A multicenter observational study on the role of comorbidities in the recurrent episodes of benign paroxysmal positional vertigo.

OBJECTIVE: Primary objective of this study was to find a statistical link between the most worldwide comorbidities affecting the elderly population (hypertension, diabetes, osteoarthrosis, osteoporosis and depression) and recurrent episodes of BPPV. Secondary objective was defining possible "groups of risk" for people suffering recurrent positional vertigo related to the presence of a well documented comorbidity. METHODS: This was an observational, cross-sectional, multicenter, spontaneous, non-pharmacological study. The data of 1092 patients suffering BPPV evaluated in 11 different Departments of Otolaryngology, Otoneurology and Neurology, referring Centers for positional vertigo evaluation, were retrospectively collected. RESULTS: Regarding evaluated comorbidities (hypertension, diabetes, osteoarthrosis, osteoporosis and depression), data analysis showed the presence of at least one comorbid disorder in 216 subjects (19.8%) and 2 or more in 408 subjects (37.4%). Moreover there was a statistical significant difference between the number of comorbidities and the number of recurrences, otherwise said as comorbidity disorders increased the number of relapses increased too. CONCLUSION: The presence of a systemic disease may worsen the status of the posterior labyrinth causing a more frequent otolith detachment. This condition increases the risk for patients suffering BPPV to have recurrent episodes, even if correctly managed by repositioning maneuvers. The combination of two or more of aforementioned comorbidities further increases the risk of relapsing BPPV, worsened by the presence of osteoporosis. On the basis of this results it was possible to define "groups of risk" useful for predicting BPPV recurrence in patients with one or more comorbidity.

New criteria of indication and selection of patients to cochlear implant.

Numerous changes continue to occur in cochlear implant candidacy. In general, these have been accompanied by concomitant and satisfactory changes in surgical techniques. Together, this has advanced the utility and safety of cochlear implantation. Most devices are now approved for use in patients with severe to profound unilateral hearing loss rather then the prior requirement of a bilateral profound loss. Furthermore, studies have begun utilizing short electrode arrays for shallow insertion in patients with considerable low-frequency residual hearing. This technique will allow the recipient to continue to use acoustically amplified hearing for the low frequencies simultaneously with a cochlear implant for the high frequencies. The advances in design of, and indications for, cochlear implants have been matched by improvements in surgical techniques and decrease in complications. The resulting improvements in safety and efficacy have further encouraged the use of these devices. This paper will review the new concepts in the candidacy of cochlear implant. Medline data base was used to search articles dealing with the following topics: cochlear implant in younger children, cochlear implant and hearing preservation, cochlear implant for unilateral deafness and tinnitus, genetic hearing loss and cochlear implant, bilateral cochlear implant, neuropathy and cochlear implant and neural plasticity, and the selection of patients for cochlear implant.

Schwannoma de forame jugular: relato de caso / Jugular foramen schwannoma: case report

Introdução: As lesões do forame jugular são raras, sendo os paragangliomas os tumores mais comuns desta região seguidos pelos schwannomas. Os schwannomas são tumores benignos de crescimento lento e origem principalmente nos nervos cranianos sensitivos. Quando localizados no forame jugular, apresentam-se clinicamente com perda auditiva, ataxia e cefaleia, sendo comuns as alterações dos nervos cranianos IX, X e XI. A excisão cirúrgica é a opção terapêutica de escolha. Relato do Caso: Relatamos o caso de um paciente adulto jovem que procurou o serviço de Otorrinolaringologia do Hospital Universitário de Brasília com quadro de otalgia e otorreia piossanguinolenta no ouvido esquerdo, associada a zumbido, hipoacusia e tumor no conduto auditivo externo. Iniciada investigação diagnóstica com tomografia computadorizada e biópsia, ambas com resultados inconclusivos. Realizadas então nova biópsia e ressonância nuclear magnética, com diagnóstico definitivo de schwannoma do foram jugular. Na ocasião a lesão foi definida como tipo D pela classificação de Kaye-Pellet, por envolver o forame jugular, apresentar formato de halter e componentes intra e extracraniano. Realizada cirurgia por craniotomia com excisão parcial do tumor. Não houve sequelas do procedimento, apesar da persistência dos sintomas otológicos. Comentários Finais: O caso é um exemplo de uma doença rara, com pouco mais de duzentos casos relatados na literatura, e apresentação clínica incomum. O desafio diagnóstico e terapêutico é enfrentado pelas equipes de Otorrinolaringologia e Neurocirurgia, que programam para breve nova abordagem cirúrgica combinada para extirpação completa do tumor.

