Diagnóstico de otitis media con efusión en adultos / Diagnosis of otitis media with effusion in adults

La otitis media con efusión (OME) se define como la presencia de líquido en la cavidad del oído medio, sin signos ni síntomas de infección. Es una patología frecuente en niños, alcanzando una prevalencia del 14,8% en población de 4 a 16 años y su patogenia en este grupo se encuentra ampliamente estudiada. Sin embargo, en adultos su prevalencia es baja y, consecuentemente, su patogenia y mecanismos están menos dilucidados. El objetivo de esta revisión es describir la fisiopatología de la OME en adultos, describir sus etiologías y proponer un algoritmo de estudio diagnóstico adecuado.

Otitis media with effusion (OME), is defined as the presence of fluid in the middle ear, with no signs of acute infection. It is a frequent pathology in children, with a prevalence of 14.8% in the population between 4-16 years old, and its pathology has been widely studied in this group. However, its prevalence in adults is low; therefore, the pathology and mechanisms are less elucidated. The aim of this review is to describe the physio-pathology of the OME in adults, its etiology, and propose an algorithm for the proper diagnosis of this disease.

La otitis media con efusión como un proceso infeccioso relacionado a la microbiota de la amígdala faríngea / Otitis media with effusion as an infectious process related to the pharyngeal amygdala microbiote / Otitis media com efusão como um processo infeccião relacionadocom o microbiota do faríngea amígdala

Introducción: la otitis media con efusión es una patología muy prevalente en la infancia, frente a la cual se suele indicar tratamiento médico no antibiótico por 90 días. En caso de no revertir, se indica colocación de tubos transtimpánicos, que puede acompañarse de adenoidectomía. La terapéutica suele mejorar la evolución pero la refractariedad de esta patología hace pensar que no es un proceso estéril. Existen estudios que demuestran la presencia de ADN bacteriano en la efusión. El mismo se encontraría junto con la presencia de ARN y proteínas, los cuales son indicadores de metabolismo y actividad bacteriana. Los agentes patógenos más frecuentes, productores de infección de oído medio, incluyen a Streptococcus pneumoniae, Haemophilus influenzae y Moraxella catarrhalis, entre otros, los cuales podrían ser los responsables de la refractariedad de esta patología frente al tratamiento no antibiótico...

Introduction: otitis media with effusion is a very prevalent childhood pathology, usually nonantibiotic medical treatment is indicated for 90 days as its treatment. If there is no improvement, transthympanic tubes are indicated, which may be accompanied by adenoidectomy. These treatments most of the times improve the evolution, nevertheless the refractoriness of this pathology, suggests that it is not a sterile process. There are studies that demonstrate the presence of bacterial DNA in the effusion. Also RNA and proteins were found in it, which indicates metabolism and bacterial activity. The most common pathogens involved in middle ear infections include Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, among others, which could be responsible for the refractoriness of this pathology to non-antibiotic treatment...

Introdução: a otite média com efusão é uma patologia muito prevalente na infância, contra a qual geralmente o tratamento médico não antibiótico é indicado por 90 dias. Se não for revertido, é indicada a colocação de tubos transtimpânicos, que pode ser acompanhada de adenoidectomia. A terapêutica geralmente melhora a evolução, mas a refração desta patologia, sugere que não é um processo esté- ril. Existem estudos que demonstram a presença de DNA bacteriano no derrame. O mesmo seria encontrado junto com a presença de RNA e proteínas, que são indicadores de metabolismo e atividade bacteriana. Os agentes patogénicos mais comuns que causam a infecção da orelha média incluem Streptococcus pneumoniae, Haemophilus influenzae e Moraxella catarrhalis, entre outros, que podem ser responsáveis pela refractariedade desta patologia quando o tratamento não antibiótico é indicado...

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.

The historic data series on AIDS in the state of Ceará, Brazil / Série histórica da AIDS no Estado do Ceará, Brasil

This study describes the historic records on AIDS in the Brazilian state of Ceará, with analysis by gender, age group and race. It is a descriptive, retrospective, ecological study, analyzing 7,896 notifications of cases of AIDS, of people aged 13 and above, resident in the Ceará, over the period 2001 through 2011. Percentage occurrences and other data were calculated based on the variables gender, age group and race. Average and comparison tests were made, considering p < 0.05 and the trend line. There is a progressive increase in the number of cases. The majority of cases are in men. The ratio between the sexes falls from 2003 through 2007, but the number of women is still lower overall in the period. Higher rates of occurrence were found between the ages of 30 and 39, and of those with black-white mixed-race skin color (80%). Based on the variables studied in the series that was analyzed, the results indicate a need for differentiated strategies in prevention and control of the disease in the state.

