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1.
Chinese Journal of Internal Medicine ; (12): 814-818, 2023.
Article in Chinese | WPRIM | ID: wpr-985991

ABSTRACT

Objective: To investigate the spontaneous nystagmus (SN) and the frequency characteristics of affected semicircular canals in patients with vestibular neuritis (VN). Methods: This is a cross-sectional study. A total of 61 patients with VN admitted to the Department of Neurology of Shanxi Bethune Hospital from June 2020 to October 2021, 39 were male and 22 were female, with a mean age of (46±13) years old and male to female ratio of 1.77∶1. According to SN characteristics, 61 patients were divided into non-nystagmus group(nSN), horizontal nystagmus group(hSN) and horizontal-torsional nystagmus group (htSN). Clinical data were collected, and SN, unilateral weakness (UW), directional preponderance (DP), and video head impulse test (vHIT) gain were used as observation indicators. Statistical analysis by SPSS23.0 software. Normal distributed quantitative data (age, semicircular canal gain, SN intensity) were expressed by x¯±s, non-normal distributed quantitative data (disease course, UW, DP) were expressed by M(Q1,Q3), qualitative data were expressed by rate and composition ratio, difference analysis by one-way ANOVA, rank sum test, Chi-square test or Fisher's exact probability method, considered by P value<0.05. Results: (1)The disease course of nSN, hSN and htSN was 7.0 (4.0, 12.5), 6.0 (3.5, 11.5), and 3.0 (2.0, 6.5) days respectively, and there were statistical differences (χ2=7.31,P=0.026).(2)The horizontal nystagmus intensity of htSN was (16.8±8.6)°/s, which was significantly higher than that of (9.8±4.7)°/s in hSN (t=3.71, P<0.001). There was no significant difference in the positive rate of UW between the three groups (P=0.690), and there was a significant difference in the positive rate of DP in the three groups (χ2=12.23, P=0.002). The horizontal nystagmor intensity in the htSN was positively correlated with the vertical nystagmus intensity (r=0.59, P=0.001).(3)The gain of the affected horizontal canal of the three groups was statistically different (F=8.28, P=0.001), and the gain of the horizontal canal of hSN and htSN was significantly lower than that of nSN (t=2.74, P=0.008; t=4.05, P<0.001); The gain of the affected anterior canal in the three groups was statistically different (F=5.32, P=0.008). The gain of the anterior canal in both nSN and hSN was significantly higher than that in htSN (t=3.09, P=0.003; t=2.15, P=0.036). The horizontal canal gain of htSN is positively correlated with the anterior canal gain (r=0.74, P<0.001).(4)The affected semicircular canals in the two groups with no-vertical-component nystagmus (nSN and hSN) and the htSN were counted. The composition ratio of the affected semicircular canals in the two groups was different (χ2=8.34, P=0.015). Conclusion: The occurrence of SN in patients with VN is related to many factors, such as the disease course, low and high frequencies, and the severity of the condition in the affected semicircular canal.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Vestibular Neuronitis , Cross-Sectional Studies , Semicircular Canals , Nystagmus, Pathologic , Head Impulse Test , Disease Progression
2.
Journal of Clinical Otorhinolaryngology Head and Neck Surgery ; (12): 409-414, 2023.
Article in Chinese | WPRIM | ID: wpr-982759

ABSTRACT

Isolated otolith dysfunction(iOD) involves a group of unexplained vestibular syndromes that manifest clinically as a sense of translation, tilting or floating, and blurred vision with head movement, with normal semicircular canal function but abnormal otolith function on laboratory vestibular testing. As vestibular medicine has gained widespread popularity in recent years, increasing attention has also been paid to iOD and case reports, clinical studies and diagnostic criteria have been published. However, there is no consensus document to guide the diagnosis of this disease in China. In this context, the Special Committee on Vertigo of China Medical Education Association organized a group of domestic experts in vestibular medicine and formulated this diagnostic consensus after thorough discussion based on the latest evidence in China and abroad, in order to promote the best clinical practice for iOD.


Subject(s)
Humans , Otolithic Membrane , Vestibular Diseases/diagnosis , Vertigo/diagnosis , Vestibule, Labyrinth , Semicircular Canals
3.
Journal of Clinical Otorhinolaryngology Head and Neck Surgery ; (12): 310-312, 2023.
Article in Chinese | WPRIM | ID: wpr-982739

ABSTRACT

Electrode array misplacement is a rare complication of cochlear implant. This article reports an 11-year-old boy who was mistakenly implanted the cochlear electrode array into the superior semicircular canal during the initial cochlear implant. After the diagnosis was confirmed, he underwent a second cochlear implant and the electrode array were successfully implanted into the cochlea. This article conducted a systematic review of the literature on electrode array misplacement, and the causes of electrode array misplacement were analyzed from different implantation position.


Subject(s)
Male , Humans , Child , Electrodes, Implanted , Reoperation , Cochlea , Cochlear Implantation , Cochlear Implants/adverse effects , Semicircular Canals/surgery
4.
Journal of Clinical Otorhinolaryngology Head and Neck Surgery ; (12): 268-271, 2023.
Article in Chinese | WPRIM | ID: wpr-982730

ABSTRACT

Objective:To evaluate the influence of an additional roll test on the repositioning procedure by SRM-vertigo diagnosis system for horizontal canal benign paroxysmal positional vertigo(HC-BPPV). Methods:A total of 713 patients diagnosed with HC-BPPV in Department of Otolaryngology Head and Neck Surgery,the First Affiliated Hospital of Xi'an Jiaotong University from Jan 2020 to Feb 2022 were enrolled. The patients were divided into two groups by hospital card numbers, in which the number is odd were considered as group A, and the number is even were considered as group B. The group A underwent two circles of Barbecue repositioning procedure by SRM-vertigo diagnosis system, while the group B first performed an additional roll test and then underwent two circles of Barbecue repositioning procedure by SRM-vertigo diagnosis system, to observe the cure rate and compare influence of HC-BPPV by an additional roll test. The quality of life and sleep of patients before and one-month after the treatment were assessed by the dizziness handicap inventory(DHI) and the pittsburgh sleep quality(PSQI). Results:The cure rate of group A was 63.21%, and the cure rate of group B was 87.68%,the difference between the two groups was statistically significant(P<0.05); The DHI score of patients after the repositioning was significantly lower than that before the repositioning(P<0.05). The PSQI score after the repositioning was significantly lower than that before the repositioning(P<0.05). The DHI and the PSQI scores after the repositioning were significantly lower than that before the repositioning, with a statistically significant difference (P< 0.05). The total score of DHI in group B after treatment was lower than that in group A, with a statistically significant difference(P<0.05). The total score of PSQI in group B after treatment was lower than that in group A, with non-statistically significant difference (P< 0.05). Conclusion:An additional roll test before the repositioning procedure by SRM-vertigo diagnosis system can significantly improve the cure rate of HC-BPPV, relieve anxiety, and improve the quality of life.


Subject(s)
Humans , Benign Paroxysmal Positional Vertigo/diagnosis , Quality of Life , Patient Positioning/methods , Dizziness , Semicircular Canals
5.
Journal of Clinical Otorhinolaryngology Head and Neck Surgery ; (12): 263-267, 2023.
Article in Chinese | WPRIM | ID: wpr-982729

ABSTRACT

Objective:To analyze the site of vestibular nerve damaged in patients with acute vestibular neuritis. Methods:Fifty-seven patients with acute vestibular neuritis were recruited, and each patient underwent caloric irrigation test, video head impulse test(vHIT) and vestibular evoked myogenic potentials(VEMPs). The results were further analyzed. Results:Analysis of abnormal rates of different vestibular function tests: the abnormal rate of caloric irrigation test, horizontal semicircular canal vHIT, anterior semicircular canal vHIT, and posterior semicircular canal vHIT were 92.98%, 92.98%, 92.98%, and 52.63%, respectively. The abnormal rate of cervical vestibular evoked myogenic potentials(cVEMP) and ocular vestibular evoked myogenic potentials(oVEMP) were 52.63% and 89.47%. The abnormal rate of caloric irrigation test, horizontal semicircular canal vHIT, anterior semicircular canal vHIT, and oVEMP were significantly higher than posterior semicircular canal vHIT and cVEMP(P<0.01). Combination analysis of different vestibular function tests: there are twenty-six patients(45.61%, superior and inferior vestibular nerve) with abnormal caloric irrigation test, video head impulse test, and VEMPs. There are twenty-five patients(43.86%, superior vestibular nerve) with abnormal caloric irrigation test, horizontal semicircular canal vHIT, anterior semicircular canal vHIT, and oVEMP. There are 4 patients(7.02%, inferior vestibular nerve) with abnormal posterior semicircular canal vHIT and cVEMP. There are two patients(3.51%, ampullary vestibular nerve) with abnormal caloric irrigation test, horizontal semicircular canal vHIT, and anterior semicircular canal vHIT. The rate of superior and inferior vestibular neuritis and superior vestibular neuritis were significantly higher than inferior vestibular neuritis and ampullary vestibular neuritis(P<0.01). Conclusion:Acute vestibular neuritis subtypes can be divided into four categories: superior and inferior vestibular neuritis, superior vestibular neuritis, inferior vestibular neuritis, and ampullary vestibular neuritis. Video head impulse test can accurately assess the site of vestibular nerve damage in patients with acute vestibular neuritis. In addition, vHIT combined with VEMPs can provide objective evidence for the diagnosis of ampullary vestibular neuritis.


Subject(s)
Humans , Vestibular Neuronitis/diagnosis , Vestibule, Labyrinth , Vestibular Nerve , Semicircular Canals , Head Impulse Test/methods
6.
Journal of Clinical Otorhinolaryngology Head and Neck Surgery ; (12): 829-836, 2023.
Article in Chinese | WPRIM | ID: wpr-1011052

