Thesis (M.S.)--University of British Columbia, 2006. / Includes bibliographical references (leaves 40-42). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Thesis (M.Communication Pathology)--Universiteit van Pretoria, 2002. / Summary in English and Afrikaans. Includes bibliographical references (leaves 142-159).

The aim of this study was to investigate the vestibular system in a Type 1 Diabetic mellitus population, justifying its accomplishment for the narrow relation existing between the metabolic disturbances and vestibular and/or auditory alterations and the great prevalence of these disturbances in general population. The present study was developed in the Otology Health Clinic of the Santa Maria University Hospital (HUSM), according to the approval of the Research Ethic Committee of the Sciences Health Center from Santa Maria Federal University (UFSM). 19 individuals, being 10 of the female gender (52,6%) and 9 of the male gender (47,3%), with ages varying of 8 to 25 years old, with medical diagnosis of Type 1 Diabetes mellitus. For comparison of the results, a control group was selected with others 19 individuals, equalizing itself age and sex. These individuals should not complaint about auditory or vestibular disturbances, as well as Type 1 Diabetes mellitus diagnosis or other illnesses that could affect the evaluation. The evaluation protocol consisted of anamnese, otoscopic inspection, basic audiologic evaluation, dynamic and static balance evaluation, cerebellar tests and vectoeletronystagmographic evaluation. Alteration in the vectoeletronystagmographic evaluation were found in 36,84% (n=7) Type 1 Diabetes mellitus individuals, being 21.06% (n=4) Periferic Deficitary Vestibular Syndrome and 15.79% (n=3) Periferic Irritativ Vestibular Syndrome. We conclude that Type 1 Diabetes mellitus can affect the vestibular organ. We suggest that be include in the routine evaluation of patients suffering from this disturbance, the vestibular evaluation and the accomplishment of more researchs with a larger population, to deep the knowledge regarding the alterations type that can occur related to Diabetes time. / Este estudo foi desenvolvido com o objetivo de investigar o aparelho vestibular em uma população de indivíduos portadores de Diabetes mellitus tipo 1, justificando-se sua realização pela estreita relação existente entre os distúrbios metabólicos e as alterações vestibulares e/ou auditivas e a grande prevalência destes distúrbios na população em geral. O presente estudo foi desenvolvido no Ambulatório de Otologia do Hospital Universitário de Santa Maria (HUSM), em conformidade com a aprovação do Comitê de Ética em Pesquisa do Centro de Ciências da Saúde da Universidade Federal de Santa Maria (UFSM). Foram avaliados 19 indivíduos, sendo 10 do gênero feminino (52,6%) e 9 do gênero masculino (47,3%), com idades variando de 8 a 25 anos, com diagnóstico médico de Diabetes mellitus tipo 1. Para comparação dos resultados, foi selecionado um grupo controle com outros 19 indivíduos, equiparando-se idade e sexo. Estes indivíduos não deveriam apresentar qualquer queixa auditiva ou vestibular, bem como diagnóstico de Diabetes mellitus tipo 1 ou outras doenças que pudessem interferir na avaliação. O protocolo de avaliação consistiu de anamnese, inspeção otoscópica, avaliação audiológica básica, avaliação do equilíbrio estático e dinâmico, provas cerebelares e avaliação vectoeletronistagmográfica. Encontrou-se na amostra estudada alteração a vectoeletronistagmografia em 36,84% (n=7) dos indivíduos portadores de Diabetes mellitus Tipo 1, sendo 21,06% (n=4) Síndrome Vestibular Periférica Deficitária e 15,79% (n=3) Síndrome Vestibular Periférica Irritativa. Conclui-se que o Diabetes mellitus Tipo 1 pode afetar o aparelho vestibular. Sugere-se que seja incluída na avaliação de rotina de pacientes com este distúrbio, a avaliação do aparelho vestibular e a realização de mais pesquisas com uma população maior, para aprofundar os conhecimentos a respeito dos tipos de alterações que podem ocorrer relacionadas com tempo de Diabetes.

