Prevalência das alterações metabólicas em pacientes portadores de queixas vestibulares

Saúde auditiva e qualidade de vida em trabalhadores expostos a agrotóxicos

O objetivo deste estudo foi determinar a relação entre a exposição ao agrotóxico e a ocorrência de perda auditiva nos trabalhadores rurais do Povoado Colônia Treze, Lagarto (SE). Foram selecionados 351 trabalhadores adultos na faixa etária de 18 a 59 anos, com atividade laboral atual ou pregressa na área rural, com ou sem uso de agrotóxico. A avaliação audiológica foi composta de ficha para registro dos limiares tonais aéreos pelo critério de normalidade preconizado por Merluzzi 1979. O instrumento usado para a avaliação da qualidade de vida foi a versão brasileira do Short Form 36 (SF-36). Foi realizada análise estatística (testes qui-quadrado χ², não paramétrico de Kruskal-Wallis, V de Cramer e d de Cohen) com nível de significância de 95% (p < 0,05). Os resultados relacionaram o uso de agrotóxico com o grau de toxicidade, com a presença de perda auditiva e com os índices de qualidade de vida (p < 0,001). Este estudo pode comprovar que os agricultores, usuários de agrotóxicos apresentaram piores níveis de qualidade de vida quando comparados com aqueles que não os utilizaram. O uso de agrotóxico e sua classe toxicológica interferiram de maneira mais impactante na classificação de perda auditiva apresentada nos mesmos e novos estudos são recomendados para avaliar outros impactos nesta população.

Metabolic disorders prevalence in sudden deafness

OBJECTIVES

The aim of the present study was to establish the frequency of metabolic disorders among patients with sudden deafness and to compare this frequency with data from population surveys.

INTRODUCTION

No consensus has been reached regarding the prevalence of metabolic disorders among sudden deafness patients or their influence as associated risk factors.

METHODS

This cross-sectional study enrolled all sudden deafness patients treated in the Otolaryngology Department of the University of São Paulo between January 1996 and December 2006. Patients were subjected to laboratory exams including glucose and cholesterol levels, low-density lipoprotein cholesterol fraction, triglycerides, free T4 and TSH.

RESULTS

The sample comprised 166 patients. We observed normal glucose levels in 101 (81.5%) patients and hyperglycemia in 23 (18.5%) patients, which is significantly different (p < 0.0001) compared to the diabetes mellitus prevalence (7.6%) in the Brazilian population. Cholesterol levels were normal in 78 patients (49.7%) and abnormal in 79 (50.3%) patients, which is significantly different compared to the Brazilian population (p = 0.0093). However, no differences were observed in low-density lipoprotein cholesterol fraction (p = 0.1087) or triglyceride levels (p = 0.1474) between sudden hearing loss patients and the Brazilian population. Normal levels of thyroid hormones were observed in 116 patients (78.4%), and abnormal levels were observed in 32 (21.6%) patients. Compared with the prevalence of thyroid disorders in the general population (10%), statistical analysis revealed a significant difference (p = 0.0132) between these two groups.

DISCUSSION

Among sudden deafness patients, we observed frequencies of hyperglycemia and thyroid disorders that were more than twice those of the general population.

CONCLUSIONS

Hyperglycemia and thyroid disorders are much more frequent in patients with sudden deafness than in the general population and should be considered as important associated risk factors.

Sensação subjetiva do zumbido pré e pós intervenção nutricional em alterações metabólicas

TEMA: diferentes etiologias estão relacionadas com a presença de zumbido, incluindo doenças metabólicas (glicêmicas e lipídicas). OBJETIVO: comparar o grau de severidade do zumbido por meio de medidas de auto-análise em sujeitos com alterações metabólicas pré e pós-intervenção nutricional, utilizando o Questionário de Gravidade do Zumbido. MÉTODO: vinte e um sujeitos, homens e mulheres, com idade entre 40 e 82 anos, participaram deste estudo. Critérios de inclusão abrangeram a presença de zumbido e de alteração metabólica diagnosticada por meio de exames laboratoriais. Todos os sujeitos foram submetidos a um programa de intervenção nutricional. A avaliação audiológia e o questionário de gravidade de zumbido foram aplicados pré e pós-intervenção. RESULTADOS: comparando os resultados pré e pós-intervenção os dados mostram uma diferença estatisticamente significante com relação à sensação do zumbido em 71,5% dos sujeitos, os quais referiram menor impacto do zumbido nas atividades diárias. CONCLUSÃO: uma importante diferença foi observada com relação à influência do zumbido na vida do sujeito quando utilizadas as medidas de auto-análise. Verificou-se uma relação direta entre zumbido e alterações metabólicas em casos relacionados a estes sintomas.

Critical analysis of vestibular rehabilitation outcome according to dizziness etiology

Summary

Vestibular rehabilitation (VR) is an excellent therapy for dizziness patients. However, despite well managed, sometimes results are not suitable.

