Audiological profile and handicap levels in people with vestibular disorders at Centro Equilibra, Vértigo and Equilibrio, San José, Costa Rica

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A) Type I tympanic glomus. B) Type II tympanic glomus. C) Congenital cholesteatoma. D) Neurinoma of the tympanic cord." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Francisco Larrosa, Nesly González-Sánchez, Joan Remacha, Marta Sandoval, Manuel Bernal-Sprekelsen" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Francisco" "apellidos" => "Larrosa" ] 1 => array:2 [ "nombre" => "Nesly" "apellidos" => "González-Sánchez" ] 2 => array:2 [ "nombre" => "Joan" "apellidos" => "Remacha" ] 3 => array:2 [ "nombre" => "Marta" "apellidos" => "Sandoval" ] 4 => array:2 [ "nombre" => "Manuel" "apellidos" => "Bernal-Sprekelsen" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573522000783?idApp=UINPBA00004N" "url" => "/21735735/0000007300000005/v1_202209140708/S2173573522000783/v1_202209140708/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Audiological profile and handicap levels in people with vestibular disorders at Centro Equilibra, Vértigo and Equilibrio, San José, Costa Rica" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "271" "paginaFinal" => "278" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Adriana Chacón Rodríguez, Jorge Antonio Jiménez Gómez, Mónica Dávila Rojas" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Adriana" "apellidos" => "Chacón Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Jorge Antonio" "apellidos" => "Jiménez Gómez" "email" => array:1 [ 0 => "jorge.jimgo@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Mónica" "apellidos" => "Dávila Rojas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Licenciada en Audiología de la Universidad de Costa Rica, Centro Equilibra, Escazú, San José, Costa Rica" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Licenciado en Audiología de la Universidad de Costa Rica, Centro Equilibra, Escazú, San José, Costa Rica" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Médica especialista en Otorrinolaringología con subespecialización en vértigo y rehabilitación funcional de los trastornos del equilibrio de la Universidad de París, France. Centro Equilibra, Escazú, San José, Costa Rica" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Perfil audiológico y grados de discapacidad en las personas con alteraciones vestibulares pertenecientes a la consulta del Centro Equilibra, Vértigo y Equilibrio, San José, Costa Rica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 939 "Ancho" => 1508 "Tamanyo" => 81582 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Percentages according to type of hearing loss. Mod: moderate; prof: profound; sev: severe. Compiled by the authors, 2020." ] ] ] "textoCompleto" => "IntroductionVestibular disorders are defined as disturbances originating in the vestibular system and encompass diseases that affect both the vestibular system and its connections, including brainstem, cerebellum, subcortical structures, and vestibular cortex. Therefore, dysfunction in any of these structures, whether primary or secondary, can adversely affect balance.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> They are estimated to affect 20%–30% of the world’s population, with a prevalence of approximately 5% in adults and a total annual incidence of 5%–10%.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Depending on the disorder diagnosed, individuals may present with audiological manifestations such as tinnitus and hearing loss in isolation, or accompanying symptoms of vestibular manifestations.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> The audiological profile in Ménière’s disease has been extensively described thanks to the abundant studies that describe and characterise the condition, which has provided broad understanding of the auditory and vestibular involvement in the disease process.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> In contrast, the audiological profile in disorders such as vestibular migraine, vestibular neuritis, and benign paroxysmal positional vertigo (BPPV) shows almost no auditory involvement, and if it does exist, it presents as isolated symptoms of the condition.<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a>According to the World Health Organisation,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> between 5% and 6% of the world's population suffers from disabling hearing loss, which is one of the sensory deprivations of greatest impact on the sufferer’s communication process, limiting their activities of daily living and affecting their role in society.In Costa Rica, according to data from the National Institute of Statistics and Censuses,<a class="elsevierStyleCrossRef" href="#bib0040">8</a> in the 2011 census, of the 4,301,712 registered inhabitants, a total of 70,709 people had impaired hearing, most aged between 40 and 75 years. However, no data or figures are reported for vestibular disorders in the country to indicate the number of sufferers.Due to this lack of epidemiological research to determine the onset of auditory manifestations together with vestibular disorders in Costa Rica, the main objective of this study was to characterise the audiological profile and degrees of disability in people with vestibular disorders attending the Equilibra, Vertigo and Equilibrium Centre from September to November 2019.Material and methodsThis is a descriptive, cross-sectional, quantitative, and observational-analytical study of patients with vestibular disorders attending the Equilibra, Vertigo and Equilibrium Centre. The Equilibra Centre is a private clinic specialising in the diagnosis, treatment, and rehabilitation of patients with vestibular disorders, in the city of San José, capital of Costa Rica. Patients come directly or are referred by other doctors, and because it is one of the few specialist centres it receives patients from all over the country. Each patient attending the Centro Equilibra during the study period underwent a vestibular evaluation by the clinic’s ENT specialist subspecialising in vertigo and functional rehabilitation of balance disorders. After the vestibular assessment for which they came to the centre, they were asked to participate in the study.The inclusion criteria were people over 18 years of age with vestibular disorders, and the exclusion criteria ruled out patients with physical or psychological problems that limited their ability to respond autonomously and voluntarily, those who did not want to undergo hearing evaluation tests, and individuals who were not residents of Costa Rica.All the subjects voluntarily signed an informed consent form in accordance with the international ethical principles of beneficence, non-maleficence, autonomy, and justice, necessary to conduct biomedical research on human subjects, to demonstrate a commitment to their personal information and the institution where the research was conducted. Both the study and the informed consent were approved by the Scientific Ethical Committee of the University of Costa Rica.The following data were collected from each participant by taking their history: age, sex, personal pathological history, and primary vestibular symptoms, as described in the International Classification of Vestibular Disorders of the Bárány Society,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> i.e., vertigo, dizziness, vestibulo-visual symptoms, and postural symptoms (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The vestibular assessment included a medical history aimed at identifying and classifying primary vestibular symptoms, a clinical vestibular assessment including eye movements, assessment of spontaneous nystagmus with and without fixation, positional nystagmus, direction-changing positional nystagmus, head-shake test, vibration-induced nystagmus at 100 Hz (SYNAPSYS® VVIBF3 vestibular vibrator), all of the above assisted by SYNAPSYS® Nystagview digital video equipment. Vestibular function was measured with a video-assisted cephalic impulse test with OTOMETRICS ICS Impulse vHIT equipment. Where necessary, computerised dynamic posturography testing (sensory organisation test, motor control test, adaptation test, and limits of stability) was performed with a Neurocom Smart Equitest posturograph. The diagnostic criteria of the Barany Society<a class="elsevierStyleCrossRefs" href="#bib0005">1,4,5</a> were used, except those for presbyvestibulopathy, which were published when the study was underway (September 2019).Tone audiometry and speech audiometry were used to assess hearing function. The parameters for hearing loss established by the American Speech-Language-Hearing Association (ASHA)<a class="elsevierStyleCrossRef" href="#bib0045">9</a> were used to analyse the degree of hearing loss (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Acuphenometry was also performed, which evaluates the psychoacoustic characteristics of tinnitus, such as: intensity, frequency and residual inhibition (this occurs after a masking noise is presented that acts as a suppressor, and once the stimulus is removed, a change occurs in the tinnitus, eliminating it completely or reducing its intensity for a few seconds; when the tinnitus is completely cancelled, it is called total inhibition; if it only reduces in intensity, it is called partial inhibition, and if does not change, it is known as negative inhibition).