ABSTRACT
Introducción: En los schwannomas vestibulares (SV), la incidencia de disfunción vestibular como principal síntoma es del 10%, sin embargo, producen un notorio impacto en la calidad de vida de los pacientes. Objetivo: Evaluar el impacto funcional que produce la exéresis de SV por via translaberintica y la rehabilitación vestibular sobre los síntomas vestibulares, en los pacientes tratados en nuestro hospital. Material y Métodos: Se realizó un análisis prospectivo de 2 pacientes con diagnóstico de SV y disfunción vestibular agregada. En ambos pacientes, se realizó la resección a través de un abordaje translaberíntico. Los pacientes fueron evaluados funcionalmente antes y después de la cirugía. El impacto de la misma sobre la calidad de vida se evalúo mediante la Escala de Discapacidad por Mareo (DHI). Todos los pacientes realizaron un plan de rehabilitación vestibular personalizado y a los 12 meses postoperatorios presentaron una mejoría clínica significativa en comparación con el preoperatorio. Discusión: Las posibles opciones de tratamiento en estos pacientes resultan limitadas. En la literatura, se ha demostrado que la laberintectomía es un tratamiento eficaz para el tratamiento de síntomas vestibulares persistentes e incapacitantes, en los pacientes sin audición funcional. La calidad de vida de los mismos es reducida, y mejoraría significativamente después de la cirugía translaberintica y de un programa personalizado de rehabilitación vestibular. Conclusión: Debido a su eficacia comprobada, el abordaje translaberíntico y la resección de la lesión, acompañado de la realización un programa de rehabilitación vestibular, como estrategia de tratamiento para estos pacientes debe ser considerado.
Introduction: The incidence of disabling vestibular symptoms in vestibular schwannoma patients has been reported at roughly 10%. Despite their relative rarity, however, such symptoms can lead to physical and social limitations and reduce patients' quality of life. Unfortunately, published evidence on possible treatment options for vestibular schwannoma patients with disabling vestibular symptoms is limited. Objective: To report the functional impact of trans-labyrinthine microsurgery and vestibular rehabilitation, performed at our hospital, in two vestibular schwannoma patients with disabling vestibular symptoms. Methods: A prospective analysis was performed of two patients with a unilateral vestibular schwannoma, without serviceable hearing in their affected ear, and severely handicapped by attacks of rotatory vertigo and constant dizziness. Trans-labyrinthine surgery, with complete tumor resection, was performed in both patients. Preoperative and postoperative quality of life was measured using Dizziness Handicap Inventory (DHI) scores. Both patients also underwent a customized vestibular rehabilitation program and had a final evaluation 12 months post-operatively. Results: Relative to their preoperative evaluation, both patients experienced significant clinical improvement that persisted through 12 months of post-operative follow-up. Conclusions: Consistent with the few prior reports already published, we found that surgical removal of vestibular schwannomas by trans-labyrinthine surgery and vestibular rehabilitation was safe and effective for persistent, disabling vestibular symptoms. Postoperative vertigo and quality of life both improved significantly when microsurgery was combined with a personalized vestibular rehabilitation program. Disabling vestibular symptoms that impair quality of life in patients with vestibular schwannoma without serviceable hearing in the affected ear should be considered for trans-labyrinthine microsurgery and personalized vestibular rehabilitation.
