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SUMMARY OBJECTIVE To present scientific evidence based on a systematic review of the literature (PRISMA), aiming to systematize evidence of the ototoxic effects of hydroxychloroquine (HCQ). METHODS The studies were selected using a combination based on the Medical Subject Headings (MeSH). The databases searched were MEDLINE (PubMed), LILACS, SciELO, and BIREME, encompassing articles from January 2010 to May 2020, with no restrictions of language and place of publication. RESULTS A total of 148 articles with the potential to be included were retrieved. Of these, two answered the research question, which consisted of seeking evidence of the ototoxic effects of hydroxychloroquine. These studies scored 11 in their quality assessment with the modified protocol by Pithon et al.13. CONCLUSIONS The studies reported possible ototoxicity of HCQ. Audiovestibular changes, such as hearing loss, peripheral vestibular syndrome, and tinnitus were evidenced in patients submitted to HCQ. The improvement in the audiological examinations and the regression in the vestibular syndrome after stopping the treatment with HCQ are strong arguments in favor of the ototoxicity caused by this medication. However, there are still divergences about the relationship between ototoxic effects and the use of HCQ.

A four-year-old female French bulldog was presented for evaluation of acute, left-sided peripheral vestibular syndrome. Computed tomographic (CT) examination of the head revealed the presence of air within the left cochlea and vestibule, consistent with pneumolabyrinth. This was concurrent with ipsilateral otitis media and externa. Pneumolabyrinth is an uncommon finding in humans and is most frequently due to head trauma and temporal bone fracture. This is the first report describing pneumolabyrinth in a dog, apparently of nontraumatic origin in this case.

Made available in DSpace on 2014-09-30T18:18:25Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-12-01Bitstream added on 2014-10-01T14:03:36Z : No. of bitstreams: 1 S0102-09352013000600014.pdf: 160128 bytes, checksum: fbea325306b8f17a8a2cf56e4d281f50 (MD5) Potencial evocado auditivo é um método eletrodiagnóstico que permite avaliação funcional das vias auditivas desde a orelha média até o tronco encefálico. O uso desse teste em medicina veterinária é pouco difundido no Brasil. O presente artigo relata o uso do potencial evocado auditivo para detecção de deficiência auditiva unilateral em um gato com síndrome vestibular periférica secundária a otite média. The brainstem auditory evoked potential is an electrodiagnostic test that allows a functional assessment of the auditory pathways from the middle ear to the brainstem. This test, in veterinary medicine, is not commonly used in Brazil. This paper reports the use of auditory evoked potential for deafness detection in a cat with unilateral peripheral vestibular syndrome secondary to otitis media. Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina Veterinária e Zootecnia Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina Veterinária e Zootecnia

Introduction: The Parkinson disease can be among the multiple causes of alterations in the physical equilibrium. Accordingly, this study has the objective to evaluate Parkinson patients' physical equilibrium. Method: Potential study in which 12 Parkinson individuals were evaluated by way of tests of static and dynamic equilibrium, dynamic posturography and vectoelectronystagmograph. To compare the dynamic posturography results a group of gauged control was used. Results: Alterations in Romberg-Barré, Unterberger and Walk tests were found. The vestibular exam revealed 06 normal cases, 04 central vestibular syndrome and 02 cases of peripheral vestibular syndrome. In the dynamic posturography, an equilibrium alteration has been verified, when compared to the control group in all Sensorial Organization Tests, in average and in the utilization of vestibular system. Conclusion: Parkinson patients present a physical equilibrium alteration. The dynamic posturography was more sensitive to detect the equilibrium alterations than vectoelectronystagmograph.

