Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 836
Filtrar
1.
Braz. j. otorhinolaryngol. (Impr.) ; 90(2): 101382, 2024. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1557339

RESUMO

Abstract Objective To find out if motion sickness susceptibility (MSS) of vestibular migraine (VM) patients and migraine only (MO) patients can be reliably detected with a single simple question: "Can you read while travelling in a car without getting motion sick?". Method Ninety-two definite VM and 58 MO patients and 74 healthy control (HC) subjects were asked about their MSS and about being able to read while riding in a car without becoming motion sick. A Motion Sickness Susceptibility Questionnaire (MSSQ-Short) including childhood (MSA), adulthood (MSB) and total (MST) parts was also administered to all participants. ROC curves of MSSQ-Short were prepared for "not being able to read in a car" as the gold standard. Results Mean MSA scores were significantly higher in both VM and MO patients than in HCs (p< 0.001), but their scores were not significantly different (p= 0.171). Mean MSB and MST scores were significantly higher in VM than in MO patients (p< 0.001) and both VM and MO patients had significantly higher scores than HCs (p< 0.001). MSA scores were significantly higher than MSB scores in MO patients (p< 0.001). All sections of the questionnaire were associated with high area-under-curve values for MSS detected by the question about being able to read in a car without becoming motion sick. Conclusion We propose that all migraine patients could have the same level of MSS in childhood but MO patients are able to compensate over years, but VM patients are not. A quick way to determine MSS is to ask about the ability to read without becoming motion sickness while riding a car.

2.
Chinese Journal of Experimental Traditional Medical Formulae ; (24): 215-222, 2024.
Artigo em Chinês | WPRIM | ID: wpr-1012711

RESUMO

Aural vertigo frequently encountered in the otolaryngology department of traditional Chinese medicine (TCM) mainly involves peripheral vestibular diseases of Western medicine, such as Meniere's disease, benign paroxysmal positional vertigo, vestibular neuritis, and vestibular migraine, being a hot research topic in both TCM and Western medicine. Western medical therapies alone have unsatisfactory effects on recurrent aural vertigo, aural vertigo affecting the quality of life, aural vertigo not relieved after surgery, aural vertigo with complex causes, and children's aural vertigo. The literature records and clinical practice have proven that TCM demonstrates unique advantages in the treatment of aural vertigo. The China Association of Chinese medicine sponsored the "17th youth salon on the diseases responding specifically to TCM: Aural vertigo" and invited vertigo experts of TCM and Western medicine to discuss the difficulties and advantages of TCM diagnosis and treatment of aural vertigo. The experts deeply discussed the achievements and contributions of TCM and Western medicine in the diagnosis and treatment of aural vertigo, the control and mitigation of the symptoms, and the solutions to disease recurrence. The discussion clarified the positioning and advantages of TCM treatment and provided guidance for clinical and basic research on aural vertigo.

3.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1560343

RESUMO

El vértigo posicional paroxístico benigno (VPPB) es un síndrome vestibular episódico (SVE) que es reconocido por ser el trastorno más frecuente observado en la clínica, siendo de buena y pronta resolución en la gran mayoría de los casos. Sin embargo, pueden presentarse variantes muy poco habituales o atípicas, donde el canalith jam es una de las formas más resistentes al tratamiento mediante maniobras de reposición, y por lo mismo, el reconocimiento adecuado de este cuadro es esencial para su correcto abordaje. Se presentan dos casos de VPPB con canalith jam en el CSC horizontal y se proponen cinco criterios diagnósticos para su identificación.


Benign paroxysmal positional vertigo (BPPV) is an episodic vestibular syndrome (EVS) that is recognized for being the most frequent disorder observed in the clinic, with good and prompt resolution in the vast majority of cases. However, very unusual or atypical variants can occur, where the canalith jam is one of the forms most resistant to treatment by means of repositioning maneuvers, and for the same reason, the adequate recognition of this condition is essential for its correct approach. Two cases of BPPV with canalith jam in the horizontal semicircular canal and five diagnostic criteria for its identification are presented.

4.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1560344

RESUMO

Barotrauma se define como el daño tisular generado por diferencias de presión entre un espacio no ventilado dentro del cuerpo y el gas o fluido circundante. La causa más frecuente de barotrauma es el viaje en avión y se espera un aumento progresivo de los casos en el tiempo. Los órganos habitualmente comprometidos son el oído, cavidades paranasales y nervio facial. La fisiopatología del barotrauma por vuelo se fundamenta en la exposición a cambios bruscos de altitud y presión asociados a infecciones respiratorias altas y/o disfunción de la tuba auditiva. Los síntomas más frecuentes son otalgia, hipoacusia, tinnitus, vértigo y parálisis facial periférica. Muchas formas de barotrauma son autolimitadas y prevenibles mediante técnicas simples como la deglución de líquidos o maniobras de Valsalva durante las fases de ascenso o descenso. El tratamiento del barotrauma puede ser conservador, médico o quirúrgico, la decisión será individualizada de acuerdo con las características del paciente, gravedad del cuadro y recurrencias. Esto incluye el uso de descongestionantes orales y tópicos, dispositivos de autoinflación, técnicas quirúrgicas, entre otros. La mayoría de estas intervenciones se basan en recomendaciones de expertos y algoritmos extrapolados de guías clínicas para el manejo de otras patologías similares. Esta revisión presenta los principales hallazgos fisiopatológicos y clínicos, las opciones de tratamiento y las medidas preventivas para el barotrauma otorrinolaringológico inducido por el vuelo, en base a la evidencia disponible.


