Comparative Study Between Single Layer and Double Layer Graft Technique in Tympanoplasty for Subtotal Tympanic Membrane Perforation

Abstract Introduction Tympanoplasty is the main treatment of mucosal type of chronic suppurative otitis media. Objective The aim of the present study was to compare clinical outcomes in terms of healing and audiological outcomes of two groups. The authors used single layer graft (perichondrium with cartilage island) graft in one group and double layer grafts (perichondrium cartilage island composite plus temporalis fascia) were used in the second group. Methods Forty patients complained of chronic suppurative otitis media safe type with subtotal perforation subdivided into two groups. The first group author used single-layer perichondrium with cartilage island graft (composite graft) while in the second group authors used double graft in the form of perichondrium/cartilage island (composite graft) plus temporalis fascia. Results There was no significant difference in the mean Air bone gap (ABG) between pre- and post-operative audiometry in subjects who had single layer tympanoplasty. There was a significant difference in the mean ABG between pre- and postoperative audiometry in subjects who had double layer tympanoplasty. There was a significant difference in in the mean ABG differences between subjects who had single layer tympanoplasty and double layer tympanoplasty. Also, there was a significant difference in the healing of the tympanic membrane between subjects who had single layer tympanoplasty and double layer tympanoplasty. Conclusion Tympanoplasty by double graft (temporalis fascia and tragal cartilage/perichondrium) achieved a considerable improvement in healing of the tympanic membrane ™ with lower risk for residual perforation or graft rejection.

Perforación timpánica y colesteatoma, una patología de niños y adultos / Tympanic perforation and cholesteatoma, a pathology of children and adults

INTRODUCCIÓN. La patología de oído es una enfermedad frecuente en nuestro medio, asociada a infecciones a repetición del oído, con la presencia de perforación timpánica y colesteatoma, que determinará la presencia de lesiones mucho más acentuadas en cuanto a la evolución auditiva o complicaciones locales o sistémicas. OBJETIVO. Determinar la asociación existente entre la presencia de colesteatoma y perforación timpánica en pacientes con otitis media crónica. MATERIALES Y MÉTODOS. Estudio epidemiológico analítico retrospectivo. Población de 4 733 y muestra de 75 pacientes para casos y 75 para controles basados en historias clínicas tomadas del sistema informático AS 400, que acudieron a la consulta externa de torrinolaringología del Hospital de Especialidades Carlos Andrade Marín en el periodo de enero de 2018 a diciembre de 2019; Criterios de inclusión para grupo de casos: Hombres y mujeres de 20 a 65 años de edad, diagnóstico de otitis media crónica, diagnóstico de colesteatoma ótico. Criterios de inclusión para grupo controles: Hombres y mujeres de 20 a 65 años de edad, no presentar diagnóstico de colesteatoma. RESULTADOS. Se observó una relación fuerte entre el poseer perforación timpánica y el desarrollo de colesteatoma con un valor de OR 33,14 con un IC al 95% de 31,94 ­ 34,34, con lo que se comprobó la hipótesis del estudio. Se determinó que la perforación timpánica es un factor de riesgo asociado con el desarrollo de colesteatoma en pacientes con otitis media crónica, la prevalencia de colesteatoma en relación a la edad estuvo en un 72% en pacientes de 41 a 65 años, con mayor predominancia en mujeres en un 57,3%. DISCUSIÓN. La presencia de perforación timpánica de acuerdo a lo observado es un factor de riesgo para el desarrollo de colesteatoma, ligado en su mayoría a cuadros de Otitis Media Crónica. CONCLUSIONES. Se confirmó que la perforación timpánica, es un factor de riesgo en el desarrollo del colesteatoma en los pacientes que tienen otitis media crónica, lo que demuestra la necesidad de manejo actualizado y continuo en pacientes con esta patología de oído. Se requieren estudios con muestras más amplias para determinar otros factores de riesgo como sexo, nivel de educación y edad que podrían influir en el desarrollo de colesteatoma.

