reproduce two different head on trunk targets, neutral head position (NHP) and 30° target position, with a 3D motion analyser before, directly after and 15 min after experimentally induced neck pain. Pain was induced by hypertonic saline infusion at C2/3 level in the splenius capitis muscle on one side (referred to as "injected side"). RESULTS: All subjects experienced temporary pain and the head repositioning error increased significantly during head repositioning to the 30° target to the injected side (p = 0.011). A post hoc analysis showed that pain interfered with proprioception to the injected side during acute pain (p < 0.001), but also when the pain had waned (p = 0.002). Accuracy decreased immediately after pain induction for the 30° target position to the side where pain was induced (3.3 â 5.3°, p = 0.033), but not to the contralateral side (4.9 â 4.1°, p = 0.657). There was no significant impact of pain on accuracy for NHP. A sensory mismatch appeared in some subjects, who experienced dizziness. CONCLUSIONS: Acute cervical pain distorts sensorimotor control with side-specific changes, but also has more complex effects that appear when pain has waned.
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Movimentos da Cabeça , Mialgia/fisiopatologia , Cervicalgia/fisiopatologia , Adulto , Feminino , Humanos , Masculino , PropriocepçãoRESUMO
BACKGROUND: Menière's disease is an idiopathic disorder characterized by recurrent episodes of vertigo lasting more than 20 min, unilateral sensorineural hearing loss, and tinnitus. If vertigo attacks occur frequently, the patient is usually severely incapacitated. Currently, there is no consensus on the treatment of Menière's disease. The evidence regarding most treatment options is sparse due to a lack of randomized trials together with an often-spontaneous relief over time and a considerable placebo effect. Insertion of a transmyringeal tube is a simple and relatively safe, minimally invasive procedure and previous open-label trials have shown promising results. STUDY DESIGN: This is a prospective, sham-controlled, double-blinded, randomized, clinical trial. AIM: This trial aims to assess the effects of inserting a ventilation tube into the tympanic membrane compared with sham treatment for definite or probable unilateral Menière's disease according to the criteria formulated by the Classification Committee of the Bàràny Society. OUTCOMES: The primary outcome will be the number of spontaneous vertigo attacks lasting more than 20 min and time to treatment failure. In addition to the primary outcome, we will assess various secondary outcomes related to hearing, ear fullness, dizziness, and serious adverse events. SAMPLE SIZE: An estimated 104 participants in total or 52 participants in each group will be necessary. The primary analysis will be according to the intention-to-treat principle. The trial will be initiated in 2021 and is expected to end in 2025. TRIAL STATUS: ClinicalTrials.gov : NCT04835688 . Registered on April 8, 2021. PROTOCOL VERSION: 1.8, 26-09-2022. Date of first enrollment: October 1st, 2021. End of study: anticipated January 2025.
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Doença de Meniere , Zumbido , Humanos , Doença de Meniere/complicações , Doença de Meniere/diagnóstico , Doença de Meniere/terapia , Ventilação da Orelha Média/efeitos adversos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Zumbido/complicações , VertigemRESUMO
Superior semicircular canal dehiscence syndrome (SCDS) is caused by a bony defect of the superior semicircular canal. The bony defect allows low-frequency acoustic stimuli of high intensity to travel to the vestibular organ. This can be induced by sound stimuli or pressure stimuli leading to vertigo, torsional nystagmus, pulsatile tinnitus, hyperacusis, hearing loss and autophony. SCDS is diagnosed with provocative testing, audiometry, CT-scan, vestibular evoked myogenic potentials and electrocochleography. Treatment is conservative, however, surgery with occlusion of the defect can be necessary for debilitating symptoms, as argued in this review.
