Fistula Salival: presentación atípica en parotiditis bacteriana, a propósito de un caso / Salival Fistula, atypical presentation of bacterial parotiditis, by the purpose of a case

Introducción: La fístula salival es la comunicaciónde la glándula salival o el conducto parotídeo hacia la piel,debido a una lesión traumática del parénquima o del conducto deexcreción; no suele ser una complicación frecuente en parotiditisaguda. El objetivo de este trabajo es destacar la presentaciónatípica de un caso de parotiditis bacteriana asociado a fistulasalival hacia el conducto auditivo externo y cavidad oral, y aparálisis facial periférica. Caso clínico: Paciente masculino de15 años de edad, quien consulta por otalgia y otorrea derechaasociado a aumento de volumen en región parotídea ipsilateralde 5 días de evolución. Al examen físico se evidencia, caraasimétrica con desviación de comisura labial hacia la izquierda ycierre palpebral completo sin esfuerzo, con aumento de volumende parótida derecha con signos de flogosis, otorrea purulentaderecha . solución de continuidad en tercio medio de pisode conducto auditivo externo. Ecosonograma de piel y partesblandas, reveló cambios inflamatorios en glándula parótida concolección de 112 cc., Los hallazgos tomográficos de oído medioy mastoides corroboraron hallazgos del ecosonograma. se realizódrenaje quirúrgico del absceso y se trató con Clindamicina600 mg vía endovenosa cada 6 horas y Penicilina Cristalina200 mg/kg/ peso cada 6 horas y su evolución fue satisfactoria.Conclusión:Los abscesos parotídeos pueden presentarse demanera atípica o en raras ocasiones con drenaje a través delconducto auditivo externo(AU)

Introduction: Salivary fistula is the communicationof the salivary glands or the parotid duct to the skin, due toa traumatic injury to the parenchyma or the excretion duct; Itis not usually a frequent complication in acute parotitis. the eobjective of this work is to highlight the atypical presentation of acase of bacterial parotitis associated with salivary fistula towardsthe external auditory canal and oral cavity, and peripheralfacial paralysis. Clinical case: A 15-year-old male patient, whoconsulted due to otalgia and right otorrhea associated with anincrease in volume in the ipsilateral parotid region of 5 days ofevolution. On physical examination, an asymmetrical face withdeviation of the lip corner to the leth and complete palpebralclosure without effort, with increased volume of the rightparotid gland with signs of phlogosis, right purulent otorrhea and continuity solution in the middle third of the external auditory canal are evident. Ultrasound of the skin and so the tissues revealed inflammatory changes in the parotid glands with a collection of 112 cc. yhe tomographic findings of the middle ear and mastoids corroborated the findings of the echosonogram; Surgical drainage of the abscess was performed and he was treated with clindamycin 600 mg intravenously every 6 hours and crystalline penicillin 200 mg/kg/weight every 6 hours, and his evolution was satisfactory. Conclusion: Parotid abscesses can present atypically or rarely with drainage through the external auditory canal(AU)

Quiste epidermoide en conducto auditivo externo: reporte de caso / Epidermoid cysts of the external auditory canal: case report

Resumen El quiste epidérmico es una lesión benigna y común de la piel. Se desarrolla por un bloqueo de la unidad pilosebácea, con la consecuente proliferación de células epiteliales y secuestro de queratina. El 7% se desarrollan en cabeza y cuello, sin embargo, son infrecuentes en canal auditivo externo. Su patrón de crecimiento es lento y progresivo durante años, siendo asintomáticos. Al aumentar de tamaño causan sintomatología variable, acorde a su localización; en el canal auditivo tienen un comportamiento obstructivo que genera síntomas como otalgia e hipoacusia. Se presenta caso de una paciente de 69 años, con acúfeno e hipoacusia progresiva derecha. Durante la otoscopia se observó una neoformación obstructiva del 100% de la luz del conducto. Se realizaron estudios de imagen que reportaron tumoración de características quísticas de conducto auditivo derecho, bien circunscrita, sin erosión ósea. Para el diagnóstico definitivo, se realizó resección quirúrgica y biopsia reportando quiste epidérmico. Durante el seguimiento posoperatorio sin hallazgos de recidiva.

Abstract The epidermal cyst is a common and benign lesion of the skin. It develops due to a blockage of the pilosebaceous unit, with the consequent proliferation of epithelial cells and keratin sequestration. Seven percent develop in the head and neck; however, they are infrequent in the external auditory canal. Its growth pattern is slow and progressive over the years, being asymptomatic. As they increase in size, they cause variable symptoms, according to their location. In the ear canal they have an obstructive behavior that generates symptoms such as earache and hearing loss. A case of a 69-year-old female with tinnitus and progressive right hearing loss is presented. At otoscopy, a 100% obstructive neoformation of the canal lumen was observed. Imaging studies showed a well circumscribed, cystic tumor of the right ear canal, without bone erosion. For the definitive diagnosis, a resection and biopsy were performed, reporting an epidermal cyst. During follow up there was no recurrence of tumor.

Plasmocitoma extramedular de canal auditivo externo: caso clínico / Extramedullary plasmacytoma of external auditory canal: a case report

Resumen El plasmocitoma extramedular es una neoplasia de células plasmáticas poco frecuente, que se ubica en 80% a 90% de los casos en la cabeza o cuello. Esta neoplasia representa menos del 1% de toda la patología maligna de cabeza y cuello. Dada la poca frecuencia de la patología y la escasez de casos publicados, esta entidad presenta una gran dificultad clínica y terapéutica. El diagnóstico se basa en el análisis histológico con inmunohistoquímica de la muestra obtenida, y el tratamiento varía según la ubicación, donde se puede realizar radioterapia o cirugía. En este artículo presentamos el caso de una paciente de 56 años, con antecedentes de otorrea de larga data en oído derecho, al examen físico presentaba un tumor que obstruía todo el conducto auditivo externo. Se realizó exéresis tumoral y la biopsia evidenció un plasmocitoma.

