Effect of Epley's maneuver on the quality of life of paroxismal positional benign vertigo patients

Quality of life (QoL) is significantly impaired by vertigo. The effect of specific treatments on QoL deserves investigation.AimTo assess the effect of repositioning maneuvers on the QoL of benign paroxysmal positioning vertigo (BPPV) patients.Materials and MethodsA retrospective study design consiting of reviews of charts of BPPV patients in a vestibular rehabilitation unit at a teaching institution in Belo Horizonte, MG, Brazil, from 2007 to 2008. Pre- and post-therapy (Epley's repositioning maneuver) scores on the physical, functional and emotional dimensions of the Dizziness Handicap Inventory (DHI) were analyzed.ResultsTwenty-one patients were included, eighteen (86%) were females; the average age was 53.2 years. Ten patients presented bilateral BPPV; in eleven it was unilateral. The mean interval between assessments (pre- and post-treatment) was 21 days. The average number of required maneuvers was 2.3 (±1.1). Pre-treatment DHI results showed a significant impact of BPPV on quality of life. Initial scores for physical (17.5), functional (17.3), emotional (13.2) dimensions decreased with therapy: respectively 3.7, 3.9, and 3.2 (p<0.001).ConclusionIn the present sample, Epley's maneuver had a positive and significant effect on emotional, physical and functional dimensions of quality of life, as measured by the DHI scores before and after therapy.     

Vestibular rehabilitation and 6-month follow-up using objective and subjective measures

Conclusions. Vestibular rehabilitation improves quality of life by reducing the degree of handicap, improving the ability to perform everyday tasks and providing long-term rehabilitation stability (at 6 months). Recovery of the vestibulo-ocular reflex and the vestibulo-spinal reflex efficiency was proven by the objective results obtained in this study. Vestibular rehabilitation improves both subjective and objective parameters, although no significant correlation between these two indices was found. Objective. To determine the outcome of subjective and objective parameters and long-term rehabilitation stability after vestibular rehabilitation in 43 patients with vestibular disorders. Material and methods. The subjective tests used were the Medical Outcomes Study 36-item Short Form, the Dizziness Handicap Inventory and the Activity-specific Balance Confidence scale. The objective tests used were video-oculoscopy, dynamic visual acuity, the Equitest and the Dynamic Gait Index. All indices were evaluated before and after rehabilitation and at follow-up. Results. All patients showed an improvement in quality of life and a reduction in handicap due to dizziness. Improvement in objective test results was also seen. These results were stable at follow-up. A correlation was found between different subjective measures, but there was no correlation between subjective and objective measures.     

Quality of life in elderly with dizziness

Dizziness is frequent in elderly people.AimsTo evaluate the Quality of Life (QoL) in elderly subjects with dizziness, relate it with gender and age.Material and MethodA prospective study comprising 120 elderly patients with dizziness evaluated with Brazilian versions of the Whoqol-bref and the dizziness handicap inventory (DHI). The factor analysis (FA), the Mann Whitney and Kruskal Wallis tests, and the Spearman correlation were applied to study the results.ResultsThe most compromised domains were the DHI physical domain and the Whoqol-bref physical and environment domains. FA resulted in 3 factors in the DHI and 5 factors in the Whoqolbref. There was a moderate correlation (-0.596) in the total scores of both instruments. Males had a better QoL in the “environment perception and introspectivity” and “health perception” factors of the Whoqol-bref test. Females had a better QoL in the “functionality perception” factor of the Whoqol-bref test. There were no significant age differences.ConclusionsElderly patients with dizziness have a worse QoL. Elderly females with dizziness have worse QoL scores in “environment perception and introspectivity” and “health perception” and better QoL in the “functionality perception” factor compared to elderly males.     

Quality of life in elderly patients with dizziness: analysis of the short-form health survey in 197 patients

Conclusion Elderly patients with chronic dizziness had a poor HRQoL, which could be successfully assessed using the SF-36, a generic health-status instrument. The frequency of dizziness and comorbid psychological distress were predictive of impairment in QoL.

Objectives To evaluate health-related quality of life (HRQoL) and its relationship to characteristics of dizziness in elderly persons with chronic dizziness.

