Colesteatoma del conducto auditivo externo: Experiencia de 5 años Hospital del Salvador / External ear canal cholesteatoma: 5-year experience Hospital del Salvador

Introducción: El colesteatoma del conducto auditivo externo (CCAE) es una estructura quística revestida por epitelio escamoso estratificado queratinizado que tiene la capacidad de invadir y erosionar localmente al hueso temporal. Su incidencia es de 0,19 a 0,3/100.000 habitantes siendo 60 veces menos frecuente que el de oído medio. Objetivo: Describir las características epidemiológicas, clínicas, imagenológicas y tratamiento de los pacientes diagnosticados con CCAE en el Servicio de Otorrinolaringología Hospital del Salvador. Material y Método: Se presenta una serie de ocho casos clínicos recopilados durante el período 2017 y 2021. Se realizó revisión de fichas clínicas, biopsias y tomografías computadas de oídos (TC oídos). Se describen los hallazgos y tratamiento efectuado. Resultados: El promedio de edad fue de 65,6 años, correspondiente a 5 mujeres y 3 hombres con presencia de tabaquismo y diabetes en la mitad de los casos. Los síntomas y signos más frecuentes fueron otalgia e hipoacusia seguido de otorrea. 7 pacientes se presentaron con tímpano íntegro y el compromiso de la pared inferior del conducto se evidenció en 6 de 8 pacientes. La TC oídos mostró erosión ósea del conducto, con o sin compromiso de estructuras adyacentes, en todos los casos y el diagnóstico histológico fue efectuado en el 100% de los pacientes. Se privilegió el tratamiento conservador mediante curaciones óticas periódicas asociado a ácido salicílico al 3% y/o antibióticos tópicos en 6/8 pacientes. Conclusiones: El CCAE es una entidad poco frecuente sin signos ni síntomas patognomónicos por lo que el diagnóstico histológico junto con el estudio imagenológico es perentorio. El tratamiento conservador es una alternativa terapéutica válida que ofrece buenos resultados en pacientes con adecuada adherencia al tratamiento y posibilidad de seguimiento estricto.

Introduction: External ear canal cholesteatoma (EECC) is a cystic structure lined by keratinized stratified squamous epithelium that has the ability to locally invade and erode the temporal bone. Its incidence is 0.19 to 0.3 / 100,000 habitants, being 60 times less frequent than that of the middle ear. Aim: To describe the epidemiological, clinical, imaging and treatment characteristics of patients diagnosed with EECC in the Hospital del Salvador ENT department. Material and Methods: A series of eight clinical cases collected during the period 2017 and 2021 is presented. A review of clinical records, biopsies and computed tomography of the ear (ear CT) was carried out. The findings and treatment carried out are described. Results: The average age was 65.6 years corresponding to 5 women and 3 men with the presence of smoking and diabetes in half of the cases. The most frequent symptoms and signs were earache and hearing loss followed by otorrhea. 7 patients presented with an intact eardrum and compromise of the inferior wall of the canal was evidenced in 6 of 8 patients. Ears CT showed bone erosion of the canal with or without compromise of adjacent structures in all cases and the histological diagnosis was made in 100% of the patients. Conservative treatment with periodic ear dressings associated with 3% salicylic acid and / or topical antibiotics was favored in 6/8 patients. Conclusion: EECC is a rare entity without pathognomonic signs or symptoms, therefore the histological diagnosis together with the imaging study is peremptory. Conservative treatment is a valid therapeutic alternative that offers good results in patients with adequate adherence to treatment and the possibility of strict follow-up.

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.

Potencial cortical P3: nível de dificuldade para diferentes estímulos / P3 cortical potential: difficulty level for different stimulus

Objetivo Avaliar o nível de dificuldade de identificação dos estímulos verbais e não verbais, segundo classificação dos próprios participantes, e comparar com a latência do potencial cortical P3. Métodos Foram avaliados 30 sujeitos, com média de idade de 23 anos, normo-ouvintes. O potencial P3 foi pesquisado com estímulos não verbais (tone burst)e verbais (/ba/ x /di/, /ba/ x /ga/, /ba/ x /da/). Cada sujeito classificou os estímulos em "mais fácil" e "mais difícil".Resultados : A maioria dos indivíduos classificou o contraste /ba/ x /di/ como sendo o mais fácil de identificar e o contraste /ba/ x /ga/, como o mais difícil. Os sujeitos referiram que os estímulos de fala foram mais fáceis de identificar quando comparados com tone burst. O nível de dificuldade descrito pelos indivíduos influenciou nas latências dos estímulos /Di/ e /Da/, classificados como mais fáceis, e evidenciados na menor latência do P3.Conclusão O contraste /Ba/ x /Di/ foi considerado o de maior facilidade de percepção, sendo evidenciado pela menor latência do P3. Os contrastes de fala foram classificados mais fáceis quando comparados com os estímulos tonais. Essas comparações auxiliam o clínico na escolha do estímulo utilizado e no correto diagnóstico audiológico.