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>A MAICO MA41 brand audiometer was used for the above tests, with TDH39 airway transducers, a B-71 bone transducer, and a soundproof audiometric booth made in Costa Rica by the company JR Sánchez Audiología, which meets the acoustic parameters necessary to perform the audiometric studies.Questionnaires were also used to quantify the perceived degree of disability in relation to hearing loss: the Hearing Handicap Inventory for Adults (HHIA) and the Hearing Handicap Inventory for the Elderly (HHIE);<a class="elsevierStyleCrossRefs" href="#bib0050">10,11</a> in relation to tinnitus, the Tinnitus Handicap Inventory (THI),<a class="elsevierStyleCrossRef" href="#bib0060">12</a> and in relation to dizziness or vertigo, the Dizziness Handicap Inventory (DHI).<a class="elsevierStyleCrossRef" href="#bib0065">13</a> The modified Spanish version was used in each case.All the audiological tests and questionnaires were undertaken by two final year students of the Audiology degree course at the University of Costa Rica, as a final graduation project, endorsed and supervised by the clinic’s ENT doctor.All the data were compiled in Microsoft Excel version 2015, and once collected and tabulated, they were processed using SPSS version 23, generating outputs of values such as: mean, median and mode, frequency distributions, estimation of frequencies and percentages, and cross-references of variables (sex, age, place of residence, type of hearing loss, type of vestibular alteration). Pearson’s χ2 statistical test was used to analyse the information collected, to analyse the relationship of independence and/or dependence between two variables, obtaining a p-value (hypothesis test), understanding that, if this value is less than 0.05, the research hypothesis is accepted that there is a relationship between the variables analysed.<a class="elsevierStyleCrossRef" href="#bib0070">14</a>ResultsDuring the study period, 177 people with vestibular disorders were assessed, ranging in age from 19 to 91 years; the average age of the population was 56 years, and the distribution by sex was 72% female and 28% male. The statistical analysis shows that some variables such as sex and age are not a risk factor for vestibular disturbance, hearing loss or tinnitus, which indicates that it can occur in both sexes equally and at any time in a person’s life.Most (66%) had at least one metabolic disease (a term used arbitrarily to group diseases related in varying degrees to different metabolic disorders), 40% had arterial hypertension, 32% dyslipidaemia, 18% thyroid dysfunction, and 11% reported diabetes. From the bivariate analysis performed (Pearson's χ2 test), with the variables of: metabolic diseases and primary vestibular symptoms (dizziness, vertigo, vestibulo-visual symptoms, and postural symptoms), a p-value > 0.05 value was obtained, which proves that for this particular population there is no statistically significant association between the variables analysed, establishing that the presence of a history of these disorders does not constitute a risk factor for primary vestibular symptoms.The most common medical diagnosis was vestibular migraine (28.2%) and BPPV (28.2%), followed by anxiety disorder (9.6%), Ménière's disease (9%), unilateral vestibular hypofunction (7.9%), bilateral vestibular hypofunction (6.2%), and other diagnoses (20.3%), such as: inactive BPPV, unsteadiness, central positional vertigo, vestibular paroxysmia and panic attacks.The most frequent primary vestibular symptom seen in the clinic was vertigo (85.3%), followed by postural symptoms (63.8%), dizziness (33.9%), and vestibulo-visual symptoms (11.3%) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). The most prevalent secondary vestibular symptom was vertigo triggered by positional changes (49%); it was unsteadiness for postural symptoms (89%); for dizziness it was spontaneous dizziness (58%), and for vestibulo-visual symptoms the most prevalent was motion-induced blurred vision (70%).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>With regard to the hearing of people with vestibular impairment included in this study, the pure tone average (PTA) of the speech frequencies 500 Hz, 1000 Hz, and 2000 Hz (PTA 512) of the right ear assessed by pure-tone audiometry was 20.63 dB HL, and therefore the right ear can be defined as having mild hearing loss according to the ASHA<a class="elsevierStyleCrossRef" href="#bib0045">9</a> criteria. For the left ear, the PTA 512 was 18.84 dB HL, indicating that the left ear also had slight hearing loss according to ASHA<a class="elsevierStyleCrossRef" href="#bib0045">9</a> criteria.Of the population, 46.3% presented peripheral hearing within the normal range according to the PTA 512; however, only 27.1% presented a completely flat audiometric curve (corresponding to perfect hearing); the remaining 19.2% had some drop at high or low frequencies, either unilaterally or bilaterally.The prevalence of hearing loss was 53.7%; 20.9% was unilateral and 32.8% was bilateral. Sensorineural hearing loss was found in 93.5%, mixed hearing loss in 14.4% and there were no cases of conductive hearing loss.Most of the patients had slight hearing loss (49.7%), followed by moderate loss (24.8%), with lower percentages of the remaining degrees of hearing loss (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The most common audiometric profile was gradually descending (51%); flat curve (17.6%), high frequency drop (13.1%), inverted (7.8%), in the vessel (7.2%), Fuji Yama (1.3%), auditory remnants (1.3%) and cophosis (0.7%) configurations were also found in lower percentages).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Although the primary vestibular symptoms were accompanied by auditory manifestations (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>), statistical analysis showed that the presence of hearing impairment was directly related to the metabolic profile of the population studied and not to the vestibular disorders. Therefore, the auditory manifestations relate to the profile of the population studied and not to vestibular disorders.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>According to the percentages of auditory discrimination obtained in the speech audiometry, the patients with normal hearing presented an average discrimination of 100%, whereas the population with hearing loss presented 90% in both ears.Of the population, 33.9% reported tinnitus: 70% unilateral and 30% bilateral. The most common frequency was 8000 Hz, in 41%, and 49% presented partial and 33% total residual inhibition.According to the HHIA questionnaire, 52% reported a degree of perceived disability, while in the HHIE, 23% of older adults reported impaired hearing. For the THI, 37% reported a slight degree of hearing disability and 34% a mild degree of disability. Finally, in the IHD, 87% of the total population presented disability due to their vestibular impairment. The physical (83%) and functional (51%) subscales were the most affected.DiscussionIn this study, the mean age of the people with vestibular disorders was 56 years, the female sex was most affected (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>), at a female-to-male ratio of 2.6:1, similar information to other studies.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> Most of the patients evaluated had concomitant metabolic diseases, but the most frequent were arterial hypertension and dyslipidaemia, as in the 2013 study by Castro and Braga.<a class="elsevierStyleCrossRef" href="#bib0010">2</a><elsevierMultimedia ident="tbl0025"></elsevierMultimedia>According to medical diagnoses, BPPV and vestibular migraine were the most frequent in the study population (28.2% each), data that are similar to other studies;<a class="elsevierStyleCrossRef" href="#bib0080">16</a> in terms of primary vestibular symptoms, a greater presence of vertigo (85.3%) and postural symptoms (63.8%) was observed, results similar to the research by Jalil et al. <a class="elsevierStyleCrossRef" href="#bib0085">17</a> in 2014 and Sacconi et al.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> in 2016.The following are the results from the data analysed in the hearing averages of the entire population evaluated: a right and left ear with slight hearing loss according to the PTA 512 and the ASHA<a class="elsevierStyleCrossRef" href="#bib0045">9</a> classification; it should be noted that at the high frequencies there is slight impairment compared to the low and medium frequencies; this same configuration is presented in the study by Rodríguez,<a class="elsevierStyleCrossRef" href="#bib0095">19</a> showing a gradually descending drop at the high frequencies in both ears.It can also be observed that in both studies there is slightly greater deterioration in the right ear than the left, the information collected coincides with that of Rodríguez.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> We would add that the latter study has 217 patients and the present 177, with a difference of only 40 people.The prevalence of hearing loss was 53.75%; 45.8% for the right ear and 40.7% for the left. This information is similar to the 2006 study by Torre et al.,<a class="elsevierStyleCrossRef" href="#bib0100">20</a> where there was a prevalence of hearing loss in 57.6% of the population. It is also important to note that from the age of 50 years onwards the patients evaluated had increased hearing loss.The study by Sacconi et al.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> found that the most common audiometric profile was the high-frequency drop, at 70% of all patients with hearing loss, with lower percentages observed in flat curves, bell, low, and u-shaped drop, which is consistent with this research study. It also suggests that many studies of this type do not detail the normal hearing parameters used, which is of utmost importance in detecting early hearing loss. It is important to highlight that only 27.1% of the population presented peripheral hearing within the normal range, which is consistent with the literature.