Comparação do nível de confiança para realização de atividades diárias pré e pós reabilitação vestibular em pacientes com disfunção vestibular / Comparison of the level of confidence to perform daily activities before and after vestibular rehabilitation in patients with vestibular dysfunction / Comparación del nivel de confianza para la realización de actividades diarias antes y después de la rehabilitación vestibular en pacientes con disfunción vestibular

Introdução: A reabilitação vestibular (RV) surge como uma opção terapêutica em casos de tontura e desequilíbrio postural. O The Activities-specific Balance Confidence Scale (ABC Scale) é um questionário utilizado para avaliar a interferência destes sintomas vestibulares por meio do nível de confiança dos indivíduos em realizar atividades diárias que envolvem o equilíbrio postural. Objetivo: comparar o nível de confiança na realização de atividades diárias relacionadas ao equilíbrio corporal, pré e pós reabilitação vestibular (RV) em pacientes com disfunção vestibular. Método: Estudo primário, intervencional, clínico, longitudinal, prospectivo, analítico, não controlado. Participaram 14 indivíduos, do sexo feminino e masculino, portadores de vestibulopatia periférica. Foi aplicado o Activities-specific Balance Confidance Scale (ABC Scale) nas condições pré e pós RV. Os dados foram analisados de forma descritiva e inferencial, pelos testes Exato de Fisher, t-Sudent e o modelo linear de efeitos mistos. Resultados: A amostra se caracterizou por 78.57% do sexo feminino e 21.43% do sexo masculino, com média de idade de 59.21 anos. Observou-se diferença estatística quando comparados os resultados do ABC Scale nas condições pré e pós RV (p<0.0001). Não foi verificada diferença estatística entre os escores deste instrumento com as variáveis sexo, idade e número de sessões terapêuticas. Conclusão: Foi possível concluir que o nível de confiança dos pacientes dessa amostra modificou de baixo, na fase pré reabilitação, para alto, na fase final da intervenção, o que consolida a ocorrência do aumento no nível de confiança que acarretou melhoria na qualidade de vida. (AU)

Introduction: Vestibular rehabilitation (VR) appears as a therapeutic option in cases of dizziness and postural imbalance. The Activities-specific Balance Confidence Scale (ABC Scale) is a questionnaire used to assess the interference of these vestibular symptoms with the individuals' level of confidence to carry out daily activities involving postural balance. Objective: to compare the level of confidence to carry out daily activities related to body balance, before and after VR, in patients with vestibular dysfunction. Method: Primary, interventional, clinical, longitudinal, prospective, analytical, and noncontrolled study. The sample comprised 14 male and female individuals with peripheral vestibulopathy. The ABC Scale was applied before and after VR. Descriptive and inferential data analysis were performed, using Fisher's Exact test, Student's t-test, and the linear mixed-effects model. Results: The sample had 78.57% females and 21.43% males, with a mean age of 59.21 years. There was a statistical difference in ABC Scale results before and after VR (p < 0.0001). There was no statistical difference between its scores and sex, age, or the number of therapy sessions. Conclusion: It was concluded that this study patients' confidence level changed from low in the pre-rehabilitation phase, to high in the final phase of the intervention, which consolidates the increase in confidence level that led to an improvement of quality of life. (AU)

Introducción: La rehabilitación vestibular (RV) aparece como una opción terapéutica en casos de mareos y desequilibrio postural. La Escala de Confianza en el Equilibrio Específica de Actividades (Escala ABC) es un cuestionario utilizado para evaluar la interferencia de estos síntomas vestibulares a través del nivel de confianza de los individuos en la realización de actividades diarias que involucran el equilibrio postural. Objetivo: comparar el nivel de confianza en la realización de actividades cotidianas relacionadas con el equilibrio corporal, pre y post rehabilitación vestibular (RV) en pacientes con disfunción vestibular. Método: Estudio primario, intervencionista, clínico, longitudinal, prospectivo, analítico, no controlado. Participaron 14 individuos, hombres y mujeres y con vestibulopatía periférica. La Escala de Confianza del Equilibrio Específica de Actividades (Escala ABC) se aplicó en condiciones previas y posteriores a la RV. Los datos fueron sometidos a análisis descriptivo e inferencial mediante la prueba exacta de Fisher, t-Sudent y el modelo lineal de efectos mixtos. Resultados: La muestra se caracterizó por 78,57% del sexo femenino y 21,43% del masculino, con una edad media de 59,21 años. Hubo diferencia estadística al comparar los resultados de la Escala ABC en condiciones pre y post RV (p<0,0001). No hubo diferencia estadística entre los puntajes de este instrumento con las variables sexo, edad y número de sesiones terapéuticas. Conclusión: Fue posible concluir que el nivel de confianza de los pacientes de esta muestra pasó de bajo, en la fase de pre-rehabilitación, a alto, en la fase final de la intervención, lo que consolida la ocurrencia del aumento en el nivel de confianza que llevó a una mejora en la calidad de vida. (AU)

Subjective Visual Vertical and Vestibular Evoked Myogenic Potential in Meniere's disease,

Abstract Objective To evaluate otolith function by comparing the findings of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential and the ocular Vestibular Evoked Myogenic Potential tests in patients in the inter-crisis period of unilateral definite Meniere's disease. Methods The sample consisted of an experimental group (n = 22; 10 men and 12 women, mean age 47.32 ± 12.82 years) with definite unilateral Meniere's disease and a control group (n = 14; 5 men and 9 women, with a mean age of 41.64 ± 13.45 years). They all underwent vestibular evaluation by means of Subjective Visual Vertical with the bucket method and, cervical and ocular Vestibular Evoked Myogenic Potential tests. The data were collected and subjected to statistical analysis. Results The results of the comparison of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential, the ocular Vestibular Evoked Myogenic Potential and, the association of cervical Vestibular Evoked Myogenic Potential with the ocular Vestibular Evoked Myogenic Potential showed no significant difference, indicating concordance among the tests. Conclusion The identified abnormalities and the concordance between the combined proportion of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential and the ocular Vestibular Evoked Myogenic Potential findings indicate that the association of these three tests contributes to the identification of sustained and transient otolith dysfunction in the inter-crisis of unilateral definite Meniere's disease. Level of evidence 2.

