ABSTRACT
Abstract Introduction: Neurotology is a rapidly expanding field of knowledge. The study of the vestibular system has advanced so much that even basic definitions, such as the meaning of vestibular symptoms, have only recently been standardized. Objective: To present a review of the main subjects of neurotology, including concepts, diagnosis and treatment of Neurotology, defining current scientific evidence to facilitate decision-making and to point out the most evidence-lacking areas to stimulate further new research. Methods: This text is the result of the I Brazilian Forum of Neurotology, which brought together the foremost Brazilian researchers in this area for a literature review. In all, there will be three review papers to be published. This first review will address definitions and therapies, the second one will address diagnostic tools, and the third will define the main diseases diagnoses. Each author performed a bibliographic search in the LILACS, SciELO, PubMed and MEDLINE databases on a given subject. The text was then submitted to the other Forum participants for a period of 30 days for analysis. A special chapter, on the definition of vestibular symptoms, was translated by an official translation service, and equally submitted to the other stages of the process. There was then a in-person meeting in which all the texts were orally presented, and there was a discussion among the participants to define a consensual text for each chapter. The consensual texts were then submitted to a final review by four professors of neurotology disciplines from three Brazilian universities and finally concluded. Based on the full text, available on the website of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery, this summary version was written as a review article. Result: The text presents the official translation into Portuguese of the definition of vestibular symptoms proposed by the Bárány Society and brings together the main scientific evidence for each of the main existing therapies for neurotological diseases. Conclusion: This text rationally grouped the main topics of knowledge regarding the definitions and therapies of Neurotology, allowing the reader a broad view of the approach of neurotological patients based on scientific evidence and national experience, which should assist them in clinical decision-making, and show the most evidence-lacking topics to stimulate further study.
Resumo Introdução: A otoneurologia é uma área de conhecimento que tem se expandido muito rapidamente. O estudo do sistema vestibular tem avançado tanto que mesmo definições básicas, como o significado dos sintomas vestibulares, foram apenas recentemente padronizadas. Objetivo: Apresentar uma revisão dos principais assuntos da otoneurologia, inclusive conceitos, diagnóstico e tratamento da otoneurologia, definir a evidência científica atual para facilitar a tomada de decisões e demonstrar as áreas mais carentes de evidência para estimular novas pesquisas. Método: Este texto é fruto do I Fórum Brasileiro de Otoneurologia, que reuniu os principais pesquisadores brasileiros dessa área para uma revisão da literatura. Serão feitos três trabalhos de revisão a serem publicados. Este primeiro abordou as definições e as terapias, o segundo abordará as ferramentas diagnósticas e o terceiro definirá os principais diagnósticos. Cada autor fez um levantamento bibliográfico na base de dados da Lilacs, SciELO, Pubmed e Medline de um determinado assunto. O seu texto foi então submetido aos demais participantes do Fórum por 30 dias para análise. Um capítulo especial, da definição dos sintomas vestibulares, foi traduzido por serviço de tradução oficial e igualmente submetido às demais etapas do processo. Houve então uma reunião presencial em que todos os textos foram apresentados oralmente e houve uma discussão entre os participantes para a definição de um texto consensual para cada capítulo. Os textos consensuais foram então submetidos a uma revisão final por quatro professores de otoneurologia de três universidades brasileiras e, por fim, finalizado. A partir do texto completo, publicado no site da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, foi escrita esta versão-resumo como artigo de revisão. Resultado: O texto apresenta a tradução oficial para o português da definição dos sintomas vestibulares propostos pela Barany Society e agrupa as principais evidências científicas para cada um das principais terapias existentes para as doenças otoneurológicas. Conclusão: Este texto agrupou de forma racional os principais tópicos de conhecimento a respeito das definições e terapias da otoneurologia, permite ao leitor uma visão ampla da abordagem dos pacientes otoneurológicos baseada em evidências científicas e experiência nacional, que deverá auxiliá-lo na tomada de decisões clínicas, e mostra os assuntos mais carentes de evidência para estimular novos estudos.