<a class="elsevierStyleCrossRef" href="#bib0090">18</a>Abreu et al.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> found that more than 70% of the sample in their study had mild to moderate sensorineural hearing loss, with a slightly descending audiometric configuration towards the high frequencies; this is corroborated in the present study.Because there was no direct relationship between hearing manifestations and vestibular symptoms (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>), the hearing loss present in the majority of the population could have developed gradually in each individual due to external factors, and only a small percentage is due to vestibular disorders, such as Ménière's disease. Due to the audiometric characteristics of this population, slight hearing loss was the most prevalent, consistent with 37.8% being unaware of their hearing diagnosis.The percentage of patients with tinnitus (33.9%) is similar to that found in the literature, and the frequencies affected are consistent with the audiometric profile found most in the hearing loss population.<a class="elsevierStyleCrossRefs" href="#bib0090">18,19</a> The residual inhibition test showed encouraging results, with 49% showing partial residual inhibition, implying that almost half of the tinnitus patients responded well to this masking technique, resulting in decreased tinnitus perception. This indicates that this group may benefit from treatment or therapy that includes an external masking device.<a class="elsevierStyleCrossRefs" href="#bib0110">22,23</a>Statistical analysis shows that vestibular symptoms are not related to the presence of concomitant metabolic diseases. However, a significant relationship was established between concomitant metabolic diseases and hearing impairment, and therefore the audiological profile of the participants in this study is related to metabolic diseases and not to the presence of a vestibular disorder.According to the HHIA, 52% of the population with hearing loss had some degree of perceived hearing disability, the most frequent being mild to moderate impairment at 29%. Similar results are found in other studies, where 32% of the population studied had a perception of mild to moderate disability.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> Of the older adult population with hearing loss in whom the HHIE was used, 77% did not perceive hearing impairment, while those who did (14%) had a mild to moderate degree. Similar results are found in other studies, where 82% of the population had no disability and only 17% did, with a significant difference between the two groups.<a class="elsevierStyleCrossRef" href="#bib0120">24</a>The degrees shown in the results of the THI indicate that most patients manage to live with their tinnitus. Similar results are shown in other studies, where 26% of the population is reported to have mild to moderate disability.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> Finally, from the results of the DHI, disability was present in 87% of people, and physical disability was the subscale with the highest prevalence. These results are related to the data collected by Ceballos and Vargas<a class="elsevierStyleCrossRef" href="#bib0125">25</a> in 2004, who found that physical disability was present in 82% of the population, while functional disability was present in 55%, and emotional disability in 48%.ConclusionsThe most frequent medical diagnoses for people with vestibular disorders were BPPV and vestibular migraine. The most common vestibular symptom in these patients was vertigo. Hearing loss was the most common auditory manifestation, and although statistical analysis shows that it is not directly related to vestibular disorders, it is related to concomitant metabolic diseases. Therefore, prevention of metabolic diseases should be promoted as a measure to improve hearing health, even from an early age. In addition, gradually descending mild sensorineural hearing loss was the audiological diagnosis with the highest percentages. The disability perceived most frequently was due to vestibular disorders.FundingThis research study received no specific support from public sector agencies, commercial sector, or non-profit organisations.Conflict of interestsMónica Dávila Rojas is founder and director of Centro Equilibra.Adriana Chacón Rodríguez and Jorge Antonio Jiménez Gómez have no conflict of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1770559" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1555553" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1770558" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1555554" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 11 => array:2 [ "identificador" => "xack625452" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-06-22" "fechaAceptado" => "2021-04-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1555553" "palabras" => array:4 [ 0 => "Vestibular disorder" 1 => "Hearing loss" 2 => "Tinnitus" 3 => "Handicap inventory" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1555554" "palabras" => array:4 [ 0 => "Alteración vestibular" 1 => "Hipoacusia" 2 => "Acúfeno" 3 => "Inventario de discapacidad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Background and objectiveVestibular disorders are linked to a group of pathologies that can affect the vestibular part, the auditory part, or both parts of the inner ear. The problem in this study is the little information that exists about the audiological profile of people suffering from vestibular disorders in Costa Rica. There are international research studies on this topic, but there are no records of studies conducted in the Costa Rican population. This is why there is interest in developing this research which aims to characterize the audiological profile and the levels of handicap in people with vestibular disorders under Centro Equilibra, Vertigo and Equilibrio consultation during the months of September to November 2019. Patients and methodsA descriptive, cross-sectional, quantitative, and observational analytical study with patients over 18 years old who attended Centro Equilibra. The main variables analysed were sex, age, personal pathological history, medical diagnosis, main vestibular symptoms, auditory manifestations, and levels of handicap. ResultsThe data was obtained from 177 people; vestibular disorders occurred more in the female sex (ratio 2.6:1). The mean age was 56 years. Fifty-three point seven percent presented slight sensorineural hearing loss, gradually decreasing. Of the population, 33.9% presented tinnitus, mostly at high frequencies. In the adult population, 52% presented some level of hearing handicap, unlike older adults, where the majority (77%) did not present any level of handicap. People with vestibular disorders perceive greater physical handicap (83%). ConclusionsHearing loss was the most common hearing manifestation and although statistical analysis shows that it is not directly related to vestibular disorders, it is related to concomitant metabolic diseases. For this reason, it is necessary to promote the prevention of metabolic diseases as one of the measures to improve hearing health, even from an early age." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Antecedentes y objetivoLas alteraciones vestibulares se encuentran ligadas a un grupo de patologías que pueden afectar estructuras vestibulares, auditivas, o ambas partes del oído interno del ser humano. El problema abordado en este estudio responde a una escasez de información sobre el perfil audiológico de las personas que cursan con alteraciones vestibulares en Costa Rica. Existen investigaciones internacionales que abordan este tema, pero no hay registros de estudios realizados en la población costarricense. Es por este motivo que surge el interés de desarrollar esta investigación, cuyo objetivo es caracterizar el perfil audiológico y los grados de discapacidad en las personas con alteraciones vestibulares pertenecientes a la consulta del Centro Equilibra, durante los meses de septiembre a noviembre de 2019. Pacientes y métodosSe realizó un estudio descriptivo, transversal, cuantitativo y observacional-analítico con pacientes mayores de 18 años que acudieron al Centro Equilibra. Las principales variables analizadas fueron el sexo, la edad, los antecedentes patológicos personales, el diagnóstico médico, los síntomas vestibulares primarios, las manifestaciones auditivas y los grados de discapacidad. ResultadosSe obtuvieron datos de 177 personas, donde las alteraciones vestibulares se presentaron más en el sexo femenino (razón 2,6:1). La media de edad fue de 56 años. El 53,7% presentó pérdida auditiva, de tipo neurosensorial, ligera, gradualmente descendente. El 33,9% de la población presentó acúfeno, en su mayoría en frecuencias agudas. En la población adulta el 52% presentó algún grado de percepción de discapacidad auditiva; contrariamente, en los adultos mayores la mayoría (77%) no presentó ningún grado de discapacidad. El 87% de las personas percibieron discapacidad vestibular debido a su alteración vestibular. ConclusionesLa pérdida auditiva fue la manifestación auditiva más común, y aunque el análisis estadístico demuestra que no se relaciona directamente con las alteraciones vestibulares, sí se relaciona con las enfermedades metabólicas concomitantes. Por esta razón es necesario promover la prevención de enfermedades metabólicas como una de las medidas para mejorar la salud auditiva, incluso desde edades tempranas." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 939 "Ancho" => 1508 "Tamanyo" => 81582 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Percentages according to type of hearing loss. Mod: moderate; prof: profound; sev: severe. Compiled by the authors, 2020." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Compiled by the authors (2020) from Bisdorff et al.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Primary vestibular symptoms \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Secondary vestibular symptoms \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vertigo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spontaneous vertigo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Triggered vertigo</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positional vertigo \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vertigo triggered by head movement \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Visually induced vertigo \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sound-induced vertigo \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Valsalva-induced vertigo \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Orthostatic vertigo \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other triggered vertigo \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dizziness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spontaneous dizziness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Triggered dizziness</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positional dizziness \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dizziness brought on by head movement \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Visually induced dizziness \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sound-induced dizziness \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Valsalva-induced dizziness \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Orthostatic dizziness \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other triggered vertigo \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vestibulo-visual \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">External vertigo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oscillopsia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Visual lag \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Visual tilt \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Movement induced blurred vision \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postural \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unsteadiness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Directional pulsion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Balance-related near fall \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Balance related fall. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "Classification of vestibular symptoms." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Compiled by the authors (2020) from Clark J.<a class="elsevierStyleCrossRef" href="#bib0045">9</a>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Degree of hearing loss \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hearing loss range (dB HL) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–10 to 15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Slight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16−25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26−40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41−55 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderately severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56−70 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71−90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Profound \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90 + \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "ASHA classification of hearing loss by intensity of hearing loss." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Ab. freq.: absolute frequency; Rel. freq.: relative frequency.Compiled by the authors, 2020." "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Primary vestibular symptoms \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Female</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Male</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ab. freq. \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rel. freq. \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ab. freq. \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rel. freq. \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ab. Freq. \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rel. freq. \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vertigo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">109 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">151 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postural symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">113 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dizziness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vestibulo-visual symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total population \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">128 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">177 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "Distribution of the study population by primary vestibular symptom, according to gender." ] ] 4 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Pearson's χ2 was used to assess the relationship between vestibular symptoms and the presence of hearing loss. A p-value > 0.005 was obtained in all scenarios.Ab. freq.: absolute frequency; Rel. freq.: relative frequency.Compiled by the authors, 2020." "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Presence of hearing loss \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="8" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Primary vestibular symptoms</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vertigo</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Postural</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dizziness</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vestibulo-visual</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ab. freq. \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rel. freq. \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ab. freq. \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rel. freq. \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ab. freq. \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rel. freq. \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ab. freq. \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rel. freq. \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">151 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">113 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "Distribution of the population studied by primary vestibular symptom, according to presence of hearing loss." ] ] 5 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Compiled by the authors, 2020." "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Authors \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% female sex \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean age (years) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% hearing loss \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% tinnitus \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% vertigo \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% postural \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% dizziness \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% vestíbulo-visual \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Castro and Braga<a class="elsevierStyleCrossRef" href="#bib0010">2</a> (2013) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Jalil et al.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> (2014) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sacconi et al.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> (2016) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">This study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of results obtained with other research studies." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Overview of the International Classification of Vestibular Disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.R. Bisdorff" 1 => "J.P. Staab" 2 => "D.E. Newman-Toker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ncl.2015.04.010" "Revista" => array:6 [ "tituloSerie" => "Neurol Clin" "fecha" => "2015" "volumen" => "33" "paginaInicial" => "541" "paginaFinal" => "550" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26231270" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mareo y/o vértigo como motivo de consulta en la policlínica neurológica: estudio descriptivo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Castro" 1 => "P. Braga" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Méd Urug" "fecha" => "2013" "volumen" => "29" "paginaInicial" => "208" "paginaFinal" => "218" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manifestaciones auditivas en alteraciones vestibulares" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Ortiz" 1 => "A. Mendilaharzu" 2 => "A. Ricardo" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Rev Faso" "fecha" => "2015" "paginaInicial" => "22" "paginaFinal" => "26" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "http://faso.org.ar/revistas/2015/suplemento_vestibular/4.pdf" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic criteria for Menière’s disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.A. Lopez-Escamez" 1 => "J. Carey" 2 => "W.H. Chung" 3 => "J.A. Goebel" 4 => "M. Magnusson" 5 => "M. 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Original article

