Diagnostic accuracy of the video otoscope in tympanic membrane perforation

Abstract Objective The video otoscope has already proven to be useful for the diagnosis of several pathologies, so the objective of this study was to evaluate the diagnostic accuracy of the video otoscope in cases of tympanic membrane perforation. Methods This is a diagnostic accuracy study performed at the hearing health division of a tertiary-level referral hospital. Patients older than 8 years of age who had any symptom that could be related to perforation (otalgia, otorrhea, tinnitus, and/or hypoacusis) were invited to participate in the study. Participants were evaluated by three different diagnostic methods (otomicroscope, conventional otoscope, and video otoscope) performed by three different evaluators in a blind fashion. The microscope was considered the reference standard. Results 176 patients were evaluated, totaling 352 tympanic membranes. Twenty-seven tympanic membrane perforations were diagnosed by the microscope, a prevalence of 7.7%. The video otoscope showed a sensitivity of 85.2% (95% CI 81.5%‒88.9%), specificity of 98.1% (95% CI 96.7%‒99.5%) and accuracy of 97.1% (95% CI 95.4 %-98.8 %). The conventional otoscope showed a sensitivity of 96.3% (95% CI 94.3-98.3), specificity of 98.8% (95% CI 97.7-99.9) and accuracy of 98.6% (95% CI 97.4-99.8). The Kappa value between the microscope and the video otoscope was 0.8 and between the microscope and the conventional otoscope was 0.9. Regarding the participants' perception, 53.4% (p < 0.001) considered the video otoscope as the best method for understanding the tympanic membrane condition presented by them. Conclusions The video otoscope showed relevant sensitivity and specificity for clinical practice in the diagnosis of tympanic membrane perforation. Moreover, this is an equipment that can facilitate the patient's understanding of the otologic pathology presented by him/her. In this regard, this method may be important for better patient compliance, requiring further studies to evaluate this hypothesis. Level of evidence Is this diagnostic or monitoring test accurate? (Diagnosis)—Level 2 (Individual cross-sectional studies with consistently applied reference standard and blinding).

Clinical analysis of otoendoscopic myringoplasty with tragus perichondrium in 20 cases / 中国基层医药

Objective:To analyze the clinical application effect of otoendoscopic myringoplasty with tragus perichondrium.Methods:The clinical data of 20 patients with tympanic membrane perforation who received treatment in Suixian Traditional Chinese Medicine Hospital from March 2019 to March 2020 were retrospectively analyzed. Among the 20 patients, 6 patients had traumatic tympanic membrane perforation, and 14 patients had tympanic membrane perforation caused by chronic suppurative otitis media (stationary phase). All patients underwent otoendoscopic myringoplasty with tragus perichondrium. After surgery, the healing of tympanic membrane perforation and the improvement of hearing were evaluated.Results:After surgery, all patients were followed up for 12 months. Traumatic tympanic membrane perforation healed in six patients. The tympanic membrane grafts survived in 12 patients with tympanic membrane perforation caused by chronic suppurative otitis media (stationary phase). One patient had poor postoperative healing and the remaining small perforation healed after secondary treatment under local anesthesia. Healing from tympanic membrane perforation was not achieved in one patient because of perforation caused by otitis media. The healing rate of tympanic membrane perforation caused by chronic suppurative otitis media was 95%. Before surgery, the air conduction pure tone hearing threshold was (42 ± 11) dBHL, and it was (25 ± 10) dBHL 12 months after surgery. There was a significant difference in air conduction pure tone hearing threshold between before and after surgery ( t = 4.00, P < 0.05). No complications such as tragus cartilage infection, skin flap necrosis of external auditory meatus, peripheral facial paralysis, hearing loss, or tinnitus occurred in 20 patients with tympanic membrane perforation. Conclusion:Otoendoscopic myringoplasty with tragus perichondrium leads to a high perforation healing rate, improves healing greatly, has no serious complications, produces minimal trauma, and contributes to a rapid recovery from tympanic membrane perforation.

Smartphone-enabled otoscopy: method evaluation in clinical practice

Abstract Objective: To assess the diagnostic agreement between smartphone-enabled otoscopy and rigid otoendoscopy in tympanic membrane and middle ear diseases. Methods: A cross-sectional study was carried out to analyze otoscopies in patients seen at a general otorhinolaryngology (ORL) outpatient clinic, from June to December 2019. Eighty-three images of patients obtained from otoscopies performed through a smartphone device and a rigid endoscope were included, recorded, and stored for further analysis. The images were first analyzed by an experienced otologist, who assigned his diagnostic impression (defined as the gold standard) on each of the images. After this analysis, the images were displayed to a group of secondary raters (an experienced otorhinolaryngologist, a second-year resident in ORL, and a general practitioner). A questionnaire was applied related to each image. Results: There was high agreement between the smartphone device and the otoendoscopy images for all professionals, with a Kappa coefficient of 0.97 (p < 0.001). The smartphone device showed a diagnostic sensitivity of 81.1% and a specificity of 71.1%. As for the otoendoscopy, it showed a sensitivity of 84.7% and a specificity of 72.4%. The image classification as "2 = Good" was the most frequent one, with 34.9% for otoendoscopy and 31.6% for the smartphone device. Conclusion: There was a high diagnostic agreement between smartphone device-guided otoscopy and the rigid otoendoscopy, demonstrating the feasibility of using this device in clinical practice. Level of Evidence: 3

