BrazJOtorhinolaryngol.2015;81(2):117---119
www.bjorl.org
Brazilian
Journal
of
OTORHINOLARYNGOLOGY
EDITORIAL
Do
hearing
and
postural
balance
influence
the
life
quality?
夽
Audic
¸ão
e
equilíbrio
corporal
influenciam
a
qualidade
de
vida?
The theme for this editorialhas derived fromthelecture withthesametitlegivenbytheauthorofthistexton invi-tationbyaschoolofYogaMeditationforatargetaudience ofadultsandelderlypeople.Theproposedapproach, moti-vatedbytheinterestofthegeneralpublic,hasbeenlinked todisorders of hearing, labyrinthitis andthe influence of theseconditionsonqualityoflife.
Inthefirstpartofthelecture,wedescribedsomeofthe anatomicophysiologicalaspectsoftheauditoryand periph-eralandcentralvestibularsystem,aboutbodybalanceand the integration of sensorysystems in the central nervous systemandformedconnections.Morefrequentauditoryand vestibulardisordersinadultsandtheelderlyalongwiththeir clinical andotoneurologicmanifestationswerepresented, andit wasdecidedthat BenignParoxysmal Positional Ver-tigowouldbemoreemphasized,indetrimentofmetabolic andcardiovasculardisorders.Hereinafter,Healthand Qual-ityofLifeanditsfieldsofanalysis,accordingtotheWorld HealthOrganization(WHO),areconceptualized.According to WHO, Health is ‘‘a complete state of physical, men-tal and social well-being, and not merely the absenceof disease’’. Quality of Life is defined by the WHO’s Mental Health group asthe individuals’ perception of their posi-tion in life, in the context of culture and value systems inwhich theyliveandin relation totheirgoals, expecta-tions, standards and concerns. Quality of life is affected by physical and psychological states, the level of inde-pendence, social relationships and by personal beliefs of individualsandtheirrelationshipwiththeenvironment.1In
thelasttopicof thelecture,pharmacologicaltreatments, vestibularrehabilitation andcomplementarytherapies for vestibular disorders, including exercise, nutrition educa-tion, and control of underlying diseases were cited, and
夽
Please cite this article as: Isaac ML. Do hearing and
pos-turalbalanceinfluencethelifequality? Braz JOtorhinolaryngol.
2015;81:117---9.
theaudienceshowedinterest,expressedbyquestionsabout measures, such as meditation, acupuncture and Tai Chi Chuan.
Withregardtohearing,itisknownthat,inadultsand2
intheelderly,qualityoflifemaybeimpaired whenthere ishearingloss,duetothedifficultyofcommunicationand topsychologicalandsocialrelationshipcommitments,often resultinginsocialisolation.Thisthemehasbeenevaluated throughtheapplicationofqualityoflife(and,specifically, qualityof liferelatingtohealth)protocols,some ofthem already translated and validated for the Portuguese lan-guage.Besides hearing loss,tinnitus canalsocompromise thequalityoflife,dependingonitsintensity,whichcanbe aggravatedby stresstriggered bythisproblem inpatients alreadypsychologically predisposed,that can trigger psy-chosomaticmanifestations.Theuseofhearingaids3canlead
toanimprovedqualityoflife,3,4thankstotheamplification,
andtotinnitusreduction4;ontheotherhand,manypatients
abandon the use of hearing aids due to an unsuccessful adaptation,2,5 or to barriers to the use of these devices,
such as access, cost, social embarrassment and auditory training.6
Dizziness and vertigo are common complaints among adultsandelderlypatients,withmultifactorialcauses,and especiallyintheelderly, duetotheassociation ofchronic diseases and the concomitant use of several drugs that can affect the functions of the vestibular system. These clinical manifestations can lead to an impaired quality of life in relation to physical, functional and emotional aspects.7---9
InabibliographicsearchinPUBMED,crossingthewords ‘‘vertigo’’and‘‘dizziness’’with‘‘qualityoflife’’,articles linkingthesesymptomstovestibulardiseasein adultsand tofallsinolderadultshavebeenfound;aswellasarticles linking them to psychosomatic disorders interacting with vestibulardisorders,orfunctioningastriggeringfactors10,11;
andtostress,anxietyanddepression.Anxietymustbetaken intoaccount,either asatriggering or predisposingfactor,
http://dx.doi.org/10.1016/j.bjorl.2014.12.005
1808-8694/©2014Associac¸ãoBrasileirade OtorrinolaringologiaeCirurgiaCérvico-Facial.Published byElsevierEditoraLtda.Allrights
118 EDITORIAL
being already an integral part of the subjectivity of the patient with vertigo. Vertigo may worsen with the crisis ofbody instability. Anxiety can raisethe Dizziness Handi-capInventoryonallscales.12Psychosomaticandpsychiatric
comorbiditiesmaybe moreprevalentin womenwith ver-tigo,comparedwithhealthyindividuals.13
Currently,severalfactorshave generated anxiety,such asthegreatexposuretoinformationandtherapidchange intechnologytowhichpeoplemustadapt;mentalpressures intheworkplace,eventothepointofmentalharassment; changesinsocialvaluesthat,accordingtothesubjectivityof theindividual,canleadtopsychosomaticdisorders accom-paniedbyvertigoanddecreasedqualityoflife.Asystematic reviewofvertigoandpsychotherapyshowedclear prelimi-narysignsthatpsychotherapycanbeeffective inpatients withvertigothatisnotclinicallyexplainedenoughorwhich arisesfromapsychiatricdisorder.14
Currently,psychological factorsareacceptedas stress-orsand can causesignificant behavioral and physiological changes.15 This also leads to a reflection in the opposite
direction to the title of this editorial: Do quality of life affectshearingand balance?Inadditiontovestibular dis-orders,more frequent cases of functional or psychogenic deafnessinindividualsunderstress,anxietyanddepression havebeenobservedintheclinicenvironment.