Relação entre a idade, o risco de queda e o nível de confiança no equilíbrio corporal com a função dos canais semicirculares / Relationship between age, the risk of falling and level of confidence in body balance with semicircular canal function

RESUMO Objetivo verificar a relação entre o risco de queda, o nível de confiança nas atividades que envolvem equilíbrio e a idade com os valores de ganho e simetria dos canais semicirculares (CSCs), por meio do Vídeo Teste do Impulso Cefálico (vHIT), em pacientes com disfunção vestibular periférica. Método estudo transversal, composto por 12 indivíduos submetidos à avaliação funcional por meio da Activities-specific Balance Confidance Scale (ABC Scale) e do Dynamic Gait Index (DGI) e avaliação vestibular com o vHIT. Os resultados foram comparados por meio do Coeficiente de Correlação de Spearman. Resultados observou-se predomínio do gênero feminino (75%), com média de idade de 59 anos e 8 meses. A média de escore no DGI foi de 19,70 pontos e 43,65% na ABC Scale, característico de baixo nível de confiança. Observou-se correlação de grau moderado entre os parâmetros idade com o DGI, DGI e ABC Scale com os valores de ganho e simetria dos CSCs do vHIT. Conclusão Observaram-se relações entre o maior risco de queda em pacientes com hipofunção vestibular e idade avançada e entre o baixo nível de confiança para realizar atividades diárias diante da assimetria de ganho dos CSCs.

ABSTRACT Purpose to verify the relationship between the risk of falling, the level of confidence in activities involving balance, and age with the values of gain and symmetry of the semicircular canals (SSCs), using the Head Video Impulse Test (vHIT) in patients with peripheral vestibular dysfunction. Methods Cross-sectional study in 12 individuals submitted to functional evaluation using the Activities-specific Balance Confidence Scale (ABC Scale) and the Dynamic Gait Index (DGI), and vestibular evaluation with vHIT. The results were compared using Spearman's Correlation Coefficient. Results There was a predominance of females (75%), with a mean age of 59 years and 8 months. The mean score in DGI was 19.70 points and on the ABC Scale, 43.65%, which is characteristic of a low confidence level. A moderate correlation was observed between age and DGI and between DGI and ABC Scale and SCC gain and symmetry values with vHIT. Conclusion A relationship was observed between a higher risk of falling in patients with vestibular hypofunction and advanced age and between a low level of confidence to perform daily activities due to asymmetrical SCC gain.

Resonancia magnética de alta definición para la evaluación de trastornos laberínticos / High definition magnetic resonance imaging for the evaluation of labyrinthic disorders

Resumen Objetivo: Describir los hallazgos en resonancia magnética (RM) en lesiones intralaberínticas. Methods: Se incluyeron pacientes evaluados entre enero de 2012 y marzo de 2019 que se sometieron a una RM del oído interno. Se recogieron datos demográficos y de imagen. Las RM incluyeron secuencias ponderadas en T2 de alta resolución (T2 AR), secuencias ponderadas en T1 sin contraste (T1 SC) y secuencias ponderadas en T1 con contraste (T1 CC). Resultados: Se analizaron las imágenes de RM de 23 pacientes con una mediana de edad de 60 años (rango: 43-73). Encontramos 8 (34,8%) pacientes con neurinoma intralaberíntico, 7 (30,4%) con laberintitis inflamatoria, 5 (21,7%) con laberintitis osificante y 3 (13%) con hemorragia intralaberíntica. Todos los pacientes con neurinoma intralaberíntico tenían una baja señal en la secuencias T2 AR, ligera hiperseñal en las secuencias T1 SC y realce poscontraste. Tres pacientes (42,5%) con laberintitis inflamatoria tenían baja señal en las secuencias T2 AR y 5 (71%) tenían realce en las secuencias T1 CC. Los pacientes con laberintitis osificante tenían una baja señal en las secuencias T2 AR y los pacientes con hemorragia tenían una señal alta en las secuencias T1 SC. Los pacientes con neurinoma intralaberíntico tenían señal más baja en T2 AR que los pacientes con laberintitis inflamatoria (p = 0,026). Conclusiones: Existen diferentes condiciones que pueden alterar la señal del laberinto en la RM. El patrón radiológico permite establecer su diagnóstico. La investigación proporciona información relevante para la interpretación de las alteraciones de la señal del laberinto membranoso en la RM.