Audiological profile and handicap levels in people with vestibular disorders at Centro Equilibra, Vértigo and Equilibrio, San José, Costa Rica

Perfil audiológico y grados de discapacidad en las personas con alteraciones vestibulares pertenecientes a la consulta del Centro Equilibra, Vértigo y Equilibrio, San José, Costa Rica

Adriana Chacón Rodrígueza, Jorge Antonio Jiménez Gómezb,

Corresponding author

jorge.jimgo@hotmail.com

Corresponding author.

, Mónica Dávila Rojasc

a Licenciada en Audiología de la Universidad de Costa Rica, Centro Equilibra, Escazú, San José, Costa Rica

b Licenciado en Audiología de la Universidad de Costa Rica, Centro Equilibra, Escazú, San José, Costa Rica

c Médica especialista en Otorrinolaringología con subespecialización en vértigo y rehabilitación funcional de los trastornos del equilibrio de la Universidad de París, France. Centro Equilibra, Escazú, San José, Costa Rica

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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Percentages according to type of hearing loss&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Mod&#58; moderate&#59; prof&#58; profound&#59; sev&#58; severe&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Compiled by the authors&#44; 2020&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Vestibular disorders are defined as disturbances originating in the vestibular system and encompass diseases that affect both the vestibular system and its connections&#44; including brainstem&#44; cerebellum&#44; subcortical structures&#44; and vestibular cortex&#46; Therefore&#44; dysfunction in any of these structures&#44; whether primary or secondary&#44; can adversely affect balance&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> They are estimated to affect 20&#37;&#8211;30&#37; of the world&#8217;s population&#44; with a prevalence of approximately 5&#37; in adults and a total annual incidence of 5&#37;&#8211;10&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Depending on the disorder diagnosed&#44; individuals may present with audiological manifestations such as tinnitus and hearing loss in isolation&#44; or accompanying symptoms of vestibular manifestations&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The audiological profile in M&#233;ni&#232;re&#8217;s disease has been extensively described thanks to the abundant studies that describe and characterise the condition&#44; which has provided broad understanding of the auditory and vestibular involvement in the disease process&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In contrast&#44; the audiological profile in disorders such as vestibular migraine&#44; vestibular neuritis&#44; and benign paroxysmal positional vertigo &#40;BPPV&#41; shows almost no auditory involvement&#44; and if it does exist&#44; it presents as isolated symptoms of the condition&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">According to the World Health Organisation&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> between 5&#37; and 6&#37; of the world&#39;s population suffers from disabling hearing loss&#44; which is one of the sensory deprivations of greatest impact on the sufferer&#8217;s communication process&#44; limiting their activities of daily living and affecting their role in society&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In Costa Rica&#44; according to data from the National Institute of Statistics and Censuses&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> in the 2011 census&#44; of the 4&#44;301&#44;712 registered inhabitants&#44; a total of 70&#44;709 people had impaired hearing&#44; most aged between 40 and 75 years&#46; However&#44; no data or figures are reported for vestibular disorders in the country to indicate the number of sufferers&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Due to this lack of epidemiological research to determine the onset of auditory manifestations together with vestibular disorders in Costa Rica&#44; the main objective of this study was to characterise the audiological profile and degrees of disability in people with vestibular disorders attending the Equilibra&#44; Vertigo and Equilibrium Centre from September to November 2019&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">This is a descriptive&#44; cross-sectional&#44; quantitative&#44; and observational-analytical study of patients with vestibular disorders attending the Equilibra&#44; Vertigo and Equilibrium Centre&#46; The Equilibra Centre is a private clinic specialising in the diagnosis&#44; treatment&#44; and rehabilitation of patients with vestibular disorders&#44; in the city of San Jos&#233;&#44; capital of Costa Rica&#46; Patients come directly or are referred by other doctors&#44; and because it is one of the few specialist centres it receives patients from all over the country&#46; Each patient attending the Centro Equilibra during the study period underwent a vestibular evaluation by the clinic&#8217;s ENT specialist subspecialising in vertigo and functional rehabilitation of balance disorders&#46; After the vestibular assessment for which they came to the centre&#44; they were asked to participate in the study&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The inclusion criteria were people over 18 years of age with vestibular disorders&#44; and the exclusion criteria ruled out patients with physical or psychological problems that limited their ability to respond autonomously and voluntarily&#44; those who did not want to undergo hearing evaluation tests&#44; and individuals who were not residents of Costa Rica&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">All the subjects voluntarily signed an informed consent form in accordance with the international ethical principles of beneficence&#44; non-maleficence&#44; autonomy&#44; and justice&#44; necessary to conduct biomedical research on human subjects&#44; to demonstrate a commitment to their personal information and the institution where the research was conducted&#46; Both the study and the informed consent were approved by the Scientific Ethical Committee of the University of Costa Rica&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The following data were collected from each participant by taking their history&#58; age&#44; sex&#44; personal pathological history&#44; and primary vestibular symptoms&#44; as described in the International Classification of Vestibular Disorders of the B&#225;r&#225;ny Society&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> i&#46;e&#46;&#44; vertigo&#44; dizziness&#44; vestibulo-visual symptoms&#44; and postural symptoms &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The vestibular assessment included a medical history aimed at identifying and classifying primary vestibular symptoms&#44; a clinical vestibular assessment including eye movements&#44; assessment of spontaneous nystagmus with and without fixation&#44; positional nystagmus&#44; direction-changing positional nystagmus&#44; head-shake test&#44; vibration-induced nystagmus at 100&#8239;Hz &#40;SYNAPSYS&#174; VVIBF3 vestibular vibrator&#41;&#44; all of the above assisted by SYNAPSYS&#174; Nystagview digital video equipment&#46; Vestibular function was measured with a video-assisted cephalic impulse test with OTOMETRICS ICS Impulse vHIT equipment&#46; Where necessary&#44; computerised dynamic posturography testing &#40;sensory organisation test&#44; motor control test&#44; adaptation test&#44; and limits of stability&#41; was performed with a Neurocom Smart Equitest posturograph&#46; The diagnostic criteria of the Barany Society<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4&#44;5</span></a> were used&#44; except those for presbyvestibulopathy&#44; which were published when the study was underway &#40;September 2019&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Tone audiometry and speech audiometry were used to assess hearing function&#46; The parameters for hearing loss established by the American Speech-Language-Hearing Association &#40;ASHA&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> were used to analyse the degree of hearing loss &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Acuphenometry was also performed&#44; which evaluates the psychoacoustic characteristics of tinnitus&#44; such as&#58; intensity&#44; frequency and residual inhibition &#40;this occurs after a masking noise is presented that acts as a suppressor&#44; and once the stimulus is removed&#44; a change occurs in the tinnitus&#44; eliminating it completely or reducing its intensity for a few seconds&#59; when the tinnitus is completely cancelled&#44; it is called total inhibition&#59; if it only reduces in intensity&#44; it is called partial inhibition&#44; and if does not change&#44; it is known as negative inhibition&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">A MAICO MA41 brand audiometer was used for the above tests&#44; with TDH39 airway transducers&#44; a B-71 bone transducer&#44; and a soundproof audiometric booth made in Costa Rica by the company JR S&#225;nchez Audiolog&#237;a&#44; which meets the acoustic parameters necessary to perform the audiometric studies&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Questionnaires were also used to quantify the perceived degree of disability in relation to hearing loss&#58; the Hearing Handicap Inventory for Adults &#40;HHIA&#41; and the Hearing Handicap Inventory for the Elderly &#40;HHIE&#41;&#59;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> in relation to tinnitus&#44; the Tinnitus Handicap Inventory &#40;THI&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> and in relation to dizziness or vertigo&#44; the Dizziness Handicap Inventory &#40;DHI&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The modified Spanish version was used in each case&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">All the audiological tests and questionnaires were undertaken by two final year students of the Audiology degree course at the University of Costa Rica&#44; as a final graduation project&#44; endorsed and supervised by the clinic&#8217;s ENT doctor&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">All the data were compiled in Microsoft Excel version 2015&#44; and once collected and tabulated&#44; they were processed using SPSS version 23&#44; generating outputs of values such as&#58; mean&#44; median and mode&#44; frequency distributions&#44; estimation of frequencies and percentages&#44; and cross-references of variables &#40;sex&#44; age&#44; place of residence&#44; type of hearing loss&#44; type of vestibular alteration&#41;&#46; Pearson&#8217;s &#967;<span class="elsevierStyleSup">2</span> statistical test was used to analyse the information collected&#44; to analyse the relationship of independence and&#47;or dependence between two variables&#44; obtaining a p-value &#40;hypothesis test&#41;&#44; understanding that&#44; if this value is less than 0&#46;05&#44; the research hypothesis is accepted that there is a relationship between the variables analysed&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">During the study period&#44; 177 people with vestibular disorders were assessed&#44; ranging in age from 19 to 91 years&#59; the average age of the population was 56 years&#44; and the distribution by sex was 72&#37; female and 28&#37; male&#46; The statistical analysis shows that some variables such as sex and age are not a risk factor for vestibular disturbance&#44; hearing loss or tinnitus&#44; which indicates that it can occur in both sexes equally and at any time in a person&#8217;s life&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Most &#40;66&#37;&#41; had at least one metabolic disease &#40;a term used arbitrarily to group diseases related in varying degrees to different metabolic disorders&#41;&#44; 40&#37; had arterial hypertension&#44; 32&#37; dyslipidaemia&#44; 18&#37; thyroid dysfunction&#44; and 11&#37; reported diabetes&#46; From the bivariate analysis performed &#40;Pearson&#39;s &#967;<span class="elsevierStyleSup">2</span> test&#41;&#44; with the variables of&#58; metabolic diseases and primary vestibular symptoms &#40;dizziness&#44; vertigo&#44; vestibulo-visual symptoms&#44; and postural symptoms&#41;&#44; a p-value&#8239;&#62;&#8239;0&#46;05 value was obtained&#44; which proves that for this particular population there is no statistically significant association between the variables analysed&#44; establishing that the presence of a history of these disorders does not constitute a risk factor for primary vestibular symptoms&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The most common medical diagnosis was vestibular migraine &#40;28&#46;2&#37;&#41; and BPPV &#40;28&#46;2&#37;&#41;&#44; followed by anxiety disorder &#40;9&#46;6&#37;&#41;&#44; M&#233;ni&#232;re&#39;s disease &#40;9&#37;&#41;&#44; unilateral vestibular hypofunction &#40;7&#46;9&#37;&#41;&#44; bilateral vestibular hypofunction &#40;6&#46;2&#37;&#41;&#44; and other diagnoses &#40;20&#46;3&#37;&#41;&#44; such as&#58; inactive BPPV&#44; unsteadiness&#44; central positional vertigo&#44; vestibular paroxysmia and panic attacks&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The most frequent primary vestibular symptom seen in the clinic was vertigo &#40;85&#46;3&#37;&#41;&#44; followed by postural symptoms &#40;63&#46;8&#37;&#41;&#44; dizziness &#40;33&#46;9&#37;&#41;&#44; and vestibulo-visual symptoms &#40;11&#46;3&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; The most prevalent secondary vestibular symptom was vertigo triggered by positional changes &#40;49&#37;&#41;&#59; it was unsteadiness for postural symptoms &#40;89&#37;&#41;&#59; for dizziness it was spontaneous dizziness &#40;58&#37;&#41;&#44; and for vestibulo-visual symptoms the most prevalent was motion-induced blurred vision &#40;70&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">With regard to the hearing of people with vestibular impairment included in this study&#44; the pure tone average &#40;PTA&#41; of the speech frequencies 500&#8239;Hz&#44; 1000&#8239;Hz&#44; and 2000&#8239;Hz &#40;PTA 512&#41; of the right ear assessed by pure-tone audiometry was 20&#46;63&#8239;dB HL&#44; and therefore the right ear can be defined as having mild hearing loss according to the ASHA<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> criteria&#46; For the left ear&#44; the PTA 512 was 18&#46;84&#8239;dB HL&#44; indicating that the left ear also had slight hearing loss according to ASHA<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> criteria&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Of the population&#44; 46&#46;3&#37; presented peripheral hearing within the normal range according to the PTA 512&#59; however&#44; only 27&#46;1&#37; presented a completely flat audiometric curve &#40;corresponding to perfect hearing&#41;&#59; the remaining 19&#46;2&#37; had some drop at high or low frequencies&#44; either unilaterally or bilaterally&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The prevalence of hearing loss was 53&#46;7&#37;&#59; 20&#46;9&#37; was unilateral and 32&#46;8&#37; was bilateral&#46; Sensorineural hearing loss was found in 93&#46;5&#37;&#44; mixed hearing loss in 14&#46;4&#37; and there were no cases of conductive hearing loss&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Most of the patients had slight hearing loss &#40;49&#46;7&#37;&#41;&#44; followed by moderate loss &#40;24&#46;8&#37;&#41;&#44; with lower percentages of the remaining degrees of hearing loss &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The most common audiometric profile was gradually descending &#40;51&#37;&#41;&#59; flat curve &#40;17&#46;6&#37;&#41;&#44; high frequency drop &#40;13&#46;1&#37;&#41;&#44; inverted &#40;7&#46;8&#37;&#41;&#44; in the vessel &#40;7&#46;2&#37;&#41;&#44; Fuji Yama &#40;1&#46;3&#37;&#41;&#44; auditory remnants &#40;1&#46;3&#37;&#41; and cophosis &#40;0&#46;7&#37;&#41; configurations were also found in lower percentages&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Although the primary vestibular symptoms were accompanied by auditory manifestations &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#44; statistical analysis showed that the presence of hearing impairment was directly related to the metabolic profile of the population studied and not to the vestibular disorders&#46; Therefore&#44; the auditory manifestations relate to the profile of the population studied and not to vestibular disorders&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">According to the percentages of auditory discrimination obtained in the speech audiometry&#44; the patients with normal hearing presented an average discrimination of 100&#37;&#44; whereas the population with hearing loss presented 90&#37; in both ears&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Of the population&#44; 33&#46;9&#37; reported tinnitus&#58; 70&#37; unilateral and 30&#37; bilateral&#46; The most common frequency was 8000&#8239;Hz&#44; in 41&#37;&#44; and 49&#37; presented partial and 33&#37; total residual inhibition&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">According to the HHIA questionnaire&#44; 52&#37; reported a degree of perceived disability&#44; while in the HHIE&#44; 23&#37; of older adults reported impaired hearing&#46; For the THI&#44; 37&#37; reported a slight degree of hearing disability and 34&#37; a mild degree of disability&#46; Finally&#44; in the IHD&#44; 87&#37; of the total population presented disability due to their vestibular impairment&#46; The physical &#40;83&#37;&#41; and functional &#40;51&#37;&#41; subscales were the most affected&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">In this study&#44; the mean age of the people with vestibular disorders was 56 years&#44; the female sex was most affected &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#44; at a female-to-male ratio of 2&#46;6&#58;1&#44; similar information to other studies&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Most of the patients evaluated had concomitant metabolic diseases&#44; but the most frequent were arterial hypertension and dyslipidaemia&#44; as in the 2013 study by Castro and Braga&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">According to medical diagnoses&#44; BPPV and vestibular migraine were the most frequent in the study population &#40;28&#46;2&#37; each&#41;&#44; data that are similar to other studies&#59;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> in terms of primary vestibular symptoms&#44; a greater presence of vertigo &#40;85&#46;3&#37;&#41; and postural symptoms &#40;63&#46;8&#37;&#41; was observed&#44; results similar to the research by Jalil et al&#46; <a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> in 2014 and Sacconi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> in 2016&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The following are the results from the data analysed in the hearing averages of the entire population evaluated&#58; a right and left ear with slight hearing loss according to the PTA 512 and the ASHA<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> classification&#59; it should be noted that at the high frequencies there is slight impairment compared to the low and medium frequencies&#59; this same configuration is presented in the study by Rodr&#237;guez&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> showing a gradually descending drop at the high frequencies in both ears&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">It can also be observed that in both studies there is slightly greater deterioration in the right ear than the left&#44; the information collected coincides with that of Rodr&#237;guez&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> We would add that the latter study has 217 patients and the present 177&#44; with a difference of only 40 people&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The prevalence of hearing loss was 53&#46;75&#37;&#59; 45&#46;8&#37; for the right ear and 40&#46;7&#37; for the left&#46; This information is similar to the 2006 study by Torre et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> where there was a prevalence of hearing loss in 57&#46;6&#37; of the population&#46; It is also important to note that from the age of 50 years onwards the patients evaluated had increased hearing loss&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The study by Sacconi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> found