ABSTRACT
Eagle's syndrome is characterized by cervicopharyngeal signs and symptoms associated with elongation of the styloid apophysis. This elongation may occur through ossification of the stylohyoid ligament, or through growth of the apophysis due to osteogenesis triggered by a factor such as trauma. Elongation of the styloid apophysis may give rise to intense facial pain, headache, dysphagia, otalgia, buzzing sensations, and trismus. Precise diagnosis of the syndrome is difficult, and it is generally confounded by other manifestations of cervicopharyngeal pain. OBJECTIVE: To describe a case of Eagle's syndrome. CASE REPORT: A 53-year-old man reported lateral pain in his neck that had been present for 30 years. Computed tomography (CT) of the neck showed elongation and ossification of the styloid processes of the temporal bone, which was compatible with Eagle's syndrome. Surgery was performed for bilateral resection of the stylohyoid ligament by using a transoral and endoscopic access route. The patient continued to present pain laterally in the neck, predominantly on his left side. CT was performed again, which showed elongation of the styloid processes. The patient then underwent lateral cervicotomy with resection of the stylohyoid process, which partially resolved his painful condition. FINAL COMMENTS: Patients with Eagle's syndrome generally have a history of chronic pain. Appropriate knowledge of this disease is necessary for adequate treatment to be provided. The importance of diagnosing this uncommon and often unsuspected disease should be emphasized, given that correct clinical-surgical treatment is frequently delayed. The diagnosis of Eagle's syndrome is clinical and radiographic, and the definitive treatment in cases of difficult-to-control pain is surgical...
Subject(s)
Male , Middle Aged , Neck Pain/diagnosis , Oral Surgical Procedures , Osteogenesis , Case ReportsABSTRACT
INTRODUÇÃO: Rinoscleroma é uma doença infecciosa crônica do tipo granulomatosa causada pela bactéria Klebsiella rhinoscleromatis. Acomete a mucosa do trato respiratório, mais frequentemente o nariz. É considerada endêmica em determinadas regiões com África e América Central, porém é rara no Brasil. O acometimento nasal ocorre em 3 fases: catarral, granulomatosa e cicatricial. Em todo o seu curso a doença apresenta sintomatologia inespecífica, daí a dificuldade em ser diagnosticada. Seu diagnóstico é estabelecido através de cultura ou pelo encontro de células de Mikulicz ou corpúsculo de Russel no estudo anatomopatológico. O tratamento consiste em antibioticoterapia por longo período, associada ou não a cirurgia. OBJETIVO: Este relato tem por objetivo ilustrar um caso de rinoscleroma em uma paciente jovem com queixa de obstrução nasal bilateral de longa data e cefaleia. O intuito é alertar os otorrinolaringologistas para o diagnóstico desta doença rara, que se apresenta com sintomas inespecíficos e semelhantes a inúmeras patologias que acometem a região nasal.
INTRODUCTION: Rhinoscleroma is a chronic granulomatous infectious disease, caused by the bacterium Klebsiella rhinoscleromatis. Affects the respiratory tract mucosa, more frequent in the nose. Is considered endemic in certain regions like Africa and Central America, but is rare in Brazil. The nasal involvement occurs in 3 phases: catarrhal, granulomatous and sclerotic stage. In all its course the disease presents nonspecific symptoms, and because of that, the difficulty of being diagnosed. Its diagnosis is established by culture or by the meeting of Mikulicz cell or Russel corpuscles in the anatomopathological study. The treatment consists in a long-term antibiotic, associated or not to a surgery. OBJECTIVE: This report aims ilustrate a case of rhinoscleroma in a female young patient complaining of bilateral nasal obstruction, long standing and headache. The intent is alert the otorhinolaringologists in diagnosing this rare disease, which presents itself with nonspecific symptoms as like numerous pathologies that affect the nasal region.
ABSTRACT
O tratamento da surdez súbita é uma das questões mais controversas da Otologia. No entanto, os corticoides sistêmicos têm sido a opção mais escolhida por referidos autores como padrão ouro de tratamento. O uso de corticoide intratimpânico como terapia de segunda linha para tratamento de casos refratários de surdez súbita tem sido relatado e os resultados promissores têm feito alguns autores promoverem o seu uso como terapia de primeira linha, indicando-a para todos os casos de surdez súbita. OBJETIVOS: Descrever essa nova modalidade de tratamento e avaliar a sua segurança e eficácia em quatorze pacientes tratados após falha da corticoterapia oral. MATERIAIS E MÉTODOS: Trata-se de estudo analítico prospectivo em que quatorze pacientes portadores de surdez súbita neurossensorial foram tratados com metilprednisolona intratimpânica após falha da corticoterapia oral. Limiares tonais e o índice de reconhecimento de fala pré-tratamento e pós-tratamento foram analisados. RESULTADOS: Dez dos quatorze pacientes tratados com metilprednisolona intratimpânica apresentaram recuperação da audição superior a 20 dB nos limiares tonais ou 20 por cento no IRF. CONCLUSÃO: Três injeções intratimpânicas de metilprednisolona aumentaram os limiares tonais e índices de reconhecimento da fala em um grupo de pacientes portadores de surdez súbita neurossensorial que não obtiveram benefício após corticoterapia oral.
Treatment in sudden sensorineural hearing loss is a contentious issue, today, oral steroids are the most common choice and considered the best treatment option, but the use of intratympanic steroids has become an attractive alternative, especially in cases when systemic therapy fails, or to avoid the side effects of the systemic use of steroids. AIM: To describe the results of intratympanic methylprednisolone in idiopathic sudden sensorineural hearing loss after failure of oral prednisolone. METHODS: In a prospective study fourteen patients with idiopathic sudden sensorineural hearing loss were treated with intratympanic methylprednisolone after failing in the treatment with systemic steroids. Pretreatment and post-treatment audiometric evaluations including pure tone average (PTA) and speech reception thresholds (SRT) were analyzed. RESULTS: Ten from 14 patients treated with intra-tympanic methylprednisolone presented with hearing recovery > 20 dB in PTA or 20 percent in SRT. CONCLUSION: Three intratympanic injections of methylprednisolone improved pure-tone average or speech discrimination scores for a subset of sudden hearing loss subjects that failed to benefit from oral steroids.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Glucocorticoids/administration & dosage , Hearing Loss, Sensorineural/drug therapy , Hearing Loss, Sudden/drug therapy , Methylprednisolone/administration & dosage , Salvage Therapy/methods , Audiometry, Pure-Tone , Prospective Studies , Prednisolone/administration & dosage , Treatment Outcome , Tympanic MembraneABSTRACT
Rhinoscleroma is a chronic, infectious and granulomatous disease of the respiratory tract. There is often a delay in diagnosis due to unfamiliarity with the disease and also because culture is not always positive. We report a case in a 26-year-old woman with granular mass obstructing bilateral nasal cavities and causing breathing difficulty. Histopathological examination showed characteristic Mikulicz histiocytes containing numerous Gram-negative intracellular rod-shaped bacilli consistent with the diagnosis of rhinoscleroma. The patient was treated with gemifloxacin and tetracycline and remains asymptomatic over a year follow-up period. It is important to consider rhinoscleroma in cases of chronic nasal obstruction. As culture is not always positive, histopathological examination may be crucial to the diagnosis.
Subject(s)
Adult , Female , Humans , Nasal Obstruction/etiology , Rhinoscleroma/complications , Anti-Bacterial Agents/therapeutic use , Fluoroquinolones/therapeutic use , Naphthyridines/therapeutic use , Nasal Obstruction/drug therapy , Rhinoscleroma/drug therapy , Tetracycline/therapeutic useSubject(s)
Child , Female , Humans , Eye Infections, Fungal/diagnosis , Mucormycosis/diagnosis , Orbital Diseases/diagnosis , Paranasal Sinus Diseases/diagnosis , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Eye Infections, Fungal/drug therapy , Mucormycosis/drug therapy , Orbital Diseases/drug therapy , Paranasal Sinus Diseases/drug therapy , Tomography, X-Ray ComputedABSTRACT
O lipossarcoma mixóide é um tumor lipogênico originado de tecidos moles profundos e raramente de lipomas benignos. Corresponde a cerca de 50% dos lipossarcomas e sua incidência predominante dá-se em torno dos 50 anos de idade. Pode afetar as extremidades, o retroperitônio e, menos comumente, a região da cabeça e pescoço, cursando com massa de crescimento lento e indolor. Tumores primários da glândula tireóide são extremamente raros, geralmente se apresentando com sintomas compressivos ao diagnóstico e simulação de um bócio retroesternal, representando uma armadilha para os cirurgiões. O diagnóstico e tratamento de escolha incluem a exérese radical com laudo histopatológico ou imunoistoquímico, com indicação de radioterapia adjuvante. Os autores descrevem um caso de lipossarcoma mixóide originado de tireóide em uma paciente de 55 anos de idade e discutem a possível simulação de bócios retroesternais e a importância do diagnóstico precoce.
Myxoid liposarcoma is a lipogenic tumor originated from deep soft tissues and rarely from benign lipomas, corresponding to around 50% of liposarcomas. Its predominant incidence is about 50 years old. They can affect the extremities, retroperitoneum and less commonly the region of head and neck coursing with slow growth and painless mass. Primary tumors from the thyroid gland are extremely rare, generally with compressive symptoms and simulation of a retrosternal goiter. Diagnosis and treatment include radical resection, histopathologic study and adjuvant radiotherapy. The authors report a case of a thyroid myxoid liposarcoma in a 50 year-old woman and discuss the simulation of retrosternal goiters and the importance of early detection.