ABSTRACT Purpose to verify the relationship between the risk of falling, the level of confidence in activities involving balance, and age with the values of gain and symmetry of the semicircular canals (SSCs), using the Head Video Impulse Test (vHIT) in patients with peripheral vestibular dysfunction. Methods Cross-sectional study in 12 individuals submitted to functional evaluation using the Activities-specific Balance Confidence Scale (ABC Scale) and the Dynamic Gait Index (DGI), and vestibular evaluation with vHIT. The results were compared using Spearman's Correlation Coefficient. Results There was a predominance of females (75%), with a mean age of 59 years and 8 months. The mean score in DGI was 19.70 points and on the ABC Scale, 43.65%, which is characteristic of a low confidence level. A moderate correlation was observed between age and DGI and between DGI and ABC Scale and SCC gain and symmetry values with vHIT. Conclusion A relationship was observed between a higher risk of falling in patients with vestibular hypofunction and advanced age and between a low level of confidence to perform daily activities due to asymmetrical SCC gain. balance SSCs, SSCs , (SSCs) vHIT (vHIT dysfunction Crosssectional Cross sectional 1 Activitiesspecific Activities specific DGI, (DGI) Spearmans Spearman s Coefficient 75%, 75 75% (75%) 5 months 1970 19 70 19.7 4365 43 65 43.65% (SSCs (DGI 7 (75% 197 19. 436 4 6 43.65 (75 43.6 (7 43. (

RESUMO Objetivo verificar a relação entre o risco de queda, o nível de confiança nas atividades que envolvem equilíbrio e a idade com os valores de ganho e simetria dos canais semicirculares (CSCs), por meio do Vídeo Teste do Impulso Cefálico (vHIT), em pacientes com disfunção vestibular periférica. Método estudo transversal, composto por 12 indivíduos submetidos à avaliação funcional por meio da Activities-specific Balance Confidance Scale (ABC Scale) e do Dynamic Gait Index (DGI) e avaliação vestibular com o vHIT. Os resultados foram comparados por meio do Coeficiente de Correlação de Spearman. Resultados observou-se predomínio do gênero feminino (75%), com média de idade de 59 anos e 8 meses. A média de escore no DGI foi de 19,70 pontos e 43,65% na ABC Scale, característico de baixo nível de confiança. Observou-se correlação de grau moderado entre os parâmetros idade com o DGI, DGI e ABC Scale com os valores de ganho e simetria dos CSCs do vHIT. Conclusão Observaram-se relações entre o maior risco de queda em pacientes com hipofunção vestibular e idade avançada e entre o baixo nível de confiança para realizar atividades diárias diante da assimetria de ganho dos CSCs. CSCs, , (CSCs) vHIT, vHIT (vHIT) periférica transversal 1 Activitiesspecific Activities specific (DGI Spearman observouse observou se 75%, 75 75% (75%) 5 meses 1970 19 70 19,7 4365 43 65 43,65 Observouse Observou Observaramse Observaram (CSCs (vHIT 7 (75% 197 19, 436 4 6 43,6 (75 43, (7 (

ABSTRACT Purpose to verify whether there is an association between the clinical assessment of balance and the gain in the vestibulo-ocular reflex with advancing age in patients with heart failure. Methods analytical-descriptive, observational cross-sectional study, which included patients diagnosed with heart failure, divided into two groups by age (G1, under 60 years old and G2, 60 years old or older). The patients were evaluated through anamnesis, cardiac assessment, clinical assessment of body balance (cerebellar function screening and assessment of static and dynamic balance) and instrumental assessment of vestibular function (Video Head Impulse Test-vHIT). The findings were described and compared through inferential statistical analysis. Results 34 patients with a mean age of 55 years and 9 months, mostly men (71.49%). There was no association between vestibulo-ocular reflex gain, symmetry of the semicircular canals and body balance with advancing age. Associations were observed between the results of the Unterberger-Fukuda test with the gain in the vestibulo-ocular reflex of the right lateral and left posterior semicircular canals and with the percentages of symmetry of the anterior semicircular canals for patients in Group 2. In Group 1, an association was observed between the results of the Unterberger-Fukuda test and the symmetry values of the anterior semicircular canals and the gain in the vestibulo-ocular reflex of the left anterior and right posterior semicircular canals. Conclusion there was no association between the results of the clinical assessment of body balance and the vHIT findings with advancing age in patients with heart failure. However, there was a difference between the gain of the specific vestibulo-ocular reflex for some semicircular canals, with higher rates of alteration in the dynamic balance test, in both groups. The results of the applied tests allowed characterize the predominance of chronic vestibular hypofunction of peripheral origin in patients with heart failure, regardless of age group. vestibuloocular vestibulo ocular failure analyticaldescriptive, analyticaldescriptive analytical descriptive, descriptive analytical-descriptive crosssectional cross sectional study G1, G1 G (G1 6 G2 older. older . older) anamnesis cerebellar Video TestvHIT. TestvHIT Test Test-vHIT) analysis 3 5 months 71.49%. 7149 71.49% 71 49 (71.49%) UnterbergerFukuda Unterberger Fukuda 2 1 However group (G Test-vHIT 714 71.49 7 4 (71.49% 71.4 (71.49 71. (71.4 (71. (71 (7 (