Barotrauma is defined as tissue damage caused by pressure differences between an unventilated space within the body and the surrounding gas or fluid. The most frequent cause of barotrauma is air travel, and a progressive increase in cases over time is expected. The most frequently affected organs are the ear, paranasal sinuses, and facial nerve. The pathophysiology of flight-induced barotrauma is based on exposure to sudden changes in altitude and pressure associated with upper respiratory tract infections and/or Eustachian tube dysfunction. The most frequent symptoms are otalgia, hypoacusis, tinnitus, dizziness, and peripheral facial palsy. Many forms of barotrauma are self-limiting and preventable through simple techniques such as swallowing fluids or performing Valsalva maneuvers during ascent or descent phases. The treatment of barotrauma can be either conservative, medical or surgical, according to patient's characteristics, severity of the condition, and recurrence. This includes the use of oral and topical decongestants, auto-inflation devices, surgical techniques, among others. Most of these interventions are based on expert recommendations and algorithms extrapolated from clinical guidelines for the management of other similar pathologies. This review presents key pathophysiologic and clinical findings, treatment options, and preventive measures for flight-induced otorhinolaryngologic barotrauma, based on available evidence.

5.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1560347

RESUMO

Introducción: El mareo postural perceptual persistente (MPPP) es una de las causas más frecuentes de vértigo crónico. Si bien, los pacientes con MPPP tienen alteraciones de la percepción espacial, se desconoce si presentan alteraciones en el miedo a las alturas. Para no exponer a pacientes con MPPP a ambientes reales con altura, nos propusimos utilizar la realidad virtual para estudiar el miedo a las alturas. Objetivo: Cuantificar el miedo a las alturas en pacientes con MPPP y controles mediante ambientes simulados con realidad virtual. Material y Método: Estudio transversal, prospectivo de casos y controles pareados por edad y sexo. Se reclutaron pacientes con MPPP del Servicio de Otorrinolaringología del Hospital Clínico de la Universidad de Chile entre los años 2020 y 2021. Se midió presencia subjetiva de miedo y taquicardia. Los escenarios se desarrollaron con el programa Blender 2.8 y Oculus Link para equipo Oculus Quest. Se utilizaron cinco escenarios a diferentes alturas (pisos 1, 3, 6, 12, 19). Resultados: Se reclutaron 20 sujetos (12 mujeres, 47 años en promedio), incluyendo 10 pacientes con MPPP y 10 controles sin síntomas vestibulares. Ningún sujeto del grupo control presentó miedo en los escenarios presentados, mientras que siete pacientes del grupo MPPP tuvieron miedo subjetivo a una altura menor a 40 metros virtuales (Fischer, p < 0,05). Conclusión: Los pacientes con MPPP presentan, con mayor frecuencia, miedo subjetivo a las alturas que los controles, pero se requiere de nuevos estudios para determinar si este miedo es específico de MPPP, o es general a otras causas de vértigo crónico.


Introduction: Persistent Postural Perceptual Dizziness (PPPD) is one of the most common causes of chronic vertigo. While patients with PPPD have spatial perception alterations, it is unknown whether they present alterations in fear of heights. To avoid exposing patients with PPPD to high places, we aimed to use virtual reality to quantify fear of heights. Aim: To quantify fear of heights in patients with PPPD and controls using simulated environments with virtual reality. Material and Method: A prospective cross-sectional study of age- and sex-matched case-control pairs. PPPD patients were recruited from the Otolaryngology Service of the Clinical Hospital of the University of Chile between 2020 and 2021. Presence of subjective fear and tachycardia were measured. The scenarios were developed using Blender 2.8 and Oculus Link for the Oculus Quest. Five scenarios at different heights (floors 1, 3, 6, 12, 19) were used. Results: Twenty subjects were recruited (12 women, average age of 47 years), including 10 PPPD patients and 10 controls without vestibular symptoms. None of the control group subjects presented fear in the presented scenarios, while seven patients in the PPPD group had subjective fear at a height lower than virtual 40 meters (Fischer, p < 0.05). Conclusion: Patients with PPPD present a greater proportion of subjective fear to heights than controls, but further studies are required to determine if this fear is specific to PPPD or is general to other causes of chronic vertigo.