Abstract Objective: The objective of this investigation is to describe the findings in magnetic resonance imaging (MRI) in intralabyrinthine lesions. Method: We included patients evaluated between January 2012 and March 2019 who underwent an MRI of the inner ear. Demographic and image data were collected. MRI included high-resolution T2 (HR-T2), non-contrast T1 (NC-T1) and contrast-enhanced T1 (CE-T1). Results: MRI images of 23 patients were analyzed. The median age was 60 years (range: 43-73). We found 8 (34.8%) patients with intra-labyrinthine neurinoma, 7 (30.4%) patients with inflammatory labyrinthitis, 5 (21.7%) with ossifying labyrinthitis and 3 (13%) with intra-labyrinthine hemorrhage. All patients with intra-labyrinthine neurinoma had a low signal in HR-T2, a slight high signal in NC- T1 and post-contrast enhancement. Three patients with inflammatory labyrinthitis (42.5%) had low signal in HR-T2 and 5 patients (71%) had enhancement with CE-T1. Patients with ossifying labyrinthitis had a low signal in HR-T2 and patients with hemorrhage had high signal in NC-T1. Patients with intra-labyrinthine neurinoma had a lower signal in HR-T2 than patients with inflammatory labyrinthitis (p = 0.026). Conclusions: There are multiple entities that can alter the labyrinth signal in MRI. The radiological pattern allows establishing their diagnosis. The research provides relevant information for the interpretation of the alterations of the membranous labyrinth signal in MRI.

Análise das respostas do VEMP cervical e ocular em indivíduos hígidos / Analysis of cervical and ocular VEMP responses in healthy individuals / Análisis de las respuestas VEMP cervicales y oculares en individuos sanos

Introdução: os potenciais evocados miogênicos vestibulares (VEMP) são respostas eletrofisiológicas que conseguem fornecer informações dos órgãos otolíticos sáculo, utrículo e do nervo vestibular. O VEMP é um exame complementar à avaliação vestibular, consistindo num exame rápido, de fácil aplicação e objetivo. Objetivo: analisar os parâmetros de latência, amplitude, limiar e índice de assimetria das respostas do VEMP cervical (cVEMP) e ocular (oVEMP) de indivíduos sem queixas vestibulares. Métodos: estudo transversal realizado com 53 indivíduos de ambos os sexos, sem queixas auditivas e vestibulares. Resultados: encontrou-se simetria de respostas nas latências, amplitudes e limiares de respostas do exame cVEMP. Entretanto, verificou-se diferença entre orelhas da latência P15 do exame oVEMP, sendo maior à direita no sexo feminino. Conclusão: Encontrou-se simetria nas respostas de todos os parâmetros avaliados do cVEMP. Houve assimetria apenas na latência de P15 do oVEMP no sexo feminino. Os limiares de resposta encontrados nos exames cVEMP e oVEMP foram iguais ou maiores que 75 dBNA.

Introduction: Vestibular evoked myogenic potentials (VEMP) are electrophysiological responses that can provide information on the otolithic organs saccule, utricle and of the vestibular nerve. VEMP is a complementary exam to the vestibular assessment; it is a quick exam, easy to apply and objective. Purpose: to analyze the parameters of latency, amplitude, threshold and asymmetry index of the cervical (cVEMP) and ocular VEMP (oVEMP) responses of individuals without vestibular complaints. Methods: cross-sectional study carried out with 53 individuals of both genders without hearing and vestibular complaints. Results: response symmetry was found in the latencies, amplitudes and thresholds of cVEMP test responses. However, there was a difference between the ears of the P15 latency of the oVEMP exam, and this was greater on the right ear in females. Conclusion: symmetry was found in the responses of all cVEMP evaluated parameters. There was asymmetry in oVEMP P15 latency only in female patients. The response thresholds found in the cVEMP and oVEMP tests were equal or greater than 75 dBHL.

Introducción: los potenciales miogénicos evocados vestibulares (VEMP) son respuestas electrofisiológicas que pueden proporcionar información sobre los órganos otolíticos el sáculo, el utrículo y el nervio vestibular. El VEMP es un examen complementario a la evaluación vestibular; es un examen rápido, fácil de aplicar y objetivo. Objetivo: analizar los parámetros de latencia, amplitud, umbral e índice de asimetría de las respuestas VEMP cervical (cVEMP) y ocular (oVEMP) de individuos sin quejas vestibulares. Métodos: estudio transversal realizado con 53 individuos de ambos sexos, sin quejas auditivas y vestibulares. Resultados: Se encontró simetría de respuestas en las latencias, amplitudes y umbrales de respuestas en el examen cVEMP. Sin embargo, hubo una diferencia entre los oídos de la latencia P15 del examen oVEMP, siendo mayor a la derecha en el sexo femenino . Conclusión: se encontró simetría en las respuestas de todos los parámetros evaluados de cVEMP. Hubo asimetría solo en la latencia P15 de oVEMP en el sexo femenino. Los umbrales de respuesta encontrados en las pruebas cVEMP y oVEMP fueron iguales o superiores a 75 dBHL.

Abnormal findings on digital vectoelectronystagmography in patients with temporomandibular disorders

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.

Stabilometric changes due to exposure to firearm noise in the Brazilian Army / Alterações estabilométricas produzidas na exposição ao ruído de arma de fogo em militares do Exército Brasileiro

Success in precision activities such as shooting depends on the subtle control of body motion. This study aimed to evaluate the influence on stabilometric signal responses for the motor task of aiming a pistol with different cognitive demands and levels of exposure to high sound pressure in Brazilian Army personnel. This cross-sectional analytical study used stabilometry to quantify the behavior of the body during motor, cognitive, and auditory tasks. Twenty-five volunteers recruited to participate in the study completed a questionnaire, underwent anthropometric evaluation and cinemetry, and scored the perceived difficulty during exposure to a sound pressure of 132 dB while using protective equipment. A significant increase in the displacement (p=0,02), anteroposterior amplitude (p=0,01), anteroposterior velocity (p=0,01), and the perceived difficulty scale (p=0,03) between Situation 1 (aiming without other cognitive action or environmental noise) and Situation 3 (shooting noise and progressive counting) was confirmed. number of shots heard). Correlation between the perceived difficulty scale and the variables of displacement (p=0,01), anteroposterior amplitude (p=0,01), area (p=0,006) and anteroposterior mean frequency (p=0,01) were observed. The accuracy of aiming events correlated with the median lateral median frequency (p=0,02). Stabilometric signals demonstrated increased total displacement, anteroposterior amplitude, and anteroposterior velocity in the presence of high sound pressure levels. These results indicate the need for future studies to investigate the underlying mechanisms of possible vestibular damage induced by noise.

