Facial Clinimetric Evaluation Scale and Synkinesis Assessment Questionnaire Translation into Brazilian Portuguese: A Validation Study

Abstract Introduction Facial nerve palsy results in both functional disability and psychological morbidity. There are several well-established grading scales to quantify the quality of life of these patients. Objective Translate and validate the Facial Clinimetric Evaluation (FaCE) scale and Synkinesis Assessment Questionnaire (SAQ) to Brazilian Portuguese. Methods This study adopted a forward-backward translation method and performed cross-cultural adaptation. A pilot study was conducted to correct any confusing language and to evaluate content validity. A validation study was then performed. Internal consistency of the Brazilian Portuguese version of the FaCE and SAQ items was evaluated by Cronbach's alpha coefficient. Construct validity was assessed by Spear- man's Rank Correlation Coefficient between FaCE and SAQ scores to eFACE, House- Brackmann, Short Form 12 (SF-12) and Facial Disability Index (FDI) (sub)scores. Results A total of 90 patients were included. Cronbach's alpha for total domain scored 0.881 for FaCE and 0.809 for SAQ. FaCE total score correlation to eFACE total and House- Brackmann showed Spearman's r value of 0.537 and -0.538, respectively (p < 0.001). SAQ correlation to eFACE synkinesis subdomain was -0.449 (p < 0.001). No correlation was found between SAQ and HB score. FaCE total score correlations were of 0.301 and 0.547 for SF-12 PCS and MCS, respectively (p < 0.001). Correlation between FaCE total and FDI Physical and Social/well-being functions were 0.498 and 0.567 (p < 0.001). Conclusion Brazilian Portuguese FaCE scale and SAQ versions achieved high validity and reliability in the present study. These translated instruments demonstrated good psychometric properties, being proper to use in clinical practice in Brazil and with Brazilian Portuguese speakers.

Use of an Osteoplastic Flap for the Prevention of Mastoidectomy Retroauricular Defects

Abstract Introduction After mastoidectomy, patients usually complain of bone depressions in the retroauricular region in the surgical site, especially in procedures that require extensive cortical resections. This causes inconveniences such as difficulty wearing glasses, cleaning, and aesthetics complaints. Objective This study aims to describe a vascularized flap surgical technique that uses the mastoid cortical bone adhered to the periosteum, which is pedicled on the anterior portion and repositioned at the end of the surgery. This ensures the coverage of the mastoid cavity generated by surgery and prevents ear retraction into the cavity. This preliminary report describes the technique and intraoperative and immediate postoperative complications. Methods After retroauricular incision, periosteal exposure is performed. A U-shaped incision is required for the procedure and delimits a periosteum area appropriate to the size of the mastoidectomy. The cortical bone is opened using a 2.5 mm drill around the perimeter of the "U," at a 3 mmdepth. A chisel is introduced through the surface cells of the mastoid, and a hammer evolves into the anterior direction. The flap is lifted, leaving the periosteum adhered to it and forming a cap. The flap is anteriorly fixed to not hinder the surgery, and repositioned at the end. The periosteum is then sutured to the adjacent periosteum. Results The first 14 cases had no intraoperative complications and were firm and stable when digital pressure was applied during the intraoperative and immediate postoperative periods. Conclusion The osteoplastic flap pedicle is a safe and simple procedure, with good results in the immediate postoperative period.

Minimally Invasive Surgery for Intracochlear Schwannoma Removal and Simultaneous Cochlear Implantation

