Vertigo is the presenting symptom of some peripheral vestibular disorders, like Benign Positional Vertigo (BPV), Ménière's disease, and vestibular neuritis, and for many other clinical conditions as well. Some clinicians from the Christchurch Public Hospital suspect that there is a significant need to improve the diagnostic accuracy and overall management of patients presenting with complaints of "acute vertigo or dizziness", especially BPV and Ménière's disease. The final diagnosis of many such patients treated for these conditions in the past has been suspected to be somewhat incomplete or inappropriate. These patients were commonly referred to various other departments, where they underwent a number of investigations, particularly medical imaging [head CT (Computed Tomography) / MRI (Magnetic Resonance Imaging) scans, which were in many cases not necessary. Such delays in the process led to an extra or unnecessary burden on the limited health funds available to the hospital or to the patient. Another drawback was an elevated patient stress and anxiety as critical time was lost with the increased number of admissions, or in transferring the patient between various departments without any conclusive diagnosis and treatment. It was proposed to conduct a retrospective study on the accuracy of diagnosis of those patients admitted to Christchurch Public Hospital with complaints of acute vertigo, particularly for suspected peripheral vestibular disorders (mainly BPV and Ménière's disease) over the period of 2004-2005. Implementation of a more specific and detailed management approach at the level of the initial clinical examination or diagnostic investigations (specifically, by an early Otolaryngology/Audiology intervention) was planned for the year 2006. The two groups of patients (2004-2005 and 2006) were compared to verify the final achievements concerning the diagnostic accuracy and at various other levels with the newly implemented changes in 2006.

No description available.

No description available.

Vertigo is the presenting symptom of some peripheral vestibular disorders, like Benign Positional Vertigo (BPV), Ménière's disease, and vestibular neuritis, and for many other clinical conditions as well. Some clinicians from the Christchurch Public Hospital suspect that there is a significant need to improve the diagnostic accuracy and overall management of patients presenting with complaints of "acute vertigo or dizziness", especially BPV and Ménière's disease. The final diagnosis of many such patients treated for these conditions in the past has been suspected to be somewhat incomplete or inappropriate. These patients were commonly referred to various other departments, where they underwent a number of investigations, particularly medical imaging [head CT (Computed Tomography) / MRI (Magnetic Resonance Imaging) scans, which were in many cases not necessary. Such delays in the process led to an extra or unnecessary burden on the limited health funds available to the hospital or to the patient. Another drawback was an elevated patient stress and anxiety as critical time was lost with the increased number of admissions, or in transferring the patient between various departments without any conclusive diagnosis and treatment. It was proposed to conduct a retrospective study on the accuracy of diagnosis of those patients admitted to Christchurch Public Hospital with complaints of acute vertigo, particularly for suspected peripheral vestibular disorders (mainly BPV and Ménière's disease) over the period of 2004-2005. Implementation of a more specific and detailed management approach at the level of the initial clinical examination or diagnostic investigations (specifically, by an early Otolaryngology/Audiology intervention) was planned for the year 2006. The two groups of patients (2004-2005 and 2006) were compared to verify the final achievements concerning the diagnostic accuracy and at various other levels with the newly implemented changes in 2006.

No description available.

