RESUMO
PURPOSE: Computerized posturography is the gold standard for balance assessment. Because of the great cost and dimensions of commercial equipments, low-cost and portable devices have been developed and validated, such as RombergLab, a software in open source term which works connected with a low-cost force platform. The objective of this study was to obtain normative posturography data using this software. METHODS: A multicentric prospective and descriptive study, with 350 healthy participants, was designed. Static postural stability (measured using the modified clinical test of sensory interaction on balance) was evaluated using the software connected to the force platform. Using the confidence ellipse area (CEA) in each condition, global equilibrium score (GES) was calculated and adjusted for significant variable factors using cluster analysis. RESULTS: Mean (SD) GES was 0.72 (0.22). Age (p < 0.01), height (p < 0.01) and recruitment center (p < 0.05) were found as influence factors for GES. Cluster analysis obtained 16 groups stratified by age and height. GES decreases with age and height (p < 0.005). No significant interaction of age nor height was found with GES in these clusters (p > 0.05). After correction for height and age, GES was no longer influenced by the recruitment center (p > 0.05). CONCLUSIONS: With the introduction of the global equilibrium score values of the present study into the software, we consider RombergLab v1.3 a reference posturography tool for healthy individuals. Further studies are needed for validating it as a suitable instrumented test for screening between healthy and pathologic subjects and its reliability over time for the follow-up of patients.
Assuntos
Diagnóstico por Computador/métodos , Técnicas de Diagnóstico Neurológico , Equilíbrio Postural/fisiologia , Software , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Valores de Referência , Reprodutibilidade dos Testes , Adulto JovemRESUMO
A 52-year-old man presented with left hemifacial spasm (HFS). A magnetic resonance imaging scan showed compression of the left facial nerve at the cerebellopontine angle by a dolichoectatic basilar artery. The neurotological evaluation showed an otolithic deficit, with canalicular preservation and normal hearing. The deficit improved after surgical decompression. No previous report has described the impairment of vestibular function in patients presenting with HFS.
Assuntos
Nervo Facial/cirurgia , Espasmo Hemifacial/etiologia , Insuficiência Vertebrobasilar/complicações , Doenças Vestibulares/fisiopatologia , Ângulo Cerebelopontino/irrigação sanguínea , Ângulo Cerebelopontino/diagnóstico por imagem , Descompressão Cirúrgica/métodos , Nervo Facial/patologia , Audição/fisiologia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/etiologia , Membrana dos Otólitos/anormalidades , Resultado do Tratamento , Doenças Vestibulares/diagnóstico , Potenciais Evocados Miogênicos Vestibulares/fisiologiaRESUMO
OBJECTIVE: Laryngopharyngeal Reflux (LPR) is a disease characterized by the presence of symptoms, signs and tissue alterations in the aero-digestive upper tract as a consequence of the gastric contents retrograde movement. In most cases diagnosis is clinical and it is established by the presence of symptoms and endoscopic laryngeal signs. The aim of the study was to determine the sensitivity, specificity, positive and negative Likelihood Ratio (LR) of the salivary pepsin assay (PEP-test, RD Biomed, Hull, UK) as diagnostic tool of LPR. STUDY DESIGN: Diagnostic Accuracy Study. METHOD: 221 subjects aged between 26 and 68 years were recruited. All subjects completed the Reflux Symptom Index scale. PEP-test was carried out on fasting subjects, and a second test was performed one hour after the main meal, only on those subjects with a fasting negative result. RESULTS: Fasting PEP-test showed a 98% specificity, 40% sensitivity, positive LR of 16.4 and negative LR of 0.61. The use of both PEP-test showed a 95% specificity, 48% sensitivity, positive LR of 9.61 and negative LR of 0.55. CONCLUSIONS: The PEP-test is a simple, inexpensive, non-invasive and easily reproducible test that should be considered as an alternative diagnosis tool for LPR diagnosis. When there is a clinical suspicion of LPR disease, a positive result on the test could be considered diagnostic, but on subjects with negative results it should be complemented with more complex tests such as the 24-hour dual-channel pH-metry.
Assuntos
Ensaios Enzimáticos Clínicos , Refluxo Laringofaríngeo/diagnóstico , Pepsina A/análise , Saliva/enzimologia , Adulto , Idoso , Biomarcadores/análise , Feminino , Humanos , Imunoensaio , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos TestesRESUMO
OBJECTIVES: This study aimed to determine whether, in asymmetric hearing loss, the presence of an ear with a better or worse hearing threshold is related to either better or worse speech-in-noise (SiN) intelligibility. MATERIALS AND METHODS: A total of 618 subjects with different degrees of hearing loss were evaluated for their ability to understand SiN. A stepwise forward logistic regression analysis was performed to identify the factors that affect performance. The influencing factors of very high or very low performance were determined. RESULTS: Age, especially after 70 years of age, and hearing loss, especially from moderate hearing loss, negatively influence SiN intelligibility. Remarkably high intelligibility was identified in subjects with a contralateral ear presenting a better auditory threshold. CONCLUSION: Although age and hearing loss are known factors that affect SiN intelligibility, the presence of a healthy contralateral ear is presented as the first description of preservation of SiN hearing ability.