Abstract Introduction Hearing preservation has not yet been reported in patients undergoing resection of intracochlear schwannomas. This study describes a minimally invasive procedure for intracochlear schwannoma resection with simultaneous cochlear implantation that resulted in good hearing. Objective This study aims to describe a minimally invasive procedure for intracochlear schwannoma resection with simultaneous cochlear implantation. Data Synthesis The technique described in this study was developed for a 55-year-old male with a 20-year history of bilateral progressive hearing loss and tinnitus that had a mass in the left apical turn of the cochleameasuring 0.3 cm. Surgery accessed the apical turn of the cochlea. We performed mastoidectomy and posterior tympanotomy and removed incus and tensor tympani muscle to expose the cochlear apex. The tumor was identified and completely resected. After the cochleawas anatomically preserved, it was implanted with a straight electrode via round window insertion. The histopathological examination confirmed intracochlear schwannoma. Speech perception test revealed 100% speech recognition with closed sentences and the average audiometric threshold (500 to 2000 Hz) was 23 dB. Conclusion Our technique led to rehabilitation of the patient and improved hearing without damaging the intracochlear structure, making it possible to perform CI in the same procedure with good results.

Mastoid Obliteration with Autologous Bone in Mastoidectomy Canal Wall Down Surgery: a Literature Overview

Introduction The objectives of mastoidectomy in cholesteatoma are a disease-free and dry ear, the prevention of recurrent disease, and the maintenance of hearing or the possibility to reconstruct an affected hearing mechanism. Canal wall down mastoidectomy has been traditionally used to achieve those goals with greater or lesser degrees of success. However, canal wall down is an aggressive approach, as it involves creating an open cavity and changing the anatomy and physiology of themiddle ear andmastoid. A canal wall up technique eliminates the need to destroy the middle ear and mastoid, but is associated with a higher rate of residual cholesteatoma. The obliteration technics arise as an effort to avoid the disadvantages of both techniques. Objectives Evaluate the effectiveness of the mastoid obliteration with autologous bone in mastoidectomy surgery with canal wall down for chronic otitis, with or without cholesteatoma. Data Synthesis We analyzed nine studies of case series comprehending similar surgery techniques on 1017 total cases of operated ears in both adults and children, with at least 12 months follow-up. Conclusion Mastoid Obliteration with autologous bone has been utilized for many years to present date, and it seems to be safe, low-cost, with low recurrence rates - similar to traditional canal wall down procedures and with greater water resistance and quality of life improvements.

Evaluation of Functional Outcomes after Stapes Surgery in Patients with Clinical Otosclerosis in a Teaching Institution

Introduction Otosclerosis is a primary disease of the temporal bone that leads to stapes ankylosis. Hearing loss is the main symptom. Treatment includes surgery, medical treatment, and sound amplification therapy alone or in combination. Objective To evaluate the functional outcomes of patients with clinical diagnosis of otosclerosis undergoing primary stapes surgery in a teaching institution. Method Retrospective descriptive study. Results A total of 210 ears of 163 patients underwent stapes surgery. Of the 163 patients, 116 (71.2%) underwent unilateral surgery and 47 (28.8%) underwent bilateral surgery. Six of the 210 operated ears had obliterative otosclerosis. The average preoperative and postoperative air-bone gap was 32.06 and 4.39 dB, respectively. The mean preoperative and postoperative bone conduction threshold was 23.17 and 19.82 dB, respectively. A total of 184 (87.6%) ears had a residual air-bone gap <10 dB, and 196 (93.3%) had a residual air-bone gap ±15 dB. Two patients (0.95%) had severe sensorineural hearing loss. Conclusion Stapes surgery showed excellent functional hearing outcomes in this study. This surgerymay be performed in educational institutions with the supervision of experienced surgeons.

Obliteração de cavidades mastoideas com aloenxerto ósseo particulado congelado em cirurgias revisionais de otite média crônica colesteatomatosa / Mastoid cavity obliteration with particulated frozen allograft bone in revisional surgery for chronic otitis media with cholesteatoma

