RESUMEN
The aim of this study was to retrospectively review the clinical presentation, diagnostic features, in particular cervical vestibular evoked myogenic potentials (cVEMPs), and the outcomes of surgical repair for superior semicircular canal dehiscence syndrome (SSCDS). SSCDS is a well-described syndrome of auditory and vestibular symptoms due to a bony dehiscence of the superior semicircular canal in the middle cranial fossa. A series of six procedures on five patients with SSCDS who underwent surgical repair via a middle fossa craniotomy were retrospectively reviewed. Preoperative and postoperative audiometric and vestibular symptoms as well as investigation findings were reviewed. Auditory and vestibular symptoms improved and hearing was preserved in all patients. The low frequency pseudo-conductive loss was corrected in four out of five patients, and the lowered preoperative cVEMP thresholds normalised following successful middle cranial fossa repair. In this series, middle fossa repair of SSCD was safe and effective with excellent sensorineural hearing preservation.
Asunto(s)
Fosa Craneal Media/patología , Pérdida Auditiva/diagnóstico , Pérdida Auditiva/cirugía , Enfermedades Vestibulares/diagnóstico , Enfermedades Vestibulares/cirugía , Estimulación Acústica/métodos , Adulto , Fosa Craneal Media/cirugía , Potenciales Evocados Auditivos/fisiología , Femenino , Lateralidad Funcional/fisiología , Pérdida Auditiva/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Canales Semicirculares , Resultado del Tratamiento , Enfermedades Vestibulares/complicacionesRESUMEN
A randomised control prospective study was carried out examining patient outcomes after performing a 10-week vestibular home exercise programme. Thirty-two adults with vestibular dysfunction who reported vestibular symptoms negatively affecting daily life were enrolled. Test subjects were provided with an individualised vestibular rehabilitation programme designed by a physiotherapist. Control subjects received a set of strength and endurance exercises only. All subjects performed their exercises 3 times a day for 10 weeks. Subjective and objective patient measures were collected at 0, 6, 10 and 26 weeks. Results showed that both groups improved after beginning exercise, and that test subjects significantly benefited compared to the controls. These benefits were long term and measurable 6 months later. This study provides evidence that individualised vestibular exercises promote better outcomes for patients with vestibular dysfunction.
Asunto(s)
Mareo/rehabilitación , Terapia por Ejercicio/métodos , Satisfacción del Paciente , Modalidades de Fisioterapia , Enfermedades Vestibulares/rehabilitación , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Equilibrio Postural , Estudios Prospectivos , Encuestas y CuestionariosRESUMEN
OBJECTIVES: To investigate whether a history of maternal tobacco smoking affected the maturation of arousal responses and whether sleeping position and infant age alters these relations. DESIGN: Healthy term infants (13 born to mothers who did not smoke and 11 to mothers who smoked during pregnancy) were studied using daytime polysomnography on three occasions: (a) two to three weeks after birth, (b) two to three months after birth, and (c) five to six months after birth. Multiple measurements of arousal threshold in response to air jet stimulation were made in both active sleep (AS) and quiet sleep (QS) when infants slept both prone and supine. RESULTS: Maternal smoking significantly elevated arousal threshold in QS when infants slept supine at 2-3 months of age (p<0.05). Infants of smoking mothers also had fewer spontaneous arousals from QS at 2-3 months in both prone (p<0.05) and supine (p<0.001) sleeping positions. In infants of non-smoking mothers, arousal thresholds were elevated in the prone position in AS at 2-3 months (p<0.01) and QS at 2-3 weeks (p<0.05) and 2-3 months (p<0.001). CONCLUSIONS: Maternal tobacco smoking significantly impairs both stimulus induced and spontaneous arousal from QS when infants sleep in the supine position, at the age when the incidence of sudden infant death syndrome is highest.
Asunto(s)
Nivel de Alerta/fisiología , Efectos Tardíos de la Exposición Prenatal , Sueño/fisiología , Fumar/efectos adversos , Cotinina/orina , Femenino , Humanos , Lactante , Estudios Longitudinales , Masculino , Madres , Embarazo , Posición Prona , Fumar/orinaRESUMEN
OBJECTIVE: To investigate whether the prone sleeping position impaired arousal from sleep in healthy infants and whether this impairment was related to cardiorespiratory variables, temperature, or age. STUDY DESIGN: Healthy term infants (n = 24) were studied with daytime polysomnography on 3 occasions: 2 to 3 weeks after birth, 2 to 3 months after birth, and 5 to 6 months after birth. Multiple measurements of arousal threshold (cm H(2)O) in response to air-jet stimulation applied alternately to the nares were made in both active sleep and quiet sleep when infants slept both prone and supine. RESULTS: Arousal thresholds were significantly higher in both active sleep and quiet sleep when infants slept prone at 2 to 3 weeks and 2 to 3 months, but not at 5 to 6 months. These increases were independent of any sleep position-related change in either rectal or abdominal skin temperature, respiratory rate, oxygen saturation, or heart rate. CONCLUSIONS: The prone position significantly impairs arousal from both active sleep and quiet sleep in healthy term infants. This impairment in arousability occurred with no clinically significant changes in cardiorespiratory variables or body temperature. Decreased arousability from sleep in the prone position provides an important insight into its role as a risk factor for sudden infant death syndrome.