Abstract Extramedullary plasmacytoma is a rare plasma cell neoplasm, affecting 80% to 90% of the head or neck. This neoplasm represents less than 1% of all malignant head and neck pathology. Given the infrequency of the pathology and the scarcity of published cases, this entity presents great clinical and therapeutic difficulty. Diagnosis is based on histology and immunohistochemistry and treatment varies depending on the location, where radiation therapy or surgery can be performed. In this article, we present the case of a 56-year-old patient with a history of long-standing otorrhea in the right ear. Physical examination presented a tumor that obstructed the entire external auditory canal. Tumor excision was performed, and the biopsy revealed a plasmacytoma.

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.

Prognostic value of pre-operative peripheral inflammation markers in patients with squamous cell carcinoma of the external auditory canal / Valor prognóstico dos marcadores de inflamação periférica pré-operatórios em pacientes com carcinoma espinocelular do meato acústico externo

Abstract Introduction: Squamous cell carcinoma of the external auditory canal is a rare entity. Previous studies have suggested predictors for tumor recurrence. However, most of the prognostic factors were from the clinicopathological aspect. Objective: This study aims to analyze the correlation between pre-operative peripheral inflammation markers and survival outcomes, in order to identify prognostic biomarkers for patients with squamous cell carcinoma of the external auditory canal. Methods: We retrospectively analyzed patients diagnosed with squamous cell carcinoma of the external auditory canal who underwent surgery at our institute. The pre-operative circulating inflammatory markers, such as the neutrophil, lymphocyte, platelet, and monocyte counts were measured and their ratios including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and lymphocyte-to-monocyte ratio were calculated. The prognostic value of the measured hematologic parameters in relation to the survival outcomes was also evaluated. Results: A total of 83 patients were included, of which 26 patients showed tumor recurrence and 57 without recurrence. Neutrophil counts and neutrophil-to-lymphocyte ratio were closely connected with tumor stage. In the patients with recurrence, neutrophil counts, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were elevated (p< 0.0001, p< 0.0001 and p = 0.001), while lymphocyte counts and lymphocyte-to-monocyte ratio were decreased (p = 0.013 and p = 0.016, respectively). The receiver operating curve analysis indicated that pre-operative neutrophil-to-lymphocyte ratio is a potential prognostic marker for recurrence of squamous cell carcinoma of the external auditory canal (area under curve = 0.816), and the cut-off points was 2.325. Conclusions: Pre-operative neutrophil and lymphocyte counts, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte are significantly correlated with tumor recurrence in patients with external auditory canal squamous cell carcinoma. Furthermore, neutrophil-to-lymphocyte ratio may be unfavorable prognostic factors of this disease.

Resumo Introdução: O carcinoma espinocelular do meato acústico externo é uma doença rara. Estudos anteriores sugeriram preditores de recorrência do tumor. Entretanto, a maioria dos fatores prognósticos se originou do aspecto clínico-patológico. Objetivo: Analisar a correlação entre marcadores inflamatórios periféricos pré-operatórios e os desfechos de sobrevida e identificar biomarcadores prognósticos para pacientes com carcinoma espinocelular do meato acústico externo. Método: Analisamos retrospectivamente pacientes com diagnóstico de carcinoma espinocelular do meato acústico externo submetidos à cirurgia em nosso instituto. Os marcadores inflamatórios circulantes pré-operatórios, como as contagens de neutrófilos, linfócitos, plaquetas e monócitos, foram medidos e as suas relações calculadas, inclusive as relações neutrófilos/linfócitos, plaquetas/linfócitos e linfócitos/monócitos. O valor prognóstico dos parâmetros hematológicos medidos em relação aos desfechos de sobrevida também foi avaliado. Resultados: Foram incluídos 83 pacientes, entre os quais 26 apresentaram recorrência tumoral e 57 não apresentaram. A contagem de neutrófilos e a relação neutrófilo/linfócito estavam intimamente associadas ao estágio do tumor. Nos pacientes com recorrência, a contagem de neutrófilos, a relação neutrófilos/linfócitos e a relação plaquetas/linfócitos eram elevadas (p < 0,0001, p > 0,0001 e p = 0,001), enquanto a contagem de linfócitos e a relação linfócitos/monócitos estavam diminuídas (p = 0,012 ep = 0,016, respectivamente). A análise da curva, Receiver Operating Characteristic, indicou que a relação neutrófilos/linfócitos pré-operatória era um potencial marcador prognóstico para a recorrência de carcinoma espinocelular do meato acústico externo (Área sob a curva = 0,816) e o ponto de corte foi de 2,325. Conclusão: A contagem pré-operatória de neutrófilos e linfócitos, as relações neutrófilos/linfócitos, plaquetas/linfócitos e linfócitos/monócitos estão significativamente correlacionadas com a recorrência do tumor em pacientes com carcinoma espinocelular do meato acústico externo. Além disso, a relação neutrófilos/linfócitos pode ser um fator prognóstico desfavorável dessa doença.

