Videolaryngoscopy Findings of the Vocal Health Program in Dysphonic Teachers in the Federal District, Brazil

Abstract Introduction The high phonatory demand required of teachers is a direct cause of the onset of vocal symptoms and of the development of laryngeal disorders. Objective To describe the findings of the laryngeal screening performed as part of the Vocal Health Program held in the Federal Distrcit of Brazil in 2014 and 2015. Methods The study was performed with 361 dysphonic teachers from public schools who attended the laryngeal screening (videolaryngoscopy) part of the program. Data on anamnesis, the degree of dysphonia, the findings of the laryngeal screening, the referrals made after the laryngeal screening, and the result of the assessment of vocal aptitude for work were analyzed from the forms of each participating teacher. Results The sample of the present study (N= 361) represents 18.23% of the 1,980 teachers that went through the vocal screening of the program in 2014 and 2015. In total, 98 (27.15%) teachers presented mild dysphonia, 221 (61.22%), moderate dysphonia, and 42, (11.63%) severe dysphonia. Regarding the laryngeal screening (videolaryngoscopy exam), 269 teachers (74.52%) presented laryngeal disorders, and the main ones found were vocal nodules (43.87%), signs of laryngopharyngeal reflux (37.17%), hourglass chink (18.22%), vascular dysgenesis (18.22%), midposterior triangular chink (9.67%), and double chink (8.55%). Conclusion Laryngeal screening through videolaryngoscopy and auditory-perceptual screening of the voice as part of vocal health programs are essential to define the diagnosis and therapeutic conduct for teachers with dysphonia. Together with intervention activities, continuing education and adequate and accessible treatment, the periodic evaluation of vocal health can contribute to reduce absenteeism and improve the quality of life and of the voice of teachers.

Polysomnography Applied to Patients with Tinnitus: A Review

Abstract Introduction Tinnitus has been defined as an "auditory phantom perception," meaning that tinnitus results from an abnormal activity within the nervous system, in the absence of any internal or external acoustic stimulation. About 10 to 15% of the adult population is affected by tinnitus, and a relevant percentage of tinnitus sufferers experience symptoms severe enough to significantly affect quality of life, including sleep disturbances, work impairment, and, in some cases, psychiatric distress. The selfrated complaints about tinnitus focus on emotional distress, auditory perceptual difficulties, and sleep disturbances. Objectives To evaluate the works that show sleep disorders in patients with tinnitus, and sleep disorders assessed by polysomnography. Data Synthesis We found four studies with polysomnography to assess sleep disorders in patients with tinnitus. The first study evaluated 80 patients who were military personnel without major psychiatric disturbances, and their tinnitus was associated with noise-induced permanent hearing. The second study was a prospective, case-control, nonrandomized study of 18 patients affected by chronic tinnituswho were compared with a homogeneous control group consisting of 15 healthy subjects. The last work evaluated questionnaires mailed to patients before their initial appointment at the Oregon Health Sciences University Tinnitus Clinic between 1994 and 1997. These questionnaires requested information pertaining to insomnia, tinnitus severity, and loudness. Follow-up questionnaires were mailed to 350 patients 1 to 4 years (mean 5 ± 2.3 years) after their initial appointment at the clinic. Conclusion There are few studies with polysomnography for the evaluation of patients with sleep disorders caused by tinnitus. This shows the need for more studies on this subject.

Desfecho dos professores afastados da Secretaria de Estado de Educação do Distrito Federal por distúrbios vocais entre 2009-2010 / Outcomes of teachers away from work for voice disorders, State Secretariat for Education, Federal District, 2009-2010

Contexto: A voz é uma importante ferramenta de trabalho para professores. Esses profissionais são frequentemente afastados da docência por distúrbios vocais, repercutindo no grande número de licença médica, restrição de função e readaptação profissional. Objetivo: Avaliar o perfil epidemiológico de professores afastados por distúrbios vocais e a repercussão da disfonia na diminuição das atividades laborais, na restrição de função e na readaptação profissional. Métodos: Estudo retrospectivo realizado entre janeiro de 2009 e dezembro de 2010, a partir da coleta de dados de prontuários da Secretaria de Estado de Educação do Distrito Federal, sobre os professores afastados por período superior a 30 dias. Resultados: Foram analisados 153 professores afastados por disfonia. A maior prevalência de distúrbios vocais ocorreu no gênero feminino (96,7%). Os nódulos vocais predominam no diagnóstico, representando 40% das lesões vocais encontradas. O tempo médio de afastamento foi de 120 dias. Aproximadamente 55% dos professores em licença médica estavam em restrição de função e ficaram em média 166 dias nessa condição. Ao todo, 25,5% dos professores foram readaptados e 73,8% retornaram à sala de aula. Conclusão: Adoecimento vocal é uma causa frequente de afastamento profissional, gerando grandes gastos anuais. Medidas preventivas e a consolidação de orientações quanto ao uso vocal reduziriam significativamente o número de professores em restrição ou readaptação de função.