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Nistagmo Patológico , Deiscência do Canal Semicircular , Potenciais Evocados Miogênicos Vestibulares , Humanos , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/etiologia , Canais Semicirculares/diagnóstico por imagem , Canais Semicirculares/cirurgia , Vertigem/etiologiaRESUMO
Background: Functional head impulse test (fHIT) tests the ability of the vestibulo-ocular reflex (VOR) to allow visual perception during head movements. Our previous study showed that active head movements to the side with a vestibular lesion generated a dynamic visual performance that were as good as during movements to the intact side. Objective: To examine the differences in eye position during the head impulse test when performed with active and passive head movements, in order to better understand the role of the different saccade properties in improving visual performance. Method: We recruited 8 subjects with complete unilateral vestibular loss (4 men and 4 women, mean age 47 years) and tested them with video Head Impulse Test (vHIT) and Functional Head Impulse Test (fHIT) during passive and active movements while looking at a target. We assessed the mean absolute position error of the eye during different time frames of the head movement, the peak latency and the peak velocity of the first saccade, as well as the visual performance during the head movement. Results: Active head impulses to the lesioned side generated dynamic visual performances that were as good as when testing the intact side. Active head impulses resulted in smaller position errors during the visual perception task (p = 0.006) compared to passive head-impulses and the position error during the visual perception time frame correlated with shorter latencies of the first saccade (p < 0.001). Conclusion: Actively generated head impulses toward the side with a complete vestibular loss resulted in a position error within or close to the margin necessary to obtain visual perception for a brief period of time in patients with chronic unilateral vestibular loss. This seems to be attributed to the appearance of short-latency covert saccades, which position the eyes in a more favorable position during head movements.
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Objective: The use of goggles to assess vertical semicircular canal function has become a standard method in vestibular testing, both in clinic and in research, but there are different methods and apparatus in use. The aim of this study was to determine what the cause of the systematic differences is between gain values in testing of the vertical semicircular canals with two different video head impulse test (vHIT) equipment in subjects with normal vestibular function. Study Design: Retrospective analysis of gain values on patients with clinically deemed normal vestibular function (absence of a corrective eye saccade), tested with either Interacoustics or Otometrics system. Prospective testing of subjects with normal vestibular function with the camera records the eye movements of both eyes. Finally, 3D sensors were placed on different positions on the goggles measuring the actual vertical movement in the different semicircular planes. Results: In the clinical cohorts, the gain depended on which side and semicircular canal was tested (p < 0.001). In the prospective design, the combination between the stimulated side, semicircular canal, and position of the recording device (right/left eye) highly influenced the derived gain (p < 0.001). The different parts of the goggles also moved differently in a vertical direction during vertical semicircular canal testing. Conclusion: The gain values when testing the function of the vertical semicircular canals seem to depend upon which eye is recorded and which semicircular plane is tested and suggests caution when interpreting and comparing results when different systems are used both clinically as well as in research. The results also imply that further research and development are needed to obtain accurate vertical semicircular canal testing, in regard to both methodology and equipment design.
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Background and aims Symptoms of dizziness and pain are both common complaints and the two symptoms often seem to coincide. When symptoms appear concomitant for sustained periods of time the symptoms might maintain and even exacerbate each other, sometimes leading to psychological distress. In order to evaluate such comorbidity we studied patients referred to a vestibular unit and to a psychiatric outpatient clinic with respectively balance disorders and psychological issues. Methods Consecutive patients referred to a vestibular unit (n = 49) and a psychiatric outpatient clinic (n = 62) answered the Dizziness Handicap Inventory (DHI) questionnaire and a questionnaire detailing occurrence of dizziness and pain. Results The experience of dizziness and pain often coincided within individuals across both clinical populations, especially if the pain was located to the neck/shoulder or the back (p = 0.006). Patients who reported dizziness had significantly more often pain (p = 0.024); in the head (p = 0.002), neck/shoulders (p = 0.003) and feet (p = 0.043). Moreover, patients who reported dizziness stated significantly higher scoring on emotional (p < 0.001) and functional (p < 0.001) DHI sub-scales. Furthermore, patients who reported an accident in their history suffered significantly more often from dizziness (p = 0.039) and pain (p < 0.001); in the head (p < 0.001), neck/shoulders (p < 0.001) and arms (p = 0.045) and they scored higher on the emotional (p = 0.004) and functional (p = 0.002) DHI sub-scales. Conclusions The findings suggest comorbidity to exist between dizziness and neck/shoulder or back pain in patients seeking health care for balance disorders or psychological issues. Patients suffering from dizziness and pain, or with both symptoms, also reported higher emotional and functional strain. Thus, healthcare professionals should consider comorbidity when determining diagnosis and consequent measures. Implications Clinicians need to have a broader "receptive scope" in both history and clinical examinations, and ask for all symptoms. Although the patients in this study visited a vestibular unit respectively a psychological clinic, they commonly reported pain conditions when explicitly asked for this symptom. A multimodal approach is thus to favor, especially when the symptoms persist, for the best clinical management.