6.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1560350

RESUMO

Introducción: El traumatismo craneoencefálico (TCE) puede generar vértigo, mareo e inestabilidad. Posibles causas otorrinolaringológicas son el vértigo postural paroxístico benigno (VPPB) que constituye el diagnóstico más frecuente, y la hipofunción vestibular. Objetivo: Describir la prevalencia de hipofunción vestibular en un grupo de pacientes con VPPB asociado a TCE. Material y Método: Estudio retrospectivo de pacientes con VPPB asociado a TCE que requirieron maniobra de reposición (MRP) entre los años 2017 y 2021. La información clínica, características clínico-demográficas, hallazgos en pruebas de función vestibular y número de MRP fueron evaluados. Resultados: Se incluyeron 48 pacientes con una edad promedio de 60,8 ± 16,5 años, siendo un 52% mujeres. La prevalencia de pacientes con paresia vestibular concomitante correspondió al 35,4%. Al comparar al grupo con y sin paresia se observó: (1) en el grupo con paresia fue, significativamente, más frecuente presentar contusión cerebral asociada, 47,1% vs 12,9%; (2) el sexo masculino fue, significativamente, más frecuente en el grupo con paresia, 70,59% vs 35,5%; (3) en ambos grupos, la mediana de MRP fue 1. Conclusión: La presencia de paresia vestibular en pacientes con VPPB secundario a TCE, no es un hallazgo infrecuente, en nuestro estudio, correspondió a un 35,4%, siendo este más frecuente en hombres. Adicionalmente, la contusión cerebral asociada es más frecuente en el grupo con paresia.


Introduction: Head trauma can generate vertigo, dizziness and instability. Possible otorhinolaryngologic causes are benign paroxysmal postural vertigo (BPPV), which is the most frequent diagnosis, and vestibular hypofunction. Aim: To describe the prevalence of vestibular hypofunction in a group of patients with BPPV associated with head trauma. We studied the clinical characteristics, vestibular function test findings and the number of (PRM). Material and Method: Retrospective study of patients with BPPV associated with head trauma who underwent particle repositioning maneuvers (PRM) during the years 2017 to 2021. Clinical characteristics, vestibular function test findings and the number of PRM were evaluated. Results: 48 patents were included. The mean age was 60.8 ± 16.5 years old, 52% were women. The prevalence of patients with concomitant vestibular paresis was 35.4%. When comparing the groups with and without paresis the following was observed: (1) associated brain contusions were significatively more frequent in the paresis group, 47.1% vs 12.9%; (2) male sex was significatively more frequent in the paresis group, 70.59% vs 35.5%; (3) in both groups, the median of needed PRM was 1. Conclusion: The presence of vestibular paresis in patients with BPPV secondary to head trauma is not an infrequent finding. In our study, its prevalence was 35.4%, being significatively more frequent in men. Also, associated brain contusions were significatively more frequent in the paresis group.

7.
Distúrb. comun ; 35(2): 57752, 02/08/2023.
Artigo em Inglês, Português | LILACS | ID: biblio-1452416

RESUMO

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


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


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


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Atividades Cotidianas/psicologia , Confiança/psicologia , Vertigem/reabilitação , Inquéritos e Questionários , Estudos Retrospectivos , Tontura/reabilitação , Doenças do Labirinto/terapia
8.
Rev. chil. obstet. ginecol. (En línea) ; 88(3): 160-166, jun. 2023. graf, tab
Artigo em Espanhol | LILACS | ID: biblio-1515206

RESUMO

OBJETIVO: Evaluar las características clínicas, el impacto en la calidad de vida y los factores asociados con vértigo en gestantes hospitalizadas en una institución de alta complejidad. MÉTODO: Estudio transversal. Se realizó una encuesta dirigida a la presencia de vértigo y sus características clínicas en 2020-2021. La calidad de vida se evaluó con el cuestionario Dizziness Handicap Inventory (DHI). El análisis estadístico incluyó un modelo lineal generalizado. RESULTADOS: De 103 mujeres, el 19,4% indicaron vértigo principalmente en el segundo trimestre de gestación (60%), con una mediana de 3,5 (rango intercuartil: 1,5-7,5) episodios. Fueron referidos vértigos episódicos asociados con cambios posicionales (40%), acompañados de inestabilidad (60%), cefalea (60%), fotopsias (55%) y tinnitus (45%). Las mujeres con vértigo presentaron mayor frecuencia de discapacidad moderada a grave en las dimensiones del DHI emocional (30 vs. 2,4%; p = 0,001), funcional (40 vs. 2,4%; p < 0,001) y física (55 vs. 2,4%; p < 0,001) en comparación con las mujeres sin la patología. La hospitalización durante el embarazo Razón de proporción (RP): 4,02; intervalo de confianza del 95% [IC95%]: 1,64-9,85; p = 0,002) y la presencia de vértigo pregestacional (RP: 2,37; IC95%: 1,15-4,88; p = 0,019) se identificaron como factores asociados. CONCLUSIONES: La alta frecuencia de vértigo en las gestantes sugiere la importancia de estudiar esta condición durante el embarazo, para lograr un manejo integral y generar acciones de prevención y control efectivas.