ABSTRACT

Objective:This study aims to compare the examination results of the vestibular evoked myogenic potential(VEMP) and video head impulse testing(vHIT) in patients with vestibular neuritis(VN), thus exploring the methods to distinguish superior and inferior vestibular nerve damages in VN patients, and their feasibility. Methods:A total of 25 patients with unilateral VN treated in the Otology Department of the First Hospital of Qinhuangdao from May 2018 to July 2021 were recruited. They were respectively tested for ocular VEMP(oVEMP), cervical VEMP(cVEMP) and vHIT, and the examination results were analyzed. Results:Examination results of oVEMP showed that 96%(24/25) patients had one-ear abnormalities with the amplitude decline or no waveform introduced, and 4%(1/25) patient had no waveform introduced of both ears. The overall abnormal rate examined by oVEMP was 100%(26/26). Examination results of cVEMP showed that 36%(9/25) patients had one-ear abnormalities with the amplitude decline or no waveform introduced, and 4%(1/25) patients had no waveform introduced of both ears. The overall abnormal rate examined by cVEMP was 40%(10/25), and 60%(15/25) patients had normal waveforms of both ears. Examination results of vHIT showed that 100%(25/25) patients had semicircular canal gain decline of one side, 92%(23/25) had anterior Semicircular canal decline of one side, and 36%(9/25) had posterior semicircular canal decline of one side. VEMP and vHIT results were compared. Examination results of VEMP showed that 60%(15/25) VN patients had superior vestibular nerve damage, and 40%(10/25) had both superior and inferior vestibular nerve damages. Examination results of vHIT showed that 64%(16/25) VN patients had superior vestibular nerve damage, and 36%(9/25) had both superior and inferior vestibular nerve damages. There was no significant difference in the ratio of VN patients with superior and inferior vestibular nerve damages examined by VEMP or vHIT(χ²=0.085, P>0.05). The matching ratio of VEMP and vHIT results was 80%(20/25), and the non-matching ratio was 20%(5/25). Conclusion:Consistent results obtained from both VEMP and vHIT can preliminarily identify the type of vestibular nerve damage. If their results are not consistent, it is recommended not to identify the scope of the vestibular nerve damage.


Subject(s)
Humans , Vestibular Neuronitis/diagnosis , Vestibular Nerve , Head Impulse Test/methods , Semicircular Canals , Vestibular Evoked Myogenic Potentials/physiology
7.
Journal of Clinical Otorhinolaryngology Head and Neck Surgery ; (12): 786-795, 2023.
Article in Chinese | WPRIM | ID: wpr-1011043

ABSTRACT

Objective:To investigate the influence of Barbecure combined with Epley on residual dizziness of horizontal canal benign paroxysmal positional vertigo(HC-BPPV) by SRM-vertigo diagnosis system. Methods:A total of 406 patients diagnosed with HC-BPPV from Nov 2021 to Nov 2022 were enrolled by rapid axial roll test and Dix-Hallpike in the department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Xi'an Jiaotong University. The patients were divided into two groups by hospital card numbers, in which the numbers that were odd were considered as group A, and the numbers that were even were considered as group B. The group A underwent two circles of Barbecure repositioning procedure by SRM-vertigo diagnosis system, while the group B underwent two circles Barbecure combined with Epley repositioning procedure by SRM-vertigo diagnosis system. The treatment was stopped on the next day when two groups of patients were cured, and those who were not cured will continue treatment with the same method. Results:The cure rate of group A was 83.41%, and the cure rate of group B was 80.51%, the difference between the two groups was not-statistically significant difference(P>0.05). The rate of residual dizziness of group A was 23.30%, the rate of residual dizziness of group B was 11.46%, the difference between the two groups was statistically significant(P<0.05). Conclusion:The Barbecure combined with Epley otoliths repositioning maneuver by SRM-vertigo diagnosis system can significantly reduce the rate of residual dizziness after the treatment of HC-BPPV, and improve the quality of life of patients.


Subject(s)
Humans , Benign Paroxysmal Positional Vertigo/therapy , Dizziness , Quality of Life , Patient Positioning/methods , Semicircular Canals
8.
Journal of Clinical Otorhinolaryngology Head and Neck Surgery ; (12): 670-672, 2023.
Article in Chinese | WPRIM | ID: wpr-1011029

ABSTRACT

Delayed endolymphatic hydrops (DEH) is a rare disease that causes vertigo and is often misdiagnosed as other vertigo diseases. This article reports on a patient with vertigo who was easily misdiagnosed. The patient was a middle ear cholesteatoma complicated by labyrinthine fistula (LF); however, his vertigo was episodic vertigo, which could not be explained solely by LF causing labyrinthitis. The possibility of endolymphatic hydrops was suspected, which was confirmed by inner ear magnetic resonance gadolinium imaging. This is the first reported case of middle ear cholesteatoma complicated by LF and DEH. The patient underwent surgical resection of the cholesteatoma and three semicircular canal obstructions at the same time. During two years postoperative follow-up, the patient did not experience a recurrence of vertigo. When diagnosing vertigo diseases, a careful history of vertigo is of utmost importance.


Subject(s)
Humans , Endolymphatic Hydrops/diagnosis , Cholesteatoma, Middle Ear/complications , Vertigo/complications , Labyrinth Diseases/complications , Magnetic Resonance Imaging/adverse effects , Semicircular Canals
9.
Audiol., Commun. res ; 28: e2790, 2023. tab
Article in Portuguese | LILACS | ID: biblio-1447432

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Accidental Falls , Semicircular Canals , Risk Factors , Dizziness/diagnosis , Head Impulse Test/methods , Vestibular Diseases , Cross-Sectional Studies , Postural Balance
10.
Audiol., Commun. res ; 28: e2750, 2023. tab, graf
Article in Portuguese | LILACS | ID: biblio-1429892