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Dor Crônica/complicações , Tontura/complicações , Transtornos Mentais/complicações , Equilíbrio Postural , Adulto , Estudos de Casos e Controles , Tontura/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
The aim was to investigate the relative importance of cervical proprioception compared to vestibular input for head movements on trunk. Subjects with bilateral vestibulopathy (n = 11) were compared to healthy controls (n = 15). We studied their ability to move the head accurately to reproduce four specified target positions in the horizontal yaw plane (neutral head position, 10 degrees target, 30 degrees target, and 30 degrees target with oscillating movements applied during target introduction). Repositioning ability was calculated as accuracy (constant error, the mean of signed differences between introduced and reproduced target) and precision (variable error, the standard deviation of differences between introduced and reproduced targets). Subjects with bilateral vestibulopathy did not differ significantly from controls in their ability to reproduce different target positions. When the 30 degrees target position was introduced with oscillating movements, overshoot diminished and accuracy improved in both groups, although only statistically significantly when performed towards the right side. The results suggest that at least in some conditions, accurate head on trunk orientation can be achieved without vestibular information and that cervical somato-sensory input is either up-regulated as a compensatory mechanism after bilateral vestibular loss or is important for such tasks.
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Movimentos da Cabeça , Cabeça/fisiopatologia , Pescoço/fisiopatologia , Propriocepção , Desempenho Psicomotor , Doenças Vestibulares/fisiopatologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/inervação , Orientação , Adulto JovemRESUMO
Wernicke encephalopathy is a condition in which thiamine deficiency causes cognitive dysfunction, ataxia and eye motor abnormalities. The condition is potentially reversible if treated with high doses of intravenous thiamine (vitamin B1). The video head impulse test, in which the vestibulo-ocular reflex is tested, can reveal an early specific sign of selective dysfunction in the medial vestibular nuclei by demonstrating selective dysfunction of the horisontal vestibulo-ocular reflex. We present two cases with clinical and neuroradiological findings consistent with Wernicke encephalopathy where such oculomotor findings were detected.
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Reflexo Vestíbulo-Ocular , Encefalopatia de Wernicke/diagnóstico , Teste do Impulso da Cabeça , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tiamina/administração & dosagem , Tiamina/uso terapêutico , Encefalopatia de Wernicke/diagnóstico por imagem , Encefalopatia de Wernicke/tratamento farmacológicoRESUMO
OBJECTIVE: To present findings that suggest steroid treatment within 24âhours of onset of vestibular neuronitis results in better restitution of vestibular function than treatment between 25 and 72âhours. PATIENTS: Thirty-three consecutive patients (17 men, 16 women, mean age 57 yr, range 17-85 yr) with acute vestibular neuronitis and treated with steroids within 72âhours after symptom onset. Patients were divided into two groups depending on if they were treated within the first 24âhours or not. INTERVENTIONS: Oral prednisolone 50âmg/d for 5 days with tapering of doses for the next 5 days, or combined with initial intravenous betamethasone 8âmg the first 1 to 2 days if the patient was nauseous. MAIN OUTCOME MEASURES: Proportion of patients with normal caloric test result (canal paresis valueâ<â32%) at follow-up after 3 or 12 months. RESULTS: All 9 patients (100%) treated within 24âhours from onset of vestibular neuronitis had normal caloric test results at follow-up after 3 months, as compared with 14 of 24 (58%) of the patients treated between 25 and 72âhours (pâ<â0,05, Fisher's exact test). CONCLUSIONS: The timing of steroid treatment of vestibular neuronitis may be of importance for subsequent vestibular restitution, and hence, for both time to recovery and late symptoms according to the literature.
