Estimulação calórica gelada com ar nas vestibulopatias periféricas crônicas com nistagmo espontâneo
Ice air caloric test in chronic peripheral vestibular dysfunction with spontaneous nystagmus
Flavia Silveira dos Santos Cabral; Cristina Freitas Ganança; Fernando Freitas Ganança; Maurício Malavasi Ganança; Heloisa Helena Caovilla
Resumo
Objetivo: analisar o efeito da estimulação gelada com ar a 10°C sobre o nistagmo pós-calórico em pacientes com vestibulopatias periféricas crônicas que apresentam nistagmo espontâneo com olhos fechados.
Métodos: 61 pacientes foram submetidos às estimulações com ar a 42, 18 e 10°C.
Resultados: em 42 casos (69,8%) foram encontrados valores anormais de preponderância direcional e/ou de predomínio labiríntico a 42 e 18°C. A prova a 10°C apresentou valores de assimetria dentro dos padrões de normalidade em 52,5% dos casos e valores anormais de assimetria em 16,4% (p=0,012), confirmou hiporreflexia unilateral em 11,5% e identificou anormalidades não evidenciadas a 42 e 18°C em 8,2%.
Conclusão: a estimulação gelada com ar a 10°C possibilitou retirar a influência do nistagmo espontâneo de olhos fechados sobre o nistagmo pós-calórico em pacientes com vestibulopatias periféricas crônicas.
Palavras-chave
Abstract
Purpose: to analyze the effect of air caloric stimulation at 10°C on the post-caloric responses in patients with chronic peripheral dysfunction who presented spontaneous nystagmus with the eyes closed.
Methods: 61 patients with spontaneous nystagmus with closed eyes were submitted to air caloric stimulation under the following temperatures: 42, 18 and 10°C.
Results: in 42 patients (69.8%), abnormal values of directional preponderance and / or unilateral hypoexcitability were observed following the 42°C and 18°C stimulations. For the 10°C stimulations an asymmetry within normal limits was seen in 52.5% of the patients, while abnormal values were seen in 16.4% (p=0.012). Unilateral hypoexcitability was confirmed in 11.5% of the cases. In 8.2% of the patients there were abnormal findings not evidenced under 42°C and 18°C stimulations.
Conclusion: in patients with chronic peripheral labyrinthine disorders who show spontaneous nystagmus with closed eyes, the 10°C caloric test makes it possible to remove the influence of the spontaneous nystagmus on the post-caloric responses.
Keywords
References
1. Mangabeira Albernaz PL, Gananca MM, Caovilla HH. Critérios em vestibulometria. Acta AWHO. 1982; (Supl 2):1-63.
2. Baloh RW, Furman JM. Modern vestibular function testing. West J Med. 1989; 150(1):59-67.
3. Dayal VS, Tarantino L, Farkashidy J, Paradisgarten A. Spontaneous and positional nystagmus: a reassessment of clinical significance. Laryngoscope. 1974; 84(11):2033-44.
4. Toupet M, Moreau JL, Frachet B, Pialoux P. Le nystagmus pseudo-calorique. Ann Oto-laryng. 1981; 98:353-8.
5. Fitzgerald G, Hallpike CS. Studies in human vestibular function. I: observations on the directional preponderance ("nystagmusbereitschaft") of caloric nystagmus resulting from cerebral lesions. Brain. 1942; 62(part 2):115-37.
6. Toupet M. Comment le nystagmus spontané modifie le nystagmus provoqué par la stimulation vestibulaire calorique, chez 34 patients atteints de névrite vestibulaire. Ann Oto-laryng. 1982; 99:453-64.
7. Downie DB, Simmons FB. Spontaneous nystagmus direction does not indicate laterality. Arch Otolaryngol. 1975; 101(6):358-60.
8. Baloh RW, Sills AW, Honrubia V. Caloric testing. 3. Patients with peripheral and central vestibular lesions. Ann Otol Rhinol Laryngol Suppl. 1977; 86(5 Pt 3 Suppl 43):24-30.
9. Jongkees LB, Philipszoon AJ. Electronystagmography. Acta Otolaryngol Suppl. 1964; 189:Suppl 189:1+.
10. Gananca MM, Mangabeira Albernaz PL, Caovilla HH, Ito YI, Novo NF, Juliano Y et al. Como diagnosticar e tratar a vertigem. Rev Bras Med. 1987; 44(6):143-56.
11. Jacobson GP, Newman CW, Kartush JM. Handbook of balance function testing. St. Louis: Mosby; 1993. 439p.
12. Frazza M, Cabete CF, Gushikem P, Sanchez ML, Freitas Gananca C, Camera JLS et al. Exemplos da capacidade de informação do laboratório otoneurológico. In: Gananca MM, Munhoz MSL, Caovilla HH, Silva MLG. Otoneurologia ilustrada. São Paulo: Atheneu; 2005. p.13-140.
13. Munhoz MSL, Caovilla HH, Silva MLG, Gananca MM. Audiologia Clínica. São Paulo: Atheneu; 2000. 284p.
14. Freitas Gananca C, Souza JAC, Segantin LA, Caovilla HH, Gananca MM. Limites normais dos parâmetros de avaliação à vectoelectronistagmografia digital Neurograff. Acta AWHO. 2000; 19(2):105.
15. Caovilla HH, Ganança MM, Mangabeira Albernaz PL. Computer analysis in vectornystagmography. IX Scientific Meeting of the Neurootological and Equilibriumetric Society, Bad Kissingen (Germany), marco de 1982.
16. Shepard NT, Telian SA. Practical management of the balance disorder patient. San Diego: Singular; 1996. 221p.
Submitted date:
10/10/2007
Accepted date:
07/16/2008
Facebook
Twitter
LinkedIn
Mendeley
Email