The prevalence of vertigo and dizziness in people aged more than 60 years reaches 30%, and due to aging of world population, the number of patients is rapidly increasing. The presence of dizziness in the elderly is a strong predictor of falls, which is the leading cause of accidental death in people older than 65 years. Balance disorders in the elderly constitute a major public health problem, and require an adequate diagnosis and management by trained physicians. In the elderly, common causes of vertigo may manifest differently, as patients tend to report less rotatory vertigo and more non-specific dizziness and instability than younger patients, making diagnosis more complex. In this mini review, age-related degenerative processes that affect balance are presented. Diagnostic and therapeutic approaches oriented to the specific impaired system, including visual, proprioceptive, and vestibular pathways, are proposed. In addition, presbystasis – the loss of vestibular and balance functions associated with aging – benign paroxysmal positional vertigo, and stroke (in acute syndromes) should always be considered.

Safe-use recommendations were outlined, whereas selecting the lowest volume setting comfortable remained the main suggestion. High background noise attenuating earphones may help in reducing comfortable listening levels and should be preferred. A risk table was elaborated, presenting time limits before reaching a risky exposure.

Objective To evaluate whether listening to music through binaural headphones contributes to the perception of pain and anxiety in patients undergoing closed nasal bone fracture reductions. Study Design Randomized controlled trial. Subjects and Methods We recruited patients from San Juan de Dios Hospital with displaced nasal fractures who required a reduction and assigned them to a control group or a music group. For both groups, a protocolized closed reduction of the nasal fracture with local anesthesia was performed. The music group heard music through headphones during the pre-, intra-, and postprocedural periods of the intervention. Physiological variables (blood pressure and heart rate) were measured. An anxiety survey (State-Trait Anxiety Inventory) and the visual analog scale for measuring pain were also applied. Results The music group exhibited significantly lower levels of systolic blood pressure ( P = .0001), anxiety ( P < .0001), and pain ( P = .0004) than the control group. Conclusion Listening to music through headphones—a safe and low-cost intervention—appears to aid in pain and anxiety management associated with procedures that are usually uncomfortable, such as the reduction of nasal bone fractures with local anesthesia. We believe that this effect is achieved by the modulation of pain and anxiety on an emotional-affective dimension at a central level. Given its safety, feasibility, and low cost, music therapy should be considered a complementary treatment for pain and anxiety management for nasal fracture reduction performed with local anesthesia, as well as for other medical procedures of similar pain levels conducted without general anesthesia.

The orientation of the basal turn and the corresponding ideal electrode insertion vector vary widely among subjects. A proper preoperative estimation on a case-to-case scenario for this feature might lead to technique adaptation during insertion, possibly contributing to minimizing electrode insertion trauma and thus optimizing the anatomical and functional results.

Objective: To determine whether performance in a virtual spatial navigational task is poorer in persistent postural perceptual dizziness (PPPD) patients than in healthy volunteers and patients suffering other vestibular disorders. Methods: Subjects were asked to perform three virtual Morris water maze spatial navigational tasks: (i) with a visible target, (ii) then with an invisible target and a fixed starting position, and finally (iii) with an invisible target and random initial position. Data were analyzed using the cumulative search error (CSE) index. Results: While all subjects performed equally well with a visible target, the patients with PPPD (n = 19) performed poorer (p < 0.004) in the invisible target/navigationally demanding tasks (CSE median of 8) than did the healthy controls (n = 18; CSE: 3) and vestibular controls (n = 19; CSE: 4). Navigational performance in the most challenging setting allowed us to discriminate PPPD patients from controls with an area under the receiver operating characteristic curve of 0.83 (sensitivity 78.1%; specificity 83.3%). PPPD patients manifested more chaotic and disorganized search strategies, with more dispersion in the navigational pool than those of the non-PPPD groups (standard distance deviation of 0.97 vs. 0.46 in vestibular controls and 0.20 in healthy controls; p < 0.001). Conclusions: While all patients suffering a vestibular disorder had poorer navigational abilities than healthy controls did, patients with PPPD showed the worst performance, to the point that this variable allowed the discrimination of PPPD from non-PPPD patients. This distinct impairment in spatial navigation abilities offers new insights into PPPD pathophysiology and may also represent a new biomarker for diagnosing this entity.

IntroductionBenign paroxysmal positional vertigo (BPPV) secondary to canalolithiasis of the posterior semicircular canal is perhaps the most frequent cause of vertigo and dizziness. One of its properties is a high response rate to canalith repositioning maneuvers. However, delays in the diagnosis and treatment of this entity can range from days to years, depending on the setting. Here, we present an abbreviated variation of the Dix–Hallpike maneuver, which can be used to diagnose this disease. It is similar to the standard maneuver but can be performed without an examination bed/table and requires only a backed chair (a difference that we feel is very important in settings where a clinical bed/table is not readily available).MethodsA diagnostic assessment study was conducted in 163 patients who presented with vertigo or dizziness.ResultsThe abbreviated test had fairly good sensitivity (80%) and high specificity (95%) for diagnosing posterior BPPV.DiscussionThis new diagnostic maneuver may serve as a screening procedure for quickly identifying this pathology. This will allow patients to be more directly treated, without requiring unnecessary referrals or full vestibular testing, and will be especially useful in primary care settings or heavily overloaded otolaryngology or neurology departments.

Validation of the sino-nasal outcome test in Chile Background: Allergic rhinitis and sinusitis are common diseases that affect quality of life of pediatric and adult patients. Aim: To adapt and validate the Sino-Nasal Outcome Test 20 indicators (SNOT-20) survey in Chilean subjects. Material and Methods: In a psychometric validation study, an adapted version of the SNOT-20 adapted version was applied to 181 volunteers on two different occasions, three weeks apart. Feasibility (response time and perceived diffi culty), reliability (internal consistency and test-retest) and validity (concurrent validity, correlating results with an independent instrument; predictive validity assessing its sensitivity to detect changes and discriminant validity, assessing receiver operating characteristic (ROC) curves), were assessed. An exploratory factor analysis was performed to confi rm the presence of previously described underlying constructs. Results: Eighty percent of participants considered SNOT-20 easy to complete. This task was completed in less than 5 minutes. Cronbach's alpha was 0.946. Temporal stability on a healthy subgroup was strong with an intraclass correlation coeffi cient of 0.92. SNOT-20 had a correlation coefficient of 0.82 with an independent instrument and its score signifi cantly decreased after 3 weeks of treatment (p = 0.003).The area under ROC curve was 0.895. Factor analysis identifi ed four principal components which possessed identical structure as previously described. Conclusions: SNOT-20 survey was valid, reliable and easy to implement among Chilean subjects.

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