Audiologists are challenged with various neurological diseases, such as Multiple Sclerosis. This disease causes demyelination of the white matter in the central nervous system resulting in desynchronisation of neural impulses. Despite controversy in the literature many studies illustrated some degree of auditory involvement associated with this disease. The auditory brainstem response has dominated the field during the assessment of the auditory system of patients with Multiple Sclerosis. Although this objective test procedure is useful during the assessment of the auditory nerve on a brainstem level, it reveals its own set of limitations when used in isolation as a single test procedure. A multiple test battery approach has shown promise in addressing the limitations of any single test procedure. This approach aims to assess the auditory nervous system of patients with Multiple Sclerosis on different levels (sensory and neural). The aim of the current study was to determine the effectiveness of a clinically appropriate battery of test procedures during the assessment of the auditory nervous system of 25 adult subjects with Multiple Sclerosis. The subjects were divided into two groups: Group 1 consisted of fifteen (15) subjects without a history of noise exposure, whereas the ten (10) subjects in Group 2 had previously been exposed to noise. A combined experimental-descriptive research design was selected in order to describe both the qualitative and quantitative results obtained during the study. The following test procedures were included in the test battery: • A self-assessment questionnaire allowing subjects to report on hearing abilities, related auditory-vestibular symptoms and communicative competence during every day life; • Puretone audiometry, distortion product otoacoustic emissions as well as the cochlear microphonic; and • Auditory brainstem response recording using both the rarefaction and condensation click polarities consecutively. The results indicated that a high percentage of subjects experienced vestibular symptoms such as dizziness and vertigo by the time the study was conducted. The presence of tinnitus and hearing difficulties were uncommon among subjects. Despite this, more than half of the subjects experienced difficulty with communication in the presence of background noise. Puretone audiometry demonstrated that some of the subjects presented with mild high-frequency hearing losses. However other configurations with impaired hearing thresholds were also observed. Most of the subjects’ auditory brainstem response recordings displayed abnormalities using either the rarefaction or condensation click polarity. The use of the condensation click polarity displayed more ABR abnormalities compared to the rarefaction click polarity. Several subjects displayed additional cochlear involvement while a smaller percentage of subjects presented only with neural involvement. / Dissertation (M (Communication Pathhology))--University of Pretoria, 2006. / Speech-Language Pathology and Audiology / unrestricted

Made available in DSpace on 2015-07-22T20:49:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-01-26 / Objetivo: comparar o nistagmo pós-calórico da prova com ar a 50 e 24°C com o da prova com água a 44 e 30°C. Método: estudo transversal controlado em 40 indivíduos hígidos, sem sintomas e sinais de alteração da audição e do equilíbrio corporal e que não estavam fazendo uso de medicamentos. Os indivíduos foram instruídos quanto ao preparo do exame e submetidos à avaliação vestibular incluindo a prova calórica com ar a 50 e 24°C e com água a 44 e 30°C. Os mesmos foram distribuídos de forma aleatória em dois grupos, segundo a ordem de estimulação calórica, ora iniciando com ar, ora com água. 