Bilateral vestibular loss after caloric irrigation: clinical application of vestibular rehabilitation.

UNLABELLED: Bilateral vestibular loss is a rare diagnosis among patients with dizziness and imbalance. Nevertheless, symptoms are often disabling and therapy has yet to be established. AIM: To evaluate and describe the clinical outcome of patients with imbalance due to bilateral vestibular loss after a caloric test treated with vestibular rehabilitation. STUDY DESIGN: Retrospective case report. METHOD: Pre- and post-treatment outcomes were evaluated in 8 individuals suffering from post-caloric bilateral vestibular paresis who were submitted to vestibular rehabilitation. RESULTS: Clinical improvement after vestibular rehabilitation was observed in 7 (87.5%) of the 8 patients. CONCLUSION: Although complete compensation for bilateral vestibular loss is not expected, vestibular rehabilitation may be used as a therapeutic method in these patients.

Chloroquine gestational use in systemic lupus erythematosus: assessing the risk of child ototoxicity by pure tone audiometry.

The objective of this study was to assess child chloroquine ototoxicity after its use during the gestational period in systemic lupus erythematosus (SLE). Nineteen children over four years old were evaluated: nine were exposed to chloroquine diphosphate (CDP) during gestation and 10 were born from mothers that did not take this drug before conception or anytime during pregnancy (CONTROL). Pure tone audiometry was performed in all children and high and low frequency threshold means were compared to evaluate the hearing status. All nine mothers taking CDP were exposed to this drug at least during the first trimester of pregnancy (56% during the whole gestational period) and the mean time of CDP use was 6.1 +/- 2.9 months. No significant difference was found in children of CDP and CONTROL groups regarding age (7.6 +/- 4.4 versus 12.3 +/- 7.2 years; P = 0.10, respectively) and gender (P = 0.65). Pure tone high frequency thresholds, which are the first to be affected by ototoxic drugs, presented within normal limits in children exposed or not to CDP (8.5 +/- 5.0 versus 7.4 +/- 3.6 dBHL; P = 0.55, respectively). Likewise, the mean hearing thresholds at low frequencies were also similar in both groups (11.4 +/- 4.5 versus 11.9 +/- 3.0 dBHL; P = 0.66). In conclusion, child in utero exposure to chloroquine diphosphate does not seem to induce hearing impairment as measured by pure tone audiometry, reinforcing its safe use during pregnancy of lupus patients.

Treating vertigo with vestibular rehabilitation: results in 155 patients.

Balance is fundamental to our daily activities and the vestibular system, together with vision and proprioceptive functions, are the main structures involved in this process. Dizziness is the main clinical manifestation of malfunction of these systems. The mechanisms of vestibular compensation are one of the most studied aspects since they play an important role in the patient's everyday activities. In this retrospective description of a series of cases the authors present their results in 155 patients that underwent a program of vestibular rehabilitation (VR). The program, first described by Cawthorne and Coosey, is based on mechanisms of potentiation of the cervico-ocular reflex and substitution of the lost vestibular cues for visual and somatosensory cues. The results were satisfactory (remission or partial cure) in 75.5% of the patients, with an average treatment time of up to 2 months and 5 or fewer sessions performed in most of the cases. The results were somewhat inferior in those cases in which a central vestibular lesion or more than one etiologic factor was present. The results of a subgroup of elderly patients (age > 65 years) were similar to those of the total number of studied subjects. Vestibular rehabilitation, associated to the specific etiological treatment, appears to be a very useful tool in the management of patients suffering from dizziness of all ages, although different clinical responses to the therapy may vary according to the presence of a central or a peripheral vestibular lesion or multiple etiological factors.

Sensorineural hearing loss associated to gonadal dysgenesis in sisters: Perrault's syndrome.

Genetic alterations that involve the inner ear and other systems may present well-defined clinical differences. We present two oriental sisters, age 34 and 26 years, with a picture of primary amenorrhea and "infantile" uterus associated with progressive hearing loss begun in infancy in the older sister, and after 20 years of age in the younger sister. The gynecologic evaluation showed uterine hypoplasia and gonadal dysgenesis in both sisters. The audiologic study showed bilateral sensorineural hearing loss with a flat-type curve in both cases, with an average threshold of 500, 1000 and 2000 Hz (PTA) in 80 dB (older sister) and 60 dB (younger sister), with recruitment measured by stapedial reflex in the second case. Vocal discrimination was 30 percent and 80 percent, respectively. The clinical picture fits Perrault's syndrome: recessive autosomal genetic alteration, with XX gonadal dysgenesis and sensorineural hearing loss.