Caloric test and video head impulse test sensitivity as vestibular impairment predictors before cochlear implant surgery

OBJECTIVES: Currently, cochlear implant procedures are becoming increasingly broad and have greatly expanded. Bilateral cochlear implants and cochlear implants are more frequently applied in children. Our hypothesis is that the video head impulse test may be more sensitive than the caloric test in detecting abnormal vestibular function before cochlear implant surgery. The objective of this study was to compare the video head impulse test and caloric test results of patients selected for cochlear implant procedures before surgery. METHODS: The patients selected for cochlear implant surgery were submitted to a bithermal caloric test and video head impulse test. RESULTS: By comparing angular slow phase velocity values below 5° in the bithermal caloric test (hypofunction) and video head impulse test with a gain lower than 0.8, we identified 37 (64.9%) patients with vestibular hypofunction or canal paresis and 21 (36.8%) patients with abnormal video head impulse test gain before the cochlear implant procedure. Of the 37 patients with caloric test vestibular hypofunction, 20 (54%) patients exhibited an abnormal gain in the video head impulse test. CONCLUSION: The caloric test is more sensitive than the video head impulse test (Fisher's exact test, p=0.0002) in detecting the impaired ear before cochlear implant delivery. The proportion of caloric test/video head impulse test positive identification of abnormal vestibular function or caloric test/video head impulse test sensitivity was 1.8:1.

Effects of cavity reconstruction on morbidity and quality of life after canal wall down tympanomastoidectomy / Efeitos da reconstrução da cavidade da timpanomastoidectomia com técnica aberta na morbidade e qualidade de vida

Abstract Introduction: Canal wall down tympanomastoidectomy is commonly used to treat advanced chronic otitis media or cholesteatoma. The advantages of canal wall down mastoidectomy are excellent exposure for disease eradication and postoperative control of residual disease; its disadvantages include the accumulation of debris requiring life-long otological maintenance and cleaning, continuous ear drainage, fungal cavity infections, and the occurrence of dizziness and vertigo by changing temperature or pressure. Objective: To evaluate whether cavity-induced problems can be eliminated and patient comfort can be increased with mastoid cavity reconstruction. Methods: In total, 11 patients who underwent mastoid cavity reconstruction between March 2013 and June 2013 comprised the study group, and 11 patients who had dry, epithelialized CWD cavities were recruited as the control group. The study examined three parameters: epithelial migration, air caloric testing, and the Glasgow Benefit Inventory. Epithelial migration, air caloric testing, and the Glasgow Benefit Inventory were evaluated in the study and control groups. Results: The epithelial migration rate was significantly faster in study group (1.63 ± 0.5 mm/week) than control group (0.94 ± 0.37 mm/week) (p = 0.003, p < 0.05). The mean slow component velocity of nystagmus of the study group (13.33 ± 5.36°/s) was significantly lower when compared to control group (32.11 ± 9.12°/s) (p = 0.018). The overall the Glasgow Benefit Inventory score was −7.21, and the general subscale, physical and social health scores were −9.71, −21.09, and +20.35, respectively in the control group. These were +33.93, +35.59, +33.31, and +29.61, respectively in the study group. All but the social health score improved significantly (0.007, 0.008, 0.018, and 0.181, respectively). Conclusions: Cavity reconstruction improves epithelial migration, normalizes caloric responses and increases the quality of life. Thus, cavity rehabilitation eliminates open-cavity-induced problems by restoring the functional anatomy of the ear.

