Reparación de fractura aislada del mango del martillo con cemento ionomérico vidrioso autocurado / Repair of a malleus handle fracture using glass ionomer luting cement

Resumen La fractura aislada del mango del martillo es una entidad clínica poco habitual, pero frecuentemente subdiagnosticada. Lo fundamental es la sospecha clínica. El diagnóstico se confirma con la otoscopia neumática o la otomicroscopia con maniobra de Valsalva, en la cual se observa una movilidad anormal del mango del martillo. El rasgo de fractura se puede demostrar con tomografía computada de alta resolución o cone beam. Existen diferentes opciones de tratamiento como interposición de cartílago o uso de prótesis de reemplazo osicular así como cemento óseo. El cemento ionomérico vidrioso autocurado, muy utilizado en odontología, se ha usado en distintas cirugías otológicas con buenos resultados y biocompatibilidad. A nuestro saber no se ha usado en esta patología por lo que presentamos esta serie de tres casos en los cuales se ha usado esta novedosa técnica con buenos resultados clínicos.

Abstract Isolated fracture of the manubrium of the malleus is a rare clinical entity. Clinical suspicion is paramount. The usual clinical presentation is acute otalgia followed by tinnitus and fluctuating hearing loss after a brisk introduction and withdrawal of a finger into the external auditory canal. On physical examination, the eardrum looks normal on otoscopy. Only in pneumatic otoscopy or otomicroscopy with Valsalva an abnormal motility of the manubrium could bee seen. High-resolution computed tomography (CT) or cone beam CT is able to show the fracture line. Several treatment options have been proposed, such as interposition of bone or cartilage between the manubrium and the incus, total or partial ossicular replacement prosthesis; and the use of bone cement. Glass ionomer luting cement, with wide use in dentistry, has been used in several otological procedures with good biocompatibility and results, however, to our best knowledge, it has not been used to repair this type of fractures, so we present this novel material in three cases.

Hearing and clinical otologic profile of Filipinos living in Southern Tagalog Region IV-A (CALABARZON), Philippines: The Southern Tagalog ENT Hearing Specialists (STENTS) Survey 2012-2017

@#<p><strong>Objective:</strong> To determine the prevalence of hearing loss and otologic diseases among Filipinos living in the Southern Tagalog Region IV-A: CALABARZON (Cavite, Laguna, Batangas, Rizal and Quezon), Philippines.</p><p><strong>Methods:</strong></p><p><strong>               Design:</strong> Retrospective Review of Community Survey Data</p><p><strong>               Setting:</strong> Communities in Region IV-A provinces, Philippines</p><p><strong>               Participants:</strong> 3267 residents of the five provinces aged 0 months and above</p><p> <strong>Results:</strong> About 71.29% and 74.60% had at least mild hearing loss, in right and left ears, respectively. For disabling hearing impairment, overall prevalence was 26.33%, distributed into 11.87% among 4 to 18-year-olds; 8.97% for 19 to 64-year-olds; and 3.17% for 65-year-olds and above. Absence of prevalent and hearing loss-associated diseases: serous otitis media [OR 0.362, 95% CI 0.167 to 0.782, p = .010], CSOM [OR 0.407, 95% CI 0.236 to 0.703, p = .001] COM [OR 0.229, 95% CI 0.106 to 0.494, p < .001] can decrease the risk for hearing loss development in the region. Prevention of noise-induced hearing loss or delay in the manifestation of presbycusis can reduce the risk of having hearing loss by as much as 75% [OR 0.253, 95% CI (0.180 to 0.355), p < .001]. All pure tone audiometry measurements were obtained with surrounding median ambient noise of 55dB (IQR 46 to 60dB).</p><p><strong>Conclusion:</strong> The prevalence of hearing loss among surveyed residents of the Southern Tagalog Region IV-A provinces was high compared to the previous nationwide study but low compared to other low- and middle-income countries. The top otologic conditions of this population (ear occlusion with ear wax, chronic suppurative otitis media, chronic otitis media, presbycusis, noise-induced hearing loss) were associated with hearing loss and their absence decreased the risks for hearing impairment.</p>

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.