Using the external auditory canal skin graft of the healthy side to treat unilateral congenital aural atresia: preliminary results of clinical research / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate whether the contralateral normal external auditory canal (EAC) skin graft can maintain the ear canal health after EAC reconstruction in unilateral congenital aural atresia (CAA) cases. Methods: A Zelen design randomized controlled study was used to collect unilateral CAA patients for EAC reconstruction prospectively (clinical trial registration number: ChiCTR2000032103). The patients were randomly divided into the control group and the trial group. The trial group used the contralateral normal EAC skin graft group (transplant part of the contralateral normal EAC skin to repair the atresia side for unilateral CAA patients), the control group all used scalp blade thick skin. We observed the EAC health and hearing results of the two groups after EAC reconstruction. Results: A total of 13 cases were enrolled from July 2020 to August 2021. There were eight patients in the trial group, including six males and two females, with an average age of 22.3 years (14-36 years). There were two patients with CAA on the left and six patients on the right. The average follow-up time was 8.8 months (4-14 months). There were five patients in the control group, all cases were male with an average age of 16.2 years (12-20 years). There were four patients with CAA on the left and one patient on the right. The average follow-up time was 7.0 months (2-14 months). In the trial group, eight cases of reconstructed EAC epithelium were healthy, one patient had cicatricial stenosis of EAC opening and lateralization of the tympanic membrane. The other patient had cicatricial stenosis of reconstructed EAC, this case also had scar hyperplasia of the contralateral EAC opening but recovered after soft packing and triamcinolone acetonide injection treatment. The healthy side EAC of the rest trial group had no scarring stenosis or local bone hyperplasia during long-term follow-up. In the control group, one patient was lost to follow-up and the other four patients had dry ears of reconstructed EAC, but easily to form crusts and needed to be cleaned repeatedly, one patient had lateralization of the tympanic membrane, the EAC epithelium was not healthy for long-term follow-up. The incidence of complications related to EAC reconstruction was lower than previous studies (χ²=5.55, P=0.018), and the average postoperative Air-Bone Gap increased (18.8±10.0)dB. Conclusion: By optimizing the EAC reconstruction technology, the health of the reconstructed EAC is improved compared with the previous study. After active intervention and treatment, there should be no scarring stenosis or local bone hyperplasia on the contralateral side EAC.

Patrones de resistencia en agentes bacterianos involucrados en otitis caninas en Medellín, Colombia, durante 2019: análisis retrospectivo / Patterns of resistance in bacterial agents involved in canine otitis at Medellín, Colombia, during 2019: retrospective analysis

RESUMEN Dentro de los agentes patógenos en los procesos otíticos bacterianos, se destacan microorganismos como Staphylococcus pseudintermedius, Pseudomona auriginosa, Proteus mirabi-lis, Escherichia coli, Corynebacterium spp., Enterococcus spp. y Streptococcus spp., para los cuales se ha descrito resistencia frente a los antibióticos empleados para combatirlos. En Colombia son pocos los reportes acerca de la resistencia antibiótica de microorganismos causantes de otitis. Por ello, el objetivo de esta investigación fue determinar los agentes bacterianos más frecuentemente aislados en infecciones otíticas de caninos remitidas a un laboratorio veterinario de Medellín durante el 2019 y su resistencia a antibióticos. Para llevarlo a cabo, se realizó un estudio descriptivo transversal retrospectivo. Se analizaron los resultados de los antibiogramas realizados a partir de cultivos bacterianos en muestras óticas remitidas a un laboratorio de referencia de la ciudad de Medellín. Además, se efectuó un análisis de frecuencias para la muestra total. Se encontró que los principales microorganismos bacterianos aislados fueron Staphylococcus pseudintermedius, Pseudomona auriginosa, Proteus mirabili y Staphylococcus aureus. La gentamicina fue el medicamento que mayor porcentaje de resistencia presentó y la cefalexina el que menos resistencia presentó. Se pudo concluir que el Staphylococcus pseudintermedius está presente en más del 60% de los casos de otitis bacteriana. Adicionalmente, se observó una variación de la resistencia presentada por los microorganismos en el tiempo. Estos presentaron mayor resistencia ante los antibióticos aminoglucósidos.

ABSTRACT Among the pathogens in bacterial otic processes, microorganisms such as Staphylococcus pseudintermedius, Pseudomona auriginosa, Proteus mirabilis, Escherichia coli, Corynebac-terium spp., Enterococcus spp., and Streptococcus spp. stand out, for which resistance to antibiotics has been described employed to combat them. In Colombia there are few reports about the antibiotic resistance of microorganisms that cause otitis. For that reason, the purpose of this study was to determine the bacterial agents most frequently isolated from canine ear infections and their resistance to antibiotics from samples of ear secretions sent to a veterinary laboratory in Medellín during 2019. In order to do that, an cross-sectional, retrospective descriptive study was done. The results of the antibiograms performed from bacterial cultures obtained from ear samples sent to a reference laboratory in the city of Medellín were analyzed. A frequency analysis was carried out for the total sample. It was found that the main isolated bacterial microorganisms were Staphylococcus pseudintermedius, Pseudomona auriginosa, Proteus mirabili and Staphylococcus aureus. Gentamicin was the drug with the highest percentage of resistance and cephalexin the one with the least resistance. It was possible to conclude that Staphylococcus pseudintermedius is linked in more than 60% of cases of bacterial otitis and the resistance presented by microorganisms varies over time. The group of aminoglycosides antibiotics was the one which microorganisms are manifesting more percentage of resistance.