Assuntos
Compreensão/fisiologia , Perda Auditiva/fisiopatologia , Ruído , Inteligibilidade da Fala/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Audiometria de Tons Puros , Limiar Auditivo/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
The caloric test is widely used to assess vestibular function, but the conditions in which it is performed can vary. Caloric nystagmus obtained in 57 healthy subjects were compared: 24 subjects studied in ideal conditions and 33 subjects in non-ideal conditions. A statistically significant decrease in the slow phase velocity of the 4 irrigations performed on the subjects in non-ideal conditions was observed. This must be considered, especially in subjects with suspected bilateral involvement. Stringent conditions reduce the risk of misdiagnosis with bilateral deficit.
Assuntos
Testes Calóricos/métodos , Nistagmo Fisiológico/fisiologia , Adulto , Testes Calóricos/normas , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Reprodutibilidade dos Testes , Projetos de PesquisaRESUMO
OBJECTIVE: To analyze the frequency in which vibration-induced nystagmus (VIN) with ipsilesional direction appears in subjects with Ménière's disease (MD) or vestibular schwannoma (VS). STUDY DESIGN: Cross-sectional study. SETTING: Tertiary referral center. PATIENTS: Fifty-two subjects with MD and 21 subjects with vestibular schwannoma. INTERVENTION: Videonystagmographic recordings of VIN at 30, 60, and 100âHz. MAIN OUTCOME MEASURES: Direction and slow phase velocity of VIN at 30, 60, and 100âHz. RESULTS: Ipsilesional Nystagmus was observed in 8 of 52 subjects with MD (15.4%) and in 11 of 21 subjects affected of unilateral VS (52.4%). Ipsilesional nystagmus was significantly higher in patients with VS (pâ=â0.003). The frequency of appearance of ipsilesional nystagmus in the subjects with VS who has not been treated was significantly higher than those who underwent radiosurgery (84.6% vs 0%, pâ=â0.046). CONCLUSION: Ipsilesional vibration-induced Nystagmus can be present in subjects with vestibular deficits caused by MD and VS.
Assuntos
Doença de Meniere/complicações , Neuroma Acústico/complicações , Nistagmo Patológico/etiologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , VibraçãoRESUMO
A cholesteatoma is a relatively common condition within the middle ear cavity, whereas a cholesteatoma of the squamous part of the temporal bone is an exceptionally rare entity. A case of an iatrogenic cholesteatoma located in the squamous part of the temporal bone is presented, which was revealed by an intermittent purulent discharge from an opening above the right ear 20 years after retroauricular myringoplasty. The diagnosis of an iatrogenic cholesteatoma is often made after several years of evolution, sometimes even at the stage of complications. This set the importance of the otoscopic and radiological regular monitoring of patients who have undergone a surgery of the temporal bone.
Assuntos
Doenças Ósseas/etiologia , Colesteatoma/etiologia , Miringoplastia/efeitos adversos , Osso Temporal , Adulto , Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/cirurgia , Colesteatoma/diagnóstico por imagem , Colesteatoma/cirurgia , Feminino , Humanos , Doença Iatrogênica , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To assess the effectiveness and response over time of intratympanic dexamethasone on the symptoms of Meniere's disease. MATERIALS AND METHODS: We performed a matched cohort study of 24 patients with Meniere's disease who were unresponsive to initial treatment and underwent 3 sessions of weekly intratympanic dexamethasone injections using a concentration of 16 mg/mL and 24 matched controls with the same characteristics with regard to vertigo spells. RESULTS: Compared with control subjects, intratympanic dexamethasone injections resulted in a decrease in the frequency of vertigo spells in the first 6-month period. In the dexamethasone-treated group, a ≥60% decrease in vertigo spells was achieved by 70.8% of patients in the first 6 months. Total remission was achieved by 20.8% of patients in the first 8 months, but after this, the effect tapered. A slight improvement in Tinnitus loudness and no changes in hearing levels were found. The stage of Meniere's disease, years from disease onset, and mean number of vertigo spells per month did not have any effects on the percentage of decrease in vertigo spells. CONCLUSION: Intratympanic dexamethasone temporarily reduces the frequency of vertigo spells during the initial months but does not remove the probability of having further spells in the future. This therapy provides a valuable tool to accomplish a rapid decrease in vertigo spells in subjects with Meniere's disease, and it is considered an alternative to chemical or surgical labyrinthectomy.
Assuntos
Dexametasona/administração & dosagem , Injeção Intratimpânica , Doença de Meniere/diagnóstico , Doença de Meniere/tratamento farmacológico , Testes de Função Vestibular , Adulto , Idoso , Estudos de Coortes , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Zumbido/diagnóstico , Zumbido/tratamento farmacológicoRESUMO
OBJECTIVE: Velocity storage mechanism is a multisensory rotation estimator; it compensates for errors in the information provided by the peripheral vestibular organs by means of an adjustment in the duration of the vestibular signal. The aim of this study was to determine the activity of the velocity storage mechanism in the presence of a labyrinthine disorder, using galvanic vestibular stimulation to cause direct activation of the vestibular afferent neurons. MATERIALS AND METHODS: Forty-one subjects with definite Meniere's disease (MD) and 36 healthy volunteers were evaluated using a 20-s galvanic vestibular stimulation. RESULTS: We found a post-stimulus nystagmus overshoot exclusively in subjects with MD (47% in subjects with unilateral disease and 82% in subjects with bilateral disease), but no overshoot in healthy subjects. CONCLUSION: Because post-stimulus nystagmus overshoot is caused by the velocity storage mechanism, this finding suggests an increase in the velocity storage in subjects with a labyrinthine disease.