Traumatic perforations of the tympanic membrane: immediate clinical recovery with the use of bacterial cellulose film / Perfurações traumáticas da membrana timpânica: recuperação clínica imediata com o uso de fragmento de celulose bacteriana

Abstract Introduction: Perforation of the tympanic membrane is a reasonably frequent diagnosis in otorhinolaryngologists' offices. The expectant management is to wait for spontaneous healing, which usually occurs in almost all cases in a few weeks. However, while waiting for healing to be completed, the patients may experience uncomfortable symptoms. Although some research suggests the use of various materials to aid in the recovery of the tympanic membrane, none presented robust evidence of improvement in the cicatricial process. Nevertheless, the occlusion of the perforation with some material of specific texture and resistance can alleviate the patients' symptoms and accelerate the healing process. Objective: To evaluate the clinical (symptomatic and functional) improvement after the placement of bacterial cellulose film (Bionext®) on tympanic membrane perforations (traumatic). Methods: We evaluated 24 patients, victims of traumatic perforations of the tympanic membrane, who were evaluated in the Otorhinolaryngology Emergency Room. Following otoscopy and audiometric examination was performed, before and after the use of cellulose film occluding the tympanic membrane perforation. Results: Twenty-four patients were included, whose degree of overall discomfort caused by the tympanic membrane perforation and the presence of symptoms of autophonia, ear fullness and tinnitus were investigated. The mean score attributed to the overall annoyance caused by tympanic membrane perforation was 7.79, decreasing to a mean value of 2.25 after the film application. Symptom evaluation also showed improvement after using the film: autophonia decreased from a mean value of 6.25 to 2.08, tinnitus from 7 to 1.92 and ear fullness from 7.29 to 1.96. The auditory analysis showed mean threshold values still within the normal range at low and medium frequencies, with slight hearing loss at acute frequencies, but with significant improvement at all frequencies, with the exception of 8000 Hz, after film use. Conclusion: The use of bacterial cellulose film fragment on traumatic perforations of the tympanic membrane promoted immediate functional and symptomatic recovery in the assessed patients.

Resumo Introdução: A perfuração da membrana timpânica é uma condição clínica relativamente frequente em consultórios de otorrinolaringologistas. A conduta é quase sempre expectante, aguardando cicatrização espontânea, que costuma ocorrer na quase totalidade dos casos em algumas semanas. No entanto, enquanto não se completa, os pacientes mantêm sintomas desconfortáveis. Embora algumas pesquisas sugiram o uso de materiais diversos para auxiliar na recuperação da membrana timpânica, nenhuma apresentou evidência substancial de melhoria no processo cicatricial. Por outro lado, a oclusão da perfuração com alguns materiais de textura e resistência específicas poderia aliviar os sintomas dos pacientes durante o processo cicatricial. Objetivo: Avaliar a melhoria clínica (sintomática e funcional) após a colocação de película de celulose bacteriana (Bionext®) sobre a perfuração da membrana timpânica (traumática). Método: Foram avaliados pacientes com perfurações traumáticas da membrana timpânica que deram entrada no pronto-socorro de otorrinolaringologia. Eles foram avaliados em relação a suas queixas e exame audiométrico, antes e após a aplicação de película de celulose que oclui a perfuração da membrana timpânica. Resultados: Foram incluídos 24 pacientes, nos quais foram pesquisados o grau de incômodo global causado pela perfuração da membrana timpânica e a presença de sintomas de autofonia, plenitude auricular e tinnitus. A média da nota atribuída ao incômodo global causado pela perfuração foi de 7,79; caiu para valor médio de 2,25 após a aplicação da película. A avaliação dos sintomas também apresentou melhoria após uso da película, autofonia caiu de valor médio de 6,25 para 2,08; zumbido de 7 para 1,92 e plenitude auricular de 7,29 para 1,96. A análise auditiva apresentou um valor médio de limiares ainda dentro da normalidade em frequências baixas e médias, com perda de audição leve em frequências agudas, porém com melhoria significante em todas as frequências, com exceção de 8000 Hz, após a colocação da película. Conclusão: A aplicação de fragmento de película de celulose bacteriana sobre perfurações traumáticas da membrana timpânica promoveu recuperação funcional e sintomática imediata nos pacientes estudados.