Background: Voice is an important working tool for teachers. These professionals often stay away from work due to voice disorders, resulting in a high frequency of sick leave, function restriction and professional re-adaptation. Objective: To evaluate the epidemiological profile of teacher absenteeism due to voice disorders and the impact of dysphonia in reducing labor activities, function restriction and professional re-adaptation. Methods: A retrospective study of teachers away from work for more than 30 days was performed from January 2009 to December 2010 based on data collected from medical records at State Secretariat for Education, Federal District, Brazil. Results: A total of 153 teachers away from work due to dysphonia were analyzed. The highest prevalence of voice disorders was found among women (96.7%). Vocal nodules were the most prevalent diagnosis, corresponding to 40% of vocal lesions. The average time away from work was 120 days. About 55% of the teachers on sick leave exhibited function restriction and remained in that condition for 166 days, on average. In total, 25.5% of the teachers needed re-adaptation, and 73.8% were able to return to the classroom. Conclusion: Voice disorders are a frequent cause of sick leave, resulting in a high annual cost. Preventive measures and vocal orientation would significantly reduce the number of teachers with function restriction or requiring re-adaptation.

The Study of Otoacoustic Emissions and the Suppression of Otoacoustic Emissions in Subjects with Tinnitus and Normal Hearing: An Insight to Tinnitus Etiology

Introduction Analysis of the suppression effect is a simple method to evaluate cochlear status and central auditory mechanisms and, more specifically, the medial olivocochlear system. This structure may be involved in the generation of mechanisms that cause tinnitus and in the pathophysiology of tinnitus in patients with tinnitus and normal hearing. Objective To review the literature of the etiology of tinnitus on the lights of otoacoustic emissions in patients with normal hearing. Data Synthesis Individuals with tinnitus and normal hearing have a higher prevalence of alterations in transient-evoked otoacoustic emissions and distortion-product otoacoustic emissions than normal subjects. This fact suggests that dysfunctions of the outer hair cells (OHCs) might be important in the generation of the tinnitus; however, this feature is not always present in those who have the symptoms of tinnitus. Final Comments These findings suggest that OHC dysfunction is not necessary for tinnitus development—that is, there might be mechanisms other than OHC damage in the tinnitus development. On the other hand, OHC dysfunction alone is not sufficient to cause the symptom, because a great many individuals with OHC dysfunction did not complain about tinnitus. .

Applicability and Effectiveness of Closed Reduction of Nasal Fractures under Local Anesthesia

Introduction: A significant portion of patients treated in emergency departments have nasal fracture. It is important that the otolaryngologist know how to treat such damage. Objectives To evaluate the effectiveness of nasal fracture reduction under local anesthesia and tolerance to the procedure. Methods: Twenty-four patients treated in the emergency department with closed reduction under local anesthesia were prospectively followed. Epidemiologic information and data regarding pain and complications during the management were noted. The degree of satisfaction was researched by visual analog scale. Results: The majority of patients were male (75%), and the most common cause of injury was motor vehicle accident. We found a significant association between time to reduction and referred pain during the procedure. In patients in whom the procedure was delayed (over 3 days), there was less pain, and those who bled during the procedure had a shorter average time to reduction than the group of patients who did not bleed. Most patients were very satisfied, with more than 95% of these willing to undergo the same process again, if necessary. Conclusions: The closed approach in the clinic under local anesthesia was effective and safe in restoration of the nose...

