Barreto Renato Gonzaga, Yacovino Darío Andrés, Cherchi Marcello, Nader Saulo Nardy, Teixeira Lázaro Juliano, Silva Delice Alves da, Verdecchia Daniel Hector
Neurotology and Vestibular Rehabilitation, Clínica de Neurologia e Psiquiatria, São Paulo, SP, Brazil.
Otovestibular Section, Neurology Department, Hospital Dr. César Milstein, Buenos Aires, Argentina.
Int Arch Otorhinolaryngol. 2021 Aug 4;25(4):e602-e609. doi: 10.1055/s-0041-1736340. eCollection 2021 Oct.
Vestibular disorders (VDs) are highly prevalent in primary care. Although in general they comprise conditions that are not life-threatening, they are associated with significant functional and physical disability. However, the current coronavirus disease 2019 (COVID-19) pandemic has imposed limitations on the standard treatment of benign conditions, including VDs. In this context, other resources may aid in the diagnosis and management of patients with VDs. It is well known that teleconsultation and teletreatment are both safe and effective alternatives to manage a variety of conditions, and we maintain that VDs should be among these. To develop a preliminary model of clinical guidelines for the evaluation by teleconsultation of patients with suspected diagnosis of vestibular hypofunction during the COVID-19 pandemic and beyond. A bibliographic review of the diagnostic feasibility in VDs by teleconsultation was carried out in the LILACS, SciELO, MEDLINE, and PubMed databases; books and specialized websites were also consulted. The legal, regulatory, and technical issues involving digital consultations were reviewed. We found 6 field studies published between 1990 and 2020 in which the efficiency of teleconsultations was observed in the contexts of epidemics and environmental disorders and disadvantageous geographical conditions. After reviewing them, we proposed a strategy to examine and address vestibular complaints related to vestibular hypofunction. The creation of a digital vestibular management algorithm for the identification, counseling, initial intervention, monitoring and targeting of people with possible vestibular hypofunction seems to be feasible, and it will provide a reasonable alternative to in-person evaluations during the COVID-19 pandemic and beyond.
前庭疾病(VDs)在初级保健中非常普遍。虽然总体而言它们所包含的病症并不危及生命,但却与严重的功能和身体残疾相关。然而,当前的2019冠状病毒病(COVID-19)大流行对包括VDs在内的良性病症的标准治疗施加了限制。在这种情况下,其他资源可能有助于VDs患者的诊断和管理。众所周知,远程会诊和远程治疗都是管理各种病症的安全有效的替代方法,我们认为VDs也应包括在内。
为了制定一个初步的临床指南模型,用于在COVID-19大流行期间及之后通过远程会诊对疑似前庭功能减退的患者进行评估。
在LILACS、SciELO、MEDLINE和PubMed数据库中对通过远程会诊诊断VDs的可行性进行了文献综述;还查阅了书籍和专业网站。审查了涉及数字会诊的法律、监管和技术问题。
我们发现1990年至2020年间发表了6项实地研究,其中观察到在流行病、环境紊乱和不利地理条件的背景下远程会诊的效率。在对这些研究进行审查后,我们提出了一项策略,以检查和处理与前庭功能减退相关的前庭主诉。
创建一个数字前庭管理算法,用于识别、咨询、初始干预、监测和针对可能患有前庭功能减退的人群,这似乎是可行的,并且它将为COVID-19大流行期间及之后的面对面评估提供一个合理的替代方案。