that the most common audiometric profile was the high-frequency drop&#44; at 70&#37; of all patients with hearing loss&#44; with lower percentages observed in flat curves&#44; bell&#44; low&#44; and u-shaped drop&#44; which is consistent with this research study&#46; It also suggests that many studies of this type do not detail the normal hearing parameters used&#44; which is of utmost importance in detecting early hearing loss&#46; It is important to highlight that only 27&#46;1&#37; of the population presented peripheral hearing within the normal range&#44; which is consistent with the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Abreu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> found that more than 70&#37; of the sample in their study had mild to moderate sensorineural hearing loss&#44; with a slightly descending audiometric configuration towards the high frequencies&#59; this is corroborated in the present study&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Because there was no direct relationship between hearing manifestations and vestibular symptoms &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#44; the hearing loss present in the majority of the population could have developed gradually in each individual due to external factors&#44; and only a small percentage is due to vestibular disorders&#44; such as M&#233;ni&#232;re&#39;s disease&#46; Due to the audiometric characteristics of this population&#44; slight hearing loss was the most prevalent&#44; consistent with 37&#46;8&#37; being unaware of their hearing diagnosis&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">The percentage of patients with tinnitus &#40;33&#46;9&#37;&#41; is similar to that found in the literature&#44; and the frequencies affected are consistent with the audiometric profile found most in the hearing loss population&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a> The residual inhibition test showed encouraging results&#44; with 49&#37; showing partial residual inhibition&#44; implying that almost half of the tinnitus patients responded well to this masking technique&#44; resulting in decreased tinnitus perception&#46; This indicates that this group may benefit from treatment or therapy that includes an external masking device&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Statistical analysis shows that vestibular symptoms are not related to the presence of concomitant metabolic diseases&#46; However&#44; a significant relationship was established between concomitant metabolic diseases and hearing impairment&#44; and therefore the audiological profile of the participants in this study is related to metabolic diseases and not to the presence of a vestibular disorder&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">According to the HHIA&#44; 52&#37; of the population with hearing loss had some degree of perceived hearing disability&#44; the most frequent being mild to moderate impairment at 29&#37;&#46; Similar results are found in other studies&#44; where 32&#37; of the population studied had a perception of mild to moderate disability&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Of the older adult population with hearing loss in whom the HHIE was used&#44; 77&#37; did not perceive hearing impairment&#44; while those who did &#40;14&#37;&#41; had a mild to moderate degree&#46; Similar results are found in other studies&#44; where 82&#37; of the population had no disability and only 17&#37; did&#44; with a significant difference between the two groups&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">The degrees shown in the results of the THI indicate that most patients manage to live with their tinnitus&#46; Similar results are shown in other studies&#44; where 26&#37; of the population is reported to have mild to moderate disability&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Finally&#44; from the results of the DHI&#44; disability was present in 87&#37; of people&#44; and physical disability was the subscale with the highest prevalence&#46; These results are related to the data collected by Ceballos and Vargas<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> in 2004&#44; who found that physical disability was present in 82&#37; of the population&#44; while functional disability was present in 55&#37;&#44; and emotional disability in 48&#37;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0200" class="elsevierStylePara elsevierViewall">The most frequent medical diagnoses for people with vestibular disorders were BPPV and vestibular migraine&#46; The most common vestibular symptom in these patients was vertigo&#46; Hearing loss was the most common auditory manifestation&#44; and although statistical analysis shows that it is not directly related to vestibular disorders&#44; it is related to concomitant metabolic diseases&#46; Therefore&#44; prevention of metabolic diseases should be promoted as a measure to improve hearing health&#44; even from an early age&#46; In addition&#44; gradually descending mild sensorineural hearing loss was the audiological diagnosis with the highest percentages&#46; The disability perceived most frequently was due to vestibular disorders&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0205" class="elsevierStylePara elsevierViewall">This research study received no specific support from public sector agencies&#44; commercial sector&#44; or non-profit organisations&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0210" class="elsevierStylePara elsevierViewall">M&#243;nica D&#225;vila Rojas is founder and director of Centro Equilibra&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Adriana Chac&#243;n Rodr&#237;guez and Jorge Antonio Jim&#233;nez G&#243;mez have no conflict of interest to declare&#46;</p></span></span>"
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          "titulo" => "Introduction"
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    "fechaRecibido" => "2020-06-22"
    "fechaAceptado" => "2021-04-30"
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1555553"
          "palabras" => array:4 [
            0 => "Vestibular disorder"
            1 => "Hearing loss"
            2 => "Tinnitus"
            3 => "Handicap inventory"
          ]
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      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1555554"
          "palabras" => array:4 [
            0 => "Alteraci&#243;n vestibular"
            1 => "Hipoacusia"
            2 => "Ac&#250;feno"
            3 => "Inventario de discapacidad"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Vestibular disorders are linked to a group of pathologies that can affect the vestibular part&#44; the auditory part&#44; or both parts of the inner ear&#46; The problem in this study is the little information that exists about the audiological profile of people suffering from vestibular disorders in Costa Rica&#46; There are international research studies on this topic&#44; but there are no records of studies conducted in the Costa Rican population&#46; This is why there is interest in developing this research which aims to characterize the audiological profile and the levels of handicap in people with vestibular disorders under Centro Equilibra&#44; Vertigo and Equilibrio consultation during the months of September to November 2019&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">A descriptive&#44; cross-sectional&#44; quantitative&#44; and observational analytical study with patients over 18 years old who attended Centro Equilibra&#46; The main variables analysed were sex&#44; age&#44; personal pathological history&#44; medical diagnosis&#44; main vestibular symptoms&#44; auditory manifestations&#44; and levels of handicap&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">The data was obtained from 177 people&#59; vestibular disorders occurred more in the female sex &#40;ratio 2&#46;6&#58;1&#41;&#46; The mean age was 56 years&#46; Fifty-three point seven percent presented slight sensorineural hearing loss&#44; gradually decreasing&#46; Of the population&#44; 33&#46;9&#37; presented tinnitus&#44; mostly at high frequencies&#46; In the adult population&#44; 52&#37; presented some level of hearing handicap&#44; unlike older adults&#44; where the majority &#40;77&#37;&#41; did not present any level of handicap&#46; People with vestibular disorders perceive greater physical handicap &#40;83&#37;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Hearing loss was the most common hearing manifestation and although statistical analysis shows that it is not directly related to vestibular disorders&#44; it is related to concomitant metabolic diseases&#46; For this reason&#44; it is necessary to promote the prevention of metabolic diseases as one of the measures to improve hearing health&#44; even from an early age&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0005"
            "titulo" => "Background and objective"
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            "identificador" => "abst0010"