O sucesso em atividades de precisão, como o tiro, depende do sutil controle das oscilações corporais.Analisar a influência nas respostas do sinal estabilométrico para a tarefa motora de pontaria com pistola, acrescidas de diferentes demandas cognitivas e exposição ao nível de pressão sonora elevado, em militares do Exército Brasileiro.Estudo de caráter transversal analítico utilizou a estabilometria para quantificar o comportamento do corpo durante três situações de pontaria distintas (variando tarefas motoras, cognitivas e auditivas). Vinte e cinco voluntários foram submetidos à pesquisa e utilizou-se: questionário, avaliação antropométrica, cinemetria, escala de dificuldade percebida e exposição ao nível de pressão sonora de 132 dB, com uso do equipamento de proteção individual. Confirmou-se um aumento significativo nas variáveis de deslocamento (p=0,02), amplitude anteroposterior (p=0,01), velocidade anteroposterior (p=0,01) e a escala de dificuldade percebida (p=0,03) entre a Situação 1 (pontaria sem outra ação cognitiva ou ruído ambiental) e a Situação 3 (pontaria com ruído de tiros e contagem progressiva do número de disparos ouvidos). Observou-se correlação entre escala de dificuldade percebida e as variáveis deslocamento (p=0,01), amplitude anteroposterior (p=0,01), área (p=0,006) e frequência média anteroposterior (p=0,01). A precisão dos eventos de pontaria se correlacionou com a frequência mediana médio lateral (p=0,02).Os sinais estabilométricos demonstraram um aumento nas oscilações do deslocamento total, amplitude ântero-posterior e a velocidade ântero-posterior, na presença de um nível de pressão sonora elevado. O resultado motiva a expansão de estudos futuros, visando averiguar os mecanismos subjacentes dos possíveis danos vestibulares induzidos por ruído.

Video head impulse test (v-hit) em indivíduos com diabetes mellitus tipo 1 / Video head impulse test (v-hit) in individuals with type 1 diabetes mellitus

RESUMO Objetivo Verificar a função dos canais semicirculares do labirinto de indivíduos com diabetes tipo 1, submetidos ao Video Head Impulse Test (v-HIT), e compará-los com indivíduos sem diabetes. Métodos Estudo transversal, observacional, analítico, realizado com uma amostra de conveniência, formada por 35 indivíduos diabéticos e 100 não diabéticos. Todos os participantes foram submetidos à avaliação vestibular por meio do v-HIT. Resultados A casuística foi composta por 135 participantes, divididos em dois grupos. O grupo de estudo foi composto por indivíduos com diabetes tipo 1, totalizando 21 mulheres e 14 homens. A idade variou entre 18 e 71 anos, com média de 35,37 anos e desvio padrão de 10,98. O grupo sem diabetes foi composto por 77 mulheres e 23 homens. A idade variou entre 20 e 83 anos, com média de 46,44 e desvio padrão de 19,82. Os grupos foram pareados entre si, com relação à idade (p=0,098) e sexo (p=0,052). Os pacientes diabéticos apresentaram ganho diminuído nos canais semicirculares posteriores e anterior esquerdo. A velocidade apresentou diferença significativa nos canais lateral esquerdo, anterior direito e posterior esquerdo no grupo com diabetes mellitus tipo 1, porém não apresentou correlação com o ganho dos canais semicirculares. Conclusão Os participantes com diabetes mellitus tipo 1 apresentaram um ganho diminuído nos canais semicirculares posteriores e no canal anterior esquerdo quando comparados com indivíduos não diabéticos.

ABSTRACT Purpose To verify the function of the labyrinth semicircular channels of type 1 diabetes individuals submitted to the Video Head Impulse Test (v-HIT) and to compare them with individuals without diabetes. Methods Cross-sectional, observational, analytical study conducted with a convenience sample of 35 diabetic and 100 non-diabetic individuals. All participants were submitted to vestibular evaluation using v-HIT. Results The sample consisted of 135 participants divided into two groups. The study group was composed of individuals with type 1 diabetes, totaling 21 women and 14 men. The age range was between 18 and 71 years, with a mean of 35.37 years and standard deviation of 10.98. The group without diabetes was composed of 77 women and 23 men. The age range was between 20 to 83 years, with a mean of 46.44 and standard deviation of 19.82. The groups were matched for age (p=0.098) and gender (p=0.052). Diabetic patients showed decreased gain in the posterior and left anterior semicircular canals. Velocity showed a significant difference in the left lateral, anterior right and posterior left canals in the group with DM1, however velocity did not show correlation with the gain of the semicircular canals. Conclusion participants with type 1 diabetes mellitus showed a decreased gain in the posterior semicircular canals and in the left anterior canal when compared to non-diabetic individuals.