ABSTRACT

RESUMO Objetivo Avaliar a efetividade da reabilitação vestibular na funcionalidade, ganho dos canais semicirculares ao Video Head Impulse Test (v-HIT), nas respostas ao Potencial Evocado Miogênico Vestibular (VEMP), sintomas depressivos, equilíbrio e tontura em idosos. Métodos Estudo longitudinal, quase experimental e analítico, realizado entre dezembro de 2019 e julho de 2022, com 50 idosos com disfunção vestibular, submetidos à reabilitação vestibular e à aplicação dos exames VEMP, v-HIT, dos questionários e escalas Escala Visual Analógica, Dizziness Handicap Inventory e Escala de Equilíbrio de Berg, além do Questionário de Atividades Funcionais de Pfeffer e Escala de Depressão Geriátrica. Todos os exames e questionários foram aplicados antes e após oito sessões semanais de reabilitação vestibular. A análise estatística foi realizada pelo programa SPSS, por meio do teste Wilcoxon (p<0,05). Resultados Observou-se melhora do ganho do canal semicircular anterior direito (0,71/0,78), redução do incômodo da tontura (7/5), do impacto da tontura na qualidade de vida (35/15), melhora do equilíbrio (45/51), além de melhora da funcionalidade (2/1) e redução dos sintomas depressivos (5/3). Conclusão Idosos com disfunção vestibular submetidos à reabilitação vestibular apresentaram melhora do ganho do reflexo vestíbulo-ocular, do equilíbrio, da funcionalidade, redução do impacto da tontura na qualidade de vida e dos sintomas depressivos.


ABSTRACT Purpose To assess the effectiveness of vestibular rehabilitation on functioning, gains in semicircular canals in the Video Head Impulse Test (v-HIT), on responses to the vestibular evoked myogenic potentials (VEMP), depressive symptoms, balance, and dizziness in older adults. Methods Longitudinal, quasi-experimental, analytical study conducted between December 2019 and July 2022, in 50 older adults with vestibular disorders, submitted to vestibular rehabilitation and examinations: VEMP, v-HIT, the questionnaires, visual analog scale, Dizziness Handicap Inventory, Berg Balance Scale, Pfeffer's Functional Activities Questionnaire, and Geriatric Depression Scale. All examinations and questionnaires were applied before and after eight weekly vestibular rehabilitation sessions. Statistical analysis was performed in SPSS, with the Wilcoxon test (p<0.05). Results There was a gain in the anterior right semicircular canal (0.71/0.78), reduction in dizziness discomfort (7/5) and in the impact of dizziness on the quality of life (35/15), improvement in balance (45/51) and functioning (2/1), and reduction in depressive symptoms (5/3). Conclusion Older adults with vestibular disorder submitted to vestibular rehabilitation improved their gain in vestibulo-ocular reflex, balance, and functional activities and reduced their depressive symptoms and the impact of dizziness on their quality of life.


Subject(s)
Humans , Middle Aged , Aged , Aged, 80 and over , Quality of Life , Vestibular Diseases/rehabilitation , Treatment Outcome , Depression , Dizziness , Postural Balance , Reflex, Vestibulo-Ocular , Semicircular Canals , Surveys and Questionnaires , Vestibular Evoked Myogenic Potentials
11.
Rev. otorrinolaringol. cir. cabeza cuello ; 82(1): 50-59, mar. 2022. ilus, tab, graf
Article in Spanish | LILACS | ID: biblio-1389830

ABSTRACT

Resumen Introducción: El vértigo posicional paroxístico benigno (VPPB) es la afección periférica más común en las enfermedades otoneurológicas. Con el reposicionamiento de partículas se busca eliminar el vértigo y sus síntomas asociados como lo son el mareo residual y la inestabilidad. Objetivo: Determinar si la maniobra de reposicionamiento de Epley (MRE) produce una modificación significativa del control postural (CP) en aquellos pacientes con VPPB de canal semicircular posterior (VPPB-CSC-P). Material y Método: Se realizó un estudio descriptivo prospectivo en una muestra de 21 pacientes con diagnóstico de VPPB-CSC-P. Comparamos el desplazamiento, la velocidad y el área del centro de presión (CoP) antes y después de la MRE. Resultados: La velocidad y el área de la CoP estudiada por posturografía computarizada muestra una disminución significativa en sus valores después de la MRE, mientras que el desplazamiento de la CoP se mantuvo sin cambios. Conclusión: La MRE ejecutada en pacientes con VPPB-CSC-P produce una modulación en el control de la CoP, demostrada por la disminución de la velocidad y el área de desplazamiento de la CoP. El éxito de la MRE produce modulación del CP.


Abstract Introduction: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral condition in otoneurologic diseases. With the repositioning of particles, the aim is to eliminate vertigo and its associated symptoms, such as residual dizziness and instability. Aim: To determine if the Epley repositioning maneuver (ERM) produces a significant modification of postural control (PC) in those patients with posterior semicircular canal BPPV (BPPV-CSC-P). Material and Method: A prospective descriptive study was carried out in a sample of 21 patients diagnosed with BPPV-CSC-P. We compared the displacement, velocity, and area of the center of pressure (CoP) before and after the Epley repositioning maneuver. Results: The velocity and the area of the CoP studied by computed posturography show a significant decrease in its values after the MRE, while the CoP shift remained unchanged. Conclusion: ERM performed in patients with BPPV-CSC-P produces an improvement in the control of the CoP, demonstrated by the decrease in the speed and the area of movement of the CoP. The success of the MRE produces modulation of the PC.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Semicircular Canals , Physical Therapy Modalities , Patient Positioning/methods , Benign Paroxysmal Positional Vertigo/therapy , Epidemiology, Descriptive , Prospective Studies
12.
Article in Spanish | LILACS, COLNAL | ID: biblio-1413923