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Prednisolona/administração & dosagem , Neuronite Vestibular/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Background: Loss of the vestibulo-ocular reflex (VOR) affects visual acuity during head movements. Previous studies have shown that compensatory eye-saccades improve visual acuity and that the timing of the saccade is important. Most of the tests involved in testing VOR are made with passive head movement, that do not necessarily reflect the activities of daily living and thus not being proportionate to symptoms and distresses of the patients. Objective: To examine differences between active (self-generated) or passive (imposed by the examiner) head rotations while trying to maintain visual focus on a target. Method: Nine subjects with unilateral total vestibular loss were recruited (4 men and 5 women, mean age 47) and tested with video Head Impulse Test (vHIT) and Head Impulse Testing Device-Functional Test (HITD-FT) during passive and active movements while looking at a target. VOR gain, latencies of covert saccades, frequency of covert saccades and visual acuity were measured and analyzed. Results: Active head-impulses toward the lesioned side resulted in better visual acuity (p = 0.002) compared to conventional passive head-impulses and generated eye-saccades with significantly shorter latencies (p = 0.004). Active movements to the lesioned side generated dynamic visual acuities that were as good as when testing the intact side. Conclusion: Actively generated head impulses resulted in normal dynamic visual acuity, even when performed toward the side of total vestibular loss. This might be attributed to the appearance of short-latency covert saccades. The results show a strong relationship between self-generated movements, latencies of covert saccades and outcome in HITD-FT, i.e., a better dynamic visual function with less retinal slip which is the main function of the VOR. The method of active HITD-FT might be valuable in assessing vestibular compensation and monitoring ongoing vestibular rehabilitation.
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OBJECT: To evaluate post-surgical postural stability when treating patients with remaining vestibular function with intratympanic gentamicin (PREHAB) prior to schwannoma surgery. METHOD: 44 consecutive patients with some form remaining vestibular function scheduled for vestibular schwannoma surgery. 20 were medically deafferented with intratympanic gentamicin before surgery and 24 were not. Both groups were of the same age, had the same tumor size, same type of surgery, and same perioperative sensory rehabilitation (training exercises), and no surgical complications. Postural stability measured as energy expenditure while standing on a force platform during vibratory stimulation of the calf muscles, performed prior to surgery (or gentamicin treatment) and 6 months after surgery. RESULTS: Patients pretreated with gentamicin had significantly better postural stability at the time for follow-up (pâ<â0.05) and displayed a better adaptive capacity when faced with a postural challenge (pâ<â0.01). They were also able to use vision more efficiently to control their stability (pâ<â0.05). CONCLUSIONS: By separating the sensory loss (through intratympanic gentamicin, that ablates the remaining vestibular function) from the intracranial surgical trauma, the postural control system benefited from a better short-term (adaptation) and long-term (habituation) recovery, when experiencing a postural challenge or resolving a sensory conflict. The benefits could be attributed to; active and continuous motor learning as the vestibular function slowly attenuates; no concomitant central nervous dysfunction due to effects from neurosurgery, thus allowing time for a separate unimpeded recovery process with more limited challenges and objectives; and the initiation and certain progression of sensory reweighting processes allowed prior to surgery. In contrast, worse compensation could be due to; immobilization from nausea after surgery, harmful amount of stress and cognitive dysfunction from the combination of surgical and sensory trauma and an abrupt vestibular deafferentation and its consequences on sensory reweighting.
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Antibacterianos , Gentamicinas , Neuroma Acústico/terapia , Equilíbrio Postural/fisiologia , Simpatectomia Química , Vestíbulo do Labirinto/fisiologia , Adaptação Fisiológica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/fisiopatologia , Neuroma Acústico/reabilitação , Neuroma Acústico/cirurgia , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Recuperação de Função Fisiológica/fisiologia , Estudos RetrospectivosRESUMO
Alcohol intoxication affects the vestibular system and balance control in many ways. We have investigated how acute, moderate (blood alcohol concentrations of 0.06+/-0.01%), and high (0.10+/-0.02%) alcohol intoxication affects the ability to perceive the visual horizontal and vertical and the visual field dependence measured with the rod and frame tests in 24 healthy participants. Alcohol ingestion impaired the ability to use gravitational vestibular cues when determining the visual vertical and horizontal, and caused increased visual field dependence. With conflicting gravitational and visual information, alcohol seems to promote a reweighting in balance control from a vestibular to a more visual dependency. Furthermore, the results indicate that alcohol intoxication at these levels start instigating a decompensation of minute subclinical vestibular asymmetries.
