Sintomas vestibulares encaminhados ao otorrinolaringologista pela atenção primária da cidade do Recife / Vestibular symptoms referred to otorhinolaryngologist for primary care in the city of Recife / Síntomas vestibulares referidos al otorrinolaringólogo por atención primaria en la ciudad de Recife

Introdução: A Atenção Primária é a "porta de entrada" do usuário ao Sistema Único de Saúde. Caso o médico tenha dificuldade em conduzir o caso, ele encaminha-o a um especialista. A otorrinolaringologia é uma das especialidades que mais recebe referências, com longo tempo de espera em nosso meio. Objetivo: Estimar a frequência das queixas de tontura e suspeita de doença vestibular nos encaminhamentos dos pacientes que aguardam consulta com otorrinolaringologista. Há poucos estudos semelhantes na literatura, e esse levantamento é importante para traçar o perfil desses pacientes e planejar ações de saúde pública. Métodos: Estudo observacional, longitudinal, descritivo, baseado na coleta de dados secundários do Sistema de Regulação da Secretaria de Saúde da Prefeitura do Recife. Foram incluídas as solicitações dos médicos da Estratégia Saúde da Família para o serviço de otorrinolaringologia em outubro-novembro de 2019, que estavam na fila de espera desde junho­julho de 2018. Resultados: A frequência dos encaminhamentos por tontura e suspeita de doença vestibular foi 22,5% de todas as solicitações para otorrinolaringologia. O tempo de espera foi um ano e quatro meses. A maioria era de mulheres (74,7%) e idosos acima de 60 anos (48,3%). Os motivos dos encaminhamentos foram: zumbido (43,2%), labirintite (20%), múltiplos sintomas (17,3%), tontura (11,6%), vertigem (3,9%), labirintopatia (3,6%) e vertigem posicional paroxística benigna (0,6%). Os sintomas aumentam com a idade. Conclusão: A taxa de encaminhamento foi compatível com a literatura. O zumbido é um sintoma muito incômodo, comum tanto nas doenças do labirinto quanto em outras patologias, por isso a alta frequência de solicitação. O termo labirintite nem sempre se refere à neuronite vestibular, mas erroneamente pode ser usado para qualquer síndrome vertiginosa, o que pode justificar a alta taxa de encaminhamento em detrimento de outras vestibulopatias. A educação continuada na Atenção Primária é importante tanto para o diagnóstico correto quanto para a solicitação apropriada da interconsulta. É preciso novas estratégias para diminuir o tempo de espera, como o aumento da oferta de serviços de especialistas, a qualificação da demanda e a otimização do sistema de regulação.

Introduction: Primary Care is the user's "gateway" to the Unified Health System: if the physician has difficulty conducting the case, they refer it to a specialist. Otorhinolaryngology is one of the specialties that receives referrals the most, with long waiting time in this setting. Objective: To estimate the frequency of complaints of dizziness and suspected vestibular disease in referrals of patients awaiting consultation with an otorhinolaryngologist. There are few studies addressing this topic in the literature, and this survey is important because it helps design the profile of these patients and plan public health actions. Methods: Observational, longitudinal, descriptive study based on collection of secondary data from the Regulatory System of the Health Department of the City of Recife. Requests from Family Health Strategy (FHS) physicians for the Otorhinolaryngology service in October-November 2019 were included, and those who had been on the waiting list since June-July 2018. Results: The frequency of referrals for dizziness and suspected vestibular disease was 22.5% of all requests for Otorhinolaryngology. The waiting time was one year and four months. most patients were women (74.7%) and aged over 60 years (48.3%). The reasons for referrals were: tinnitus (43.2%), labyrinthitis (20%), multiple symptoms (17.3%), dizziness (11.6%), vertigo (3.9%), labyrinthopathy (3.6%), and benign paroxysmal positional vertigo (0.6%). Symptoms increase with age. Conclusions: The referral rate was compatible with the literature. Tinnitus is a very uncomfortable symptom, common in labyrinthine diseases and other pathologies, so the high frequency of solicitation. The term labyrinthitis does not always refer to vestibular neuronitis, but it can erroneously be used for any vertiginous syndrome, which may justify a high referral rate to the detriment of other vestibular pathologies. Continuing education in Primary Care is important for both the correct diagnosis and the appropriate request for interconsultation. New strategies to reduce waiting times are needed such as increasing the supply of specialist services, demanding qualification, and optimizing the regulatory system.