Subject(s)
Humans , Vestibular Diseases/diagnosis , Vestibular Diseases/therapy , Evidence-Based Medicine , Societies, Medical , Acute Disease , Chronic Disease , NeurotologyABSTRACT
PURPOSE: To evaluate the tissue response of the mucosa of the tympanic cavity of guinea pigs, when receiving biodegradable implant. METHODS: A total of 20 male guinea pigs were divided into 2 groups. After paracentesis in both ears, a biodegradable polymer of poly lactic-co-glycolic acid was implanted in only one middle ear. Histological analysis using neutrophil exudate and vascular neoformation (acute inflammation) and fibroblast proliferation and mononuclear inflammatory cells (chronic inflammation) as parameters was performed after 10 and 30 days of survival (groups 1 and 2, respectively). RESULTS: Four ears in group 1 and 7 in group 2 had an increase of neutrophil exudate. Vascular neoformation occurred in ears with or without the implant, in both groups. Fibroblast proliferation and mononuclear inflammatory cells (lymphocytes and macrophages) increased in ears with implant in group 2. CONCLUSION: The tissue response by histological analysis of the mucosa of the tympanic cavity of guinea pigs, when receiving biodegradable implant, showed no statistically significant difference between ears with or without the implant. .
Subject(s)
Animals , Guinea Pigs , Male , Absorbable Implants , Ear, Middle/drug effects , Lactates/therapeutic use , Polymers/therapeutic use , Thioctic Acid/analogs & derivatives , Biopolymers/therapeutic use , Exudates and Transudates , Ear, Middle/pathology , Fibroblasts/drug effects , Mucous Membrane/drug effects , Mucous Membrane/pathology , Neovascularization, Pathologic , Neutrophils/drug effects , Random Allocation , Reproducibility of Results , Time Factors , Thioctic Acid/therapeutic useABSTRACT
INTRODUCTION: Benign Paroxysmal Positional Vertigo (BPPV) is a very common vestibular disorder characterized by brief but intense attacks of rotatory vertigo triggered by simple rapid movement of the head. The integrity of the vestibular pathways can be assessed using tests such as digital vectoelectronystagmography (VENG) and vestibular evoked myogenic potentials (VEMP). AIM: This study aimed to determine the VEMP findings with respect to latency, amplitude, and waveform peak to peak and the results of the oculomotor and vestibular components of VENG in patients with BPPV. METHODS: Although this otoneurological condition is quite common, little is known of the associated VEMP and VENG changes, making it important to research and describe these results. RESULTS: We examined the records of 4438 patients and selected 35 charts after applying the inclusion and exclusion criteria. Of these, 26 patients were women and 9 men. The average age at diagnosis was 52.7 years, and the most prevalent physiological cause, accounting for 97.3% of cases, was ductolithiasis. There was a statistically significant association between normal hearing and mild contralateral sensorineural hearing loss. The results of the oculomotor tests were within the normal reference ranges for all subjects. Patients with BPPV exhibited symmetrical function of the semicircular canals in their synergistic pairs (p < 0.001). The caloric test showed statistically normal responses from the lateral canals. The waveforms of all patients were adequate, but the VEMP results for the data-crossing maneuver with positive positioning showed a trend toward a relationship for the left ear Lp13. There was also a trend towards an association between normal reflexes in the caloric test and the inter-peak VEMP of the left ear. It can be concluded that although there are some differences between the average levels of the VENG and VEMP results, these differences were not statistically significant. CONCLUSION: In...
Subject(s)
Male , Female , Middle Aged , Vertigo , Vestibular Evoked Myogenic Potentials , Vestibular Function Tests , Vestibular DiseasesABSTRACT
Vertigem Posicional Paroxística Benigna (VPPB) pode alterar o equilíbrio corporal em pacientes idosos. OBJETIVO: Observar os efeitos da manobra de Epley em idosos com VPPB, avaliando os aspectos clínicos e funcionais do equilíbrio corporal. Forma de estudo: clínico e prospectivo. MÉTODO: Após o diagnóstico da doença (teste de DixHallpike), os testes Time Up and Go (TUGT), Clinical test of Sensory Interaction and Balance (CTSIB) e o teste de membros inferiores (MMI) foram realizados antes e após a manobra de reposicionamento de Epley modificada. RESULTADOS: O gênero feminino foi o mais prevalente e a média etária foi de 70,10 anos (DP = 7,00). Todos os pacientes apresentaram ductolitíase de canal posterior. Os seguintes sintomas melhoraram após a manobra: a instabilidade postural (p = 0,006), náusea e vômito (p = 0,021) e zumbido (p = 0,003). Em relação ao TUGT e o escore do teste de MMII, observou-se diminuição significante do tempo pós-manobra de Epley (p < 0,001). Observou-se melhora no CTSIB pós-manobra de Epley nas condições 2 (p < 0,003), condição 3 (p < 0,001), condição 4 (p < 0,001), condição 5 (p < 0,001), e condição 6 (p < 0,001). CONCLUSÃO: Houve melhora nos aspectos clínicos e funcionais do equilíbrio corporal em idosos com VPPB após o tratamento com a Manobra de Epley modificada.
