Associations between skeletal discrepancies, breathing pattern, and upper airway obstruction in Class III malocclusions.

OBJECTIVE: To verify the associations between sagittal and vertical skeletal discrepancies, changes in upper airways, and breathing pattern in children and adolescents with Angle Class III and Class III subdivision malocclusions. METHODS: Eighty-five children and adolescents with a mean age of 9.5 ± 1.74 years were selected. Cephalometry assessed the sagittal relationship (AO-BO measurement), facial types (Ricketts VERT index), nasopharynx, and oropharynx. An otorhinolaryngologist analyzed the breathing pattern and upper airway obstruction during anamnesis, physical examination, anterior rhinoscopy, and nasofibroscopy. Medical records were also reviewed. For statistical analysis, ordinary one-way ANOVA, Kruskal-Wallis (Tukey's post-hoc), unpaired t-test, Pearson's correlation, chi-square, and Fisher's exact tests (p < 0.05) were used. RESULTS: The nasopharyngeal cephalometric dimension and pharyngeal tonsil hypertrophy were associated, whereas the oropharyngeal cephalometric dimension and palatine tonsils hypertrophy were not. Sagittal discrepancies were associated with septum deviation, while facial type was associated with inferior turbinate and palatine tonsils hypertrophy. However, facial type was not associated with breathing pattern, septum deviation, and pharyngeal tonsils hypertrophy. CONCLUSIONS: Sagittal discrepancies and type of malocclusion were not associated with breathing pattern and changes in upper airways, except for the severity of septum deviation and Class III malocclusions, which were associated with large sagittal discrepancies. Although the facial types analyzed presented signs of airway obstruction, the highest prevalence of inferior turbinate and palatine tonsils hypertrophy were found in patients with dolichofacial type.

Variables with prognostic value in the onset of idiopathic sudden sensorineural hearing loss / Variáveis com valor prognóstico no momento da instalação da perda auditiva neurossensorial súbita idiopática

ABSTRACT INTRODUCTION: The establishment of an individualized prognostic evaluation in patients with a diagnosis of idiopathic sudden sensorineural hearing loss (ISSHL) remains a difficult and imprecise task, due mostly to the variety of etiologies. Determining which variables have prognostic value in the initial assessment of the patient would be extremely useful in clinical practice. OBJECTIVE: To establish which variables identifiable at the onset of idiopathic sudden sensorineural hearing loss have prognostic value in the final hearing recovery. METHODS: Prospective, longitudinal cohort study. Patients with ISSHL followed by the Department of Otology-Neurotology of a quaternary hospital were included. The following variables were evaluated and correlated with final hearing recovery: age, gender, vertigo, tinnitus, initial degree of hearing loss, contralateral ear hearing, and elapsed time to treatment. RESULTS: 127 patients with ISSHL were evaluated. Rates of absolute and relative recovery were 23.6 dB and 37.2% respectively. Complete hearing improvement was observed in 15.7% patients; 27.6% demonstrated significant improvement and improvement was noted in 57.5%. CONCLUSION: During the onset of ISSHL, the following variables were correlated with a worse prognosis: dizziness, profound hearing loss, impaired hearing in the contralateral ear, and delay to start treatment. Tinnitus at the onset of ISSHL correlated with a better prognosis.

RESUMO Introdução: Elaborar avaliação prognóstica individualizada em pacientes com diagnóstico deperda auditiva neurossensorial súbita idiopática (PANSI) permanece tarefa árdua e imprecisa devido, em grande parte, à variedade de etiologias. A determinação de quais variáveis teriam valor prognóstico na avaliação inicial do paciente seria de extrema utilidade na prática clínica. Objetivo: Estabelecer quais variáveis, identificáveis no momento de instalação da perda auditiva neurossensorial súbita idiopática, têm valor prognóstico na recuperação auditiva final. Método: Estudo de coorte prospectivo, longitudinal. Incluídos pacientes com PANSI acompanhados pela Disciplina de Otologia-Neurotologia de um hospital quaternário. As seguintes variáveis foram avaliadas e correlacionadas com a recuperação auditiva final: idade, gênero, vertigem, zumbido, grau de perda auditiva inicial, audição na orelha contralateral, tempo para início de tratamento. Resultado: Foram avaliados 127 pacientes com PANSI. As taxas de recuperação absoluta e relativa foram 23,6 dB e 37,2% respectivamente. Apresentaram melhora completa da audição 15,7% dos pacientes; 27,6% apresentaram melhora significativa e 57,5% melhora. Conclusão: No momento da instalação da PANSI, as seguintes variáveis correlacionaram-se com pior prognóstico: vertigem, perda auditiva profunda, audição alterada na orelha contralateral e demora para início do tratamento. Presença de zumbido na instalação da PANSI correlacionou-se com melhor prognóstico.