lt;p align="justify"gt;Propuesta: El objectivo de esta investigación fue el de determinar el significado de un tratamiento kinesiterápico a través de un programa personalizado de rehabilitación vestibular en el control de los trastornos vestibulares con la asociación de la reeducación del equilíbrio y de la marcha en la población anciana. Metodología: La pesquisa desarrollada fue analítica, caracterizada como un estudio clínico prospectivo casi experimental con el grupo-control. Se optó por la aplicación de un control diario el cúal los sujetos rellenaron por todo el período de la investigación, demostrando así una característica longitudinal al trabajo. El tratamiento estadístico fue constituido de estadística descriptiva y la inferencial, a través de la cúal se realizó la aplicación de los testes de hipótesis con test t de Student y el Chi-cuadrado que constituyeron la base del proceso comparativo de los valores medios y distribuciones de frecuencias calculadas, de acuerdo a las variables descritas consideradas. El nivel de significancia fue plt;0,05. Sujetos: de un total de 235 pacientes, fueron seleccionados 62 (55 de sexo femenino y 7 del sexo masculino), no institucionalizados, en el Hospital Publico de Buenos Aires. El grupo seleccionado quedo constituido por sujetos con disfunción vestibular, con edad entre 58 a 87 años (aproximado de 67 a 45 años; DP: 6,34), siendo que 31 quedarón en el grupo experimental y 31 en el grupo control. Resultados: el tratamiento kinesitertapico propuesto debe ser aceptado como instrumento de alteración significativa en el cuadro de los pacientes sometidos. Los resultados combinados denotarón que la respuesta clínica y la auto evaluación fueron concordantes en la percepción de mejora del grupo sometido al tratamiento experimental. Hubo diferencias estadísticamente significativas a lo largo de tres meses para los parámetros analisados. Conclusiones: Los resultados de este estudio indican que programas personalizados y supervisados para el control de las vestibulopatias sin eficazes y su oferta debería ser considerada rutineramente en servicios publicos y privados.lt;/pgt; / Proposal: The objective of this investigation was the one to determine the meaning of a kinesitherapy treatment through a customized program in the control of the vestibular disorders with the association of the vestibular rehabilitation and reeducation of the balance and the gait in the elderly. Methodology: The developed search analytical was characterized as quasi experimental design a prospective clinical study with the group-control. It was decided on the application of a daily control which the subjects filled up by all the period of the investigation, demonstrating therefore a longitudinal characteristic to the work. The statistical treatment was constituted of descriptive statistic and the inferencial, through which it was made the application of the tests of hypothesis with test t of Student and the Chi-square that constituted the base of the comparative process of the values average and calculated frequency allocations, according to the described variables considered. The significance level was plt;0,05. Subjects: of a total of 235 patients, noninstitutionalized ones were selected 62 (55 female and 7 male), in the publish hospital of Buenos Aires. The selected group was constituted by subjects with vestibular disorders, with age between 58 to 87 years (approximated of 67 to 45 years; SD 6,34), being that 31 in experimental group and 31 in the control group. Outcomes: the kinesitherapy treatment proposed must be accepted like instrument of significant alteration in the vestibulopath patients. The combined results exposes that clinical answer and the self-evaluation were concordant in the perception of improvement of the group submited of the experimental treatment. There were statistically significant differences throughout three months for the analized parameters. Conclusions: The outcomes of this study indicate that supervisioned physical therapy programs for the control of vertigo is considered efficacy and its supply would be considered in public and private services.