Introducción: La atención primaria es la "puerta de entrada" del usuario al Sistema Único de Salud, si el médico tiene dificultades en el manejo del caso lo deriva a un especialista. La otorrinolaringología es una de las especialidades que más derivaciones recibe, con un largo tiempo de espera en nuestro país. Objetivo: Estimar la frecuencia de quejas de mareo y sospecha de enfermedad vestibular en las derivaciones de pacientes en espera de consulta con un otorrinolaringólogo. Existen pocos estudios similares en la literatura, y esta encuesta es importante para perfilar el perfil de estos pacientes y planificar acciones de salud pública. Métodos: Estudio observacional, longitudinal, descriptivo, basado en la recolección de datos secundarios del Sistema de Regulación de la Secretaría de Salud del Municipio de Recife. Se incluyeron solicitudes de médicos de la Estrategia Salud de la Familia, para el servicio de Otorrinolaringología en octubre-noviembre de 2019, y que estaban en lista de espera desde junio-julio de 2018. Resultados: A menudo, dos derivaciones por turbidez y suspensión de enfermedad vestibular representaron el 22,5% de todas las solicitudes de Otorrinolaringología. El tiempo de espera fue de un año, cuatro meses. La mayoría eran mujeres (74,7%) y mayores de 60 años (48,3%). Los dos motivos de derivación fueron: acúfenos (43,2%), laberintitis (20%), síntomas múltiples (17,3%), embotamiento (11,6%), vértigo (3,9%), laberintopatía (3,6%) y vértigo posicional paroxístico benigno (0,6%). Los síntomas aumentaron con la edad. Conclusiones: la tasa de derivación fue compatible con la literatura. El tinnitus es un síntoma muy incómodo, común tanto en las enfermedades del laberinto como en otras patologías, de ahí la alta frecuencia de solicitación. El término laberintitis no siempre se refiere a neuronitis vestibular, pero se puede utilizar erróneamente para cualquier síndrome de vértigo, lo que puede justificar una alta tasa de derivación en detrimento de otros trastornos vestibulares. La formación continua en Atención Primaria es importante tanto para el correcto diagnóstico como para la adecuada solicitud de interconsultas. Se necesitan nuevas estrategias para reducir los tiempos de espera, como aumentar la oferta de servicios especializados, calificar la demanda y optimizar el sistema regulatorio.

Influence of socioeconomic factors on the perception of cochlear-vestibular symptoms and adherence to the treatment of congenital hypothyroidism / Influência dos fatores socioeconômicos na percepção de sintomas cócleo-vestibulares e na adesão ao tratamento do hipotireoidismo congênito

Abstract Objectives: to verify if there is an association between socioeconomic factors and adherence to treatment in congenital hypothyroidism and to verify if there is an association between socioeconomic factors and vestibulocochlear symptoms noticed by parents/caregivers of children diagnosed with congenital hypothyroidism. Methods: a cross-sectional, exploratory and descriptive study, with a convenience sample. The sample consisted of 108 children with clinical and laboratory diagnosis of congenital hypothyroidism, of both sexes, aged ≥ 5 years. The researchers applied a structured questionnaire to parents/caregivers, consisting of closed and objective questions about the presence or absence of tinnitus, hearing loss and dizziness/vertigo in children with congenital hypothyroidism. Results: There was no association between socioeconomic factors and adherence to treatment or perception of cochlear-vestibular symptoms. Conclusions: socioeconomic factors did not influence treatment adherence or perceived cochlear-vestibular symptoms by caregivers of children with congenital hypothyroidism.

Resumo Objetivos: verificar se existe associação entre fatores socioeconômicos e adesão ao tratamento no hipotireoidismo congênito e verificar se existe associação entre fatores socioeconômicos e sintomas vestibulococleares percebidos pelos pais / cuidadores de crianças diagnosticadas com hipotireoidismo congênito. Métodos: estudo transversal, exploratório e descritivo, com amostra de conveniência. A casuística foi composta por 108 crianças com diagnóstico clínico e laboratorial de hipotireoidismo congênito, de ambos os sexos com idade ≥ 5 anos. Foi aplicado um questionário estruturado para os pais/cuidadores, formado por questões fechadas e objetivas sobre a presença ou ausência de zumbido, hipoacusia e tontura/vertigem nas crianças com hipotireoidismo congênito. Resultados: não houve associação entre fatores socioeconômicos e adesão ao tratamento ou percepção dos sintomas cócleo-vestibulares. Conclusões: os fatores socioeconômicos não influenciaram na adesão ao tratamento nem na percepção de sintomas cócleo-vestibulares pelos cuidadores de crianças com hipotireoidismo congênito.

Pitfalls in the Diagnosis of Vertigo

Vertigo/dizziness is a common complaint in patients who are seeking a primary health clinic. Vertigo is traditionally attributed to damage of the vestibular system. Many peripheral and central vestibular disorders are usually presented with vertigo. However, patients with benign paroxysmal positional vertigo (BPPV), a leading cause of vertigo, may present with postural lightheadedness, near faint, imbalance rather than true vertigo. On the contrary, patients with orthostatic hypotension may present with true spinning vertigo, not dizziness. Persistent postural perceptual dizziness, a second most common cause of dizziness (after BPPV), is mainly occurred after organic vestibular disorders such as BPPV or vestibular neuritis, and classified as a chronic functional vestibular disorder. This article describes non-vestibular disorders presenting dizziness and/or vertigos, which conditions may be misdiagnosed as structural vestibular disorders.

Paroxismia vestibular: reporte de un caso / Vestibular paroxysmia: case report

Presentamos el caso de un paciente joven quien presenta 4 a 5 crisis diarias de vértigo espontáneo de segundos de duración, todos o casi todos los días desde hace 9 meses. Estas crisis no tienen gatillo posicional, y hay completa ausencia de sintomatologia entre crisis. Como discutimos en el artículo, este cuadro coíncide con los recientemente publicados criterios para una paroxismia vestibular, entidad supuestamente secundaria a la compresión neurovascular del nervio vestibular. El paciente respondió de forma inmediata y completa a carbamazepina a dosis bajas, el tratamiento de elección en la paroxismia vestibular.