RESUMO Objetivo verificar se existe associação entre a avaliação clínica do equilíbrio e o ganho do reflexo vestíbulo-ocular com o avanço da idade em pacientes com insuficiência cardíaca. Métodos estudo transversal analítico-descritivo, de caráter observacional, que incluiu pacientes com diagnóstico de insuficiência cardíaca, divididos em dois grupos, por idade (G1, menos de 60 anos e G2, 60 anos ou mais). Os pacientes foram avaliados por meio de anamnese, avaliação cardiológica, avaliação clínica do equilíbrio corporal (triagem da função cerebelar e avaliação do equilíbrio estático e dinâmico) e instrumental da função vestibular (Video Head Impulse Test-vHIT). Os achados obtidos foram descritos e comparados por meio de análise estatística inferencial. Resultados foram avaliados 34 pacientes com média de idade de 55 anos e 9 meses, a maioria homens (71,49%). Não houve associação do ganho do reflexo vestíbulo-ocular, simetria dos canais semicirculares e avaliações do equilíbrio corporal com o avanço da idade. Observaram-se associações entre os resultados da prova de Unterberger-Fukuda com o ganho do reflexo vestíbulo-ocular do canal semicircular lateral direito e posterior esquerdo e com os percentuais de simetria dos canais semicirculares anteriores para os pacientes do Grupo 2. Para os indivíduos do Grupo 1, foi observada associação entre os resultados da prova de Unterberger-Fukuda com os valores de simetria dos canais semicirculares anteriores e do ganho de reflexo vestíbulo-ocular dos canais semicirculares anterior esquerdo e posterior direito. Conclusão não houve associação entre os resultados da avaliação clínica do equilíbrio corporal e dos achados do vHIT com o avanço da idade, em pacientes com insuficiência cardíaca. Entretanto, observou-se diferença entre o ganho do reflexo vestíbulo-ocular específico para alguns canais semicirculares, com maiores índices de alteração na prova de equilíbrio dinâmico, em ambos os grupos. Os resultados dos testes aplicados permitiram caracterizar o predomínio da hipofunção vestibular crônica de origem periférica nos pacientes com insuficiência cardíaca, independentemente da faixa etária. vestíbuloocular vestíbulo ocular cardíaca analíticodescritivo, analíticodescritivo analítico descritivo, descritivo analítico-descritivo observacional grupos G1, G1 G (G1 6 G2 mais. mais . mais) anamnese cardiológica triagem dinâmico Video TestvHIT. TestvHIT Test Test-vHIT) inferencial 3 5 meses 71,49%. 7149 71,49% 71 49 (71,49%) vestíbuloocular, ocular, Observaramse Observaram UnterbergerFukuda Unterberger Fukuda 2 1 Entretanto observouse observou etária (G Test-vHIT 714 71,49 7 4 (71,49% 71,4 (71,49 71, (71,4 (71, (71 (7 (

ABSTRACT Multiple sclerosis (MS) is a chronic and inflammatory autoimmune disease that affects the central nervous system (CNS). Dysfunction of body balance is also a common symptom and may be related to neurological injuries resulting from this disease. The aim of this study was to characterize the neurological and vestibular findings of three clinical cases diagnosed with MS. Data on the neurological evaluation and the magnetic resonance imaging of the skull were collected from the medical records. The patients responded to an initial interview and underwent clinical assessment of body balance and Video Head Impulse Test (vHIT). Vestibular symptoms and alterations were observed in at least one of the clinical tests of body balance and cerebellar function. In vHIT, changes were obtained in oculomotor tests, such as the presence of semi-spontaneous nystagmus and in parameters of the saccade test, and reduced gain in one or more vertical channels. Lesions were found on MRI of the skull in central areas that process vestibular information, such as the cerebellum and brainstem. The association of these findings suggests the presence of central vestibular dysfunction, compatible with the lesions detected in imaging exams. MS (MS CNS. CNS . (CNS) records vHIT. vHIT (vHIT) function semispontaneous semi spontaneous test channels information brainstem dysfunction exams (CNS (vHIT