Resumo Introdução: A timpanomastoidectomia com a técnica Canal Wall Down, ou técnica aberta, é comumente utilizada para tratar otite média crônica avançada ou colesteatoma. As vantagens da mastoidectomia pela técnica aberta são uma excelente exposição para a erradicação da doença e controle pós-operatório da doença residual; suas desvantagens incluem o acúmulo de detritos que requerem manutenção e limpeza otológica ao longo da vida, drenagem contínua da orelha, infecções fúngicas na cavidade e a ocorrência de tonturas e vertigem com alterações de temperatura ou pressão. Objetivo: Avaliar se os problemas induzidos pela cavidade podem ser eliminados e o conforto do paciente aumentado com a reconstrução da cavidade mastoide. Método: No total, 11 pacientes submetidos à reconstrução da cavidade mastoide entre março de 2013 e junho de 2013 constituíram o grupo de estudo, e 11 pacientes com cavidades secas e epitelizadas, operadas pela técnica aberta, foram recrutados como grupo controle. O estudo analisou três parâmetros: migração epitelial, prova calórica com estimulação a ar e o questionário Glasgow Benefit Inventory. A migração epitelial, a prova calórica e o Glasgow Benefit Inventory foram avaliados nos grupos de estudo e controle. Resultados: A taxa de migração epitelial foi significativamente mais rápida no grupo de estudo (1,63 ± 0,5 mm/semana) do que no grupo controle (0,94 ± 0,37 mm/semana) (p = 0,003, p < 0,05). A velocidade média do componente lento do nistagmo no grupo de estudo (13,33 ± 5,36°/s) foi significativamente menor se comparada ao grupo controle (32,11 ± 9,12°/s) (p = 0,018). O escore global do Glasgow Benefit Inventory foi de -7,21 e os escores da subescala geral, saúde física e social foram -9,71, -21,09 e +20,35, respectivamente, no grupo controle. Esses escores foram +33,93, +35,59, +33,31 e +29,61, respectivamente, no grupo de estudo. Todos, exceto o escore de saúde social, melhoraram significativamente (0,007, 0,008, 0,018 e 0,181, respectivamente). Conclusões: A reconstrução da cavidade melhora a migração epitelial, normaliza as respostas da prova calórica e aumenta a qualidade de vida. Assim, a reabilitação da cavidade elimina os problemas induzidos por cavidades abertas ao restaurar a anatomia funcional da orelha.

Sensitivity of caloric test and video head impulse as screening test for chronic vestibular complaints

OBJECTIVE: This study compared the results of the caloric test with those of the video head impulse test obtained during the same session and evaluated whether the former can be used to screen for non-acute vestibular dysfunction. METHODS: A total of 157 participants complaining of dizziness with vestibular characteristics of varying durations and clinical courses completed the caloric test and video head impulse test. RESULTS: Significantly more caloric test results than video head impulse test results were abnormal. CONCLUSIONS: The results of the caloric test and video head impulse test are distinct but complement each other. Within our sample, the caloric test was more sensitive for vestibular dysfunction. Therefore, the video head impulse test is not a suitable screening tool of the vestibular system in patients with chronic complaints.

Evaluación del Video Head Impulse Test (V-Hit) en el diagnóstico del neurinoma del acústico / Evaluation of video Head Impulse Test (v-HIT) in the diagnosis of acoustic neuroma

Introducción: La gran mayoría de lesiones que comprometen el conducto auditivo interno corresponden a schwannomas vestibulares (90%). Dentro de las nuevas pruebas diagnósticas del sistema vestibular aparece la prueba de impulso cefálico y su registro con el video Head Impulse Test (v-HIT) que permite el estudio de todos los canales semicirculares. Objetivo: Comparar el v-HIT para canales semicirculares laterales con las pruebas calóricas clásicas registradas mediante videonistagmografía en el comportamiento de los neurinomas intracanaliculares y evaluar su utilidad como test diagnóstico. Material y método: Dieciocho pacientes fueron reclutados con diagnóstico de neurinomas, confirmado mediante resonancia magnética y estudios con pruebas calóricas clásicas y v-HIT para canal horizontal. Resultados: Los resultados anormales de asimetría de ganancia y de sacadas correctivas fue de 13 pacientes (72%) y con hipoexcitabilidad en la prueba calórica fue de 9 pacientes (50%), con una sensibilidad de la prueba de 72% para vHIT y de 50% para la prueba calórica al compararlo con la resonancia magnética. Conclusión: El v-HIT es una herramienta complementaria a las pruebas calóricas y debe ser incluida como test diagnóstico dentro de la batería de exámenes para evaluar el sistema vestibular en forma completa mediante un vestibulograma.

Introduction: The majority of injuries involving the internal auditory canal correspond to vestibular schwannomas (90%). Within the new diagnostic tests for the vestibular system appears the Head Impulse test and the video head impulse test (v-HIT) which allows the studying of all the semicircular canals. Aim: Compare the v-HIT lateral semicircular canals with classical caloric tests recorded by videonistagmography (VNG) in the behavior of intracanalicular neuroma and evaluate its usefulness as a diagnostic test. Material and method: Eigtheen patients were enrolled with a diagnosis of schwannomas, confirmed by MRI and studied classical caloric tests and v-HIT for horizontal channel. Results: Abnormal results of asymmetry gain and corrective saccades was 13 patients (72%) and hypoexcitability in the caloric test was 9 patients (50%), with a test sensitivity of 72% for vHIT and 50% for caloric test compared with MRI. Conclusions: The v-HIT is a complementary tool to caloric tests and should be included as a diagnostic test within the battery of tests to evaluate the vestibular system in complete form by vestibulogram.

