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Objective: Galvanic vestibular stimulation has been evaluated in the context of vestibular rehabilitation. The objective was to identify evidence in the scientific literature about the clinical applications of galvanic vestibular stimulation., Methods: In this systematic review, the articles describing the applications of galvanic vestibular stimulation were extracted from PubMed, Web of Science, MEDLINE, Scopus, LILACS and SciELO databases. The survey was limited to articles published in English, Portuguese and Spanish. All the articles about the clinical applications of galvanic vestibular stimulation were compiled. Repeated articles in the databases, literature review articles, case reports, letters and editorials were excluded. The descriptors included: galvanic vestibular stimulation, postural balance, central nervous system diseases, vestibular diseases, spinal cord diseases and cognition., Results: The search strategy resulted in the initial selection of 994 articles; the reading of titles and abstracts was accomplished in 470 articles and the complete reading in 23 articles. Clinical applications of galvanic vestibular stimulation included Ménière's disease, vestibular neuritis, bilateral vestibular disorders, vestibular schwannoma, Parkinson's disease, ischemic central lesions, motor myelopathies, anxiety disorders, cognition and memory., Conclusion: Galvanic vestibular stimulation has been considered a potentially useful strategy for balance rehabilitation, since it has the effect of stimulating the central connections related to the postural balance, favoring new neuronal synapses that allow the partial or total recovery of postural imbalance., (Copyright © 2022 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Introduction: The vestibular evoked myogenic potential (VEMP) generated by galvanic vestibular stimulation (GVS) is related to the vestibulo-spinal pathway. The response recorded from soleus muscle is biphasic with onset of short latency (SL) component around 60 ms and medium latency (ML) component around 100 ms. The first component reflects otolith function (sacule and utricle) and the last deals with semicircular canals., Aim: To describe VEMP generated by GVS., Methods: In this cross-sectional clinical study, VEMP was generated by 2 mA/400 ms binaural GVS, frequency of 5-6 ms that was recorded from soleus muscles of 13 healthy adults, mean age 56 years. The subjects remained standing, head turned contralateral to the GVS applied to the mastoid. Thirty GVS were applied to the mastoid in the position cathode right anode left, followed by 30 in inverted position. SL and ML were measured., Results: SL and ML components were recorded from both legs of all participants and were similar. The average of SL component was 54 ms and of ML was 112 ms., Conclusion: The components SL and ML of the VEMP response in soleus were reproducible and are useful measures of vestibular-spinal function.

Unlabelled: Mucocutaneous Leishmaniasis (ML) can lead to serious sequela; however, early diagnosis can prevent complications., Aim: To evaluate clinical markers for the early diagnosis of ML., Materials and Methods: A series study of 21 cases of ML, which were evaluated through clinical interview, nasal endoscopy, biopsy and the Montenegro test., Results: A skin scar and previous diagnosis of cutaneous leishmaniasis (CL) were reported in 8(38%) patients, and 13(62%) of them denied having had previous CL and had no scar. Nasal/oral symptom onset until the ML diagnosis varied from 5 months to 20 years, mean value of 6 years. In the Montenegro test, the average size of the papule was 14.5 mm, which did not correlate with disease duration (p=0.87). The nose was the most often involved site and the extension of the injured mucosa did not correlate with disease duration. The parasite was found in 2 (9.52%) biopsy specimens., Conclusions: ML diagnosis was late. Finding the parasite in the mucosa, cutaneous scar and/or previous diagnosis of CL were not clinical markers for ML. ML diagnosis must be based on the Montenegro test, chronic nasal and/or oral discharge and histological findings ruling out other granulomatous diseases.

Unlabelled: Alterations in early auditory evoked potentials (EAEP) in individuals with demyelinating disease are suggestive of lesions in the brainstem., Aim: this study aims to evaluate the prevalence of hearing disorders and altered EAEP in multiple sclerosis (MS) patients., Materials and Method: sixteen female and nine male patients with a defined diagnosis of multiple sclerosis took part in this study. All individuals underwent hearing and EAEP tests. The wave forms were categorized according to Jerger (1986)., Results: fifty EAEP tests were carried out; 70% were classified as type I (normal response) according to Jerger's criteria. Altered EAEP results in at least one ear were classified into types II, III, IV or V according to Jerger. Females accounted for 31.25% of alterations, and males 44.44%, adding up to 36% of all cases., Conclusions: these findings stress the importance of looking at EAEP in cases where there is suspicion of demyelinating disease and in patients with a defined diagnosis for MS.

Unlabelled: Epidermolysis bullosa (EB) is a group of skin diseases with different clinical manifestations and varied inheritance patterns. Blisters may appear spontaneously or following minimal trauma to the skin or mucosa., Aim: this paper aims to describe the otorhinolaryngological manifestations and esophageal complications related to EB, and the experience in treating patients with esophageal stenosis secondary to this disease., Materials and Method: this descriptive study enrolled 60 patients with EB seen from June 1999 to December 2006 at the Head and Neck Surgery Service of X Hospital, a reference center for EB., Results: the patients' mean age was 14.5 years. Twenty-eight (46.6%) were females and 32 (53.4%) were males. Eight (13.4%) were diagnosed with epidermolysis bullosa simplex, while 51 (85%) had epidermolysis bullosa dystrophica; one (1.6%) patient had one acquired EB. Lips, mouth, tongue and ears were the most frequently involved sites (32 patients - 53.3%). Dysphagia was found in 28 patients (46.6%). After esophageal dilatation the symptoms subsided., Conclusion: EB is a rare disease and patients must be sent for treatment at reference centers. Physicians treating patients for EB must be aware of the measures required to improve the quality of the treatment provided without putting the patients in harm's way.