Manejo de Otitis Media Aguda en los Servicios de Pediatría y Otorrinolaringología y Cirugía de Cabeza y Cuello del Hospital de Clínicas / Treatment of Acute Otitis Media in the Pediatrics and Otorhinolaryngology, Head and Neck services in the Clinical Hospital

La otitis media aguda (OMA) es una patología muy común en pediatría y constituye la indicación más frecuente de prescripción de antibióticos en la infancia. Para el diagnóstico se tienen en cuenta hallazgos en la otoscopia, diversos signos clínicos y el tiempo de evolución de los síntomas principales. La decisión de iniciar antibioticoterapia debe determinarse según cada paciente. La espera vigilante como alternativa a la antibioticoterapia inmediata en casos seleccionados reduce el uso de antibióticos sin aumentar el riesgo de daño al paciente y ha demostrado ser una medida costo-efectiva. El fármaco de elección para el tratamiento empírico de la OMA es la amoxicilina, aunque según nuestros resultados es la amoxicilina-IBL la utilizada como primera línea en ambos servicios.

Acute otitis media (AOM) is a pathology commonly found in pediatrics, and the most frequent cause of antibiotics prescription in infants. For its diagnostics, several criteria are taken in consideration, such as otoscopy observations, diverse clinical signs, and the time of evolution of the main symptoms. The decision to initiate antibiotic therapy must be determined particularly for each patient. As an alternative to immediate antibiotic therapy, watchful waiting is preferred in certain cases to reduce the antibiotic use without elevating the patients' risk and has been proven to be a cost-effective approach. The preferred drug for empiric antibiotic therapy in AOM is amoxicillin, although we have observed that the first choice in both our services, pediatrics and otorhinolaryngology, is amoxicillin-IBL.

Otologic Findings Based on no Complaints in a Pediatric Examination

Abstract Introduction the otological evaluation is highly significant in those branches of medicine in which the general evaluation of the patient is conducted by general practitioners and pediatricians. Objectives To investigate the otologic findings and their incidences in the sample, which consisted of patients who presented to the pediatric outpatient clinic with nonotologic complaints. Methods Patients, aged between 2 and 16 years, who had neither otorhinolaryngological complaints nor history of surgery by the otolaryngology (ear, nose and throat, ENT) department were included in the present study. The findings detected in the external auditory system and in the tympanic membranes as well as the otorhinolaryngologists' otologic examination findings of the referred patients were recorded from the files of each patient along with the applied medical and surgical treatments, and diagnostic investigations. Results Of a total of 973 patients evaluated, 129 (13.2%) were referred to the ENT outpatient clinic due to any otologic pathology. In the otorhinolaryngological examinations, false positivity was detected in 12 (1.2%) patients, and pathological findings were detected in 117 (12%) patients who received the following diagnoses: 68 (6.9%) had otitis media with effusion(OME); 37 (3.8%) had cerumen impactions; 8 (0.8%) had acute otitismedia (AOM); 2 (0.2%) had ticks in the external auditory canal; 2 (0.2%) had a retraction pocket in tympanic membrane; 1 (0.1%) had unilateral central dry perforation of the tympanic membrane; and 1(0.1%) had congenital cholesteatoma. Conclusion Any complications and sequelae that may develop due to any pathologies and predominantly infections can be prevented by an early diagnosis, which can be made by means of a simple examination, performed merely with an otoscope. Pediatricians and general practitioners should be in close contact with otorhinolaryngologists regarding the pathologies they identify. (AU)

Cartilage Tympanoplasty in Atelectatic and Adhesive Otitis Media: Our Experience in a Tertiary Care Hospital