Extracranial landmarks for surgical skull base approaches / Puntos de referencia extracraneales para abordajes quirúrgicos de la base del cráneo

SUMMARY: Surgical operations regarding to skull base are challenging and reliable anatomical landmarks are required. There is a lack of knowledge on anatomical variations in this region. The aim of this study was to determine the safe extracranial landmarks for surgical approach to the skull base. In this study, 23 adult dry skulls were evaluated: the age and sex of the specimens were unknown. All measurements were taken from external surface of inferior aspect of the skull by using digital calipers accurate to 0.01 mm. In right and left sides; the distances between the external acoustic meatus (EAM) and the following anatomical landmarks were measured: articular tubercle (AT); anterior margin of squamous suture (ASS); superior margin of squamous suture (SSS); posterior margin of squamous suture (PSS); end point of styloid process (SP); midpoints of pterygomaxillary fissure (PMF); foramen ovale (FO); foramen spinosum (FS); and of carotid canal (CC).The distances of the external acoustic meatus to the anatomical structures on the right and left sides were: EAM-SP; 24.24±3.19 mm, 23.16±3.17 mm; EAM-PMF; 46.56±4.51mm, 46.25±3.96 mm; EAM-FO; 27.57±2.87 mm, 28.70±2.85 mm; EAM-FS; 22.53±3.19 mm, 22.72±3.47 mm; EAM-CC; 17.35±3.56 mm, 17.19±3.39 mm; EAM-AT; 19.31±3.79 mm, 18.95±3.42 mm; EAM-ASS; 43.14±4.80 mm, 46.82±4.61 mm; EAM-SSS; 49.17±4.74 mm, 48.83±3.34 mm and EAM-PSS; 36.15±4.24 mm, 35.39±4.25 mm, respectively. We think that the findings obtained from this study related to external acoustic meatus can be an important reference for surgical anatomy and surgical procedures in skull base.

RESUMEN: Las cirugías relacionadas con la base del cráneo son un desafío, las cuales requieren puntos de referencia anatómicos confiables. Existe una falta de conocimiento sobre las variaciones anatómicas en esta región. El objetivo de este estudio fue determinar los puntos de referencia extracraneales seguros para el abordaje quirúrgico de la base del cráneo. En este estudio se evaluaron 23 cráneos secos adultos: se desconocía la edad y el sexo de los ejemplares. Las medidas se tomaron de la superficie externa de la cara inferior del cráneo utilizando calibradores digitales con una precisión de 0,01 mm. En lados derecho e izquierdo se midieron las distancias entre el meato acústico externo (MAE) y los siguientes puntos de referencia anatómicos: tubérculo articular (TA); margen anterior de la sutura escamosa (MASE); margen superior de sutura escamosa (MSSE); margen posterior de sutura escamosa (MPSE); punto final del proceso estiloides (PFPE); puntos medios de la fisura pterigomaxilar (PMFP); foramen oval (FO); foramen espinoso (FE); y del canal carotídeo (CC). Las distancias del meato acústico externo a las estructuras anatómicas de los lados derecho e izquierdo fue- ron: MAE-PFPE; 24,24 ± 3,19 mm, 23,16 ± 3,17 mm; MAE-PMFP; 46,56 ± 4,51 mm, 46,25 ± 3,96 mm; MAE-FO; 27,57 ± 2,87 mm, 28,70 ± 2,85 mm; MAE-FE; 22,53 ± 3,19 mm, 22,72 ± 3,47 mm; MAE-CC; 17,35 ± 3,56 mm, 17,19 ± 3,39 mm; MAE-TA; 19,31 ± 3,79 mm, 18,95 ± 3,42 mm; MAE-MASE; 43,14 ± 4,80 mm, 46,82 ± 4,61 mm; MAE-MSSE; 49,17 ± 4,74 mm, 48,83 ± 3,34 mm y MAE-MPSE; 36,15 ± 4,24 mm, 35,39 ± 4,25 mm, respectivamente. Creemos que los hallazgos obtenidos de este estudio relacionados con el meato acústico externo pueden ser una referencia importante para la anatomía quirúrgica y los procedimientos quirúrgicos en la base del cráneo.

Identification of a thaumatin-like protein as a new allergen in persimmon (Diospyros kaki) with cross-reactivity with banana (Musa acuminata) / Identificação de uma proteína semelhante à taumatina como um novo alérgeno no caqui (Diospyros kaki) com reatividade cruzada com a banana (Musa acuminata)

Allergy to persimmon (Diospyros kaki ) has been only rarely reported. The antigenic composition of the fruit is not entirely known. Thaumatin-like proteins (TLPs) have been described as allergens in pollens and various fruits, such as kiwi and banana, but not in persimmon. We report the case of a 22-year-old man, with persistent moderate-to-severe allergic rhinitis, sensitized to house dust mites. The patient describes an episode of oral mucosa and ear canal pruritus, followed by diffuse urticaria, which rapidly evolved to dysphonia, dyspnea, and dizziness, after eating raw persimmon. A few months later he developed similar cutaneous symptoms accompanied by nausea, vomiting, abdominal colic, and hypotension immediately after the intake of banana. The prick-prick test with raw persimmon and banana were positive, as well as the serum specific IgE to the extract of these fruits. The ImmunoCAP ISAC_112i test demonstrated a positive specific IgE against Act d 2 (kiwi thaumatin), which is homologous to banana TLP (Mus a 4). Serum IgE inhibition test with "sponge" of Diospyros kaki ImmunoCAP (f301) showed partial inhibition (40%) of IgE to Act d 2. This raises the suspicion that a TLP is at least partially responsible for the referred sensitization. This patient is sensitized to Diospyros kaki and Musa acuminata. An anaphylactic reaction to consumed persimmon, presumably as a result from cross-allergy with banana thaumatin was diagnosed in our patient. Thaumatin has not been previously described as an allergen of persimmon with cross-reactivity with banana, and in vitro with Act d 2 (kiwi TLP).