Material and methods A standardized dizziness questionnaire was used to evaluate characteristics of dizziness as well as medical, functional and demographic data in 197 consecutive patients with chronic dizziness aged≥60 years. HRQoL was evaluated using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS).

Results Compared with normative data, results from patients with dizziness indicated a pervasive multidimensional decline in SF-36 scores. This decline was most notable in terms of role limitations in the physical and emotional dimensions. The frequency of attacks of dizziness correlated with perceived disability. Patients with chronic dizziness also had great psychological distress, as measured by the HADS score, which had a detrimental influence on their QoL.     

Vestibular rehabilitation with biofeedback in patients with central imbalance

Central Nervous System disorders may cause important functional unbalance in the maintenance of balance and posture. There is no effective rehabilitation for these symptoms until now.ObjectiveThe aim of this paper is to evaluate the use of tongue electrotactile stimulation on patients with central imbalance using BrainPort.Materials and MethodsThis is a prospective case series study. We evaluated 8 patients with central imbalance, 6 men and 2 women, with mean age of 67.75 years. The patients were submitted to Computed Dynamic Posturography (CDP) and then received 18 sessions of electrotactile stimulation by BrainPort® device for 20 minutes, twice a day. Then they were submitted to a new CDP test and to a self-perception scale to assess symptom remission, partial improvement and no improvement at all.Results75% of the patients reported being more stable. There was no improvement in the balance control of the mass center in these patients.ConclusionThe patients were able to use the electrotactile stimulus to improve their balance control.     

Factors associated with quality of life in Menière's disease

The aim of this study was to identify the factors associated with better or worse quality of life in a sample of people with Menière's disease drawn from a UK self‐help group (the Menière's Society) and to assess the forms of support on which the respondents could draw. A postal survey was sent to 1000 randomly selected group members, containing validated questionnaires assessing: (1) quality of life (the Short Form 36 (SF‐36)); (2) factors that might predict quality of life; and (3) usage of resources provided to members by the Menière's Society. A total of 509 members completed the main survey, and 370 the second part of the survey. Factors associated with a less good quality of life included more severe vertigo, pressure in the ear, hearing loss and tinnitus, being younger, being female, living alone, having a lower occupational status and believing that the attitude of the consultant is unhelpful. Levels of vertigo severity in this sample were similar to those found in hospital samples, but it is possible that these respondents may differ in other respects from patients who do not join a self‐help group.     

良性阵发性位置性眩晕治疗前后生活质量研究

目的:探讨管石复位法(CRP)治疗前后良性阵发性位置性眩晕(BPPV)患者健康相关生活质量(QOL)的变化。方法:采用中文版SF-36健康调查量表(SF-36)和汉化英文版眩晕障碍量表(DHI),分别对86例施行CRP的BPPV患者(治疗组)和120名健康体检者(对照组)进行QOL的调查与评估,并将2组的结果进行对比。结果:通过SF-36和DHI评估显示,BPPV患者治疗前SF-36的维度计分均低于对照组,DHI各条目计分均高于对照组,差异均有统计学意义(均P<0.05)。BPPV患者治疗后3个月SF-36和DHI量表得分与对照组差异均无统计学意义(均P>0.05)。结论:CRP可明显改善BPPV患者的QOL;SF-36和汉化DHI量表能有效评估BPPV患者的QOL。     

Evaluation of the quality of life of patients with chronic rhinosinusitis by means of the SNOT-22 questionnaire

SNOT-22 is a questionnaire used to assess the quality of life of patients with chronic rhinosinusitis (CRS). It is broadly utilized to assess the surgical treatment of patients with CRS. In Brazil there are no studies utilizing the SNOT-22 in non-surgical patients.ObjectiveTo use the SNOT-22 questionnaire to assess the quality of life of individuals with chronic rhinosinusitis without previous surgery and with indication for clinical treatment.MethodProspective and analytical cohort and cross-sectional controlled clinical trial. We had 2 groups, one made up of patients with CRS and another one with adult individuals without the sinonasal disease, consecutively seen in an otorhinolaryngology clinic in Salvador, Bahia, between August of 2011 and June of 2012. They all filled out the Consent Form, a registration form and the SNOT-22.Results176 patients, 78 with CRS and 98 without the disease, the groups matched as far as gender, medication and respiratory allergies were concerned. Age was 40.7 + 13.5 years in the study group and 37.8 + 12.9 in controls (p = 0.26). The SNOT-22 median value in the study group was 53, compared to 8 in the control group (p = 0.001).ConclusionChronic rhinosinusitis reduces the quality of life of patients, according to the SNOT-22 questionnaire.     