Avaliar o controle da supuração de cavidades mastoideas após cirurgia revisional e obliteração de mastoide com aloenxerto ósseo particulado congelado (AOPC). Desenho do estudo: Exploratório, prospectivo, tipo série de casos. Pacientes: Dez adultos selecionados entre pacientes já submetidos à cirurgia de mastoidectomia cavidade aberta ou fechada para tratamento de otite média crônica colesteatomatosa e que tinham indicação de cirurgia revisional. Intervenção: Revisão de mastoidectomia e obliteração da cavidade com AOPC, material de preenchimento de baixo custo obtido de um banco de tecidos. Desfecho(s): Desfecho primário: controle da supuração. Desfechos secundários incluem: integração do AOPC na cavidade mastoidea, presença de colesteatoma residual ou recorrente, resultados audiológicos, complicações pós-operatórias, tais como infecção e extrusão do enxerto, e qualidade de vida após o procedimento medida com a escala de resultados de Glasgow (ERG). Resultados: O tempo médio de seguimento foi de 28 meses. Sete pacientes apresentaram o ouvido seco, em média, 8 semanas após a cirurgia. Três pacientes desenvolveram exposição do enxerto ósseo seguido de infecção e extrusão do material de preenchimento. A densidade média do enxerto ósseo no local da obliteração foi de 755.35 unidades Hounsfield medida na tomografia realizada após um tempo médio pós-operatório de 31 meses. A porcentagem do volume mastoideo obliterado foi de 75 a 100% em 6 casos e de 50 a 75% em 1 caso. Nos 7 pacientes, houve um aumento na densidade óssea durante o período de seguimento. Um paciente apresentou colesteatoma epitimpânico recorrente (0,5cm) identificado na ressonância magnética 1 ano após a cirurgia, embora este não estivesse na área de obliteração. A audição foi preservada em 80% dos pacientes 12 meses após o procedimento. A qualidade de vida melhorou em todos os pacientes, com média do escore ERG de 52, em escala que varia de -100 a +100...

Assess the control of suppuration after revision surgery with mastoid obliteration for chronic otitis media (COM) with cholesteatoma using particulated frozen allograft bone (PFAB). Study Design: Exploratory, prospective, case series. Patients: Ten adults were selected from among patients who had undergone canal wall down or canal wall up mastoidectomy for COM with cholesteatoma, and had an indication for revision surgery. Intervention(s): Revision mastoidectomy with obliteration of the open cavity was performed with PFAB, a low-cost filler material obtained from a tissue bank. Main Outcome Measure(s): The main outcome measure was the control of suppuration. Secondary outcome measures included PFAB integration in the mastoid cavity, presence of recurrent or residual cholesteatoma, hearing outcomes, postoperative complications as infection and bone graft extrusion and quality of life after the procedure using the Glasgow benefit inventory (GBI) survey. Results: Mean follow-up was 28 months. Seven patients achieved a dry ear at a mean of 8 weeks postoperatively. Three patients developed bone graft exposure followed by infection and extrusion of the filler material. Mean bone density was 755.35 Hounsfield units at the obliteration site measured at computed tomography performed after a mean of 31 months postoperatively. Percentage of mastoid volume obliterated was between 75% and 100% in 6 cases and between 50% and 75% in 1 case. In all 7 patients, there was an increase in bone density postoperatively. One patient presented with recurrent epitympanic cholesteatoma (0.5 cm) at 1 year postoperatively, but it was not in the obliteration area. At 12 months postoperatively, 80% of patients had preserved hearing. All patients had an improvement of quality of life after mastoid obliteration, the average score on the GBI was 52 in a scale from -100 to +100. Conclusions: This study demonstrated that PFAB may be used to achieve a dry mastoid cavity with...

Implantable and Semi-Implantable Hearing Aids: A Review of History, Indications, and Surgery

Introduction: The complaints associated with the use of conventional amplifying hearing aids prompted research at several centers worldwide that ultimately led to the development of implantable devices for aural rehabilitation. Objectives: To review the history, indications, and surgical aspects of the implantable middle ear hearing devices. Data Synthesis Implantable hearing aids, such as the Vibrant Soundbridge system (Med-El Corporation, Innsbruck, Austria), the Maxum system (Ototronix LLC, Houston, Texas, United States), the fourth-generation of Carina prosthesis (Otologics LLC, Boulder, Colorado, United States), and the Esteem device (Envoy Medical Corporation - Minnesota, United States), have their own peculiarities on candidacy and surgical procedure. Conclusion: Implantable hearing aids, which are currently in the early stages of development, will unquestionably be the major drivers of advancement in otologic practice in the 21st century, improving the quality of life of an increasingly aged population, which will consequently require increased levels of hearing support...