Aim

evaluate VR outcome between patients according to dizziness etiology. Study design: Retrospective review of medical records. Method: Patients' records were analyzed between January 2002 and December 2004. As for inclusion criteria, patients should have had finished VR therapy and an established diagnosis. Patients were included in three VR outcome groups and compared according to etiology.

Results

according to VR outcome 13 patients had no improvement, 24 had partial improvement and 22 complete improvement. The main etiologies were cervical syndrome, trauma, metabolic disorders, central nervous system disorders, anxiety and mood disorders, autoimmune disease and orthostatic intolerance. Patients with metabolic disorders showed better VR outcome than the others.

Conclusion

VR therapy combined with clinical etiology treatment is an excellent approach for dizziness patients.

Auditory Evaluation in Patients with Type 1 Diabetes

Objectives:

We performed a prospective clinical study of the cochleovestibular symptoms and the risk cofactors and characteristics of hearing loss in patients with type 1 diabetes.

Methods:

Group 1 consisted of 40 patients with type 1 diabetes, and group 2 consisted of 20 control subjects without diabetes. All participants answered a questionnaire, and their medical records were reviewed. They also were submitted to otorhinolaryngological examinations and to auditory tests (pure tone audiometry and acoustic immitance and auditory brain stem response [ABR] tests).

Results:

Dyslipidemia, hypertension, retinopathy, and diabetic neuropathy were not frequent in the patients of group 1, but incipient nephropathy was present in 47.5% of them. The most frequent cochleovestibular symptoms were tinnitus and hearing loss. Sensorineural hearing loss was found in 4 patients of group 1 and was predominantly bilateral, symmetric, and affecting the high frequencies, coexisting with normal vocal discrimination. These patients had a longer time from diabetes diagnosis and had poor glycemia control. A delay of ABR interpeak latency I-III was observed in 11.25% of the group 1 ears. All patients of group 2 presented normal audiograms and ABR tests.

Conclusions:

In group 1, the most frequent cochleovestibular symptoms were tinnitus and hearing loss. The sensorineural hearing loss was mild, symmetric, and predominantly high-frequency. A delay of ABR interpeak latencies was detected in the patients of group 1 who had normal audiometric thresholds.

Clinical evaluation of elderly people with chronic vestibular disorder

Dizziness is common among the elderly.

Aim

To characterize social, demographic, clinical, functional and otoneurological data in elderly patients with chronic vestibular disorder.

Method

A sequential study of 120 patients with chronic vestibular disorder. Simple descriptive analyses were undertaken.

Results

Most of the patients were female (68.3%) with a mean age of 73.40±5.77 years. The average number of illnesses associated with the vestibular disorder was 3.83±1.84; the patients were taking on average 3.86±2.27 different medications. The most prevalent diagnosis on the vestibular exam was unilateral vestibular loss (29.8%) and the most prevalent etiology was metabolic vestibulopathy (40.0%) followed by benign paroxysmal positional vertigo (36.7%). Fifty-two patients (43.3%) had experienced dizziness for 5 years or more. Sixty-four patients (53.3%) had at least one fall in the last year and thirty-five (29.2%) had recurrent falls.

Conclusions

Most of the sample included females with associated diseases, and using many different drugs. The most prevalent vestibular diseases were metabolic and vascular labyrinth conditions. Dizziness is a chronic symptom in elderly patients. The association of two vestibular diseases is common. Falls are prevalent in chronic dizzy elderly patients.

Caracterização clínica de idosos com disfunção vestibular crônica

A tontura de origem vestibular é comum entre idosos. OBJETIVO: Caracterizar idosos com disfunção vestibular crônica em relação aos dados sociodemográficos, clínico-funcionais e otoneurológicos. MATERIAL E MÉTODO: Estudo de casos que incluiu 120 idosos com disfunção vestibular crônica. Foram realizadas análises descritivas simples. RESULTADOS: A 5,77±amostra apresentou maioria feminina (68,3%), com média etária de 73,40 1,84±anos. O número médio de doenças associadas ao quadro vestibular foi de 3,83 e o número médio de medicamentos foi de 3,86±2,27. O exame vestibular evidenciou vestibulopatia periférica deficitária unilateral (29,8%) e as hipóteses diagnósticas prevalentes foram labirintopatia metabólica (40,0%) e vertigem posicional paroxística benigna (36,7%). Para 52 (43,3%) pacientes, a tontura começou há mais de 5 anos. Em relação à queda, 64 idosos (53,3%) apresentaram pelo menos uma queda no último ano e 35 (29,2%) referiram quedas recorrentes. CONCLUSÕES: A amostra foi representada por maioria feminina e média etária elevada, com doenças associadas ao quadro vestibular e polifarmacoterapia. As vestibulopatias e a topografia mais freqüentes foram, respectivamente, labirintopatia metabólica e vascular e síndrome periférica deficitária unilateral. A tontura é uma condição crônica e a associação de vestibulopatias é comum. A ocorrência de quedas é prevalente na população de idosos com disfunção vestibular crônica.