Prevalencia y hallazgos radiográficos en conejos, cuyos y chinchillas diagnosticados con maloclusión en el Hospital Veterinario de Especialidades en Fauna Silvestre y Etología Clínica de la UNAM, México / Prevalence and radiographic findings in rabbits, guinea pigs and chinchillas diagnosed with malocclusion at the UNAM Exotic Pet and Wildlife Teaching Hospital, Mexico

RESUMEN Los lagomorfos y los histricomorfos, como los cuyos y las chinchillas, comparten características dentales como: dentadura elodonta e hipsodonta. Estas peculiaridades predisponen la presentación de maloclusión debido al consumo de dietas inadecuadas, poco abrasivas. El propósito de este trabajo es identificar la prevalencia de maloclusión en cada una de las especies mencionadas, de acuerdo con su sexo y grupo etario. Además, tiene como objetivo hacer una evaluación objetiva de los estudios radiográficos de los ejemplares, basada en líneas de referencia anatómica, para determinar los principales hallazgos radiográficos según el grado de maloclusión diagnosticado de forma clínica. El 30% de todos los individuos evaluados presentaron problemas de maloclusión, 42,86% de ellos conejos, 16,6% cuyos y 23% chinchillas. No se evidenciaron diferencias significativas en la presentación por sexo. En conejos fue más común el diagnóstico de ejemplares del grupo etario I y II, mientras que en cuyos lo fue en los grupos II y III. El grado I y II fueron los más diagnosticados en conejos y cuyos. En las radiografías las lesiones más comunes fueron el sobrecrecimiento de las raíces maxilares y mandibulares, elongación de incisivos, pérdida de la superficie de oclusión y deformación de las raíces mandibulares. Se propone un método de corrección para las proyecciones radiográficas LL con rotación evidente para mantener la objetividad de la evaluación radiográfica.

ABSTRACT Lagomorphs and histricomorphs, as guinea pigs and chinchillas, have common dental characteristics, such as the elodont and hypsodont teeth. These peculiarities predispose to the presentation of malocclusion due to the consumption of inadequate, non-abrasive diets. The purpose of this work is to identify the prevalence of malocclusion in each case. In addition, it aims to make an objective evaluation of the radiological studies of the specimens, based on anatomical reference lines, to determine the main radiographic findings according to the degree of malocclusion clinically diagnosed. 30% of the individuals evaluated presented malocclusion problems being 42.86% rabbits, 16.6% guinea pigs and 23% chinchillas. There is no evidence of significant differences in the presentation by sex. In rabbits, the diagnosis of the specimens from the group I and II were more common, while in guinea pigs they were II and Ill. Grade I and II were the most diagnosed in rabbits and guinea pigs. In the radiographs, the most common lesions are the overgrowth of the maxillary and mandibular roots, elongation of the incisors, loss of the occlusal surface and deformation of the mandibular roots. A method of correction for LL radiographic projections with evident rotation is proposed to maintain the objectivity of the radiographic evaluation.

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)

Identification and management of inverted or everted edges of traumatic tympanic membrane perforations / Identificação e conduta nas perfurações traumáticas da membrana timpânica com bordas invertidas ou evertidas

