DSpace Repository :: Browsing by Author "Breinbauer, Hayo"

Browsing by Author "Breinbauer, Hayo"

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A Chair-based Abbreviated Repositioning Maneuver (ChARM) for fast treatment of posterior BPPV
(2019) Michael, Pia; Muñoz, Daniel; Tuma, Anton; Gárate, Matías; Barraza, Cristian; Nuñez, Marcia; Breinbauer, Hayo
Purpose: To assess the effectiveness of a variation of the Epley maneuver, which we have titled "Chair-based Abbreviated Repositioning maneuver (ChARM)", in solving cases of benign positional paroxysmal vertigo (BPPV) of the posterior canal. ChARM addresses multiple issues of highly overloaded medical centers that delay its due and timely resolution. For example it does not necessitate an examination bed/table and requires only a backed chair, and less than 3 min to be performed. In combination with a recently published abbreviated diagnostic maneuver it can solve BPPV cases within few minutes of single medical visit. Methods: Patients being diagnosed with posterior BPPV by means of an abbreviated diagnostic maneuver were recruited. Immediately after diagnosis, a single attempt of ChARM was conducted. The patient was followed for 48 h and at 1 month after these procedures to assess the persistence of symptomatology. Results: 124 patients were treated with ChARM immediately after diagnosis during their very first medical visit. 92 patients (74.2%) solved their symptomatology completely after a single attempt of ChARM. The absence of symptoms persisted during the 30 days of follow-up. Discussion: ChARM showed high success rates in solving posterior BPPV. The entire diagnostic-treatment procedure takes less than 5 min to perform and may allow direct treatment of patients, thereby avoiding unnecessary referrals or full vestibular testing. These abbreviated tools may be particularly useful in primary care settings or heavily overloaded otolaryngology or neurology departments.
An abbreviated diagostic maneuver for posterior benign positional paroxysmal vertigo
(Frontiers Research Foundation, 2016) Michael, Pia; Estibaliz Oliva, Carolina; Nuñez, Marcia; Barraza, Cristian; Faundez, Juan; Breinbauer, Hayo
Introduction Benign 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). Methods A diagnostic assessment study was conducted in 163 patients who presented with vertigo or dizziness. Results The abbreviated test had fairly good sensitivity (80%) and high specificity (95%) for diagnosing posterior BPPV. Discussion This 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.
Central nystagmus and alterations in vestibular tests due to an inadvertent gentamicin administration into spinal space: A CARE case report
(2022) Breinbauer, Hayo; Eyzaguirre, M.; Herrero, D.; Delano, P.
Introduction Gentamicin has a well-known potential for damaging the peripheral vestibular organs. However, it is considered to be innocuous to the CNS as it crosses the blood-brain barrier poorly. Here, we describe central neuro-otological abnormalities developed by a patient after deployment of gentamicin into his spinal space. Case summary. A 61-year-old male unintentionally received gentamicin during spinal locoregional anesthesia for a urological procedure. During the first 48 hours the patient presented upper extremity dysmetria, dysarthria, and bilateral abducens nerve paralysis from which he recovered completely. He remained asymptomatic from day 3 to 10 after the incident. On day 11 he presented an acute vestibular syndrome. Severe bilateral vestibulopathy was confirmed by means of video head impulse testing. From day 14 onwards, he presented a persistent horizontal left-beating nystagmus, showing no variation or signs of compensation after 14 months, not responding to intensive vestibular rehabilitation or vestibular suppressant drugs. During follow-up, intercurrent gaze-evoked/direction-changing nystagmus has been recorded in various opportunities. Discussion We interpreted these findings as signs of both severe peripheral bilateral vestibulopathy and cerebellar and/or midbrain late-onset neurotoxicity, which can be explained by the intrinsic neurotoxic capability of high doses of gentamicin in the CNS.
Central nystagmus and alterations in vestibular tests due to an inadvertent gentamicin administration into spinal space: A CARE case report
(2021) Breinbauer, Hayo; Eyzaguirre, Magdalena; Herrero, Diego; Delano, Paul H.