Variables with prognostic value in the onset of idiopathic sudden sensorineural hearing loss.

INTRODUCTION: The establishment of an individualized prognostic evaluation in patients with a diagnosis of idiopathic sudden sensorineural hearing loss (ISSHL) remains a difficult and imprecise task, due mostly to the variety of etiologies. Determining which variables have prognostic value in the initial assessment of the patient would be extremely useful in clinical practice. OBJECTIVE: To establish which variables identifiable at the onset of idiopathic sudden sensorineural hearing loss have prognostic value in the final hearing recovery. METHODS: Prospective, longitudinal cohort study. Patients with ISSHL followed by the Department of Otology-Neurotology of a quaternary hospital were included. The following variables were evaluated and correlated with final hearing recovery: age, gender, vertigo, tinnitus, initial degree of hearing loss, contralateral ear hearing, and elapsed time to treatment. RESULTS: 127 patients with ISSHL were evaluated. Rates of absolute and relative recovery were 23.6dB and 37.2% respectively. Complete hearing improvement was observed in 15.7% patients; 27.6% demonstrated significant improvement and improvement was noted in 57.5%. CONCLUSION: During the onset of ISSHL, the following variables were correlated with a worse prognosis: dizziness, profound hearing loss, impaired hearing in the contralateral ear, and delay to start treatment. Tinnitus at the onset of ISSHL correlated with a better prognosis.

Glucocorticoid influence on prognosis of idiopathic sudden sensorineural hearing loss.

INTRODUCTION: Idiopathic Sudden Sensorineural Hearing Loss (ISSHL) is defined when a loss of at least 30 dB occurs in over 3 continuous frequencies, in up to 72 hours, of which etiology is not established, despite adequate investigation. Different types of treatment regimens have been proposed, but only glucocorticoids have shown some evidence of benefit in the literature. OBJECTIVE: To analyze whether the type of treatment or time of treatment with glucocorticoids have any influence on hearing recovery in ISSHL. METHODS: Observational retrospective cohort study. One hundred twenty-seven patients with ISSHL, treated at outpatient clinics between the years 2000 and 2010, were studied. We evaluated the prognostic correlation of the type of treatment and time to treatment with glucocorticoids and ISSHL. RESULTS: The absolute hearing gain and the relative hearing gain was as follows: 23.6 dB and 37.2%. Complete recovery was observed in 15.7% of patients, significant recovery in 27.6% and recovery in 57.5%. CONCLUSION: In this study, there was no difference between the use and nonuse of glucocorticoids in hearing improvement. However, when started within seven days after onset, the use of glucocorticoids was a factor of better prognosis.

Glucocorticoid influence on prognosis of idiopathic sudden sensorineural hearing loss / Influência dos corticosteroides no prognóstico auditivo da perda auditiva neurossensorial súbita idiopática

INTRODUCTION: Idiopathic Sudden Sensorineural Hearing Loss (ISSHL) is defined when a loss of at least 30 dB occurs in over 3 continuous frequencies, in up to 72 hours, of which etiology is not established, despite adequate investigation. Different types of treatment regimens have been proposed, but only glucocorticoids have shown some evidence of benefit in the literature. OBJECTIVE: To analyze whether the type of treatment or time of treatment with glucocorticoids have any influence on hearing recovery in ISSHL. METHODS: Observational retrospective cohort study. One hundred twenty-seven patients with ISSHL, treated at outpatient clinics between the years 2000 and 2010, were studied. We evaluated the prognostic correlation of the type of treatment and time to treatment with glucocorticoids and ISSHL. RESULTS: The absolute hearing gain and the relative hearing gain was as follows: 23.6 dB and 37.2%. Complete recovery was observed in 15.7% of patients, significant recovery in 27.6% and recovery in 57.5%. CONCLUSION: In this study, there was no difference between the use and nonuse of glucocorticoids in hearing improvement. However, when started within seven days after onset, the use of glucocorticoids was a factor of better prognosis. .