ABSTRACT

Introducción: múltiples factores se han relacionado con el desarrollo de la recurrencia del vértigo posicional paroxístico benigno (VPPB). Objetivo: determinar la asociación entre la falla terapéutica de las maniobras de reposición canalicular (MRC) y las variables sociodemográficas y clínicas en los pacientes con diagnóstico de VPPB. Diseño: estudio observacional de cohorte retrospectiva. Materiales y métodos: revisión de historias clínicas de la consulta de vértigo de la Clínica Orlant, Medellín, Colombia. Resultados: se incluyeron 41 pacientes con diagnóstico de VPPB a quienes se les realizó MRC y seguimiento clínico entre 1 y 8 semanas. El 90,2 % eran de sexo femenino, con una mediana de edad de 58 (±183) años; se encontró uso de vestibulosupresores en un 68,3 %, y es la betahistina el más consumido (43,9 %). El 51,2 % de pacientes presentaron falla terapéutica y se identificó una asociación con el número total de MRC realizadas y el uso de vibrador mastoideo (p < 0,001), teniendo en cuenta que los pacientes mejoraron clínicamente al final del seguimiento con una media de 77 % (p < 0,001). No se encontraron asociaciones estadísticamente significativas con el resto de variables. Conclusión: no hubo asociación entre la falla terapéutica y las variables estudiadas, excepto número de MRC, el uso del vibrador mastoideo y la mejoría clínica final, posiblemente porque el vibrador mastoideo se aplica a los pacientes en quienes hay persistencia de síntomas y signos con las maniobras desencadenantes, y por factores fisiopatológicos no esclarecidos; con esto finalmente se logra una mejoría clínica con más de dos MRC


Introduction: Multiple factors have been related to the development of recurrence of benign paroxysmal positional vertigo (BPPV). Objective: To determine the association between therapeutic failure of canalicular repositioning maneuvers (CRM) with sociodemographic and clinical variables in patients with a diagnosis of BPPV. Design: Observational retrospective cohort study. Materials and methods: Review of medical records of the vertigo clinic of the Orlant Clinic, Medellín - Colombia. Results: 41 patients with a diagnosis of BPPV who underwent CRM and clinical follow-up between 1 and 8 weeks were included. 90.2% were female, with a median age of 58 (± 18.3) years, use of vestibulosuppressants was found in 68.3%, betahistine being the most consumed (43.9%). 51.2% of patients presented therapeutic failure, identifying an association with the total number of CRMs performed and the use of a mastoid vibrator with (p < 0.001), taking into account that the patients improved clinically at the end of follow-up with a mean of 77% (p < 0.001). No statistically significant associations were found with the rest of the variables. Conclusion: There was no association between therapeutic failure and the variables studied except number of CRM, use of the mastoid vibrator and final clinical improvement, possibly because the mastoid vibrator is applied to patients in whom there are persistence of symptoms and signs with the triggering maneuvers for unclear pathophysiological factors, finally achieving clinical improvement with more than two CRMs.


Subject(s)
Humans , Vertigo , Semicircular Canals , Benign Paroxysmal Positional Vertigo
13.
Braz. j. otorhinolaryngol. (Impr.) ; 87(6): 671-677, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1350350

ABSTRACT

Abstract Introduction: Vestibular migraine as an entity was described in 1999 and its pathophysiology is still not established. Simultaneously with research to better understand vestibular migraine, there has been an improvement in vestibular function assessment. The video-head impulse test is one of the latest tools to evaluate vestibular function, measuring its vestibular-ocular reflex gain. Objective: To evaluate vestibular function of vestibular migraine patients using video-head impulse test. Methods: Cross-sectional case-control study homogeneous by age and gender with vestibular migraine patients according to the 2012-2013 Barany Society/International Headache Society diagnostic criteria submitted to video-head impulse test during intercrisis period. Results: 31 vestibular migraine patients were evaluated with a predominantly female group (90.3%) and mean age of 41 years old. Vestibular function was normal in both patient and control groups. Gain values for horizontal canals were similar between the two groups, but gain values for vertical canals were higher in the group with vestibular migraine (p < 0.05). Patients with vestibular migraine felt more dizziness while performing the video-head impulse test than control subjects (p < 0.001). Conclusions: Patients with vestibular migraine present normal vestibular function during intercrisis period when evaluated by video-head impulse test. Vertical canals, however, have higher gains in patients with vestibular migraine than in control subjects. Vestibular migraine patients feel dizziness more often while conducting video-head impulse test.


Resumo Introdução: A enxaqueca vestibular foi descrita como uma entidade em 1999 e sua fisiopatologia ainda não está estabelecida. Simultaneamente às pesquisas para entender melhor essa condição clínica, houve uma melhoria na avaliação da função vestibular. O teste de impulso cefálico por vídeo, vHIT, é uma das mais recentes ferramentas para avaliar a função vestibular, mede seu ganho do reflexo vestíbulo-ocular. Objetivo: Avaliar com o vHIT a função vestibular de pacientes com enxaqueca vestibular. Método: Estudo transversal de caso-controle, homogêneo em relação a idade e sexo, de pacientes com enxaqueca vestibular, de acordo com os critérios de diagnóstico da Barany Society/International Headache Society de 2012-2013, submetidos ao vHIT durante o período intercrises. Resultados: Foram avaliados 31 pacientes com enxaqueca vestibular com um grupo predominantemente feminino (90,3%) e média de 41 anos. A função vestibular era normal nos grupos paciente e controle. Os valores de ganho para canais horizontais foram semelhantes entre os dois grupos, mas os valores de ganho para canais verticais foram maiores no grupo com enxaqueca vestibular (p < 0,05). Pacientes com enxaqueca vestibular sentiram mais tontura ao fazer o vHIT do que os controles (p < 0,001). Conclusões: Pacientes com enxaqueca vestibular apresentam função vestibular normal durante o período intercrises quando avaliados pelo vHIT. Os canais verticais, no entanto, apresentam ganhos maiores em pacientes com enxaqueca vestibular do que em indivíduos controle. Pacientes com enxaqueca vestibular sentem tontura com maior frequência enquanto fazem o vHIT.