Benign paroxysmal positional vertigo (BPPV) may compromise the balance of elderly subjects. OBJECTIVE: To observe the effects of the Epley maneuver in elderly subjects with BPPV and assess clinical and functional aspects of body balance. METHOD: This is a prospective clinical study. Patients diagnosed with BPPV (Dix-Hallpike test) were submitted to the Timed Up & Go (TUG) test, the Clinical Test of Sensory Interaction and Balance (CTSIB), and lower limb testing before and after they were repositioned using the modified Epley maneuver. RESULTS: Most subjects were females, and the group's mean age was 70.10 years (SD = 7.00). All patients had canalithiasis of the posterior canal. The following symptoms improved after the maneuver: postural instability (p = 0.006), nausea and vomiting (p = 0.021), and tinnitus (p = 0.003). Subjects improved their times significantly in the TUG and lower limb tests after the Epley maneuver (p < 0.001). Patients performed better on the CTSIB after the Epley maneuver on condition 2 (p < 0.003), condition 3 (p < 0.001), condition 4 (p < 0.001), condition 5 (p < 0.001), and condition 6 (p < 0.001). CONCLUSION: Clinical and functional aspects of body balance in elderly with BPPV improved after treatment with the modified Epley maneuver.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Postural Balance/physiology , Sensation Disorders/physiopathology , Vertigo/physiopathology , Prospective Studies , Sensation Disorders/therapy , Treatment Outcome , Vertigo/therapyABSTRACT
OBJETIVO: Avaliar o número de manobras necessárias para abolir o nistagmo posicional em pacientes com Vertigem Posicional Paroxística Benigna e verificar possíveis influências do substrato fisiopatológico e/ou canal semicircular acometido. FORMA DE ESTUDO: clínico prospectivo com coorte transversal. MATERIAL E MÉTODO: Sessenta pacientes com Vertigem Posicional Paroxística Benigna foram tratados por meio das manobras de reposicionamento de estatocônios, repetidas semanalmente até a abolição do nistagmo. A Análise de Variância foi aplicada para verificar diferenças entre as variáveis dos fatores "substrato fisiopatológico" e "canal semicircular acometido". RESULTADOS: Foram necessárias de 1 a 8 manobras, em média 2,13 para abolir o nistagmo posicional. A cupulolitíase necessitou de um número maior de manobras que a ductolitíase (p=0,0002*) e não houve diferença entre os canais semicirculares (p=0,5213). Nos canais anterior e posterior, a ductolitíase precisou em média de uma a duas manobras e a cupulolitíase precisou em média de três manobras. No canal lateral, tanto a ductolitíase quanto a cupulolitíase precisaram de duas manobras, em média. CONCLUSÕES: São necessárias de uma a oito manobras semanais de reposicionamento de estatocônios, em média duas, para eliminar o nistagmo posicional na Vertigem Posicional Paroxística Benigna. A cupulolitíase necessita de maior número de manobras que a ductolitíase. O canal semicircular acometido não influencia o número de manobras terapêuticas.
AIM: To evaluate the number of weekly canalith repositioning procedures needed to eliminate positioning nystagmus in patients with benign paroxysmal positional vertigo and to verify influences of canalithiasis or cupulolithiasis and/or semicircular canal involvement. STUDY DESIGN: clinical prospective with transversal cohort. MATERIAL AND METHOD: Sixty patients with benign paroxysmal positional vertigo were consecutively selected according to each combination of canalithiasis or cupulolithiasis with semicircular canal involvement. Patients were treated by means of canalith repositioning procedures repeated weekly until the elimination of the positioning nystagmus. Analysis of Variance was used to verify differences between the variables. RESULTS: An average of 2.13 procedures (from 1 to 8) was needed to eliminate the positioning nystagmus. Canalithiasis required an average of 1.53 procedures, while cupulolithiasis needed 2.92 procedures (p=0.0002). An average of two procedures was needed to eliminate the positioning nystagmus in cases with posterior canal involvement, 2.39 procedures in cases with anterior canal involvement and 2.07 procedures in cases with lateral canal involvement (p=0.5213). CONCLUSIONS: From one to eight weekly canalith repositioning procedures were needed, with an average of two, to eliminate positioning nystagmus in benign paroxysmal positional vertigo. Cupulolithiasis requires a greater number of procedures than canalithiasis to eliminate positioning nystagmus. Semicircular canal involvement didn't influence the number of therapeutic maneuvers.