INTRODUÇÃO: A perda auditiva neurossensorial súbita idiopática (PANSSI) é definida pela queda dos limiares auditivos tonais de, pelo menos, 30 dB em três frequências contíguas em até 72 horas e apesar de uma investigação apropriada, a etiologia da lesão não é encontrada. Diversos tipos de tratamentos já foram idealizados para a PANSSI, no entanto, os corticosteroides são os que encontram as melhores evidências de efetividade na literatura. OBJETIVO: Avaliar se o tipo de tratamento e o tempo de demora em iniciar o tratamento com corticosteroides têm correlação com a melhora dos limiares auditivos na PANSSI. MÉTODOS: Estudo de coorte retrospectivo observacional. Foram avaliados 127 pacientes com PANSSI provenientes do ambulatório entre os anos de 2000 e 2010. Foi avaliada a correlação prognóstica do tipo de tratamento e tempo de demora para o início de tratamento e a PANSSI. RESULTADOS: As taxas de recuperação absoluta e relativa foram 23,6 dB e 37,2% respectivamente. Apresentaram melhora completa 15,7% dos pacientes, 27,6% apresentaram melhora significativa e 57,5% melhora. CONCLUSÃO: Neste estudo, não houve diferença entre o uso ou não de corticosteroide na melhora auditiva. Contudo, quando iniciado até sete dias, o uso de corticosteroide foi fator de melhor prognóstico. .

Comparison of hearing recovery criteria in sudden sensorineural hearing loss.

UNLABELLED: The countless methods available to analyze hearing recovery in idiopathic sudden sensorineural hearing loss (ISSHL) cases hinder the comparison of the various treatments found in the literature. OBJECTIVE: This paper aims to compare the different criteria for hearing recovery in ISSHL found in the literature. MATERIALS AND METHODS: This is an observational clinical cohort study from a prospective protocol in patients with ISSHL, treated between 2000 and 2010. Five criteria were considered for significant hearing recovery and four for complete recovery by pure tone audiometry, using non-parametric tests and multiple comparisons at a significance level of 5%. After determining the stricter criteria for hearing recovery, vocal audiometry parameters were added. RESULTS: There was a significant difference between the criteria (p < 0.001) as they were analyzed together. Mild auditory recovery occurred in only 35 (27.6%) patients. When speech audiometry was added, only 34 patients (26.8%) showed significant improvement. CONCLUSIONS: There is a lack of consistency among the criteria used for hearing recovery. The criterion of change of functional category by one degree into at least mild hearing recovery was the stricter. Speech audiometry did not prove essential to define significant hearing recovery.

Comparação entre critérios de recuperação auditiva na perda neurossensorial súbita / Comparison of hearing recovery criteria in sudden sensorineural hearing loss

Inúmeros métodos de análise da recuperação auditiva na perda auditiva neurossensorial súbita idiopática (PANSI) dificultam a comparação adequada dos diversos tratamentos encontrados na Literatura. OBJETIVO: Comparar diversos critérios de recuperação auditiva na PANSI, baseados na Literatura. MATERIAL E MÉTODO: Foi realizado um estudo clínico observacional de coorte, a partir de um protocolo prospectivo, em pacientes com PANSI, atendidos entre 2000 e 2010. Foram comparados cinco critérios de recuperação auditiva significativa e quatro critérios para recuperação completa, pela audiometria tonal, por meio de teste não paramétrico e de comparações múltiplas, ambos com um nível de significância de 5%. Após determinação do critério de recuperação auditiva mais rígido, foram adicionados parâmetros da audiometria vocal. RESULTADOS: Houve diferença significativa, entre esses critérios (p < 0,001), quando analisados em conjunto. A recuperação auditiva para, pelo menos, grau leve, ocorreu em apenas 35 (27,6%) pacientes. Ao adicionarmos parâmetros da audiometria vocal, apenas 34 pacientes (26,8%) tiveram melhora significativa. CONCLUSÕES: Existe falta de uniformidade entre os critérios de recuperação auditiva utilizados pela literatura. O critério de mudança de categoria funcional para um grau, pelo menos leve, foi o mais rígido. O uso da audiometria vocal não foi fundamental para definir recuperação auditiva significativa.

The countless methods available to analyze hearing recovery in idiopathic sudden sensorineural hearing loss (ISSHL) cases hinder the comparison of the various treatments found in the literature. OBJECTIVE: This paper aims to compare the different criteria for hearing recovery in ISSHL found in the literature. MATERIALS AND METHODS: This is an observational clinical cohort study from a prospective protocol in patients with ISSHL, treated between 2000 and 2010. Five criteria were considered for significant hearing recovery and four for complete recovery by pure tone audiometry, using non-parametric tests and multiple comparisons at a significance level of 5%. After determining the stricter criteria for hearing recovery, vocal audiometry parameters were added. RESULTS: There was a significant difference between the criteria (p < 0.001) as they were analyzed together. Mild auditory recovery occurred in only 35 (27.6%) patients. When speech audiometry was added, only 34 patients (26.8%) showed significant improvement. CONCLUSIONS: There is a lack of consistency among the criteria used for hearing recovery. The criterion of change of functional category by one degree into at least mild hearing recovery was the stricter. Speech audiometry did not prove essential to define significant hearing recovery.

Comparison of full versus short induced-sleep polysomnography for the diagnosis of sleep apnea.

OBJECTIVES/HYPOTHESIS: Polysomnography (PSG) is the gold-standard method for diagnosing obstructive sleep apnea (OSA). However, the gap between demand and capacity in performing PSG is a major health-care problem. We sought to validate a short day-time induced sleep for the diagnosis of OSA. STUDY DESIGN: Prospective diagnostic method validation. METHODS: We studied 25 consecutive patients referred to the sleep laboratory and 15 healthy volunteers. All subjects were evaluated by means of full overnight PSG (Full-PSG) and short day-time induced-sleep PSG (Induced-PSG). Sleep was monitored during both procedures (Embla, 16 channels). Sleep was induced by slow intravenous drip infusion of midazolam. RESULTS: The population studied (N = 40) was 60% male (mean age, 42 ± 10 years; body mass index, 29 ± 6.5 kg/m(2)). Sleep was successfully induced in all subjects, and no complications were observed (midazolam doses, 6.2 ± 3.8 mg; time of induced sleep 41.5 ± 18.9 minutes). The apnea-hypopnea index (AHI) and minimal oxygen saturation during Full-PSG versus Induced-PSG were similar: median AHI (with 25%-75% interquartile range) was 13 (3-35) events per hour versus 17 (4-36) events per hour, and median oxygen saturation was 84% (75-90) versus 85% (76-92); P = .89 and P = .53, respectively. The majority of the respiratory events during induced sleep were obstructive and similar to those observed during Full-PSG. AHI and lowest oxygen saturation during Induced-PSG correlated significantly with Full-PSG (r = 0.67 and r = 0.77, respectively). Sensitivity and specificity for the diagnosis of OSA (AHI > 15 events per hour) by Induced-PSG were 0.83 and 0.72, respectively. CONCLUSIONS: Induced-PSG by midazolam during the day is safe and correlates with Full-PSG; it therefore is a promising alternative method in the diagnosis of OSA.

Presentation, treatment, and clinical course of otogenic lateral sinus thrombosis.

CONCLUSIONS: Otogenic lateral sinus thrombosis (OLST) is almost always associated with other complications of chronic otitis media (COM) and did not present a distinct clinical expression. In our experience, OLST exhibits a benign course if the underlying disease is controlled. Mastoidectomy in combination with broad-spectrum antibiotics provided effective treatment. Anticoagulation therapy is no longer used routinely. Recanalization is rare and is independent of the use of anticoagulants. OBJECTIVES: This study aimed to contribute to the understanding of the clinical aspects and evolution of OLST. PATIENTS AND METHODS: The study investigated a retrospective case series in a tertiary teaching hospital. From 1993 to 2007, eight cases of OLST were treated. The clinical and imaging data, treatments, and outcomes were analyzed. The follow-up period ranged from a minimum of 6 months to 5 years. RESULTS: In all eight patients, the lateral sinus thrombosis was detected by imaging studies performed to evaluate complications and symptoms related to COM. Fever, headache, and cranial nerve paralysis were the main clinical manifestations associated with coexisting mastoiditis, meningitis, and cerebellar and epidural abscess. We could not identify features specific to lateral sinus thrombosis in any case. All patients underwent mastoidectomy and were given broad-spectrum antibiotics for 2 months. Four cases were anticoagulated and all eight cases experienced complete clinical recovery without sequelae.