A alergia ao caqui (Diospyros kaki ) tem sido raramente documentada, não sendo a composição antigênica da fruta totalmente conhecida. Proteínas semelhantes à taumatina (TLPs) foram descritas como alergênicos em pólens e várias frutas, como no kiwi e banana, mas não no caqui. Apresenta-se o caso de um doente de 22 anos, com rinite alérgica persistente moderadagrave, sensibilizado a ácaros do pó doméstico. O doente refere episódio de prurido na mucosa oral e canal auditivo, seguido de urticária generalizada, que rapidamente evoluiu para disfonia, dispneia e tontura, após ingestão de caqui. Poucos meses depois, desenvolveu sintomas cutâneos semelhantes, acompanhados de náuseas, vómitos, cólica abdominal e hipotensão imediatamente após ingestão de uma banana. O teste cutâneo por picada com caqui e banana em natureza foram positivos, bem como o doseamento de IgE específica. O teste ImmunoCAP ISAC_112i identificou a presença de IgE específica para Act d 2 (taumatina do kiwi), homóloga da TLP da banana (Mus a 4). O estudo de inibição ImmunoCAP ISAC com "esponja" de Diospyros kaki (f301) produziu uma inibição parcial (40%) da ligação de IgE a Act d 2, permitindo presumir que uma proteína semelhante à taumatina é, pelo menos, parcialmente responsável pela referida sensibilização. Este doente encontra-se sensibilizado a Diospyros kaki e Musa acuminata. Uma anafilaxia ao caqui ingerido, presumivelmente resultante de reatividade cruzada com a taumatina da banana foi diagnosticada. Não estão descritas na literatura TLPs como alergênicos do caqui com reatividade cruzada com a banana e com Act d 2 in vitro (TLP do kiwi).

Clinical manifestation and treatment of temporal bone tympanic plate fracture / 中华耳鼻咽喉头颈外科杂志

Objective: To elucidate the clinical manifestations of temporal bone tympanic plate fracture and the correlation between treatment time after injury and its prognosis, and to discuss the importance of early treatment of tympanic fracture. Methods: Retrospective analysis was carried out on the clinical data of 15 patients(17 ears)with temporal bone tympanic plate fracture from March 2006 to July 2019. The course of disease was less than 1 month (initial stage) in 7 cases (7 ears), 1 month to 6 months (middle stage) in 2 cases (3 ears), and 6 months or more (late stage) in 6 cases (7 ears). The symptoms, signs, CT findings, pure tone audiometry results, surgical methods and clinical efficacy of each group were summarized. Results: Most patients with temporal bone tympanic plate fracture were referred to otology department by maxillofacial surgery. Fracture occured indirectly with the chin or zygomatic region as the direct stress point. Thirteen of the 15 patients had mental region wounds or scars, and 14 patients had external acoustic canal bleeding immediately after injury. In the initial-stage group, hearing was mostly unchanged, while in the middle and late-stage groups, hearing loss was mainly caused by conduction factors. In the initial stage group, 6 cases/7 cases were cured by external acoustic canal packing; External acoustic canal stenosis or atresia occurred in 2 cases in the middle-stage group and were cured by external acoustic canal plasty. All the 6 patients in the late-stage group had external acoustic canal stenosis or atresia, among whom 5 patients with external acoustic canal cholesteatoma were cured by external acoustic canal plasty, and the other one patient with middle ear cholesteatoma was cured by modified radical mastoidectomy and tympanoplasty after external acoustic canal plasty for three times. Conclusions: Temporal bone tympanic plate fracture is a special type of temporal bone fracture. In the early stage of temporal bone tympanic fracture, bleeding of the external acoustic canal is the main symptom, and hearing is normal mostly. Advanced conductive deafness may result from external acoustic canal stenosis and/or cholesteatoma formation later. Bleeding of the external acoustic canal and irregular bulge of the anterior wall of the external acoustic canal with mental region wound are important signs for early diagnosis of temporal bone fracture. Temporal bone tympanic fracture should be paid attention to, early detection and timely treatment can avoid external acoustic canal stenosis and atresia.

Estudio anatómico de la dehiscencia timpánica (foramen de Huschke) en la población arqueológica de Tutuquén, Región del Maule, Chile / Anatomical study of tympanic dehiscence (foramen of Huschke) in the archaeological population of Tutuquén, Maule Region, Chile

RESUMEN: La dehiscencia timpánica o Foramen de Huschke (FH) se considera un rasgo craneal morfológico menor, hipostósico, no estocástico, transitorio, ubicado en laplaca timpánica del hueso temporal, cuya expresión se considera fisiológica hasta los 5 años de edad, denominándose como persistente su presencia a mayor edad. La mención de este rasgo en la literatura anatómica se presenta de manera escasa, debido a una muy baja presencia en poblaciones modernas, situación que cambia al estudiar poblaciones arqueológicas. El propósito de este estudio es describir la expresión del foramen de Huschke en una población arqueológica de Chile central. Fueron analizados 27 huesos temporales obtenidos de los restos óseos de la población del Monumento Arqueológico Cementerio Tutuquén, los cuales están depositados en el Museo Regional de Rancagua, Chile. Se evaluó presencia y ubicación del foramen, sexo, temporalidad y rango etáreo para cada muestra incluida. El FH se presentó en un 77,78% de los temporales, siendo 47,62% restos masculinos, 28,57% femeninos y 23,81% de sexo indeterminado. La totalidad de los restos de niños y subadultos presentaron FH, mientras que en adultos su expresión disminuye hasta un 68,42%. La ubicación fue un 38,10% en cuadrante inferomedial, 33,33% superolateral, 23,81% superomedial, 4,71% central. No se encontraron FH de ubicación inferolateral. El único temporal observable del período 10.000 AP (antes del presente, 1950) presentó FH, mientras que, en el período 7.000 AP se presentó en 6/7 temporales y en 14/19 temporales del período 1.000 AP. Los datos aportados complementan el conocimiento anatómico del proceso de osificación del hueso timpánico y la expresión de la dehiscencia timpánica como rasgo morfológico menor desde el estudio de poblaciones arqueológicas.