Caloric testing is an otoneurologic evaluation of the status of the vestibular-ocular reflex; it allows an evaluation of each labyrinth separately. The main aspects on the use and interpretation of caloric testing are reviewed., Method: A systematic review of papers published in the past one hundred years on caloric testing was undertaken. The inclusion criteria were: cross-sectional, longitudinal, original articles, reviews and meta-analyses. Reviews of patient charts, case reports and editorials were excluded. The key-words were: caloric testing, nystagmus, vestibular system, directional preponderance, labyrinth predominance, monothermal caloric test, ice water caloric testing, Bell s phenomenon. The databases were: COCHRAINE, MEDLINE, LILACS, CAPES., Results: Ninety-three of 818 abstracts fulfilled the inclusion criteria. After reading these articles, 55 were selected for this study. These papers discussed the basics of caloric testing, the types of stimulation, the interpretation of results, variables, artifacts, and the monothermal and ice water caloric test., Final Comments: Caloric testing reference values may vary according to each unit; the the cutoff point is defined based on local studies. Attention to the technique is essential to maximize test sensitivity.

Unlabelled: Laryngomalacia is the most common cause of stridor in infancy. Diagnosis is established by associating the clinical manifestations with laryngoscopic findings in a dynamic form., Aim: To analyze diagnostic accuracy of laryngomalacia through flexible nasolaryngoscopy performed by four different examiners. Form of studying: Comparison of diagnostic tests (clinical study)., Material and Method: A protocol of videolaryngoscopic evaluation for patients with laryngomalacia was created encompassing the following items: anterior displacement of the arytenoids; omega-shaped epiglottis; short aryepiglottic folds; posterior displacement of epiglottis; vocal folds being visible or not; edema of the posterior larynx. Four different examiners analyzed the videolaryngoscopic examinations of 18 patients with established diagnosis of laryngomalacia previously established by clinical data, epidemiology and anatomical traits. The four observers knew previously that the patients had laryngomalacia and which criteria should be analyzed in the evaluation protocol. Observers were unaware of the results each one found., Results: diagnostic agreement average considering all parameters evaluated was of 88.2%., Discussion/conclusion: Dynamic flexible nasolaryngoscopy is a proven diagnostic method, regardless of physician experience.

Unlabelled: Sensorineural hearing loss (SNHL) related to chronic suppurative otitis media (CSOM) was studied to clarify the involvement of cholesteatomas in this context., Aim: to evaluate SNHL related to CSOM and its association with cholesteatomas, disease duration and patients ages., Methods: Retrospective analysis of 115 patients with CSOM with and without cholesteatoma submitted to surgical treatment. Inclusion criteria were active unilateral disease, normal contralateral ear and age below 60 years., Results: The average age was 26.3 years, 58 males and 57 females. The duration of ear disease was, in average, 12.4 years. The average threshold of hearing was 40 dB in CSOM ear and 22 dB in the normal contralateral ear (P=0.002). CSOM with cholesteatoma occurred in 78 of 115 cases. In the abnormal ear, SNHL was seen in 15 cases, being 6 cases of profound loss, that correlated with adjusted-age (P=0.003) and absence of cholesteatoma (P=0.01), but not with disease duration (P=0.458)., Conclusion: SNHL occurred in 13% of the patients with CSOM, and was correlated with older age, but not with the presence of cholesteatoma or longer duration of ear disease.

Melkersson-Rosenthal syndrome (MRS) consists of persistent or recurrent orofacial edema, relapsing facial palsy and fissured tongue. The complete triad of symptoms is uncommon, varying from 8 to 25%. The presentation of only one symptom is more common. The most frequent complaint is facial edema and enlargement of the lips. We describe a case of a 17-year-old Brazilian girl with limited edema of the lower lip and fissured tongue due to MRS. Her complaints had started two years before. She referred previous clinical treatments without success. We proposed intralesional injection of triamcinolone at 20 mg every 15 days associated with oral clofazimine at 50 mg/day for three months. The lip became normal after four triamcinolone injections. Recent studies have considered MRS a granulomatous disease, and possibly the initial presentation of Crohn's disease in orofacial area of some patients. MRS patients, therefore, should be screened and monitored for gastrointestinal symptoms. Corticosteroid treatment seems to be effective in reducing lip enlargement. We discuss the clinical features of this disease, the treatment, and the importance of corticosteroid therapy in cases of MRS-related facial palsy.

Unlabelled: Exists controversy about the interference of the caffeine in the vestibular test. Coffee is the richest source of caffeine. While in some services, the patients were oriented to suspend the ingestion of caffeine 24 to 48 hours before the vestibular test, others did not consider the suspension of this drink necessary., Aim: To evaluate the effect of caffeine in the vestibular test result., Study Design: Clinical with transversal cohort., Material and Method: Sectional and matched research. The vestibular test was performed twice in the same patient, with five days interval between the exams. In the first test, the patient did not drink coffee 24 hours before the exam; in the second, the patient drunk coffee as usual. All of the participants had clinical indication for vestibular test and were used to drinking coffee., Results: Nineteen women, medium age of 49.5 years, participated. The average coffee consumption was three cups per day. The complaints of anxiety and headache were associated with the submission to the vestibular test without coffee. The exams were not statistically different comparing the results of the tests performed with and without the coffee ingestion., Conclusion: The moderate ingestion of coffee was not shown to interfere in the results of the vestibular test. Considering that it is recommended that the patient be calm to be submitted to the vestibular test and that the half-life of the caffeine is only six hours, we suggest that the orientation of complete and abrupt drinking coffee suspension of moderate dose before the vestibular test for the individuals used to daily drinking coffee be reevaluated.