Subject(s)
Humans , Female , Adult , Head Impulse Test , Migraine Disorders/diagnosis , Reflex, Vestibulo-Ocular , Case-Control Studies , Semicircular Canals , Vertigo , Cross-Sectional Studies
14.
Chinese Journal of Otorhinolaryngology Head and Neck Surgery ; (12): 698-703, 2021.
Article in Chinese | WPRIM | ID: wpr-942506

ABSTRACT

Objective: To investigate the frequency characteristics and the pathological characteristics of the horizontal crista ampullaris in patients with Meniere's disease,and to analyse its structural basis. Methods: Between March, 2019 and November, 2019, seventy-two patients diagnosed as Meniere's disease (27 males and 45 females, aged from 13 to 74 years, with a course of disease ranging from 4 months to 32 years)in Shandong Provincial ENT Hospital were included.Caloric test, sinusoidal harmonic acceleration test (SHA), video-head impulse test (v-HIT), Gadolinium-enhanced inner-ear 3D-FLAIR MRI and pure tone audiometry were conducted in the patients. The function of the horizontal semicircular canal in these patients were analysed as well as its relationship with the degree of endolymphatic hydrops,clinical stage and duration. Light microscopy and transmission electron microscopy were used to observe the ultrastructure of horizontal semicircular canal crista ampullaris from six patients with refractory Meniere's disease who underwent labyrinthectomy. The number of type Ⅰ and type Ⅱ vestibular hair cells, the common pathophysiological changes of horizontal semicircular canal crista ampullaris were investigated in these patients. Statistical analysis was performed using SPSS 19.0. Results: With the increase of detection frequency, the abnormal rate decreased gradually. The abnormal rate of caloric test was 69.4% (50/72), SHA 51.4% (37/72), V-HIT 36.1% (26/72), comparation of the positive rate among the three tests showed statistically significant differences(P<0.05).Neither caloric test nor SHA had correlation with the degree of hydrops(P>0.05), but v-HIT(r=0.434,P<0.01).There was correlation with clinical stage to SHA and v-HIT(r=0.338,0.462,P<0.01), except caloric test(P>0.05).No significant relation was found with caloric test, SHA, v-HIT and course of disease(P>0.05).Morphological observation found abnormal monolayer epithelialization of the horizontal semicircular canal crista ampullaris significantly decreased number of type Ⅱ hair cells compared with type Ⅰhair cells. Hair cells showed perinuclear vacuolization, cytoplasmic vacuoles, mitochondrial electron density increasement and loss of stereocilia. Conclusions: The horizontal semicircular canal damage in the patients with Meniere's disease has a frequency-dependent characteristic, mainly occurres in low frequency area. With progress of the disease, the high frequency area of ampulla will be impaired gradually, and it is related to the degree of endolymphatic hydrops and hearing level. Hair cell injury would be observed,the frequency characteristics may be more associated with the disorder of type Ⅱ hair cells.


Subject(s)
Female , Humans , Male , Caloric Tests , Endolymphatic Hydrops , Meniere Disease , Semicircular Canals , Semicircular Ducts
15.
Chinese Journal of Otorhinolaryngology Head and Neck Surgery ; (12): 603-612, 2021.
Article in Chinese | WPRIM | ID: wpr-942487

ABSTRACT

Objective: We conducted a Meta-analysis to investigate the necessity of postural restrictions after manual reduction in the treatment of posterior canal benign paroxysmal positional vertigo (PC-BPPV). Methods: We searched PubMed, EBSCO, Proquest, Web of Science databases, Ovid, and screened eligible studies that investigated the effect of post-maneuver postural restriction in treating patients with PC-BPPV. Outcomes included the efficacy of treatment and recurrence. Meta-analysis was performed using Stata 15.0 software. Results: Studies of the single visit efficiency included 11 references, with a sample size of 1 733 cases. The Meta-analysis results showed that the difference in the efficacy between the postural restricted group and the non-postural restricted group in PC-BPPV patients was statistically significant(RR=1.12, 95%CI=1.07-1.18, P<0.001). There were 12 references included in the study on the total efficiency, with a cumulative sample size of 1763 cases. There was no statistically significant difference between the effect of postural restriction after manipulative reduction and that of simple manipulative reduction (RR=1.03, 95%CI=0.99-1.08, P=0.118). There were 5 references included in the study of recurrence rate, and the cumulative sample size was 659 cases. There was no statistically significant difference in the recurrence rate between the postural restricted group and the non-postural restricted group(RR=0.98, 95%CI=0.62-1.54, P=0.937). Conclusions: In comparison with non-postural restriction group, post-maneuver postural restriction after a single visit can improve the treatment effective rate of PC-BPPV and contribute to the improvement in the symptoms of patients in a short term. However, postural restrictions has no significant effect on the final prognosis of PC-BPPV, and it also has no significant effect on the recurrence.


Subject(s)
Humans , Benign Paroxysmal Positional Vertigo/therapy , Environment , Patient Positioning , Recurrence , Semicircular Canals , Treatment Outcome
16.
Chinese Journal of Otorhinolaryngology Head and Neck Surgery ; (12): 1277-1282, 2021.
Article in Chinese | WPRIM | ID: wpr-942613

ABSTRACT

Objective: To explore the characteristics of dynamic balance during the onset of benign paroxysmal positional vertigo (BPPV) and its prediction of residual symptoms after successful repositioning. Methods: From January 2018 to August 2019, patients diagnosed with unilateral posterior semicircular canal or horizontal semicircular canal BPPV were consecutively enrolled from five otolaryngology clinics in Shanghai. The dynamic balance function was measured by sensory organization test (SOT) before repositioning maneuver, and the residual symptoms and its duration were followed up from one week to up to three months. Results: A total of 260 patients were recruited. After excluding 17 cases, 243 cases were successfully followed up including 89 males and 154 females, with an average age of (52.9±13.0) years. There were 175 cases of posterior semicircular BPPV, 61 cases of horizontal semicircular BPPV and 7 cases of canal conversion (from horizontal to posterior semicircular). Among 243 patients, 118 cases reported residual symptoms, with an incidence of 48.6%. The results of SOT showed that 58.0%(141/243) of the patients had abnormal vestibular input and 41.6%(101/243) were categorized as "near falls". With respect to the detailed residual symptoms, 47 cases (39.8%) reported unsteadiness or floating, 35 cases (29.7%) had fogginess/heaviness feeling, 22 cases (18.6%) had transient dizzy while head moving, and 15 cases (12.7%) reported that the symptom was too subtle to describe. Compared with the group without residual symptoms, the group with residual symptoms had more abnormal vestibular input(χ²=67.25, P<0.001) and near falls(χ²=74.78, P<0.001) as identified by SOT test. Cox proportional hazards regression failed to reveal any SOT results having significantly impact on the duration of residual symptoms [abnormal vestibular input (HR= 0.93, 95%CI: 0.48, 1.80), and near falls (HR= 0.90, 95%CI: 0.56, 1.46)]. Kaplan-Meier survival analysis showed that there was no significant difference in the duration of residual symptoms among patients with different SOT manifestations [Log rank (Mantel-Cox) test, P>0.05]. Conclusions: The impaired dynamic balance during the onset of BPPV is characterized by "abnormal vestibular input". The residual symptoms are mainly characterized by unsteadiness or floating feeling. The defect of dynamic balance function is a predictor of the residual symptoms after successful repositioning, but not for the duration of such symptoms.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Benign Paroxysmal Positional Vertigo , China , Dizziness , Prospective Studies , Semicircular Canals
17.
Acta cir. bras ; 36(12): e361206, 2021. graf
Article in English | LILACS, VETINDEX | ID: biblio-1355568

ABSTRACT

ABSTRACT Purpose: To evaluate whether the pigeon (Columba livia) is a good model for evaluating the vestibular system involved with postural maintenance during movement. Methods: This study maps the brainstem targets of the horizontal ampullary inputs from the vestibular periphery of the pigeon. We used biotin dextran amine (BDA) injection in horizontal semicircular canal (HSCC), immunohistochemistry for GluR2/3 and GluR4 AMPA and computerized histomorphology reconstruction. Results: Our results show the same distribution pattern with ipsilateral projections to vestibular nuclear complex (VNC) from the HSCC, with the majority of labeled fibers being, long, thin, with few varicosities and many ramifications. Horizontal semicircular canal projections achieve neurons belonging to all nuclei of the VNC with exception of dorsal portion of lateral vestibular nucleus and this area express GluR2/3 and GluR4 AMPA receptors reinforcing the idea of glutamate participation in these connections. Conclusions: Pigeon is an appropriated experimental model to study of projections of HSCC and reinforcing the information that the vestibular system has strong relation with the fast responses necessary for postural control. Moreover, its phylogenetic organization apparently conservation, also seems to be a fundamental characteristic for vertebrates.


Subject(s)
Animals , Columbidae , Vestibule, Labyrinth , Phylogeny , Brain Stem , Semicircular Canals , alpha-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic Acid , Vestibular System
18.
CoDAS ; 33(4): e20200076, 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1286109

ABSTRACT

RESUMEN Objetivo Elaborar un protocolo de evaluación y establecer valores de referencia de las ganancias del reflejo vestíbulo-ocular del canal semicircular horizontal obtenidas con el v-HIT en población pediátrica sin alteraciones vestibulares. Método Estudio cuantitativo, analítico, no experimental con muestreo no probabilístico por conveniencia. Se seleccionaron 39 sujetos entre 5 a 17 años, los cuales cumplieron los criterios de inclusión y exclusión. Resultados El promedio de la ganancia obtenida para el conducto semicircular horizontal derecho fue de 0,93 y para el conducto semicircular izquierdo fue de 1,08. Existen diferencias estadísticamente significativas entre oídos. No existen diferencias estadísticamente significativas entre los subgrupos de 5 a 10 años y 11 a 17 años. Conclusión La ganancia del reflejo vestíbulo-ocular en población pediátrica se acerca a los valores encontrados en la literatura científica internacional y de la población adulta. El protocolo confeccionado puede orientar a profesionales que están comenzando en la evaluación otoneurológica de esta población.