Objetivou-se descrever a série histórica da AIDS, no Ceará, relacionada a sexo, faixa etária e raça. Estudo ecológico, descritivo e retrospectivo, analisou 7.896 notificações de casos de AIDS, de pessoas ≥ 13 anos, residentes no Ceará, entre 2001 e 2011. Calculou-se a incidência dos casos, das variáveis sexo, faixa etária e raça. Realizaram-se testes de médias e comparações, considerando p < 0,05 e a linha de tendência. A taxa de AIDS revela o aumento progressivo do número de casos. Os homens detêm a maioria dos casos. De 2003 a 2007, verificou-se queda na razão entre os sexos, porém o número de mulheres mantém-se inferior no período. Maiores incidências foram verificadas nas idades entre 30 e 39 anos, e entre os de cor parda (80%). Mediante as variáveis estudadas na série analisada, aponta-se a necessidade de estratégias diferenciadas em prevenção e controle da doença no Estado.

L'otite sereuse chez l'adulte : demarche diagnostique et therapeutique

L'otite seromuqueuse (OSM) de l'adulte est une situation regulierement rencontree en consultation ORL. Le but de notre travail est de dicter a travers notre serie et une revue de la litterature une demarche diagnostique et therapeutique en presence d'une otite seromuqueuse de l'adulte. Patients et Methodes : Nous avons mene une etude retrospective sur une periode de 10 ans allant de 2002 a 2011. Ont ete inclus les patients de plus de 18 ans chez qui a ete porte le diagnostic d'otite seromuqueuse avec un suivi minimum de un an. Resultats : Notre population etait constituee de 53 patients. 60 des patients avaient des antecedents de traitement par radiotherapie du massif facial. Vingt patients etaient suivis pour rhinite chronique. Tous les patients ont eu un examen ORL complet et un scanner des rocher dans tous les cas. 62 des patients ont eu un traitement medical. 92 de nos patients ont ete operes; 17 patients ont eu une regression complete et persistante dans le temps. Discussion : le diagnostique etiologique d'une otite seromuqueuse chronique de l'adulte passe par un examen ORL complet; suivi d'un scanner injecte des rocher. Le traitement n'est pas clairement codifie

Mastoidite e paralisia facial como manifestações iniciais de Granulomatose de Wegener / Mastoiditis and facial paralysis as initial manifestations of Wegener's Granulomatosis

A Granulomatose de Wegener (GW) é caracterizada por granulomas necrotizantes e vasculite. Sem tratamento a doença tem prognóstico pobre com índice de mortalidade de 90% em 2 anos. Diversos autores citam as manifestações otológicas no curso da GW, entretanto não é especificado em que momento da doença elas apareceram, isto é, se como manifestação inicial ou subsequente a outros achados. Objetivo: Descrever três casos confirmados de GW que apresentaram inicialmente mastoidite e evoluíram com paralisia facial periférica (PFP). Material e Método: Estudo de série de casos. Pacientes diagnosticados com GW que apresentaram inicialmente manifestações otológicas são descritos. Resultados: Os três casos descritos abriram o quadro com otalgia, otorreia e hipoacusia unilateral, associada a paralisia facial periférica ipsilateral. Tiveram resposta inadequada aos tratamentos instituídos o que motivou uma investigação de outras doenças associadas. Nessas circunstâncias, detectaram-se títulos positivos de ANCA-C em todos pacientes, confirmando-se o diagnóstico de GW, após período variável de investigação. Institui-se o tratamento para GW observando-se melhora do quadro clínico, regressão da PFP e melhora parcial dos limiares auditivos. Conclusão: Complicações de otites médias agudas (mastoidite e PFP) refratárias as terapêuticas habituais impõem a investigação de doenças associadas e a GW deverá ser pesquisada para que se possa fazer o diagnóstico o mais precocemente possível, alterando desta forma o prognóstico destes pacientes.