INTRODUCTION. Ear pathology is a frequent disease in our environment, associated with repeated ear infections, with the presence of tympanic perforation and cholesteatoma, which will determine the presence of much more accentuated lesions in terms of auditory evolution or local or systemic complications. OBJECTIVE. To determine the association between the presence of cholesteatoma and tympanic perforation in patients with chronic otitis media. MATERIALS AND METHODS. Retrospective analytical epidemiological study. Population of 4 733 and sample of 75 patients for cases and 75 for controls based on clinical histories taken from the AS 400 computer system, who attended the Otorhinolaryngology outpatient clinic of the Carlos Andrade Marín Specialties Hospital in the period from January 2018 to December 2019; Inclusion criteria for case group: Men and women aged 20 to 65 years, diagnosis of chronic otitis media, diagnosis of otic cholesteatoma. Inclusion criteria for controls group: men and women aged 20 to 65 years, no diagnosis of cholesteatoma. RESULTS. A strong relationship was observed between having tympanic perforation and the development of cholesteatoma with an OR value of 33,14 with a 95% CI of 31,94 - 34,34, thus proving the study hypothesis. It was determined that tympanic perforation is a risk factor associated with the development of cholesteatoma in patients with chronic otitis media, the prevalence of cholesteatoma in relation to age was 72% in patients aged 41 to 65 years, with greater predominance in women in 57,3%. DISCUSSION. The presence of tympanic perforation according to what was observed is a risk factor for the development of cholesteatoma, mostly linked to Chronic Otitis Media. CONCLUSIONS. It was confirmed that tympanic perforation is a risk factor in the development of cholesteatoma in patients with chronic otitis media, which demonstrates the need for updated and continuous management in patients with this ear pathology. Studies with larger samples are required to determine other risk factors such as sex, education level and age that could influence the development of cholesteatoma.

Otomyiasis: Systematic Review

Abstract Introduction Myiasis is a disease causedby fly larvae that growinthetissues of animals and humans. It can cause a variety of local symptoms, like erythema or pain, depending on its location, and generalized symptomatology, such as fever andmalaise.Myiasis can generate severe complications, for instance sepsis, or directly impact vital tissues. Its management varies depending on the location, and on the preferences of the doctor that faces this challenge. Myiasis usually occurs in tropical countries, and, in many places, it is not a rare condition. The cases are rarely reported, and there are no publishedmanagement protocols. Objective To review the literature regarding the most common agents, the predisposing factors and the treatment alternatives for otic myiasis, a rare form of human myiasis caused by the infestation of fly larvae in the ear cavities. Data synthesis We present a systematic review of the literature. The search in five databases (Medline, Embase, Cochrane Database of Systematic Reviews, LILACS and RedALyC) led to 63 published cases from 24 countries, in the 5 continents. The ages of the patients ranged fromnewborn to 65 years old. Themost common agents belong to the Sarcophagidae or Calliphoridae families. Chronic otitis media, previous otic surgical procedures, mental deficit, alcohol or drug abuse, sleeping outdoors, prostration, and malnutrition were predisposing factors. The treatment alternatives are herein discussed. Conclusion The results highlight the need for monitoring, follow-up and standardization of medical approaches. (AU)

In vitro and in vivo efficacy of tea tree essential oil for bacterial and yeast ear infections in dogs / Uso in vitro e in vivo do óleo essencial de Melaleuca (Melaleuca alternifolia) em otites bacterianas e por leveduras

Otitis externa is a common complaint in dogs. Bacteria and yeasts are commonly involved and may perpetuate inflammatory reactions inside the ear canal. Otoscopy, cytological examination of secretion and microbiological culture embody forms of diagnosis. Cytology also has great use in accessing treatment evolution. Therapy usually consists of cleaning ear canals and subsequent use of antibiotics or antifungal products. As some of them may cause hypersensitivity and even ototoxicity, searching for new pharmacological bases is currently necessary and justifies this study, which aimed to evaluate in vitro and in vivo efficacy of tea tree essential oil for bacterial and yeast ear infections in dogs. Twenty-eight dogs from a particular shelter in Cuiabá (Mato Grosso, Brazil), presenting clinical signs of otitis externa, were enrolled in this clinical trial. In all of them, clinical and cytological evaluations, as well as culture and susceptibility testing of the affected ears were carried out. From each dog, one ear was treated with 5% tea tree essential oil lotion and the other with standard otic formulation, according to the type of infection (bacterial, yeast or both). In vitro susceptibility testings of all ear cultures, to the same drugs used in treatment, were also carried out. Culture results showed 62.5% bacterial and fungal infection, 33.9% bacterial infection and 3.6% fungal infection, from the 56 ear samples collected. The most common microorganisms isolated were Staphylococcus intermedius, Staphylococcus aureus, Proteus mirabilis and Malassezia pachydermatis. Gram-positive bacteria were susceptible to gentamycin in 60.5% and resistant in 16.3% of the samples. Five percent tea tree essential oil formulation produced a 5mm clear zone of inhibition around the disks in one of the 63 samples evaluated. Pure (100%) tea tree essential oil formulation produced a 10mm clear zone of inhibition around the disks in four of the 63 samples evaluated, a 9mm zone in three samples, an 8mm zone in 16 samples, a 7mm zone in seven samples, a 6mm zone in two samples and there was no clear zone in 31 samples. Inhibition zones were produced by strains of Staphylococcus intermedius, Staphylococcus hyicus, Corynebacterium sp., Proteus mirabilis and Enterobacter sp. tea tree essential oil ear solution significantly induced remission of clinical signs both in bacterial and yeast ear infections. It also reduced as much Malassezia pachydermatis ear infection as the nystatin solution used in this study, while gentamycin solution showed better antibacterial effect. More studies should be conducted to evaluate in vitro diffusion properties of tea tree essential oil. Good antimicrobial spectrum and the absence of adverse reactions confirm the importance of developing a tea tree formulation as an alternative therapy for ear infections in dogs.(AU)

Otite externa é queixa frequente em cães. Bactérias e leveduras estão comumente envolvidas e podem perpetuar as reações inflamatórias dentro do canal auditivo. Dentre as formas de diagnóstico, encontram-se a otoscopia, o exame citológico da secreção e a cultura microbiológica. Citologia também tem grande utilidade no acesso à evolução do tratamento. A terapia consiste de limpeza dos canais auditivos e posterior utilização de antibióticos ou produtos antifúngicos. Como alguns antimicrobianos utilizados no tratamento podem causar hipersensibilidade e até mesmo ototoxicidade, a busca por novas bases farmacológicas justifica a existência deste estudo, que teve como objetivo avaliar in vitro e in vivo a eficiência do óleo de Melaleuca alternifolia em otites bacterianas e fúngicas de cães. Vinte e oito cães, de um abrigo particular, apresentando sinais clínicos de otite externa, foram incluídos neste estudo clínico. Todos passaram por avaliação clínica, citologia e cultura de material das orelhas afetadas. De cada animal, uma orelha foi tratada com óleo de Melaleuca 5% e a outra com formulação ótica padrão, de acordo com a afecção (bacteriana, fúngica ou mista). As culturas também foram submetidas a testes de susceptibilidade in vitro aos mesmos agentes utilizados no tratamento in vivo. Os resultados da cultura mostraram 62,5% de infecção mista (bacteriana e fúngica), 33,9% de infecção bacteriana e 3,6%, de infecção fúngica a partir das 56 orelhas. Os micro-organismos mais isolados foram Staphylococcus intermedius, Staphylococcus aureus, Proteus mirabilis e Malassezia pachydermatis. As bactérias GRAM-positivas foram sensíveis à gentamicina em 60,5% e resistentes em 16,3% das amostras. A formulação com 5% de óleo essencial de Melaleuca produziu uma zona de inibição de 5mm em torno dos discos em uma das 63 amostras avaliadas. A formulação pura (100%) do mesmo produto produziu uma zona de 10mm de inibição em quatro das 63 amostras analisadas, uma zona de 9 mm em três amostras, uma zona de 8mm em 16 amostras, uma zona de 7mm em sete amostras, uma zona de 6mm em duas amostras e não havia nenhuma zona clara em 31 amostras. Zonas de inibição foram produzidas por estirpes de Staphylococcus intermedius, Staphylococcus hyicus, Corynebacterium sp., Proteus mirabilis e Enterobacter sp. Clinicamente, a formulação com o óleo essencial de melaleuca induziu significativamente uma melhora nas manifestações, tanto nas otites bacterianas quanto nas causadas por leveduras, sendo estatisticamente semelhante ao tratamento com nistatina (nas otites por levedura), mas menos eficaz que a solução de gentamicina nas otites bacterianas. Mais estudos devem ser realizados para avaliar as propriedades de difusão in vitro do óleo essencial de melaleuca. O bom espectro antimicrobiano, a boa resposta clínica e a ausência de reações adversas confirmam a possibilidade de desenvolvimento de formulação ótica com o óleo essencial de melaleuca, como uma alternativa para a terapia de infecções do ouvido em cães.(AU)

Susac's syndrome: isolated retinal artery occlusion after 10 years of remission / Síndrome de Susac: oclusão isolada da artéria retiniana após 10 anos de remissão

ABSTRACT Susac's syndrome, or microangiopathy of the retina, inner ear, and brain, is a rare condition characterized by the clinical triad of encephalopathy, branch retinal artery occlusion, and sensorineural hearing loss. The complete triad has been documented in 85% of reported cases. At clinical onset, the most common manifestations are central nervous system symptoms, followed by visual symptoms and hearing disturbances. Although the clinical course of Susac's syndrome is usually self-limiting, fluctuating, and monophasic, clinical polycyclic and chronic courses have also been described. Likewise, recurrences of the full triad after more than 10 years of remission have been reported. We describe a 21-year-old woman who presented with branch retinal artery occlusions and magnetic resonance imaging findings compatible with Susac's syndrome without objective hearing loss. After 10 years of remission, the patient complained of visual field loss due to new retinal ischemia. Neither other symptoms nor neuroimaging or audiometry pathologic findings were found during the clinical course.

RESUMO A síndrome de Susac, ou a micro angiopatia da retina, do ouvido interno e do cérebro, é uma condição rara caracterizada pela tríade clínica de encefalopatia, oclusão de ramo da artéria retiniana e perda de audição neuro-sensorial. A tríade completa é documentada em 85% dos casos registrados. No início dos sinais clínicos, a manifestação mais comum relaciona-se ao sistema nervoso central, seguida por sintomas visuais e distúrbios auditivos. Apesar do curso clínico da síndrome de Susac ser usualmente auto limitante, variável e monofásico, cursos clínicos policíclicos e crônicos têm sido também descritos. Do mesmo modo, recorrências da tríade completa após mais de 10 anos de remissão têm sido relatadas. Descrevemos o caso de uma mulher de 21 anos que apresentava oclusões de ramos da artéria retiniana e imagens por ressonância magnética compatíveis com a síndrome de Susac, sem comprometimento objetivo da audição. Dez anos após a remissão, a paciente queixou-se de perda de campo visual devido a uma nova isquemia da retina. Nenhum outro sintoma, ou neuroimagem ou achado audiométrico patológico foi observado durante o curso clínico.

Revisão da literatura: afecções auriculares parte 1: traumas físicos e por alteração térmica / Literature review: auricular disorders Part 1 - physical and thermal change related traumas

A orelha é estrutura com peculiaridades anatômicas, localizada em área exposta a traumas e suscetível a uma série de dermatoses que merecem atenção, muitas vezes subdiagnosticadas pelos dermatologistas. Realizou-se revisão de literatura incluindo a embriologia e a anatomia do pavilhão auricular, bem como diagnóstico e tratamento das lesões traumáticas de natureza física e por alterações de temperatura, entre outras.

The ear is a structure with anatomical peculiarities. It is located in an area exposed to trauma and susceptible to a series of dermatoses that are often underdiagnosed by dermatologists and deserve attention. A literature review was carried out including the embryology and anatomy of the auricular pavilion, as well as the diagnosis and treatment of traumatic lesions of physical nature and due to changes in temperature, among others.

Efficacy of autologous fat injection to treat patulous Eustachian tube / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the efficacy of autologous fat injection of eustachian tube pharyngeal orifice in the treatment of Patulous eustachian tube (PET). METHODS We selected 18 patients who had no obvious improvement after medical treatment of PET over 1 months. They were treated with autologous fat injections to narrow the pharyngeal ostium of the eustachian tube. The treatment results were documented, including the patient's supervisory feeling and visual analogue scale (VAS). RESULTS The total effective rate was 83.3％ after 12 months of follow-up (symptoms significantly reduced in 27.8％ of patients and partial improvement is 55.6％), 16.7％ the symptoms remain unchanged, no one worsened. No patients had any complications. CONCLUSION Autologous fat injection of the eustachian tube is a effective and safe treatment for PET with the percentage of significant or partial relief of 83.3％, It is easy to conduct in clinical practice which could potentially serve as an alternative treatment for PET.

Numerical analysis on sound compensation performance of round window stimulation in typical middle ear diseases / 医用生物力学

Objective To study the effect of typical middle ear diseases on sound compensation of round window (RW) stimulation, so as to provide references for the optimal design of middle ear implants by RW stimulation. Methods The finite element model of the middle ear and cochlea was built by CT scanning and reverse engineering technique, and its reliability was also verified. On the basis of the model and by changing material properties of corresponding tissues, three typical middle ear diseases were simulated: hardening of stapedial annular ligaments, abnormal stapedial bone growth and hardening of anterior mallear ligaments. Then the response from displacement of basilar membrane (BM) was compared to analyze the impact of 3 types of middle ear diseases on sound compensation of RW stimulation. Results The stapes with abnormal bone growth severely deteriorated the equivalent sound pressure (ESP) of RW stimulation at higher frequencies, while the hardening of stapedial annular ligaments and the hardening of anterior malleus ligaments prominently decreased ESP of RW stimulation at lower frequencies. Among the 3 types of middle ear diseases, hardening of stapedial annular ligaments affected the sound compensation of RW stimulation more significantly with the amount of the ESP reduction up to 17 dB. Conclusions Middle ear diseases can deteriorate the sound compensation of RW stimulation seriously with large deterioration, Therefore, the output stimulation of the actuator should be targeted to improve the design of the middle ear implants by RW stimulation.

Effectiveness of ear molding in the treatment of congenital auricular deformation / 中国耳鼻咽喉头颈外科

OBJECTIVE To evaluate the short-term efficacy of ear molding in the treatment of congenital auricular deformation. METHODS Twenty-four infants(twenty-eight ears) were treated with ear molding devices(EarWell Infant Ear Correction System). Doctors and parents were surveyed 1 months after treatment. RESULTS All cases were treated successfully without severe complications. 25 ears(89％) and 26(92％) were rated as very satisfied or satisfied by doctors and parents, respectively. CONCLUSION Ear molding is a noninvasive treatment, and effectively corrects congenital auricular deformation.

Efficacy of ultrasound-guided great auricular nerve block with different concentrations of ropivacaine for postoperative analgesia in patients undergoing tympanic and mastoid surgery / 中华麻醉学杂志

Objective To evaluate the efficacy of ultrasound-guided great auricular nerve block with different concentrations of ropivacaine for postoperative analgesia in patients undergoing tympanic and mastoid surgery.Methods Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 18-60 yr,with body mass index of 19-25 kg/m2,undergoing elective tympanic and mastoid surgery under general anesthesia,were divided into 3 groups (n=30 each) using a random number table:control group (group C),0.25％ ropivacaine group (group R1) and 0.50％ ropivacaine group (group R2).In R1 and R2 groups,great auricular nerve block was performed under ultrasound guidance before anesthesia induction,0.25％ and 0.50％ ropivacaine 2 ml were injected,respectively,10 min later the block in the area innervated by great auricular nerve was evaluated using the method of acupuncture in comparison with the contralateral area.After successful block was confirmed,the patients were ventilated using the laryngeal mask airway under general anesthesia.Flurbiprofen axetil was given as rescue analgesic,sufentanil was used when the efficacy was not satisfactory,and visual analog scale score was maintained less than or equal to 3 points.The number of patients requiring rescue analgesic was recorded within 48 h after surgery.Results The great auricular nerve was successfully blocked in 60 patients of R1 and R2groups.Compared with group C,the requirement for rescue analgesic was significantly decreased within 48 h after surgery in R1and R2 groups (P＜0.01).There was no significant difference in the requirement for rescue analgesic within 48 h after surgery between group R1 and group R2 (P＞0.05).Conclusion Ultrasoundguided great auricular nerve block with 0.25％ ropivacaine provides better efficacy for postoperative analgesia in the patients undergoing tympanic and mastoid surgery.

Effect analysis of anterior wall cartilage resection plus V suture for large pseudocyst of auricle / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo evaluate the efficacy of anterior wall cartilage resection plus V suture and anterior wall cartilage resection combined with compression and fixation in treating large pseudocyst of auricle through comparison analysis.METHODSA retrospective case-control study, comparing the efficacy of anterior wall cartilage resection and suture to wear a V type (45 cases) and anterior wall cartilage resection and compression bandage fixation (43 cases) for the treatment of large pseudocyst of auricle.RESULTS6 months after surgery for observation, the cure rate of treatment group was 88.89%, the rate of control group was 72.09%, the differences between the two groups was statistically significant (P<0.05).CONCLUSIONAnterior wall cartilage resection plus V suture for large pseudocyst of auricle is simple to operate, with fast recover and reliable effect.

An empirical study on medical selection of flying cadets with ear diseases between PLAAF and USAF / 军事医学

Objective To determine whether the candidates who are disqualified because of ear diseases during medical selection of flying cadets in China are qualified or not according to United States Air Force ( USAF ) Medical Standards Directory in order to raise suggestions for revising PLAAF medical standards for flying cadets.Methods Data of final selections from 2013 to 2015 and the conclusions were compared by different standards.Results and Conclusion There was a marked difference (x2 =7.99,P0.05) in the disqualification rate related to ear diseases.Vestibular dysfunction and dysacousis were the leading causes of disqualification among ear diseases, making up 45.54% and 38.84% respectively, with other diseases less than 5%.Medical standards for ear diseases in China are more strict than in the USAF, so we should revise some PLAAF standards according to the USAF standards for reference, such as those for vestibular neuritis, dysacousis and tympanic disease in order to enlarge the source of cadets.

Pattern of Ear Diseases in the Patients Attending Ear Outpatient Department of a Tertiary Center in Eastern Nepal.

Introduction: The prevalence of disabling hearing loss for adults and children is greatest in South Asia followed by Asia Pacific and Sub-Saharan Africa. Nepal is one of the least developed nation where hearing loss and ear diseases is very common. Objective: To find out the pattern of ear diseases in the patients attending Ear outpatient department (OPD) of Biratnagar Eye Hospital. Materials and Methods: A retrospective, descriptive review of data retrieved from the medical record section of the Hospital between January 1, 2014 to December 31, 2014 was done. The data were tabulated and analysed. The results are expressed in number and percentage. Results: Chronic suppurative otitis media, mucosal (42.64%) and ear wax/otomycosis (24.39%) were the commonest ear diseases found. Eustachian tube dysfunction (12.89%), acute otitis media (0.74%), acute suppurative otitis media (2.9%), otitis media with effusion (0.54%) were other common diseases. Presbyacusis (10.09%) was found to be a common problem in adults. Various other external auditory canal problems and those of inner ear were also detected. Conclusions: Ear diseases are one of the major health problems in Nepal. This study has found chronic otitis media and ear wax/otomycosis to be commonest problems in children and adults attending the Ear OPD of Biratnagar eye hospital.

Relationship between otolaryngologic complaints and systemic comorbidities observed in a group of hearing aid users

Introduction Optimization of the selection, adaptation, and benefit of hearing aids is necessary to characterize and manage hearing loss, user expectations, otolaryngologic symptoms, and systemic comorbidities. Objective To compare the occurrence of otologic complaints, systemic diseases, and effective use of hearing aids in men and women with deafness. Methods Patients from a Unified Health System-accredited hearing health service, who reported problems in adapting to their hearing aids, were evaluated by a physician and audiologist. An anamnesis, ENT evaluation, and audiological evaluation were performed. Results During the data collection period, 278 subjects came in for follow-up visits; of these, 61 (21%) reported otologic or operational problems with their equipment. The most prevalent type of hearing loss was basocochlear, a characteristic of presbycusis, in both men and women; the most frequently reported comorbidities were hypercholesterolemia (more significant in women) and hypertension (more significant in men). Fourteen subjects reported using their device discontinuously, with no significant difference between genders; the reasons for discontinuation of use were itching and ringing, with more complaints from women. Conclusion The incidence of systemic and audiological complaints is high in this population. These patients should be evaluated thoroughly, as resolutions of these complaints can contribute to improving the quality of life and assist in the process of hearing aid fitting.

Evaluation on short-term efficacy of balloon dilation in the treatment of symptomatical eustachian tube dysfunction / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo evaluate the short-term efficacy of Eustachian tube balloon dilation (ETBD) in the treatment of symptomatic Eustachian tube dysfunction (SETD) by subjective and objective analysis.METHODS Forty patients who underwent ETBD were included. Subjects’ inclusion criteria were as followed: symptoms of ETD (aural fullness predominantly, with or without otalgia, muffle hearing and tinnitus), normal tympanic membrane, type A or C tympanograms, and without a history of any middle ear diseases. Main outcomes including subjective improvement, otoscopy, pure-tone audiometry, impedance audiometry, R-value in tubomanometry (TMM) and Eustachian Tube Score (ETS) were assessed 1 week and 6 months postoperatively.RESULTSAll cases were dilated successfully. A significant effect of treatment was documented when measuring subjective improvement, impedance audiometry, R-value in TMM and ETS 1 week and 6 month postoperatively. Subjective symptoms were not relieved only in one patient. The overall success rate for all patients was 98%.CONCLUSIONETBD can provide short-term benefits to those who are diagnosed with SETD and refractory to medical management. SETD might be an optimal indication for ETBD in the treatment of ETD.

Application of Sinogram-afifrmed Iterative Reconstruction in Routine Dose Temporal Bone High Resolution CT / 中国医学影像学杂志

PurposeTo evaluate the impact of filtered back-projection (FBP) and sinogram-affirmed iterative reconstruction (SAFIRE) technique on the image quality of routine dose temporal bone high resolution CT (HRCT) scan, and to provide reference for the realization of low dose scanning.Materials and Methods Sixty patients underwent routine dose temporal bone HRCT scan, 6 groups of images were reconstructed with FBP and SAFIRE (strength grade 1-5), average CT value, noise (SD), signal to noise ratio (SNR), contrast to noise ratio (CNR), subjective score and lesion detection were compared between different groups.Results There was no significant difference of average CT value among the 6 groups (P>0.05); compared with FBP, SD of SAFIRE (strength 1-5) reconstruction decreased gradually (F=1.78,P<0.01), which was 23.1%, 39.2%, 42.4%, 54.1% and 61.2% respectively; SNR and CNR increased gradually (F=1.42 and 3.15, P<0.05), SNR increased 26.6%, 40%, 71.1%, 117.7% and 153.3% respectively, while CNR increased 17.4%, 33.1%, 63.2%, 104.1% and 147.2% respectively. The differences among the 6 groups were statistically significant (P<0.05), subjective scores of SAFIRE 2-4 were higher than those of FBP, SAFIRE 1 and SAFIRE 5 group, while the difference among SAFIRE 2-4 group was statistically insignificant, reconstruction smoothness and edge sharpness of SAFIRE 3 group was better, with highest objective score.Conclusion Routine dose temporal bone HRCT scan combined with SAFIRE reconstruction can increase the image quality of temporal bone high resolution scan effectively, with the potential for radiation dose reduction.

Malformación congénita del oído interno bilateral y del conducto auditivo interno derecho en un paciente con hipoacusia profunda neurosensorial bilateral: Presentación de caso / Congenital Malformation of the Bilateral Inner Ear and the Right Internal Auditory Canal in a Patient with Deep Bilateral Sensorineural Hearing Loss: Case Report

La tomografía computarizada y la resonancia magnética se consideran estudios complementarios que constituyen una herramienta de gran valor para el diagnóstico de malformaciones que afectan el oído interno. Para el estudio de los elementos óseos la tomografía brinda mayor detalle; por su parte, la resonancia magnética se emplea para la evaluación del laberinto membranoso y de los nervios vestibulococlear y facial (VIII y VII pares craneales). Este artículo presenta el caso de un niño de 1 año que cursa con grave hipoacusia neurosensorial bilateral; por medio de TC y RM se pudo determinar malformación congénita del oído interno bilateral tipo cavidad común, la cual está asociada a atresia del conducto auditivo interno derecho. Esto permitió descartar otras patologías dentro de su diagnóstico diferencial, como aplasia coclear, anomalía quística cocleovestibular y aplasia de canales semicirculares.

CT and MRI are complementary studies and are a valuable tool for the diagnosis of malformations affecting the inner ear. Tomography provides greater detail in the study of bony elements. On the other hand, MRI is used to evaluate the membranous labyrinth and the vestibule-cochlear and facial nerve (cranial nerves VIII and VII). This review presents the case of a one-year old child coursing with severe bilateral sensorineural hearing loss. Bilateral congenital malformation common cavity type was diagnosed through CT and MRI, associated with atresia of the right internal auditory canal. This enabled to rule out other pathologies within its differential diagnosis, such as cochlear aplasia, cochleovestibular cystic anomaly and aplasia of semicircular canals.

Hearing loss among patients with Turner's syndrome: literature review / Perda auditiva em pacientes com síndrome de Turner: revisão da literatura

INTRODUCTION: Turner's syndrome (TS) is caused by a partial or total deletion of an X chromosome, occurring in 1:2,000 to 1:5,000 live born females. Hearing loss is one of its major clinical manifestations. However, there are few studies investigating this problem. OBJECTIVES: To review the current knowledge regarding the epidemiology, etiology, clinical manifestations and diagnosis of hearing impairment in patients with TS. METHODS: A bibliographic search was performed in the Medline and Lilacs databanks (1980-2012) to identify the main papers associating Turner's syndrome, hearing impairment and its clinical outcomes. CONCLUSIONS: Recurrent otitis media, dysfunction of the Eustachian tube, conductive hearing loss during infancy and sensorineural hearing loss in adolescence are the audiologic disorders more common in ST. The karyotype appears to be important in the hearing loss, with studies demonstrating an increased prevalence in patients with monosomy 45,X or isochromosome 46,i(Xq). Morphologic studies of the cochlea are necessary to help out in the clarifying the etiology of the sensorineural hearing loss. .

INTRODUÇÃO: A síndrome de Turner (ST) é causada por uma deleção total ou parcial de um cromossomo X, ocorrendo em 1:2.000 até 1:5.000 meninas nascidas vivas. A perda auditiva é uma de suas principais manifestações clinicas. Entretanto, existem poucos estudos na literatura descrevendo essa associação. OBJETIVO: Rever o conhecimento atual sobre a epidemiologia, etiologia, manifestações clínicas e diagnósticas da deficiência auditiva em pacientes com ST. MÉTODOS: A pesquisa bibliográfica, realizada entre 1980-2012, utilizou os bancos de dados Medlinee Lilacs identificando os principais artigos que relataram associação entre ST e deficit auditivo e suas repercussões clínicas. CONCLUSÕES: Otite média de repetição, disfunção das trompas de Eustáquio, perdas auditivas condutivas durante a infância e perdas auditivas sensorioneurais a partir da adolescência são os distúrbios audiológicos mais comuns na ST. O cariótipo parece ter relação com a perda auditiva, com estudos mostrando aumento da prevalência de perda auditiva em pacientes com monossomia 45,X e isocromossomos 46,i(Xq). Estudos morfológicos da cóclea são necessários para ajudar a esclarecer a etiologia da perda auditiva sensorioneural. .

Eritromelalgia: apresentação clínica incomum / Erythromelalgia: an unusual clinical presentation

Eritromelalgia é uma doença rara caracterizada pela tríade: eritema, calor e dor em queimação. Pode envolver os pés, as mãos e, menos comumente, o segmento cefálico. Geralmente é bilateral, entretanto, pode manifestar-se de forma unilateral. O resfriamento das áreas afetadas pode resultar em alívio dos sintomas. Relatamos um caso de eritromelalgia no pavilhão auricular direito, uma localização não habitual.

Correção de orelha de abano por técnica combinada: análise de resultados e alteração da qualidade de vida / Otaplasty using cambined techniques: analysis af results and changes in patient quality af life

Introduction: Prominent ears are relatively frequent and are the most common congenital ear deformity. Numerous otoplasty procedures are described in the literature, including some that recommend the use of combined techniques. Outstanding ears cause considerable aesthetic alteration of the facial symmetry and are associated with psychological and behavioral problems. Thus, it is important to assess the improvement in patient quality of life that this surgical procedure provides. This study aimed to analyze the results of otoplasty procedures using combined techniques and assess the improvement in patient quality of life after the procedure. Method: A retrospective analysis of the results of otoplasty procedures conducted between February 2010 and June 2012 using combined Stenstroem, Mustardé, and Furnas techniques was performed. Epidemiological data and incidence of complications were analyzed, and improvement of quality of life was assessed using the Glasgow benefit inventory questionnaire. Results: Forty patients were included in the study, corresponding to a sample of 77 ears subjected to surgery. The patients' mean age was 24.4 years. Of the patients, 80% were women. Seven complications (9%) were observed in 7 patients who underwent surgery. The Glasgow benefit inventory questionnaire was answered by 26 patients. The mean score for overall benefit was 62.45 points (range, 30.5-97.2 points). Conclusions: The use of the combined techniques in otoplasty showed low incidence of complications and yielded results similar to those described in the literature. Moreover, this study demonstrated that this procedure has the potential to improve the quality of life of patients with prominent ears.

Introdução: Orelhas proeminentes são relativamente frequentes, sendo a alteração congênita mais comum da orelha. Inúmeros procedimentos de otoplastia são descritos na literatura, dentre eles alguns que preconizam a utilização de técnicas combinadas. A orelha de abano, além de proporcionar considerável prejuízo estético para a harmonia facial, está relacionada a problemas psicológicos e de comportamento. Assim, torna-se importante a mensuração da melhora da qualidade de vida proporcionada por esse procedimento cirúrgico. Este estudo teve por objetivo analisar os resultados das otoplastias utilizando técnica combinada e avaliar a melhora na qualidade de vida advinda após esse procedimento. Método: Análise retrospectiva dos resultados das otoplastias realizadas no período de fevereiro de 2010 a junho de 2012, com técnica combinada de Stenstroem, Mustardé e Furnas. Foram analisados dados epidemiológicos e incidência de complicações, bem como foi avaliada a melhora da qualidade de vida pelo questionário Glasgow Benefit Inventory. Resultados: Quarenta pacientes foram incluídos no estudo, correspondendo a uma amostra de 77 orelhas operadas. A média de idade dos pacientes foi de 24,4 anos, sendo 80% do sexo feminino. Ocorreram 7 complicações na amostra (9%) em 7 pacientes operados. O questionário Glasgow Benefit Inventory foi respondido por 26 pacientes. A pontuação de benefício geral revelou uma média de 62,45 pontos (30,5 pontos a 97,2 pontos). Conclusões: A utilização de técnicas combinadas na correção da orelha de abano revelou baixa incidência de complicações, com resultados comparáveis aos da literatura. Este estudo demonstrou ainda que a realização desse procedimento apresenta a possibilidade de modificar positivamente a qualidade devida dos pacientes operados.