SUMMARY: The tympanic dehiscence or Foramen of Huschke (FH) is considered a transient minor, hypostosic, non-stochastic cranial feature, located in the tympanic plate of the temporal bone. Its expression is considered physiological until the age of five, and its presence is constant after that. This characteristic is seldom mentioned in anatomical literature since it is infrequent in modern populations. However, there is a difference when archaeological populations are studied. The purpose of this study is to describe the expression of the Huschke foramen in an archaeological population of central Chile. For this analysis, 27 temporal bones were obtained from human skeletal remains of the Tutuquén Cemetery Archaeological Monument. Presence and location of the foramen, sex, time period and age range were evaluated for each sample. The FH occurred in 77.78% of the temporal bones, with 47.62% male, 28.57% female and 23.81% of undetermined sex. All children and subadults presented FH, while in adults it decreased to 68.42%. The location was 38.10% in the inferomedial quadrant, 33.33 % superolateral, 23.81% superomedial, 4.71% central, and no FH was found at the inferolateral position. The only temporal bone identified in the 10,000 BP (before the present 1950) presented FH, while in the 7,000 BP period, it presented in 6/7 temporal bones and in the 1000 BP period, it was found in 14/ 19 temporal bones. The data provided complements anatomical knowledge of the tympanic bone ossification process, and in archaeological population studies, tympanic dehiscence presents as a lesser morphological characteristic.

Queratosis folicular invertida del conducto auditivo externo: Una patología benigna poco frecuente y de localización inusual / INVERTED FOLLICULAR KERATOSIS OF THE EXTERNAL AUDITORY CANAL

La queratosis folicular invertida es una neoplasia benigna poco frecuente originada en el epitelio folicular a nivel del infundíbulo. Si bien no posee una clínica característica ni patognomónica, suele presentarse como una lesión solitaria, asintomática, de crecimiento lento, en la cara. El diagnóstico de certeza se realiza con el estudio histopatológico, que evidencia una proliferación de células basaloides y de células escamosas queratósicas con remolinos escamosos, que se extienden a la dermis. El tratamiento de elección es la extirpación quirúrgica, con buen pronóstico y escasa tendencia a la recurrencia. La localización en conducto auditivo externo es extremadamente infrecuente (en la literatura revisada hemos encontrado sólo tres casos comunicados) y representa un desafío tanto diagnóstico como terapéutico. Se presenta un paciente con una queratosis folicular invertida localizada en conducto auditivo externo izquierdo de 5 años de evolución que comprometía significativamente su calidad de vida por la sintomatología (dolor, otorrea, hipoacusia) y que evolucionó satisfactoriamente con el tratamiento instaurado (extirpación quirúrgica y posterior topicación de la zona con ácido tricloroacético 50%)

Inverted follicular keratosis is a rare benign neoplasm originating from the infundibulum of the follicular epithelium. Although it does not have a characteristic or pathognomonic clinic, it usually presents as a solitary, asymptomatic, slow-growing lesion on the face. The certain diagnosis is made with the histopathological study, which shows a proliferation of basaloid cells and squamous keratotic cells with squamous eddies, which extend to the dermis. The treatment of choice is surgical removal, with a good prognosis and little tendency to recur. Localization in the external auditory canal is extremely rare (in the reviewed literature we have found only three reported cases) and represents both a diagnostic and therapeutic challenge. We present a patient with an inverted follicular keratosis located in the left external auditory canal of 5 years of evolution that significantly compromised his quality of life due to the symptoms (pain, otorrhea, hearing loss) and that evolved satisfactorily with the established treatment (surgical excision and subsequent topication of the area with 50% trichloroacetic acid).

Resolução cirúrgica de pólipo inflamatório em ouvido médio de felino através da técnica de avulsão e tração por abordagem lateral: relato de caso / Surgical resolution of feline middle ear inflammatory polyp by lateral approach traction and avulsion technique: case report

O objetivo desse trabalho foi descrever um caso de pólipo inflamatório em ouvido médio de um felino e sua resolução cirúrgica através da avulsão e tração da massa após abordagem lateral. Um felino, fêmea, de 2 anos de idade, foi atendido no Hospital Veterinário Professor Sylvio Barbosa Cardoso, apresentando prurido intenso, dor e secreção fétida em região auricular. Pelo exame físico foi possível observar um nódulo em região de ouvido médio esquerdo. Associado a isso, o animal apresentava "headtilt" (inclinação da cabeça para o lado afetado). Foram solicitados exames hematológicos, radiografia de crânio e citologia da massa. O animal foi encaminhado para cirurgia de extirpação da massa. Foi feita uma incisão na pele sob o canal auditivo vertical palpável. A cartilagem foi liberada até o nível da junção entre as cartilagens auricular e anular. Com o auxílio de um fórceps, o pólipo foi agarrado e delicadamente girado até ser completamente extirpado de sua origem. A cartilagem e o subcutâneo foram fechados com material de sutura monofilamentar 4-0 e a pele foi fechada em um padrão de sutura subdérmica usando o mesmo material. A peça foi encaminhada para exame histopatológico, pelo qual confirmou-se a suspeita de pólipo inflamatório, através da observação de epitélio colunar ciliado. Utilizando a técnica cirúrgica TALA (avulsão e tração após abordagem lateral) foi possível obter melhora do quadro clínico do animal referido, rápida recuperação pós-cirúrgica e sem nenhuma complicação decorrente da técnica. Essa técnica, portanto, se mostrou satisfatória, melhorando significativamente a qualidade de vida do animal.

