ROSELI SARAIVA MOREIRA BITTAR
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina
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- Contribution of audiovestibular tests to the topographic diagnosis of sudden deafness(2013) OITICICA, Jeanne; BITTAR, Roseli Saraiva Moreira; CASTRO, Claudio Campi de; GRASEL, Signe; PEREIRA, Larissa Vilela; BASTOS, Sandra Lira; RAMOS, Alice Carolina Mataruco; BECK, RobertoINTRODUCTION: Sudden hearing loss (SHL) is an ENT emergency defined as sensorineural hearing loss (SNHL) > 30 dB HL affecting at least 3 consecutive tonal frequencies, showing a sudden onset, and occurring within 3 days. In cases of SHL, a detailed investigation should be performed in order to determine the etiology and provide the best treatment. Otoacoustic emission (OAE) analysis, electronystagmography (ENG), bithermal caloric test (BCT), and vestibular evoked myogenic potential (VEMP) assessments may be used in addition to a number of auxiliary methods to determine the topographic diagnosis. OBJECTIVE: To evaluate the contribution of OAE analysis, BCT, VEMP assessment, and magnetic resonance imaging (MRI) to the topographic diagnosis of SHL. METHOD: Cross-sectional and retrospective studies of 21 patients with SHL, as defined above, were performed. The patients underwent the following exams: audiometry, tympanometry, OAE analysis, BCT, VEMP assessment, and MRI. Sex, affected side, degree of hearing loss, and cochleovestibular test results were described and correlated with MRI findings. Student's t-test was used for analysis of qualitative variables (p < 0.05). RESULTS: The mean age of the 21 patients assessed was 52.5 ± 15.3 years; 13 (61.9%) were women and 8 (38.1%) were men. Most (55%) had severe hearing loss. MRI changes were found in 20% of the cases. When the audiovestibular test results were added to the MRI findings, the topographic SHL diagnosis rate increased from 20% to 45%. CONCLUSION: Only combined analysis via several examinations provides a precise topographic diagnosis. Isolated data do not provide sufficient evidence to establish the extent of involvement and, hence, a possible etiology.
- Glucose metabolism disorders and vestibular manifestations: evaluation through computerized dynamic posturography(2016) BITTAR, Roseli Saraiva Moreira; SANTOS, Maruska D'Aparecida; MEZZALIRA, RaquelIntroduction: Global sugar consumption has increased in the past 50 years; its abusive intake is responsible for peripheral insulin resistance, which causes the metabolic syndrome - obesity, diabetes mellitus, hypertension, and coronary heart disease. Objective: To evaluate the effect of a fractionated diet without glucose as treatment for labyrinthine disorders associated with glucose-insulin index. Methods: The study design was a prospective randomized controlled trial. Fifty-one patients were divided into two groups: the diet group (DG), which comprised subjects treated with a fractionated diet with glucose restriction, and the control group (CG), in which individuals were not counseled regarding diet. Patients underwent computerized dynamic posturography (CDP) and visual analog scale (VAS) on the first and 30th days of the study. Results: There was improvement in the assessed posturographic conditions and VAS self assessment in the DG group after 30 days when compared to the control group. Conclusion: The fractionated diet with glucose restriction was effective for the treatment of vestibular dysfunction associated with glucose metabolism disorders. (C) 2015 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial.
- P3 Cognitive Potential in Cochlear Implant Users(2018) GRASEL, Signe; GRETERS, Mario; GOFFI-GOMEZ, Maria Valeria Schimidt; BITTAR, Roseli; WEBER, Raimar; OITICICA, Jeanne; BENTO, Ricardo FerreiraIntroduction The P3 cognitive evoked potential is recorded when a subject correctly identifies, evaluates and processes two different auditory stimuli. Objective to evaluate the latency and amplitude of the P3 evoked potential in 26 cochlear implant users with post-lingual deafness with good or poor speech recognition scores as compared with normal hearing subjects matched for age and educational level. Methods In this prospective cohort study, auditory cortical responses were recorded from 26 post-lingual deaf adult cochlear implant users (19 with good and 7 with poor speech recognition scores) and 26 control subjects. Results There was a significant difference in the P3 latency between cochlear implant users with poor speech recognition scores (G-) and their control group (CG) (p = 0.04), and between G-and cochlear implant users with good speech discrimination (G+) (p = 0.01). We found no significant difference in the P3 latency between the CG and G+. In this study, all G-patients had deafness due to meningitis, which suggests that higher auditory function was impaired too. Conclusion Post-lingual deaf adult cochlear implant users in the G-group had prolonged P3 latencies as compared with the CG and the cochlear implant users in the G+ group. The amplitudes were similar between patients and controls. All G-subjects were deaf due to meningitis. These findings suggest that meningitis may have deleterious effects not only on the peripheral auditory system but on the central auditory processing as well.