Do nistagmo às provas calóricas com ar e com água / From nystagmus to the air and water caloric tests

A prova calórica é uma importante ferramenta na avaliação da função labiríntica. OBJETIVO: Comparar o nistagmo pós-calórico da prova com ar a 50ºC e 24ºC com o da prova com água a 44ºC e 30ºC. Desenho científico: Estudo clínico cruzado randomizado. MATERIAL E MÉTODO: 40 indivíduos hígidos submetidos à avaliação da função vestibular incluindo a prova calórica com ar a 50ºC e 24ºC e com água a 44ºC e 30ºC. RESULTADOS: À comparação das provas com ar e com água, não houve diferença significante entre os valores da velocidade angular da componente lenta (VACL) do nistagmo pós-calórico quanto à ordem de realização das estimulações, entre as orelhas e entre os valores de predomínio labiríntico e de preponderância direcional. Os valores da VACL foram maiores nas estimulações com água (p = 0,008; p < 0,001) e a temperatura fria evocou respostas mais intensas (p < 0,001). CONCLUSÃO: À comparação entre as provas com ar a 50ºC e 24ºC e com água a 44ºC e 30ºC, observam-se valores de velocidade da componente lenta similares em ambas as orelhas, maiores na temperatura fria e na prova com água e resultados semelhantes de predomínio labiríntico ou de preponderância direcional do nistagmo pós-calórico em ambas as provas.

The caloric test is an important tool for the assessment of labyrinthine function. OBJECTIVE: To compare the nystagmus response in the caloric tests with air at 50ºC and 24ºC and with water at 44ºC and 30ºC. Study Design: Randomized crossover clinical trial. MATERIALS AND METHODS: 40 healthy individuals were submitted to a neurotological evaluation, including caloric tests with air at 50ºC and 24ºC and water at 44ºC and 30ºC. RESULTS: Comparing the air and water caloric tests, there were no significant differences among the post-caloric nystagmus slow-phase velocity in relation to the stimulation order, between ears and between the values of unilateral weakness and directional preponderance. The slow-phase velocity values were higher with water (p = 0.008, p < 0.001), and cold stimulation produced stronger responses (p < 0.001). CONCLUSION: Comparing 50ºC and 24ºC air caloric test and 44ºC and 30ºC water caloric test, we observed similar slow-phase velocity values for both ears, higher responses in the cold temperature and in the test with water, and similar results of unilateral weakness or directional preponderance for post-caloric nystagmus in both tests.

Estudo do equilíbrio postural estático em pacientes com vestibulopatia mediante sistema de sensores eletromagnéticos tridimensionais / Static postural balance study in patients with vestibular disorders using a three dimensional eletromagnetic sensor system

A avaliação do reflexo vestíbulo ocular é importante; porém, insuficiente. Sistemas de sensores eletromagnéticos tridimensionais são uma nova opção para avaliação posturográfica. OBJETIVO: Avaliar a oscilação corporal em voluntários hígidos, com Manobras de Epley e Dix-Hallpike positivas e com outras disfunções vestibulares usando um sistema tridimensional. Forma de estudo: Prospectivo. MATERIAL E MÉTODO: Participaram: 23 mulheres saudáveis, 15 com disfunção vestibular periférica detectada à prova calórica e 10 com manobras de Epley e Dix-Hallpike positivas. Todas realizaram exames nas posições: olhos abertos e fechados em superfície estável e instável. RESULTADOS:Na condição Olhos Abertos e Superfície Estável, houve p < 0,01 entre o grupo controle e o com disfunção vestibular periférica em todas variáveis, exceto no deslocamento máximo a-p. Velocidade total e velocidade na trajetória médio-lateral apresentaram p < 0,01 entre o grupo com disfunção vestibular e o controle em todas as posições. O grupo com manobras de Epley e Dix-Hallpike positivas obteve p < 0,01 nas velocidades total e em seus componentes x e y nas posições de olhos abertos e fechados em superfície instável. CONCLUSÃO: O sistema de sensores eletromagnéticos tridimensionais utilizado foi capaz de gerar informações confiáveis quanto à oscilação corporal nos voluntários do estudo.