RESUMO A Esclerose Múltipla (EM) é uma doença autoimune crônica e inflamatória que afeta o sistema nervoso central (SNC). A disfunção do equilíbrio corporal também é um sintoma comum e pode estar relacionada às lesões neurológicas decorrentes desta doença. O objetivo deste estudo foi caracterizar os achados neurológicos e vestibulares de três casos clínicos com diagnóstico de EM. Dados sobre a avaliação neurológica e do exame de ressonância magnética de crânio foram coletados dos prontuários. Os pacientes responderam a uma entrevista inicial e foram submetidos à avaliação clínica do equilíbrio corporal e ao Video Head Impulse Test (vHIT). Observou-se presença de sintomas vestibulares e alterações em pelo menos uma das provas clínicas do equilíbrio corporal e função cerebelar. No vHIT, obteve-se alterações em testes oculomotores, como presença de nistagmo semi-espontâneo e em parâmetros do teste sacádico, e ganho reduzido em um ou mais canais verticais. Foram verificadas lesões, na ressonância magnética de crânio, em áreas centrais que processam as informações vestibulares, como cerebelo e tronco encefálico. A associação destes achados sugere a presença de disfunção vestibular central, compatível com as lesões detectadas nos exames de imagem. EM (EM SNC. SNC . (SNC) prontuários vHIT. vHIT (vHIT) Observouse Observou se cerebelar obtevese obteve oculomotores semiespontâneo semi espontâneo sacádico verticais encefálico imagem (SNC (vHIT

Abstract Objectives: To evaluate the impact of temporomandibular disorders on the quality of life of patients with dizziness. Methods: An observational, case-control study evaluated 60 individuals with dizziness (20 cases and 40 controls), who were matched for gender and age. The individuals underwent to anamnesis, overall physical and otoneurological examination, tonal and vocal audiometry and impedanciometry, video head impulse test and the dizziness handicap inventory questionnaire. Results: The otoscopy was normal for all patients. There was an association between the presence of temporomandibular disorders and aural fullness (p<0.01) and otalgia (p<0.01). Audiometry was normal in 90% of the patients in the case group, with a significant association between temporomandibular disorders and normal audiometry (p<0.01). The video head impulse test findings were normal in 66% of the patients in the case group and 45% of the control group, and there was no association between having temporomandibular disorders and vestibular alterations at the video head impulse test (p = 0.12). There were significant differences in total dizziness handicap inventory and in the functional and emotional domains (p<0.01), with higher scores in the control group. Conclusion: Aural fullness and otalgia symptoms are associated with temporomandibular disorders in patients with dizziness, and there is an association between normal complementary audiological tests and temporomandibular disorders. Vestibular alterations are not associated with temporomandibular disorders. However, patients with dizziness and without temporomandibular disorders showed greater quality of life impairment. Level of evidence: 3. Original case-control study. Objectives Methods observational casecontrol 6 20 (2 4 controls, controls , controls) age anamnesis examination impedanciometry questionnaire Results p<0.01 p001 p 0 01 (p<0.01 p<0.01. . 90 66 45 0.12. 012 0.12 12 0.12) p<0.01, Conclusion However impairment evidence 3 2 ( p<0.0 p00 (p<0.0 9 0.1 1 p<0. p0 (p<0. 0. p<0 (p<0 p< (p<

RESUMO Objetivo: verificar a associação entre o sentimento de incapacidade autorrelatada e a prática de atividade física com o impacto dos sintomas vestibulares sobre a qualidade de vida em pacientes com disfunção vestibular. Métodos: estudo documental, analítico, transversal e retrospectivo, aprovado pelo Comitê de Ética em Pesquisa (parecer 4.462.519), no qual foram selecionados 50 prontuários de pacientes diagnosticados com disfunção vestibular periférica, analisada anamnese e os resultados do questionário Dizziness Handicap Inventory (DHI). Resultados: a amostra obteve média de idade de 55.38 anos e predomínio do sexo feminino (70%). O DHI evidenciou impacto moderado da tontura. Os pacientes que praticavam atividade física perceberam um menor impacto da doença (p-valor=0.0167) e, os pacientes que apresentavam sentimento de incapacidade, devido aos sintomas vestibulares, tiveram maior prejuízo na qualidade de vida (p-valor=0.0468). Conclusão: houve associação entre a prática de atividade física com o menor prejuízo da tontura na qualidade de vida e associação entre um maior impacto na qualidade de vida dos indivíduos que apresentavam sentimento de incapacidade relacionado às queixas vestibulares.