ABSTRACT Purpose To develop an assessment protocol and establish reference values of vestibulo-ocular reflex gain of the horizontal semicircular canal obtained with vHIT in a pediatric population without vestibular changes. Methods Quantitative, non-experimental, analytical study with a non-probabilistic convenience sample. A total of 39 subjects aged 5 to 17 years were selected based on the inclusion and exclusion criteria. Results The mean gain obtained of the horizontal right semicircular canal was 0.93 and of the left one, 1.08, with statistically significant differences between the ears. There were no statistically significant differences between the 5-to-10-year and 11-to-17-year subgroups. Conclusion The vestibulo-ocular reflex gain in children neared the values found in the international scientific literature and the adult population. The protocol developed can guide beginning professionals in the otoneurological evaluation of children.


Subject(s)
Humans , Child , Adult , Vestibule, Labyrinth , Head Impulse Test , Reference Values , Reflex, Vestibulo-Ocular , Semicircular Canals
19.
Rev. otorrinolaringol. cir. cabeza cuello ; 80(1): 19-27, mar. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1099198

ABSTRACT

INTRODUCCIÓN: El vértigo posicional paroxístico benigno (VPPB) es el vértigo periférico más frecuente. El tratamiento depende del compromiso de los canales semicirculares (CSC) y/o cúpulas, y consiste en maniobras de reposición de partículas. OBJETIVO: Evaluar los factores de riesgo asociados al VPPB en pacientes atendidos en el Servicio de Otorrinolaringología de la Red de Salud UC Christus. Evaluar la tasa de éxito de las maniobras de reposición. MATERIAL Y MÉTODO: Estudio retrospectivo. Se revisaron casos de VPPB con indicación de maniobras de reposición durante los años 2016-2017. Se obtuvo información demográfica, antecedentes médicos, la maniobra realizada y su éxito. Se evaluaron comorbilidades y temporada del año. RESULTADOS: Se incluyeron 195 consultas, realizándose 293 maniobras. La mayoría de los pacientes fueron mujeres (74%) con edad promedio de 63 años. Comorbilidades más frecuentes fueron hipertensión, dislipidemia y diabetes mellitus. El 20% presentó una hipofunción vestibular concomitante, 23% presentó antecedentes de VPPB y 8% compromiso bilateral. Canalolitiasis del CSC posterior fue predominante (90%). En el 77,3% se resuelve el caso con una maniobra. Los casos fueron más frecuentes en primavera y otoño. CONCLUSIONES: El VPPB fue más frecuente en mujeres, con una edad promedio de 63 años. La mayoría presentó canalolitiasis unilateral lográndose resolución con una maniobra de reposición.


INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. The treatment depends on the semicircular canal (SCC) and/or cupula involved and consists of particle repositioning maneuvers. AIM: Analyze risk factors associated with BPPV for patients seen at the otorhinolaryngology department of the UC Christus health center. Evaluate the success rate of the repositioning maneuvers. MATERIAL AND METHODS: Retrospective study. All cases of BPPV for which a repositioning maneuver was prescribed during the years 2016-2017 were reviewed. Data obtained includes demographics, medical history, maneuver performed, and its success rate. Comorbidities and seasonality were evaluated. RESULTS: 195 cases were included; with 293 maneuvers. The majority were women (74%), and the average age was 63 years. Common comorbidities were hypertension, dyslipidemia and diabetes mellitus. Concurrently, 20% had unilateral vestibular hypofunction, 23% had a history of BPPV, and 8% had bilateral involvement. Posterior SCC canalithiasis was most common (90%). In 77.3%, the case was resolved with one maneuver. Cases were most frequent in the spring and autumn season. CONCLUSION: BPPV was more common in women with an average age of 63 years. The majority of patients presented with unilateral canalithiasis obtaining a complete recovery with a single maneuver.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Physical Therapy Modalities , Patient Positioning/methods , Benign Paroxysmal Positional Vertigo/therapy , Benign Paroxysmal Positional Vertigo/epidemiology , Comorbidity , Semicircular Canals/physiopathology , Retrospective Studies , Risk Factors , Treatment Outcome , Benign Paroxysmal Positional Vertigo/rehabilitation
20.
Philippine Journal of Otolaryngology Head and Neck Surgery ; : 74-75, 2020.
Article in English | WPRIM | ID: wpr-973899

ABSTRACT

@#A 31-year-old woman presented with the very unusual symptom of being able to hear the movement of her eyeballs in her left ear: “I can hear my eyeballs move!” She initially described hearing a recurrent “swishing” sound that would occur intermittently. She eventually realized that its occurrence coincided with eyeball movement. In the eight months’ duration of her symptom, she had been unable to obtain a diagnosis from physicians whom she consulted and had even been referred for psychiatric evaluation and treatment. An otolaryngologist whom she consulted had a standard pure tone audiometric examination done, and this showed normal hearing acuity in both ears. A Magnetic Resonance Imaging (MRI) of the inner ear and brain likewise showed no abnormalities. Due to the peculiarity of the patient’s complaint, the otolaryngologist consulted with a neurotologist who suspected the presence of a semicircular canal dehiscence. A computerized tomographic imaging study of the temporal bone confirmed the presence of a left superior semicircular canal dehiscence syndrome.


Subject(s)
Semicircular Canal Dehiscence , Semicircular Canals , Eye Movements
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