Clinic-epidemiological analysis of an otorhinolaryngology emergency unit care in a tertiary hospital / Análise clínico-epidemiológica do atendimento de pronto-socorro de otorrinolaringologia de um hospital terciário

Emergencies are common in our Otorhinolaringology specialty. However, the clinical and epidemiological features are not very well known. OBJECTIVES: To evaluate the clinical and epidemiological profiles of otorhinolaryngological disorders in an emergency unit of a tertiary hospital, and to determine the appropriateness of the level of health care for a tertiary hospital. MATERIALS AND METHODS: An analytical study using data records of an otorhinolaryngological emergency unit at a tertiary hospital in the Federal District for a year, full time, and no screening. The age, sex, arrival time and clinical diagnosis were evaluated. The entities were separated into cases of pharingolaryngoesthomatology, otology, rhinology, and head and neck surgery. These were evaluated according to the urgency level, the required care, and the arrival time. RESULTS: 26,584 data records were selected, of which 2,001 were excluded. The group comprised 54. 48 percent women, and 45. 51 percent men. Otological complaints (62. 27 percent) prevailed. 61. 26 percent of cases were considered emergencies. Only 9. 7 percent of those required medium or high complex resources for resolution. CONCLUSIONS: The study showed that 61. 26 percent of the otorhinolaryngological cases are emergencies, and only 9. 7 percent required medium or high complexity resources.

Pronto-atendimento em Otorrinolaringologia é uma prática constante da especialidade. Entretanto, as características clínico-epidemiológicas são pouco conhecidas. OBJETIVOS: Avaliar fatores clínico-epidemiológicos referentes às doenças otorrinolaringológicas de pacientes atendidos no pronto-socorro de um hospital terciário e avaliar a adequação do nível de atenção em saúde em relação ao atendimento prestado em um hospital terciário. MATERIAIS E MÉTODOS: Estudo analítico, transversal a partir dos dados de guias de atendimentos do pronto socorro de otorrinolaringologia de um hospital terciário do Distrito Federal durante 01 ano, em horário integral, sem triagem. Foram avaliados: idade, sexo, horário de chegada e diagnóstico clínico. Os eventos foram divididos em otologia, rinologia, faringolaringoestomatologia e cirurgia de cabeça e pescoço. Os eventos foram avaliados segundo o grau de urgência, nível de assistência necessário e o horário de chegada. RESULTADOS: Foram colhidas 26. 584 guias de atendimentos, sendo excluídas 2001. 54,48 por cento eram mulheres e (45,51 por cento) homens. Queixas otológicas foram as mais prevalentes (62,27 por cento). Foram consideradas urgências 61,26 por cento dos atendimentos; apenas 9,7 por cento atendimentos necessitaram de recursos de média ou alta complexidade. CONCLUSÃO: O estudo mostrou que 61,26 por cento das doenças otorrinolaringológicas atendidas no pronto-socorro são urgências e que apenas 9,7 por cento necessitam de recursos de média ou alta complexidade.

The quality of life among Otorhinolaryngology residents in Distrito Federal (Brazil) / A qualidade de vida entre os residentes de Otorrinolaringologia do Distrito Federal

Otorhinolaryngology residents' quality of life must be investigated during medical residency. Work-related factors impacting their lives, such as depression, sleep deprivation and excessive work load may impact the well-being of these individuals. OBJECTIVE: To assess and discuss the quality of life of Otorhinolaryngology Resident Physicians in Distrito Federal (Reuni-ORL). MATERIALS AND METHODS: Cross-sectional study, the quality of life of each individual was assessed by means of a questionnaire specifically designed for this purpose - Whoqol-bref, proposed by the WHO. RESULTS: Males had better psychological scores when compared to females (p= 0. 013). Mean scores comparison among the years in residency were statistically significant only in the psychological domain when comparing the first and second years (p=0. 046), in which 2nd-year residents had the higher scores. CONCLUSIONS: Despite constant changes to the ENT program (Reuni-ORL) in the Distrito Federal, aiming at improving work and training conditions for residents, there still is a psychological burden in their first year of residency.