Elderly patients with head and neck cancer: short‐term effects of surgical treatment on quality of life

Elderly patients with head and neck cancer are less likely to be treated surgically. However, little is known about surgical outcome and quality of life (QOL) in elderly patients after a major surgery. This prospective study compared the QOL and the surgical outcome of 54 elderly (≥70 years) and 75 younger patients (45–60 years) with carcinoma of the oral cavity (stage ≥ II), pharynx (stage ≥ II) or larynx (stage ≥ III). Before and 3 months after surgery, the patients completed questionnaires about QOL (EORTC QLQ‐C30 and QLQ‐H&N35) and depression (CES‐D). Before treatment, elderly and younger patients did not differ in QOL. Three months after the treatment, both groups scored worse on most QOL aspects, but there were no significant differences between the elderly and the younger patients. Surgical and systemic complication rates were similar for both the groups. In conclusion, we found no significant differences in the complication rate and QOL aspects between surgically treated elderly and younger patients.     

Long-term effect of adenotonsillectomy on quality of life in pediatric patients

HYPOTHESIS: Adenotonsillectomy improves general and disease-specific quality of life for properly selected patients suffering for upper airway obstruction secondary to adenotonsillar hypertrophy (UAO) and obstructive sleep apnea (OSA). STUDY DESIGN: Prospective, nonrandomized questionnaire. SPECIFIC AIMS: To evaluate quality of life in patients with UAO and OSA using general quality of life instruments as well as disease-specific instruments. The results will be compared both pre- and postoperatively. METHODS: Fifty-five patients aged 2 to 16 with the clinical diagnosis of UAO or OSA were recruited. The caregivers completed Children's Health Questionnaire Parent Form-28 (CHQPF-28) and OSA-18 quality of life measures both pre- and postoperatively in the long and short term. Statistical analysis was performed using the unpaired Student t test, P value less than.05, and Spearman Rank coefficient. RESULTS: CHQ-PF28 scores were improved in the Physical Summary parameter in long-term follow-up. Psychosocial scores did not improve significantly. OSA-18 scores showed improvement in both the short-and long-term scores. Physical findings and symptoms did not impact scores in any domain. CONCLUSIONS: Quality of life in children with OSA does improve after adenotonsillectomy. Disease-specific clinometric instruments show improvement in domains affected by the disease process. However, instruments used to assess general quality of life may show physical improvement but not psychosocial.     

The effect of vestibular rehabilitation on sleep disturbance in patients with chronic dizziness

Conclusions: Improvement in sleep, emotional distress, and health-related quality-of-life (QoL) accompanied the improvement in dizziness symptoms after vestibular rehabilitation. Persistent sleep disturbance could prevent improvements in self-perceived handicap due to chronic dizziness and anxiety.

Objective: The present study investigated prospectively the effects of intervention for dizziness (vestibular rehabilitation) on sleep disturbance, and the relationship between improvements in dizziness symptoms and improvements in sleep disturbance after the intervention.

Methods: The participants of this study were 127 chronic dizziness inpatients with comorbid sleep disturbance (Pittsburgh sleep quality index [PSQI-J] global score ≥6). Participants completed the Dizziness Handicap Inventory (DHI, three sub-scales: Physical, Emotional, and Functional), PSQI-J, Hospital Anxiety and Depression Scale (HADS), and SF-8 (health-related QoL), and underwent gravity center fluctuation measurement before (time 1) and 1 month after (time 2) an in-hospital rehabilitation program.

Results: All measured variables were significantly improved at time 2, compared to time 1. At time 2, 80.31% of patients still reported sleep disturbance. Analysis of covariance showed that chronic dizziness patients with sleep disturbance at time 2 had significantly higher DHI total, DHI-physical, and HADS-anxiety scores at time 2 than patients without sleep disturbance at time 2, after adjusting for these scores at time 1.     