ABSTRACT Purpose: to verify the association of self-reported feelings of disability and physical activity with the impact of vestibular symptoms on the quality of life of patients with vestibular dysfunction. Methods: a retrospective, cross-sectional, analytical, documentary study approved by the Research Ethics Committee (evaluation report no. 4.462.519), with 50 selected medical records of patients diagnosed with peripheral vestibular dysfunction, including a survey of their medical history and results of the Dizziness Handicap Inventory (DHI). Results: the sample’s mean age was 55.38 years, and the majority were females (70%). The DHI revealed a moderate impact of dizziness. Physically active patients perceived less impact of the disease (p-value = 0.0167), while patients with feelings of disability, due to vestibular symptoms, had a greater damage of their quality of life (p-value = 0.0468). Conclusion: physical activity was associated with less damage of dizziness to the quality of life; also, a greater impact on the quality of life was associated with feelings of disability related to vestibular complaints.

RESUMO Esta pesquisa teve como objetivo caracterizar o efeito da reabilitação vestibular (RV) sobre o ganho do reflexo vestíbulo-ocular (RVO), a ocorrência das sacadas compensatórias, bem como sobre o equilíbrio corporal e a qualidade de vida, em três pacientes com hipofunção vestibular periférica. Trata-se de um estudo descritivo. Participaram da pesquisa três pacientes do gênero feminino, duas com 55 anos e uma com 67 anos, com diagnóstico médico de disfunção vestibular periférica. As participantes foram submetidas à anamnese, questionário Dizziness Handicap Inventory (DHI), avaliação clínica do equilíbrio corporal e ao Vídeo Teste do Impulso Cefálico (vHIT), pré e após RV. A RV foi aplicada de forma personalizada, baseada no protocolo de Cawthorne e Cooksey, associada a estímulos de realidade virtual. Após a RV, observou-se a redução da média do escore total do DHI, sugestivo da diminuição na restrição de participação. Na avaliação clínica do equilíbrio obtiveram-se resultados dentro da normalidade para as provas alteradas, pré RV. Quanto ao vHIT, constatou-se aumento do ganho do RVO para os canais semicirculares anteriormente afetados, condizente com padrões de normalidade, e extinção ou diminuição de ocorrência das sacadas compensatórias, nos três casos avaliados. O aumento do ganho do RVO e a extinção ou redução das sacadas compensatórias, após a RV, evidenciam sinais sugestivos de compensação vestibular. Esses resultados mostraram-se compatíveis com o aumento da estabilidade postural e menor restrição da qualidade de vida. Os achados, em conjunto, demonstram o benefício proporcionado pela RV nos três casos avaliados.

ABSTRACT The purpose of this research is to characterize the vestibular rehabilitation (VR), vestibulo-ocular reflex (VOR) gain, the occurrence of compensatory saccades, the static and dynamic balance, and the impact on quality of life in three patients with peripheral vestibular hypofunction. This is a descriptive study, approved by the ethics in research committee, under number 4,462.519. Three female patients participated in the study, two aged 55 and one aged 67, with a medical diagnosis of peripheral vestibular dysfunction. The participants underwent anamnesis, Dizziness Handicap Inventory (DHI) questionnaire, clinical assessment of postural balance and Video Head Impulse Test (vHIT), pre and post VR. The VR was applied in a personalized manner, based on the Cawthorne and Cooksey protocol, associated with virtual reality stimuli. After VR, a reduction in the total score average of DHI was observed, suggesting a decrease in participation restriction. The clinical balance assessment results were within the normal range for the altered tests, pre VR. In the three evaluated cases, vHIT showed increased RVO gain for the previously affected semicircular ducts (SCDs), compatible with normality standards, and reduction or extinction in the occurrence of compensatory saccades. The increase in VOR gain and the reduction or suppression of compensatory saccades after VR are suggestive signs of vestibular compensation. These results were compatible with increased postural stability and less restricted quality of life. These findings demonstrate the benefit provided by VR in the three evaluated cases.