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 de VACL foram maiores nas estimulações com água do que com ar (p=0,008; p<0,001). A temperatura fria evocou respostas mais intensas do que a temperatura quente nas provas com ar e com água (p<0,001). Conclusão: A prova calórica com água apresenta valores de VACL maiores do que a prova calórica com ar, mas ambas as provas apresentam semelhança nos valores da VACL maiores na temperatura fria e nos resultados dos valores relativos de predomínio labiríntico e preponderância direcional do nistagmo. / Purpose: to compare the nystagmus response in air (50°C/24°C) and water (44°C/30°C) caloric tests. Method: controlled cross-sectional study in 40 healthy individuals without any symptoms or signs of either hearing or balance disorders who were not making use of any medications. The individuals underwent an otoneurological evaluation, including air (50°C/24°C) and water (44°C/30°C) caloric tests. Results: Comparing air and water caloric tests, no significant difference was found among the values of slow-phase velocity post-caloric nystagmus regarding the stimulation order, between ears and between the values of unilateral weakness and directional preponderance. Slow-phase velocity values were higher in water than in air stimulation (p=0.008, p<0.001). Cold stimulation evoked more intense responses than warm stimulation in both air and water tests (p<0.001). Conclusion: In air (50°C/24°C) and water (44°C/30°C) caloric tests, the post-caloric nystagmus is similar in terms of slow-phase velocity values in both ears, higher responses in the cold temperature, unilateral weakness and directional preponderance results but it is different with regard to slow-phase velocity values which are higher in water test. / TEDE / BV UNIFESP: Teses e dissertações

Made available in DSpace on 2016-04-27T18:12:03Z (GMT). No. of bitstreams: 1 Luciana da Mata Lupoli.pdf: 310454 bytes, checksum: 0f58dca528bb3505001ab2f3f9c78db0 (MD5) Previous issue date: 2014-02-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / AIM: To analyze the issue of body balance in children with ADHD . METHODS: A survey was conducted in the electronic databases LILACS , SciELO , Cochrane , PEDro and Embase through the association of the following descriptors : disorder attention deficit hyperactivity disorder, child, postural balance, electronystagmography, vestibular function tests, vertigo, dizziness and gait, center of pressure, static balance, gaze and body equilibrium in Portuguese, English and Spanish. The inclusion criteria were: target population (children) and the title and abstract language (Portuguese , English or Spanish). RESULTS: Seven articles were found in PubMed, one article in Lilacs and eight in Embase. No articles were found in the databases SciELO, Cochrane, Medline and PEDro. Among the articles that were found, 10 articles were excluded because the text is in Chinese, Japanese or Czech, the article was not available or referred to Annals of Congress abstract. All articles are case-control type (level of evidence V). To evaluate balance, the articles used Static or Dynamic Posturography, equilibrium subtest of a Development Scale, stabilogram, Oscillation posture test, movement coordination test and gait tests. Except fo two studies, all of them point to the presence of body balance dysfunction in children with ADHD. Some studies, however, presented methodological shortcomings: studies that did not considered the types of ADHD or not mentioned the types that were included in the study; and omited the presence or absence of medication use among children with ADHD. CONCLUSION: It was concluded that there is a relationship between ADHD and disorders of postural balance. Furthermore, the use of drugs seems to positively influence the postural control. All tests used to assess postural balance were effective, but the posturography provided more information about the involved systems. However, it is necessary further investigations / OBJETIVO: Analisar a questão do equilíbrio corporal em crianças com TDAH. MÉTODO: A pesquisa foi realizada nas bases de dados eletrônicas LILACS, PubMed, Scielo, Cochrane, PEDro e Embase, por meio da associação entre os seguintes descritores: transtorno do déficit de atenção e hiperatividade, crianças, equilíbrio postural, eletronistagmografia, teste de função vestibular, vertigem, tontura e marcha, em português, inglês e espanhol. Os critérios de inclusão foram: população-alvo (criança) e idioma do título e resumo (português, inglês