Subject(s)
Humans , Neurilemmoma , Therapeutics , Vestibular Diseases , Neuroma, AcousticABSTRACT
Introducción y objetivos: El Dizziness Handicap Inventory es una herramienta útil para cuantificarla autopercepción de la discapacidad en pacientes con vértigo, mareo o inestabilidad y su impacto en actividades de la vida diaria. El Dizziness Handicap Inventory identifica problemas de orden funcional, físico y emocional relacionados con trastornos del equilibrio. Nuestro objetivo es realizar la adaptación cultural y validación del Dizziness Handicap Inventory al castellano argentino a partir de la versión española. Métodos: Se incluyeron personas sanas y pacientes con vértigo, mareo o inestabilidad, de 18 a 85 años, argentinos nativos capaces de comprender castellano. Sobre la versión española se realizaron modificaciones lingüísticas y culturales para obtenerla versión argentina. Esta versión se administró a un grupo de 108 pacientes, 2 veces, en un lapso de 24 a 72 h. Se evaluó consistencia interna, confiabilidad test-retest y validez de constructo a través de: Escala Visual Análoga, Romberg, Romberg en tándem y marcha en tándem. Resultados: Se encontró una alta consistencia interna (Alfa=0,87), y muy alta confiabilidad testretest del Dizziness Handicap Inventory total (coeficiente de correlación intraclase: 0,98) y sus subescalas. Se encontraron correlaciones significativas entre Romberg y el Romberg en tándemcon el Dizziness Handicap Inventory total y la subescala funcional. La subescala emocional mostró una correlación significativa cuando se comparó con Romberg y Romberg en tándem ojos abiertos (p < 0,05).Conclusiones: La versión argentina del Dizziness Handicap Inventory mostró ser una herramienta confiable y válida para cuantificar la autopercepción de la discapacidad debida a vértigo, mareo o inestabilidad(AU)
Introduction and objectives: The Dizziness Handicap Inventory is a useful tool for quantifying self-perceived handicap in patients with vertigo, dizziness or unsteadiness and its impact on daily living activities. The Dizziness Handicap Inventory identifies functional, physical and emotional disorders related to balance disturbance. Our objective was to cross-culturally adapt the Peninsular Spanish version of the Dizziness Handicap Inventory for use in Argentina and validate the adapted Argentinian version. Methods: We included both healthy subjects and patients with vertigo, dizziness or unsteadiness, aged 18 to 85 years, native Spanish-speaking Argentinians. We introduced linguistic and cultural modifications to the Peninsular Spanish version to obtain the Argentinian one. This version was given twice to 108 patients, 24 to 72 h apart. Internal consistency, test-retest reliability and construct validity were assessed using a visual analogue scale, the Romberg test, the tandem Romberg test and the tandem gait test. Results: We found high internal consistency (Alfa=0.87) and very high test-retest reliability for the total Dizziness Handicap Inventory score (intraclass correlation coefficient: 0.98) and its subscales. The total Dizziness Handicap Inventory and the functional subscale were found to correlate significantly with the Romberg and tandem Romberg tests. The emotional subscales howed a significant correlation with the Romberg test and the eyes-open tandem Romberg test(P<.05)Conclusions: The Argentinian version of the Dizziness Handicap Inventory proved to be a reliable and valid tool to quantify self-perceived handicap resulting from vertigo, dizziness or unsteadiness(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Disability Evaluation , Vertigo/complications , Vertigo/diagnosis , Self Concept , Dizziness/complications , Dizziness/diagnosis , Cultural Factors , Statistics on Sequelae and Disability , International Classification of Functioning, Disability and Health , Cultural Characteristics , Cross-Cultural Comparison , Surveys and Questionnaires , 28599ABSTRACT
INTRODUCTION AND OBJECTIVES: The Dizziness Handicap Inventory is a useful tool for quantifying self-perceived handicap in patients with vertigo, dizziness or unsteadiness and its impact on daily living activities. The Dizziness Handicap Inventory identifies functional, physical and emotional disorders related to balance disturbance. Our objective was to cross-culturally adapt the Peninsular Spanish version of the Dizziness Handicap Inventory for use in Argentina and validate the adapted Argentinian version. METHODS: We included both healthy subjects and patients with vertigo, dizziness or unsteadiness, aged 18 to 85 years, native Spanish-speaking Argentinians. We introduced linguistic and cultural modifications to the Peninsular Spanish version to obtain the Argentinian one. This version was given twice to 108 patients, 24 to 72 h apart. Internal consistency, test-retest reliability and construct validity were assessed using a visual analogue scale, the Romberg test, the tandem Romberg test and the tandem gait test. RESULTS: We found high internal consistency (α=0.87) and very high test-retest reliability for the total Dizziness Handicap Inventory score (intraclass correlation coefficient: 0.98) and its subscales. The total Dizziness Handicap Inventory and the functional subscale were found to correlate significantly with the Romberg and tandem Romberg tests. The emotional subscale showed a significant correlation with the Romberg test and the eyes-open tandem Romberg test (P<.05) CONCLUSIONS: The Argentinian version of the Dizziness Handicap Inventory proved to be a reliable and valid tool to quantify self-perceived handicap resulting from vertigo, dizziness or unsteadiness.