The vestibular-ocular reflex assessment is important, but not enough. Tridimensional electromagnetic sensor systems represent a new method to assess posturography. AIM: To assess body sway in healthy subjects who had positive Dix Hallpike and Epley maneuvers and with other vestibular dysfunctions by means of a three-dimensional system. Study design: Prospective. MATERIALS AND METHODS: We had 23 healthy women, 15 with peripheral vestibular dysfunction found upon caloric test and 10 with positive Epley and Dix Hallpike maneuvers. All tests performed in the following positions: open and closed eyes on stable and unstable surfaces. RESULTS: With the Eyes Open and on a stable surface, p < 0.01 between the control group and the one with peripheral vestibular dysfunction in all variables, except the a-p maximum, full speed and mediolateral trajectory velocity, which had a p < 0.01 between the group with vestibular dysfunction and controls in all positions. The group with positive Epley and Dix Hallpike maneuvers had p < 0.01 at full speed and in its components in the x and y in positions with open and eyes closed on an unstable surface. CONCLUSION: The tridimensional electromagnetic sensors system was able to generate reliable information about body sway in the study volunteers.

Estimulação calórica a ar em mastoidectomias abertas unilaterais / Air caloric test in canal wall down mastoidectomy

Poucos trabalhos desde a década de 70 foram realizados a fim de elucidar a prova calórica em alterações da orelha média, apesar de inúmeras controvérsias que este exame pode trazer em estruturas anatômicas tão distintas. Na mastoidectomia radical, estes estudos são mais escassos. OBJETIVO: Este estudo teve como objetivo analisar os achados da estimulação calórica a ar em indivíduos com mastoidectomia radical unilateral sem queixas de tontura. MATERIAL E MÉTODO: Estudo prospectivo, realização da estimulação calórica a ar em 36 indivíduos sem queixas vestibulares, sendo 21 com cirurgia de mastoidectomia aberta unilateral e 15 sem nenhuma alteração na orelha média ou externa. RESULTADOS: 80,95% dos indivíduos apresentaram respostas assimétricas na prova calórica frias, sendo as respostas maiores do lado da mastoidectomia aberta. Em 72,73%, o mesmo efeito ocorreu com a prova calórica quente. Na análise das quatro estimulações, encontrou-se assimetria das provas quente e frias em 81,82% dos casos. Em 47,61%, foi encontrada estimulação paradoxal da prova calórica quente. CONCLUSÃO:As respostas nistágmicas do lado da mastoidectomia aberta foram maiores se comparadas com o lado saudável. A estimulação paradoxal da prova calórica quente foi um achado frequente. Não foram encontradas respostas hipofuncionantes.

Since the 1970s, few studies have been conducted to elucidate the use of caloric tests on middle ear disorders, despite the many controversies that this test may produce in anatomical structures that are so distinct. In cases of mastoidectomy, such studies are even rarer. OBJECTIVE: This study aims to analyze the findings from air caloric stimulation done in individuals submitted to unilateral radical mastoidectomy without complaints of dizziness. MATERIALS AND METHOD: Thirty-six individuals without vestibular complaints were enrolled in this prospective study. Air caloric stimulation was offered to all subjects. Twenty-one individuals had undergone unilateral open mastoidectomy and 15 did not present any middle or outer ear abnormalities. RESULTS: 80.95% of the individuals presented asymmetrical responses in the cold caloric test, with greater response on the side of the open mastectomy. In 72.73% of the subjects the same effect was observed in the hot caloric test. The four stimulation modes revealed asymmetries in both hot and cold tests in 81.82% of the cases. Paradoxical stimulation was observed in 47.61% of hot caloric tests. CONCLUSION: Nystagmic responses on the side of the open mastoidectomy were greater than on the healthy side. Paradoxical stimulation in caloric tests was a frequent finding. No hypofunctioning responses were found.

Air stimulation in tympanic perforation: inverted nystagmus study / Estimulação a ar na perfuração timpânica: estudo da inversão nistágmica

Response inversion during warm air stimulation is the most controversial finding seen in caloric tests of individuals with tympanic membrane perforation. In such cases, very few studies explore the possible interferences found in the caloric test, bringing about controversies in the interpretation of test results. AIM: This paper aimed at analyzing warm air stimulation effects in individuals with tympanic membrane perforation in comparison with normal healthy controls. MATERIALS AND METHODS: Prospective, non-randomized study in which 48 individuals without vestibular complaints were assessed, 33 had one tympanic membrane perforated and 15 had no ear drum alteration. RESULTS: 39.39 percent of the individuals had response inversion found during the warm air test. In the absence of this phenomenon, nystagmus responses were symmetrical. CONCLUSION: Nystagmus responses to the caloric test in individuals with tympanic membrane perforation were similar to those from healthy controls, with the exception of the fact that they had inverted responses in the warm caloric test.