Abstract Introduction: Most of traumatic tympanic membrane perforations have inverted or everted edges, however, the effects of inverted and everted edges on the spontaneous healing of the eardrum remain controversial. Objective: We investigated the influence of inverted or everted edges on the spontaneous healing of traumatic tympanic membrane perforations. Methods: The clinical records of patients with a traumatic tympanic membrane perforations who met the study criteria were retrieved and categorized into two groups, based on whether the eardrum was inverted or everted. The features along the edge of each inverted or everted eardrum were described using 30º and 70º endoscopes. Results: In total, 196 patients (196 ears) met the inclusion criteria; of these, 148 had inverted or everted eardrums while 48 did not. Of the 148 patients with inverted or everted eardrums, the perforation edges were everted in 77 patients, inverted in 44 patients, drooping in 17 patients, and both inverted and everted in 10 patients. The perforation shape was triangular in 18.9% of patients, sector-shaped in 11.5%, kidney-shaped in 14.2%, ovoid in 20.3%, and irregularly shaped in 35.1% of patients. The difference was not significant between the with and without inverted/everted eardrum edges groups in terms of the closure rate or closure time. Similarly, the difference was not significant between the with and without edge approximation groups in terms of the closure rate or closure time at the end of the 12-month follow-up period. Conclusion: This study suggests that endoscopic inspection can clearly identify inverted/everted eardrum edges using 30º and 70º endoscopes. The edge is glossy in inverted/everted eardrums, whereas the edge is rough and irregular in non-inverted/everted cases. The inverted/everted eardrums gradually became necrotic, but this did not affect the healing process. Additionally, edge approximation did not improve the healing outcome of traumatic tympanic membrane perforations.

Resumo Introdução: A maioria das perfurações de membrana timpânica traumáticas apresenta bordas invertidas ou evertidas; no entanto, os efeitos dessas configurações sobre a cicatrização espontânea do tímpano continuam a ser uma questão controversa. Objetivo: Investigar a influência de bordas invertidas ou evertidas sobre a cicatrização espontânea de perfurações traumáticas de membrana timpânica. Método: Os prontuários clínicos de pacientes com perfuração traumática de membrana timpânica que preencheram os critérios do estudo foram recuperados e categorizados em dois grupos, baseados na configuração invertida ou evertida das bordas da membrana timpânica. As características de configuração da borda de cada membrana foram descritas com o uso de endoscópios de 30º e 70º. Resultados: No total, 196 pacientes (196 orelhas) preencheram os critérios de inclusão; desses, 148 apresentavam bordas de membranas timpânicas invertidas ou evertidas, enquanto 48 não. Dos 148 pacientes, as bordas da perfuração estavam evertidas em 77 pacientes, invertidas em 44 pacientes, caídas em 17 pacientes e ambas invertidas e evertidas em 10 pacientes. O formato da perfuração era triangular em 18,9% dos pacientes, em forma de fatia de pizza em 11,5%, em forma de rim em 14,2%, ovoide em 20,3% e de forma irregular em 35,1% dos pacientes. A diferença não foi significante entre os grupos com e sem membrana timpânica invertida/evertida em termos de taxa ou tempo de fechamento. Da mesma forma, a diferença não foi significativa entre os grupos com e sem aproximação das bordas em termos de taxa de fechamento ou tempo de fechamento no fim do período de seguimento de 12 meses. Conclusões: Este estudo sugere que a avaliação com endoscópios de 30º e 70º pode identificar claramente as bordas invertidas/evertidas das perfurações de membranas timpânicas. A borda da perfuração timpânica em casos invertidos/evertidos é brilhante, enquanto a borda é áspera e irregular em casos não invertidos/evertidos. O rebordo timpânico invertido/evertido gradualmente torna-se necrótico, mas isso não afetou o processo de cicatrização. Além disso, a aproximação das bordas não melhorou o resultado da cicatrização.

Tinnitus pulsátil: caso clínico y revisión de la literatura / Pulsatile tinnitus: clinical case and review

RESUMEN El tinnitus pulsátil es un síntoma otológico infrecuente pero requiere un estudio acabado. Una historia y examen físico detallados, son primordiales para orientar el estudio imagenológico posterior, con lo que se llega al diagnóstico en gran parte de los casos. El tratamiento debe ser dirigido a corregir la causa subyacente. En este trabajo, se presenta un caso clínico de tinnitus pulsátil, revisión del tema y orientación al enfoque diagnóstico.

ABSTRACT Pulsatile tinnitus is an infrequent otologic symptom but requires a thorough study. A detailed history and physical examination are essential to guide the subsequent imaging study, with which the diagnosis is reached in a large number of cases. The treatment should be aimed at correcting the underlying cause. In this study, a clinical case of pulsatile tinnitus, review of the subject and orientation to the diagnostic approach is presented.