With regard to general or individualized therapeutic strategies used in the treatment of vestibular disorders excluded in this scenario of pharmacological and surgical therapies,wehavethecontrolofsystemicdiseases; vesti-bularrehabilitation,exerciseanddietarycontrol.
Intheagegroupinwhichvertigoordizzinessaremore frequent,highbloodpressureandcardiovasculardiseaseare increasinglycommon,duetothestresscausedbychanges inlifestylegeneratedbyglobalizationandmodernity.Some studies mentiontechniques of meditation as complemen-tarytherapyinthemanagementofthoseclinicalconditions describedabove.Thesetechniqueshavebeenshowing pos-itive results, as they work on breathing and postures, andmay leadto physical andmental well-being and pro-mote harmony. Although there is already some evidence in favor of the above results, more rigorous studies with moreappropriatestatistical analysesareneeded, evento verify the role played by multiple concomitant interven-tions.Therearealsostudiesontheeffectsofmeditationin reducingstressandanxietyandincardiovasculardiseases, showing favorable results proven even by fMRI. How-ever, further randomized studies with largersamples are needed.16
Regarding acupuncture,a technique of traditional Chi-nese medicine, this option has been applied in various clinical scenarios in many hospitals for the control of severalsymptoms.For severalyearsin Hospital das Clíni-cas,FaculdadedeMedicinadeRibeirãoPreto(USP),many patientswithotoneurologicaldisordershavebeen treated withacupunctureasadjunctivetherapy,withimprovement ofsymptomsbeingnoted.Thispracticeoccursnexttoone ofourOtologyoutpatientclinicsandhasalreadygenerated aMasterthesis,inadditiontoadatacollectionprocedure indevelopmentofadoctoraldissertation.
Weshouldalsokeepinmindthatbalancederives from theinteractionofvestibular,proprioceptiveandvisual path-ways,whoseinformationisconveyedtothecentralnervous
system for balance processing and control. Furthermore, thesepathwayshaveanatomicophysiologicalcomplexityin interconnectionswithsupratentorialcentersrelatedto cog-nition and emotions, besides other aspects, as has been shownbyNeuroscienceresearch.
Studiesinvolvingneuroplasticitywillbeincreasingly cru-cialandwillbringforwardbenefitstoacomprehensionof vestibular compensation, resulting in the development of therapeutic tools involving all sensory areas of balance, in association with different techniques that can relieve anxiety and stress, conditions increasingly present in the modern world. Pieces of evidence have revealed CNS as a dynamic and functional organ, which is interconnected with the environment withplastic capacity, and that can undergostructuralandfunctionalchangescausedby adap-tiveprocessesinfaceoftheenvironment.Thisconception canleadtothepromotionofpreventivemeasuresforhuman health and education,aswell asitsdysfunctions, helping in diagnosis, prognosis andselection of more appropriate therapies.15
Itisknownthat,indizzinessand/orimbalancepatients’ care,thediagnosisdependsonacarefulhistory,17on
appro-priate otoneurological tests18 and onclinical and imaging
tests,whenindicated.17
Thesereadingsonbalanceandqualityoflifeandonthe roleplayedbypatient’ssubjectivityledtoareflection: cur-rently,arewepayingattentiontotheanamnesis,thefirst stage of classical otoneurological assessment, to charac-terize signs andsymptoms;tothe assessment of personal characteristics and lifestyle of the patient,his/her social background, environmental factors, attitudes, emotions, thoughts, motivations, values, beliefs? ‘‘In dealing with ourpatients,arewebeingcorrect,prudent,attentive?’’.I repeatthisquestionposedbyFernandoGananc¸a,ABORLCCF President,inhismessagetoRevistaVoxOtorrino.19
Are we open to new multidisciplinary treatments and complementary therapies for the improvement of our patients?Arethedesiresandautonomyofthepatientbeen takenintoaccount,accordingtotheCodeofMedicalEthics, whenturningtoothertherapeuticmethodsforrecoveryof his/herwell-being?
Whatdowe knowabout acupuncture andexerciseand relaxationpractices---amongother,MeditationandTaiChi Chuan,thelatteralreadyhavingsomeevidenceinfavorof thecontroloffallsintheelderly?
Itisknownthatmorerandomizedstudiesontheseissues areneeded,butareassuchasCardiology,Neuroscience, Psy-chiatry,andGeriatricshavealreadyfoundevidenceofthe roleof meditation inthe welfareof the individualand in anxiety and blood pressurecontrol, with improvement of certainclinicalconditions.
The search for new avenues toimprove the quality of lifeshouldbeagoalnotonlyinbehalfofourpatients,but mostlyforeachofus.
Whatare we doingto ourphysical, mental, emotional balance?Areweseeingourselvesasabodyinparts,orasa whole?
EDITORIAL 119
Conflicts
of
interest
Theauthordeclaresnoconflictsofinterest.
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