Vestibular disease is in dogs and cats, and it may be the result of central or peripheral disease. The pathophysiology is unknown, however it can be related to an abnormal dynamic of endolymphatic fluid or neuritis of the vestibular portion of the VIII cranial nerve. The recovery of neurological sings is slow and, in chronic cases, the neurological deficits can be irreversible. The betahistine dihydrochloride is a drug used in humans with peripheral vestibular disorders and was used in four dogs with vestibular syndrome. The results showed clinical improvement in 7 to 10 days of treatment and completed recovery in 20 to 30 days. One year after the treatment, the dogs didn’t have recurrence of the syndrome. The use of betahistine dihydrochloride in dogs with peripheral vestibular syndrome shows rapid clinical recover, without laboratorial abnormalities or recurrence of the clinical signs.

Resume Objectifs Decrire une entite pseudotumorale expansive compliquant une chirurgie d'otospongiose. Methode Realisation d'un bilan radiologique et exploration chirurgicale d'une surdite rapidement progressive post-stapedectomie. Resultats Le scanner initial normal est repete a sept mois postoperatoires. Il met en evidence un elargissement du conduit auditif interne ainsi qu'une destruction du vestibule. L'imagerie par resonance magnetique (IRM) en sequence CISS confirme la presence d'un comblement de tout le conduit auditif interne, de la cochlee et du labyrinthe posterieur, de l'oreille moyenne rehaussee de facon homogene apres injection de gadolinium. L'exploration chirurgicale confirme l'aspect invasif du processus et l'examen anatomopathologique conclut a un remaniement inflammatoire associe a la presence de calcifications. Il n'y a pas de lesion autre qu'inflammatoire. Discussion Les imageries tomodensitometrique et par resonance magnetique confirment le diagnostic rare de processus expansif pseudotumoral au niveau de l'oreille interne apres stapedectomie. Conclusion Le bilan radiologique pour une surdite de perception post-stapedectomie doit comporter un scanner complete par une IRM si un processus inflammatoire est suspecte. Les atteintes inflammatoires de l'oreille interne peuvent prendre l'aspect de pseudotumeur expansive.

Hintergrund und Fragestellung. In der Ampulle des Bogengangs ist die Cupula, ahnlich wie die Tektorialmembran in der Kochlea, das wesentliche Bindeglied in der Reizubertragung von Flussigkeitsbewegungen auf die Haarzellen. Uber die physiologische Cupulabewegung gibt es erst seit Ende der 1970er Jahre klare Vorstellungen. Man geht von einer stabilen Anhaftung der Cupula an der Ampullenwand aus, wahrend Bewegungen v. a. in der Cupulamitte und an der Basis stattfinden. Patienten/Methodik. Trotz detaillierter Funktionsbeschreibungen existieren bis heute nur sehr wenige Untersuchungen zur Morphologie der Cupula. Diese werden durch die sehr wasserhaltige Struktur, welche zwangslaufig beim Fixierungsvorgang Formveranderungen nach sich zieht, erschwert. Das gilt im Besonderen fur die Elektronenmikroskopie. Die vorliegenden morphologischen Untersuchungen wurden deshalb in kunstlicher Endolymphe am Frischpraparat, in diesem Fall vom Lachs (Salmo salar), durchgefuhrt. Ergebnisse. Nach Anfarbungen der Cupula und Isolierung aus der Ampulle erfolgte eine genaue morphologische Beschreibung. Dabei fanden sich neben einem relativ uniformen Grundbauprinzip vereinzelt erhebliche Abweichungen in der Cupulaform. Schlussfolgerungen. Solche Varianten deuten an, dass es im Einzelfall erhebliche Variationen in der Ausformung der Cupula geben kann, welche moglicherweise mit einer veranderten peripher-vestibularen Funktion einhergehen.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary form of small vessel disease in which the pons may show lacunar infarcts and leukoaraiosis. Acute pure vestibular syndrome may be due to caudal pontine lesions and is probably underestimated. We describe a case of CADASIL with acute vestibular syndrome mimicking peripheral vestibulopathy, and evidence of focal infarction in the ponto-medullary junction at gadolinium-enhanced MRI including diffusion-weighted imaging, involving the area of the right vestibular nucleus and root entry zone of the ipsilateral vestibular nerve bundle. In CADASIL, both focal brainstem lesions and leukoaraiosis may parallel supratentorial white matter changes and may be related to poor outcome. Their actual extent should be evaluated in longitudinal studies that might predict clinical outcome and progression of disability.