Cervical Vestibular-Evoked Myogenic Potentials in Sedated Toddlers

Abstract Introduction Cervical vestibular-evoked myogenic potentials (cVEMPs) are difficult to test in toddlers who cannot follow instructions or stay calm. Objective Due to the growing need for vestibular testing in very young children as a part of a delayed walking assessment battery, this study aimed to provide a solution to this problem by recording the cVEMPs in toddlers during sedation. Method The cVEMPs measures were assessed in 30 toddlers aged 12 to 36 months with normal motormilestones. They were sedated with chloral hydrate. Then, the head was retracted ~ 30° backward with a pillow under the shoulders, and turned 45° contralateral to the side of stimulation to put the sternocleidomastoid (SCM)muscle in a state of tension. Results The P13 and N23 waves of the cVEMPs were recordable in all sedated toddlers. The cVEMPs measures resulted in the following: P13 latency of 17.5 ± 1.41 milliseconds, N23 latency of 25.58 ± 2.02 milliseconds, and peak-topeak amplitude of 15.39 ± 3.45 μV. One-sample t-test revealed statistically significant longer latencies and smaller amplitude of the toddlers' cVEMPs relative to the normative data for adults. Conclusions The difficulty of cVEMPs testing in toddlers can be overcome by sedating them and attaining a position that contracts the SCM muscle. However, the toddlers' recordings revealed delayed latencies and smaller amplitudes than those of adults.

Applicability of Evoked Auditory Brainstem Responses with Complex Stimuli in Adults with Hearing Loss

Abstract Introduction The use of the speech-evoked auditory brainstem response (ABR) shows how the brainstem operates up to the subcortex in a more complexmanner than when the click-evoked ABR is used. Objective To study the applicability of the speech-evoked ABR in adults with hearing loss. Methods The sample was composed of a study group of 11 subjects, with ages ranging between 18 and 59 years, and auditory thresholds within normal standards, with loss of up to 65 dB at high frequencies or up to moderately severe symmetric sensorineural hearing loss. The sample underwent a basic audiological assessment, as well as speech-evoked ABR and click-evoked ABR, in which waves I, III and V, and V, A, C, D, E, F were respectively marked. The electrophysiological assessments were performed using the SmartEP device (Intelligent Hearing Systems, Miami, FL, US). Results For the speech-evoked ABR, the reference values were used in the identification and analysis of the study group. Those values found for the study group were: V = 8.56; A = 10.97; C = 21.33; D = 29.51; E = 37.93; F = 46.96; and O = 55.97. In the comparison between groups, the study group presented an increase in latency only in wave C. Conclusion The speech-evoked ABR can be performed in subjects with up to moderately severe hearing loss, and the test proved to be appropriate, because, unlike the click-evoked ABR, the former does not suffer influence of peripheral hearing loss.

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.

Initial otoacoustic emission hearing screening results in newborns with patent ear canals, vernix caseosa and collapsed ear canals

@#<p style="text-align: justify;"><strong>OBJECTIVES: </strong>This study determined the initial otoacoustic (OAE) hearing screening results of newborns with collapsed ear canals and vernix caseosa in the ear canal and compared these to ears that were patent.<br /><strong>METHODS:</strong> Two hundred term newborns (400 ears) with normal APGAR scores, birth weight, maternal and gestational history, who were born between August 2013 to October 2013 and who had OAE hearing screening test done by trained midwives were included in this study. All of them underwent otoscopy after the OAE hearing screening test was done to determine patency of the ear canal and presence of vernix caseosa. The examining physician was blinded to the OAE results. Comparison between the OAE results and the otoscopic findings were done.<br /><strong>RESULTS:</strong> Four hundred ears were included in the study. Two hundred and fifty one ears (62.8%) had vernix caseosa and 42 ears (10.5%) had collapsed ear canal. The overall initial OAE hearing screening test pass rate of the newborns tested was 69.5%. The initial OAE hearing screening test pass rate of newborns those with ear canal vernix caseosa or collapsed ear canal, were 72.1% and 47.6%, respectively. Patent ears were found in 107 (26.7%) with a pass rate of 71.9%.<br /><strong>CONCLUSION:</strong>The pass rates of ears with vernix caseosa and collapsed ear canal were 72.1% and 47.6%, respectively. There was no significant difference between the OAE hearing screening test pass rates of ears with patent canal and ears that were collapsed and/ or had vernix caseosa. However, there was a statistically significant difference in pass rates between patent ear canals and collapsed ear canal</p>

Hearing function after betahistine therapy in patients with Ménière's disease / Função auditiva após terapia com beta-histina em pacientes com doença de Ménière

ABSTRACT INTRODUCTION: Preventing or reversing hearing loss is challenging in Ménière's disease. Betahistine, as a histamine agonist, has been tried in controlling vertigo in patients with Ménière's disease, but its effectiveness on hearing problems is not known. OBJECTIVE: To examine the effect of betahistine on hearing function in not-previously-treated patients with Ménière's disease and to define possible contributors in this regard. METHODS: A total of 200 not-previously-treated patients with definite unilateral Ménière's disease received betahistine by mouth (initial dose, 16 mg three times a day; maintenance dose, 24-48 mg daily in divided doses). Changes in indicators of hearing status before and six months after treatment were documented. Hearing loss was considered as the mean hearing level >25 dB HL at five frequencies. RESULTS: The mean duration of disease was 3.37 years. Six months after treatment the mean hearing level decreased by 6.35 dB compared to that at the baseline (p < 0.001). Both patients' age and the duration of disease correlated negatively with the improvement in hearing function. Post treatment hearing loss was independently associated with age, the initial hearing level and the chronicity of disease. The corresponding optimal cut-off points for predicating a persistent hearing loss 6 months after treatment were 47 years, 38 dB HL, and 1.4 years, respectively. CONCLUSION: Oral betahistine was significantly effective in preventing/reversing hearing deterioration in patients with Ménière's disease. Age, the hearing level on admission, and the disease duration were independent predictors of hearing status after treatment.

Resumo Introdução: Prevenir ou reverter a perda auditiva é um desafio na doença de Ménière. A betahistina, um agonista de histamina, tem sido testada no controle de vertigem em pacientes com doença de Ménière, mas sua eficácia em problemas de audição ainda não é conhecida. Objetivo: Analisar o efeito da betahistina na função auditiva em pacientes com doença de Ménière não tratados previamente, e definir possíveis contribuintes a esse respeito. Método: Um total de 200 pacientes sem tratamento prévio, e com diagnóstico definido de doença de Ménière unilateral, recebeu beta-histina por via oral (dose inicial de 16 mg três vezes ao dia; dose de manutenção de 24-48 mg por dia, em doses divididas). Alterações dolimiar auditivo antes e após seis meses de tratamento foram documentadas. Considerou-se como perda auditiva uma média do nível de audição > 25 dB NA em cinco frequências. Resultados: A média de duração da doença foi de 3,37 anos. Seis meses após o tratamento, a média do limiar auditivo diminuiu em 6,35 dB, em comparação com o valor da linha de base (p < 0,001). Tanto a idade dos pacientes quanto a duração da doença apresentaram correlação negativa com a melhora da função auditiva. A perda auditiva após o tratamento foi independentemente associada à idade, ao nível inicial de audição e à cronicidade da doença. Os pontos de corte ótimos correspondentes para prever uma perda auditiva persistente seis meses após o tratamento foram 47 anos, 38 dB HL e 1,4 ano, respectivamente. Conclusão: A betahistina oral foi significantemente eficaz na prevenção/reversão da deterioração auditiva em pacientes com doença de Ménière. Idade, nível de audição na admissão e duração da doença foram fatores preditivos independentes da condição auditiva após o tratamento.

Otologic and audiologic characteristics of type 2 diabetics in a tertiary health institution in Nigeria / Características audiológicas e otológicas de diabéticos tipo 2 em uma instituição de saúde terciária na Nigéria

ABSTRACT INTRODUCTION: This cross-sectional comparative study was carried out at the Diabetes outpatient clinic of LAUTECH Teaching Hospital (LTH) Ogbomoso, Nigeria. OBJECTIVE: This study assessed patterns of otologic diseases and auditory acuity among type 2 diabetics and determinants of these findings among diabetics. METHODS: Ninety-seven consenting patients with clinical diagnosis of diabetes mellitus (194 ears) were matched for age and sex with ninety non-diabetic patients (180 ears). These patients were screened using otoscopy and pure tone audiometry over a 6-month period. RESULTS: The study reported a crude prevalence rate of 21.6% hearing loss in T2DM patients. The most common type of otologic disease that showed significant association with T2DM patients was otitis media with effusion (p = 0.027). T2DM was significantly associated with abnormal audiometric findings (p = 0.022), particularly sensorineural hearing loss (p = 0.022), of the moderate grade (p = 0.057). There were no differences of the audilogical findings for any particular ear, and no differential affectation of frequency range was observed. Coexisting hypertension and poor glycaemic control were significantly associated with aggravation of the hearing of the T2DM patients (p < 0.001, and p = 0.009 respectively). CONCLUSION: T2DM had appreciable effects on hearing acuity. T2DM was significantly associated with the type and the degree of the hearing loss. The need for screening of hearing acuity of T2DM patients, in order to detect early changes, and promptly offer an adequate management and remedial measures was emphasized in this study.

Resumo Introdução: Este estudo de caso-controle foi realizado no Ambulatório de Diabetes do LAUTECH Teaching Hospital (LTH), em Ogbomoso, Nigéria. Objetivos: Este estudo avaliou os padrões de doenças otológicas e acuidade auditiva entre os diabéticos tipo 2 e os fatores determinantes desses achados entre os diabéticos. Método: Ao todo, 97 pacientes com diagnóstico clínico de diabetes melito (194 orelhas) deram seu consentimento e foram pareados por idade e sexo, com 90 pacientes não diabéticos (180 orelhas). Eles foram avaliados por otoscopia e audiometria tonal liminar por um períodode seis meses. Resultados: O estudo relatou uma taxa de prevalência bruta de 21,6% de perda auditiva em pacientes com DM2. O tipo mais comum de doença otológica, afetando significativamente pacientes com DM2, foi otite média com efusão (p = 0,027). A DM2 foi associada com achados audiométricos alterados (p = 0,022), principalmente perda auditiva neurossensorial (p = 0,012), de grau moderado (p = 0,057). Não houve predileção dos efeitos da DM2 para uma das orelhas em particular, e também não houve efeito diferencial da faixa de frequência. A coexistência de hipertensão e controle glicêmico inadequado associou-se significativamente à piora da audição dos pacientes com DM2 (p < 0,001 e p = 0,009, respectivamente). Conclusão: A DM2 mostrou apresentar efeitos significantes na acuidade auditiva afetando significativamente o tipo e o grau da disacusia. Este estudo mostrou a necessidade de avaliação da acuidade auditiva de pacientes com DM2, a fim de detectar as alterações iniciais, e poder rapidamente oferecer medidas corretivas adequadas.

Pneumococcal conjugate vaccine (Non-Typeable Haemophilus influenzae (NTHi) protein D, diphtheria or tetanus toxoid conjugates) in prevention of acute otitis media in children: A cohort study

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To compare the incidence of acute otitis media among children aged 2 to 6 months old in Sampaloc, Manila who were previously given 3 doses of pneumococcal conjugate vaccine (Non-Typeable Haemophilus influenzae (NTHi) protein D, diphtheria or tetanus toxoid conjugates) and those who did not receive the vaccine over a period of one year.<br /><strong>METHODS:</strong> <br /><strong>Design:</strong> Cohort Study<br /><strong>Setting:</strong> Primary Health Center in Sampaloc, Manila, Philippines<br /><strong>Participants:</strong> Medical records of well children aged 2 to 6 months were reviewed for inclusion. Participants were categorized into vaccinated and unvaccinated groups. Both groups underwent baseline history and physical examination including otoscopy and any signs and symptoms of active ear infection were noted. Subjects were followed up for a period of one year on a monthly basis for signs or symptoms of acute otitis media. <br /><strong>RESULTS:</strong> A total of 176 subjects participated in the study. The overall incidence of AOM among participants was 5.11% (9 out of 176). An AOM incidence of 3.75% (3 out of 80) and 6.25% (6 out of 96) was found among the exposed and unexposed groups, respectively. Fisher's exact test (one-tailed) p value= .34, relative risk (RR) .6 (95% Cl 0.155, 2.323).<br /><strong>CONCLUSION:</strong> The results of this study showed no difference in the development of AOM in the two groups. However, based on the relative risk, Pneumococcal conjugate vaccine is still beneficial in preventing AOM in children.</p>