Introduction: Adhesive otitis media is a type of chronic otitismedia, the development of which is essentially influenced bydisturbed ventilation of the middle ear. Anatomic and someother predisposing factors may play a part in the origin ofthis disease. Study aimed to find the efficacy and outcome ofcartilage tympanoplasty in patients with grade 3 and 4 parastensa retraction. (atelectatic and adhesive otitis media).Material and Methods: This study was conducted in thedepartment of ENT and HNS Govt Medical College Srinagar.A total of 25 patients with grade3 and 4 retraction wereincluded in this study. In all patients otoscopic examination,Pure Tone audiometry (PTA), impedance audiometry andoto-endoscopic examination / EUM (Examination underMicroscope) was done. Proper consent was taken from allpatients included in this study.Results: Cartilage Tympanoplasty is an effective method oftreating grade3 and 4 parastensa retraction in adhesive otitismedia patients. In our study we found less recurrence ofadhesion at 9 months followup with better compliance andimprovement in hearing. Out of 25 patients, 23 (92%) patientshad intact tympanic membrane, better hearing outcome at9 months follow-up. However in 2(8%) patients, amongthem one had displaced cartilage, another had no hearingimprovement at 9 months follow up.Conclusion: Cartilage tympanoplasty is a better surgicaloption for treating atelectatic and adhesive otitis media,with better outcome of hearing, patient compliance and lessfailure rate in terms of recurrence of disease7. Cartilage usedas reconstruction gives good tensile strength and preventsrecurrence of disease in terms of retraction

Effect of endoscopic tympanic membrane repair on chronic suppurative otitis media with perforation of tympanic membrane / 中国基层医药

Objective@#To investigate the effect of endoscopic tympanic membrane repair in the clinical treatment of patients with chronic suppurative otitis media with tympanic membrane perforation.@*Methods@#From November 2014 to September 2018, 72 patients with chronic suppurative otitis media with tympanic membrane perforation in Taizhou Central Hospital were divided into control group and observation group according to different treatment methods, with 36 cases in each group.The control group underwent microsurgical tympanic membrane repair, the observation group underwent endoscopic tympanic membrane repair.The bleeding volume and operation time of the two groups were compared.The pain degrees of the two groups were evaluated by numerical simulation scale (VAS). The postoperative hospital stay and complications were recorded.The postoperative follow-up of 6 months was used to evaluate the aesthetics of the two groups.The hearing improvement status and treatment effect of the two groups were evaluated.@*Results@#The average surgical bleeding volume of the observation group was (6.14±1.25)mL, which was significantly less than that of the control group [(19.87±2.65)mL], and the operation time was (75.69±2.54)min, which was significantly shorter than that of the control group [(102.34±3.69)min](t=28.116, 35.694, all P<0.05). The VAS score of the observation group was (2.34±0.62)points, which was significantly lower than that of the control group [(3.59±0.85)points](t=7.128, P<0.05). The average length of hospital stay in the observation group was (4.89±1.25)d, which was significantly shorter than that in the control group [(9.18±1.36)d](t=13.935, P<0.05). The incision satisfaction of the observation group was significantly higher than that of the control group(P<0.05). The improvement in hearing of the observation group was (22.058±10.129)dB, which of the control group was (21.695±9.764)dB, the difference was not statistically significant (P=0.487). The effective rate of the observation group was 94.44%(34/36), which of the control group was 91.67%(33/36) (χ2=3.598, P=0.165). The incidence rate of complications in the observation group was 2.78%(1/36), which was significantly lower than 16.67%(6/36) in the control group(χ2=3.956, P=0.046).@*Conclusion@#Chronic suppurative otitis media tympanic membrane perforation patients treatment with endoscopic tympanic membrane repair is more effective, and the surgical method is better after surgery, so it is more acceptable to patients, it is worthy of promoting.

Effect of endoscopic tympanic membrane repair on chronic suppurative otitis media with perforation of tympanic membrane / 中国基层医药

Objective To investigate the effect of endoscopic tympanic membrane repair in the clinical treatment of patients with chronic suppurative otitis media with tympanic membrane perforation .Methods From November 2014 to September 2018,72 patients with chronic suppurative otitis media with tympanic membrane perforation in Taizhou Central Hospital were divided into control group and observation group according to different treatment methods , with 36 cases in each group.The control group underwent microsurgical tympanic membrane repair ,the observation group underwent endoscopic tympanic membrane repair.The bleeding volume and operation time of the two groups were compared.The pain degrees of the two groups were evaluated by numerical simulation scale ( VAS).The postoperative hospital stay and complications were recorded.The postoperative follow －up of 6 months was used to evaluate the aesthetics of the two groups.The hearing improvement status and treatment effect of the two groups were evaluated.Results The average surgical bleeding volume of the observation group was (6.14 ±1.25)mL,which was significantly less than that of the control group [( 19.87 ±2.65 ) mL], and the operation time was (75.69 ± 2.54)min,which was significantly shorter than that of the control group [( 102.34 ±3.69) min] ( t ＝28.116, 35.694,all P＜0.05).The VAS score of the observation group was (2.34 ±0.62) points,which was significantly lower than that of the control group [(3.59 ±0.85)points](t＝7.128,P＜0.05).The average length of hospital stay in the observation group was (4.89 ±1.25)d,which was significantly shorter than that in the control group [(9.18 ± 1.36)d](t＝13.935,P＜0.05).The incision satisfaction of the observation group was significantly higher than that of the control group(P＜0.05).The improvement in hearing of the observation group was (22.058 ±10.129) dB, which of the control group was (21.695 ±9.764)dB,the difference was not statistically significant (P＝0.487).The effective rate of the observation group was 94.44%(34／36),which of the control group was 91.67%(33／36) (χ2 ＝3.598,P＝0.165).The incidence rate of complications in the observation group was 2.78%(1／36),which was significantly lower than 16.67%(6／36) in the control group (χ2 ＝3.956,P＝0.046).Conclusion Chronic suppurative otitis media tympanic membrane perforation patients treatment with endoscopic tympanic membrane repair is more effective , and the surgical method is better after surgery ,so it is more acceptable to patients ,it is worthy of promoting.

Aproximación diagnóstica de patología otológica mediante imágenes, en médicos APS, de la I y II Región de Chile / Diagnostic approach of othologic patology using images, in primary health physicians from the first and second region of Chile

Introducción: La otoscopía corresponde a la herramienta principal que muchos médicos deben utilizar durante la evaluación de patologías otorrinolaringológicas, cuya enseñanza se realiza durante la formación del médico general en un tiempo acotado. Objetivo: En este trabajo se pretende evaluar el diagnóstico correcto de imágenes características de otoscopía por médicos de APS. Material y método: Se realizó un estudio no experimental, descriptivo, cuantitativo y de corte transversal donde se aplicó un test a médicos no especialistas de APS de la I y II región de Chile. Resultados: Se encuestó a un total de 89 médicos. El porcentaje total de respuestas correctas correspondió a 24,8%. La imagen más reconocida corresponde a la perforación timpánica. Sólo 20,2% reconoció la imagen correspondiente a un tímpano normal. Conclusión: Estos resultados se pueden atribuir a la falta de conocimientos y entrenamiento adquirido por los médicos generales, por lo que se debe trabajar en un mejor entrenamiento en otoscopía en el pregrado.

Introduction: Otoscopy is the main tool used by general practitioners for the assesment of ENT patologies, wich is taught during a short period in medicine schools. Aim: The intention of this study is to evaluate the accurate diagnosis of characteristic otoscopy images by primary health physicians. Material and method: A non-experimental, descriptive, quantitative and cross-cut study was carried out; A survey was applied to general practitioners who were working on primary health care of I and II region of Chile. Results: A total of 89 physicians were surveyd. The total percentage of correct answers was 24.8%. The most recognized image was timpanic perforation. Just a 20.2% recognized the image corresponding to a normal timpanic membrane. Conclusion: This results can be attributed to the lack of knowledge and training acquired by the general practitioners, So we must work on a better training in otoscopy in the undergraduate.

Assessment of the light intensity of otoscopes utilized in teaching hospitals / Avaliação da intensidade da luz dos otoscópios em hospitais-escola

ABSTRACT INTRODUCTION: To attain an accurate otoscopic diagnosis, a functioning device with adequate capacity must be used. OBJECTIVE: Evaluate the light intensity of otoscopes, comparing it utilizing the batteries present at the moment of calibration and after new batteries were supplied. METHODS: Cross-sectional study of a historical cohort, which assessed 38 otoscopes, measuring the light intensity with the batteries present at the moment of assessment compared to the intensity with new batteries, as well as charge of the test batteries and the new batteries. RESULTS: The mean of the sum of new batteries' charge was 3.19 V, and of the test batteries was 2.70 V, representing a decrease of 18.02% in charge. The mean luminosity with the new batteries was 366.89 lumens, whereas in the test batteries it was 188.32 lumens, representing a decrease of 83.75% in the light intensity. Student's t-test was applied for data comparison, showing a statistical difference between the light intensity with the original batteries and the new batteries (p = 0.0001; CI = 0.95). CONCLUSION: There was a statistically significant difference between the proportions of light intensity in the otoscopes. A small variation in battery charge results in a great variation in light.

RESUMO Introdução: Para a realização de um diagnóstico otoscópico preciso deve-se utilizar um aparelho funcionando com uma capacidade adequada. Objetivo: Avaliar a intensidade luminosa dos otoscópios comparando a intensidade da luz comas pilhas encontradas no momento da aferição e com pilhas novas. Método: Estudo de coorte histórica com corte transversal, onde foram analisados 38 otoscópios, sendo realizada a aferição da qualidade luminosa com a pilha utilizada e comparado com uma pilha nova, e a aferição da carga das pilhas novas e em utilização no momento do exame. Resultados: A média da soma das cargas das pilhas novas foi de 3,19 V, e a das pilhas testes foi de 2,70 V, representando decréscimo de 18,02% na carga das pilhas. A média da luminosidade comas pilhas novas foi de 366.89 lúmens, e com a pilha teste foi de 188.32 lúmens, representando decréscimo de 83,75% na intensidade luminosa. Foi aplicado o teste T para comparação entre os dados, onde percebe-se diferença estatística entre a intensidade luminosa com pilhas testes e novas (p = 0,0000; IC = 0,95). Conclusão: Houve diferença estatisticamente significativa entre a proporção de intensidade da luz dos otoscópios. Uma pequena variação da pilha proporciona uma grande variação na luz.

Otoscopic Changes Before and After Shooting Amongst Military Army Personnel

The effect of loud noise to the army personnel is often identifi ed when hearing loss had already developed. Acoustic trauma during shooting training can also lead to acute changes in the ear which is shown on otoscopic examination. This study was undertaken to determine the effectiveness of hearing protective device (earplug) on the prevalence of external ear changes amongst military personnel during shooting. This is a prospective cross sectional study that was conducted among 76 military personnel, who were divided into two groups: those with and without earplugs during shooting. Each participant underwent 3 otoscopic examinations: (a) pre-shooting, (b) immediate post-shooting (within 48 hours) and (c) 2 weeks after shooting. A total of 78 army personnel who were scheduled to undergo shooting training were otoscopically examined. Eighty three percent of them did not wear earplugs before. The percentage of infl ammation of external auditory canal and tympanic membrane dullness increased tremendously among subjects from non–earplug group less than 48 hours post-shooting. Assessment after 2 weeks showed improvement in around 30% of the subjects. Loud noise has become an occupational hazard not only to the inner ear but it also predisposes the external and middle ear structures to some form of injury. Although improvement is seen after some period, a protective device such as an earplug should be recommended and the usage should be reinforced among the army personnel involved in shooting.

Video otoscopy as a diagnostic tool for canine otoacariasis / Video otoscopia como técnica diagnóstica para otoacaríase canina

Canine otoacariasis, or otodectic mange, is a common parasitic disorder of dogs' ear canals caused by the mite Otodectes cynotis. Infestation can be detected through diverse protocols of varying sensitivity. We evaluated the use of video otoscopy in comparison with conventional otoscopy and cerumen examination under a microscope for diagnosing O. cynotis in dogs. Thirty-five dogs were evaluated bilaterally for the presence of ear mites, using a veterinary otoscope (Gowlands®), a video otoscope (Welch Allyn®) and the gold-standard technique of examination of swab-collected cerumen under a microscope. Each ear was considered to represent one sample, and 69 ears were examined, since one dog presented with one completely stenotic ear canal. Ear mites were diagnosed in 59.42% (41/69) through video otoscopy. The same 41 infested ear canals were detected by means of cerumen examination under a microscope, whereas conventional otoscopy was able to diagnose mites in only 39.13% (27/69). This difference was statistically significant (p < 0.001). Video otoscopy proved to be superior to conventional otoscopy, and equivalent to the gold standard for detection of O. cynotis in canine ear canals, and should be recommended for controlled trials on drug efficacy for treatment of canine otoacariasis.

A sarna otodécica ou otoacaríase canina é uma doença parasitária comum em cães causada pelo ácaro Otodectes cynotis. A infestação no conduto auditivo dos animais pode ser diagnosticada através de diversos protocolos com diferentes sensibilidades. Avaliamos o uso da video otoscopia comparada à otoscopia convencional e à observação do cerumem sob microcópio, no diagnóstico de O. cynotis em cães. Trinta e cinco cães foram avaliados bilateralmente para a presença de ácaros através do uso de um otoscópio veterinário (Gowlands®), um vídeo otoscópio (Welch Allyn®) e pela técnica padrão, que é o exame microscópico do cerumem coletado por um "swab". Cada orelha foi considerada uma unidade, sendo que foram examinadas 69 orelhas, pois um cão apresentou o conduto auditivo completamente estenosado. Os ácaros foram detectados pela video otoscopia em 59.42% (41/69) dos condutos. Os mesmos 41 infestados foram diagnosticados através do exame do cerumem sob microscopia óptica, enquanto a otoscopia convencional identificou os parasitos em apenas 39.13% (27/69) das orelhas. A diferença foi estatisticamente significativa (p < 0,001). A video otoscopia provou ser superior a otoscopia convencional para o diagnóstico do ácaro O. cynotis nos condutos auditivos de cães e deve ser recomendada para ensaios controlados de eficácia de medicamentos para o tratamento da otocaríase canina.

Análise comparativa das emissões otoacústicas com a timpanometria em lactentes de 0 a 6 meses / Comparative analysis of otoacoustic emissions with tympanometry in 0-6 month infants

OBJETIVO: comparar os achados das emissões otoacústicas evocadas por estímulos transientes (EOAT) com a timpanometria usando tom sonda de 226 e 1000Hz em lactentes. MÉTODO: o estudo foi realizado no Serviço de Otorrinolaringologia do Hospital Santa Juliana de Maceió - Alagoas. Selecionaram-se lactentes de ambos os gêneros, com faixa etária de recém nascido a seis meses. Foram excluídos aqueles com fissura lábio palatinos, malformação de orelha externa e/ou média, síndromes e história familiar de perda auditiva. Foram realizados os seguintes procedimentos: anamnese para identificar as queixas auditivas e selecionar a amostra de acordo com os critérios de inclusão e exclusão; avaliação otorrinolaringológica por meio de otoscopia e avaliação auditiva que se constituiu de emissões otoacústicas evocadas por estímulo transiente (EOAET) e timpanometria com tom teste da sonda de 226 e 1000Hz. Para analisar as variáveis qualitativas, foi utilizado o teste de Igualdade de Duas Proporções, além do teste Qui-Quadrado para Independência e o intervalo de confiança para a Média, utilizados para a análise das variáveis quantitativas dos resultados. RESULTADOS: comparando-se os resultados das EOAT com os resultados da timpanometria obtida com os tons testes de 226 Hz e 1000Hz , observou-se uma associação da EOAT com a sonda de 1000Hz em ambas as orelhas, ou seja, houve ausência das EOAT nos lactentes que apresentaram timpanogramas alterados e presença quando os timpanogramas estavam normais. CONCLUSÃO: a timpanometria com sonda de 1000 Hz teve maior correlação com as EOAT tanto para identificação de respostas em orelhas normais como para as alterações de orelha média.

PURPOSE: to compare the findings of TEOAE with tympanometry in 226 and 1000 Hz in infants. METHOD: the study was conducted in the Department of Otolaryngology, Hospital Santa Juliana Maceio - Alagoas. We selected infants of both genders, aged from newborn to six months. We excluded those with cleft palate, external and/or middle ear malformation, syndromes, and family history of hearing loss. The following procedures were conducted: anamnesis in order to identify hearing impairment and to select the sample according to the criteria of inclusion and exclusion; otorrinolaringological assessment using otoscopy and hearing evaluation that consisted of transient evoked otoacoustic emissions (TEOAE) and tympanometry with 226 and 1000Hz probe tones. In order to analyze the qualitative variables, we used the test for Equality of Two Proportions, and the Chi-Square for Independence and the confidence interval for the average used for the analysis of the results of quantitative variables. RESULTS: comparing the results of TEOAE with the tympanometry results that were obtained with 226Hz and 1000Hz probe tones, we observed an association of TEOAE with the 1000Hz probe for both ears, the infants with TEOAEs absence had altered tympanogram results and the ones where the TEOAEs were present had normal tympanograms. CONCLUSION: There was a higher correlation between the results of the 1000 Hz probe tympanometry and the TEOAE in order to identify normal ear responses and middle ear disorders.

Otoscopia: exame da orelha / Otoscopy: examination of ear

Otoscopia é o exame que permite ao médico avaliar o conduto auditivo e a membrana timpânica, além de diagnosticar enfermidades da orelha externa e da orelha média. A otoscopia, uma boa anamnese e um exame físico completo são fundamentais para o estudo das doenças da orelha. O presente trabalho faz uma revisão da otoscopia e de suas principais afecções.

Otoscopy is the examination of the external auditory meatus and the tympa nic membrane. It is used for the purpose of diagnosing diseases of the external and middle ear. The anmanesis and the clinical examination associated with ear examination (otoscopy) are essential in ear diaseases. The purpose of this study is to review the examination of the ear (otoscopy) and principal disease of the ear.

Virtual otoscopy for evaluating the inner ear with a fluid-filled tympanic cavity in dogs

The feasibility of virtual otoscopy (VO) imaging was evaluated in five dogs with experimentally induced otitis media, two control dogs, and two canine patients with otitis media. VO images of the tympanic cavity and ossicles were generated with commercially available software using raw computed tomography (CT) data. Eight out of 10 ears inoculated with pathogen exhibited obvious clinical signs associated with otitis externa. CT images revealed soft tissue density material occupying the tympanic bulla compatible with otitis media in three dogs with experimentally induced otitis media and two patients. No remarkable features were observed on the radiographs. Four different VO views (ear canal, tympanic bulla, eustachian tube, and ossicular chain) were created. Promontory, cochlea window, tympanic, and septum bulla as well as ossicles were easily and clearly distinguished except for the incus and stapes of the clinical patients. VO images were not more suitable than images created with conventional CT for accurately diagnosing otitis media in this study. However, it appears that VO could be more feasible for assessing the complex structure of the inner ear in dogs with fluid-filled tympanic cavities since fluid accumulation within the tympanic bulla did not affect the evaluation of bony tissue in the middle ear on VO images.