Introduction : Gentamicin has a well-known potential for damaging the peripheral vestibular organs. However, it is considered to be innocuous to the CNS as it crosses the blood-brain barrier poorly. Here, we describe central neuro-otological abnormalities developed by a patient after deployment of gentamicin into his spinal space. Case summary : A 61-year-old male unintentionally received gentamicin during spinal locoregional anesthesia for a urological procedure. During the first 48 hours the patient presented upper extremity dysmetria, dysarthria, and bilateral abducens nerve paralysis from which he recovered completely. He remained asymptomatic from day 3 to 10 after the incident. On day 11 he presented an acute vestibular syndrome. Severe bilateral vestibulopathy was confirmed by means of video head impulse testing. From day 14 onwards, he presented a persistent horizontal left-beating nystagmus, showing no variation or signs of compensation after 14 months, not responding to intensive vestibular rehabilitation or vestibular suppressant drugs. During follow-up, intercurrent gaze-evoked/direction-changing nystagmus has been recorded in various opportunities Discussion : We interpreted these findings as signs of both severe peripheral bilateral vestibulopathy and cerebellar and/or midbrain late-onset neurotoxicity, which can be explained by the intrinsic neurotoxic capability of high doses of gentamicin in the CNS.
Functional Dizziness as a Spatial Cognitive Dysfunction
(2024) Breinbauer, Hayo; Stecher, Ximena; Zamorano, Francisco; Billeke, Pablo; Arévalo, Camilo; Villarroel, Karen; Lavin, Claudio; Faúndez, Felipe; Garrido, Rosario; Alarcón, Kevin; Delano, Paul
(1) Background: Persistent postural-perceptual dizziness (PPPD) is a common chronic dizziness disorder with an unclear pathophysiology. It is hypothesized that PPPD may involve disrupted spatial cognition processes as a core feature. (2) Methods: A cohort of 19 PPPD patients underwent psycho-cognitive testing, including assessments for anxiety, depression, memory, attention, planning, and executive functions, with an emphasis on spatial navigation via a virtual Morris water maze. These patients were compared with 12 healthy controls and 20 individuals with other vestibular disorders but without PPPD. Vestibular function was evaluated using video head impulse testing and vestibular evoked myogenic potentials, while brain magnetic resonance imaging was used to exclude confounding pathology. (3) Results: PPPD patients demonstrated unique impairments in allocentric spatial navigation (as evidenced by the virtual Morris water maze) and in other high-demand visuospatial cognitive tasks that involve executive functions and planning, such as the Towers of London and Trail Making B tests. A factor analysis highlighted spatial navigation and advanced visuospatial functions as being central to PPPD, with a strong correlation to symptom severity. (4) Conclusions: PPPD may broadly impair higher cognitive functions, especially in spatial cognition. We discuss a disruption in the creation of enriched cognitive spatial maps as a possible pathophysiology for PPPD
Music Therapy for Pain and Anxiety Management in Nasal Bone Fracture Reduction: Randomized Controlled Clinical Trial
(2019) Ortega, Alvaro; Gauna, Felipe; Munoz, Daniel; Oberreuter, Gerardo; Breinbauer, Hayo; Carrasco, Loreto
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 preprocedural, intraprocedural and postprocedural periods of the intervention. Physiological variables (blood pressure and heart rate) were measured. An anxiety survey (STAI) and the visual analog scale (VAS) for measuring pain were also applied. Results: The music group exhibited significantly lower levels of systolic blood pressure (p = 0.0001), anxiety (p<0.0001) and pain (p = 0.0004) 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 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 as 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.