Endoscopic Adenoidectomy in Children With Otitis Media With Effusion and Mild Hearing Loss

OBJECTIVES: Surgical management of children with chronic otitis media with effusion (OME) includes tympanostomy tube insertion or adenoidectomy, alone or with myringotomy and tube insertion. The aim of this study was to compare the effectiveness of transoral microdebrider endoscopic-assisted adenoidectomy (TOMEA) and traditional adenoidectomy in the management of children with mild hearing loss due to OME and chronic adenoiditis. METHODS: This prospective, double-blind and controlled study involved 120 consecutive patients aged 4-12 years, who were randomised 1:1 to undergo TOMEA or traditional adenoidectomy under general anesthesia. All the patients underwent a complete otolaryngological examination, including nasopharyngeal fibre endoscopy (NFE), pneumatic otoscopy, otomicroscopy, tympanometry and supraliminar tonal audiometry, upon enrolment, and three and nine months postoperatively. RESULTS: There were no statistically significant differences in age or gender distribution between the TOMEA group (mean age, 4.9±1.1 years; 53.3% males) and the traditional adenoidectomy group (mean age, 5.3±0.9 years; 56.7% males). Both procedures led to a significant improvement in choanal patency (P<0.01) and all of the otological and audiological parameters (P<0.01) 3 and 9 months postoperatively, although postoperative NFE showed that the mean percentage of residual choanal obstruction was significantly less in the TOMEA group (P=0.02). There was no significant between-group difference in the percentage of children with tympanic membrane changes, but the postoperative prevalence of children with a type B tympanogram was significantly lower in the TOMEA group after 3 (15.0% vs. 31.7%, P=0.05) and 9 months (18.3% vs. 38.3%, P=0.02), as was the percentage of children with mild conductive hearing loss (3.3% vs. 23.3%, P<0.01; and 8.3% vs. 28.3%, P<0.01). CONCLUSION: Although both TOMEA and traditional adenoidectomy are effective in treating children with mild hearing loss due to adenoidal hypertrophy and OME, the former achieves the greater reduction in residual adenoidal hypertrophy and better audiological outcomes.

A Case of Recurrent External Ophthalmomyiasis Caused by Lucilia sericata Meigen in a Healthy Patient

PURPOSE: To report a case of recurrent external ophthalmomyiasis caused by Lucilia sericata Meigen in a healthy patient. CASE SUMMARY: A 72-year-old male, who was diagnosed 7 months earlier with ophthalmomyiasis and obtained permanent relief by surgical treatment, presented with severe tearing, redness, foreign body sensation, pain in both eyes and aural discomfort in the left ear. On presentation, visual acuity in both eyes was hand movement. On slit lamp examination, total corneal epithelial defect with stromal infiltrations was observed. However, there were no motile organisms in his eyes due to previous removal of maggots at a local clinic. On physical examination, eschar change was observed at the inferomedial area of the left lower eyelid. On otorhinolaryngological examination, several motile organisms with tympanic membrane perforation were observed in the left external acoustic meatus. The patient was treated with topical antibiotic eye drops hourly with systemic antibiotics, and 6 larvae were removed from the external acoustic meatus using otoscopy. Microscopic findings of the removed larvae revealed L. sericata in their third stage of development. After 1 month, corneal epithelial defect and stromal infiltration improved. However, visual acuity in both eyes was 0.1 due to remaining stromal opacities. CONCLUSIONS: In a healthy patient without any predisposing factors, recurrent ophthalmomyiasis accompanied with aural myiasis can develop under poor hygiene conditions.

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.