Association between diabetes and vestibular dysfunction: an integrative review / Associação entre diabetes e disfunções do sistema vestibular: revisão integrativa

ABSTRACT Purpose: to identify, in the literature, the factors associated with the development of vestibular dysfunctions in individuals with type 2 diabetes mellitus (DM2). Methods: an integrative review of the literature, whose survey was conducted in the databases ISI, SciELO, LILACS and PubMed, using the following descriptors: "type 2 diabetes mellitus", "vertigo", "dizziness", and "vestibular diseases". Articles published in the last 10 years that answered the research question ("What factors are associated with the development of vestibular disorders in individuals with DM2?") were included in the study. Results: the search returned 426 articles, 10 of which met the eligibility criteria. Most of the participants of the selected studies who had vestibular dysfunctions were women over 40 years old and had more than one comorbidity related to DM2, the main one being the systemic arterial hypertension (SAH). According to the literature, the physiology of the inner ear allows small glucose alterations to influence its normal functioning, which makes diabetic individuals more susceptible to developing vestibular dysfunctions. Conclusion: according to this study, DM2 can trigger or contribute to the manifestation of vestibular dysfunction, whose main associated factors are advanced age, female gender, and various comorbidities, as dyslipidemia, SAH and metabolic syndrome.

RESUMO Objetivo: identificar na literatura os fatores que estão associados ao desenvolvimento de disfunções vestibulares em indivíduos com diabetes mellitus tipo 2 (DM2). Métodos: trata-se de uma revisão integrativa da literatura, cuja busca foi realizada nas bases de dados ISI, Scielo, LILACS e PubMed, sendo utilizados os descritores: "type 2 diabetes mellitus", "vertigo", "dizziness" e "vestibular diseases". Foram incluídos artigos publicados nos últimos dez anos e que respondessem a seguinte questão: quais fatores estão associados ao desenvolvimento de disfunções vestibulares em indivíduos com DM2? Resultados: a busca resultou em 426 artigos, sendo que 10 atenderam aos critérios de elegibilidade. A maioria dos participantes dos estudos selecionados que apresentaram disfunções vestibulares eram do sexo feminino, idade superior a 40 anos e possuíam mais de uma comorbidade associada a DM2, sendo a principal, a hipertensão arterial sistêmica (HAS). De acordo com a literatura, a fisiologia da orelha interna permite que pequenas alterações de glicose influenciem seu funcionamento normal, o que torna os indivíduos diabéticos mais suscetíveis a desenvolverem disfunções vestibulares. Conclusão: o presente estudo constatou que a DM2 pode desencadear ou contribuir para a manifestação da disfunção vestibular, tendo como principais fatores associados a idade avançada, o sexo feminino e comorbidades diversas, tais como dislipidemia, HAS e síndrome metabólica.

Postural responses of galvanic vestibular stimulation: comparison between groups of older adults and young people / Respostas posturais frente à estimulação vestibular galvânica: comparação entre grupo de pessoas idosas e jovens

Abstract Objective: To evaluate the effect of vestibular manipulation on the postural sway and muscle activation of younger and older adults. Methods: The study analyzed the effects of three intensity levels of galvanic vestibular stimulation (GVS) (0.3; 0.6 and 1m) on the pattern of muscle activity and center of pressure (CP) displacements of 12 older adults (EG) and 12 young adults (CG) while maintaining their balance on a stable surface, with no vision. Results: The EG showed a positive correlation between CP displacement and muscle activity and GVS intensity. On the other hand, the magnitude of postural response in the EG was not modulated in accordance with GVS intensities. Additionally, during the highest GVS intensity level (1 mA) greater muscle activity was used to increase stiffness, decrease the amplitude of oscillation and ensure stability. This unusual response characterizes a pattern of co-activation and is perhaps a safety mechanism to ensure stability. Conclusion: The EG individuals were not able to select the appropriate motor strategy to efficiently compensate the effects of GVS. This unusual strategy reflects deficits in the vestibular system of older adults, a fact which negatively interferes with their ability to reevaluate sensory information.

Resumo Objetivo: Avaliar a interferência da manipulação das informações vestibulares na oscilação postural e atividade muscular de jovens e idosos. Métodos: Foi analisado o efeito de três intensidades (0,3; 0,6 e 1mA) de estimulação vestibular galvânica (GVS) no padrão de ativação muscular e deslocamento do centro de pressão (CP) de 12 idosos (GI) e 12 adultos jovens (GC), durante a manutenção do equilíbrio em uma superfície estável sem visão. Resultados: O GC mostrou correlação positiva entre o deslocamento de CP e a ativação muscular com a intensidade da GVS. Por outro lado, o GI não foi capaz de modular a magnitude da resposta postural com a intensidade da GVS. Durante o maior valor de GVS (1mA), houve um aumento da ativação muscular de agonista e antagonista caracterizando um padrão de coativação que aumentou a rigidez e diminuiu a amplitude de oscilação. Conclusão: Os indivíduos do GI selecionaram uma estratégia motora atípica para compensar os efeitos da GVS. Essa estratégia incomum refletiu deficit no sistema vestibular dos idosos e pode interferir negativamente na capacidade de reorganização das informações sensoriais.

The role of magnetic resonance imaging in Ménière disease: the current state of endolymphatic hydrops evaluation / O papel da ressonância magnética na doença de Ménière: a avaliação da hidropsia endolinfática nos dias atuais

ABSTRACT Technical advances in magnetic resonance imaging have allowed to accurately detect and grade endolymphatic space distension in Ménière disease; this was only possible in post-mortem histological studies until a few years ago. Magnetic resonance imaging rules out other causes of vertigo and hearing loss, and is able to evaluate the cochlear and vestibular compartments of the endolymphatic space using a dedicated protocol.

RESUMO Os avanços técnicos na ressonância magnética têm permitido detectar e classificar com acurácia a distensão do espaço endolinfático na doença de Ménière; isso só era possível nos estudos histológicos post-mortem até poucos anos atrás. Além de afastar outras causas de vertigem e de perda auditiva, a ressonância magnética é capaz de avaliar os compartimentos coclear e vestibular do espaço endolinfático por meio de um protocolo dedicado.

