Page 38 - Portuguese Journal - SPORL - Vol 61. Nº2
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vestibular involvement is scarce. Recent Vestibular evaluation
studies have suggested that there may be Vestibular function was assessed preoperatively
some degree of involvement of the vestibular using the vHIT system (ICS Impulse System,
system in patients with otosclerosis, which GN Otometrics). After the initial evaluation for
may be detected through a comprehensive the presence of spontaneous nystagmus, the
vestibular evaluation—through the video device was calibrated. The examination was
head impulse test (vHIT), caloric tests, performed with the acquisition of 20 head
and cervical and ocular vestibular evoked impulses in each direction in each of the three
myogenic potentials (cVEMPs and oVEMPs). 4–6 vestibular planes—horizontal, RALP (right
Nevertheless, there is no consensus on the anterior/left posterior), and LARP (left anterior/
etiology and pathophysiology of vestibular right posterior). The criteria used to establish
involvement or the best method to assess it. the dysfunction of the semicircular canal
This study aimed to characterize the vestibular were gains lower than 0.8 (in the horizontal
function in patients with otosclerosis who semicircular canals) or 0.7 (in the vertical
had not been operated on, using the vHIT semicircular canals), asymmetry greater than
and quality of life questionnaire related to 15%, and the presence of corrective saccades
vestibular symptoms using the Dizziness (overt and covert), defined as pathological
Handicap Inventory (DHI) and compare this according to the system’s software, after visual
sample with a healthy population. inspection of the graph to exclude artifacts.
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The examinations were performed by a trained
Materials and Methods physician or audiologist.
Sample Additionally, the DHI questionnaire—
This was a cross-sectional observational case- the version that has been translated and
control study. The participants were recruited validated in Portuguese —was administered.
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between October 2022 and February 2023 It comprises 25 items (scored from 0 to 4) on
and divided into two groups. The first group the subjective evaluation of vestibular and
(cases) comprised patients with otosclerosis balance symptoms and, consequently, the
referred from the otorhinolaryngology clinic quality of life associated with these symptoms.
of a tertiary hospital (Centro Hospitalar de This questionnaire is subdivided into three
Entre o Douro e Vouga) who were recruited domains: physical, functional, and emotional.
using consecutive sampling.
The inclusion criteria were as follows: clinical Statistical analysis
and audiological suspicion of otosclerosis Descriptive analysis was used to document the
(evidence of conductive hearing loss with characteristics of the study sample. Normal
an intact tympanic membrane); unilateral or distribution was assessed through visual
bilateral disease in unoperated ears; diagnosis analysis of the histogram. Categorical variables
confirmed intraoperatively a posteriori. The are expressed as frequencies and percentages
exclusion criteria were as follows: presence of (n, %), and normal continuous variables are
vestibular disease; previous history of otologic expressed as means ± standard deviation (SD).
surgery; chronic otitis media; absence of The non-parametric Mann-Whitney, Wilcoxon,
surgical confirmation of the diagnosis. and Kruskal-Wallis tests were used to compare
The second group comprised controls— the mean gain of the vestibulo-ocular reflex
healthy patients recruited at the hospital (VOR) of the semicircular canals between the
through convenience sampling—who had groups, and the Mann-Whitney test was used
no previous history of otologic or vestibular to compare the scores obtained in the DHI.
disease; they were matched for age and sex. Fisher’s exact test was used to compare the
presence of corrective saccades in the vHIT
between the groups.
180 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery
