Atypical Manifestation of Vestibular Schwannoma

Vestibular schwannoma (also known as acoustic neuroma) is a benign tumor whose cells are derived from Schwann sheaths, which commonly occurs from the vestibular portion of the eighth cranial nerve. Furthermore, vestibular schwannomas account for ∼8% of intracranial tumors in adults and 80 to 90% of tumors of the cerebellopontine angle. Its symptoms are varied, but what stands out most is a unilateral sensorineural hearing loss, with a low index of speech recognition. Objective: Describe an atypical manifestation of vestibular schwannoma. Case Report: The 46-year-old woman had vertigo and binaural hearing loss and fullness, with ear, nose, and throat examination suggestive of cochlear injury. After 6 months, the patient developed worsening of symptoms and onset of right unilateral tinnitus. In further exams the signs of cochlear damage remained, except for the vestibular test (hyporeflexia). Magnetic resonance imaging showed an expansive lesion in the right cerebellopontine angle. Discussion: This report warns about the atypical manifestations of vestibular schwannoma, which must always be remembered in investigating and diagnosing hearing loss...

Avaliação da necessidade do uso do tampão nasal após septoplastia com turbinectomia / Evaluation about the requirement to use a pack after septoplasty with turbinectomy

Introdução: A septoplastia associada a turbinectomia inferior parcial é uma das cirurgias mais realizada no pacientes com obstrução nasal. O tampão nasal tem sido usado para controle primário do sangramento nestas cirurgias. Várias complicações têm sido relacionadas com o uso do tampão nasal, alem de causarem dor e desconforto importante com seu uso. Alguns estudos têm questionado a eficácia do tampão nasal no controle do sangramento e das complicações após septoplastia e turbinectomia. Objetivo: Comparar o grau de sangramento nasal entre os pacientes submetidos à septoplastia com turbinectomia parcial inferior bilateral que usaram ou não tampão nasal. Método: Foi realizado estudo prospectivo no qual foram avaliados 60 pacientes com diagnóstico de desvio do septo nasal com hipertrofia das conchas inferiores. Os pacientes foram submetidos à septoplastia com turbinectomia bilateral com visualização direta. Foram divididos em 2 grupos: sem tampão e com tampão (Merocel® e dedo de luva). Estes foram avaliados no pós-operatório, a partir da avaliação da intensidade do sangramento. Resultado: Foi observado que o grau de sangramento no pós-operatório no grupo submetido à turbinectomia inferior parcial bilateral e que usou tampão nasal foi menor, do que no grupo que não usou tampão. Conclusão: Pacientes submetidos à septoplastia com turbinectomia parcial inferior bilateral e não usaram tampão nasal no pós-operatório apresentaram mais sangramento do que os pacientes que usaram tampão nasal.

Introduction: Septoplasty associated with a partial inferior turbinectomy is one of the most frequent surgeries performed in patients with nasal obstruction. The nasal pack has been used to control primary bleeding in these surgeries. Several complications have been related to the nasal pack, besides causing pain and a relevant discomfort. Some studies have investigated both the efficiency of the nasal pack to control bleeding and the complications after septoplasty and turbinectomy. Objective: To compare the degree of nasal bleeding among patients submitted to septoplasty with partial bilateral inferior turbinectomy, whether using the nasal pack or not. Method:An outlook study was performed to evaluate 60 patients diagnosed of a deviated nasal septum with an inferior concha hypertrophy. The patients were submitted to bilateral turbinectomy septoplasty under direct visualization. They were divided into 2 groups: without pack and with pack (Merocel* and protective sheath). These were evaluated after surgery, based on the evaluation of bleeding intensity. Result: It was observed that the post-surgical bleeding degree of the group submitted to partial bilateral inferior turbinectomy, who used the nasal pack, was lower than the group not using a pack. Conclusion: Patients submitted to septoplasty with partial bilateral inferior turbinectomy, not using a post-surgical nasal pack, appeared to bleed more than patients using a nasal pack.