A inversão de respostas durante a estimulação a ar quente é o achado mais controverso que aparece na prova calórica de indivíduos com perfuração da membrana timpânica. Nestes casos, poucos estudos exploraram as possíveis interferências nos achados da prova calórica, trazendo controvérsias de interpretação no resultado do exame. OBJETIVO: Este trabalho teve o objetivo de analisar a estimulação calórica a ar em indivíduos com perfuração da membrana timpânica em comparação com indivíduos hígidos, sem esta alteração. MATERIAL E MÉTODO: Estudo prospectivo, não-randomizado, no qual foram avaliados 48 indivíduos sem queixas vestibulares, sendo 33 indivíduos com membrana timpânica perfurada unilateralmente e 15 indivíduos sem nenhuma alteração na membrana timpânica. RESULTADOS: 39,39 por cento dos indivíduos apresentaram inversão de respostas na prova calórica a ar quente. Na ausência deste fenômeno as respostas das nistágmicas foram simétricas. CONCLUSÃO: As respostas nistágmicas na prova calórica em indivíduos com perfuração da membrana timpânica foram similares aos indivíduos hígidos, com exceção da presença de inversão de respostas na prova calórica quente.

Achados à prova calórica e canal semicircular acometido na vertigem posicional paroxística benigna / Caloric test results and damaged semicircular canal in benign positional paroxysmal vertigo

OBJETIVO: Caracterizar os achados da prova calórica em pacientes com vertigem posicional paroxística benigna, segundo o canal semicircular comprometido. MÉTODOS: Foram analisados 1033 prontuários de pacientes submetidos à pesquisa de nistagmo posicional e de posicionamento e à eletronistagmografia. Os achados da prova calórica, de acordo com os canais semicirculares acometidos, foram submetidos à análise estatística. RESULTADOS: No comprometimento de canal posterior, houve prevalência de normorreflexia (p<0,0001); hiporreflexia prevaleceu sobre hiper-reflexia (p<0,0001) e preponderância direcional (p<0,0001), e hiper-reflexia prevaleceu sobre preponderância direcional (p<0,0001). No comprometimento de canal lateral, normorreflexia prevaleceu sobre hiporreflexia (p<0,0001) e hiper-reflexia (p<0,0001); hiporreflexia tendeu a prevalecer sobre hiper-reflexia (p=0,0771), e preponderância direcional não ocorreu. No comprometimento de canal anterior, normorreflexia prevaleceu sobre hiporreflexia (p<0,0001); hiper-reflexia e preponderância direcional não ocorreram. CONCLUSÃO: Na prova calórica de pacientes com vertigem posicional paroxística benigna, normorreflexia, hiporreflexia, hiper-reflexia ou preponderância direcional do nistagmo pós-calórico ocorrem em ordem decrescente de prevalência, quando há comprometimento do canal posterior; normorreflexia prevalece sobre hiporreflexia ou hiper-reflexia e hiporreflexia tende a prevalecer sobre hiper-reflexia, no comprometimento do canal lateral; normorreflexia prevalece sobre hiporreflexia, no comprometimento do canal anterior.

PURPOSE: To characterize caloric test results in benign paroxysmal positional vertigo patients, according to the damaged semicircular canal. METHODS: The data of 1033 patients submitted to Dix-Hallpike testing, positional nystagmus and electronystagmography were analyzed. Caloric test results were compared to the damaged semicircular canals and were submitted to statistical analysis. RESULTS: In cases with posterior canal damage, there was prevalence of normal responses compared to abnormal results (p<0.0001); hypo activity was more prevalent than hyperactivity (p<0.0001) and directional preponderance (p<0.0001), and hyperactivity more prevalent than directional preponderance (p<0.0001). In cases with lateral canal damage, normal responses were more prevalent than hypo activity (p<0.0001) and hyperactivity (p<0.0001); there was a tendency of prevalence of hypo activity over hyperactivity (p=0.0771), and directional preponderance was not observed. In cases with anterior canal damage, normal responses were more prevalent than hypo activity (p<0.0001); hyperactivity and directional preponderance were not observed. CONCLUSION: In the caloric test of benign positional paroxysmal vertigo patients, normal responses, hypo activity, hyperactivity or directional preponderance of post-caloric nystagmus occur in decreasing order of prevalence when the posterior canal is damaged; normal responses are more prevalent than hypoactive or hyperactive caloric responses, and there is a tendency of prevalence of hypoactive over hyperactive caloric responses when the lateral canal is damaged; normal responses are more prevalent than hypoactive caloric responses when the anterior canal is damaged.