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2015-04-06T11:55:29Z No. of bitstreams: 1 Disserta¿¿o de Mestrado de Vanessa Rolim Barreto Cavalcante.pdf: 1233921 bytes, checksum: 2bf201233b3b4d85802d8ca7d3ef1552 (MD5) / Made available in DSpace on 2015-04-06T11:55:29Z (GMT). No. of bitstreams: 1 Disserta¿¿o de Mestrado de Vanessa Rolim Barreto Cavalcante.pdf: 1233921 bytes, checksum: 2bf201233b3b4d85802d8ca7d3ef1552 (MD5) Previous issue date: 2014-05-12 / INTRODUCTION: The term labyrinthitis is often used to designate general dizziness. This vicious and faulty attitude, when performed by medical professionals, can result in errors in diagnosis, therapy, orientation given to the patient and prognosis. OBJECTIVES: To analyze the training characteristics and knowledge on vestibular diseases (especially labyrinthitis) of the physicians working in the hinterland of Paraiba. METHOD: The study design was crosssectional, in which the knowledge and training characteristics of physicians working in the cities of São João do Rio do Peixe, Bom Jesus, Cachoeira dos Índios, Cajazeiras, Carrapateira, Santa Helena and São José de Piranhas were evaluated by means of specific questionnaire with objective questions, directly applied. A descriptive analysis of the data was conducted and the presence of risk factors for poor performance (percentage of correct answers to the specific questions below 60%) was investigated, using logistic regression. RESULTS: Most physicians (77.1%) graduated more than five years ago. Most of them graduated in educational institutions in Paraíba or other northeastern states; however, 6.9% of participants graduated abroad. Nearly three-quarters of the respondents had postgraduation and 26.7% had attended residency program and specialization simultaneously. Most professionals (66.4%) have diagnosed more than one case of labyrinthitis in the last year and stated that disabling rotator dizziness, tinnitus and vomiting are symptoms of this pathology. Hearing acuity reduction was less related to labyrinthitis (6.1%), and the treatment more often chosen for this disease was the use of vestibular suppressant (82.4%). Most respondents replied that labyrinthitis is the most frequent cause of dizziness (32.8%), which is typically rotational, chronic and benign (48.1%). Vestibular suppressant drugs are widely prescribed and for a long time. The only risk factor for failure in the questionnaire was to have graduated after 2006 (odds ratio of 5.13 with a confidence interval 1.05 to 24.92). Knowledge of dizziness was mostly acquired during Medicine school; however 26% of respondents state that they had notions from non-scientific sources. CONCLUSIONS: Most physicians have good clinical experience, attended graduation within their working region and have done a post graduation. There is insufficient knowledge of the physicians who participated in this study in relation to vestibular disorders. The lower performance of the recently graduated calls for a reflection on how knowledge has been disseminated recently. The significant nonscientific source of information on dizziness among these professionals is a matter of concern. / INTRODUÇÃO: O termo labirintite é usado frequentemente para designar tonturas de forma generalista. Essa atitude viciosa e errônea, quando praticada pela classe médica, pode resultar em erros no diagnóstico, na terapêutica, na orientação a ser dada ao paciente e no prognóstico. OBJETIVOS: Analisar as características de formação e o conhecimento acerca das doenças vestibulares (especialmente sobre labirintite) dos médicos que trabalham no sertão paraibano. MÉTODO: O desenho do estudo foi transversal, em que o conhecimento e a formação dos médicos que atuam nas cidades de São João do Rio do Peixe, Bom Jesus, Cachoeira dos Índios, Cajazeiras, Carrapateira, Santa Helena e São José de Piranhas foram avaliados através de questionário específico com perguntas objetivas, aplicado presencialmente. Realizou-se uma análise descritiva dos dados e se investigou a presença de fatores de risco para desempenho insuficiente (percentual de acerto das questões específicas inferior a 60%), utilizando-se regressão logística. RESULTADOS: A maioria dos médicos (77,1%) se graduou há mais de cinco anos. As instituições de ensino da Paraíba e de estados do Nordeste do Brasil foram as maiores formadoras dos médicos da região, todavia, 6,9% dos participantes se graduaram fora do país. Quase três quartos dos participantes eram pós-graduados, sendo que 26,7% haviam feito residência médica e especialização simultaneamente. A maioria dos profissionais respondeu ter diagnosticado mais de um caso de labirintite no último ano (66,4%) e afirmou que tontura rotatória incapacitante, zumbido e vômitos são os sintomas dessa patologia. A diminuição da acuidade auditiva foi pouco relacionada à labirintite (6,1%), e o tratamento mais escolhido para essa enfermidade foi o uso de supressor vestibular (82,4%). A maior parte dos entrevistados respondeu que a labirintite é a causa mais frequente de tontura (32,8%), a qual é tipicamente rotatória, crônica e benigna (48,1%). Medicações depressoras vestibulares são prescritas em demasia e por tempo prolongado. O único fator de risco para insuficiência no questionário aplicado foi ter sido formado a partir de 2006 (razão de chances de 5,13 com intervalo de confiança de 1,05 a 24,92). Os conhecimentos sobre tontura foram em sua maioria adquiridos na graduação em Medicina, contudo 26% dos entrevistados referem que têm conceitos advindos de fontes não científicas. CONCLUSÕES: A maioria dos médicos tem boa experiência clínica, realizou a graduação na região em que trabalha e cursou pós-graduação. Há insuficiência no conhecimento dos médicos que participaram deste estudo em relação às vestibulopatias. O desempenho inferior dos formados há menos tempo exige uma reflexão sobre a forma como o conhecimento vem sendo difundido recentemente. A expressiva origem não científica das informações sobre tontura entre esses profissionais é preocupante.