负性生活事件对耳鸣患者生活质量的影响

目的：研究负性生活事件与耳鸣患者生活质量的关系,探讨负性生活事件在耳鸣心理咨询及康复中的作用。方法：对61例耳鸣患者和6l例正常对照者进行耳鸣残疾量表及生活事件量表问卷调查,得分进行对照及相关分析。结果：耳呜患者负性生活事件刺激量总和,与对照组比较差异有统计学意义（Z=-2．56,P〈0．05）。耳鸣患者负性生活事件发生率,与对照组比较差异无统计学意义（X2-0．05,P〉O．05）。耳鸣患者负性生活事件得分异常者发生率,与对照组比较差异有统计学意义（X2-16．68,P〈O．01）。耳鸣患者负性生活事件刺激量总和与生活质量得分有正相关性（r=0．41,P〈0,01）。结论：负性生活事件严重程度与耳鸣发病关系密切,负性生活事件可以使耳鸣患者的生活质量降低,耳鸣心理咨询及康复应重视负性生活事件。对负性生活事件的干预,能够改善耳鸣患者的生活质量,为耳鸣心理咨询及康复提供针对性的、个体化的理论依据。     

Measures of quality of life in children with cochlear implant: systematic review

The use of cochlear implant (CI) in children enables the development of listening and communication skills, allowing the child's progress in school and to be able to obtain, maintain and carry out an occupation. However, the progress after the CI has different results in some children, because many children are able to interact and participate in society, while others develop limited ability to communicate verbally. The need for a better understanding of CI outcomes, besides hearing and language benefits, has spurred the inclusion of quality of life measurements (QOL) to assess the impact of this technology.ObjectiveIdentify the key aspects of quality of life assessed in children with cochlear implant.MethodThrough a systematic literature review, we considered publications from the period of 2000 to 2011.ConclusionWe concluded that QOL measurements in children include several concepts and methodologies. When referring to children using CI, results showed the challenges in broadly conceptualizing which quality of life domains are important to the child and how these areas can evolve during development, considering the wide variety of instruments and aspects evaluated.     

Nonpharmacologic effects of botulinum toxin on the life quality of patients with spasmodic dysphonia

OBJECTIVE: Botulinum toxin (BT) injection improves objective and subjective voice measurements in spasmodic dysphonia; however, it is not clear whether the results are entirely caused by the neuromuscular blocking effects of BT or whether other factors (e.g., psychological or emotional) play a part. The aim of this study is to investigate whether nonpharmacologic factors contribute to the changes observed in the quality of life (QoL) after BT treatment of spasmodic dysphonia. STUDY DESIGN: Prospective cohort study. METHODS: Thirty-eight consecutive spasmodic dysphonic patients attending for repeat BT injections were investigated by recording their Voice Handicap Index (VHI) scores at three time points: 1) immediately prior to injection (baseline), 2) 1 day postinjection (when least pharmacologic change is expected), and 3) 2 weeks postinjection (when most pharmacologic change is expected). The changes in the total and domain VHI scores were compared between the two postinjection scores and the baseline value using two-way analysis of variance and the post hoc Bonferroni test. RESULTS: Most of the change in VHI score occurred between the baseline and first postinjection measurement. For two of the domains (total and emotional), the change was statistically significant. The change between the two postinjection assessments was minimal, and no domain showed statistically significant change. CONCLUSIONS: Our data indicate that the early improvements in QoL after BT injection can only in small part be attributed to the neurotoxic effects of the agent. We cannot say whether the reported effects in our study are attributable to a strong placebo response or are a real consequence of the patient's changing emotional state.     

Voice related quality of life in pediatric patients with a history of prematurity

Objective

To determine incidence of dysphonia in patients with history of prematurity and evaluate the correlation between dysphonia and risk factors unique to premature infants. The aim of this study is to determine parent-perceived vocal quality in patients with history of prematurity and whether duration of intubation, number of intubations, and incidence of patent ductus arteriosus repair were correlated with these perceptions.