RESUMO Objetivos verificar a aplicabilidade do Video Head Impulse Test (vHIT) em doenças do sistema nervoso central (SNC), bem como os resultados encontrados e as doenças descritas. Estratégia de pesquisa revisão integrativa da literatura, em que foi realizada a busca em nove bases eletrônicas de dados, a partir da palavra-chave “video head impulse test”. Critérios de seleção foram incluídos estudos que utilizaram o vHIT no diagnóstico de doenças do SNC e excluídos os estudos publicados antes de 2009 e estudos que realizaram outros procedimentos de investigação clínica, ou que aplicaram o teste no diagnóstico de doenças vestibulares periféricas. Resultados a amostra final foi composta por 18 estudos. Os resultados verificados mostraram que o reflexo vestíbulo-ocular (RVO) tem apresentado alterações na população investigada. Foram observados achados sugestivos de acometimento central, tais como ganho ou média de ganho do RVO nos canais semicirculares verticais, inferior aos laterais, ganho aumentado, correlação negativa do ganho com a gravidade da doença na ataxia espinocerebelar tipo 3, ponto de corte de 0,70 e assimetria de ganho menor de 20% para diferenciar neurite vestibular de derrame no ramo medial da artéria cerebelar posteroinferior, ganho normal com provas oculomotoras alteradas, presença de nistagmo espontâneo vertical, além de alterações no RVO com e sem otimização visual, na perseguição sacádica e no teste de desvio de inclinação. Conclusão verificou-se que o vHIT é aplicável quanto a avaliação do RVO de alta frequência em indivíduos com doenças do SNC, uma vez que trouxe evidências clínicas sobre alterações da função vestibular periférica e central nos diferentes quadros neurológicos.

ABSTRACT Purpose To verify the applicability of the Video Head Impulse Test (vHIT) in central nervous system (CNS) diseases, as well as the results found and the diseases described. Research strategy Integrative literature review, in which nine electronic databases were searched using the keyword “video head impulse test”. Selection criteria Studies that used the vHIT in the diagnosis of CNS diseases were included, and studies published before 2009, studies that performed other clinical investigation procedures or that concerned the diagnosis of peripheral vestibular diseases were excluded. Results The final sample consisted of 18 studies. The verified results show that the vestibulo-ocular reflex (VOR) has shown alteration in this population. Suggestive findings of central involvement were observed, such as lower gain or average VOR in the vertical semicircular canals than in the lateral ones, increased gain, the negative correlation of gain with disease severity in Spinocerebellar Ataxia Type 3, cutoff point of 0.70, and gain asymmetry of less than 20% to differentiate vestibular neuritis from a stroke in the medial branch of the posteroinferior cerebellar artery, normal gain with altered oculomotor tests, presence of spontaneous vertical nystagmus, as well as alterations in the VOR with and without visual enhancement, in saccadic pursuit, and the tilt deviation test. Conclusion We found that the vHIT applies to the assessment of high-frequency VOR in individuals with CNS diseases since it provided clinical evidence of changes in peripheral and central vestibular function in different neurological conditions

Abstract Introduction Tinnitus, which is considered the third worst symptom for humans, is a common complaint among people living with hearing loss and may negatively affect the quality of life of those who have it. Objective To analyze the perception of the handicap in patients with tinnitus and hearing loss as well as the possible associations between the variables hearing loss, loudness, onset, frequency and annoyance by tinnitus, and the correlation between the visual analogue scale (VAS) and the Tinnitus Handicap Inventory (THI). Methods A total of 30 patients with complaints of tinnitus and the presence of sensorineural hearing impairment were selected for this cross-sectional, observational, and descriptive study. The loudness of the tinnitus was measured by a VAS and classified as mild,moderate, or severe. The THI was classified as slight, mild, moderate, severe, and catastrophic. Data were submitted to statistical analysis using the Fisher exact test and Spearman correlation coefficient. Results Eleven male (36.7%) and 19 female (63.3%) subjects with a mean age of 56.5 years old were evaluated. There was no significant association between loudness, annoyance, time and frequency of tinnitus, nor between hearing loss and tinnitus. There was a significant association between the variables hearing loss and loudness, and a weak correlation between VAS and THI. Conclusion Tinnitus has a practical impact in the lives of patients with hearing loss in terms of catastrophic, functional, and emotional aspects, regardless of loudness, frequency, or time of onset. Hearing loss was a factor that had an impact on the loudness of tinnitus. There was no statistically significant correlation between VAS and THI.