Situación socieconómica: diagnóstico nutricional antropométrico y dietario en niños y adolescentes de Valencia-Venezuela / Socioeconomic status: anthropometric nutritional diagnosis and dietary adequacy in children and adolescents of an area of Valencia-Venezuela

La capacidad de compra de alimentos derivada del nivel socioeconómico influye en calidad y cantidad de la dieta, pudiendo originar alteraciones nutricionales. Se planteó evaluar la asociación de indicadores socioeconómicos y antropométricos con la adecuación dietaria en niños de una zona de pobreza. Se estudiaron 257 niños menores de 18 años, de una Parroquia de Valencia, 2004. Se determinó estrato socioeconómico (ESE)(Graffar-Méndez), adecuación dietaria (recordatorios 24h, n=97) e indicadores antropométricos: P/E, T/E, P/T, circunferencia brazo, área grasa y muscular, pliegue tricipital e Índice de Masa Corporal). Análisis estadístico por distribución de frecuencia, Chi cuadrado y Pearson. Predominaron varones, escolares, estratos IV y V y una familia por vivienda. Hubo 36,6% de déficit, normalidad en 54,8% y 8,6% de exceso nutricional. Las adecuaciones calórica y proteica fueron aceptables, pero excesiva para fibra, 41,2% de déficit calórico y 45,3% en proteínas, 58,3% de los normales y en exceso tenían aporte calórico deficiente, y los desnutridos 46,5%. El exceso en consumo de fibra (49%) fue independiente del estrato y estado nutricional. La adecuación de fibra se relacionó con ingesta calórica y proteica, edad, talla y área muscular pero no hubo entre adecuación calórica y proteínas con ESE. Se concluye que hubo asociación importante entre el consumo dietario y estado nutricional pero la asociación es menor con el ESE. La evidencia no relacionó las alteraciones encontradas con la situación de pobreza. La evaluación del consumo de alimentos fue útil para complementar la información antropométrica y sociodemográfica; considerando la sub o sobreestimación del dato dietario.

Food purchase capacity is related to socioeconomic level, and it influences dietary quality and quantity. Changes on diet may cause alterations of nutritional status. In order to evaluate the association between socioeconomic and anthropometrics indicators to dietary adequacy in children from a poverty area, 257 children and adolescents randomly selected, from Valencia, Venezuela (2004) were assessed. Socioeconomic status was determined(SES, Graffar-Méndez), dietary adequacy (24h recalls, n=97) and anthropometrical indicators (W/A, H/A, W/H, arm circumference, fat and muscular area, tricipital skinfold and BMI) were measured. Statistical Analysis by frequency distribution, Chi² test and Pearson correlation was performed. Boys, school children; families in poverty(IV and V stratum) and one family/home were highly prevalent. Nutritional diagnosis consisted of: 36.6% of deficit, 54.8% of normality and 8.6% of excess. Mean caloric and protein intake and adequacy were acceptable, but fiber adequacy was excessive. 41.2% of subjects had inadequate energy intake and 45.3% inadequate protein intake. Energy intake was deficient in 58.3% of normal subjects and also in those in excess, and in 46.5% of undernourished children, 52.1% of the undernourished children had excessive adequacy for fiber. There was association between fiber adequacy to energy and protein intake, age; height and muscular area, but not between energy and protein intake to socioeconomic condition. It is concluded that there was an important association between dietary intake and nutritional status but only a weak relation to SES. Evaluation of dietary intake and adequacy is useful to complement anthropometric and socioeconomic information; but care has to be taken for the possibility of under or overestimation of data reported by the interviewed.

Interpretação e utilidade da prova calórica: [revisão] / Interpretation and use of caloric testing: [review]

A prova calórica é o teste da avaliação otoneurológica que verifica a integridade do reflexo vestíbulo-ocular e possibilita avaliar cada labirinto separadamente. Os principais aspectos relacionados à realização, interpretação e utilidade da prova calórica foram revistos. MÉTODOS: Realizou-se revisão sistemática sobre as publicações ocorridas nos últimos cem anos sobre o assunto. Incluíram-se artigos originais transversais e longitudinais, de revisão e meta-análise. Excluíram-se revisões de papeleta, relatos de caso e editoriais. Os descritores utilizados foram: prova calórica, nistagmo, sistema vestibular, preponderância direcional, predomínio labiríntico, teste calórico monotermal, teste calórico com água gelada, fenômeno de Bell. Pesquisou-se as bases de dados COCHRAINE, MEDLINE, LILACS, CAPES. RESULTADOS: De 818 resumos de artigos, selecionou-se inicialmente 93 que preenchiam os critérios de inclusão. A leitura dos artigos resultou na seleção final de 55. Na análise dos artigos, enfatizou-se na discussão fundamentos da prova calórica, tipos de estimulação utilizados, prova calórica monotermal e com água gelada, questões relacionadas à interpretação dos resultados, variáveis e artefatos. COMENTÁRIOS FINAIS: os valores de referência utilizados na prova calórica podem variar de serviço para serviço, com ponto de corte definido a partir de estudos locais. Semiotécnica cuidadosa é fundamental para elevar a sensibilidade do exame.