Wegener's Granulomatosis (WG) is characterized by necrotizing granulomas and vasculitis. If left untreated, the prognosis is poor - a 90% mortality rate within 2 years. Several authors have described the otologic manifestations of WG; these authors, however, have not mentioned the stage of the disease in which these findings present - whether as initial manifestations or subsequent to other findings. Aim: To describe three confirmed cases of WG with mastoiditis as the first manifestation, progressing to peripheral facial paralysis (PFP). Material and Method: A clinical series study. Patients diagnosed with WG that initially presented with otologic findings are described. Results: The three cases presented with unilateral otalgia, otorrhea, and hearing loss associated with ipsilateral PFP. None recovered in spite of the treatment; an investigation of associated diseases was therefore undertaken. Positive ANCA-C titers where detected in all patients, confirming the diagnosis of WG. Clinical improvement was seen after treatment of WG; the PFP regressed and hearing thresholds improved partially. Conclusion: Complications of otitis media (mastoiditis and PFP) that do not respond to the usual treatment require an investigation of associated diseases; WG should be included for an early diagnosis to change the prognosis in these patients.

O padrão facial é fator predisponente para otite média com efusão em crianças? / Is facial pattern a predisposing factor for otitis media with effusion in children?

Anormalidades na morfologia craniofacial são associadas à disfunção da tuba auditiva e a otite média com efusão (OME). OBJETIVO: Avaliar a relação entre o padrão facial, direção do crescimento craniofacial e OME em crianças com tonsilas faríngea e palatinas aumentadas (TFPA). CASUÍSTICA E MÉTODOS: Estudo clínico prospectivo em 79 crianças (41 meninos e 38 meninas), com idades de 4 a 10 anos, com TFPA (níveis III e IV de Brodsky). O grupo de estudo foi composto por 40 crianças com OME, enquanto que o grupo controle foi composto por 39 crianças sem OME. Foi realizada análise cefalométrica. RESULTADOS: Não houve correlação entre o padrão facial e a OMS (c 2 = 0,25 p = 0,88). O grupo com OME apresentou Eixo Facial maior (F(1,75) = 3,68 p = 0,05), e uma Altura Facial Inferior menor (F(1, 75) = 3,99 p = 0,05) quando comparados ao grupo controle. CONCLUSÕES: Não houve correlação entre o padrão facial e a OME em crianças com TFPA, ainda que um padrão facial mais horizontal associado à altura facial inferior diminuída foi consistentemente observada. Isto sugere que um posicionamento anormal do tuba auditiva influencia o desenvolvimento da OME em crianças com TFPA.

Abnormalities in craniofacial morphology are associated with Eustachian tube dysfunction and otitis media with effusion (OME). AIM: to evaluate the relationship between facial pattern and craniofacial growth direction, and OME in children with enlarged tonsils and adenoids (ETA). METHODS: Clinical prospective survey in 79 children (41 male and 38 female), ranging from 4 to 10 years of age, with tonsil and adenoid enlargement (Brodsky's grades III and IV). Forty children presented with OME (study group) and 39 did not (control group). Cephalometric analysis was used to determine the facial pattern. RESULTS: There was no correlation observed between facial pattern and OME (c 2 = 0.25 p = 0.88). Facial Axis was larger in the OME group (F(1.75) = 3.68 p = 0.05) and the Lower Anterior Facial height was smaller (F(1. 75) = 3.99 p = 0.05) in children with otitis media with effusion. CONCLUSIONS: There was no correlation between OME and facial pattern in children with ETA although a more horizontal facial growth direction, and a smaller lower anterior facial height was observed consistently among subjects in this group. This suggests that abnormal positioning of the eustachian tube influences the development of OME in children with ETA.

Incidence of otitis media with effusion in children with adenoid hypertrophy

Otitis media with effusion is collection of fluid behind intact tympanic membrane. Otitis media with effusion usually coexists with the adenoid hypertrophy. The adenoid is a part of Waldeyer's ring; its basic function is thought to be antibody production. The aim is to identify the incidence of otitis media with effusion in children with adenoid hypertrophy, A prospective descriptive cohort study had been employed at Rizgari Teaching Hospital/ Erbil from January 2008 to July 2008. Summation of total 120 Child aged 3-12 years old were being conducted in the survey. All patients subjected for history, local physical examination, Information's recorded on a specially designed Questionnaire and proper investigations were done including lateral X ray of post nasal space, and audiological examination. Among 120 patients age [3-12] years old with adenoid hypertrophy, 44 patients [36.7%] had OME, mean age was 6.5 years. Most common age group was [5-6] years [21] [47%]. Adenoid Hypertrophy [AH] can be relevant in the pathogenesis of otitis media with effusion [OME] due to its anatomic position

Otitis media con efusión en pacientes con fisura palatina: comparación de estrategias terapéuticas / Otitis media with effusion in patients with cleft palate: comparison of treatment strategies

Introducción: La otitis media con efusión presenta una alta prevalencia en pacientes con fisura palatina, debido a una obstrucción funcional de la tuba auditiva. Dada su asociación con hipoacusia y una baja tendencia de resolución espontánea, existe controversia sobre la necesidad de instalar tubos de ventilación en estos pacientes. Objetivo: Comparar resultados anatómicos y audiológicos de dos estrategias de tratamiento. Material y método: Estudio de cohorte histórica en niños de 8 a 11 años con fisura velopalatina operada. La otitis con efusión de un grupo se trató con tubos de ventilación, mientras otro grupo tuvo un manejo conservador. La presencia de alteraciones timpánicas e hipoacusia se compararon entre ambos grupos mediante Xi cuadrado y test de Fischer. Resultados: Cincuenta y seis pacientes fueron reclutados, 24 en estrategia quirúrgica y 32 en conservadora. Todos los pacientes presentan una evaluación fonoaudiológica normal. Existe mayor frecuencia de retracción timpánica, perforación timpánica e hipoacusia de conducción en aquellos niños sometidos a una estrategia agresiva de tratamiento. Discusión: Existen mayores alteraciones timpánicas e hipoacusia en los pacientes sometidos a una estrategia de tratamiento quirúrgica, por lo que parece prudente realizar una evaluación individual y determinar la necesidad de cirugía de acuerdo a cada paciente.

Introduction: Otitis media with effusion (OME) is a frequent finding in patients with cleft palate due to a functional obstruction of the Eustachian tube. Because of its association with hearing loss and low rate of spontaneous resolution the use of ventilation tubes as treatment appears as beneficial The clinical and audiological consequences of this conduct areinot well established. Aim: To compare anatómical and audiologics results with two strategies of treatment. Material ana method: Historical cohort study of children from 8 to 10 years, with cleft palate, surgically corrected, and with OME. One group was treated with ventilation tubes, and an expectant management was carried out with the other group. The following parameters were compared by Xi-square test and Fischer: tympanic membrane state, presence of compiications and hearing level. Results: Fifty six patients were admitted, 24 in surgical management and 32 in conservative. Every child had a cleft palate corrected without velopharyngeal insufficiency It was found a higher frequency of tympanic membrane retraction, tympanic membrane perforation and hearing loss in the case groups were found. Discusion: We found a greater presence of tympanic alterations and hearing disorders in patients subjected to ventilation tubes as treatment of OME. It seems prudent to evalúate the surgical alternative individually according to each patient characteristic.

Displasia fibrosa de temporal: caso clínico y revisión del tema / Fibrous displasia of temporal bone: clinical case

La displasia fibrosa es una enfermedad caracterizada por el reemplazo progresivo de hueso normal por tejido fibroso. Es un desorden benigno, poco común, de etiología desconocida. Según su forma de presentación se puede clasificaren: monostótica, que afecta a un hueso; poliostótica, que afecta varios huesos y poliostótica, asociada a endocrinopatfas. Aunque el esqueleto craneofacial es involucrado frecuentemente, el hueso temporal raramente llega a estar afectado; el síntoma más común es la sordera y el diagnóstico es basado en imágenes radiológicas e histopatología; cuando la displasia presenta complicaciones la cirugía es recomendada, el seguimiento de estos pacientes es necesario para un diagnóstico temprano de recurrencias. En este artículo reportamos un caso clínico de displasia fibrosa del temporal y realizamos una revisión de sus implicaciones clínicas y manejo.

Fibrous dysplasia is a disease characterized by progressive replacement of normal bone by fibrous tissue. It is a benign disorder, rare, of unknown etiology. By its way of presentation can be classified into: monostotic, affecting a bone polyostotic, affecting several bones and polyostotic associated with endocrinopathies. Although the craniofacial skeleton is frequently involved, the temporal bone rarely becomes affected. The most common symptom is hearing loss and the diagnosis is based on radiological images and histopathology When dysplasia presents complications, surgery is recommended. Monitoring of these patients is necessary for early diagnosis of recurrence. In this article we report a case of fibrous temporal bone dysplasia and review the clinical implications and management.