The aim of this study was to describe a case of inflammatory polyp in the middle ear of a cat and its surgical resolution through avulsion and mass traction after lateral approach. A female feline, two year old, was admitted at the Hospital Veterinário Professor Sylvio Barbosa Cardoso, presenting intense itching, pain and fetid discharge in the ear region. Physical examination revealed a nodule in the left middle ear region. Associated with this, the animal presented head tilt (inclination of the head to the affected side). Hematological examinations, skull radiography and mass cytology were requested. The animal was referred for polyp removal surgery. A skin incision was made under the palpable vertical ear canal. The cartilage was released to the level of the junction between the auricular and annular cartilages. With the help of a forceps, the polyp was grasped and gently rotated until completely removed from its origin. The cartilage and subcutaneous tissue were closed with 4-0 monofilament suture material and the skin was closed in a subdermal suture pattern using the same material. The piece was referred for histopathological examination, which confirmed the suspicion of inflammatory polyp by observing ciliated columnar epithelium. Using the TALA surgical technique (avulsion and traction after lateral approach) it was possible to obtain improvement of the clinical 3 picture of the referred animal, rapid postoperative recovery and without any complications resulting from the technique. This technique therefore proves satisfying, significantly improving the quality of life of the animal.

Aural foreign bodies in children in a pediatric Senegalese hospital

Introduction: aural foreign bodies (FB) are frequent in pediatric otorhinolaryngology and in pediatric emergencies. The objective of this study was to describe the socio-demographic, clinical and therapeutic aspects of aural FB in children in a pediatric hospital in Senegal. Methods: this was a four-year hospital-based descriptive study performed in the Otorhinolaryngology department of the Children's Hospital of Diamniadio, from 1st January 2013 to 31 December 2016 including all children under 15 years of age received for aural FB. The variables studied were age, gender, provenance, presenting symptom, time to consultation, the type of FB and morbidity. Results: sixty three FB were extracted. Mean age was 6 years 4 months. 52.4% of patients were under 5 years old. There was a slight female predominance (32/63). Location was in the right ear canal in 55.6%. Seventy three percent of patients presented in our office were asymptomatic. The median time to consultation was 4 days. Within the first 24 hours after insertion, 22.2% of children presented to our office. Beads were the first FB (29.68%), followed by seeds and cotton (12.5% respectively). Foreign bodies' extraction were performed in consultation for 79.4% of patients. The morbidity was 20.6%. It was primarily otitis externa (8%). Myringoplasty was performed in one patient who had sequelae of tympanic membrane perforation. Conclusion: aural FB is a common accident in under-5 year-olds. In our context there is a delayed consultation. Morbidity is similar to that of the literature

Contralateral Occlusion Test (COT): the effect of external ear canal occlusion with aging / Teste de Oclusão Contralateral (TOC): o efeito da oclusão do canal auditivo externo com a idade

ABSTRACT Purpose This study aimed to evaluate the effects of complete external ear canal occlusion on hearing thresholds with aging. The goal was to decide which tuning fork is more appropriate to use for the contralateral occlusion test (COT), in individuals of different ages. Methods Forty-two normal hearing subjects between 21 and 67 years were divided into three age groups (20-30 years, 40-50 years, and 60-70 years). Participants underwent sound field audiometry tests with warble tones, with and without ear canal occlusion. Each ear was tested with the standard frequencies (250, 500, 1000, and 2000 Hz). The contralateral ear was suppressed by masking. Results Hearing thresholds showed an increase as the frequency increased from 20.85 dB (250 Hz, 20-30 years group) to 48 dB (2000 Hz, 60-70 years group). The threshold differences between occlusion and no occlusion conditions were statistically significant and increased ranging from 11.1 dB (250 Hz, 20-30 years group) to 32 dB (2000 Hz, 20-30 years group). We found statistically significant differences for the three age groups and for all evaluations except to 500 Hz difference and average difference. The mean hearing loss produced by occlusion at 500 Hz was approximately 19 dB. We found no statistically significant differences between right and left ears and gender for all measurements. Conclusion We conclude that the use of the 512 Hz tuning fork is the most suitable for COT, and its use may allow clinicians to distinguish mild from moderate unilateral conductive hearing loss.

RESUMO Objetivo O objetivo deste estudo foi avaliar o efeito da oclusão completa do canal auditivo externo nos limiares auditivos, em indivíduos de idades distintas, para apurar qual o diapasão mais adequado na realização do teste de oclusão contralateral (TOC). Método 42 indivíduos normo-ouvintes (21-67 anos) foram divididos em três grupos etários (20-30, 40-50 e 60-70 anos). Os participantes foram avaliados com testes de audiometria tonal liminar em campo livre, com e sem oclusão completa do canal auditivo externo. Cada ouvido foi testado para as frequências 250, 500, 1000 e 2000 Hz. No ouvido contralateral, foi realizado mascaramento, para evitar a ocorrência de audição contralateral. Resultados Verificou-se aumento dos limiares auditivos, diretamente proporcional ao aumento da frequência (desde 20.85 até 48 dB). A diferença nos limiares auditivos entre a condição de oclusão e de não oclusão foi estatisticamente significativa em todas as frequências e aumentou de forma diretamente proporcional com a frequência (desde 11.1 até 32 dB). Foram também encontradas diferenças estatisticamente significativas para os três grupos etários, em todos os parâmetros, exceto na diferença a 500 Hz e na diferença total média. A perda auditiva média resultante da oclusão aos 500 Hz foi de 19 dB. Não se encontraram diferenças estatisticamente significativas entre o ouvido direito e o esquerdo, e entre o gênero. Conclusão A utilização do diapasão de 512 Hz é a mais adequada para o TOC. A sua utilização pode permitir aos clínicos, em ambiente de consulta e de forma rápida, a distinção entre perda condutiva de grau leve a moderada.