OBJECTIVE: To evaluate clinical characteristics, impact on quality of life and factors associated with vertigo in pregnant women hospitalized in a highly complex institution. METHOD: A cross-sectional study was conducted in 2021-2022. One focused survey including Dizziness Handicap Inventory (DHI) was performed. The statistical analysis was performed using a generalized lineal regression. RESULTS: 103 patients were included, 19.4% indicated vertigo mostly during the second semester (60%). A median of 3.5 episodes was obtained (RIC: 1.5-7.5). Positional and episodic vertigos (40%) associated with unsteadiness (60%), headache (60%), photopsia (55%) and tinnitus (45%) were described. DHI in pregnant females with vertigo compared to those without vertigo, presented higher rates of moderate to severe disability in the emotional (30 vs. 2.4%: p = 0.001), functional (40 vs. 2.4%; p < 0.001) and physical (55 vs. 2.4%; p < 0.001) dimensions. Hospitalizations during the pregnancy (RP: 4.02; 95%CI: 1.64-9.85; p = 0.002) and previous episodes before pregnancy (RP: 2.37; 95%CI: 1.15-4.88; p = 0.019) were identified as associated factors with current vertigo episodes. CONCLUSIONS: The high frequency of vertigo in pregnant women suggests the importance of studying this condition during pregnancy, to achieve comprehensive management and generate effective prevention and control actions.


Assuntos
Humanos , Feminino , Gravidez , Adulto , Adulto Jovem , Vertigem/epidemiologia , Qualidade de Vida , Modelos Lineares , Fatores Desencadeantes , Vertigem/diagnóstico , Vertigem/psicologia , Estudos Transversais , Inquéritos e Questionários , Fatores de Risco , Fatores Sociodemográficos , Hospitalização
9.
Braz. j. otorhinolaryngol. (Impr.) ; 89(2): 313-320, March-Apr. 2023. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1439717

RESUMO

Abstract Objective: The COVID-19 pandemic adversely affects the mental health of vertigo patients. Thus, this study aimed to investigate the effects of coronavirus anxiety, health anxiety, anxiety symptom levels, and demographic variables on vertigo and its severity in vertigo patients during the pandemic. Methods: This cross-sectional study was conducted from May 15 to November 15, 2021. In total, 118 patients with vertigo and 82 healthy controls participated in the study. Besides demographic and clinical data, Coronavirus Anxiety Scale (CAS), Hospital Anxiety Depression Scale-Anxiety Subscale (HAD-A), and Short Health Anxiety Inventory (SHAI) were applied to all participants. Additionally, Vertigo Symptom Scale-Short Form (VSS-SF) was administered to vertigo patients. Results: According to the findings, vertigo patients experienced higher levels of coronavirus anxiety, health anxiety, and anxiety disorder compared to the healthy controls. In vertigo patients, the rate of coronavirus anxiety was 20.3%, and the rate of anxiety disorder was 32.2%. Majority of the patients (80.5%) were found to have severe-level vertigo. Additionally, most of the patients (82.1%) reported that the severity of vertigo during the pandemic was higher than before the pandemic. Conclusion: The COVID-19 pandemic causes serious mental health problems in vertigo patients, and pathological levels of these problems increase the discomfort of vertigo. Therefore, psychological assessment should be considered in these patients, and required psychological support and guidance services should be provided.

10.
Acta fisiátrica ; 30(1): 34-40, mar. 2023.
Artigo em Português | LILACS-Express | LILACS | ID: biblio-1434896

RESUMO

Objetivo: Investigar os efeitos de um protocolo de Fisioterapia Vestibular (FV), baseado no modelo da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) em um paciente com sequelas da síndrome de Arnold-Chiari do tipo I nas queixas de tontura, alterações oculomotoras, desequilíbrio e impacto da tontura na qualidade de vida. Método: Trata-se da descrição do caso de um paciente de 40 anos que realizou um protocolo de FV em 44 sessões, uma a duas vezes por semana, envolvendo exercícios de estabilização do olhar, oculomotores, habituação, equilíbrio estático e dinâmico, tanto em ambiente clínico presencial, quanto remoto e domiciliar. Foram realizadas avaliações da intensidade da tontura e desequilíbrio, do sistema oculomotor, do equilíbrio estático e dinâmico, bem como da qualidade de vida. As informações coletadas na avaliação inicial foram convertidas para os domínios da CIF. Resultados: Houve redução no relato da intensidade da tontura e desequilíbrio, na distância do ponto próximo de convergência, melhora no equilíbrio postural estático e início da prática de atividade física regular, porém manteve o risco de queda no teste de equilíbrio dinâmico e deficiência grave quanto à qualidade de vida. Conclusão: O protocolo de FV, planejado a partir do uso da CIF, mostrou resultados positivos quanto à intensidade da queixa de tontura e desequilíbrio, convergência ocular e equilíbrio estático, com manutenção dos resultados quanto ao equilíbrio dinâmico e à qualidade de vida em um paciente com sequelas da síndrome de Arnold-Chiari. Os resultados deste estudo podem direcionar a conduta clínica e pesquisas futuras relacionadas a esta população