ou espanhol). RESULTADOS: Foram encontrados sete artigos na base de dados PubMed, um artigo no Lilacs e oito no Embase. Não foram encontrados artigos nas bases de dados Scielo, Cochrane, Medline e PEDro. Entre os artigos encontrados, 10 tiveram que ser excluídos, pois o texto encontra-se em chinês, japonês ou tcheco, não estavam disponíveis ou referiam-se anais de congresso. Todos os artigos são do tipo caso-controle (nível de evidência V). As formas de avaliação do equilíbrio utilizadas foram a Posturografia (Estática ou Dinâmica), substeste de equilíbrio de uma Escala de Desenvolvimento, Estabilograma, teste de Oscilação Postura, teste de coordenação dos movimentos e provas de marcha. Com exceção de dois trabalhos, todos apontam para a presença de disfunção do equilíbrio corporal em crianças com TDAH. Em alguns trabalhos, entretanto, foram observadas falhas metodológicas: estudos que não levaram em consideração os tipos de TDAH ou não referiram os tipos incluídos no estudo e a omissão da presença ou não do uso de medicamento no grupo de crianças com TDAH. CONSIDERAÇÕES FINAIS: É possível concluir que existe relação entre TDAH e distúrbios do equilíbrio postural. Além disso, o uso de medicamentos parece influenciar positivamente no controle do equilíbrio postural. Todos os métodos de avaliação do equilíbrio postural mostraramse eficientes, porém a posturografia forneceu mais informações sobre os sistemas envolvidos. São necessárias investigações mais detalhadas

Introdução: A instabilidade postural é uma manifestação tardia da doença de Parkinson (DP), sendo incapacitante e um fator de risco para quedas. O comprometimento das respostas posturais na DP é provavelmente a causa mais importante das quedas. Estas respostas posturais dependem de informações vestibulares, somatossensoriais e visuais, que são integradas nos núcleos da base, tronco cerebral e medula espinhal. Este estudo avalia um possível papel do sistema vestibular na fisiopatologia da instabilidade postural através da vertical visual subjetiva (VVS). A VVS avalia o julgamento da vertical gravitacional e é um teste sensível da função otolítica. Objetivo: Analisar a VVS em pacientes com DP e comparar com os controles normais; correlacionar a direção das inclinações da VVS e o lado de maior comprometimento da doença; correlacionar a VVS com as escalas Unified Parkinsons Disease Rating Scale (UPDRS), Hoehn e Yahr (HY); determinar se as inclinações da VVS estão relacionadas à instabilidade postural. Métodos: Pacientes com DP foram submetidos a: exame neurológico completo; escalas UPDRS e HY; teste clínico para avaliação da instabilidade postural e o teste da VVS foi realizado em 45 pacientes e 45 controles normais. Resultados: As inclinações da VVS nos controles tiveram valores entre -2,7º a +2,4º, média +0,18º e DP = 1.17, e entre -6,4º a +5,6º, média -0,50º e DP = 2.89 nos pacientes. Não houve diferença das médias entre pacientes e controles, porém os pacientes tiveram variabilidade maior. A avaliação da variabilidade no grupo dos pacientes utilizou os valores absolutos de cada medida da VVS. As médias dos valores absolutos da VVS nos controles e pacientes foram 1,55º e 3,65º, respectivamente, sendo maiores nos pacientes (p<0,0001). Houve uma fraca correlação positiva entre os resultados da VVS a avaliação motora da escala UPDRS; razoável correlação positiva com a escala HY e uma boa correlação entre a VVS e a severidade da instabilidade postural. Conclusões: Os erros do julgamento da VVS foram significantemente maiores em pacientes comparados aos controles. Além disso, houve uma fraca correlação com as escalas UPDRS e Hoehn e Yahr, e boa correlação da VVS com a instabilidade postural. Estes resultados sugerem que as vias aferentes do sistema vestibular estão comprometidas nos pacientes com DP e poderiam estar envolvidas nos mecanismos que levam à instabilidade postural, indicando que a instabilidade postural não é um fenômeno exclusivamente motor / Introduction: Postural instability is a late manifestation of Parkinsons disease (PD). The impairment of postural responses on PD is probably the most important cause of falls. These