RESUMEN
The literature review presents approaches to the management of patients with vestibular disorders. The principles of organization of vestibular rehabilitation in peripheral vestibular hypofunction, indications for appointment, factors influencing its implementation, technique, methods of evaluating effectiveness are considered in detail. Attention is drawn to the fact that the selection of exercises and the duration of vestibular rehabilitation is carried out individually and depends on many factors, including the nature of vestibular deficiency and the specific characteristics of the patient. The possibilities of using additional pharmacological therapy with histamine preparations, which can accelerate the onset of vestibular compensation, are shown. It is noted that vestibular rehabilitation is a safe and effective method of treating peripheral vestibular hypofunction and should be recommended to patients of all ages with vestibular disorders leading to limited social and physical activity.
Asunto(s)
Enfermedades Vestibulares , Vestíbulo del Laberinto , Humanos , Consenso , Enfermedades Vestibulares/tratamiento farmacológico , Terapia por Ejercicio/métodos , Histamina/uso terapéuticoRESUMEN
BACKGROUND: Typical cloth and medical masks, which are mandatory to wear during the COVID 19 pandemic, create visual barrier, obscure linguistic and nonverbal communication and interaction. Ski-slope hearing loss patients often don't admit their auditory insufficiency and do not use hearing aids due to acceptable speech intelligibility by using visual access to the mouth and other potential facial cues. PURPOSE: To assess the impact of universal face medical masks in public places on motivation to using hearing aids of patients with ski-slope hearing loss. PATIENTS AND METHODS: All the 504 patients (18-65 years old), who applied for < hearing care assistance and for the first time bought hearing aid were included. 266 patients (group A) applied from June to November 2020, when wearing facial masks was mandatory; 238 patients (group B) applied from June to November 2019, when wearing facial masks wasn't required. In both groups patients, who fulfilled the following criteria, were selected: 1) binaural mild to severe sensorineural ski-slope hearing loss lasting more than 3 years; 2) no progression of hearing loss within the last 3 years; 3) pure tone audiometry <20 dB HL at 125-1000 Hz frequencies; 4) hearing care with mono- or binaural hearing aids with the receiver-in-the-canal open-type. Questionnaires were administered to eligible patients in group A to assess the motivational components of acquiring hearing aids. RESULTS AND DISCUSSION: In group A, 74 (28%) patients received hearing aids according to the inclusion criteria, and in group B, 46 (19%) patients received hearing aids (p=0.033). Significant factors determining hearing aid acquisition were lack of visual contact when wearing a mask, communication difficulties in noisy environments and lack of intelligibility in a concert hall or lecture. CONCLUSION: Patients' motivation to hearing care grows in mandatory wearing facial masks conditions during the COVID-19 pandemic leading to an increase in patients using hearing aids.
Asunto(s)
COVID-19 , Audífonos , Adolescente , Adulto , Anciano , Audición , Humanos , Máscaras , Persona de Mediana Edad , Pandemias , SARS-CoV-2 , Adulto JovenRESUMEN
The goal of this paper is to review the pharmacological profile of betahistine and evidence for using it in the treatment of common vestibular disorders. Betahistine is a weak agonist for histamine H1 receptors and strong antagonist for histamine H3 receptors. It demonstrates the maximum benefit in different types of peripheral vertigo, especially in Meniere's disease. The best results in decreasing intensity of vertigo, frequency of attacks and stimulation of vestibular compensation were obtained in daily dose 48 mg during 3 months. In benign paroxysmal positional vertigo betahistine is used to treat residual dizziness after successful treatment of otolithiasis and to reduce the severity of vertigo during repositioning maneuvers. In vestibular neuritis betahistine stimulates central compensation during vestibular rehabilitation. A new once-daily drug formulation of modified-release betahistine is non-inferior to traditional and has a comparable safety profile, and could improve patient adherence. The implication of betahistine in the treatment of central vestibular disorders is under-researched. The efficacy of betahistine in increasing of vestibular compensation in post-stroke central vestibular disorders, persistent postural-perceptual dizziness and its role in vestibular migraine need further investigation.
Asunto(s)
Enfermedad de Meniere , Enfermedades Vestibulares , Vértigo Posicional Paroxístico Benigno , Betahistina , Mareo/etiología , Humanos , Enfermedad de Meniere/diagnóstico , Enfermedad de Meniere/tratamiento farmacológico , Enfermedades Vestibulares/diagnóstico , Enfermedades Vestibulares/tratamiento farmacológicoRESUMEN
This article reports the results of the international post-marketing observational program VIRTUOSO aimed at the evaluation of the efficacy of betahistine dihydrochloride at the dose of 48 mg/day for 1-2 months in patients with paroxysmal vertigo of various origins. The clinical response was rated as good, very good or excellent in 74.1% of the patients (p<0.001). Monthly vertigo attack frequency with betahistine decreased in average from 8.0 to 3.0 (p<0.001). Vertigo attack frequency further decreased during the 2-month follow-up after the end of betahistine treatment. No serious adverse effects of betahistine have been reported.
Asunto(s)
Vértigo Posicional Paroxístico Benigno/tratamiento farmacológico , Betahistina/uso terapéutico , Betahistina/administración & dosificación , Betahistina/efectos adversos , Humanos , Vigilancia de Productos Comercializados , Resultado del TratamientoRESUMEN
Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder. The confirmation of BPPV is easy and based on a set of positioning tests. The authors present the recent data concerning the-etiology, pathophysiology a:nd the most effective positioning tests for the posterior, horizontal and anterior semicircular canals. The differential diagnosis of BPPV from other diseases, manifesting with positional vertigo, is discussed as well.