Prevalência de apêndices préauriculares isolados em recémnascidos e resultados na triagem auditiva neonatal / Prevalence of isolated pre-auricular appendages in newborns and results in neonatal hearing screening

Introdução: os apêndices pré-auriculares, em conjunto com outras malformações craniofaciais e do osso temporal, estão associados à deficiência auditiva. Dentre as malformações do pavilhão auricular, encontram-se os apêndices pré-auriculares, formados por pele e cartilagem, e que podem estar presentes em qualquer ponto entre o trágus da orelha e o ângulo da boca, uni ou bilaterais. Objetivo: avaliar a resposta auditiva em 906 recém-nascidos sem indicadores de risco para deficiência auditiva e com apêndices pré-auriculares isolados (uni ou bilaterais) quanto a: prevalência de recém-nascidos com apêndices pré-auriculares; respostas de reflexo cócleo-palpebral; características das emissões otoacústicas; características do potencial evocado auditivo de tronco encefálico; e a incidência dessa causuística que apresente perda auditiva. Método: a identificação de indicadores de risco para deficiência auditiva foi realizada a partir da carteira do recém-nascido, do prontuário médico e de uma entrevista com os pais. Foram avaliados o meato acústico externo e a membrana timpânica através de otoscopia e espéculos auriculares. O reflexo cócleo-palpebral foi testado percutindo-se um agogô próximo ao recém-nascido. Pesquisa das emissões otoacústicas foi realizada com o aparelho ero scan etymotic research. Avaliou-se o potencial evocado auditivo do tronco encefálico. Resultado e discusssão: a prevalência de apêndices pré-auriculares foi de 1,1%. Todos apresentaram reflexo cócleo palpebral presente, passaram pelas EOA e o potencial evocado auditivo de tronco encefálico apresentou resposta eletrofisiológica dentro dos padrões de normalidade em todos os pacientes estudados. Conclusão: não houve correlação entre a perda auditiva e a presença de apêndices pré-auriculares

Introduction: pre-auricular appendages, together with other craniofacial malformations and temporal bone, are associated with hearing loss. Among the malformations of the auricle are the preauricular appendages, formed by skin and cartilage, and that can be present at any point between the tragus of the ear and the angle of the mouth, uni or bilateral. Objective: to evaluate the auditory response in 906 newborns without risk indicators for hearing loss and with isolated pre-auricular appendages (uni- or bilateral) for: prevalence of newborns with pre-auricular appendages; responses of cochlear-eyelid reflex; characteristics of otoacoustic emissions; characteristics of auditory brainstem evoked potential; and the incidence of this cause that presents hearing loss. Method: identification of risk indicators for hearing loss was carried out from the newborn's wallet, the medical record and the interview with the parents. The external acoustic meatus and the tympanic membrane were evaluated through otoscopy and atrial speculum. The cochlear-eyelid reflex was tested by percututing an agogot close to the newborn. Research on otoacoustic emissions was performed using the ero scan etymotic research apparatus. The auditory evoked potential of the brainstem was evaluated. Results and discussion: the prevalence of pre-auricular appendages was 1.1%. All of them presented a palpebral cochlear reflex present, passed through the OAE, and the auditory evoked potential of the brainstem presented an electrophysiological response within normality patterns in all patients studied. Conclusion: there was no correlation between hearing loss and the presence of pre-auricular appendages alone.

Audiología y Mareo de Origen Cervical / Audiology and dizziness of cervical origin

En la presente revisión sistemática se discute la relación entre la etiología del mareo de origen cervical, el uso de pruebas vestibulares y el rol del especialista en audiología en el abordaje de esta patología. La búsqueda de artículos se realizó a través de bases de datos electrónicas. Se usaron términos libres como mareo de origen cervical, vértigo cervicogénico, cervicogenic dizziness, dolor cervical, latigazo cervical y espondilosis cervical. La valoración de la calidad de los estudios incluidos se realizó con la guía de análisis crítico de calidad metodológica propuesta por (Carvajal C, 2004). Los resultados de la revisión muestran las evidencias etiológicas del mareo de origen cervical reportadas en la literatura y si el especialista en audiología, por su formación, puede abordar esta condición de acuerdo con los procedimientos hallados para su manejo actualmente. Las evidencias sugieren que la afectación de las estructuras musculo esqueléticas del cuello puede derivar en sensaciones de mareo. Adicionalmente, a partir de la revisión se concluye que, aunque la literatura no reporte el rol específico del especialista en audiología en el abordaje del mareo de origen cervical, es pertinente que este lo aborde desde su fase diagnóstica y de inter vención

This systematic review discusses the relationship between the etiology of cervical dizziness, the use of ear canal testing, and the role of the audiology specialist in approaching this pathology. An electronic database was used in researching articles that utilized open terminologies such as cervical dizziness, cervicogenic vertigo, cervicogenic dizziness, sharp cervical pain, and cervical spondylosis. The studies included were evaluated for quality by using the critical analysis guide of methodological quality. The results of the review show reported etiological evidence of cervicogenic dizziness in literature and whether an audiology specialist, through their training, is able to address and handle this condition in accordance with the most up-to-date procedures. The evidence suggests that the affectation of the musculoskeletal framework in the neck can be derived from dizziness symptoms. Additionally, it could be concluded from the review that although the literature does not report the specific role of the audiology specialist in approaching cervical dizziness, it is pertinent to address this role as early as the diagnostic and intervention phases

Absence de méat acoustique externe et fixation antérieure du malleus : à propos d'un cas

L'absence de méat acoustique externe constitue 5.7% de l'ensemble des malformations de l'oreille. Il peut être isolé ou associé à d'autres malformations de l'oreille dont la fixation du malléus à la paroi latérale de la caisse du tympan. Nous rapportons un cas d'absence de méat acoustique externe gauche associée à une fixation pariétale antérieure bilatérale du malléus à la caisse tympanique