postural responses depend on vestibular, somatossensorial and visual inputs, and they are integrated on basal ganglia, brainstem and spinal cord. By use of the subjective visual vertical (SVV), this study evaluates a possible role of the vestibular system on the hysiopathology of postural instability. The SVV makes the judgment of gravitational vertical and is a specific test of otolith function. Objective: To analyze the SVV in patients with PD and to compare with normal controls; to correlate the direction of SVV-inclinations with the side of more impairment disease; to correlate the SVV with the Unified Parkinsons Disease Rating Scale (UPDRS), the Hoehn and Yahr (HY) scales, to determine if the inclination of SVV is related to the postural instability. Methods: Patients with idiopathic PD were submitted to: complete neurological examination; the scales UPDRS and HY; the clinical test to postural instability and the SVV test. The measurement of SVV was performed in 45 patients and 45 normal controls. Results: The SVV-inclination ranged from -2.7º to +2.4º, mean 0.18º and SD = 1.17 in controls, and from -6.4º to +5.6º, mean -0.50º and SD = 2.89 in patients. There was no difference in mean between patients and controls, but patients had a greater deviation. The variability evaluation in patients group used absolute values of SVV. The means of absolute values of SVV in controls and patients were 1.55º and 3.65º, respectively, and were greater in patients (p < 0.0001). There was a weak correlation between SSV and scores in the motor evaluation of UPDRS scale. A reasonable correlation was found between SVV values and scores in the HY scale. There was a good correlation between SVV and severity of postural instability. Conclusions: The error of judgment of SVV was significantly increased in the patients compared to controls. Further, there was a weak correlation with UPDRS and HY scales, and a good correlation of SVV with postural instability. These results suggest that the afferent pathways of vestibular system are impaired in patients with PD and could be involved in mechanisms underlying postural instability; so that, postural instability is not only a motor phenomemon

Vestibular evoked myogenic potentials (VEMP) are short latency electromyograms (EMG) evoked by high-level acoustic stimuli and recorded from surface electrodes over the tonically contracted sternocleidomastoid (SCM) muscle and are presumed to originate in the saccule. The present experiments examined the effects of click and tone-burst level and stimulus frequency on the latency, amplitude, and threshold of the VEMP in subjects with normal hearing sensitivity and no history of vestibular disease. VEMPs were recorded in all subjects using 100 dB nHL click stimuli. Most subjects had VEMPs present at 500, 750, and 1000 Hz, and few subjects had VEMPs present at 2000 Hz. The response amplitude of the VEMP increased with click and tone-burst level, whereas VEMP latency was not influenced by the stimulus level. The largest tone-burst-evoked VEMPs and lowest thresholds were obtained at 500 and 750 Hz. VEMP latency was independent of stimulus frequency when tone-burst duration was held constant.

Vestibular-evoked myogenic potentials (VEMPs) are proposed as a reliable test to supplement the current vestibular test battery by providing diagnostic information about saccular and/or inferior vestibular nerve function. VEMPs are short-latency electromyograms (EMGs) evoked by high-level acoustic stimuli and recorded from surface electrodes over the tonically contracted sternocleidomastoid muscle. VEMP amplitude is influenced by the EMG level, which must be controlled. This study examined the ability of subjects to achieve the EMG target levels over a range of target levels typically used during VEMP recordings. In addition, the influence of target EMG level on the latency and amplitude of the click- and tone-evoked VEMP was examined. The VEMP amplitude increased as a function of EMG target level, and the latency remained constant. EMG target levels ranging from 30 microV to 50 microV are suggested for clinical application of the VEMP.