Objective: To investigate the effects of a Vestibular Physiotherapy (VP) protocol, according to the International Classification of Functioning, Disability and Health (ICF) model, in a patient with Arnold-Chiari syndrome type I sequelae on complaints of dizziness, oculomotor disorders, imbalance and the impact of dizziness on quality of life. Method: This is the case description of a 40-year-old patient who underwent a VP protocol into 44 sessions, up to twice a week. The protocol involved eye stabilization, oculomotor, habituation, static and dynamic balance exercises, which were performed through face-to-face clinical setting, remote assistance and home-based exercises. Assessments of the intensity of dizziness and imbalance, oculomotor system, static and dynamic balance and the impact of dizziness on quality of life were performed. The information collected in the initial assessment was converted into the ICF domains. Results: There was a reduction in the report of the intensity of dizziness and imbalance, in the distance from the near point of convergence, improvement in static postural balance, and started the practice of physical activities. However, the risk of falling was maintained in the dynamic balance test and also severe impairment on quality of life. Conclusions: The VP protocol, planned according to ICF, demonstrated positive results regarding the intensity of dizziness and imbalance, ocular convergence and static balance, with maintenance of the results regarding dynamic balance and quality of life in a patient with sequelae of Arnold-Chiari syndrome. The results of this study may guide clinical management and future research related to this population

11.
Int. arch. otorhinolaryngol. (Impr.) ; 27(1): 67-76, Jan.-Mar. 2023. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1421682

RESUMO

Abstract Introduction Variations in clinical practice regarding the management of benign paroxysmal positional vertigo (BPPV) among clinicians have been noted in previous studies. Such variations might be related to the different adherence to clinical practice guidelines. Objective To evaluate clinicians' adherence to BPPV guidelines and investigate the variations in the adherence between different specialties and qualifications. Methods This is a cross-sectional study with a vignettes-based survey conducted between June and August, 2020. We included clinicians engaged in managing BPPV that had at least one year of clinical experience. We excluded students, and clinicians who were not involved in the management of individuals with BPPV. Participants were asked to make their management choices based on four hypothetical patient vignettes. The sample ranged from 77 participants for the first vignette to 45 participants for the last vignette. Results We included 77 clinicians in the study, with the majority being Otolaryngologists (31.2%). The respondents' mean adherence to the guideline was of 63.3%. Result showed that Otolaryngologists' adherence was higher than that of clinicians from different specialties (p = 0.006, d = 0.72). Furthermore, clinicians with a postgraduate degree were more likely to adhere than those with a bachelor's degree only (p = 0.014, d = 0.58) and participants who were aware of the guideline were more likely to adhere to it (p < 0.001, d = 1.05). Lastly, regression analysis exhibited that adherence was affected by postgraduate degree and guideline awareness. Conclusion Otolaryngologists were more likely to adhere to the guideline than other specialties. Among all specialties, higher adherence was associated with guideline awareness and postgraduate degrees.

12.
Artigo | IMSEAR | ID: sea-225570

RESUMO

Objective: The aim of our study is to evaluate the effectiveness of intratympanic gentamicin injection (ITG) on vertigo control with reduced doses and its hearing effects. Materials and Method: The study was conducted at Otolaryngology Department of AORN “S.G. Moscati” between January 2005 and January 2015 on 72 patients with disabling unilateral Meniere’s disease. We use 0.2-0.3 mL of gentamicin sulfate at a concentration of 40mg/ml, injected into the affected ear through the posterior-inferior quadrant of the tympanic membrane. The procedure was carried out for three following days. Main outcome measures: vertigo control and hearing threshold changes after ITG treatment. Results: In 98.6% of the patients(n=71) the ITG produced the full remission of the vertiginous symptoms. In 91.6% of cases(n=66) a single treatment (three consequent injections) was sufficient to control vertigo, in 5.5% of cases(n=4) two treatments were necessary to control vertigo and in 1.3% of patients(n=1) three treatments were necessary to control vertigo. In no case we have had hearing loss after ITG procedure. The pre-treatment pure tone average was 48db. The post-treatment pure tone average was 49.2db. This difference was no statistical difference. Conclusion: In this study we reported high vertigo control, long follow-up and no case of significant hearing worsening. We consider the three injections in the following three days with low doses of gentamicin a safe and valid treatment for Meniere’s disease.