Arterial blood gases were analyzed in 121 patients with dizziness. Sixty-one showed arterial blood gas abnormalities in the dizziness period. An increase in bicarbonate was seen in 57, increases in both bicarbonate and arterial carbon dioxide pressure in 8, and a low arterial oxygen pressure in 22 patients. The frequency of the abnormalities was significantly higher in those with central-peripheral diseases than in those with Meniere's disease. Arterial blood gases were also checked at random in the remission period in 22 patients. The frequency of dizziness recurrence was significantly higher in patients with the abnormalities in the remission period than in patients without them. These results indicate that approximately half of the patients with dizziness tend to have arterial blood gas abnormalities in the dizziness period. It is suggested that arterial blood gas abnormalities cause temporary vestibular dehabituation that increases the frequency of dizziness in central-peripheral diseases and Meniere's disease.

The tympanic membrane displacement technique (TMD) is aimed at evaluating intracochlear and intracranial pressure changes non-invasively. Therefore, the present paper describes the findings in patients with Meniere's disease where an increase in volume of the endolymphatic spaces is discussed. It should be investigated to which extent a change in the intracochlear pressure corresponds to different stages of the disease. It could be described that the intracochlear pressure does change over a certain period of persisting Meniere's, but that there is no extensive increase in intracochlear pressure between the attacks. The glycerol test as well as the acute attack (case report on one patient) are, however, characterised by distinct patterns. The same holds true for the late-stage Meniere's. It could be demonstrated that the functional patency of the cochlear aquaeduct in patients with long-term Meniere's history is reduced. This finding is surprising and should be investigated further. In essence, the TMD technique enables to better characterise Meniere patients, but it should not be a tool of routine diagnosis of the disease. In some audiological patients, it can also be beneficially applied (10).

Vestibular disease is a common syndrome in small animals that may resulst of central or peripheral disease. The pathophysiology of peripheral vestibular syndrome is unknown, however it can be related to an abnormal dynamic of endolymphatic fluid or neuritis of the vestibular portion of the VIII cranial nerve. The recovery of neurological sings is slow and, in chronic cases, the neurological deficits can be irreversible. In veterinary medicine, thera are few medical options to treat this condition, however, in Medicine, betahistine dihydrochloride is used to treat peripheral vestibular disorders. These drug was used in four dogs with vestibular syndrome. The results showed clinical improvement in 7 to 10 days of treatment and completed recovery in 20 to 30 days, followed by the cure. One year after the treatment, the dogs did not have recurrence of the syndrome. This report shows the use of betahistine dihydrochloride in dogs with peripheral vestibular syndrome, with rapid clinical recover, without laboratorial abnormalities or recurrence of the clinical signs .The results encourage the use of betahistine dihydrochloride in the treatment of peripheral vestibular disorders in small animals. KEY WORDS: Betahistine, dog, vestibular syndrome.

An 18-year-old woman, while suffering from acute acquired toxoplasmosis, experienced sudden deafness and a total loss of vestibular function first in the right ear and three months later also in the left. Following treatment with sulphadiazine and pyrimethamine, hearing was retrieved to such a degree that the patient was enabled to communicate by means of a body-worn hearing aid and lip-reading. Taking the differential diagnostic possibilities into account, we believe that toxoplasmosis was the cause of the severe hearing loss. Since effective treatment seems to be available, we recommend that patients with acute bilateral sensorineural hearing loss of unknown origin are examined for acute toxoplasmosis with a view to instituting chemotherapy.