Middle ear adenoma with neuroendocrine differentiation: relate of two cases and literature review

Adenomas with neuroendocrine differentiation are defined as neuroendocrine neoplasms, and they are rarely found in the head and neck. OBJECTIVE: To describe two cases of a middle ear adenoma with neuroendocrine differentiation, with a literature review. CASE REPORT: Patient 1 was a 41-year-old woman who presented with a 3-year history of left aural fullness associated with ipsilateral "hammer beating" tinnitus. Patient 2 was a 41-year-old male who presented with unilateral conductive hearing loss. CONCLUSION: Adenoma with neuroendocrine differentiation of the middle ear is a rare entity, but it should be considered in patients with tinnitus, aural fullness, and a retrotympanic mass and remembered as a diferential diagnosis of tympanic paraganglioma...

A brief history of mastoidectomy

AIM: To describe to the new generation of otologists the origins of mastoidectomy as well as the difficulties our predecessors encountered and the solutions they devised to improve otologic surgery. METHODS: Retrospective literature review-based study. RESULTS: Before the mid-19th century, mastoidectomy was performed only sporadically and in most cases as a desperate attempt to save the lives of people suffering from complications of infectious otitis. The drainage of acute abscesses became a common procedure at the beginning of the 20th century, within the pre-antibiotic era. The first documented surgical incision to drain an infected ear was described by the French physician Ambroise Paré in the 16th century. The credit for performing the first mastoidectomy for the removal of purulent secretions went to Jean-Louis Petit. Mastoidectomies were normally performed to treat infections. However, mastoidectomies were also carried out for other purposes, particularly for the treatment of deafness and tinnitus, during various periods. Sir Charles Ballance credited Johannes Riolanus with recommending mastoidectomy for the treatment of tinnitus. William Wilde began the era of modern mastoidectomy with his introduction of the eponymous retroauricular incision. CONCLUSION: Mastoidectomy has evolved significantly throughout its history. Improvements in mastoidectomy have relied on the introduction of more elaborate surgical procedures, especially the advances in surgical equipment during the last century. Mastoidectomy continues to be a life-saving surgical procedure.

Rinite alérgica / Allergic rhinitis

A rinite alérgica representa um problema de saúde pública, apresentando um impacto econômico e social cada vez maior. É a forma mais comum de todas as rinites, afetando cerca de 25% a 35% dos indivíduos adultos, embora sua prevalência seja subestimada. Esta doença pode afetar seriamente a qualidade de vida dos pacientes, sendo uma causa de desconforto físico e emocional, e está associada com múltiplas afecções, como asma, rinossinusite, otite média secretora e pólipos nasais. O adequado tratamento da rinite alérgica requer que um diagnóstico correto seja feito: a história clínica e o exame físico são fundamentais. Estudos controlados apoiam a utilidade de diversas opções terapêuticas disponíveis, que diminuem os sintomas, melhoram a qualidade de vida e previnem comorbidades. Uma abordagem que inclua evitar o contato com alérgenos, tratamento farmacológico e imunoterapia ajuda a reduzir a progressão do processo inflamatório. A farmacoterapia é a modalidade terapêutica mais empregada. Os anti-histamínicos de segunda geração são preferíveis, por causa da baixa sedação e efeitos anticolinérgicos. Os corticosteroides tópicos intranasais permanecem como o melhor método terapêutico para o tratamento da rinite alérgica sazonal (intermitente) e perene (persistente). Evitar os alérgenos é recomendado, mas pode ser de difícil realização, dependendo do fator desencadeante. A imunoterapia deve ser considerada em face de uma má resposta à farmacoterapia e à evitação dos alérgenos.