Diagnóstico da otite média em cães: comparação entre radiografia convencional, canalografia e audiometria de impedância / Diagnosis of otitis media in dogs: comparison between conventional radiography, canalography and impedance audiometry

Radiography (conventional and contrasted - canalography) and audioelectrophysiologic (impedance audiometry) tests were correlated with otitis media in 12 middle ear affected and 12 healthy dogs. When comparing both diagnostic methods, it was found that the reliability in the detection of otitis media in dogs was 100 percent for the first and 58.3-60.0 percent for the latter. Thus, it was possible to attest that the impedance audiometry was the most accurate method in the identification of otitis media in dogs when compared with radiographic assessments.

Emprego da vídeo-otoscopia no diagnóstico de otites externas de cães / Video-otoscopy use in the diagnosis of external otitis in dogs

O objetivo deste trabalho foi estudar a utilização da vídeo-otoscopia como método diagnóstico para otites externas de cães. Para tanto, foram utilizados 20 cães adultos. O grupo A foi formado por 10 animais (cinco machos e cinco fêmeas) provenientes do canil da Universidade Estadual Paulista, Campus de Jaboticabal, sem sinais clínicos aparentes de otite externa, e o grupo B foi formado por 10 animais (cinco machos e cinco fêmeas) encaminhados pelo setor de Clínica Médica do Hospital Veterinário da faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista, Campus de Jaboticabal, apresentando sinais clínicos de otite. Para realização dos exames, todos os animais foram submetidos ao mesmo protocolo anestésico (acepromazina na dose de 0,1mg kg-1 e tiletamina-zolazepan na dose de 10mg kg-1). Foram diagnosticadas três otites unilaterais e 13 bilaterais, e dentro dos achados estão secreção purulenta; epitélio ulcerado, hiperêmico ou hiperplásico; estenose do meato e alterações da membrana timpânica. A vídeo-otoscopia mostrou ser um método efetivo e um procedimento fundamental no auxílio diagnóstico e prognóstico das desordens auriculares.

The objective of this study was the use of video-otoscopy as a method to diagnose external otitis in dogs. Hence 20 adult dogs were used. The group A was formed by 10 animals (5 males and 5 females) with no apparent symptoms of the external otitis and the group B, formed by 10 animals (5 males and 5 females) sent by the Medical Clinics section of the Veterinary Hospital at the Universidade Estadual Paulista - Câmpus Jaboticabal, with otitis symptoms. All the animals tested have undergone the same anesthesic protocol (acepromazine in a dosis of 0,1mg kg-1 and tiletamine-zolazepan in a dosis of 10mg kg-1). Three unilateral and 13 bi-lateral otitis were diagnosed and the findings include purulent secretion; ulcerated, hyperemic or hyperplasic epithelium; meathus stenosis and alterations in the timpanic membrane. Video-otoscopy has shown to be an effective and a fundamental procedure to help diagnosing and prognosting auricular disorders.

Miringosclerose em pacientes com insuficiência renal crônica: análise comparativa com um grupo controle / Myringosclerosis in patients with chronic renal failure: comparative analysis with a control group

A miringoesclerose é uma alteração cicatricial da lâmina própria da membrana timpânica caracterizada por proliferação de fibras colágenas, seguida de hialinização, deposição de cálcio e fósforo, seguindo uma seqüência semelhante ao que ocorre em outros tipos de calcificação patológica comuns em pacientes com doença renal crônica. OBJETIVO: Verificar a influencia da insuficiência renal crônica (IRC) na prevalência da miringoesclerose. MÉTODO: Foi realizada otoscopia em 341 pacientes com IRC em hemodiálise e em 356 indivíduos de um grupo controle. Foi comparada a freqüência de otoscopia positiva entre os dois grupos, procurando-se relacionar com variáveis pessoais e relacionadas a IRC. RESULTADOS: O grupo de pacientes apresentou 11,7 por cento de otoscopia positiva contra 5,1 por cento do grupo controle. Não houve influência do sexo ou cor na freqüência da miringoesclerose. Porém, os grupos foram heterogêneos em relação à faixa etária. Também não houve diferença importante no tempo de diálise nem nos níveis séricos de minerais e do PTH entre os pacientes do grupo de estudo que apresentavam otoscopia positiva ou negativa. CONCLUSÃO: Os achados, embora apontem para uma maior ocorrência da miringoesclerose nos pacientes renais crônicos, não nos permitem concluir com certeza que exista alguma relação entre a IRC e as alterações timpânicas.