13.
Audiol., Commun. res ; 28: e2780, 2023. tab
Artigo em Português | LILACS | ID: biblio-1513726

RESUMO

RESUMO Objetivo verificar se existe associação entre a avaliação clínica do equilíbrio e o ganho do reflexo vestíbulo-ocular com o avanço da idade em pacientes com insuficiência cardíaca. Métodos estudo transversal analítico-descritivo, de caráter observacional, que incluiu pacientes com diagnóstico de insuficiência cardíaca, divididos em dois grupos, por idade (G1, menos de 60 anos e G2, 60 anos ou mais). Os pacientes foram avaliados por meio de anamnese, avaliação cardiológica, avaliação clínica do equilíbrio corporal (triagem da função cerebelar e avaliação do equilíbrio estático e dinâmico) e instrumental da função vestibular (Video Head Impulse Test-vHIT). Os achados obtidos foram descritos e comparados por meio de análise estatística inferencial. Resultados foram avaliados 34 pacientes com média de idade de 55 anos e 9 meses, a maioria homens (71,49%). Não houve associação do ganho do reflexo vestíbulo-ocular, simetria dos canais semicirculares e avaliações do equilíbrio corporal com o avanço da idade. Observaram-se associações entre os resultados da prova de Unterberger-Fukuda com o ganho do reflexo vestíbulo-ocular do canal semicircular lateral direito e posterior esquerdo e com os percentuais de simetria dos canais semicirculares anteriores para os pacientes do Grupo 2. Para os indivíduos do Grupo 1, foi observada associação entre os resultados da prova de Unterberger-Fukuda com os valores de simetria dos canais semicirculares anteriores e do ganho de reflexo vestíbulo-ocular dos canais semicirculares anterior esquerdo e posterior direito. Conclusão não houve associação entre os resultados da avaliação clínica do equilíbrio corporal e dos achados do vHIT com o avanço da idade, em pacientes com insuficiência cardíaca. Entretanto, observou-se diferença entre o ganho do reflexo vestíbulo-ocular específico para alguns canais semicirculares, com maiores índices de alteração na prova de equilíbrio dinâmico, em ambos os grupos. Os resultados dos testes aplicados permitiram caracterizar o predomínio da hipofunção vestibular crônica de origem periférica nos pacientes com insuficiência cardíaca, independentemente da faixa etária.


ABSTRACT Purpose to verify whether there is an association between the clinical assessment of balance and the gain in the vestibulo-ocular reflex with advancing age in patients with heart failure. Methods analytical-descriptive, observational cross-sectional study, which included patients diagnosed with heart failure, divided into two groups by age (G1, under 60 years old and G2, 60 years old or older). The patients were evaluated through anamnesis, cardiac assessment, clinical assessment of body balance (cerebellar function screening and assessment of static and dynamic balance) and instrumental assessment of vestibular function (Video Head Impulse Test-vHIT). The findings were described and compared through inferential statistical analysis. Results 34 patients with a mean age of 55 years and 9 months, mostly men (71.49%). There was no association between vestibulo-ocular reflex gain, symmetry of the semicircular canals and body balance with advancing age. Associations were observed between the results of the Unterberger-Fukuda test with the gain in the vestibulo-ocular reflex of the right lateral and left posterior semicircular canals and with the percentages of symmetry of the anterior semicircular canals for patients in Group 2. In Group 1, an association was observed between the results of the Unterberger-Fukuda test and the symmetry values of the anterior semicircular canals and the gain in the vestibulo-ocular reflex of the left anterior and right posterior semicircular canals. Conclusion there was no association between the results of the clinical assessment of body balance and the vHIT findings with advancing age in patients with heart failure. However, there was a difference between the gain of the specific vestibulo-ocular reflex for some semicircular canals, with higher rates of alteration in the dynamic balance test, in both groups. The results of the applied tests allowed characterize the predominance of chronic vestibular hypofunction of peripheral origin in patients with heart failure, regardless of age group.


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Testes de Função Vestibular , Reflexo Vestíbulo-Ocular , Tontura , Equilíbrio Postural , Teste do Impulso da Cabeça/métodos , Insuficiência Cardíaca/complicações , Fatores de Risco
14.
Braz. j. otorhinolaryngol. (Impr.) ; 89(4): 101277, Jan.-Feb. 2023. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1505890