The expression and function of acid-sensing ion channels in auditory system and vestibular system / 中华耳鼻咽喉头颈外科杂志

Acid-sensing ion channels are a class of extracellular H+ activated cation channels, belonging to the amiloride-sensitive epithelial Na+ channel/degenerin (ENaC/DEG) superfamily. During extracellular acidification, the channels are activated and produce corresponding action potential. Acid-sensing ion channels are extensively expressed in the peripheral and central nervous system. It plays an important in synaptic plasticity, mechanical sensation, injury sensation related to acidosis of local tissues, acid reception and retinal regulation. This article reviews the expression, biological characteristics and functions of acid-sensing ion channels in cochlea, vestibular tissue and auditory center, so as to improve the understanding of physiology and pathophysiology of auditory system.

Rehabilitación vestibular de la Enfermedad de Meniere en el estadio tardío: Reporte de un caso / Vestibular rehabilitation of Meniere's Disease in its chronic stage: A case report

La enfermedad de Meniere (EM), se caracteriza por ataques fluctuantes de vértigos, hipoacusia y acúfenos. Una vez que se controlan los síntomas agudos, la rehabilitación vestibular es una alternativa de tratamiento efectiva. Se presenta el caso de una mujer de 46 años con EM en la fase crónica que presenta persistencia de vértigo postural e inestabilidad de la marcha, quien fue intervenida con maniobras de reposición y rehabilitación vestibular con ejercicios de adaptación y sustitución, ejercicios de habituación del equilibrio vestibular y de control postural. Se obtuvo una respuesta favorable, con desaparición del vértigo posicional, disminución significativa de la inestabilidad y gran mejoría en su calidad de vida. No se puede llegar a conclusiones con un solo caso, sin embargo, es importante el abordaje integral en el tratamiento de pacientes con EM. (AU)

Meniere's disease presents fluctuating attacks of dizziness, hearing loss and tinnitus. Once acute symptoms are controlled, vestibular rehabilitation is an effective treatment alternative. We present the case of a 46-year-old woman with Meniere's disease in the chronic phase, who presented persistent postural vertigo and gait instability and who was treated with repositioning maneuvers, along with vestibular rehabilitation with adaptation, substitution and habituation exercises, vestibular balance and postural control. A favorable response is achieved, with the disappearance of positional vertigo, a significant decrease in instability and a great improvement in her quality of life. No conclusions can be drawn from a single case; however, a comprehensive approach is important in the treatment of patients with MS. (AU)

Malformaciones congénitas del oído interno. Revisión de tema / Congenital Malformations of the Inner Ear

Existe una gran variedad de malformaciones congénitas que pueden afectar al oído interno, con distintas fisiopatologías, diferentes estructuras alteradas y edad de aparición de los síntomas. Por lo anterior, es necesario conocer e identificar dichas alteraciones, con el fin de actuar oportunamente y reducir el riesgo de las complicaciones, entre otras ­de gran importancia­ las alteraciones en el área del lenguaje y en el ámbito social.

There are a great variety of congenital malformations that can affect the inner ear, with a diversity of physiopathologies, involved altered structures and age of symptom onset. Therefore, it is important to know and identify these alterations opportunely to lower the risks of all the complications, being of great importance, among others, the alterations in language development and social interactions.

Whole ear involvement in non-elder patients with relapsing polychondritis / 中华风湿病学杂志

Objective To investigate the clinical and audiological characteristics of non-elder patients with relapsing polychondritis (RP).Methods Clinical and audiological data of patients with RP under 60 years old were collected consecutively and analyzed.The t-test and Mann-Whitney U test were used for statistical analysis between the two groups in quantitative data in normal distribution and non-normal distribution respectively,while Chi-square test was use for qualitative data analysis.Results One hundred and seventy four patients with complete data who fulfilled the Michet criteria were enrolled with a M∶F=1∶1.1.The mean age of disease onset was (39±13) (8-60) years;the median time of disease duration was 12 (1-480) months;the median relapsing polychondritis disease activity index (RPDAI) was 38(10-77) and the median RPODI was 2.4(0.1-56).Auricular chondritis (32.8％,57/174),ocular involvement (24.7％,43/174) and airway chonchritis (21.3％,37/174) were the top three onset-pattern.All parts of external,middle and inner ear were involved in RP.Inner-ear damage was the most common (95.4％,166/174) with insidious cochlea and vestibule equally distributed.Auricular chondritis was predominant in external ear involvement (55.2％,96/174);ET dysfunction was included in eardrum abnormalities of neglected middle-ear involvement (29.9％,52/174).Positive HL by active detection was 71.8％(125/174) with 14.3(25/174) HL fulfilled world health organization (WHO)-2006 criteria,including 52.0％(13/25) disabling HL.Sensorineural hearing loss (SNHL) was predominant in RP after 21 years old while 60.0％(6/10) was seen in childhood RP with non-SNHL.At least two parts of ear involvement were seen in almost all patients with heavy overlap.Conclusion All parts of ear are involved in non-elder RP with age related clinical characteristics.Active detection is a key to find insidious middle-and inner-ear involvement for early RP recognition.RPODI is a potential marker for RP evaluation.

Labyrinthectomy and Vestibular Neurectomy for Intractable Vertiginous Symptoms

Abstract Introduction Labyrinthectomy and vestibular neurectomy are considered the surgical procedures with the highest possibility of controlling medically untreatable incapacitating vertigo. Ironically, after 100 years of the introduction of both transmastoid labyrinthectomy and vestibular neurectomy, the choice of which procedure to use rests primarily on the evaluation of the hearing and of the surgical morbidity. Objective To review surgical labyrinthectomy and vestibular neurectomy for the treatment of incapacitating vestibular disorders. Data Sources PubMed, MD consult and Ovid-SP databases. Data Synthesis In this review we describe and compare surgical labyrinthectomy and vestibular neurectomy. A contrast between surgical and chemical labyrinthectomy is also examined. Proper candidate selection, success in vertigo control and complication rates are discussed on the basis of a literature review. Conclusions Vestibular nerve section and labyrinthectomy achieve high and comparable rates of vertigo control. Even though vestibular neurectomy is considered a hearing sparing surgery, since it is an intradural procedure, it carries a greater risk of complications than transmastoid labyrinthectomy. Furthermore, since many patients whose hearing is preserved with vestibular nerve section may ultimately lose that hearing, the long-term value of hearing preservation is not well established. Although the combination of both procedures, in the form of a translabyrinthine vestibular nerve section, is themost certain way to ablate vestibular function for patients with no useful hearing and disabling vertigo, some advocate for transmastoid labyrinthectomy alone, considering that avoiding opening the subarachnoid space minimizes the possible intracranial complications. Chemical labyrinthectomy may be considered a safer alternative, but the risks of hearing loss when hearing preservation is desired are also high.

Combined ocular and cervical vestibular evoked myogenic potential in individuals with vestibular hyporeflexia and in patients with Ménière's disease / Potencial evocado miogênico vestibular ocular e cervical simultâneo em indivíduos com hiporreflexia vestibular e em indivíduos com doença de Ménière

Abstract Introduction: The vestibular evoked myogenic potential is a potential of mean latency that measures the muscle response to auditory stimulation. This potential can be generated from the contraction of the sternocleidomastoid muscle and also from the contraction of extraocular muscles in response to high-intensity sounds. This study presents a combined or simultaneous technique of cervical and ocular vestibular evoked myogenic potential in individuals with changes in the vestibular system, for use in otoneurologic diagnosis. Objective: To characterize the records and analyze the results of combined cervical and ocular VEMP in individuals with vestibular hyporeflexia and in those with Ménière's disease. Methods: The study included 120 subjects: 30 subjects with vestibular hyporeflexia, 30 with Ménière's disease, and 60 individuals with normal hearing. Data collection was performed by simultaneously recording the cervical and ocular vestibular evoked myogenic potential. Results: There were differences between the study groups (individuals with vestibular hyporeflexia and individuals with Ménière's disease) and the control group for most of wave parameters in combined cervical and ocular vestibular evoked myogenic potential. For cervical vestibular evoked myogenic potential, it was observed that the prolongation of latency of the P13 and N23 waves was the most frequent finding in the group with vestibular hyporeflexia and in the group with Ménière's disease. For ocular vestibular evoked myogenic potential, prolonged latency of N10 and P15 waves was the most frequent finding in the study groups. Conclusion: Combined cervical and ocular vestibular evoked myogenic potential presented relevant results for individuals with vestibular hyporeflexia and for those with Ménière's disease. There were differences between the study groups and the control group for most of the wave parameters in combined cervical and ocular vestibular evoked myogenic potential.

Resumo Introdução: O potencial evocado miogênico vestibular é um potencial de média latência que avalia a resposta muscular decorrente de estimulação auditiva. Pode ser gerado a partir da contração do músculo esternocleidomastóideo e também a partir da contração de músculos extraoculares em resposta a sons de elevada intensidade. Este estudo apresenta uma técnica combinada ou simultânea de potencial evocado miogênico vestibular cervical e ocular em indivíduos com alterações no sistema vestibular para que possa ser usada no diagnóstico otoneurológico. Objetivo: Caracterizar o registro e analisar os resultados do potencial evocado miogênico vestibular cervical e ocular combinado em indivíduos com hiporreflexia vestibular e em indivíduos com doença de Ménière. Método: Participaram do estudo 120 indivíduos, 30 com hiporreflexia vestibular, 30 com doença de Ménière e 60 com audição dentro dos padrões de normalidade. A coleta de dados foi feita por meio do potencial evocado miogênico vestibular cervical e ocular registrados simultaneamente. Resultados: Houve diferença entre o grupo de estudo (indivíduos com hiporreflexia vestibular e indivíduos com doença de Ménière) e o grupo controle para a maioria dos parâmetros das ondas no potencial evocado miogênico vestibular cervical e ocular combinado. Para o potencial evocado miogênico vestibular cervical observou-se que o prolongamento da latência das ondas P13 e N23 foi a alteração mais encontrada no grupo de indivíduos com hiporreflexia vestibular e no grupo de indivíduos com doença de Ménière. Para o potencial evocado miogênico vestibular ocular o prolongamento da latência das ondas N10 e P15 foi a alteração mais encontrada no grupo de estudo. Conclusão: O potencial evocado miogênico vestibular cervical e ocular combinado apresentou resultados relevantes para os indivíduos com hiporreflexia vestibular e para os indivíduos com doença de Ménière. Houve diferença entre o grupo de estudo e o grupo controle para a maioria dos parâmetros das ondas no potencial evocado miogênico vestibular cervical e ocular combinado.

3D visualization of membranous labyrinth from voxel models / 解剖学报

Objective: To explore three dimensional (3D) visualization of membranous labyrinth using a voxel model. Methods: 3D Slicer software was used to deal with MRI images of the temporal bone, volume clipping with the model, three-dimensional display of the membranous labyrinth by both surface rendering and volume rendering. Results With the inner voxel model we explored not only the surface of inner ear,but also the membranous labyrinth inside. The file size of inner ear voxel model file was smaller than surface model file. Conclusion: Inner ear voxel model is invaluable in the study of inner ear anatomy.

