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Abstract Introduction Neuroendocrine adenomas of the middle ear (NAME) are uncommon causes of middle ear masses. Mostly limited to case reports and small series, the literature is poor in providing an overall assessment of these tumors. Objective To review the current literature about all aspects of the disease, including its etiology, clinical manifestations, diagnosis, and treatment. Data Synthesis The pathogenesis of adenomatous tumors of the middle ear is not clear yet. One potential explanation is that an undifferentiated pluripotent endodermal stem cell may still be present in the middle ear mucosal surface, and may be the origin of the tumors. It typically appears as a nonspecific retrotympanic mass. The average age of onset for the disease is the fifth decade, and the most common clinical symptom is conductive hearing loss. Malign behavior is rare. There are numerous differential diagnoses of NAME. The final diagnosis depends on microscopic findings. The preoperative evaluation should include the use of computed tomography and magnetic resonance imaging. The adjunctive therapy of middle ear adenomatous tumors with radiotherapy, chemotherapy or somatostatin analogs is generally not recommended. Conclusion There is still much debate on pathogenesis and classification of NAME. Saliba's classification is currently the most complete and preferable one. Aggressive surgical procedure with ossicular chain excision is the gold standard treatment. Followup with physical and radiological exams is mandatory, particularly if the first procedure was conservative, without the removal of the encased ossicles.
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Síndrome da dor vesical é a nomenclatura proposta para substituir o termo antigamente conhecido como cistite intersticial. Deve ser diagnosticada com base nas queixas de dor, pressão ou desconforto pélvico crônico, relacionados à bexiga acompanhados por pelo menos outro sintoma urinário como urgência ou aumento de frequência. A prevalência estimada é de 300 por 100.000 mulheres. A etiologia e a fisiopatologia ainda não foram elucidadas, mas mecanismos neurológicos centrais, fatores genéticos, imunológicos e infecciosos parecem estar envolvidos. O diagnóstico é de exclusão e deve ser baseado nos sintomas. O teste com cloridrato de potássio intravesical não deve ser usado como ferramenta diagnóstica. A cistoscopia com hidrodistensão e biópsia auxilia na documentação e classificação da doença. O tratamento deverá ser multidisciplinar e multimodal, associando-se medicações orais com intravesicais, modificações na dieta e no estilo de vida e medidas não farmacológicas
Bladder pain syndrome is the nomenclature proposed to replace the term formerly known as interstitial cystitis. It should be diagnosed based on complaints of pain, chronic pelvic pressure or discomfort related to bladder accompanied by at least one other urinary symptom, such as urgency or increased frequency. The estimated prevalence is 300 per 100,000 women. The etiology and pathophysiology have not been elucidated, but central neurologic mechanisms, genetic, immunological and infectious factors seem to be involved. The diagnosis is by exclusion and should be based on symptoms. The test with intravesical potassium chloride should not be used as a diagnostic tool. Cystoscopy with hydrodistenstion and biopsy assist in the documentation and classification of the disease. Treatment should be multidisciplinary and multimodal, associating intravesical and oral medications, changes in diet and in lifestyle and nonpharmacological measures