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Intoxicação Alcoólica/fisiopatologia , Membrana dos Otólitos/fisiopatologia , Reflexo Vestíbulo-Ocular/fisiologia , Percepção Espacial/fisiologia , Percepção Visual/fisiologia , Adulto , Intoxicação Alcoólica/sangue , Etanol/efeitos adversos , Etanol/sangue , Feminino , Lateralidade Funcional/efeitos dos fármacos , Gravitação , Humanos , Masculino , Membrana dos Otólitos/efeitos dos fármacos , Desempenho Psicomotor/efeitos dos fármacos , Desempenho Psicomotor/fisiologia , Reflexo Vestíbulo-Ocular/efeitos dos fármacos , Percepção Espacial/efeitos dos fármacos , Testes de Função VestibularRESUMO
BACKGROUND: Phobic postural vertigo is characterized by dizziness in standing and walking despite normal clinical balance tests. Patients sometimes exhibit anxiety reactions and avoidance behavior to specific stimuli. Different treatments are possible for PPV, including vestibular rehabilitation exercises, pharmacological treatment, and cognitive behavioral therapy. We recently reported significant benefits of cognitive behavioural therapy for patients with phobic postural vertigo. This study presents the results of a one-year follow-up of these patients. METHODS: Swedish translations of the following questionnaires were administered: (Dizziness Handicap Inventory, Vertigo Symptom Scale, Vertigo Handicap Questionnaire, and Hospital Anxiety and Depression Scale) were administered to 20 patients (9 men and 11 women; mean age 43 years, range 23-59 years) one year after completion of cognitive behavioral therapy. RESULTS: Test results were similar to those obtained before treatment, showing that no significant treatment effects remained. CONCLUSION: Cognitive behavioral therapy has a limited long-term effect on phobic postural vertigo. This condition is more difficult to treat than panic disorder with agoraphobia. Vestibular rehabilitation exercises and pharmacological treatment might be the necessary components of treatment.
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Terapia Cognitivo-Comportamental/métodos , Transtornos Fóbicos/terapia , Postura , Vertigem/terapia , Doenças Vestibulares/terapia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Transtornos Fóbicos/complicações , Inquéritos e Questionários , Resultado do Tratamento , Vertigem/complicações , Doenças Vestibulares/complicaçõesRESUMO
CONCLUSIONS: Preoperative gentamicin in combination with vestibular 'prehab' offers a possibility to reduce postoperative malaise and speed up recovery and may be used for patients undergoing such surgery when there is remaining vestibular function. OBJECTIVES: Removal of pontine angle tumours in a patient with remaining vestibular function causes symptoms of acute vestibular loss. A simultaneous cerebellar lesion can cause a combined vestibule-cerebellar lesion. PATIENTS AND METHODS: Twelve patients with pontine angle tumours but with near normal vestibular function were treated with intratympanic gentamicin in combination with vestibular 'prehab' to achieve preoperative vestibular ablation and compensation. After work-up patients started with a home-based vestibular training programme for 14 days. They then received a total of 1.2 ml of 30 mg/ml buffered gentamicin in four intratympanic installations over 2 days. They continued training and returned 6-16 weeks later. All patients were tested with calorics, vestibular video-impulse testing of all six canals, VEMP, subjective visual vertical and horizontal, posturography and pure tone and speech audiometry. RESULTS: There was a loss of caloric reactions and loss of impulses. In two patients the hearing deteriorated and in one hearing improved. All subjects were vestibulary compensated before surgery and no patient complained of dizziness or vertigo after surgery.