Nasopharyngeal carcinoma presenting with cavernous sinus involvement, trigeminal neuralgia and middle ear effusion

We reported and analyzed an unusual case of NPC [Nasopharyngeal carcinoma] where the patient had initial clinical features of cavernous sinus involvement followed by trigeminal neuralgia and middle ear dysfunction. In the present case, the initial involvement of the cavernous sinus resulted in the left sided third nerve involvement. Later on, the extension of the tumor in and around the trigeminal ganglion resulted in facial pain. Up to that point in time, a possibility of cavernous sinus lesion was considered and this caused a delay in the diagnosis. In accordance with the literature, this case illustrates that the tumor is difficult to diagnose during the early stages for multiple reasons, including: the non-specificity of the initial symptoms and the difficulty of examining the postnasal space

Management outcome of secretory otitis media

Secretory otitis media is a common otological manifestation, that most of the time is left undiagnosed on account of unawareness and negligence in seeking early medical attention for trivial ailments. Untreated, it might end up in serious consequences in the form of poor speech and intellectual development and permanent anatomical disabilities within middle ear cleft, The objectives of the study were to determine most affected age group, the common etiological factors, to access the efficacy of medical and surgical treatment and finally to find out the complication associated with the surgical procedures. This study was conducted in the ENT, Head and Neck Surgery department of the Ayub Teaching Hospital, Abbottabad from January 2001 to December 2003.Only the diagnosed cases of SOM were included in the study. After detailed history, clinical examination, routine investigations and special investigations such as pure tone audiogram and tympanometry were carried out to confirm the diagnosis of SOM. All patients were initially treated by medical therapy. In cases of failure, underwent myringotomy with or without ventilation tube insertion and where indication present adenotonsillectomy and antral lavage was done. Follow up of cases was carried out from 18-24 months. It included 87 patients, 58 were males [66.6%] and 29 females [33.3%]. Majority of the patients were between 5-8 years [62%]. The most common aetiological factor was rhinosinusitis [36.7%] followed by hypertrophic adenoids [34.5%]. All patients were initially given medical treatment. Out of 87 patients,30 patients [34.4%] improved and 57 patients [65.5%] had no response and underwent surgery. Surgical procedures included myringotomy with and without ventilation tube insertion, adenotonsillectomy and antral lavage. It is concluded from this study that conservative treatment has a definite role and should be tried before any surgical step is taken however surgery is the treatment of choice in more resistant cases

Secretory otitis media in adults

The otitis media with effusion is not very rare in adults. This study was carried out to find etiology and assess different modes of treatment of secretory otitis media in adults. It was a reterospective study carried out at Allied Hospital Faisalabad from Jan 1998 to Dec 2002. Total 20 patients 13 male [65 percent] and 7 females [35 percent] between 20 to 60 years of age. The mean age was 30 years. In 15 patients [75 percent] glue ear was bilateral and in 5 patients [25 percent] it was unilateral. Tympanometery was performed in all the 20 patients which showed type-B tympanogram in all subjects [100 percent]. The most common etiological factor was upper respiratory tract infection [61 percent]. The most common presenting symptom was conductive deafness [90 percent]. The most common sign was immobile tympanic membrane [77 percent]. The severity of the hearing loss in majority of the cases was moderate [60 percent]. The treatment modalities used in majority of patients were antibiotic [35 percent] followed by grommet insertion [30 percent]. The otitis media with effusion in adults must be properly investigated to rule out any grave pathology in nasopharynx and treated properly to avoid further complications of otitis media with effusion such as adhesions, perforation etc

Parental smoking and risk of otitis media with effusion among children

Serous otitis is due to eustachian tube dysfunction and accumulation of fluid in the middle ear cavity. Otitis media with effusion [OME] is common among children and can cause hearing loss. Smoking is a common predisposing factor of this condition. The present study was conducted with the aim of determining the effects of smoking on the prevalence of OME among children residing in urban area of Tehran between 1996 and 1998. This cross-sectional study performed on 3833 pre-school and school-aged children which their age ranged from 2 to 11 years. Children were examined with pneumatic otoscope and tympanometry was performed; meanwhile, their parents were asked to complete a questionnaire. The incidence of OME was 9.1% and 14.1% in pre-school and school-aged children; respectively, and was higher among children with smoker parents. Parental smoking is a preventable predisposing factor for OME; meanwhile, there are significant statistical differences between healthy and sick children regarding their parents pack-years smoking

Plasmocitoma extramedular nasofaringeo. reporte de caso / Extramedulary plasmocytoma in the nasopharynx. case report

