ISSN 1612-3352

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Prof. Dr. Claus F. Claussen, Neurootological Research Institute of the Research Society for Smell, Taste, Hearing and Equilibrium Disorders at Bad Kissingen (4-G-F). Bad Kissingen, Germany.
Dr. med. Julia M. Bergmann,
Dr. med. Guillermo O. Bertora,
Otoneuroophthalmological Neurophysiology,
Buenos Aires, Argentina.

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Dr. med. Julia M. Bergmann,
Dr. med. Guillermo O. Bertora,
Otoneuroophthalmological Neurophysiology,
Buenos Aires, Argentina.


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Vestibular rehabilitation after retrosigmoid vestibular neurectomy in patients with meniere disease.

Abstract

Introduction:
The goal of this study is to evaluate the role of vestibular rehabilitation (VR) with feed-back techniques such us dynamic posturography compared with conventional postural and oculocephalic maneuvers, after vestibular neurectomies (VN), in patients with unilateral Ménière disease, and to demonstrated if instrumental (VR) improves recovery of balance.
Material and Methods:
Sixty three patients were operated of retrosigmoid vestibular neurectomy followed by vestibular rehabilitation. Their ages ranged from twenty to fifty five years. Fifty two per cent were males and forty eight females. Thirty one (group A) did conventional postural and oculocephalic maneuvers, during thirty days begining the fifth day after surgery. In the remaining thirty two patients (group B) vestibular rehabilitation with feedback techniques (dynamic posturography) was added to the previous treatment.
The differences in postoperative compensation were evaluated using condition 5 (eyes closed and mobile platform) and 6 (movile platform and visual environtment) of the sensorial organization test of dynamic posturography. The patients were asked to fill questionnaires to measure incapacity due to dizziness (American Academy of HNS; and Dizziness Handicap Inventory).
The significance level was studied with t of Student test and Fisher test, considering significant results: p < 0.05. Results: Patients of group B improved with significant differences compared to group A ( p < 0.05). Both groups showed worse stability in condition 5 and 6 than the normal population (p < 0.05). All patients (100 %) were asymptomatic of vertigo after surgery, according to the incapacity questionnaires. Eight per cent of the patients in group B and 18 % of the patients in group A, complained of unsteadiness for twelve months after surgery. Discussion and Conclusion: In order to achieve vestibular compensation after vestibular neurectomy the patients must start slow active movilization as soon as possible. Vestibular rehabilitation is usefull after peripheral vestibular unilateral sudden paralysis due to vestibular neurectomy The dynamic posturography maneuvers accelerate significantly the vestibular rehabilitating process as compared to conventional exercices. The advantages of instrumental rehabilitation improving recovery of balance after (VN) is shown in this paper.

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