We present the case of a young patient, with a 9-month long history of 4 to 5 daily spells of spontaneous vertigo, each lasting only seconds. There is no positional trigger, and there is a complete lack of symptoms between attacks. As is discussed in the article, this matches the recently published criteria for Vestibular Paroxysmia, an entity allegedly secondary to neurovascular compression of the vestibular nerve. The patient responded immediately and completely to carbamazepine at low dosage, the preferred treatment for vestibular paroxysmia.

Deficiencia del nervio coclear: logros obtenidos y expectativas con el implante coclear / Coclear nerve deficiency: achievements and expectations with the coclear implant / Deficiência de nervos coculares: realizações e expectativas como implante cocular

Introducción: la deficiencia del nervio coclear se define como un nervio coclear hipoplásico o aplásico, presente en más del 18% de los niños con hipoacusias neurosensoriales profundas y cuya indicación de implante coclear sigue generando controversias. Objetivo: Analizar el protocolo de estudio en pacientes con sospecha de deficiencia del nervio coclear y exponer los resultados clínico-audiológicos pos-implante coclear en nuestro servicio. Material y método: Estudio retrospectivo de historias clínicas en el período 2011-2017, analizando los estudios solicitados dentro de la evaluación preimplante coclear y el estudio extendido en pacientes con sospecha de deficiencia del nervio coclear. Resultados: Dentro de la población, un caso correspondió a un paciente con hipoacusia neurosensorial profunda bilateral con sospecha de deficiencia del nervio coclear (Birman: GRADO I y Casselman: TIPO I/IIa bilateral). El potencial evocado auditivo de tronco encefálico eléctrico permitió determinar el oído a implantar, mostrando mejor configuración de ondas para el oído derecho. Actualmente, presenta una óptima adaptación al implante (categoría de performance auditivo: 2-categoría de Moog-Geers: 3), con una puntuación de 8/40 en el cuestionario IT-MAIS. Conclusión: El protocolo de estudio prequirúrgico extendido es aplicable a pacientes con sospecha de deficiencia del nervio coclear. Estudios funcionales aportan datos de utilidad para determinar cuál de estos pacientes podrían beneficiarse tras la colocación del mismo. El asesoramiento familiar sobre las limitaciones y los objetivos reales es fundamental.

Introduction: cochlear nerve deficiency is defined as a hypoplastic or aplastic cochlear nerve present in more than 18% of children with profound sensorineural hearing loss. Cochlear implant indication continues to generate controversy. Objective: Analyze the study protocol in patients with suspected cochlear nerve deficiency and expose the clinical-audiological results after cochlear implant in our service. Material and method: Retrospective study of medical records in the period 2011-2017. Analyzing the studies requested within the cochlear pre-implant evaluation and the extended study in patients with suspected cochlear nerve deficiency. Results: Within the population, one case corresponded to a patient with bilateral profound sensorineural hearing loss with suspicion of Cochlear nerve deficiency (Birman GRADE I and Casselman TYPE I/IIa bilateral). The auditory evoked potentials by electrical stimulation allowed to determine the ear to be implanted, showing better configuration of waves for the right ear. Currently, it presents an optimal adaptation to the implant (Auditory per formance category: 2- Category of Moog-Geers: 3), with a score of 8/40 in the IT-MAIS questionnaire. Conclusion: The extended preoperative study protocol is appropriate for patients with suspected cochlear nerve deficiency. Functional studies provide useful data to determine which patients could benefit. Family counseling about real limitations and goals is critical.

Introdução: a deficiência do nervo coclear é definida como um nervo coclear hipoplásico ou aplástico presente em mais de 18% das crianças com perda auditiva neurossensorial profunda onde a indicação do implante coclear continua a gerar polêmica. Objetivo: Analisar o protocolo do estudo em pacientes com suspeita de deficiência do nervo coclear e apresentar os resultados clínico-audiológicos após o implante coclear em nosso serviço. Material e método: Estudo retrospectivo dos registros clínicos no período de 2011-2017, analisando os estudos solicitados na avaliação pré-implante coclear e o estudo prolongado em pacientes com suspeita de deficiência de nervo coclear. Resultados: Dentro da população, um caso correspondeu a um paciente com perda auditiva neurossensorial profunda bilateral com suspeita de deficiência do nervo coclear (Birman: GRADO I e Casselman: TIPO bilateral I/IIa). O potenciais evocados auditivos elétrico permitiu determinar a orelha a ser implantada, mostrando melhor configuração de ondas para a orelha direita. Atualmente, apresenta uma ótima adaptação ao implante (categoria de desempenho auditivo: 2- categoria de Moog-Geers: 3), com uma pontuação de 8/40 no questionário IT-MAIS. Conclusão: O protocolo de estudo pré-operatório estendido é aplicável a pacientes com suspeita de deficiência do nervo coclear. Estudos funcionais fornecem dados úteis para determinar quais pacientes poderiam se beneficiar do implante coclear. O aconselhamento familiar sobre limitações e metas reais é crítico.