- Neurotology: definitions and evidence-based therapies - Results of the I Brazilian Forum of Neurotology(2020) SALMITO, Marcio Cavalcante; MAIA, Francisco Carlos Zuma e; GRETES, Mario Edvin; VENOSA, Alessandra; GANANCA, Fernando Freitas; GANANCA, Mauricio Malavasi; MEZZALIRA, Raquel; BITTAR, Roseli Saraiva Moreira; GASPERIN, Alexandre Camilotti; PIRES, Anna Paula Batista de Avila; RAMOS, Bernardo Faria; BERTOLDO, Cesar; JR, Cicero Ferreira; REAL, Danilo; GUIMARAES, Humberto Afonso; OITICICA, Jeanne; LAVINSKY, Joel; LOPES, Karen Carvalho; DUARTE, Juliana Antoniolli; MORGANTI, Ligia Oliveira Goncalves; SANTOS, Lisandra Megumi Arima dos; JOFFILY, Lucia; LAVINSKY, Luiz; SANTOS, Monica Alcantara de Oliveira; MANO, Patricia Mauro; ARAUJO, Pedro Ivo Machado Pires de; ALBERNAZ, Pedro Luis Mangabeira; CAL, Renato; DORIGUETO, Ricardo Schaffeln; GUIMARAES, Rita de Cassia Cassou; CARVALHO, Rogerio Castro Borges deIntroduction: Neurotology is a rapidly expanding field of knowledge. The study of the vestibular system has advanced so much that even basic definitions, such as the meaning of vestibular symptoms, have only recently been standardized. Objective: To present a review of the main subjects of neurotology, including concepts, diagnosis and treatment of Neurotology, defining current scientific evidence to facilitate decision-making and to point out the most evidence-lacking areas to stimulate further new research. Methods: This text is the result of the I Brazilian Forum of Neurotology, which brought together the foremost Brazilian researchers in this area for a literature review. In all, there will be three review papers to be published. This first review will address definitions and therapies, the second one will address diagnostic tools, and the third will define the main diseases diagnoses. Each author performed a bibliographic search in the LILACS, Sci ELO, PubMed and MEDLINE databases on a given subject. The text was then submitted to the other Forum participants for a period of 30 days for analysis. A special chapter, on the definition of vestibular symptoms, was translated by an official translation service, and equally submitted to the other stages of the process. There was then a in-person meeting in which all the texts were orally presented, and there was a discussion among the participants to define a consensual text for each chapter. The consensual texts were then submitted to a final review by four professors of neurotology disciplines from three Brazilian universities and finally concluded. Based on the full text, available on the website of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery, this summary version was written as a review article. Result: The text presents the official translation into Portuguese of the definition of vestibular symptoms proposed by the Barany Society and brings together the main scientific evidence for each of the main existing therapies for neurotological diseases. Conclusion: This text rationally grouped the main topics of knowledge regarding the definitions and therapies of Neurotology, allowing the reader a broad view of the approach of neurotological patients based on scientific evidence and national experience, which should assist them in clinical decision-making, and show the most evidence-lacking topics to stimulate further study. (C) 2019 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial.