RESUMO Objetivo: verificar o nível de evidência científica da relação entre a tontura e a aprendizagem em crianças. Métodos: a pesquisa foi realizada a partir dos seguintes descritores: “dizziness”, “vertigo”, “child”, “learning”, “spelling”, “learning skills”, “academic skills”, “reading” e seus correspondentes em língua portuguesa entre as bases de dados: PubMed, Scielo, LILACS e PsychINFO. Consideraram-se os seguintes critérios de seleção: ser um estudo observacional que apontasse a relação entre tontura e aprendizagem em crianças, estar entre o período de 2007 a 2017. Desses artigos, foram excluídos os estudos que não permitiam o acesso ao texto completo e com amostras de sujeitos portadores de alterações motoras, auditivas, cognitivas. Resultados: a busca resultou em 315 artigos. Após as etapas de seleção, três dos artigos atenderam aos critérios de elegibilidade estabelecidos. Esses foram classificados com scores entre 2 e 3 de acordo com a Escala de Newcastle-Ottawa Modificada e como IIb segundo os níveis de evidências e indicadores de qualidade empregados pela American Speech-Language Hearing Association. Conclusão: verificou-se um baixo nível de evidência científica acerca da relação entre tontura e aprendizagem em crianças. Destaca-se a importância de metodologias bem definidas para a compreensão desta relação, propiciando o melhor delineamento preventivo, avaliativo e interventivo.

ABSTRACT Purpose: this study aims to verify the level of scientific evidence on the relationship between dizziness and academic achievement in childhood. Methods: the study was performed using the following search terms: dizziness, vertigo, child, learning, spelling, learning skills, academic skills, reading, and their correspondents in Portuguese in the following databases: PubMed, Scielo, LILACS and PsycINFO. Observational studies that examined the relationship between dizziness and academic achievement in childhood, published between 2007 and 2017, were included. Articles that did not allow access to the full text, and studies based on samples with motor, hearing, and cognitive disorders were excluded. Results: we initially found 315 articles and three met the established inclusion and exclusion criteria. These were scored according to the Newcastle-Ottawa Modified Scale with scores between 2 and 3 and as IIb according to the American Speech-Language Hearing Association levels of evidence and quality indicators. Conclusion: the results of this integrative review showed a low level of scientific evidence on the relationship between dizziness and academic achievement in childhood. It is important to emphasize the importance of improving study design to better understand their relationship, to allow provision of the best preventive, assessment, and intervention methods.

RESUMO Objetivo: verificar doenças e sintomas associados às alterações do equilíbrio postural em indivíduos de meia-idade e idosos com Diabetes Mellitus tipo 2. Métodos: trata-se de uma revisão integrativa da literatura. A busca foi realizada a partir dos descritores: “Dizziness”, “Vertigo”, “Vestibular Diseases”, “Labyrinth Diseases”, “Diabetes Mellitus, Type 2” e seus correspondentes no português nas bases de dados: PubMed, Scielo, LILACS, Web of Science e Scopus. Foram inseridos artigos observacionais com cauística constituida por indivíduos a partir de 40 anos, com alteração no equilíbrio postural e Diabetes Mellitus tipo 2, e que apresentassem pelo menos uma doença ou sintoma associado a esta alteração. Resultados: a busca resultou em 1209 artigos, porém somente cinco atenderam os critérios de elegibilidade. Os participantes dos estudos selecionados apresentaram hipertensão arterial sistêmica, índice de massa corporal elevado, neuropatia periférica, instabilidade postural ao andar em superfícies irregulares e no escuro, ao olhar para objetos em movimento, ao movimentar a cabeça rapidamente e ao mudar de postura, tropeços ao andar e quedas. Os artigos foram classificados como IIb e III, segundo os níveis de evidências da American Speech-Language Hearing Association. Conclusão: foram identificadas alterações cardiovasculares, neuropatia periférica, sintomas vestibulares, dificuldades em tarefas/movimentos em contextos desafiadores e quedas em indivíduos de meia-idade e idosos com Diabetes Mellitus tipo 2.

ABSTRACT Purpose: to verify the diseases and symptoms associated with changes in postural balance in middle-aged and elderly individuals with type 2 diabetes mellitus. Methods: an integrative review was performed using the following descriptors: "Dizziness," "Vertigo," "Vestibular Diseases," "Labyrinth Diseases," and "Type 2, Diabetes Mellitus" in English and in Portuguese in databases such as PubMed, SciELO, LILACS, Web of Science, and Scopus. Observational articles involving individuals aged 40 years or more with type 2 diabetes mellitus and with alteration in postural balance having presented at least one disease or symptom associated with that alteration were selected. Results: the search yielded 1,209 articles, but only five met the eligibility criteria. Individuals in the selected studies had systemic arterial hypertension, high body mass index, peripheral neuropathy, and postural instability when walking on irregular surfaces and in the dark, when looking at moving objects, moving the head quickly and changing posture, resulting in stumbling when walking, and falls. The articles were classified as IIb and III, according to the levels of evidence of the American Speech-Language Hearing Association. Conclusion: the subjects in the studied articles presented cardiovascular alterations, peripheral neuropathy, vestibular symptoms, difficulties in tasks/movements in challenging contexts, and falls.