Evaluation of central vestibular syndrome in dogs using brainstem auditory evoked responses recorded with surface electrodes / Avaliação da síndrome vestibular central em cães usando respostas evocadas auditivas do tronco cerebral gravadas com eletrodos de superfície

The present study aimed to analyse the wave morphology, amplitude, latency, and intervals of the brainstem auditory evoked responses (BAERs) in dogs with central vestibular syndrome (CVS) recorded with surface electrodes. Ten dogs with CVS were examined by mono- and binaural stimulation, using the Neuropack electrodiagnostic system, with stimulus intensities of 90 dBSPL. BAERs examinations revealed morphological changes of waves I, II, III, and V and decreased amplitudes of all waves in 7/10 dogs. P values obtained were = 0.014 for wave I amplitude, 0.031 for II, and III and 0.032 for V. Comparing the latencies of waves I, II, III, and V generated by right and left monoaural stimulation in dogs with CVS, we did not observe significant differences (P > 0.05). No statistical differences were observed for BAERs latencies of the waves recorded after binaural and monaural stimulation (left or right). As far as we know, this is the first study of BAERs using surface electrodes, obtained from dogs with CVS.(AU)

Este estudo destina-se à análise da morfologia, da amplitude, da latência e do intervalo das ondas das respostas evocadas auditivas no tronco cerebral (BAERs) em cães com síndrome vestibular central (CVS) registrados com eletrodos de superfície. Dez cães com CVS foram examinados por estimulação mono e binaural usando um sistema de eletrodiagnóstico Neuropack, com intensidade do estímulo de 90 dBSPL. Os exames BAERs relevaram alterações morfológicas das ondas I, II, III e V, bem como baixas amplitudes para todas as ondas no caso dos 7/10 cães. Os valores de P obtidos foram = 0.014 para ampitude da onda I, 0.031 para a II e 0.032 para a V. Compararam-se as latências das ondas I, II, III e V geradas pelo estímulo monoaural direito e esquerdo em cães com CVS e não foram constatadas diferenças significativas (P > 0.05). Igualmente não foram observadas diferenças estatísticas no caso das latências BAERs no que diz respeito às ondas gravadas depois de estímulos binaural e monoaural (esquerdo ou direito). Pelo que é de conhecimento dos autores da presente pesquisa, este é o primeiro estudo sobre BAERs usando eletrodos de superfície obtidos em cães com CVS.(AU)

The First Case of Vestibulocochlear Neuritis in a Patient with Acquired Immunodeficiency Syndrome in Korea

The incidence of human immunodeficiency virus (HIV) infections continue to increase throughout the world. Although neurologic complications are frequent in individuals with HIV infection or acquired immunodeficiency syndrome (AIDS), vestibulocochlear neuritis is still a relatively rare manifestation. We report the first case of vestibulocochlear neuritis occurring in an AIDS patient in Korea.

El vértigo como primer síntoma de un infarto cerebeloso / The dizziness as the first symptom of a cellebelar stroke

Introducción: El vértigo es un motivo frecuente de consulta en los servicio de urgencias, por lo tanto es primordial para iniciar un tratamiento adecuado diferenciar un origen periférico de uno central. La historia clínica y la exploración neurológica completa son fundamentales para llegar a un diagnóstico, ya que las pruebas de imagen tienen una baja sensibilidad en la fase aguda y no siempre están disponibles en los servicios de urgencias. Objetivo: Presentar el caso clínico de una paciente de 74 años con vértigo agudo que sugiere inicialmente un origen periférico, pero que se debe a un infarto cerebeloso. Diseño: Reporte de caso. Materiales y métodos: Se presenta el caso de una paciente de 74 años que acude a urgencias por presentar de manera súbita vértigo objetivo con los movimientos cefálicos, intenso cortejo vegetativo, sin síntomas otológicos, con factores de riesgo cardiovascular importantes; al examen físico nistagmo horizontal derecho, no agotable, dismetría, disdiadococinesia izquierda e inestabilidad marcada que le impide la bipedestación. En tomografía craneal, se observa hipodensidad en región superior del hemisferio cerebeloso izquierdo sugestiva de lesión isquémica aguda en territorio vascular de la arteria cerebelosa superior. Resultados: Se diagnosticó mediante resonancia magnética nuclear, infarto isquémico en fase subaguda en el territorio de arteria cerebelosa superior izquierda. Conclusiones: Es importante diferenciar el vértigo aislado por causa vascular de trastornos más benignos que se relacionan con el oído interno, ya que la estrategia terapéutica y el pronóstico difieren considerablemente

Introduction: Vertigo is a frequent reason for consultation in the emergency department, therefore it is essential to differentiate between peripheral and central origin to initiate a suitable treatment. The clinical history and neurological examination are essential to reach a diagnosis, because imaging tests have low sensitivity in the acute phase and are not always available in the Emergency Department. Objective: To present the clinical case of a 74 year old patient with acute vertigo which initially suggested a peripheral origin, but it was due to an acute cerebellar infarction. Design: Case report. Materials and methods: We present the case of a patient of 74 years who came to the emergency department because of a sudden objective vertigo with was presented with head movements, severe vegetative symptoms without otologic symptoms. Important cardiovascular risk factors was identified; physical examination revealed an inexhaustible, horizontal, right nistagmus; dysmetria, left dysdiadochokinesia and marked instability. In tomography, a suggestive image of acute ischemic injury in vascular territory of the superior cerebellar artery hemisphere was seen. Results: A subacute ischemic stroke in the territory of the left superior cerebellar artery was diagnosed by nuclear magnetic resonance. Conclusions: It is important to differentiate isolated vertigo caused by more benign inner ear disease from those caused by vascular disorders, since therapeutic strategy and prognosis differ considerably.

