Efficacy of Vestibular Rehabilitation Following Acute Vestibular Neuritis: A Randomized Controlled Trial.

OBJECTIVE: To investigate whether a vestibular rehabilitation program started early after diagnosis of vestibular neuritis combined with standard care reduces dizziness and improves functions of daily life more effectively than standard care alone in patients with acute vestibular neuritis. STUDY DESIGN: Non-blinded, randomized controlled trial with 2 parallel groups. SETTING: Specialist centers in 2 university hospitals. PATIENTS: Patients, 18-70 years, with acute vestibular neuritis confirmed by videonystagmography. INTERVENTION: Standard care was 10 days of prednisolone, general information, and counseling given to all patients. In addition to standard care, the intervention group received supervised exercise therapy (vestibular rehabilitation). Vestibular rehabilitation was given in a group format, individually tailored, and supported by home exercises. MAIN OUTCOME MEASURE: Perceived dizziness during head motion. Secondary outcomes were walking speed, standing balance, Hospital Anxiety and Depression Scale (HADS), Vertigo Symptom Scale, Visual Analog Scales (VASs), Dizziness Handicap Inventory (DHI), The University of California Los Angeles Dizziness Questionnaire. RESULTS: Sixty-five patients were included, 27 participated in the vestibular rehabilitation group. There was a statistically significant difference in favor of the vestibular rehabilitation group in overall perceived dizziness at 3 (p = 0.007) and 12 months (p = 0.001). No statistically significant differences were found in standing balance and walking speed. Results from self-report measures showed a statistically significant difference at 12 months in HADS (p = 0.039), DHI (p = 0.049) and VAS-C (p = 0.012). CONCLUSION: A vestibular rehabilitation program started early after confirmed vestibular neuritis diagnosis in addition to standard care reduces the perception of dizziness and improves functions of daily life more effectively than standard care alone.

Effects of cochlear implants: a qualitative study.

This qualitative study aimed to gain a deeper insight into the effects of cochlear implants on recipients' lives, as perceived by the recipients themselves. To obtain this insight, we used four open-ended questions. We invited 107 adult patients from two Norwegian implant centres. Of these, 74 returned completed questionnaires (69%). Recipients perceived that they had got 'A new life' with the implant. Contributing to this global category of effects were four other categories. These concerned subjects' interactions with the world around them, experience of themselves, ability to hear the world around them and finally certain device-related issues. Overall, psychological well-being was improved. The questionnaire described might prove a useful tool in the follow-up of patients.

[Use of hearing aid--coping and functional disability]. / Bruk av høreapparat--mestring og funksjonstap.

BACKGROUND: Hearing loss is a common health problem and affects social life. We studied how adults' use of hearing aids was influenced by socio-demographic and audiological characteristics, use of coping strategies, and perceived functional disability. MATERIAL AND METHODS: 162 adult patients (82 men) who had previously used hearing aids and were referred to St. Olavs University Hospital (Trondheim, Norway) for a renewed assessment and prescription, were consecutively included in the study. Questionnaires were used to capture their experience with using hearing aids and the negative consequences of hearing loss, as well as use of specific coping strategies and the presence of tinnitus. Relations between reported use and explanatory variables were assessed by using logistic regression analyses. RESULTS: Advanced hearing loss increased the probability of using aids more frequently, while non-persistent tinnitus and a medium long experience with using hearing aids (7?-?17 years) reduced the probability. Maladaptive behaviour interferring with effective communication reduced the daily use. Use of verbal and nonverbal communication strategies, and degree of perceived functional disability did not influence the use of hearing aids. INTERPRETATION: A low degree of hearing loss, occasional tinnitus, a medium long experience in the use of hearing aids, and frequent use of dysfunctional communication strategies were associated with little use of the aids.

[Should vestibular neuritis be treated with corticosteroids?]. / Bør vestibularisnevritt behandles med kortikosteroider?

Recent studies have shown that corticosteroid treatment of patients with vestibular neuritis significantly improves recovery of peripheral vestibular function. At follow-up, the number of patients with a normal caloric response was larger among those treated with corticosteroids. However, improvement of caloric responses may not correlate directly with patient symptoms and up to now improved vertigo/dizziness due to corticosteroid treatment has not been reported. Consequently, although corticosteroid may be a treatment option, it should currently only be considered in those vestibular neuritis patients who are willing to take part in a structured follow-up with both caloric testing and evaluation of subjective symptoms.

Activity limitation and participation restriction in adults seeking hearing aid fitting and rehabilitation.

PURPOSES: We first aimed to describe demographic and audiological characteristics of adults referred to a university hospital for hearing aid (HA) fitting and rehabilitation. Our second aim was to employ an inventory that assesses life consequences of hearing impairment (HI) in terms of perceived activity limitation and participation restriction for the first time in a Norwegian adult outpatient population. A third aim was to study life consequences by audiological and demographic characteristics. SUBJECTS AND METHODS: During one year consecutive patients (n = 343) were requested to answer the Hearing Disability and Handicap Scale (HDHS) assessing activity limitation and participation restriction in relation to an audiological examination and medical consultation. The mean threshold of hearing (MTH) was ascertained by pure tone thresholds at 0.5 - 1 - 2 - 4 kHz in the better ear. RESULTS: Activity limitation and participation restriction were both higher for HA experienced than HA naïve subjects ( p < 0.01). In a multivariable model, the explained adjusted variance of activity limitation (R2) was 43.4% with MTH, perceived duration, and severity of hearing problems as predictor variables. Correspondingly, the explained adjusted variance of participation restriction was 28.4% for a model with MTH, age, gender and perceived severity of hearing problems as predictors. CONCLUSIONS: As a standard supplement to audiometric tests, HDHS may be successfully applied as a clinical tool among similar hearing impaired outpatients in order to assess activity limitation and participation restriction as part of audiological rehabilitation.