Methods

Cohort study of premature patients presenting to outpatient clinics from January 2010 to January 2013 in tertiary care center. Patients gestational age ≤37 weeks at birth without history of tracheostomy or known vocal fold pathology were eligible. A volunteer sample was obtained from patients presenting in Otolaryngology clinics from January 2010 to January 2013 whose parents agreed to complete surveys. Outcomes were assessed via parental completion of pediatric voice outcomes score (pVOS) and pediatric voice-related quality of life (pVRQOL) instruments. The primary outcome assessed was the incidence of dysphonia in infants with a history of prematurity without known vocal pathology. Additionally, patient factors associated with dysphonia were evaluated. The hypothesis tested was formulated prior to data collection.

Results

Sixty-nine participants were included. Mean age at follow-up was 28 (3–197) months. Mean gestational age was 29 (23–37) weeks. Mean intubation duration was 3 (0–22) weeks and median number of intubations was 1 (range 0–5). Voice outcome scores varied widely with pVRQOL scores demonstrating a mean of 89.2 ± 18.1 (25–100) and pVOS with a mean of 11.4 ± 2.2 (0–13). Univariate analysis utilized Spearman correlation coefficients for continuous variables and Wilcoxon Two-sample test for categorical groups. Significance was set at p < 0.05. All significant univariate associations were placed in a multivariate model. Duration of intubation ≥4 weeks was the only factor which correlated with dysphonia on multivariate analysis (p = 0.0028, OR = 6.4, 95% CI = 1.9–21.6).

Conclusions

The data suggest that prolonged intubation is associated with poorer long term parent-perceived voice quality in premature patients. Further study is required to correlate parent perceptions with objective vocal quality data and physical findings of vocal pathology. These data may increase the clinician's suspicion for and evaluation of dysphonia in this population.     

Electronystagmogrpahic findings among 127 dizzy patients: correlation wiht the aetiology of dizziness

Electronystagmography (ENG) was performed on 127 dizzy patients and the findings were compared with the diagnosis obtained with a comprehensive neurological test battery. ENG was found to be abnormal in 49 (39%) of the patients: 19 with unilateral vestibular hyporeactivity, eight with directional preponderance, 12 with spontaneous or unidirectional positional nystagmus, eight with abnormal smooth pursuit, and 13 with other abnormalities. Among the patients with abnormal ENGs, established central nervous system lesions were found in 28 cases (19 of these infratentorial lesions); nine peripheral vestibular lesions and five undefined vestibular lesions were found. Patients with normal ENGs showed fewer peripheral vestibular lesions and more dizziness of psychogenic aetiology. Almost half the patients with infratentorial lesions had normal ENGs. Patients with roatory vertigo had fewer ENG abnormalities than those with other types of dizziness.     

General and rhinosinusitis-related quality of life in patients with Wegener's granulomatosis

OBJECTIVES: The objectives of this cross-sectional study were to outline the pattern of sinonasal morbidity and determine its effects on the quality of life (QOL) of patients with Wegener's granulomatosis (WG). METHODS: The authors conducted a survey of 199 patients with WG, including two validated (QOL) instruments to assess general (SF-36) and rhinosinusitis-specific quality of life (Sinonasal Outcome Test [SNOT-22]). RESULTS: Patients with WG who have sinonasal involvement reported significantly lower general QOL scores than their unaffected counterparts (P = .000006-0.04) for all SF-36 subsets except for emotional role. WG-related sinonasal morbidity was comparable to the high levels previously demonstrated in the general rhinosinusitis population. A total of 38.2% of all patients with WG reported a nasal symptom as their most troublesome from a list of nasal and constitutional symptoms. Twenty-three percent of all patients with WG rated nasal crusting and 17% rated epistaxis as one of their top three most troublesome symptoms even in the setting of multisystem disease. The inclusion of crusting, bleeding, and nasal deformity in the SNOT scoring significantly increased average scores of patients with WG (P = .024, paired t test). CONCLUSIONS: Sinonasal involvement impacts significantly on the general QOL of patients with WG and is at least as significant as that of the general rhinosinusitis population. Nasal symptoms that are of particular relevance to this patient group include nasal crusting and epistaxis.