A qualidade de vida dos residentes de otorrinolaringologia precisa ser estudada ao longo da residência médica. Fatores decorrentes deste trabalho, como depressão, privação do sono e excessiva carga horária, podem interferir no bem-estar destes indivíduos. OBJETIVO: Avaliar e discutir a qualidade de vida dos médicos residentes de Otorrinolaringologia do Distrito Federal (Reuni-ORL). MATERIAIS E MÉTODOS: Sob a forma de estudo transversal, a avaliação da qualidade de vida de cada participante foi realizada por meio de um questionário específico para este fim, o Whoqol-bref, proposto pela OMS. RESULTADOS: O sexo masculino apresentou pontuação melhor no domínio psicológico com relação ao sexo feminino (p= 0,013). A comparação das médias de pontuação entre os anos de residência foram estatisticamente significativas apenas no domínio psicológico em relação ao primeiro e segundo ano (p=0,046), na qual os R2 apresentaram a pontuação maior. CONCLUSÃO: Apesar de constantes adaptações do programa da Reuni-ORL no Distrito Federal, visando melhorias das condições de trabalho e de estudo de seus residentes, ainda há o desgaste psicológico do primeiro ano de residência.

Histiocitose de células de Langerhans em otorrinolaringologia / Langerhans cell histiocytosis in otorhinolaryngology

Introdução: A histiocitose de células de Langerhans é um distúrbio proliferativo de células inflamatórias de etiologia desconhecida. É doença rara da faixa pediátrica. Objetivo: Realizar revisão de literatura sobre a histiocitose de células de Langerhans, focando as manifestações otorrinolaringológicas. Materiais e métodos: A metodologia utilizada foi consulta à base de dados on line MEDLINE, de 1966 a 2008, pesquisando a partir dos termos histiocitose de células de Langerhans, osso temporal e otorrinolaringologia. Revisão da Literatura: As manifestações em cabeça e pescoço são as mais frequentes e seu diagnóstico torna-se difícil uma vez que mimetiza outras doenças mais comuns vistas pelo otorrinolaringologista, como otite externa, mastoidite aguda e gengivite. A doença no osso temporal expressa-se como otorreia de repetição e granulomas de conduto auditivo externo ou retroauricular. A avaliação radiológica evidencia lesões líticas principalmente em calota craniana, mandíbula, osso temporal e costelas. O diagnóstico definitivo é feito por biópsia através dos achados histopatológicos e detecção pela imunohistoquímica do antígeno CD1a. A principal forma de tratamento é a quimioterapia e, em menor escala, radioterapia ou cirurgia. Conclusões: Manifestações otorrinolaringológicas devem ser suspeitadas por sintomas otológicos recorrentes e pela presença de tecido de granulação retroauricular ou de conduto auditivo externo. A biópsia com achados histológicos característicos e imunohistoquímica positiva para CD1a são diagnósticos. A quimioterapia pode ser o tratamento inicial na maioria dos casos ou adjuvante nas formas refratárias ou recorrentes.

Introduction: The Langerhans cell histiocytosis is an inflammatory cells proliferative disorder of unknown etiology. It is uncommon disease in children. Objective: To proceed with a literature review on Langerhans cell histiocytosis, with focus on the otorhinolaryngological complications. Materials and methods: The methodology used was advised based on online data from MEDLINE, between 1966 and 2008, with research of terms related to Langerhans cell histiocytosis, temporal bones and otorhinolaryngology. Literature Review: The manifestations in the head and neck are the most common ones and their diagnosis becomes difficult once it mimetizing other more common diseases the otorhinolaryngologist sees as external ear eczema, acute mastoiditis and gingivitis. The temporal bone disease manifests as recurrent otorrhea and external auditory meatus and retroauricular granulomas. The radiological evaluation confirms lytic lesions especially in the cranial cap, jaw, temporal bones and spines. The definitive diagnosis is made by biopsy through the histopathological discoveries and immunohistochemistry detection of the CD1a antigen. The main form of treatment is by chemotherapy and, in a lower scale, radiotherapy or surgery. Conclusions: he otorhinolaryngological manifestations must be suspected for recurrent otological symptoms and the presence of retroauricular granulation tissue or and the external auditory meatus. The biopsy with characteristic histological discoveries and immunohistochemistry positive for CD1a were diagnostic. The chemotherapy may be the initial treatment in most cases or secondary in refractory or recurrent forms.

O clima seco está relacionado com a internação hospitalar por epistaxe? / Is dry climate related to hospital admission for epistaxis?