Caloric testing is an otoneurologic evaluation of the status of the vestibular-ocular reflex; it allows an evaluation of each labyrinth separately. The main aspects on the use and interpretation of caloric testing are reviewed. METHOD: A systematic review of papers published in the past one hundred years on caloric testing was undertaken. The inclusion criteria were: cross-sectional, longitudinal, original articles, reviews and meta-analyses. Reviews of patient charts, case reports and editorials were excluded. The key-words were: caloric testing, nystagmus, vestibular system, directional preponderance, labyrinth predominance, monothermal caloric test, ice water caloric testing, Bell´s phenomenon. The databases were: COCHRAINE, MEDLINE, LILACS, CAPES. RESULTS: Ninety-three of 818 abstracts fulfilled the inclusion criteria. After reading these articles, 55 were selected for this study. These papers discussed the basics of caloric testing, the types of stimulation, the interpretation of results, variables, artifacts, and the monothermal and ice water caloric test. FINAL COMMENTS: Caloric testing reference values may vary according to each unit; the the cutoff point is defined based on local studies. Attention to the technique is essential to maximize test sensitivity.

Importancia clínica de la prueba calórica mínima / Clinical importance of the minimal caloric test

Introducción: En la evaluación de la patología vestibular habitualmente se utiliza la prueba calórica clásica de Fitzgerald y Hallpike (PCC). Sin embargo, esta sólo evalúa la función del nervio vestibular superior a través de la estimulación del canal semicircular lateral. La prueba calórica mínima (PCM) permite evaluar tanto la función del nervio vestibular superior como del nervio vestibular inferior a través de la estimulación del canal semicircular lateral y posterior respectivamente. Se desconoce el real impacto de la PCM en la evaluación clínica de pacientes con sintomatología vestibular. Objetivo: Cuantificar la utilidad diagnóstica de la PCM en pacientes con sintomatología vestibular. Material y método: Estudio diagnóstico transversal. Se obtuvo la sensibilidad y especificidad de la PCM al comparar la respuesta del canal semicircular lateral en la PCM con la prueba calórica convencional. Se evaluó en cuántos casos la información sobre la función del nervio vestibular inferior aportada por la PCM fue relevante en el diagnóstico vestibular. Resultados: Se estudió a 44 pacientes. Tanto la sensibilidad como la especificidad de la PCM para detectar patología al estimular el canal semicircular lateral fue de 93 por ciento (IC95 por ciento: 84 por ciento-100 por ciento y 80 por ciento-100 por ciento respectivamente). En 16 por ciento (N =7) de los casos la PCM detectó patología del nervio vestibular inferior con PCC normal. Conclusiones: La PCM es un examen complementario útil en la evaluación de pacientes con sintomatología vestibular, puesto que tiene una alta sensibilidad y especificidad para detectar patología del nervio vestibular superior a través de la estimulación del canal semicircular lateral y además, aporta información sobre el estado del nervio vestibular inferior a través de la estimulación del canal semicircular posterior, que no aporta la PCC.

Introduction: The classic Fitzgerald-Hallpike caloric test (CCT) is usually utilized for evaluation of vestibular pathology. With this test, however, superior vestibular nerve function is assessed through stimulation of the lateral semicircular canal only. The minimal caloric test (MCT) allows for evaluation of both superior and inferior vestibular nerve function, through horizontal and posterior semicircular canals stimulation, respectively. The actual impact of MCT on the clinical evaluation of patients presenting with vestibular symptoms is unknown. Purpose: To quantify the diagnostic usefulness of MCT in patients with vestibular symptoms. Material and Method: Transversal diagnostic study. Sensitivity and specificity of MCT were obtained by comparing the lateral semicircular canal response in both MCT and the conventional caloric test. We assessed the number of cases in which the vestibular nerve function information obtained with MCT was relevant for vestibular diagnostic. Results: 44 patients were studied. The sensitivity and specificity of MCT to detect pathologic conditions via lateral semicircular canal stimulation were 93 percent (Cl 95 percent: 84 percent-100 percent and 80 percent-100 percent, respectively). In 16 percent (n =7) of the cases, MCT detected inferior vestibular nerve involvement with normal CCT Conclusions: MCT is a complementary test, which can be useful for evaluation of patients with vestibular symptoms, given its high sensitivity and specificity to detect superior vestibular nerve pathology through lateral semicircular canal stimulation. In addition, it provides information on the inferior vestibular nerve status, through posterior semicircular canal stimulation. The latter is not provided by conventional CCT.