Dizziness is very common, but it is never normal. Dizziness can make performing daily activities, work, and walking difficult. Many people get dizzy when they turn their head, which can cause problems with walking and makes people more likely to fall. Most of the time dizziness is not from a life-threatening disease. Often dizziness is because of a disorder of the vestibular (or inner ear balance) system. People can get vestibular disorders from infections in the ear, problems with the immune system, medications that harm the inner ear, and rarely from diabetes or stroke because of a lack of blood flow to the inner ear. Stress, poor sleep, migraines, overdoing some activities, and feeling sad can increase symptoms. New guidelines for the treatment of vestibular disorders were published in the April 2016 issue of the Journal of Neurologic Physical Therapy. The guideline describes which exercises are best to treat the dizziness and balance problems commonly seen with an inner ear disorder.

The purpose of this session is to examine the vestibular consequences of mild traumatic brain injury (TBI) and blast exposure. Preliminary data will be presented showing characteristics of vestibular dysfunction and postural instability related to mild TBI and blast exposure. Also reviewed will be the latest findings including recent data collected at the War Related Illness & injury Center showing vestibular impairments in those with mTBI. The target audience is audiologists, physical therapists, neurologists, otolaryngologists. This session will cover intermediate level of content.

Introdução: Desde sua primeira descrição na década de 40 o espectro de aplicação da reabilitação vestibular vem crescendo, tornando-se opção de tratamento em disfunções vestibulares periféricas, incluindo as uni e bilaterais, e em doenças do sistema nervoso central. O presente estudo avalia a eficácia de exercícios que estimulam a adaptação do reflexo vestíbulo-ocular em indivíduos com quadro agudo de vertigem. Métodos: neste estudo clínico prospectivo foram avaliados indivíduos aleatoriamente alocados em um grupo de estudo, que realizou exercícios para adaptação do reflexo vestíbulo-ocular, e em um grupo controle, que realizou exercícios placebo. Os critérios de inclusão foram história de pelo menos um episódio de vertigem nos últimos cinco dias, idade acima de 18 anos, e alteração em pelo menos dois dos testes objetivos de equilíbrio (teste de Romberg, teste de Fukuda e \"head-shaking\" nistagmo) e/ou presença de nistagmo espontâneo. Os pacientes de ambos os grupos foram orientados a utilizar dimenidrato na dose máxima de 150 mg ao dia, divididas em três doses, podendo auto-regular a dose conforme a intensidade dos sintomas apresentados. Foram excluídos indivíduos que tivessem utilizado medicação com ação no sistema vestibular nos últimos sete dias, com presença de alterações sugestivas de doença do sistema nervoso central, diagnóstico de vertigem posicional paroxística benigna ou de fístula perilinfática. Os pacientes foram avaliados, no início do estudo e em três visitas subseqüentes, realizadas nos períodos de três a cinco dias, sete a dez dias e dezoito a vinte e um dias após o início da pesquisa. Em todas as visitas a avaliação foi realizada por meio de notas atribuídas à intensidade dos sintomas (escala analógica visual), quantidade de medicação utilizada e resultados dos testes de equilíbrio. Resultados: Foram analisados 87 xxxv indivíduos, 45 no grupo de estudo e 42 no grupo controle. Na avaliação inicial os grupos eram semelhantes do ponto de vista estatístico em relação ao sexo e idade dos pacientes, tempo decorrido entre o início dos sintomas e a primeira avaliação, intensidade dos sintomas e achados de exame físico. O grupo de estudos apresentou intensidade de sintomas inferior ao grupo controle nas segunda e terceira avaliações; na quarta e última avaliação ambos os grupos apresentaram sintomatologia semelhante. A quantidade de medicação utilizada pelos pacientes do grupo de estudos foi inferior à utilizada pelo grupo controle em todos as avaliações realizadas. Não houve diferença entre os grupos em relação ao desaparecimento do nistagmo espontâneo