Introdução: A epistaxe constitui a principal emergência otorrinolaringológica e apresenta potencial risco para a vida em casos de sangramento severo. Parece existir correlação sazonal do clima com a epistaxe e as opiniões são divididas sobre qual fator meteorológico é o principal responsável pelo sangramento nasal. Objetivo: Descrever a prevalência, distribuição, características e admissão hospitalar de epistaxe, e correlacioná-las com a variação climática. Testar a hipótese de que o clima seco está associado ao aumento da gravidade e número de internações hospitalares por epistaxe. Método: Estudo retrospectivo dos casos de epistaxe atendidos e internados em Hospital Terciário do Distrito Federal, no período de cinco anos (2003 a 2007). Correlação dos dados da variação climática obtidos no Instituto Nacional de Meteorologia (INMET). Resultados: Foram admitidos 194 pacientes com epistaxe grave. O número médio de internações por mês foi de 3,2. O mês de julho apresentou a maior média com 4,8, enquanto o mês de janeiro, a menor, com um caso por mês. Os meses com menor e maior umidade foram agosto e dezembro com 43,8% e 77,1%, respectivamente. A média da temperatura máxima foi de 26,9ºC e a mínima de 17ºC. Não houve correlação estatisticamente significante entre umidade e temperatura com o número de internações de epistaxe grave (r=0,15, p=0,20). Conclusão: O mês de julho apresentou o maior número internações hospitalares por epistaxe grave e o mês de agosto apresenta, a menor umidade. O clima seco não apresentou correlação com o aumento da gravidade e número de internações hospitalares de epistaxe.

Introduction: Epistaxis constitutes the main otorhinolaryngological emergency and presents a potential risk to life in cases of severe bleeding. There seems to be a seasonal correlation of the climate to epistaxis and the opinions are divided about which meteorological factor is the main responsible for nasal bleeding. Objective: To describe the prevalence, distribution, characteristics and hospital admission for epistaxis and correlate them to the climate variation. To test the hypothesis that the dry climate is associated to the increase of severity and number of hospital admission for epistaxis. Method: Retrospective study of the cases of epistaxis treated and admitted in a Tertiary Hospital of the Federal District, in the period of five years (2003 to 2007). Correlation of climate variation data obtained at the National Institute of Meteorology (INMET). Results: 194 patients with severe epistaxis were admitted. The average number of monthly internments was of 3.2. The month of July presented the highest average with 4.8, while the month of January, the lowest, with one case per month. The months with a lower and higher level of moisture were August and December, with 43.8% and 77.1%, respectively. The maximum average temperature was of 26.9ºC and the minimum was of 17ºC. There was no statistically significant correlation between moisture and temperature and the number of severe epistaxis admissions (r=0.15, p=0.20). Conclusion: The month of July presented the highest number of hospital admissions for severe epistaxis and the month of August presents the lowest moisture. The dry climate didn't present a correlation with the increase of the severity and the number of hospital admissions for epistaxis.

Neurilemoma de língua / Lingual neurilemmoma

O neurilemoma é um tumor benigno das células da bainha de Schwann. Quando é extracraniano, afetam as regiõesda cabeça e do pescoço em 25% dos casos, sendo a boca um sítio comum de lesão. É um tumor encapsulado,de crescimento vagaroso, cujo tratamento é excisão completa. O diagnóstico é histopatológico. Descreve-se o casode uma paciente do sexo feminino, 23 anos, não tabagista, com lesão pequena pedunculada no terço posterior dalíngua à direita. Submetida à biopsia excisional com anestesia local, em ambulatório, o diagnóstico foi neurilemoma.O estudo de imagem após excisada a lesão, no acompanhamento clínico, mostrou que a lesão foi completamenteremovida. A paciente encontra-se assintomática no momento. Mesmo raro, o neurilemoma deve ser considerado nodiagnóstico diferencial das lesões tumorais orais.

The neurilemmoma is a benign tumor of the Schwann cells. It affects the head and neck in 25% of the extracranialneurilemmomas, being the mouth the most common site. It is an encapsulated tumor with slow growing. The treatmentis complete excision. A 23-year-old woman, no-smoking is described. She had a small, pedunculated mass inthe posterior third of the tongue, at the right side. Its diagnosis is histopathologic. The ressection of the pedunculatedlesion were performed with local anesthesia. The histopathological diagnosis was neurilemmoma. In the follow up, theradiology exam demonstrated complete excision and the patient is assintomatic. Although rare, the neurilemmomashould be considered in the differencial diagnosis of oral tumor lesions.

Variações climáticas e a epistaxe no Distrito Federal / Climatic variations and epistaxis in the Distrito Federal

Introdução. A epistaxe constitui a principal urgência otorrinolaringológica e tem potencial de risco à vida em casos de sangramento grave. Parece existir correlação sazonal do clima com a epistaxe, e as opiniões são divididas sobre qual fator meteorológico é o principal responsável pelo sangramento nasal. Objetivo. Descrever prevalência, distribuição, características e admissão hospitalar de epistaxe, e correlacioná-las com a variação climática. Testar a hipótese de que o clima seco está associado ao aumento da gravidade e número de internações hospitalares por epistaxe. Métodos. Estudo retrospectivo dos casos de epistaxe atendidos e internados em hospital terciário do Distrito Federal, no período de cinco anos (2003 a 2007). Correlação dos dados da variação climática obtidos no Instituto Nacional de Meteorologia (INMET). Resultados. Foram admitidos 194 pacientes com epistaxe grave. O número médio de internações por mês foi 3,2. No mês de julho, apresentou-se a maior média com 4,8, e em janeiro, a menor, com um caso por mês. Os meses com menor e maior umidade foram agosto e dezembro com 43,8% e 77,1% respectivamente. A média da temperatura máxima foi 26,9°C e a mínima, de 17°C. Não houve correlação estatisticamente significante entre umidade e temperatura com o número de internações de epistaxe grave ( r = 0,15, p = 0,20). Conclusão. No mês de julho, houve maior número de internações hospitalares por epistaxe grave e, no mês de agosto, ocorreu menor umidade. O clima seco não teve correlação com o aumento da gravidade e o número de internações hospitalares de epistaxe.

Introduction. Epistaxis is the most frequent otorhinolaryngological emergency and is potentially life-threatening in cases of severe bleeding. A correlation seems to exist between seasonal factors and epistaxis, but opinions are divided as to which meteorological factor is mainly responsible for nosebleeds. Objective. To describe the prevalence, distribution, characteristics and hospital admission due to epistaxis, and to correlate them with climatic variations. We tested the hypothesis that a dry climate is associated with an increased severity and increased number of hospital admissions due to epistaxis. Methods. Retrospective study of epistaxis cases admitted to a tertiary hospital in the Distrito Federal, Brazil, over a 5-year period (2003 to 2007). The findings were correlated with climatic data obtained from the National Institute of Meteorology (INMET). Results. A total of 194 patients with severe epistaxis were admitted during the study period. The mean number of admissions per month was 3.2. The largest mean number of admissions (4.8) was observed in July and the smallest number in January, with one case per month. The lowest and highest humidity was observed in August and December (43.8 and 77.1%, respectively). The mean maximum temperature was 26.9°C and the minimum temperature was 17°C. No significant correlation was observed between humidity or temperature and the number of admissions due to severe epistaxis (r = 0.15, p = 0.20). Conclusion. July presented the largest number of hospital admissions due to severe epistaxis and the lowest humidity was observed in August. Dry climate was not correlated with increased severity or an increased number of hospital admissions due to epistaxis.

Sinusite aguda na gravidez: diagnóstico, complicações e revisão de tratamento / Acute pregnancy sinusitis

Os autores revisam as principais alterações fisiológicas da gravidez e os mecanismos implicados nas principais alterações nasossinusais da gestante. A própria gestação (rinite gravídica) associada a uma condição patológica subclínica ou clínica já existente (rinite alérgica) pode propiciar diretamente o surgimento de outras complicações nasais, rinite medicamentosa e sinusite. São abordados os principais pontos do diagnóstico e das complicações da sinusite. Foi feita revisão da eficácia e segurança dos fármacos no tratamento dessa entidade na gravidez.

The authors revise the main physiological changes during pregnancy and the mechanisms implied in the main naso-sinusal alterations of the pregnant. Gestation itself (rhinitis pregnancy) associated to a sub-clinical or previous pathological condition (allergic rhinitis) can directly propitiate the sprouting of other nasal complications (medicamentous rhinitis and sinusistis). The main points of the diagnosis and the complications of the sinusitis are boarded. Revision of the effectiveness and safety of drugs to treat this disease in pregnancy was accomplished.