Los plasmocitomas extramedulares (PEM) son tumores solitarios de células plasmáticas localizada en lugares lejanos al hueso. Un porcentaje variable puede desarrollar con posterioridad un mieloma múltiple. Los PEM representan cerca de un 4 por ciento de los tumores no epiteliales del tracto respiratorio superior. Generalmente se desarrollan en el tejido submucoso de vías aéreas superiores con predilección por la nasofaringe, las fosas nasales, los senos paranasales y las amígdalas. Los tumores rinofaríngeos son raros; una revisión en Medline encontró 10 casos en la nasofaringe, uno de ellos en España. Presentamos el caso clínico de un paciente varón de 69 años, con patología tubárica crónica, cuyo examen clínico reveló la existencia de una lesión polipoide en nasofaringe, sin adenopatías cervicales. La resección endoscópica transnasal permitió el estudio histológico de la pieza, que mostró una proliferación de células plasmáticas. Los estudios séricos y de médula ósea permitieron concluir el diagnóstico de plasmocitoma extramedular. El tratamiento fue completado con radioterapia, no existiendo evidencia de recurrencia de la enfermedad después de 18 meses

Procesamiento bacteriológico y micológico de muestras de infecciones de vías respiratorias superiores: otitis media (OMA) y sinusitis / Processing specimens of upper respiratory tract infections for bacteria and fungi: otitis media and sinusitis

Las infecciones del tracto respiratorio superior son la causa infecciosa más frecuente de consulta al médico. En el caso de la otitis media y sinusitis aguda, los agentes etiológicos más frecuentes son S. pneumoniae, H. influenzae no "b" y M. catarrhalis; en tanto que en las formas crónicas aumenta la incidencia de anaerobios, bacilos gram negativos y S. aureus. La punción de oído medio y de senos paranasales se recomienda para casos puntuales como inmunocomprometidos, fracaso terapéutico, complicaciones supurativas, neonatos con otitis media, pacientes intubados con sinusitis y tal vez pacientes provenientes de áreas con alto porcentaje de cepas resistentes

Qualitative and quantitative studies of adenoid mast cell in children with and without secretory otitis media

The mast number, mast cell, diameter, mast cell surface area and mast cell density were studied using an image-cell analyzer for adenoid tissues of patients with middle ear effusion and compared with patients without middle ear effusion. There was no statistical difference for both groups. The possible role of the adenoid mast cells in the pathogenesis of secretory otitis media was through its degranulation and the release of histamine and other inflammatory mediators, which led to Eustachian tube dysfunction and middle ear effusion

Estudo da prevalência e fatores de risco de otite média secretora em pré-escolares assintomáticos / Study of prevalence and risk factors of secretory medium otite in asymptomatic preschool children

A otite média secretora pode ser assintomática, especialmente em crianças que conseguem expressar suas queixas com freqüência. A prevalência de otite média secretora foi estimada em 22,82 por cento em estudo feito em Niterói, Rio de Janeiro, mediante a aplicação de questionários aos responsáveis pelas crianças que apresentaram quadro compatível com otite média secretora. A análise da anamnese junto ao exame físico mostrou que na maioria dos casos estava presente infecção do ouvido médio de repetição (68,9 por cento do total). A relação entre este fato e atopia foi de 55,1 por cento, enquanto que a relação com obstrução mecânica das vias aéreas superiores foi de 27,5 por cento. Achou-se atopia isoladamente em 65,5 por cento dos casos e associada com processos obstrutivos em 31 por cento. Obstrução mecânica à respiração foi detectada em 51,7 por cento dos casos e houve concomitância de infecção de repetição, atopia e obstrução na proporção de 24,1 por cento. Os fatores de risco mais atuantes foram alergia e obstrução mecânica de vias aéreas superiores, que nos parecem ser a base para a existência de infecção de repetição e otite média secretora.

Secretory medium otitis may be asymptomatic, specially in young chldren. The prevalence of secretory medium otits has been estimated at 22,82% in our study. Children who presented with signs and symptoms of otits were given questionnaires for their parents to answer. Physical examination depicted middle ear infection in 68,9% o cases. 55,1% of the patients had atopy while another 27,5% had mechanical high airways obstruction combined with middle ear infection. Atopy was present in 65,5% of the cases, although it was also combined of obstructive processes in 31% of the cases. Mechanical obstruction was present in 51,7% of cases and 24,1% of the patients had relapsing infection, atopy and obstruction together. The most important factors for the development of relapsing infections and secretory medium otits in our study have been allergy and mechanical high airways obstruction.