Utilidad de la prueba calórica mínima / Usefulness of the minimum caloric test

La prueba calórica mínima (PCM) es un examen diseñado para estudiar el canal semicircular lateral (CSCL) y, especialmente, el canal semicircular posterior (CSCP), el cual no es examinado por la prueba calórica clásica (PCC). Nuestro objetivo es evaluar el aparato vestibular a través de la PCM, cuando la PCC no explica los síntomas de algunos pacientes. Se incluyeron aquellos pacientes que consultaron entre enero y julio de 2003 por un síndrome vertiginoso cuya sintomatología no era explicada por la PCC. Fueron evaluados mediante PCM. Se identificaron 12 pacientes con estas características. En todos los casos la PCM permitió establecer un diagnóstico más preciso. Como conclusión, la PCM en casos seleccionados complementa la PCC, otorgando información adicional relevante para el manejo de los pacientes con patología vestibular.

Electronystagmography profile in unilateral profound sensorineural hearing loss

Forty two patients with profound sensorineural hearing loss for more than 5 years were examined by electronystagmography [ENG] to evaluate their vestibular function. Their age range was 20 - 45 years. They had no complaint of imbalance and on examination there was no spontaneous nystagmus, no nystagmus on gaze or positional tests and they showed normal saccadic, smooth pursuit and optokinetic test results. Bithermal caloric test showed weaker response recorded from either ear of the study group when referenced to the normal subjects; however, fixation suppression index was normal. There was no significant unilateral weakness of the ear with hearing loss compared to the normal ear of the same subjects. These findings could be attributed to one of the compensation mechanisms, which suppress the normal ear and stimulate the affected ear

Fluidez de ligas de níquel-cromo de procedência nacional. Açäo da elevaçäo da temperatura de estufagem dos revestimentos fosfatados / Castability of nickel-chromium Brazilian alloys. Action of the rise of mold temperature of phosphate bonded investments

O objetivo deste trabalho foi o de avaliar a fluidez de cinco ligas de níquel-cromo em virtude da elevaçäo da temperatura de estufagem de quatro marcas de revestimentos fosfatados. Os corpos-de-prova foram confeccionados com uma tela de poliéster, com filamentos de 0,26 mm de diâmetro formando uma rede de 11 x 11 filamentos com 100 espaços quadrados. Os corpos-de-prova foram obtidos incluindo a liga líquida em moldes de revestimentos fosfatados aquecidos a 700ºC, 800ºC, 900ºC e 1000ºC, e fundida em uma centrífuga comum com chama gás/oxigênio. O valor da fluidez foi obtido pela porcentagem de segmentos de malha completados após a fundiçäo. Verificou-se que a fluidez variou com as composiçöes das ligas e dos revestimentos, e que ocorre um aumento progressivo da fluidez à medida que se eleva a temperatura de estufagem dos revestimentos

Respuestas calóricas en nistagmo congénito / Caloric test in congenital nystagmus

Los autores presentan primero una revisión describiendo las características del nistagmo congénito. El trabajo estudia las respuestas calóricas (Hallpike) en 8 sujetos con nistagmo congénito. Tanto la modalidad de presentación como el tipo de respuestas son muy variables. De los 8 sujetos examinados 2 dieron respuestas normales, 2 no tuvieron respuestas y 4 dieron respuestas cuantitativa y/o cualitativamente alteradas

Study of effect of age on the caloric test results in patients complaining of balance disorders

60 patients [38 males and 22 females, with ages between 13-85years] suffering balance disorders were divided according to their ages into 2 groups: group 1 [non-aged group] composed of 30 patients their ages ranged between 13-45 years with a mean of 32.7 years and group 2[aged group] composed of 30 patients their ages between 46-85 years with a mean of 67.7 years. Every group was further subdivided according to history, physical examination and diagnostic test into 2 subgroups based on whether patients were complaining of true vertigo or non-vertiginous disequilibrium. All patients have been studied by the caloric test to find out the effect of age on the caloric response. According to our results, we concluded that there is no effect of age on the caloric response whatever the cause of dizziness