Introduction: Lesions of the jugular foramen are uncommon, and the paragangliomas are the most common tumors in this region, followed by schwannomas. Schwannomas are benign tumors, of slow growth and origin mainly in the sensitive cranial nerves. When located in the jugular foramen, the patients present with clinically auditory hearing loss, ataxia and headache, and cranial nerves IX, X and XI alterations are also common. Surgical excision is the therapeutic choice. Case Report: We reported the case of a young adult patient who sought the Otorhinolaryngology service at the School Hospital of Brasília for investigation of otalgia and chronic infection in the left ear, associated with tinnitus, hypacusis and tumor in the external ear canal. Initial diagnostic investigation by computed tomography and biopsy was inconclusive. New biopsy and magnetic resonance imaging were performed and definitive diagnosis of jugular foramen schwannoma was given. The lesion was then defined as type D by the classification of Kaye-Pellet, for it involved the jugular foramen, presented format of dumbbell and intra and extracranial components. The patient underwent a craniotomy and partial excision of the tumor. He did not have sequels of the procedure, although the otologic symptoms persisted. Final Comments: This case is an example of a rare disease. No more than two hundred cases have been reported in the literature and the clinical presentation is uncommon. The diagnostic and therapeutic challenge is faced by Otorhinolaryngology and Neurosurgery teams who are scheduling a new combined surgical procedure for a complete excision of the tumor.

Viral etiology for inner ear diseases: proven, unproven, unlikely.

This is a revision article that deals with the broad field of inner ear disease caused by viral infections. Some of these entities have been proven to have a viral etiology. Others have strong evidence in favor of a viral causation but still cannot be considered as a viral disease. Finally, other entities are suggestive of a viral etiology but when the whole body of evidence is considered one concludes that a viral etiology is indeed unlikely. We review the literature and add our own experience in this subject. Clearly, the most important evidence about this subject came from the study of temporal bone histopathology. Certainly, we can learn much more if we continue to collect and study temporal bone specimens histopathologically.

Evaluation of early postoperative morbidity in pediatric tonsillectomy with the use of sucralfate.

OBJECTIVE: The objective of this study is to evaluate the efficacy of sucralfate in alleviating posttonsilectomy morbidity in a pediatric group of patients. METHODS: A prospective, double-blind, randomized, and placebo-controlled study comparing the irrigation of a solution containing either 1g of sucralfate (study group) or 1g of lactulose (control group) was performed on 69 children aged 3-12 years, who underwent tonsillectomy at the University Hospital of Brasilia Medical School. The children were randomly assigned and each one used a solution containing sucralfate or lactulose to swish and swallow four times daily during 7 days. Eleven patients were excluded. The anesthetic was standardized and no premedication was used. Pain magnitude using an "Oucher" scale, nausea, vomiting, bleeding, earache, analgesic drug intake, changes in the interincisor teeth distance, and changes in the weight and temperature were assessed by the surgeon 6, 24h, and 7 days after the surgery. RESULTS: Patients in the study group had significantly lower pain scores in the initial 6 postoperative hours (p<0.05). The difference between the two groups was not statistically significant for the other periods following the procedure or on the evaluation of the other indices. CONCLUSIONS: The use of the sucralfate in pediatric patients undergoing tonsillectomy was not effective in reducing the postoperative morbidity according to the parameters used in this study. The surgical technique with careful mucosal dissection associated with postoperative caries could be more important in the reduction of posttonsilectomy morbidity.

Intratympanic dexamethasone injections as a treatment for severe, disabling tinnitus: does it work?

OBJECTIVE: To test the effectiveness of intratympanic dexamethasone injections as a treatment for severe disabling cochlear tinnitus. DESIGN: Randomized, prospective, single-blind study. SETTING: Academic tertiary referral hospital. PATIENTS: Thirty-six patients with severe disabling tinnitus predominantly of cochlear origin were randomly assigned to receive intratympanic injections of a dexamethasone solution or isotonic sodium chloride (saline) solution. INTERVENTIONS: Under topical anesthesia and after randomization, 36 patients received 0.5-mL intratympanic injections once per week for 4 weeks of either a 4-mg/mL dexamethasone solution or saline solution. Five patients were excluded from analysis because they did not complete the treatment or did not return for follow-up. MAIN OUTCOME MEASURE: Improvement of tinnitus measured with a visual analog scale. RESULTS: The 2 groups were similar in age, sex, tinnitus laterality, measurement of tinnitus intensity on the visual analog scale, and main otologic diagnosis. We considered a 2-point improvement on the visual analog scale to be significant. Twenty-nine percent of the ears in the saline group and 33% of the ears in the dexamethasone group showed significant improvement immediately after completion of treatment. These measurements were not significantly different from each other. Follow-up varied from 13 to 31 months, and the patients with improved tinnitus returned to the initial measurements over time. CONCLUSIONS: There was no advantage in intratympanic injections of dexamethasone over saline solution in the treatment of severe, disabling tinnitus. Both solutions produced a placebolike improvement.

Cirurgia do estribo feita por médicos residentes: resultados na Universidade de Brasília / Stapes surgery performed by residents: results in the University of Brasília

A cirurgia do estribo exige um grau de habilidade e de treinamento altos para ser executada sem riscos desnecessários para o paciente. Já de algum tempo têm aparecido artigos na literatura americana expressando preocupaçäo com os resultados de estapedectomias feitas por médicos em treinamento, alguns questionando mesmo a prática de treinar todos os residentes nesta técnica. Talvez somente os mais aptos para a microcirurgia deveriam ser iniciados na cirurgia da janela oval. No Brasil poucos relatos deste tipo têm aparecido na literatura. Nós levantamos os casos operados por residentes com supervisäo do staff de 1979 a 1992 no Hospital Universitário de Brasília e os relatamos em detalhes nesta comunicaçäo. Nossos resultados säo comparados com os publicados na literatura americana nos últimos 11 anos