Comparison and analysis of ASSR test in sensorineural hearing loss children with cochlear lesion and retrocochlear lesion / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To compare the auditory steady-state response (ASSR) test data of severe sensorineural hearing loss children with cochlear lesion and those with retrocochlear lesion and find some specific phenomena of retrocochlear lesion in ASSR, then to improve diagnostic accuracy in clinical practice.@*METHOD@#Between 2008 to 2012. 96 children (179 ears) were diagnosed with "retrocochlear auditory nerve lesion" and recieved ASSR test (" retrocochlear lesion" group). Eighty-one (143 ears) the same age children (143 ears) were diagnosed as "cochlear auditory nerve lesion" and selected them as the "cochlear lesion" group. Twenty-six (50 ears) normal hearing children at the same age who had ASSR test records selected from the pediatric hearing center database of our hospital were selected as "normal control" group. Compare the difference of ASSR threshold, ASSR elicit rate and ASSR audiogram among the three groups.@*RESULT@#(1) ASSR threshold: Compared each frequency threshold in ASSR test with cochlear.lesion group, the retrocochlear lesion group with wave V and wave I had no significant difference in 500 Hz and 1000 Hz but had significant difference in 2000 Hz and 4000 Hz. As for the retrocochlear lesion group without wave V and wave I, there was a decline in 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz compared with cochlear lesion group. (1) ASSR elicit rate: When compared to retrocochlear lesion group, the cochlear lesion group had a significance lower elicit rate in the four frequency. (3) Number of elicit reactions in ASSR test . In the retrocochlear lesion group, the elicit reactions in all the four frequency in ASSR test was significantly higher than ochlear lesion group. (4) ASSR audiogram type. The proportion of rising curve audiogram in retrocochlear lesion group was 26.83% (with wave I and wave V), 40% (with wave I and without wave V ) and 33.80% (without wave I and wave V).@*CONCLUTION@#(1) Children with a severe hearing loss in ABR test and a rise type audiogram in ASSR test should be most possibly considered as retrocochlear lesion. (2) ASSR threshold cannot be used in determinate the severity of hearing loss in children with retrocochlear lesion.

Sensitivity and Specificity of Vestibular Evoked Myogenic Potential Elicited By Different Tone Bursts to Diagnose Peripheral Vestibular Disordered

Peripheral vestibular disorder (PVD) is serious and common. Clinically, giving an accurate diagnosis of PVD can be challenging. Vestibular evoked myogenic potential (VEMP) is an objective test to evaluate the integrity of vestibular organs, particularly saccule and/or inferior vestibular nerve. This study was performed to determine the sensitivity and specificity of VEMP using different stimuli. Fourty normal and 65 PVD subjects who fulfilled the inclusion criteria were recruited. While sitting comfortably, VEMP waveforms were recorded with active electrode on sternocleidomastoid muscle and negative electrode on upper forehead. Tone bursts (500, 750 and 1000 Hz) were delivered via headphones at 90 dBnHL and 5/s presentation rate. VEMP parameters for each stimulus (amplitude and latency of P1 and N1 peak) were analyzed accordingly. Receiver operating characteristic (ROC) was performed to determine the sensitivity and specificity of VEMP at different test frequencies. N1 amplitude of 750 Hz stimulus produced the most ideal sensitivity (65% on right and 63% on left) and specificity (83% on right and 78% on left). The importance of using a few tone bursts in VEMP test in order to minimize the false negative in cases might be encountered in clinics as the certain tone burst had inadequate sensitivity in detecting PVD cases. The 750 Hz stimulus produced the most ideal VEMP with adequate values of sensitivity and specificity, at least in this study.

Comparison of Audiovestibular Dysfunction in Patients of Acute Unilateral Peripheral Vestibulopathy with and without Vascular Risk Factors / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Etiology of acute unilateral peripheral vestibulopathy (AUPV) includes virus, ischemia, and autoimmune. As anatomical distribution is similar between vasculature and innervation, AUPV with vascular risk factors could be ischemic origin. We investigated the pattern of audiovestibular dysfunction to explore the influence of risk factors on AUPV. MATERIALS AND METHODS: We collected records of 162 AUPV patients from 2011 to 2013 who were admitted within 7 days from vertigo onset and diagnosed as AUPV by caloric test and neuro-otologic examination. Vascular risk factors are stroke history, hypertension, diabetes, body mass index >25, age >60, and vertebrobasilar stenosis. Bedside examination includes spontaneous nystagmus grade, head impulse test, head shaking test. Results of rotatory chair test (n=125), caloric test (n=162), cervical (n=33) and ocular (n=23) vestibular evoked myogenic potential (VEMP), subjective visual vertical (SVV) (n=91), and pure tone audiometry (PTA) (n=62) are collected. RESULTS: Abnormalities of PTA are found more in patients with vascular risk factor than without any risk factor. Specifically, hypertension (p=0.008) and old age (p=0.025) are associated with PTA abnormality (p=0.006). Tilt angle of vertical is larger in risk factor group (p=0.019). The number of vascular risk factor correlates with abnormalities of PTA (p=0.025) and tilt angle of SVV. Results of bedside examination, rotatory chair test, caloric test, cervical and ocular VEMP are not associated with vascular risk factors. CONCLUSION: AUPV patients with vascular risk factors have more extensive involvement of audiovestibular function. Ischemic etiology may contribute to pathogenesis of extensive AUPV.