- What does the video head impulse test tell us about post-caloric vestibular recruitment?(2023) MEZZALIRA, R.; BITTAR, R. S. M.Objective: The vestibular recruitment observed in caloric testing is a new tool in the study of the vestibulo-ocular reflex. This study aimed to determine the sensitivity and specificity of the video head impulse test to detect post-caloric vestibular recruitment. Method: In this cross-sectional study, all participants underwent the standard otoneurological assessment of the service, caloric test, and video head impulse test. A non-linear mixed model was used to test for associations. Results: The study group consisted of 250 (89 male and 161 female) patients, with a mean age of 54.84 years. The control group comprised 35 participants, 18 men and 17 women, with a mean age of 40.42 years. Sex and age had no effect on group responses. There was no difference between the study and control groups regarding the interaction between recruitment and gain (p = 0.7487); recruitment and overt (p = 0.7002) and covert saccades (p = 1.0000); and recruitment and anti-compensatory saccades in the contralateral ear (p = 0.3050). The video head impulse test had a sensitivity of 51% and a specificity of 50% as a predictor of post-caloric recruitment. Conclusion: The video head impulse test results showed no relevance in predicting post-caloric vestibular recruitment. & COPY; 2022 Associac,a & SIM;o Brasileira de Otorrinolaringologia e Cirurgia C & PRIME;ervico-Facial.
- Population epidemiological study on the prevalence of dizziness in the city of Sao Paulo(2013) BITTAR, Roseli Saraiva Moreira; OITICICA, Jeanne; BOTTINO, Marco Aurelio; GANANCA, Fernando Freitas; DIMITROV, RivaThe epidemiology of dizziness is essential in clinical practice. Objective: To establish the prevalence of dizziness in the adult population of Sao Paulo, its clinical characteristics and level of discomfort. Method: A prospective cross-sectional study ran from April to October of 2012 by a field questionnaire, totaling 1,960 interviews. The predictor variables assessed were age, gender, type of dizziness and the dizziness disability index. The statistical tools used to assess the significance between variables were the chi-square test, Student's t-test and logistic regression. We used a 95% confidence interval for estimated values. Results: The prevalence of dizziness in the city of Sao Paulo was established at 42%. We found two peak of complaints, 49% in the range of 46-55 years and 44% in the elderly. Vestibular-related dizziness was estimated to affect 8.3% of the population, mainly women (p < 0.001). The symptoms caused disability in 27% of symptomatic interviewees and it is more bothersome to females (p < 0.001), who more frequently seek medical care (p < 0.001). Conclusion: The prevalence of dizziness in Sao Paulo was found to be 42%. It affects daily activities in 67% of symptomatic patients, but only 46% of them seek medical help.
- Individualized Vibrotactile Neurofeedback Training in Patients with Chronic Bilateral Vestibulopathy(2023) BASTA, Dietmar; ROSSI-IZQUIERDO, Marcos; WONNEBERGER, Kai; BRUGNERA, Cibele; BITTAR, Roseli Saraiva Moreira; GRETERS, Mario Edvin; ERNST, Arne; SOTO-VARELA, AndresPatients with bilateral vestibulopathy (BVP) suffer from postural imbalance during daily life conditions, which in turn leads to a high frequency of falls. Unfortunately, vestibular rehabilitation has only modest and somewhat inconsistent effects in this patient group. Approximately 50% of BVP patients show an improved postural control after conventional vestibular rehabilitation training. New and more promising approaches are required. The individualized vibrotactile neurofeedback training (IVNT) in stance and gait conditions has already been described as highly effective in patients with various vestibular disorders. The purpose of the present multicenter study was to determine the efficacy of the IVNT in improving balance, reducing self-perceived disability, and improving gait in patients with confirmed BVP. In total, 22 patients performed the IVNT with the Vertiguard (R) system for 10 daily sessions. The dizziness handicap inventory (DHI), the stance stability score of the sensory organization test (SOT) and the score for everyday life mobility in stance and gait tasks (SBDT) were obtained immediately before and after the rehabilitation training period, as well as 3 and 12 months later. All measures improved significantly after the IVNT. Between 77.3% and 94.4% of patients showed an individual benefit (depending on outcome measure). The effect was not significantly reduced within the follow-up period of 12 months. The results demonstrate a high efficacy of the IVNT for vestibular rehabilitation in BVP patients.
