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)

Reabilitação vestibular com realidade virtual na doença de Ménière / Vestibular rehabilitation with virtual reality in Ménière's disease

A tecnologia de realidade virtual fornece uma grande variedade de estímulos que geram conflitos sensoriais em diferentes níveis de dificuldades e em ambiente seguro. OBJETIVO: Verificar o efeito de um programa de reabilitação vestibular do equilíbrio corporal com estímulos de realidade virtual em pacientes com doença de Ménière. Forma de estudo: Estudo clínico observacional. MÉTODO: Quarenta e quatro pacientes, com idade entre 18 e 60 anos e doença de Ménière definida, distribuídos em dois grupos - experimental (GE) e controle (GC) - fizeram uso de betaistina e dieta alimentar; o grupo experimental foi submetido adicionalmente a 12 sessões de reabilitação com realidade virtual da BRU TM. Os pacientes responderam ao Dizziness Handicap Inventory (DHI), à escala analógica de tontura e realizaram a posturografia com realidade virtual antes e após a intervenção. RESULTADOS: Após a intervenção, o GE apresentou valores significantemente menores do DHI (p < 0,001) e da escala analógica de tontura (p = 0,012) e valores significantemente maiores da área do limite de estabilidade (p = 0,016), em comparação com o GC. CONCLUSÃO: A reabilitação do equilíbrio corporal com estímulos de realidade virtual é eficaz na melhora da tontura, da qualidade de vida e do limite de estabilidade de pacientes com doença de Ménière.

Virtual reality technology can provide a wide range of sensory stimuli to generate conflicts of varying degrees of complexity in a safe environment. OBJECTIVE: To verify the effect of a virtual realitybased balance rehabilitation program for patients with Menière's disease. METHOD: This observational clinical study included 44 patients aged between 18 and 60 years diagnosed with Menière's disease submitted to a controlled randomized therapeutic intervention. The case and control groups took betahistine and followed a diet. Case group subjects underwent 12 rehabilitation sessions with virtual reality stimuli in a Balance Rehabilitation Unit (BRU TM). Patients were assessed based on DHI scores, the dizziness visual analogue scale, and underwent posturography with virtual reality before and after the intervention. RESULTS: After the intervention, the case group showed significantly lower scores in DHI (p < 0,001) and in the dizziness visual analog scale (p = 0.012), and had significantly greater limit of stability areas (p = 0.016) than controls. CONCLUSION: Virtual reality-based balance rehabilitation effectively improved dizziness, quality of life, and limit of stability of patients with Menière's disease.

Evaluation of quality of life pre- and post-vestibular rehabilitation in patients with benign paroxysmal positional vertigo associated with Meniere's disease

Introduction: Vertigo is a symptom that impacts the patients' quality of life and may force them to cease performing activities of daily living. Here, we discuss benign paroxysmal positional vertigo (BPPV) and Meniere's disease (MD), which show exacerbated symptoms when they appear in association. Vestibular rehabilitation (VR) is an effective treatment in reducing vertigo, especially in conjunction with other therapies. Aim: To evaluate the quality of life of patients with BPPV and MD before and after VR. Method: We conducted a descriptive observational qualitative and quantitative case study with 12 patients aged 35 to 86 years. All patients diagnosed with BPPV and MD received treatment in the ENT clinic. The Brazilian DHI questionnaire, which assesses the quality of life with a focus on physical, emotional, and functional aspects, was used for data collection, and was completed by patients before the first session and after the fifth session of VR. Data were tested using the Shapiro-Wilk normality test, followed by Wilcoxon, Friedman, and Spearman correlation tests (p < 0.05). Results: There were significant improvements in scores for all aspects, with median changes ranging from 12 to 0 in the physical, 6 to 1 in the emotional, and 11 to 1 in the functional aspect. There were no correlations between the scores and sample characteristics. Conclusion: VR was an effective method for the treatment of patients with BPPV and MD; it improves quality of life and shows the maximal influence on physical aspect scores, regardless of age or gender...

Evaluación de evolución clínica en pacientes con enfermedad de Meniere intervenidos con descompresión de saco endolinfático en el Centro Médico Imbanaco, Cali, Valle / Clinical assessment of Meniere’s disease patients with endolymphatic sac decompression surgery at the Imbanaco Medical Center, Cali, Valle

Evaluar eficacia del procedimiento quirúrgico de descompresión del saco endolinfático (DSE) en mejoramiento de calidad de vida de los pacientes con enfermedad de Meniere intervenidos con DSE utilizando como criterios principales la evaluación de la audición y del vértigo en pacientesatendidos en el Centro Médico Imbanaco entre 2003 y 2007. Materiales y métodos: Estudio de intervención retrospectivo, comparativa (antes-después) en 30 pacientes operados de DSE, se evaluó audición y calidad de vida desde el aspecto de la funcionalidad. Resultados: Mejoría en la calidad de vida de los pacientes operados en los cuales la media de la encuesta del nivel funcional fue de 1.63 mientras que la prequirúrgica fue de 4.06 (p=0.00). No se presentaron cambios significativos en la audición siendo la media de la prequirúrgica de 40.6 y la post de 42.1.

Objective: To evaluate the efficacy of the surgical decompression of the endolymphatic sac (ESD) for the improvement of the quality of life of patients with Meniere’s disease using the patient’s vertigo control and hearing assessment as the main criteria in patients that have been operated on. Materials and methods: We performed a retrospective interventional study, comparative (beforeafter) in 30 patients with ESD at the Imbanaco Medical Center between 2003 and 2007. The quality of life and hearing preservation was assessed from the aspect of functionality. Results: Improvement in the quality of life was evident in patients who were operated on. The average functional level at the survey was 1.63 after the surgical intervention while the preoperative average was 4.06 (p=0.00). There were no significant changes in the hearing level being the preoperative mean of 40.6 and thepostoperative 42.1.

Como o implante coclear pode interferir na função vestibular? / How can the cochlear implant interfere with the vestibular function?

Introdução: O implante coclear é uma opção terapêutica para pacientes com surdez neurossensorial profunda. Alguns pacientes implantados evoluíam com tontura no pós-operatório, o que deu início ao interesse pela função vestibular. Desde então, muitos estudos relataram a associação entre o implante coclear e as disfunções vestibulares.

Introduction: The cochlear implant is a therapeutic option for patients with deep neurosensorial deafness. Some implanted patients evolved with dizziness in the postoperative, which started the interest for the vestibular function. Since then, many studies have reported the association between the cochlear implant and the vestibular dysfunctions.