RESUMO

Abstract Objective To compare the clinical features, risk factors, distribution of Benign Paroxysmal Positional Vertigo (BPPV) subtypes, and effectiveness of canalith repositioning between geriatric and non-geriatric patients with BPPV. Methods A total of 400 patients with BPPV were enrolled. Canalith repositioning was performed according to the semicircular canals involved. Patients were divided by age into a geriatric group (≥60 years) and a non-geriatric group (20-59 years). Clinical characteristics, potential age-related risk factors, distribution of subtypes, and effectiveness of canalith repositioning were compared between the groups. Results Female sex was significantly more common in all age groups, with a peak female-to-male ratio of 5.1:1 in the group aged 50-59 years. There was a higher proportion of men in the geriatric group. A history of disease associated with atherosclerosis was significantly more common in the geriatric group (p< 0.05). Migraine was significantly more common in the non-geriatric group (p= 0.018), as was posterior canal BPPV. The horizontal canal BPPV (especially horizontal canal BPPV-cupulolithiasis), and multicanal BPPV subtypes were more common in the geriatric group, whereas anterior canal BPPV was more common in the non-geriatric group. Two canalith repositioning sessions were effective in 58.0% of the geriatric cases and in 72.6% of the non-geriatric cases (p= 0.002). There was a tendency for the effectiveness of canalith repositioning to decrease with increasing age. Conclusion BPPV was more common in women. However, the proportion of men with BPPV increased with age. Elderly patients often had a history of diseases associated with atherosclerosis (i.e., hypertension, diabetes, and hyperlipidemia). The horizontal canal BPPV (particularly horizontal canal BPPV-cupulolithiasis) and multicanal BPPV subtypes were more common and the anterior canal BPPV subtype was less common in elderly patients. The effectiveness of canalith repositioning may decrease with age. Therefore, older patients should receive more comprehensive medical treatment. Level of evidence: 4.

15.
Journal of Traditional Chinese Medicine ; (12): 2063-2066, 2023.
Artigo em Chinês | WPRIM | ID: wpr-997261

RESUMO

Professor Zhang Zhiyuan, a master of Chinese medicine, made good use of Baizhu (Atractylis macrocephala (Koidz.)). Except for defecation in clinical practice, he usually prescribed processed Baizhu after stir-frying with soil. Baizhu is good at excreting water and removing dampness, so applied it in the formula series with Fuling (Poria cocos) and Guizhi (Cassia Twig) or self-made decoction for diarrhea. High-dose Baizhu could be used for edema by treating obstructive syndrome with tonics, so Baizhu were added in self-made Shugan Qushui Decoction (疏肝祛水汤) or modified Lizhong Decoction (理中汤) for liver cirrhosis ascites. It was emphasized that Baizhu could eliminate phlegm, so added it in modified Zexei Decoction (泽泻汤) for excess syndrome of vertigo. It was also acknow-ledged that Baizhu could strengthen the spleen and stomach, and was suitable for deficiency or excess syndrome of abdominal distension, so applied it in Burun Decoction (补润汤) for abdominal distension with deficiency-excess in complexity, and applied it in Zhizhu Decoction (枳术汤) or self-made Tiaozhong Decoction (调中汤) for deficient abdominal distention.

16.
Chinese Journal of Experimental Traditional Medical Formulae ; (24): 136-145, 2023.
Artigo em Chinês | WPRIM | ID: wpr-996820

RESUMO

ObjectiveThis study analyzed the outcome indicators in randomized controlled trials (RCTs) on traditional Chinese medicine (TCM) treatment of vertigo, aiming to provide a reference for clinical trial protocol design and the establishment of core indicator sets for vertigo treatment. MethodCNKI, Wanfang, VIP, SinoMed, PubMed, Embase, and Web of Science were searched for the RCTs on TCM treatment of vertigo, and data extraction was conducted. ResultA total of 375 RCTs involving 33 593 patients were included, from which 482 outcome indicators were extracted, with a frequency of 2 715 and an average of seven outcome indicators used for each RCT. In addition, there were some differences in outcome indicators reported by different study groups. According to the functional properties, the reported outcome indicators were classified into nine domains: clinical symptoms and signs, TCM symptom efficacy, physical and chemical examinations, quality of life, mental health, safety events, patients’ satisfaction degree, long-term prognosis, and economic evaluation. The outcome indicators with higher frequency were clinical total effective rate, total TCM symptom score, occurrence of adverse reactions, dizziness handicap inventory (DHI) score, average flow velocity of the basilar artery, incidence of adverse reactions, average flow velocity of the left vertebral artery, average flow velocity of the right vertebral artery, plasma viscosity, and vertigo score. ConclusionThe outcome indicators reported by RCTs of TCM treatment of vertigo mainly have two problems: lack of unified standards and norms and insufficient attention to outcome indicators that can reflect the characteristics of TCM. The construction of the core indicator set for TCM treatment of vertigo should fully highlight the characteristic advantages of TCM and unify the standards and norms for the outcome indicators on this basis, so as to improve the quality of clinical research and the value of secondary research.