- Otoneurological evaluation: current good practice(2014) GONCALVES, Denise Utsch; GANANCA, Fernando Freitas; BOTTINO, Marco Aurelio; GRETERS, Mario Edvin; GANANCA, Mauricio Malavasi; MEZZALIRA, Raquel; BITTAR, Roseli Saraiva Moreira; ALBERTINO, Sergio
- Cerebral Responses to Stationary Emotional Stimuli Measured by fMRI in Women with Persistent Postural-Perceptual Dizziness(2021) LINS, Eliane Maria Dias von Sohsten; BITTAR, Roseli Saraiva Moreira; BAZAN, Paulo Rodrigo; AMARO JUNIOR, Edson; STAAB, Jeffrey PaulIntroduction Persistent postural-perceptual dizziness (PPPD) is a functional vestibular disorder characterized by chronic dizziness, unsteadiness, and hypersensitivity to motion. Preexisting anxiety disorders and neurotic personality traits confer vulnerability to PPPD. High anxiety during acute vertigo or dizziness incites it. A functional magnetic resonance imaging (fMRI) study of chronic subjective dizziness found unexpectedly hypoactive responses to vestibular stimulation in cortical regions that integrate threat assessment and spatial perception. Objective This fMRI study used non-moving, but emotionally charged visual stimuli to investigate the brain's activity of PPPD patients and control subjects. Methods The participants included 16 women with PPPD and 16 age-matched women who recovered completely from acute episodes of vertigo or dizziness capable of triggering PPPD. Brain responses to positive, neutral, and negative figures from the International Affective Picture System were measured with fMRI and compared between the groups. Dizziness handicap, anxiety, and depression were assessed with validated questionnaires. Results Between group analyses: Participants with PPPD showed reduced activity in anterior cingulate cortex and increased activity in left angular gyrus in response to negative versus positive stimuli, which was not observed in recovered individuals. Within group analyses: Participants with PPPD had increased activity in visuospatial areas (parahippocampal gyrus, intraparietal sulcus) in negative versus positive and negative versus neutral contrasts, whereas recovered individuals had increased activity in anxiety regions (amygdala, orbitofrontal cortex). Conclusion Patients with PPPD may be more attuned to spatial elements than to the content of emotionally charged visual stimuli.
- Magnetic resonance angiography and transcranial Doppler ultrasound findings in patients with a clinical diagnosis of vertebrobasilar insufficiency(2020) LIMA NETO, Arlindo Cardoso; BOR-SENG-SHU, Edson; OLIVEIRA, Marcelo de Lima; MACEDO-SOARES, Alberto; TOPCIU, Flavia Renata; BITTER, Roseli Saraiva MoreiraOBJECTIVE: To evaluate the findings of magnetic resonance angiography (MRA) and transcranial Doppler ultrasound (TCD) in patients with a clinical diagnosis of vertebrobasilar insufficiency (VBI). METHOD: From our outpatient neurotology clinic, we selected patients (using the criteria proposed by Grad and Baloh) with a clinical diagnosis of VBI. We excluded patients with any definite cause for vestibular symptoms, a noncontrolled metabolic disease or any contraindication to MRA or TCD. The patients in the study group were sex- and age-matched with subjects who did not have vestibular symptoms (control group). Our final group of patients included 24 patients (study, n=12; control, n=12). RESULTS: The MRA results did not demonstrate significant differences in the findings between our study and control groups. TCD demonstrated that the systolic pulse velocity of the right middle cerebral artery, end diastolic velocity of the basilar artery, pulsatility index (PI) of the left middle cerebral artery, PI of the right middle cerebral artery, and PI of the basilar artery were significantly higher in the study group than in the control group, suggesting abnormalities affecting the microcirculation of patients with a clinical diagnosis of VBI compared with controls. CONCLUSION: MRA failed to reveal abnormalities in patients with a clinical diagnosis of VBI compared with controls. The PI of the basilar artery, measured using TCD, demonstrated high sensitivity (91%) and specificity (91%) for detecting clinically diagnosed VBI.