RESUMO Objetivo: empreender uma revisão integrativa referente à atuação fonoaudiológica na reabilitação vestibular com o uso de tecnologias, apresentando os tipos de tecnologias mais empregados, assim como a eficácia e os possíveis vieses. Métodos: foi realizada uma busca nas bases de dados PubMed/MEDLINE, LILACS, Scopus e SciELO, usando a estratégia de busca dizziness OR postural balance AND vestibular rehabilitation. Foram incluídos estudos desenvolvidos por pelo menos um fonoaudiólogo e que apresentaram como objeto de estudo a reabilitação vestibular com o uso de tecnologias. O período de publicação determinado foi de 2008 a 2018. Na apreciação dos artigos encontrados, foi realizada uma análise quantitativa, caracterização dos estudos incluídos e avaliação do nível de evidência e dos resultados destes. Resultados: foram selecionados seis artigos, publicados entre 2013 e 2018. A maior parte dos estudos (n=4) utilizou versões do Nintendo Wii TM nas intervenções. Dentre os autores, nove eram fonoaudiólogos. Três estudos eram ensaios clínicos, dois eram estudos observacionais sem grupo controle e um era estudo de casos. Conclusão: a partir dos resultados, verificou-se que a Fonoaudiologia tem utilizado tecnologias nas intervenções de reabilitação vestibular. Entretanto, publicações referentes a esta modalidade de terapia são escassas e ainda carecem de evidências científicas robustas.

ABSTRACT Purpose: to perform an integrative literature review regarding the Speech-Language-Hearing intervention in vestibular rehabilitation with the use of technologies, presenting the most applied ones, as well as their effectiveness and possible biases. Methods: a search was performed on the PubMed/MEDLINE, LILACS, Scopus and SciELO databases, using as search strategy, the keywords: dizziness OR postural balance AND vestibular rehabilitation. Studies carried out by at least one audiologists and which addressed vestibular rehabilitation with the use of technologies as the study object, were included. The publication period set was from 2008 to 2018. During the evaluation of these articles, a quantitative analysis, a characterization of the included studies and an evaluation of their level of evidence and results were performed. Results: six articles, published between 2013 and 2018, were chosen. Most studies (n=4) applied Nintendo WiiTM versions during interventions. Among the authors, nine were audiologists. Three studies were clinical trials, two were observational studies without a control group and one was a case study. Conclusion: it was verified that the Speech-Language-Hearing Therapy has been applying technologies in vestibular rehabilitation interventions. However, publications regarding this modality of therapy are scarce in the literature and still lack robust scientific evidence.

Resumo Introdução: O diabetes mellitus (DM) é um distúrbio metabólico crônico de várias origens, que ocorre quando o pâncreas deixa de produzir insulina em quantidade suficiente ou quando o organismo não consegue responder a esse hormônio de maneira eficiente. Objetivo: Avaliar o reconhecimento de fala em indivíduos com diabetes mellitus tipo I (DMI) no silêncio e no ruído competitivo. Método: Estudo descritivo, observacional e transversal. Foram incluídos 40 participantes de ambos os sexos entre 18 e 30 anos, divididos em um grupo controle (GC) de 20 indivíduos saudáveis sem queixas ou alterações auditivas, pareados por idade e sexo com o grupo de estudo, composto por 20 indivíduos com diagnóstico de DMI. Inicialmente aplicou-se uma avaliação audiológica (audiometria tonal, logoaudiometria e imitanciometria) para todos os indivíduos; a seguir, os mesmos foram avaliados para o Limiar de Reconhecimento de Sentenças no Silêncio (LRSS) e Limiar de Reconhecimento de Sentenças no Ruído (LRSR), em campo livre, por meio do teste Lista de Sentenças em Português. Resultados: Todos os participantes apresentaram audiometria tonal dentro dos padrões de normalidade bilateralmente, logoaudiometria compatível e curva timpanométrica do tipo A. A comparação dos grupos revelou uma diferença estatisticamente significante para LRSS (p = 0,0001), LRSR (p < 0,0001) e a relação sinal-ruído (p < 0,0001). Conclusões O desempenho dos indivíduos com DMI para LRSS e LRSR foi pior em comparação com os indivíduos sem diabetes.

Abstract Introduction: Diabetes mellitus (DM) is a chronic metabolic disorder of various origins that occurs when the pancreas fails to produce insulin in sufficient quantities or when the organism fails to respond to this hormone in an efficient manner. Objective: To evaluate the speech recognition in subjects with type I diabetes mellitus (DMI) in quiet and in competitive noise. Methods: It was a descriptive, observational and cross-section study. We included 40 participants of both genders aged 18-30 years, divided into a control group (CG) of 20 healthy subjects with no complaints or auditory changes, paired for age and gender with the study group, consisting of 20 subjects with a diagnosis of DMI. First, we applied basic audiological evaluations (pure tone audiometry, speech audiometry and immittance audiometry) for all subjects; after these evaluations, we applied Sentence Recognition Threshold in Quiet (SRTQ) and Sentence Recognition Threshold in Noise (SRTN) in free field, using the List of Sentences in Portuguese test. Results: All subjects showed normal bilateral pure tone threshold, compatible speech audiometry and "A" tympanometry curve. Group comparison revealed a statistically significant difference for SRTQ (p = 0.0001), SRTN (p < 0.0001) and the signal-to-noise ratio (p < 0.0001). Conclusion: The performance of DMI subjects in SRTQ and SRTN was worse compared to the subjects without diabetes.

Abstract Introduction A cochlear implant in adolescent patients with pre-lingual deafness is still a debatable issue. Objective The objective of this study is to analyze and compare the development of auditory speech perception in children with pre-lingual auditory impairment submitted to cochlear implant, in different age groups in the first year after implantation. Method This is a retrospective study, documentary research, in which we analyzed 78 reports of children with severe bilateral sensorineural hearing loss, unilateral cochlear implant users of both sexes. They were divided into three groups: G1, 22 infants aged less than 42 months; G2, 28 infants aged between 43 to 83 months; and G3, 28 older than 84 months.We collectedmedical record data to characterize the patients, auditory thresholds with cochlear implants, assessment of speech perception, and auditory skills. Results There was no statistical difference in the association of the results among groups G1, G2, and G3 with sex, caregiver education level, city of residence, and speech perception level. There was a moderate correlation between age and hearing aid use time, age and cochlear implants use time. There was a strong correlation between age and the age cochlear implants was performed, hearing aid use time and age CI was performed. Conclusion There was no statistical difference in the speech perception in relation to the patient’s age when cochlear implant was performed. There were statistically significant differences for the variables of auditory deprivation time between G3 - G1 and G2 - G1 and hearing aid use time between G3 - G2 and G3 - G1.

Abstract Introduction Hearing difficulties can be minimized by the use of hearing aids. Objective The objective of this study is to assess the speech perception and satisfaction of hearing aids users before and after aid adaptation and to determine whether these measures are correlated. Methods The study was conducted on 65 individuals, 54% females and 46% males aged 63 years on average, after the systematic use of hearing aids for at least three months. We characterized subjectś personal identification data, the degree, and configuration of hearing loss, as well as aspects related to adaptation. We then applied a satisfaction questionnaire and a speech perception test (words and sentences), with and without the use of the hearing aids. Results Mean speech recognition with words and sentences was 69% and 79 %, respectively, with hearing aids use; whereas, without hearing aids use the figures were 43% and 53%. Mean questionnaire score was 30.1 points. Regarding hearing loss characteristics, 78.5% of the subjects had a sensorineural loss, 20% a mixed loss, and 1.5% a conductive loss. Hearing loss of moderate degree was present in 60.5% of cases, loss of descending configuration in 47%, and plain loss in 37.5%. There was no correlation between individual satisfaction and the percentages of the speech perception tests applied. Conclusion Word and sentence recognition was significantly better with the use of the hearing aids. The users showed a high degree of satisfaction. In the present study, there was no correlation observed between the levels of speech perception and levels of user satisfaction measured with the questionnaire.

Abstract Introduction The objective of the evaluation of auditory perception of cochlear implant users is to determine how the acoustic signal is processed, leading to the recognition and understanding of sound. Objective To investigate the differences in the process of auditory speech perception in individuals with postlingual hearing loss wearing a cochlear implant, using two different speech coding strategies, and to analyze speech perception and handicap perception in relation to the strategy used. Methods This study is prospective cross-sectional cohort study of a descriptive character. We selected ten cochlear implant users that were characterized by hearing threshold by the application of speech perception tests and of the Hearing Handicap Inventory for Adults. Results There was no significant difference when comparing the variables subject age, age at acquisition of hearing loss, etiology, time of hearing deprivation, time of cochlear implant use and mean hearing threshold with the cochlear implant with the shift in speech coding strategy. There was no relationship between lack of handicap perception and improvement in speech perception in both speech coding strategies used. Conclusion There was no significant difference between the strategies evaluated and no relation was observed between them and the variables studied.