Effectiveness of cochlear implantation in children with auditory neuropathy and cochlear nerve aplasia / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The aim of this study is to assess of cochlear implantation in children with auditory neuropathy and cochlear nerve aplasia by using Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR).</p><p><b>METHODS</b>Twenty one children with cochlear implants participated in this study. They all received cochlear implant surgery at our hospital from January 2004 to October 2010. All children had hearing aid trial and hearing and speech rehabilitation before surgery at least three months.Nine children (7 male, 2 female) were diagnosed with auditory neuropathy, twelve (7 male, 5 female) with cochlear nerve aplasia. Twenty children (10 male, 10 female) with sensorineural hearing loss served as a control group. All the children received cochlear implant for more than six months. Forty two children with normal hearing served as another control group which were divided into three subgroups according to their age.Group A included 18 children aged under two yrs, group B consisted of 16 children aged from two to four yrs and group C comprised eight children aged above four yrs. CAP and SIR were used to evaluate among all the children and the scores were compared.</p><p><b>RESULTS</b>The CAP scores of children with auditory neuropathy, cochlear nerve aplasia, sensorial neural hearing loss and the three subgroups children with normal hearing were 4.44 ± 1.50, 4.83 ± 1.69, 4.55 ± 1.66, 5.22 ± 1.11, 6.75 ± 0.45 and 7.00 ± 0.00 respectively, and SIR scores were 2.66 ± 1.11, 2.33 ± 1.15, 2.40 ± 0.75, 2.56 ± 1.04, 4.12 ± 0.81 and 5.00 ± 0.00 respectively. There were significant differences among the six groups for CAP scores(χ(2) = 35.481, P < 0.001) and SIR scores(χ(2) = 40.549, P < 0.001).No significant differences for CAP and SIR scores were observed between children with auditory neuropathy/cochlear nerve aplasia and sensorial neural hearing loss as well as group A (P > 0.05 for each), and there were significant differences were shown between children with auditory neuropathy/cochlear nerve aplasia and group B as well as group C (P < 0.01 for each aplasia).</p><p><b>CONCLUSIONS</b>The auditory and speech capabilities of children with auditory neuropathy and cochlear nerve deficiency can can get benefits from cochlear implants as children with sensorineural hearing loss, however not achieve the level of those with normal hearing after cochlear implantation. The long term effects still need follow-up and evaluation.</p>

Follow-up examination for high risk infants with auditory neuropathy spectrum disorder / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The goal was to know more about the characteristic of auditory neuropathy spectrum disorder (ANSD) for high risk infants.@*METHOD@#The newborn hearing screening was performed with automatic auditory brainstem response (AABR) and transient evoked otoacoustic emission(TEOAE) for the infants in the NICUs from August 2007 to January 2011. After subsequent rescreening, children with AABR test referred were perform hearing test set including high frequency (1000 Hz) tympanometry, ABR, DPOAE and/or Cochlear Microphonics (CMs) in 3 months old. Only infants demonstrated severely abnormal ABRs along with preserved DPOAEs and/or CMs were scheduled for re-examination in 6-8 months old and Behavior audiometry in 8-12 months old.@*RESULT@#Eighteen infants (14 cases were bilateral and 4 cases were unilateral) considered as suffering from AN in 3 months old. All of them showed ABR thresholds > or = 80 dB nHL or absent at maximum test intensity. Follow-up examination revealed 9 cases (18 ears) with restoration of ABR to normal or a lower ABR thresholds and a resolution of ANSI) in 11 out of 18 infants retested in 6-8 months old. CMs were present in all ears but DPOAE were not present in 4 ears with middle ear pathology in 3 months test. Behavioral hearing of 10 cases ranged from mild (n = 2), moderate(n = 4) to severe and profound loss (n = 4).@*CONCLUSION@#ANSD in high risk neonates could show the temporary character. It was too difficult to forecast the prognosis, they would be to follow up to at least 3 years old for newborn ANSD.