17.
Chinese Journal of General Practitioners ; (6): 790-795, 2023.
Artigo em Chinês | WPRIM | ID: wpr-994768

RESUMO

Objective:To analyze the clinical characteristics of benign paroxysmal positional vertigo (BPPV) in the oldest old.Method:The clinical data of elderly patients (≥60 years old) with BPPV diagnosed in the Clinical Center for Vertigo and Balance Disturbance of Capital Medical University between January 2019 and October 2021 was collected, including basic information, clinical symptoms in a structured medical history questionnaire and the time interval from the appearance of symptoms to medical consultation. According to the age, patients were divided into elderly group (60-74 years old) and the oldest old group (≥75 years old), and the demographic information, clinical symptoms and consultation time were compared between the two groups.Results:A total of 3 019 patients with BPPV were included in analysis; there were 415 patients in the oldest-old group with the age of (79.54±3.62) years, and 2 604 patients in the elderly group with the age of (65.59±3.88) years. The incidence of vertigo, dizziness or vertigo triggered by position changes of head or body, headache and autonomic symptoms in the eldest-old group were less common than that in the elderly group (all P<0.05). But hearing loss and other types of dizziness (unable to determine the nature of dizziness or vertigo, or without typical symptoms such as dizziness, balance disorders, or instability) were more common in the eldest-old group than those in the elderly group (all P<0.05). Among 3 019 patients, 1 137 had definite time from symptom onset to diagnosis (1 004 in the elderly group and 133 in the oldest-old group), the proportion of patients with the time from the onset to diagnosis>7 days in the oldest-old group was higher than that in the elderly group ( P<0.05). Conclusion:The oldest old patients with BPPV have more atypical symptoms than the younger elderly patients.

18.
International Journal of Cerebrovascular Diseases ; (12): 122-126, 2023.
Artigo em Chinês | WPRIM | ID: wpr-989200

RESUMO

Patients with vascular vertigo usually present acute vestibular syndrome. Although vertigo caused by posterior circulation ischemic stroke is often accompanied by other neurological symptoms and signs, small infarcts in the cerebellum or brainstem can lead to vertigo without other focal neurological symptoms and signs. This article reviews the diagnosis and evaluation of isolated vascular vertigo.

19.
Chinese Medical Ethics ; (6): 698-702, 2023.
Artigo em Chinês | WPRIM | ID: wpr-1005692

RESUMO

Benign paroxysmal positional vertigo (BPPV) is a peripheral vestibular disease with the highest incidence rate, and the elderly are the high incidence population. Particle repositioning maneuver, simple and practicable, and has good clinical effects, is recognized as the preferred treatment method for BPPV. However, the elderly patients have a higher prevalence rate, often suffer from multiple chronic diseases, and their various bodily functions have entered a declining stage, with poor response to treatment and a tendency to recur. Based on these, medical staff should continuously improve their professional abilities, and pay attention to and implement some comprehensive and multi-dimensional humanistic care measures from physiological to psychological aspects such as verbal encouragement, behavioral support, and spiritual integration during the diagnosis and treatment process, to improve the quality of life of elderly BPPV patients, reduce medical disputes, and save medical resources.

20.
Journal of Traditional Chinese Medicine ; (12): 2532-2537, 2023.
Artigo em Chinês | WPRIM | ID: wpr-1003898

RESUMO

ObjectiveTo compare the short-term effectiveness of the three different manipulations for atlantoaxial joint disorders and their effects on surface electromyography of sternocleidomastoid muscle. MethodsNinty patients with atlantoaxial joint disorders were randomly divided into the tendon relaxing manipulation group, the tendon relaxing plus rehabilitation manipulation group, and the conventional manipulation group, with 30 cases in each group, and each group of patients received the corresponding manipulation treatment for 2 weeks. The changes of visual analogue score (VAS) of occipital neck pain, evaluation scale for cervical vertigo (ESCV), and averaged electromyography (AEMG) of surface electromyography of bilateral sternocleidomastoid muscles before and after the treatment were observed, and the clinical effectiveness and safety of the patients were compared among groups. ResultsThe VAS scores of patients in each group decreased, and the ESCV scores increased after treatment (P<0.01), and the tendon relaxing manipulation group and the tendon relaxing plus rehabilitation manipulation group were significantly better than the conventional manipulation group (P<0.01). The AEMG of the bilateral sternocleidomastoid muscles of the three groups increased after treatment (P<0.01); when compared among the three groups, the AEMG of the bilateral sternocleidomastoid muscles of the tendon relaxing plus rehabilitation manipulation group was higher than that of the tendon relaxing manipulation group, and the tendon relaxing manipulation group was higher than that of the conventional manipulation group (P<0.05 or P<0.01). The cure and markedly effective rates of the tendon relaxing manipulation group, the tendon relaxing plus rehabilitation manipulation group, and the conventional manipulation group were 56.67%, 86.67%, and 36.67% respectively, showing statistically difference (K=10.21, P<0.01). ConclusionThe tendon relaxing manipulation and tendon relaxing plus rehabilitation manipulation can effectively improve the symptoms of vertigo, headache, and neck pain for patients with atlantoaxial joint disorders, and can improve the contraction function of sternocleidomastoid muscle, whose effectiveness are better than that of conventional manipulation.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA