Revisión Exploratoria: Comunicación de la Articulación Temporomandibular y del Oído Medio en Fetos y Niños / Exploratory Review: Temporomandibular Joint and Middle Ear Communication in Fetuses and Infants

La Articulación temporomandibular (ATM) cumple funciones importantes para la vida; su adecuado funcionamiento se puede alterar por trastornos temporomandibulares (TTM). La sintomatología de los TTM es variada, entre ellos se encuentra dolor en los músculos masticatorios, ruidos articulares y con menos frecuencia algunos pacientes refieren síntomas auditivos, lo que sugiere la existencia de una relación entre la ATM y el oído medio; sin embargo, esta relación no es clara. En consecuencia, el presente estudio tiene como propósito realizar una revisión de literatura para identificar los aspectos conocidos, desconocidos y controvertidos sobre la relación entre la ATM y el oído medio en niños y fetos. Se efectuó una búsqueda de la literatura en bases de datos utilizando los operadores booleanos (AND/OR) y los términos clave en inglés y en español. Se identificaron inicialmente 1080 artículos, se eliminaron los artículos duplicados y se aplicaron los criterios de inclusión y exclusión. Finalmente, se seleccionaron un total de 14 artículos que se revisaron a texto completo. Los estudios encontrados se enfocan en el desarrollo histoembriológico de la ATM y cómo ese desarrollo se da en conjunto con los componentes del oído medio. Adicionalmente, se identificaron investigaciones sobre el origen, la morfología y función del ligamento discomaleolar, el ligamento esfenomandibular y la fisura petrotimpánica como estructuras que conectan la ATM y el oído medio, pero los resultados han sido controvertidos. Se concluye que son necesarios más estudios para determinar cualquier relación anatómica y fisiológica que pueda existir entre la ATM y el sistema auditivo en fetos y niños.

SUMMARY: The temporomandibular joint (TMJ) has important functions for life; its proper functioning can be altered by temporomandibular disorders (TMD). The symptomatology of TMD is varied, including pain in the masticatory muscles, joint noises and less frequently some patients report auditory symptoms, suggesting the existence of a relationship between the TMJ and the middle ear; however, this relationship is not clear. Consequently, the present study aims to conduct a literature review to identify the known, unknown and controversial aspects of the relationship between TMJ and the middle ear in children and fetuses. A literature search was performed in databases using Boolean operators (AND/ OR) and key terms in English and Spanish. A total of 1080 articles were initially identified; duplicate articles were eliminated and inclusion and exclusion criteria were applied. Finally, a total of 14 articles were selected and reviewed in full text. The studies found focus on the histoembryological development of the TMJ and how that development occurs in conjunction with the middle ear components. Additionally, research on the origin, morphology, and function of the discomalleolar ligament, sphenomandibular ligament, and petrotympanic fissure as structures connecting the TMJ and middle ear was identified, but the results have been controversial. It is concluded that further studies are necessary to determine any anatomical and physiological relationship that may exist between the TMJ and the auditory system in fetuses and children.

Students Perception Of Learning Middle Ear Anatomy Using Endoscopic Teaching And Model Teaching.

Background: An undergraduate curriculum begins with anatomy, the importance of this knowledge is essential for understanding and contextualizing clinical pathophysiology. Didactic lecture and cadaveric dissection have been the mainstay of anatomical learning. Temporal bone is the complicated bone of the skull and lodges middle ear. Middle ear surgeries requires complete evaluation of middle ear surgical anatomy, mainly posterior tympanic cavity, as it contains many irregular spaces, removal of complete cholesteatoma is a challenge that surgeons face regularly. Endoscopic dissection is the innovative way and aids in viewing of nook and corner of middle ear. To compare theObjective: learning effectiveness of students through model teaching and endoscopic teaching of middle ear anatomy on cadaver specimen. Currently wet sagittal section of face and POP model of middle ear are theMethods and Materials: materials used for the study. For the new innovative approach, third year MBBS students were divided into two groups containing 30 in each group. Assessment of both the groups was done with questionnaire. Both the groups were assessed with same questions and scoring was done. In group A, maximum score was 11 and minimum was 3.25 out of 18.Results: In group B, maximum score was 17.5 and minimum was 5 out of 18. In group A, according to scaling, students fell into poor and average category whereas in group B , students fell into good and very good category as well. Conclusions: Analysis identified, statistically significant increase in performance for the endoscopic method compared to model teaching.Overall, the endoscopic approach to middle ear anatomy education is associated to an improved gain in knowledge and more efficient as compared to model teaching

Anatomical and Clinical Evaluation of Tympanic Tegmen and Mastoid Bone with Multidetector Computed Tomography / Evaluación Anatómica y Clínica del Tegmen Timpánico y Hueso Mastoideo con Tomografía Computarizada Multidetector

SUMMARY: Tegmen level and mastoid bone thickness are important parameters of surgical risk in middle ear and mastoid region surgeries. This retrospective cohort study was conducted to provide a risk classification for the mastoid and middle ear regions. The study population comprised of 300 patients who underwent multidetector computed tomography (MDCT) for various indications. Patients with no pathology that disrupted the structure of the temporal region were included in the study. A risk classification was generated by analyzing the data obtained from mastoid and tympanic tegmen depths and the mastoid bone thickness by MDCT. The mastoid and tympanic tegmen were lower on the right side than on the left. In women, the right-sided mastoid bone thickness and mastoid tegmen were lower, and low-level tympanic and mastoid tegmen on the left and thin right mastoid bones were more common. According to the risk classifications for mastoid and middle ear region surgeries, women demonstrated a higher risk than men. In addition, as the thickness of the mastoid bone increased, the levels of the mastoid and tympanic tegmen increased. The present study provides a proper risk classification that may be helpful for preoperative risk assessment prior to middle ear and mastoid region surgery.

El nivel del tegmen y el grosor del hueso mastoideo son parámetros importantes del riesgo quirúrgico en las cirugías del oído medio y la región mastoidea. Este estudio de cohorte retrospectivo se llevó a cabo para proporcionar una clasificación del riesgo en las regiones mastoidea y del oído medio. La población de estudio estuvo compuesta por 300 pacientes que se sometieron a una tomografía computarizada multidetector (MDCT) por diversas indicaciones. Se incluyeron en el estudio pacientes sin patología que alterase la estructura de la región temporal. Se generó una clasificación de riesgo analizando los datos obtenidos de las profundidades del tegmen mastoideo y timpánico y el grosor del hueso mastoideo por TCMD. El tegmen mastoideo y timpánico estaban más bajos en el lado derecho que en el izquierdo. En las mujeres, el grosor del hueso mastoideo del lado derecho y el tegmen mastoideo eran más bajos, y eran más frecuente la presencia de tegmen timpánico y mastoideo de bajo nivel en los huesos mastoideos izquierdo y delgados en el lado derecho. Según las clasificaciones de riesgo de las cirugías de la región mastoidea y del oído medio, las mujeres presentaban un mayor riesgo que los hombres. Además, a medida que aumentaba el grosor del hueso mastoides, aumentaban los niveles del tegmen mastoideo y timpánico. El presente estudio proporciona una clasificación de adecuada de riesgo que puede ser útil para la evaluación preoperatoria del riesgo antes de la cirugía del oído medio y la región mastoidea.

Colesteatoma congénito: revisión de la literatura

El colesteatoma congénito es una entidad clínica única y desafiante, que se caracteriza por acumulación anormal de queratina en el oído medio, medial a la membrana timpánica. Se presenta, mayoritariamente, en el género masculino, con una incidencia estimada de 0.12 por 100.000 habitantes, representando el 4% a 24% de los colesteatomas en población pediátrica y un 2% a 5% del total de colesteatomas. Su origen aún es controversial, siendo la teoría más aceptada, la del arresto epitelial. Su diagnóstico es clínico, variando la sintomatología según severidad del compromiso, presentándose desde hallazgo incidental, hipoacusia de conducción, hasta presentar otalgia y perforación timpánica. Las imágenes se consideran un apoyo complementario preoperatorio. El tratamiento es quirúrgico, con diferentes técnicas disponibles, las cuales se deben definir de manera individual en el caso de cada paciente. Es fundamental su diagnóstico y manejo precoz, para lograr un tratamiento oportuno con menor tasa de complicaciones y compromiso a largo plazo. A continuación, se presenta una revisión de la literatura respecto de esta patología, para difusión en nuestro medio.

Congenital cholesteatoma (CC) is a unique and challenging clinical entity characterized by abnormal accumulation of keratin in the middle ear, medial to the tympanic membrane, being more frequent in the male gender, with an estimated incidence of 0.12 per 100,000 inhabitants. It represents 4% to 24% of cholesteatomas in the pediatric population and 2% to 5% of all cholesteatomas. Its cause is still controversial, the most accepted theory being epithelial arrest. The diagnosis is clinical, varying the symptoms according to the severity of the compromise, from incidental finding, through conduction hearing loss, to presenting otalgia and tympanic perforation. Images are considered additional preoperative support. Treatment is predominantly surgical, with different techniques available, which must be defined individually. Its early discovery and management are essential to achieve proper treatment with a lower rate of complications and long-term commitment. We present a review of the literature regarding CC to provide information relevant to our area of expertise.

Descriptive study of goat external and middle ear through computed tomography and endoscopic evaluation, compared with the human ear

Abstract Objective: To describe the external and middle ear of goats, using computed tomography and endoscopic dissection, comparing them with the anatomy of the human ear, aiming to evaluate the viability of this animal model for training in otological endoscopic surgery. Methods: Images of the external and middle ear of goats were produced by computed tomography in the coronal and axial planes and analyzed. The radiological anatomy of the external and middle goat and human ear are described. Some measures of surgical interest were described, such as the length of the external auditory canal, external and internal cross-sectional area of the external auditory canal, middle ear depth, vertical angle of the external auditory canal, length of malleus and incus. After the tomographic study, we analyzed the importance of evaluations through the endoscopic dissection of the goat ear. Results: The bony canal is extremely tortuous and shows a bony prominence with significant elevation near the lower edge of the tympanic membrane. The middle ear has a large tympanic bulla in the hypotympanum region. The malleus is shaped similarly to that of the human, but its handle is located anterior to its head. The mastoid is not pneumatized. Compared to the human mastoid, there was a statistically significant difference in the external and internal cross-sectional area, at the depth of the middle ear, in the vertical angle of the canal and in the length of the incus. Conclusion: Goat morphometric anatomy showed that this model is suitable for surgical simulation in the initial training for endoscopic otological surgery. It is an important contribution to the development of skills to accelerate the subsequent endoscopic otological surgical training in humans, despite some differences found.

Prevalence of middle ear effusion among children with adenoid hypertrophy at a national referral hospital in Tanzania

Introduction: Middle ear effusion (MEE) is a common childhood disorder that causes hearing impairment due to the presence of fluid in the middle ear which reduces the middle ear's ability to conduct sound. Temporary or persistent hearing loss as a result of MEE causes speech, language and learning delays in children. There are few studies on MEE in Tanzania despite the huge burden of hearing loss among children with adenoid hypertrophy which is a known risk factor for MEE. Method: A cross-sectional study was conducted among 420 children aged nine years and below having adenoid hypertrophy with or without MEE. The diagnosis of adenoid hypertrophy was confirmed with a lateral view x-ray of the nasopharynx and tympanometry for cases with MEE. The primary objective of the study was to assess the prevalence of MEE among children with adenoid hypertrophy. Results: The prevalence of MEE among children with adenoid hypertrophy was 61.7%, with 218 (51.9%) males and 202 (48.1%) females. The most affected age group was 2-4 years with an incidence 193 (46%) and in this age group, males (53.9%) were more affected than females (46.1%). Generally, males, 134 (51.7%) were more affected by MEE than females, 125 (48.3%) of all 259 children with MEE. In terms of age group predominance by MEE, children aged 3-4 years, 107(41.3%) were more affected than all other age groups. Additionally, 4 (1.5%) children with MEE presented with hearing loss. Conclusion: There is a high prevalence of MEE among children with adenoid hypertrophy but no significant association with hearing loss.

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.

The Endoscopic Anatomy of the External Acoustic Meatus and of the Middle Ear in Dry Temporal Bones: A Study Conducted Using Digital and Mobile Device Technology

Abstract Introduction The endoscopic anatomy of the middle ear (ME) and of the external acoustic meatus (EAM) has been described in cadavers, in fresh temporal bones, or in vivo using conventional video recording, but not in dry bones or using an alternative inspection and recording technique. Objective To study the anatomy of the ME and of the EAM in dry temporal bones using a smartphone-endoscope system. Methods The EAM and the ME were studied in dry temporal bones using an endoscopic transcanal approach with a telescope connected to a smartphone (M-scope mobile endoscope app and adaptador, GBEF Telefonia, São Paulo, SP, Brazil). Results Out of 50 specimens, 2 had exostosis of the EAM and 3 contained remains of the tympanic membrane. The anterior wall of the EAM was prominent in 10/48 specimens (20.8%). Ossicles were seen in 13/45 (28.8%), stapes at the oval window were seen in 12/45 (26.6%), and the incus was seen in 1/45 (2.2%) specimens. The facial canal was open and protruding in 15/45 (33.3%) and in 7/45 (15.5%) specimens, respectively. Of the 45 MEs evaluated, type A was predominant for finiculus (93.3%), subiculum (100%), and ponticulus (95.6%). The rest were type B. None was classified as type C. According to its position in relation to the round window, the fustis was classified into type A (68.9%) or B (31.1%). The pyramidal eminence, the bony portion of the Eustachian tube, the semicanal of the tensor tympani muscle, and the cochleariform process were visualized completely or partially in all cases. Conclusion The use of a smartphone-based endoscopic transcanal procedure in dry temporal bones allowed the evaluation of anatomical variations in the EAM and in the ME.

Wideband Acoustic Absorbance in Otosclerosis: Does Stapedotomy Restore Normal Tympanic Cavity Function?

Abstract Introduction Otosclerosis is characterized by the fixation of the stapes to the oval window, thereby impairing acoustic signal absorbance. A commonly used surgical technique for improving hearing in cases of otosclerosis is stapedotomy. However, it is unclear whether this surgery restores all the physical characteristics of the tympano-ossicular system. Objective To evaluate the tympano-ossicular system in individuals with fenestral otosclerosis pre and poststapedotomy using wideband tympanometry. Method A total of 47 individuals and 71 ears were assessed. The subjects were divided into three groups: presurgery otosclerosis; postsurgery; and a control group of normal-hearing adults. A handheld tympanometer with a wideband module (226-8,000 Hz) was used to take measurements at ambient pressure and under pressurized conditions. The level of statistical significance adopted was p ≤ 0.05. Results Acoustic absorbance at 226 Hz was low for all groups. At frequencies in the range 630 to 5,040 Hz, each group had a characteristic absorbance curve, allowing them to be distinguished from one another. In the presurgery group, absorbance values were below normal levels, with energy absorbance below 10%. Low energy absorbance was most evident at 1,000 Hz in the presurgery group, but this was not observed in the postsurgery group. Although there was an improvement in hearing, the surgery failed to restore the tympano-ossicular system to normal. Conclusion Wideband acoustic absorbance proved able to differentiate normal ears and otosclerotic ears pre and postsurgery, under both ambient pressure and pressurized conditions.

Congenital cholesteatoma: a review

Congenital cholesteatoma (CC) is a whitish mass lesion found in the middle ear cleft behind the intact tympanic membrane in early life. It is a relatively uncommon disease and shows its growth and extension over a period of time. CC is evidenced with no prior history of tympanic membrane perforation, otorrhea, previous otologic procedures, normal pars tensa, and pars flaccida. The etiopathogenesis of CC is still controversial; however, the epithelial cell rest theory is the most commonly accepted one. The most common sites of CC are the anterior-superior and posterior-superior quadrants of the tympanic cavity. The most common clinical presentation of CC is conductive hearing loss. Early detection and intervention are needed to avoid the complications of CC. The treatment of choice in CC is still surgical. The frequency of recurrence seems to be lower in patients with CC than in acquired cholesteatoma. Rapid progression of the CC may occur in older children and the recurrence has been associated with advanced progression of the cholesteatoma. There are very few reports for CC available in the medical literatureThis objective of this review article is to discuss the prevalence, etiopathology, clinical manifestations, diagnosis, and treatment.

Revision Stapedotomies: The Role of Periprosthetic Scar Tissue Formation in the Development of Unsatisfactory Hearing Results after Stapedotomy

Abstract Introduction Revision stapes surgeries are difficult to perform, and their audiological results are inferior to primary surgeries. Objective Our goal was to identify the most common and most influential postoperative reasons that cause persistent air-bone gap (ABG) after the primary surgery. Our focus was concentrated on the mechanical dysfunctions in the middle ear, with special regard to postoperative adhesion formation. Methods We performed a retrospective case series study with 23 cases that underwent revision stapedotomies. Results A significant improvement was seen in ABG and air conduction levels after surgery. The periprosthetic adhesion formation was seen in 65% of the cases, and it was the primary cause behind the unsatisfactory hearing result in 30% of cases. There was no significant difference in the level of persistent ABGs after the primary surgery, in case of the intratympanic adhesion presence, compared with the presence of other surgical failures. Concerning hearing and ABG gain after revision surgery, the non-inferiority of the negative effect associated with adhesion was shown compared with the other reasons. Conclusion The revision stapedotomy is an efficient treatment option in case of persistent ABG. Periprosthetic adhesions are the most common intratympanic reasons for compromised audiological outcomes after stapedotomy.

Osteoporosis bilateral del yunque, hallazgos otopatológicos / Case report: Bilateral incus osteoporosis, otopathological findings / Relato de caso: Osteoporose bilateral da bigorna, achados otopatológicos

La osteoporosis es una enfermedad sistémica esquelética, cuyas manifestaciones más comunes son las fracturas vertebrales y de cadera. En relación con el oído, se han realizado algunos estudios controversiales que sugieren el aumento de riesgo de pérdida auditiva en pacientes con osteoporosis, mientras otros indican que no hay relación alguna con esta enfermedad. Se realizó un reporte de caso donde se describen los hallazgos en el oído medio y oído interno, tras la valoración bajo microscopía de luz, en un espécimen de hueso temporal con antecedente de osteoporosis. Se evidencia desmineralización, porosidad y disminución cualitativa del tejido óseo, así como disminución del espacio incudomaleolar.

Osteoporosis is a skeletal systemic disease, commonly known for its affection on hips and spine. In relation to the ear, several controversial studies have documented an increased risk for hearing loss in patients with osteoporosis, while others do not find any association with these disorders. A case report was carried out which describes the findings in the middle ear and inner ear, after evaluation under light microscopy, in a temporary bone specimen with a history of osteoporosis. Demineralization, porosity and qualitative diminished bone tissue are found, as well as a decrease in the incudomallear joint.

A osteoporose é uma doença esquelética sistêmica, cujas manifestações mais comuns são as fraturas vertebrais e de quadril. Em relação ao ouvido, foram realizados alguns estudos controversos que sugerem um risco aumentado de perda auditiva em pacientes com osteoporose, enquanto outros indicam que não há relação com essa doença. Foi feito um relato de caso descrevendo os achados em ouvido médio e ouvido interno, após avaliação sob microscopia de luz, em espécime de osso temporal com histórico de osteoporose. Há evidências de desmineralização, porosidade e diminuição qualitativa do tecido ósseo, bem como diminuição do espaço incudomaleolar.

Absceso mastoideo como presentación de colesteatoma congénito en preescolar ¿cuál es el origen? / Mastoid abscess as congenital cholesteatoma presentation in a child what is the origin?

Resumen El colesteatoma congénito es una entidad que puede manifestarse con una amplia variedad de síntomas o ser silente durante largo tiempo y constituir un hallazgo incidental. Una vez diagnosticada es importante valorar su extensión y el compromiso de estructuras adyacentes, para lograr una adecuada planificación quirúrgica, eliminando la enfermedad y manteniendo la mejor funcionalidad posible. Se presenta un caso de colesteatoma congénito infantil.

Abstract Congenital cholesteatoma is an entity that can manifest with a wide variety of symptoms or be silent for a long time and constitute an incidental finding. Once diagnosed, it is important to assess the extension to apply the most efficient treatment, eliminating the disease and providing functionality if possible. A case of congenital cholesteatoma in a child is presented.

O uso do retalho de fáscia parietotemporal no tratamento do colesteatoma recidivado: caso clínico / The use of parietotemporal fascia flap in the treatment of recurrent cholesteatoma: clinical case

O colesteatoma consiste em um processo inflamatório que resulta na migração do epitélio escamoso queratinizado para o ouvido médio. Embora considerada uma entidade histopatologicamente benigna, pode se comportar de forma bastante agressiva sendo uma importante causa de surdez em todos os países. Descarga, dor, ruptura do tímpano com extensão para o ouvido interno levando à surdez e vertigem, são as manifestações clínicas mais comuns. O tratamento consiste na excisão cirúrgica de todo o epitélio estranho da orelha média. As recorrências podem chegar a 50% e são um desafio para os médicos de ouvido, nariz e garganta. Neste relato de caso descrevemos um caso de colesteatoma recorrente adquirido em um hospital terciário em Portugal, tratado com ablação radical de ouvido médio e cavidade mastóide pelos médicos otorrinolaringologistas. A opção reconstrutiva escolhida foi a obliteração do espaço morto com retalho fascial temporo-parietal pelo Serviço de Cirurgia Plástica.

Cholesteatoma consists of an inflmmatory process that results in the migration of squamous keratinized epithelium into the middle ear. Although regarded as a histopathologically benign entity it can behave quite aggressively being an important cause of deafness in all countries. Ear discharge, pain, ear drum rupture with extension into the inner ear leading to deafness and vertigo, are the most common clinical manifestations. Treatment consists of surgically excising all the foreign epithelium from the middle ear. Recurrences can be as high as 50% and are a challenge to Ear, Nose and Throat doctors. In this case report we describe a case of an acquired recurrent cholesteatoma in a tertiary hospital in Portugal, treated with radical ablation of middle ear and mastoid cavity by the otolaryngologists. The chosen reconstructive option was obliteration of the dead space using a temporo-parietal fascial flap by the Plastic Surgery Department

Perfil clínico e audiológico de pacientes submetidos a timpanostomia e inserção de tubo de ventilação / Clinical and audiological features in patients undergoing tympanostomy tube placement

Introdução: A presença de líquido na orelha médiapode causar perdas auditivas de condução e atrasos no desenvolvimento da criança. A timpanotomia e colocação do tubo de ventilação é o tratamento para casos em que o acúmulo de secreção é persistente. Objetivo: Avaliar o perfil epidemiológico e audiológico dos pacientes submetidos a timpanotomia e colocação do tubo de ventilação. Métodos: Estudo observacional, retrospectivo e transversal baseado em revisão de prontuários. Resultados: Foram incluídos 69 pacientes que realizaram o procedimento. O sexo masculino correspondeu a 64% e a média de idade foi de 8 anos. Otite média secretora foi o diagnóstico predominante. Pelo menos uma comorbidade foi encontrada em 63 pacientes, com predomínio de rinite alérgica. A maioria realizou apenas 1 operação. A bilateralidade da colocação do tubo ocorreu em 57%. Amigdalectomia e/ou adenoidectomia foram frequentemente adicionadas. Hipoacusia, roncopatia, prurido nasal, obstrução nasal e respiração oral noturna foram as queixas predominantes. Em relação à audiometria, 68% evoluíram para limiares normais; já na timpanometria 62% mostraram melhora no timpanograma. Conclusão: No tratamento com colocação de tubo de ventilação bilateral houve melhora pós-operatória na audiometria e timpanometria na maioria dos casos.

Introduction: The presence of fluid in the middle ear can cause conductive hearing loss and developmental delays in children. Tympanotomy and ventilation tube placement is the treatment for cases where secretion accumulation is persistent. Objective: To evaluate the epidemiological and audiological profile of patients submitted to tympanotomy and ventilation tube placement. Methods: Observational, retrospective and cross-sectional study based on medical records. Results: 69 patients who underwent the procedure were included. Males accounted for 64% and the mean age was 8 years. Secretory otitis media was the predominant diagnosis. At least one comorbidity was found in 63 patients, with a predominance of allergic rhinitis. Most performed only 1 operation. Bilateral tube placement occurred in 57%. Tonsillectomy and/or adenoidectomy were frequently added. Hypoacusis, snoring, nasal itching, nasal obstruction and nocturnal oral breathing were the predominant complaints. Regarding audiometry, 68% evolved to normal thresholds; in the tympanometry 62% showed improvement in the tympanogram. Conclusion: In the treatment with placement of a bilateral ventilation tube, there was postoperative improvement in audiometry and tympanometry in most cases.

Osteoma de oído medio asintomático

Resumen El osteoma de oído medio es un tumor poco común, de crecimiento lento y características benignas. Frecuentemente cursa de forma asintomática y su diagnóstico suele ser casual como en el caso que exponemos. Se presenta el caso de un varón de 26 años, que consultó por odinofagia y otalgia derecha en el contexto de una infección de vía aérea alta. Al explorarlo mediante otoscopia se visualizó en el oído izquierdo una lesión blanquecina y redondeada retrotimpánica compatible con osteoma de oído medio. El tratamiento de elección en pacientes con osteomas de oído medio sintomáticos es la cirugía. Sin embargo, en pacientes asintomáticos el seguimiento es la opción más recomendada.

Abstract The middle ear osteoma is a benign, infrequent, slow-growing tumor. This lesion is frequently asymptomatic and its diagnosis is usually accidental, as the case presented here. We present a case of a 26-year-old man who consulted for odynophagia and right ear pain in the context of an upper airway infection. By otoscopy in the left ear, we observed a whitish retrotympanic lesion that was compatible with a middle ear osteoma. To manage symptomatic patients with middle ear osteomas, surgery is the treatment of first choice. Nevertheless, for asymptomatic patients, follow up is recommended.

Disección anatómica del oído medio y el oído interno / Middle and inner ear anatomical dissection / Dissecção anatómica do ouvido médio e do ouvido interno

RESUMEN Introducción: El oído medio y el oído interno presentan una compleja constitución anatómica; La disección como método de enseñanza proporciona una comprensión óptima de la configuración tridimensional de sus estructuras debido a su carácter práctico y realista. Se propone un protocolo de disección aislada del oído medio e interno que ofrece una visión amplia de sus estructuras e incorpora esquemas didácticos. Metodología: En tres cadáveres humanos en estado de conservación se delimitaron dos cuadrángulos en la cara _ superior del hueso temporal mediante referentes anatómicos para extraer una estructura paralelepípeda correspondiente a la porción petrosa del hueso temporal, sobre la cual se realizó disección. Resultados: Se creó un protocolo de disección siguiendo esta secuencia: Extracción parcial de la porción petrosa del hueso temporal, visualización del oído medio, exposición de la membrana timpánica y visualización del oído interno. Conclusión: Esta herramienta pedagógica es aplicable al proceso de enseñanza y constituye un recurso cuyo carácter didáctico resulta potencialmente útil para los estudiantes facilitando el aprendizaje activo de los aspectos teóricos y prácticos del oído.

ABSTRACT Introduction: The middle and the inner ear have a complex anatomical constitution. As a traditional teaching method, the dissection provides an optimal knowledge of the three-dimensional configuration of its structures due to its practical and realistic qualities. It proposes a protocol of isolated dissection of the middle and the inner ear offering a broad vision of its structures and incorporates didactic schemes. Materials and Method: We delimited two quadrants in the upper face of the temporal bone of three conserved human corpses by employing anatomical referents to extract a parallelepiped structure that corresponds to the petrous portion of the temporal bone. On this portion, the dissection was performed. Results: we created a dissection protocol following this sequence: The petrous portion of the temporal bone partial removal, middle ear visualization, tympanic membrane exposure and inner ear visualization. Conclusion: This pedagogical instrument is applicable to the process of education and constitutes a resource whose didactic character results potentially useful for the students facilitating the active learning of the theoretical and practical issues of the ear anatomy

RESUMO Introdução: O ouvido médio e interior apresentam uma constituição anatómica complexa; a dissecação como método de ensino proporciona uma compreensão óptima da configuração tridimensional das suas estruturas devido ao seu carácter prático e realista. É proposto um protocolo de dissecção isolada do ouvido médio e interno, que oferece uma visão ampla das suas estruturas e incorpora diagramas didácticos. Metodologia: Em três cadáveres humanos conservados, dois quadrantes foram delimitados na face superior do osso temporal por meio de referências anatómicas, a fim de extrair uma estrutura paralelepipédica correspondente à porção petrosa do osso temporal, sobre a qual foi realizada a dissecação. Resultados: Foi criado um protocolo de dissecação seguindo esta sequência: extracção parcial da porção petrosa do osso temporal, visualização do ouvido médio, exposição da membrana timpánica e visualização do ouvido interno. Conclusão: Esta ferramenta pedagógica é aplicável ao processo de ensino e constitui um recurso cujo carácter didáctico é potencialmente útil para os estudantes, facilitando a aprendizagem activa dos aspectos teóricos e práticos do ouvido.

Prevalence of middle ear disease in Chilean natives and the impact of development over 14 years / Prevalência de doenças da orelha média em nativos chilenos e o impacto do desenvolvimento ao longo de 14 anos

Abstract Introduction The prevalence of middle ear disease and its risk factors have been the subject of multiple studies. High prevalence of middle ear disease has been described among North American natives, especially chronic otitis media. Such studies have not been carried out in South America. Objective To describe the prevalence of middle ear pathology and risk factors in native schoolchildren from southern Chile who belong to the Mapuche ethnic group, as well as the impact of socio-economic and demographic changes after 14 years of development. Material and methods Two otologic evaluations with an interval of 14 years were performed in schoolchildren with a percentage of indigenous population above 85%. Socioeconomic and demographic data were collected from national official statistical data. Results A total of 1067 schoolchildren were examined. Many described risk factors for ear pathology were found. An overall prevalence of 0.19% for tympanic membrane perforation, 5.6% for pars tensa retraction pockets, 1.5% for pars flaccida retraction pockets and 11.1% of otitis media with effusion was found. There were several socioeconomic improvements after 14 years. The difference between the prevalence of symptoms and the presence of otitis media with effusion was statistically significant (p < 0.001). Conclusions Despite the presence of several risk factors for middle ear disease, this study population showed a low prevalence of middle ear disease. The ethnic-racial factor seems to be a protective factor.

Resumo Introdução A prevalência de doenças da orelha média e seus fatores de risco já foram objeto de múltiplos estudos. A alta prevalência dessas doenças foi descrita entre os nativos da América do Norte, principalmente a otite média crônica. Tais estudos não foram feitos na América do Sul. Objetivo Descrever a prevalência de doenças da orelha média e fatores de risco em crianças de idade escolar, nativos do sul do Chile pertencentes à etnia Mapuche, bem como o impacto de mudanças socioeconômicas e demográficas após 14 anos de desenvolvimento. Método Foram feitas duas avaliações otológicas com intervalo de 14 anos em escolares com percentual da população indígena acima de 85%. Dados socioeconômicos e demográficos foram coletados a partir de dados estatísticos oficiais nacionais. Resultados Foram examinados 1.067 escolares. Foram encontrados diversos fatores de risco descritos para doença otológica. Foi encontrada uma prevalência geral de 0,19% para perfuração da membrana timpânica, 5,6% para retrações da pars tensa, 1,5% para retração da pars flácida e 11,1% de otite média com efusão. Houve várias melhorias socioeconômicas após 14 anos. A diferença entre a prevalência de sintomas e a presença de otite média com efusão foi estatisticamente significante (p < 0,001). Conclusões Apesar da presença de vários fatores de risco para doença da orelha média, a população estudada apresentou baixa prevalência da doença. O fator étnico parece ser protetor.

Eustachian tube dysfunction in sleep apnea patients and improvements afforded by continuous positive airway pressure therapy / Disfunção da trompa de Eustáquio em pacientes com apneia do sono e melhoria proporcionada pela terapia com pressão positiva contínua nas vias aéreas

Abstract Introduction Upper airway resistance may accompany eustachian dysfunction and alter middle ear pressure in patients with obstructive sleep apnea syndrome. Objective To investigate effects of obstructive sleep apnea syndrome and continuous positive airway pressure treatment on eustachian tube functions. Methods Forty-two mild obstructive sleep apnea syndrome patients, 45 moderate obstructive sleep apnea syndrome patients, 47 severe obstructive sleep apnea syndrome patients with continuous positive airway pressure therapy, 32 severe obstructive sleep apnea syndrome patients without continuous positive airway pressure therapy, and 88 individuals without sleep apnea (controls) were included. Tympanometric parameters of groups were compared. Results Right middle ear pressures in mild and moderate obstructive sleep apnea syndrome groups did not differ significantly from that of control group (p = 0.93 and p = 0.55), as was also true of the left middle ear pressures (p = 0.94 and p = 0.86). Right middle ear pressure was significantly higher in severe obstructive sleep apnea syndrome groups than in the control group, as was the left middle ear pressure (p < 0.001). Middle ear pressure (negative) was significantly lower in severe obstructive sleep apnea syndrome patients with continuous positive airway pressure therapy compared to those without (p < 0.001). Right ear type B and C tympanogram frequencies were significantly higher in patients with severe obstructive sleep apnea syndrome without continuous positive airway pressure therapy (12.4%) than in the controls (0%) (p = 0.02). Left ear type B or C tympanogram frequencies were significantly higher in patients with severe obstructive sleep apnea syndrome without continuous positive airway pressure therapy (21.9%) than in the controls (0%) (p = 0.002). Conclusion Mild and moderate obstructive sleep apnea syndrome did not affect middle ear pressure but severe obstructive sleep apnea syndrome may increase the (negative) middle ear pressure. In severe obstructive sleep apnea syndrome patients, long-term continuous positive airway pressure therapy may normalize middle ear pressure.

Resumo Introdução A resistência das vias aéreas superiores pode se acompanhar de disfunção da trompa de Eustáquio e alterar a pressão na orelha média em pacientes com síndrome da apneia obstrutiva do sono Objetivo Investigar os efeitos do tratamento da síndrome da apneia obstrutiva do sono com pressão positiva contínua nas vias aéreas nas funções da trompa de Eustáquio. Método Foram incluídos 42 pacientes com síndrome da apneia obstrutiva do sono leve, 45 pacientes com síndrome da apneia obstrutiva do sono moderada, 47 pacientes com síndrome da apneia obstrutiva do sono grave submetidos à terapia de pressão positiva contínua nas vias aéreas, 32 pacientes com síndrome da apneia obstrutiva do sono grave sem terapia de pressão positiva contínua nas vias aéreas e 88 indivíduos sem apneia do sono (controle). Os parâmetros timpanométricos dos grupos foram comparados. Resultados As pressões na orelha média direita nos grupos com síndrome da apneia obstrutiva do sono leve e moderada não diferiram significantemente das do grupo controle (p = 0,93 e p = 0,55), assim como nas pressões da orelha média esquerda (p = 0,94 e p = 0,86). A pressão na orelha média direita foi significantemente maior nos grupos com síndrome da apneia obstrutiva do sono grave do que no grupo controle, assim como a pressão na orelha média esquerda (p < 0,001). A pressão negativa na orelha média foi significantemente menor nos pacientes com síndrome da apneia obstrutiva do sono grave submetidos à terapia com pressão positiva contínua nas vias aéreas em comparação com aqueles que não receberam tratamento (p < 0,001). As frequências dos timpanogramas do tipo B e C da orelha direita foram significantemente maiores em pacientes com síndrome da apneia obstrutiva do sonograve que não receberam terapia com pressão positiva contínua nas vias aéreas (12,4%) do que nos controles (0%) (p = 0,02). As frequências dos timpanogramas do tipo B ou C na orelha esquerda foram significantemente maiores em pacientes com síndrome da apneia obstrutiva do sonograve que não receberam terapia com pressão positiva contínua nas vias aéreas (21,9%) do que nos controles (0%) (p = 0,002). Conclusão Síndrome da apneia obstrutiva do sono leve e moderada não afetou a pressão da orelha média, mas a síndrome da apneia obstrutiva do sono grave pode aumentar a pressão negativa da orelha média. Em pacientes com síndrome da apneia obstrutiva do sono grave, a terapia em longo prazo com pressão positiva contínua nas vias aéreas pode normalizar a pressão da orelha média.

Fístula perilinfática de causa traumática. Reporte de un caso pediátrico / Traumatic perilymphatic fistula. Report of a pediatric case

La fístula perilinfática de causa traumática es una patología poco habitual. En general, es causada por lápices, hisopos, hebillas de pelo y fósforos.Dentro de los síntomas más frecuentes, los pacientes pueden presentar hipoacusia y vértigo. Su diagnóstico requiere un examen físico completo que incluya otomicroscopía, audiometría ytomografía computada de ambos peñascos. El tratamiento depende de la sintomatología del paciente. En general, en un principio, es conservador, pero puede llegar a requerir cirugía. Se presenta un caso clínico de un niño de 6 años con fístula perilinfática secundaria a un traumatismo del oído izquierdo por un hisopo, que requirió tratamiento quirúrgico

Traumatic perilymphatic fistula is an unusual pathology. Generally caused by pencils, swabs, hair buckles, and matches. Among the most frequent symptoms, patients can present hearing loss and vertigo.Diagnosis requires a complete physical examination that includes otomicroscopy, audiometry and computed tomography of both boulders. Treatment depends on the patient's symptoms. In general, it is conservative at first, but may require surgery.We present a clinical case of a 6-year-old boy with perilymphatic fistula secondary to left ear trauma due to swab, which required surgical treatment