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Gentamicinas/administração & dosagem , Neuroma Acústico/terapia , Neoplasias Otorrinolaringológicas/terapia , Cuidados Pré-Operatórios/métodos , Inibidores da Síntese de Proteínas/administração & dosagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/reabilitação , Neuroma Acústico/cirurgia , Neoplasias Otorrinolaringológicas/reabilitação , Neoplasias Otorrinolaringológicas/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Vertigem/etiologia , Vertigem/prevenção & controle , Vertigem/reabilitação , Vestíbulo do Labirinto/efeitos dos fármacosRESUMO
PURPOSE: To explore musculoskeletal findings in patients with cervicogenic dizziness and how these findings relate to pain and dizziness. To study treatment effects and long-term symptom progress. METHOD: Twenty-two patients (20 women, 2 men; mean age 37 years) with suspected cervicogenic dizziness underwent a structured physical examination before and after physiotherapy guided by the musculoskeletal findings. Questionnaires were sent to the patients six months and two years after treatment. RESULTS: Dorsal neck muscle tenderness and tightness was found in a majority of the patients. Zygapophyseal joint tenderness was found at all cervical levels. Cervical range of motion was equal to or larger than expected age and gender matched values. The cervico-thoracic region was often hypomobile. Most patients had postural imbalance. Dynamic stabilization capacity was reduced. Suboccipital muscles tightness correlated with posture imbalance and poor neck stability. The treatment resulted in reduced tenderness in levator scapula, high and middle paraspinal and temporalis muscles and zygapophyseal joints at C4-C7 and increased cervico-thoracic mobility. Reduction of middle paraspinal muscle tenderness correlated with neck pain relief. Postural alignment improved, as did dynamic stabilization in trunk, neck and shoulders. After 6 months, 13 of the 17 patients had still no or less neck pain and 14 had no or less dizziness. After 2 years, 7 patients had no or less neck pain and 11 no or less dizziness. CONCLUSION: Patients with suspected cervicogenic dizziness have some musculoskeletal findings in common. Treatment based on these findings reduces neck pain as well as dizziness long-term but some patients might need a maintenance strategy.
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Tontura/fisiopatologia , Tontura/reabilitação , Músculo Esquelético/fisiopatologia , Músculos do Pescoço/fisiopatologia , Pescoço/fisiopatologia , Ombro/fisiopatologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/prevenção & controle , Exame Físico , Cefaleia Pós-Traumática/fisiopatologia , Propriocepção , Amplitude de Movimento Articular , Resultado do Tratamento , Articulação Zigapofisária/fisiopatologiaRESUMO
OBJECTIVE: We describe the neurologic, neuroradiologic, and ophthalmologic phenotype of 1 Swedish and 1 Finnish family with autosomal dominant ataxia-pancytopenia (ATXPC) syndrome and SAMD9L mutations. METHODS: Members of these families with germline SAMD9L c.2956C>T, p.Arg986Cys, or c.2672T>C, p.Ile891Thr mutations underwent structured interviews and neurologic and ophthalmologic examinations. Neuroimaging was performed, and medical records were reviewed. Previous publications on SAMD9L-ATXPC were reviewed. RESULTS: Twelve individuals in both families were affected clinically. All mutation carriers examined had balance impairment, although severity was very variable. All but 1 had nystagmus, and all but 1 had pyramidal tract signs. Neurologic features were generally present from childhood on and progressed slowly. Two adult patients, who experienced increasing clumsiness, glare, and difficulties with gaze fixation, had paracentral retinal dysfunction verified by multifocal electroretinography. Brain MRI showed early, marked cerebellar atrophy in most carriers and variable cerebral periventricular white matter T2 hyperintensities. Two children were treated with hematopoietic stem cell transplantation for hematologic malignancies, and the neurologic symptoms of one of these worsened after treatment. Three affected individuals had attention deficit hyperactivity disorder or cognitive problems. Retinal dysfunction was not previously reported in individuals with ATXPC. CONCLUSIONS: The neurologic phenotype of this syndrome is defined by balance or gait impairment, nystagmus, hyperreflexia in the lower limbs and, frequently, marked cerebellar atrophy. Paracentral retinal dysfunction may contribute to glare, reading problems, and clumsiness. Timely diagnosis of ATXPC is important to address the risk for severe hemorrhage, infection, and hematologic malignancies inherent in this syndrome; regular hematologic follow-up might be beneficial.
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CONCLUSION: Defective utricular function, reflected by deviation of the perceived visual horizontal or vertical, cannot by itself explain increased postural sway in the lateral direction for patients with unilateral vestibular deafferentation (uVD). OBJECTIVE: It is not known why some patients with chronic uVD report distressing unsteadiness while others do not. The objective of this study was to test the hypothesis that impaired utricular compensation, reflected by pathologic tilt in the subjective visual horizontal and vertical (SVH-V) test, would affect postural control in the lateral direction after uVD. PATIENTS AND METHODS: The SVH-V was tested in 28 patients 6 months after translabyrinthine surgery for unilateral vestibular schwannoma, and correlated with posturography results. RESULTS: No increase in lateral and anterior-posterior sway, or the quotients between them, or for Romberg quotients, was found with increasing SVH-V tilt.