exceto na terceira avaliação. A proporção de pacientes com teste de Romberg alterado foi menor no grupo de estudo quando comparada ao grupo controle nas segunda (tendência à significância estatística) e terceira avaliações, não havendo diferença entre os grupos na última avaliação. Nos testes de Fukuda e de \"head-shaking\" nistagmo não houve diferença entre os grupos em relação à proporção de testes alterados nas primeira e segunda avaliações, entretanto nas terceira e quarta avaliações o grupo de estudos teve menor proporção de testes alterados. Conclusões: O grupo submetido aos exercícios para adaptação do reflexo vestíbulo-ocular obteve melhora clínica mais rápida, fez uso de quantidade menor de dimenidrato e apresentou normalização dos testes clínicos de equilíbrio mais precocemente quando comparado ao grupo controle / Introduction: Since its first description in 1940 decade, the spectrum of use of vestibular rehabilitation has broadened and nowadays comprises unilateral, bilateral and even central vestibular disorders. The objective of this study is to evaluate the effect of exercises for adaptation of the vestibuloocular reflex in patients with acute vertigo. METHODS: Study design: prospective randomized trial, patients blinded to assignment groups. The study population had the following characteristics: = 18 years of age, at least one episode of vertigo in the last five days, negative results in at least two objective vestibular tests and/or presence of spontaneous nystagmus. The exclusion criteria were: use of any medication interfering with the vestibular system in the past seven days, clinical history or physical findings indicative of central nervous system disorders, clinical diagnosis of benign paroxysmal positional vertigo or perilymphatic fistula. Patients were randomly allocated to the intervention and placebo controlled groups. Intervention group performed exercises for adaptation of the vestibulo-ocular reflex; control group performed placebo exercises. Both groups were instructed to use dimenhydrinate and self-adjust the dose according to the intensity of their symptoms (up to 150mg/day). Patients evaluated by the assessment of the intensity of symptoms, by analogue visual scale, neuro-otological examination (presence of spontaneous nystagmus, Romberg test, Fukuda test and head-shaking nystagmus) and need to use the medication. There were three appointments in the follow-up period: three to five days, seven to ten days and eighteen to twenty one days after the initial evaluation. Results: There were 87 patients eligible for the study, 45 in the intervention group and 42 in the control group. At the initial evaluation, there was no statistically significant difference between the intervention and control groups in terms of sex, age, interval from onset of symptoms to inclusion in the study, intensity xxxvii of symptoms and neuro-otological tests results. Intensity of symptoms: the mean of the patients\' analogue visual scale score was similar for the intervention and control groups at the initial evaluation. At the second and third evaluations the mean score of the intervention group was significantly smaller. At the fourth and final evaluation, the groups were similar again. In the intervention group the amount of medication used by patients was always smaller than in the control group. Presence of spontaneous nystagmus was similar in between the groups at all but the third evaluation. As to the Romberg test results, the proportion of patients with a positive test was smaller for the intervention group at the second and third evaluations (borderline significant for the second intervention). At the fourth and final evaluation, the groups were similar again. As to the Fukuda and headshaking nystagmus tests, results were similar, at the third and forth evaluations the intervention group performed better than the control group. Conclusions: Vestibular exercises for adaptation of the vestibulo-ocular reflex have beneficial effects on treatment of patients with acute vertigo. The intervention group recovered faster, used a reduced amount of medication and performed better on balance tests as compared to the control group