Auditory neuropathy/auditory dyssynchrony in children with cochlear implants / Neuropatia auditiva/dessincronia auditiva em crianças usuárias de implante coclear

The electrical stimulation generated by the Cochlear Implant (CI) may improve the neural synchrony and hence contribute to the development of auditory skills in patients with Auditory Neuropathy/Auditory Dyssynchrony (AN/AD). AIM: Prospective cohort cross-sectional study to evaluate the auditory performance and the characteristics of the electrically evoked compound action potential (ECAP) in 18 children with AN/AD and cochlear implants. MATERIAL AND METHODS: The auditory perception was evaluated by sound field thresholds and speech perception tests. To evaluate ECAP's characteristics, the threshold and amplitude of neural response were evaluated at 80Hz and 35Hz. RESULTS: No significant statistical difference was found concerning the development of auditory skills. The ECAP's characteristics differences at 80 and 35Hz stimulation rate were also not statistically significant. CONCLUSIONS: The CI was seen as an efficient resource to develop auditory skills in 94 percent of the AN/AD patients studied. The auditory perception benefits and the possibility to measure ECAP showed that the electrical stimulation could compensate for the neural dyssynchrony caused by the AN/AD. However, a unique clinical procedure cannot be proposed at this point. Therefore, a careful and complete evaluation of each AN/AD patient before recommending a Cochlear Implant is advised. Clinical Trials: NCT01023932.

A estimulação elétrica gerada pelo Implante Coclear (IC) pode ser capaz de melhorar a sincronia neural e contribuir para o desenvolvimento das habilidades auditivas de sujeitos portadores de Neuropatia Auditiva/Dessincronia Auditiva (NA/DA). OBJETIVO: Estudo de coorte prospectivo transversal para avaliar o desempenho auditivo e as características do Potencial de Ação Composto Eletricamente Evocado no Nervo Auditivo (ECAP) em 18 crianças portadoras de NA/DA e usuárias de IC. MATERIAL E MÉTODOS: Percepção auditiva e características do ECAP foram avaliadas respectivamente, por meio da determinação dos limiares tonais e testes de percepção de fala e pelas medidas de limiar e amplitude da resposta neural para as frequências de estimulação de 35 e 80Hz. Não foram encontradas diferenças estatisticamente significativas no desenvolvimento das habilidades auditivas entre os sujeitos avaliados. RESULTADOS: Não foram observadas modificações estatisticamente significativas nas características de limiar e amplitude do ECAP para as duas frequências de estimulação testadas. CONCLUSÕES: O IC caracterizou-se como um efetivo recurso para o desenvolvimento das habilidades auditivas em 94 por cento dos sujeitos, sendo a estimulação elétrica capaz de compensar a alteração da sincronia neural decorrente da NA/DA. A avaliação criteriosa de cada caso de maneira específica deve ser realizada no momento anterior à indicação cirúrgica. Clinical Trials: NCT01023932.

Alterações no sistema vestibulococlear decorrentes da exposição ao agrotóxico: revisão de literatura / Vestibulocochlear system alterations caused by exposure to pesticides: a literature review

Os agrotóxicos são amplamente utilizados no meio rural e sua larga utilização, desprovida de medidas de biossegurança apropriadas, vem provocando impactos potenciais tanto para a degradação ambiental quanto para o organismo humano, aumentando a incidência de intoxicações ocupacionais. O objetivo do presente estudo foi revisar e discutir a respeito da exposição aos agrotóxicos e sua influência na função e estrutura do sistema auditivo. Foram revisados periódicos nacionais e internacionais relevantes indexados no PubMed, Medline, Bireme e LILACS, assim como capítulos de livros e dissertações publicados no período entre 1987 e 2009. As pesquisas sugerem que a exposição, principalmente crônica, aos agrotóxicos induz a alterações funcionais no sistema vestibulococlear, manifestando ainda uma série de sinais e sintomas. Apesar da escassez de dados sobre a influência do organofosforado nas características morfológicas do aparelho auditivo, os estudos indicam que a exposição de caráter agudo aos agrotóxicos pode também ser responsável por alterações no sistema auditivo, caracterizadas por lesões estruturais na cóclea, principalmente nas células ciliadas externas.

Pesticides are widely used in agriculture, and the widespread application of these agents, without the appropriate use of bio-security measures, has been causing potential impacts for environmental degradation, as well as for the human organism, increasing the incidence of occupational poisoning. The aim of the present study was to review the available literature and to carry out a discussion regarding pesticides exposure and its harmful effects on the auditory system's function and structure. Relevant national and international journals indexed in PubMed, Medline, Bireme and LILACS were reviewed, as well as book chapters and dissertations published between 1987 and 2009. The available data suggest that chronic exposure to pesticides lead to functional alterations in the vestibulocochlear system, as well as a series of signs and symptoms. In spite of the scarce data describing organophosphorus influence on morphological characteristics of the auditory system, the literature suggest that acute exposure to pesticides can also be responsible for auditory system alterations, characterized by structural lesions in the cochlea, mainly in outer hair cells.

Facial paralysis and vestibular syndrome in feedlot cattle in Argentina / Paralisia facial e síndrome vestibular de bovinos em confinamento

This paper reports 6 outbreaks of neurological disease associated with paralysis of the facial and vestibulocochlear nerves caused by intracranial space occupying lesions in feedlot cattle. The clinical signs observed were characterized by head tilt, uni or bilateral drooping and paralysis of the ears, eyelid ptosis, keratoconjunctivitis, and different degrees of ataxia. Morbidity and mortality rates ranged from 1.1 to 50 percent and 0 to 1 percent, respectively. Gross lesions observed included yellow, thickened leptomeninges, and marked enlargement of the roots of cranial nerves VII (facial) and VIII (vestibulocochlear). Histopathologically, there was severe, chronic, granulomatous meningitis and, in one case, chronic, granulomatous neuritis of the VII and VIII cranial nerves. Attempts to identify bacterial, viral, or parasitic agents were unsuccessful. Based on the morphologic lesions, the clinical condition was diagnosed as facial paralysis and vestibular syndrome associated with space occupying lesions in the meninges and the cranial nerves VII and VIII. Feedlot is a practice of growing diffusion in our country and this is a first report of outbreaks of facial paralysis and vestibular disease associated with space occupying lesions in Argentina.