Musicoterapia y otorrinolaringología
(2023) Alarcón P., Kevin; Breinbauer, Hayo
La musicoterapia es el uso profesional, planificado y estructurado de la música como intervención terapéutica, con el objetivo de mejorar la salud y calidad de vida del paciente o el grupo intervenido. Esta herramienta se basa en la evidencia de efectos neuroplásticos, psicológicos y cognitivos de la música en las personas. En las últimas décadas se ha encontrado evidencia de múltiples beneficios de musicoterapia como tratamiento adyuvante en medicina, entre ellos se destacan: reducción del dolor en enfermedades crónicas, oncológicas, procedimientos quirúrgicos y trabajo de parto, disminución de síntomas depresivos y ansiosos en trastornos del ánimo y demencia, mejoría de la sincronización motora y perceptiva en enfermedad de Parkinson, entre otros. La otorrinolaringología se ha establecido, asimismo, como un nicho plausible para musicoterapia. Actualmente existen numerosas líneas de investigación que se han dedicado a generar evidencia científica en torno a musicoterapia y su utilidad en diversos campos de la especialidad; esta revisión pretende recopilar y analizar dicha evidencia. Los resultados obtenidos en los diferentes estudios sugieren, con evidencia de calidad baja a moderada, que existen beneficios significativos en la utilización de esta herramienta en el tratamiento multimodal de tinnitus, manejo del dolor y ansiedad en procedimientos médico-quirúrgicos, y en la rehabilitación de pacientes con hipoacusia e implantes cocleares. Si bien se ha encontrado que la música es una modalidad terapéutica segura, barata y con beneficios que parecen ser prometedores, se requieren más estudios clínicos de buena calidad y validez para recomendar el uso de musicoterapia en otorrinolaringología.
Síndrome de nistagmo vertical hacia abajo: Reporte de 2 casos y revisión de la literatura
(Sociedad Chilena de Otorrinolaringología, Medicina y Cirugía de Cabeza y Cuello, 2016) Sotomayor, Daniel; Breinbauer, Hayo
Downbeat nystagmus syndrome (DBN) is a frequent form of acquired fixation nystagmus, it presents with persisting nistagmus with fast phases directed downward, dizziness, oscillopsia and gait disturbances. It is considered a vestibulocerebellar disorder due to a bilateral defect of the Purkinje cells in the cerebellar flocculus. Most reported causes are degenerative disorders of the cerebellum and cerebellar ischemia, nevertheless the etiology remains unknown in a large percentage of patients (idiopathic form). DBN may present in a broader context of somatosensory neuropathy and cerebellar ataxia as in CANVAS syndrome. Therapeutic measures includes avoiding the supine and prone position when resting, vestibular rehabilitation, and pharmacologic treatment with aminopyridines, among others. In this article we present two cases of DBN and review of literature.
Spatial Navigation Is Distinctively Impaired in Persistent Postural Perceptual Dizziness
(Frontiers Research Foundation, 2020) Breinbauer, Hayo; Contreras, María Daniela; Lira, Juan Pablo; Guevara, Claudia; Castillo, Leslie; Ruëdlinger, Katherine; Muñoz, Daniel; Délano, Paul
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.
Variability of an ideal insertion vector for cochlear implantation
(American Otological Society, American Neurotology Society and European Academy of Otology and Neurotology, 2015) Breinbauer, Hayo; Praetorius, Mark
HYPOTHESIS: Based on a three-dimensional analysis, the orientation of the basal turn of the cochlea, the disposition of the basilar membrane, and the characteristics of the hook region--all of which determine the ideal electrode insertion vector during cochlear implantation--might vary among individuals to a greater degree than previously considered. The aim of this study is to assess the variability of an ideal insertion vector among a sample of surgical candidates from a purely anatomical perspective as well as from a more intraoperative-surgical perspective. BACKGROUND: During cochlear implantation through a cochleostomy or round window approach, the angle or vector of insertion after the first entry point seems to be related to intracochlear damage, which might correlate with anatomical and functional features. METHODS: Three-dimensional reconstructions of the temporal bones of 50 cochlear implant candidates (a total of 100 ears) were assessed. The spatial orientation of an ideal insertion vector for a cochleostomy and a round window approach were estimated. RESULTS: A difference as great as 60 degrees was observed for an ideal insertion vector among the subjects. From an intraoperative perspective, this variability involves pushing the electrodes "as near to the buttress" or "as near to the emergence of the corda tympani" as possible, depending on the case. CONCLUSION: 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.
Vertigo and dizziness in the elderly
(Frontiers Research Foundation, 2015) Fernández, Lara; Breinbauer, Hayo; Hinckley, Paul
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.

Browsing by Author "Breinbauer, Hayo"

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