OBJETIVO: Correlacionar o uso de contraceptivo hormonal oral com possíveis alterações auditivas e vestibulares. MÉTODOS: Aplicou-se anamnese, teste audiométrico e teste vestibular em 60 mulheres entre 14 e 35 anos, sendo que 30 mulheres faziam uso do método contraceptivo hormonal oral composto por estrógeno e progesterona (grupo de risco), por um período igual ou superior a 6 meses, sem queixas auditivas e vestibulares anteriores ao uso do mesmo; e 30 mulheres que nunca fizeram uso desses hormônios (grupo controle), sem queixas auditivas e vestibulares. A anamnese foi utilizada como critério de seleção da amostra. RESULTADOS: Com base nos achados otoneurológicos através de uma pesquisa quantitativa, pode-se verificar uma prevalência da Síndrome Vestibular Periférica Irritativa e de zumbidos no grupo de risco, sem alterações audiométricas. CONCLUSÃO: O uso do método contraceptivo hormonal oral pode ocasionar alterações funcionais na orelha interna, principalmente zumbido e Síndrome Vestibular Periférica Irritativa no grupo de risco, mas não evidenciou alterações de limiares auditivos.

Transmastoid labyrinthectomy is an effective procedure for the control of episodic vertigo due to unilateral peripheral vestibular dysfunction. However, its application in older patients has been limited, primarily because of concerns that older patients may not compensate well postoperatively. Poor vestibular compensation results in constant disequilibrium, motion intolerance, and visual symptomatology. The purpose of this report is to review our results with transmastoid labyrinthectomy in patients over the age of 65. Complete records were available for 22 patients operated on between July 1984 and June 1994. Patient's records were reviewed for age, preoperative duration of symptoms, coexistent medical conditions, vertigo control, and postoperative disequilibrium. Advanced age need not be a contraindication to transmastoid labyrinthectomy.

Twenty-one normal adults were the subjects of this study. They were instructed to step in the same position with eyes closed for a total of 50 steps under two conditions: i) Immediately after simultaneous irrigation of the right and left auditory canals for 10 s with 30 degrees C water and 44 degrees C water, respectively, and ii) following irrigation of the right auditory canal with 30 degrees C water. The two conditions simulate two different types of imbalance of labyrinthine function: The former physiological and the latter non-physiological. Under the first condition, 33% of the subjects tended to fall to the right side during stepping. Under the second conditions, 86% showed ataxia. The difference was statistically highly significant, p0.01. The results indicate that physiological imbalance does not always cause ataxia. A physiological imbalance occurs during active turning. The motion brings about an ampullopetal lymphatic flow in the ipsilateral horizontal semicircular canal and an ampullofugal flow in the contralateral canal, as under the second condition. The former increases the function of the labyrinth, while the latter decreases it. This results in imbalance but no ataxia.

(1999). The Subjective Visual Vertical as a Clinical Parameter for Acute and Chronic Vestibular (Otolith) Disorders. Acta Oto-Laryngologica: Vol. 119, No. 2, pp. 126-127.

Der akute Vestibularisausfall ist eine im Erwachsenenalter haufige, im Kindesalter jedoch seltene Ursache eines akuten Schwindels. Die Diagnose wird aufgrund der typischen Symptomatik, eines gutartigen Verlaufs und nach Ausschlus anderer Ursachen gestellt. Vorgestellt wird ein 3jahriges Madchen, bei dem die Ursache eines plotzlichen Schwindels ein akuter Vestibularisausfall war. Diskussion: Der akute Vestibularisausfall ist im Kindesalter selten und erfordert eingehende Untersuchungen zum Ausschlus anderer, z.T. auch schwerwiegenderer Ursachen des Schwindels. Die ersten Symptome des akuten Vestibularisausfalls konnen besorgniserregend sein, der Verlauf ist jedoch gutartig und selbstlimitierend.

Objectif: Supporter l'hypothese que le syndrome connu sous le nom de visual vestibular mismatch (VVM) peut etre induit par une pathologie vestibulaire peripherique. Devis: Etude retrospective de dossiers avec questionnaire prospectif. Localisation: Clinique externe de soins tertiaires et quaternaires. Methodes: Nous avons etudie les dossiers de 28 patients traites pour maladie de Meniere. Leurs reponses a un questionnaire sur le VVM administre avant traitement ont ete comparees a celles donnees lors d'un questionnaire telephonique en suivi de traitement. Ces questionnaires ont aussi ete compares a ceux remplis par 100 controles sans pathologie de l'oreille. Variables: Reponse des patients au questionnaire sur le VVM. Resultats: Dix-sept des 28 patients avaient du VVM. Le traitement a la gentamycine a augmente le nombre de reponses positives. Il n'y avait pas de correlation entre le developpement du VVM, les tests caloriques, et la performance a la posturographie. Aucun controle ne presentait de symptomes de VVM. Conclusion: Nous concluons que le developpement de VVM indique l'apparition ou la deterioration d'une maladie vestibulaire puisqu'il peut etre induit ou exacerbe par la therapie a la gentamycine. Puisqu'il n'y a pas de correlation entre le VVM et les tests caloriques, nous suggerons qu'un dommage otolitique pourrait etre responsable pour l'apparition de ces symptomes.

Contact righting, that is, turning from a recumbent position to prone, is abolished for a few days after large electrolytic lesions of the lateral hypothalamus. With recovery, contact righting reappears, but does so in a distinct manner. At first the body is righted by backleg movements, in the absence of any active axial rotation. Later, righting switches from back to front, so that righting begins in the shoulders and then proceeds to the pelvis. Such righting is achieved by axial rotation, that is, the limbs are carried by the torso, rather than vice versa. Labyrinthectomy, when combined with lateral hypothalamic (LH) damage, slows this recovery (now taking as long as 3 weeks), and reveals many intermediate stages of contact-righting. The absence of axial rotation in the early stages of recovery from combined LH damage and labyrinthectomy is compared to the ‘axial apraxia’ seen in some parkinsonian patients.

Recovery of gaze disturbance was studied in 15 patients with bilateral labyrinthine loss who underwent active or passive rotation tests at various times after onset, 1 month to 34 years. Mean VOR gain increased rapidly against the logarithm of time under active rotations and slowly under passive rotations. Although gaze disturbance recovered in the 1st year under both active and passive rotations, active ones resulted in better gaze stabilization at higher frequencies. The present study indicated that initiation and increase of compensatory eye movement in the dark during the critical period, i.e., early in the 1st year, underlies the compensation for gaze disturbance after bilateral labyrinthine loss, similarly as in the case of unilateral lesions.

Measurements were made of the lesion-induced changes in vestibulo-ocular reflexes (VOR) to rotatory stimuli in a group of patients with bilateral peripheral labyrinthine lesions. All the patients had caloric responses that were below the confidence levels used for normal responses in our laboratory. Responses to rotatory stimuli were greatly decreased or absent at low frequencies of stimulation, but present to a much greater degree at the higher frequencies. Phase measurements showed an increase in relationship to the velocity of the stimulus; there was a corresponding shortening of the time constant as obtained from impulse response measurements. A parametric study indicated that the changes in the responses can be described by a decrease in the sensitivity coefficient and in the basic time constant of a simplified pendulum model equation of vestibular function. A theoretical analysis of the data using a new model for the organization of the vestibular pathways indicated that the preservation of the high-frequency responses was the result of adaptive changes brought about in the central vestibular pathways and/or changes in the receptor-neuron transduction characteristics. Thus, despite the almost complete absence of any caloric response, the vestibular system reflexes remained adequate to maintain gaze during normal head movements.

Records of 175 patients undergoing posturography in the author's practice over a 1-year period were reviewed. Abnormal results on posturography were identified by criteria established through the national users group of Equi-Test participants. There were 112 peripheral cases with 50 (45%) abnormal on posturography, in contrast to 53 central patients with 38 (72%) abnormal

Suppression du nystagmus horizontal par injection simultanee d'eau glacee dans les deux conduits auditifs externes (20 cc en 20 secondes minimum). Pendant la duree de l'effet calorique, amelioration des vertiges, de la marche et du test de Romberg dans les syndromes peripheriques, aggravation dramatique dans le syndrome vestibulaire d'origine centrale