Descrevem-se 6 surtos de uma doença neurológica com paralisia dos nervos facial e vestibulo-coclear causada por lesões intracraniais que ocupam espaço em bovinos em confinamento. Os sinais clínicos foram desvio da cabeça, queda e paralisia das orelhas, ptose palpebral, ceratoconjuntivite e diferentes graus de ataxia. As taxas de morbidade e mortalidade foram de 1.1 por cento-50 por cento e de 0-1 por cento, respectivamente. As lesões macroscópicas incluíram engrossamento das meninges, que se apresentavam amareladas, e marcado engrossamento das raízes dos nervos cranianos VII (facial) e VIII (vestíbulo-coclear). Histologicamente observaram-se meningite crônica granulomatosa e, em um caso, neurite granulomatosa crônica do VII e VIII pares cranianos. Cultivos para bactérias ou vírus resultaram negativos. De acordo com as lesões observadas o quadro clínico foi diagnosticado como paralisia facial e síndrome vestibular associadas a lesões que ocupam espaço nas meninges e nervos cranianos VII e VIII. O confinamento é uma prática em expansão na Argentina e este é o primeiro relato, neste país, de surtos de paralisia facial e síndrome vestibular associados com lesões que ocupam espaço.

Ski sickness in adolescents skiers

There is shortage of knowledge about medical problems in adolescents skiers. This study aimed to determine frequency of medical signs and symptoms during or after ski among adolescents skiers. This cross sectional study was performed in 1 2 consecutive weekends in winter 2005 at Dizin ski piste in Iran. All adolescents skiers [<16years] who had entered the piste during this time period were enrolled in the study. A questionnaire including demographics, duration of transport to the piste, wearing glasses and contact lenses for medical and non medical applications, duration and frequency of skiing and development of signs and symptoms of ski sickness during or after skiing was filled for each participant. In addition to determination of frequency of medical problems, association of mentioned variables with medical problems was investigated. Of 162 skiers, 111 subjects [68.5%] were males. The mean age of the participants was 14.7 +/- 2.1 years. Of them, 127 skiers wore glasses or lens during skiing. Visual disorders including myopia, hyperopia and astigmatism were found in 24 [14.8%] skiers. Our study showed that the frequency of main ski-related signs and symptoms varies from 0 to 10.5%. There was significant association between occurrence of signs and symptoms and presence of visual disorder [P=0.015]. Our results showed that development of ski-related signs and symptoms is relatively frequent. These signs and symptoms have association with minor ophthalmologic problems such as myopia or astigmatism

Application of intraoperative round window electrocochleography for screening the patients with auditory neuropathy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Most patients with auditory neuropathy (AN) could receive good even the best effects after cochlear implantation. How to diagnose AN objectively and accurately is very important. In this study, we screened the patients with AN according to the presence or absence of compound action potential (CAP) of intraoperative round window electrocochleography (RW ECochG).</p><p><b>METHODS</b>Intraoperative RW ECochG was performed on 32 patients with profound sensorineural deafness, who had normal cochlea during cochlear implantation surgery under general anesthesia in the standard operating room. The cochlear microphonic (CM) and CAP of RW ECochG was observed and recorded.</p><p><b>RESULTS</b>The presence of CM but the absence of CAP of RW ECochG occurred in 12 among the 32 patients. They were suspected to suffer from AN. The rest patients who had CM and CAP of RW ECochG were thought not to suffer from AN.</p><p><b>CONCLUSION</b>Application of intraoperative RW ECochG during the cochlear implantation surgery may objectively and accurately screen the patients with AN, and can give a meaningful clue for implanted device working.</p>

The diagnosis of auditory neuropathy in young children / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To present the clinical data of a group of children with audiological profile of auditory neuropathy.@*METHOD@#Forty-eight infants and young children who had severely abnormal click ABRs along with present CMs and/or DPOAEs were included in this retrospective study. Click ABRs, CMs, DPOAEs, tympanograms, behavioral thresholds and inner ear MRI were analysed.@*RESULT@#Fourty children present with bilateral audiological profile of AN, 8 were unilateral. Most of the ears (68.2%) were of absent click ABRs at the maximum presentation level of 100 dB nHL. However, some of them had repeatable Wave V at very high presentation levels. All ears showed present CMs while only 41.7% showed preserved DPOAEs. Four children were diagnosed as CND by further investigation of inner ear MRI.@*CONCLUSION@#It is recommended that CM testing be carried out routinely in children with severely abnormal click ABRs so as not to miss out AN; Behavioral hearing can not be predicted by auditory evoked responses; if audiological profile of AN is detected, further MRI exploration of well-developed cochlear nerve is necessary.