Purpose Evaluating the level of difficulty of identifying verbal and non-verbal stimuli, according to the classification of the participants, as well as comparing the latency of the P3 cortical potential.Methods Thirty subjects, with a mean age of 23 years and normal hearing, were evaluated. The P3 potential was performed with non-verbal stimuli (tone burst) and verbal (/ba/ x /di/, /ba/ x /ga/, /ba/ x /da/). Each subject had to classify stimulus in "the easiest" and "the most difficult".Results Most subjects rated the /ba/ x /di/ contrast as the easiest to identify and the contrast /ba/ x /ga/ the most difficult. The subjects reported that the speech stimulus were easier to identify when compared to tone burst. The difficulty level described by the subjects influenced the latencies of stimuli /Di/ and /Da/, ranked as the easiest and they were evidenced in the lowest latency of P3.Conclusion The /Ba/ x /Di/ contrast was considered the easiest for perception, being evidenced by the lowest latency of P3. The speech contrasts were classified as the easiest when compared with the tonal stimuli. These comparisons help the clinician in selecting the stimuli and in the correct audiological diagnosis.

Variabilidade teste-reteste na audiometria tonal: comparação entre dois transdutores / Test-retest variability in the pure tone audiometry: comparison between two transducers

Objetivo Caracterizar a variabilidade teste-reteste com fones supra-aurais e fones de inserção e comparar os limiares auditivos tonais entre os transdutores.Métodos Foram selecionados 74 indivíduos de ambos os gêneros, com limiares auditivos normais e curvas timpanométricas do tipo A. Todos os indivíduos foram submetidos à anamnese, meatoscopia, audiometria tonal por via aérea, ora com o fone supra-aural, ora com o fone de inserção, e logoaudiometria. Após esta primeira avaliação, foi realizada a medida de imitância acústica. Por fim, os procedimentos de audiometria tonal foram repetidos.Resultados O fone supra-aural produziu maior variabilidade teste-reteste, quando comparado com o fone de inserção. Já na comparação dos transdutores, verificou-se, tanto na primeira, quanto na segunda testagem, que as respostas mostraram-se ora semelhantes, ora favorecendo um ou outro transdutor.Conclusão Há maior variabilidade teste-reteste com o fone supra-aural do que com o fone de inserção. No entanto, foram verificados melhores limiares na condição reteste, para ambos os transdutores.

Purpose To characterize the test-retest variability with supra-aural and insert earphones and compare the pure tone thresholds between the transducers.Methods Seventy-four individuals of both genders with normal hearing and tympanometric curve of type A were selected. All subjects underwent anamnesis, meatoscopy, air conduction pure tone audiometry, either with the supra-aural earphone, or with insert earphone and speech audiometry. After this initial evaluation Acoustic Impedance Testswere performed. Finally, pure tone audiometry procedures were repeated with both transducers.Results Supra-aural earphone produced higher test-retest variability when compared to the insert earphones. Comparing a transducer with each other, the responses were sometimes similar and sometimes favoring one or the other transducer considering the first and second evaluations.Conclusion There is a greater test-retest variability with supra-aural earphones comparing with insert earphones. However, better thresholds were obtained in the retest condition for both transducers.

Primary Pleomorphic Adenoma of External Auditory Canal.

Primary pleomorhic adenoma (Chondroid syringoma) arising from the external auditory canal is very rare and because of the unremarkable clinical presentation, the diagnosis is often made after microscopic examination. We reviewed the worldwide literature and found that only forty one cases have been previously reported. In this report, we describe one such unusual case. The treatment of choice is wide local excision without esthetic or functional disruption of surrounding structures, followed by careful long-term post-operative observation of the clinical course.

[ correlation between lateral sinus position with severity of various types of chronic otitis media]

Reduced mastoid pneumatization has been seen in most patient with chronic otitis media [COM] disease. In this study we decided to measure the distance between sigmoid sinus [SS] and posterior wall of external auditory canal[EAC]as an index of mastoid pneumatization before disease and explore the correlation between this distance and different type of COM disease. This cross-sectional study was carried out between 1381-1382 years at Shafa hospital in Kerman. The distance between SS and post wall of EAC which extracted from Schuller graphy was compared with that was measured in surgery. 51 patients with COM disease were subjected to mastoidectomy included in this study. The mean distance between SS and posterior wall of EAC in patients with type III disease [10.14 +/- 5.06 mm] was remarkably smaller than patients with type I and II of disease [15.03 +/- 6.03]. This study revealed that patients with smaller mastoid air tank are susceptible to more severe form of COM diseases

Conventional plain and positive contrast radiographic imaging of the skull in dogs and cats

This study was carried out on 50 apparently healthy animals [30 dogs and 20 cats] and 15 dogs suffered from skull affections. Animals were subjected to Conventional plain radiographic imaging [lateral, dorso ventral, rostrocaudal, lateral oblique, open-mouth rostrocaudal, open-mouth lateral, open-mouth ventrodorsal and intra-oral positionings]. Also, positive contrast canalography and rhinography were done to visualize, in details, the acoustic canal and nasal structures respectively. The results revealed that the evaluated Conventional plain radiographic positionings were efficient for imaging the skull anatomy and its affections. Canalography can be regarded as an accurate technique to measure the diameter of the horizontal .ear canal and the tympanic membrane which are predictors of ear diseases. Rhinography was found to be valuable in imaging of nasal sinuses and conchae