Myringosclerosis is a scar of the tympanic membrane lamina propria, resulting from trauma or inflammation, characterized by proliferation of collagen, hyalinization, calcium and phosphate deposits and cartilaginous or osseous metaplasia of the middle ear mucosa, a sequence that is similar to that taking place in other types of pathologic calcification, common in chronic renal failure (CRF). AIM: To verify the influence of chronic renal failure on the prevalence of myringosclerosis. METHOD: The otoscopic examination was done in 341 chronic renal failure patients and in 356 normal control individuals. The frequency of positive otoscopies was compared between the two groups, based on individual variables and those pertaining to CRF. RESULTS: 11.7 percent of the patients had a positive otoscopy in the CRF group, compared to 5.1 percent in the control group. There was no statistical diference in the frequency of myringosclerosis acording to gender, ethnic group, time of dialysis or serum minerals. The groups had a wide age range. CONCLUSION: Although the findings of this study suggest a higher ocurrence of myringosclerosis in patients with renal disease, they do not provide a basis for stating that there is any relation between renal failure and tympanic alterations.

Achados otoscópicos e timpanométricos em lactentes com fissura labiopalatina / Otoscopic and tympanometric findings in infants with cleft lip and palate

A timpanometria tem papel fundamental na identificação de alterações de orelha média, as quais são de grande ocorrência na população com fissura labiopalatina. OBJETIVO: Analisar de maneira retrospectiva os resultados dos exames otoscópicos e timpanométricos de lactentes com fissura labiopalatina não operados. Estudo retrospectivo. MATERIAL E MÉTODO: Foram analisados 273 prontuários de lactentes, portadores de fissura labiopalatina, submetidos de março de 1996 a abril de 2002 a otoscopia pneumática e a timpanometria com a sonda 226Hz. RESULTADOS: Não foi encontrada significância estatística nos achados otoscópicos e timpanométricos considerando os gêneros e orelhas. Observou-se 84 por cento de alteração na otoscopia (opacificação/83,4 por cento, fluido visível na orelha média/1,5 por cento, imobilidade de membrana timpânica na insuflação/1,8 e retração/0,7) e 65 por cento nas curvas timpanométricas (B/38 por cento), A/36,5 por cento, As/21 por cento, C/4 por cento e Ad/0,5 por cento). CONCLUSÃO: Os lactentes portadores de fissura labiopalatina do gênero feminino e do masculino não diferiram nas curvas timpanométricas e nos achados otoscópicos. Todos os tipos de curvas timpanométricas estiveram presentes, sendo as do tipo B e A de maior ocorrência. A opacificação de membrana timpânica foi o achado otoscópico mais freqüente. A otoscopia pneumática identificou maior número de alteração que a timpanometria convencional.

Tympanometry plays a fundamental role in the identification of middle ear alterations, which are frequent in the population with cleft lip and palate. AIM: do a retrospective analysis of the otoscopy and tympanometric exams of infants with cleft lip and palate who were not operated. Retrospective study. MATERIALS AND METHODS: we analyzed 273 charts from infants with cleft lip and palate whom, from March 1996 to April of 2002 underwent pneumatic otoscopy and tympanometry with a 226 Hz probe. RESULTS: We did not find statistical significance in the otoscopic and tympanometric findings considering ears and genders. We observed 84 percent of alterations in otoscopy (opacification/83.4 percent, visible fluid in the middle ear /1.5 percent, the ear drum does not move during inflation /1.8 and retraction/0.7) and 65 percent in tympanometric curves (B/38 percent), A/36.5 percent, As/21 percent, C/4 percent and Ad/0.5 percent). CONCLUSION: female and male infants with cleft lip and palate did not differ as far as otoscopic and tympanometry findings are concerned. All types of tympanometric curves were present, and types A and B were the most frequent ones. Ear drum opacification was the most frequent otoscopic finding. Pneumatic otoscopy identified a larger number of alterations when compared to conventional tympanometry.

Clinical Diagnostic Accuracy of Otitis Media with Effusion in Children, and Significance of Myringotomy: Diagnostic or Therapeutic?

The specific aims of this prospective survey were to determine the accuracy of traditional diagnostic tools, such as pneumatic otoscopy, otomicroscopy, and tympanometry, and evaluate the usefulness of myringotomy as a diagnostic method; also to determine the significance of myringotomy in treating otitis media with effusion (OME). The status of middle ear of 51 children (85 ears) from November 2002 to February 2003 was examined using pneumatic otoscopy, otomicroscopy, and tympanometry, and the presence/absence of middle ear effusion was confirmed by myringotomy. The otomicroscopy was the most sensitive and specific one among three diagnostic tools. But, it had some false positive cases. This study failed to show the therapeutic efficacy of myringotomy. Otomicroscopy seems to have the potential to become the standard for diagnosis of OME and for validation of pneumatic otoscopy in children. However, when otoscopic, otomicroscopic findings and tympanogram of suspected ear show poor correlation, myringotomy can be used to confirm the presence of OME, as the diagnostic modality. As the therapeutic modality, we think that it is proper to limit indications of myringotomy to some selected cases.