Introdução: A instabilidade postural é uma manifestação tardia da doença de Parkinson (DP), sendo incapacitante e um fator de risco para quedas. O comprometimento das respostas posturais na DP é provavelmente a causa mais importante das quedas. Estas respostas posturais dependem de informações vestibulares, somatossensoriais e visuais, que são integradas nos núcleos da base, tronco cerebral e medula espinhal. Este estudo avalia um possível papel do sistema vestibular na fisiopatologia da instabilidade postural através da vertical visual subjetiva (VVS). A VVS avalia o julgamento da vertical gravitacional e é um teste sensível da função otolítica. Objetivo: Analisar a VVS em pacientes com DP e comparar com os controles normais; correlacionar a direção das inclinações da VVS e o lado de maior comprometimento da doença; correlacionar a VVS com as escalas Unified Parkinsons Disease Rating Scale (UPDRS), Hoehn e Yahr (HY); determinar se as inclinações da VVS estão relacionadas à instabilidade postural. Métodos: Pacientes com DP foram submetidos a: exame neurológico completo; escalas UPDRS e HY; teste clínico para avaliação da instabilidade postural e o teste da VVS foi realizado em 45 pacientes e 45 controles normais. Resultados: As inclinações da VVS nos controles tiveram valores entre -2,7º a +2,4º, média +0,18º e DP = 1.17, e entre -6,4º a +5,6º, média -0,50º e DP = 2.89 nos pacientes. Não houve diferença das médias entre pacientes e controles, porém os pacientes tiveram variabilidade maior. A avaliação da variabilidade no grupo dos pacientes utilizou os valores absolutos de cada medida da VVS. As médias dos valores absolutos da VVS nos controles e pacientes foram 1,55º e 3,65º, respectivamente, sendo maiores nos pacientes (p<0,0001). Houve uma fraca correlação positiva entre os resultados da VVS a avaliação motora da escala UPDRS; razoável correlação positiva com a escala HY e uma boa correlação entre a VVS e a severidade da instabilidade postural. Conclusões: Os erros do julgamento da VVS foram significantemente maiores em pacientes comparados aos controles. Além disso, houve uma fraca correlação com as escalas UPDRS e Hoehn e Yahr, e boa correlação da VVS com a instabilidade postural. Estes resultados sugerem que as vias aferentes do sistema vestibular estão comprometidas nos pacientes com DP e poderiam estar envolvidas nos mecanismos que levam à instabilidade postural, indicando que a instabilidade postural não é um fenômeno exclusivamente motor / Introduction: Postural instability is a late manifestation of Parkinsons disease (PD). The impairment of postural responses on PD is probably the most important cause of falls. These postural responses depend on vestibular, somatossensorial and visual inputs, and they are integrated on basal ganglia, brainstem and spinal cord. By use of the subjective visual vertical (SVV), this study evaluates a possible role of the vestibular system on the hysiopathology of postural instability. The SVV makes the judgment of gravitational vertical and is a specific test of otolith function. Objective: To analyze the SVV in patients with PD and to compare with normal controls; to correlate the direction of SVV-inclinations with the side of more impairment disease; to correlate the SVV with the Unified Parkinsons Disease Rating Scale (UPDRS), the Hoehn and Yahr (HY) scales, to determine if the inclination of SVV is related to the postural instability. Methods: Patients with idiopathic PD were submitted to: complete neurological examination; the scales UPDRS and HY; the clinical test to postural instability and the SVV test. The measurement of SVV was performed in 45 patients and 45 normal controls. Results: The SVV-inclination ranged from -2.7º to +2.4º, mean 0.18º and SD = 1.17 in controls, and from -6.4º to +5.6º, mean -0.50º and SD = 2.89 in patients. There was no difference in mean between patients and controls, but patients had a greater deviation. The variability evaluation in patients group used absolute values of SVV. The means of absolute values of SVV in controls and patients were 1.55º and 3.65º, respectively, and were greater in patients (p < 0.0001). There was a weak correlation between SSV and scores in the motor evaluation of UPDRS scale. A reasonable correlation was found between SVV values and scores in the HY scale. There was a good correlation between SVV and severity of postural instability. Conclusions: The error of judgment of SVV was significantly increased in the patients compared to controls. Further, there was a weak correlation with UPDRS and HY scales, and a good correlation of SVV with postural instability. These results suggest that the afferent pathways of vestibular system are impaired in patients with PD and could be involved in mechanisms underlying postural instability; so that, postural instability is not only a motor phenomemon