Potencial evocado miogênico vestibular ocular e cervical simultâneo em indivíduos normais / Ocular and cervical vestibular evoked myogenic potential simultaneous in normal individuals

RESUMO Objetivo: Caracterizar o registro e analisar os resultados do potencial evocado miogênico vestibular cervical e ocular combinado em indivíduos sem queixas auditivas e vestibulares. Métodos: Participaram da pesquisa 30 indivíduos sem queixa auditiva e com audição dentro dos padrões de normalidade. A coleta de dados foi realizada por meio do potencial evocado miogênico vestibular cervical e ocular registrados simultaneamente. Resultados: Houve diferença entre as orelhas direita e esquerda para a amplitude das ondas P13 e N23 do potencial evocado miogênico vestibular cervical e para a latência da onda N10 do potencial evocado miogênico vestibular ocular. No gênero feminino não houve diferença entre as orelhas direita e esquerda para a amplitude das ondas P13, N23, N10, P15, interamplitude no potencial evocado miogênico vestibular cervical e interamplitude no potencial evocado miogênico vestibular ocular e para a latência das ondas P13, N23, N10 e P15. No gênero masculino houve diferença entre as orelhas direita e esquerda para a amplitude da onda P13. Conclusão: Os resultados do potencial evocado miogênico vestibular cervical e ocular combinado foram consistentes, uma vez que as respostas geradas pelos potenciais evocados miogênicos vestibulares apresentaram morfologia, latência e amplitude adequadas, o que permite a avaliação da via vestibular ipsilateral descendente e da via vestibular contralateral ascendente.

ABSTRACT Purpose: To characterize the recording and analyze the results of the combined cervical and ocular vestibular evoked myogenic potential in individuals without hearing and vestibular complaints. Methods: In this study, 30 individuals without hearing complaints and hearing within normal limits were evaluated. Data were collected through the simultaneous recording of cervical and ocular vestibular evoked myogenic potential. Results: Differences were observed between the right and left ears for the amplitude of waves P13 and N23 of the cervical vestibular evoked myogenic potential and the latency of wave N10 of the ocular vestibular evoked myogenic potential. For female subjects, there was no difference between the right and left ears for the amplitude of waves P13, N23, N10, and P15; interamplitude in cervical vestibular evoked myogenic potential and interamplitude in ocular vestibular evoked myogenic potential; and latency in waves P13, N23, N10, and P15. For male subjects, there was a difference between the right and left ears for the amplitude of wave P13. Conclusion: The results of the combined cervical and ocular vestibular evoked myogenic potentials were consistent, because the responses generated by the vestibular evoked myogenic potentials presented an adequate morphology, latency, and amplitude, allowing for the evaluation of the ipsilateral descending vestibular pathways and the contralateral ascending vestibular pathways.

Morphological analysis of the vestibular system of guinea pigs poisoned by organophosphate / Análise morfológica do sistema vestibular de cobaias intoxicadas por organofosforado

ABSTRACT INTRODUCTION: The vestibular system is responsible for body balance. There are substances that damage it, causing dizziness; these are termed vestibulotoxic substances. Agrochemicals have been investigated for ototoxicity because of studies that identified dizziness as a recurrent symptom among rural workers' complaints. OBJECTIVE: To histopathologically evaluate the vestibular system in guinea pigs exposed to an organophosphate, and to identify the drug's effects on this system. METHODS: Experimental clinical study. Eighteen guinea pigs were used; six of them poisoned with the organophosphate chlorpyrifos at doses of 0.5 mg/kg/day and seven of them at 1 mg/kg/day; and a control group of five guinea pigs was exposed to distilled water, all for 10 consecutive days. Later, ciliary tufts of saccule and utricle maculae were counted by scanning electron microscopy. RESULTS: Comparing the groups, a one-way ANOVA test for the variable "saccule" ( p = 0.0569) and a Kruskal-Wallis test for the variable "utricle" ( p = 0.8958) were performed, revealing no difference among groups in both variables. CONCLUSION: The histopathologic analysis of the vestibular system of guinea pigs exposed to an organophosphate showed no difference in the amount of ciliary tufts of saccule and utricle maculae at the doses tested, although the result for the variable "saccule" was considered borderline, showing a trend for significance.

RESUMO INTRODUÇÃO: O sistema vestibular é responsável pelo equilíbrio corporal. Existem substâncias que o danificam, causando tontura; são chamadas vestibulotóxicas. Agrotóxicos tornaram-se objeto de investigação da ototoxicidade a partir de pesquisas que apontaram tontura como sintoma recorrente entre as queixas de trabalhadores rurais. OBJETIVO: Constitui-se em avaliar a histopatologia do sistema vestibular de cobaias expostas a organofosforados, identificando os efeitos nesse sistema. MÉTODO: É um estudo clínico experimental, que utilizou 18 cobaias, sendo seis intoxicadas com organofosforadoclorpirifós na dose de 0,5 mg/kg/dia; sete na dose de 1 mg/kg/dia, e grupo controle com cinco cobaias expostas a água destilada, durante 10 dias consecutivos. Posteriormente realizou-se a contagem dos tufos ciliares nas máculas dos sáculos e utrículos através microscopia eletrônica de varredura. RESULTADOS: Na comparação intergrupos, para a variável sáculo realizou-se o teste ANOVA one-way (p = 0,0569); para a variável utrículo, utilizou-se o teste Kruskal-Wallis (p = 0,8958), revelando não haver diferença entre os grupos em ambas as variáveis. CONCLUSÃO: Análise histopatológica do sistema vestibular de cobaias expostas a organofosforado não demonstrou diferença na quantidade de tufos ciliares nas máculas dos sáculos e utrículos nas doses testadas, apesar do resultado para a variável sáculo ser considerado limítrofe mostrando uma tendência a significância.