            "titulo" => "Patients and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "titulo" => "Conclusions"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Las alteraciones vestibulares se encuentran ligadas a un grupo de patolog&#237;as que pueden afectar estructuras vestibulares&#44; auditivas&#44; o ambas partes del o&#237;do interno del ser humano&#46; El problema abordado en este estudio responde a una escasez de informaci&#243;n sobre el perfil audiol&#243;gico de las personas que cursan con alteraciones vestibulares en Costa Rica&#46; Existen investigaciones internacionales que abordan este tema&#44; pero no hay registros de estudios realizados en la poblaci&#243;n costarricense&#46; Es por este motivo que surge el inter&#233;s de desarrollar esta investigaci&#243;n&#44; cuyo objetivo es caracterizar el perfil audiol&#243;gico y los grados de discapacidad en las personas con alteraciones vestibulares pertenecientes a la consulta del Centro Equilibra&#44; durante los meses de septiembre a noviembre de 2019&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio descriptivo&#44; transversal&#44; cuantitativo y observacional-anal&#237;tico con pacientes mayores de 18 a&#241;os que acudieron al Centro Equilibra&#46; Las principales variables analizadas fueron el sexo&#44; la edad&#44; los antecedentes patol&#243;gicos personales&#44; el diagn&#243;stico m&#233;dico&#44; los s&#237;ntomas vestibulares primarios&#44; las manifestaciones auditivas y los grados de discapacidad&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Se obtuvieron datos de 177 personas&#44; donde las alteraciones vestibulares se presentaron m&#225;s en el sexo femenino &#40;raz&#243;n 2&#44;6&#58;1&#41;&#46; La media de edad fue de 56 a&#241;os&#46; El 53&#44;7&#37; present&#243; p&#233;rdida auditiva&#44; de tipo neurosensorial&#44; ligera&#44; gradualmente descendente&#46; El 33&#44;9&#37; de la poblaci&#243;n present&#243; ac&#250;feno&#44; en su mayor&#237;a en frecuencias agudas&#46; En la poblaci&#243;n adulta el 52&#37; present&#243; alg&#250;n grado de percepci&#243;n de discapacidad auditiva&#59; contrariamente&#44; en los adultos mayores la mayor&#237;a &#40;77&#37;&#41; no present&#243; ning&#250;n grado de discapacidad&#46; El 87&#37; de las personas percibieron discapacidad vestibular debido a su alteraci&#243;n vestibular&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">La p&#233;rdida auditiva fue la manifestaci&#243;n auditiva m&#225;s com&#250;n&#44; y aunque el an&#225;lisis estad&#237;stico demuestra que no se relaciona directamente con las alteraciones vestibulares&#44; s&#237; se relaciona con las enfermedades metab&#243;licas concomitantes&#46; Por esta raz&#243;n es necesario promover la prevenci&#243;n de enfermedades metab&#243;licas como una de las medidas para mejorar la salud auditiva&#44; incluso desde edades tempranas&#46;</p></span>"
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            "titulo" => "Pacientes y m&#233;todos"
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            "titulo" => "Resultados"
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            "titulo" => "Conclusiones"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Percentages according to type of hearing loss&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Mod&#58; moderate&#59; prof&#58; profound&#59; sev&#58; severe&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Compiled by the authors&#44; 2020&#46;</p>"
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Compiled by the authors &#40;2020&#41; from Bisdorff et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Primary vestibular symptoms&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Secondary vestibular symptoms&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Vertigo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Spontaneous vertigo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="7" align="left" valign="\n
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                  \t\t\t\t">Triggered vertigo</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Positional vertigo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vertigo triggered by head movement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visually induced vertigo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sound-induced vertigo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Valsalva-induced vertigo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Orthostatic vertigo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Other triggered vertigo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Dizziness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spontaneous dizziness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Triggered dizziness</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positional dizziness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dizziness brought on by head movement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visually induced dizziness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sound-induced dizziness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Valsalva-induced dizziness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Orthostatic dizziness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Other triggered vertigo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vestibulo-visual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">External vertigo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oscillopsia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visual lag&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visual tilt&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Movement induced blurred vision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Postural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unsteadiness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Directional pulsion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Balance-related near fall&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Balance related fall&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Classification of vestibular symptoms&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Compiled by the authors &#40;2020&#41; from Clark J&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Degree of hearing loss&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hearing loss range &#40;dB HL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;10 to 15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Slight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#8722;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#8722;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#8722;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderately severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#8722;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#8722;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Profound&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90 &#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">ASHA classification of hearing loss by intensity of hearing loss&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Ab&#46; freq&#46;&#58; absolute frequency&#59; Rel&#46; freq&#46;&#58; relative frequency&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Compiled by the authors&#44; 2020&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Primary vestibular symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Female</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Male</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ab&#46; freq&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rel&#46; freq&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ab&#46; freq&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rel&#46; freq&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ab&#46; Freq&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rel&#46; freq&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vertigo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">109&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Postural symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">113&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dizziness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vestibulo-visual symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">128&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">177&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Distribution of the study population by primary vestibular symptom&#44; according to gender&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Pearson&#39;s &#967;<span class="elsevierStyleSup">2</span> was used to assess the relationship between vestibular symptoms and the presence of hearing loss&#46; A p-value&#8239;&#62;&#8239;0&#46;005 was obtained in all scenarios&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Ab&#46; freq&#46;&#58; absolute frequency&#59; Rel&#46; freq&#46;&#58; relative frequency&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Compiled by the authors&#44; 2020&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Presence of hearing loss&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Primary vestibular symptoms</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vertigo</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Postural</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dizziness</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vestibulo-visual</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ab&#46; freq&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rel&#46; freq&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ab&#46; freq&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rel&#46; freq&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ab&#46; freq&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rel&#46; freq&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ab&#46; freq&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rel&#46; freq&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Castro and Braga<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> &#40;2013&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">This study&nbsp;\t\t\t\t\t\t\n
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                    0 => array:2 [
                      "titulo" => "Overview of the International Classification of Vestibular Disorders"
                      "autores" => array:1 [
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                            0 => "A&#46;R&#46; Bisdorff"
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                        "tituloSerie" => "Neurol Clin"
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        "texto" => "<p id="par0220" class="elsevierStylePara elsevierViewall">We would like to thank Centro Equilibra for allowing us access to their facilities&#44; and trusting us to work with their patients over the three months&#46; We would also like to thank all the people who encouraged us to publish this article&#44; as an inspiration for future professionals to conduct further research in our country&#46;</p>"
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Article information

ISSN: 21735735
Original language: English

DOI:10.1016/j.otoeng.2022.08.001

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