The relationship between excursion of the diaphragm and curvatures of the spinal column in mouth breathing children.

OBJECTIVE: To investigate the relationship between excursion of the diaphragm muscle and spinal curvatures in mouth breathing children. METHODS: A total of 52 children of both sexes, aged from 5 to 12 years, were studied. After otorhinolaryngological assessment, the children were divided into two groups: mouth breathers and nose breathers. All of the children underwent videofluoroscopic examination of the diaphragm muscle and postural assessment. Diaphragm excursion was analyzed using Adobe Photoshop software, and postural assessment was recorded using photographs in left lateral view, which were then analyzed using SAPO postural assessment software. RESULTS: The groups studied exhibited statistically significant differences in terms of spinal curvatures (cervical lordosis: p = 0.003; lumbar lordosis: p = 0.001; thoracic kyphosis: p = 0.002; position of the pelvis: p = 0.001) and diaphragm excursion (right side diaphragm: p = 0.001; left side diaphragm: p = 0.001). The mouth breathing group exhibited reduced cervical lordosis, increased thoracic kyphosis, increased lumbar lordosis and the position of the pelvis was tilted forward. The distance traveled outwards by the diaphragm muscles of mouth breathing children was shorter than that traveled by the muscles of nose breathing children. The relationship between the behavior of spinal curvatures and diaphragm excursion had no statistical significance. CONCLUSION: There was no relationship between spinal curvatures and diaphragm excursion in the groups studied here.

Relação entre a excursão do músculo diafragma e as curvaturas da coluna vertebral em crianças respiradoras bucais / The relationship between excursion of the diaphragm and curvatures of the spinal column in mouth breathing children

OBJETIVO: Verificar a relação entre a excursão do músculo diafragma e as curvaturas da coluna vertebral em crianças respiradoras bucais. MÉTODOS: Foram avaliadas 52 crianças de 5 a 12 anos de idade, de ambos os sexos. Por meio de avaliação otorrinolaringológica, foram divididas em dois grupos: respiradores bucais e respiradores nasais. Todos os participantes foram submetidos a exame de videofluoroscopia do músculo diafragma e a avaliação postural. A excursão do diafragma foi analisada pelo programa Adobe Photoshop®, e a avaliação postural através de fotografias em norma lateral esquerda, sendo analisadas pelo Software de Avaliação Postural. RESULTADOS: Os grupos estudados apresentaram diferença estatisticamente significante quanto ao comportamento das curvaturas da coluna vertebral (lordose cervical: p = 0,003; lordose lombar: p = 0,001; cifose torácica: p = 0,002; posição da pelve: p = 0,001) e da excursão do músculo diafragma (diafragma lado direito: p = 0,001; diafragma lado esquerdo: p = 0,001). O grupo respirador bucal apresentou diminuição da lordose cervical, aumento da cifose torácica, aumento da lordose lombar e anteversão da posição da pelve. A distância excursionada pelo músculo diafragma em crianças respiradoras bucais é menor que em crianças respiradoras nasais. Não houve significância estatística ao relacionar o comportamento das curvaturas da coluna vertebral com a excursão do músculo diafragma. CONCLUSÃO: Não há relação entre as curvaturas da coluna vertebral com a excursão do músculo diafragma nos grupos estudados.

OBJECTIVE: To investigate the relationship between excursion of the diaphragm muscle and spinal curvatures in mouth breathing children. METHODS: A total of 52 children of both sexes, aged from 5 to 12 years, were studied. After otorhinolaryngological assessment, the children were divided into two groups: mouth breathers and nose breathers. All of the children underwent videofluoroscopic examination of the diaphragm muscle and postural assessment. Diaphragm excursion was analyzed using Adobe Photoshop® software, and postural assessment was recorded using photographs in left lateral view, which were then analyzed using SAPO postural assessment software. RESULTS: The groups studied exhibited statistically significant differences in terms of spinal curvatures (cervical lordosis: p = 0.003; lumbar lordosis: p = 0.001; thoracic kyphosis: p = 0.002; position of the pelvis: p = 0.001) and diaphragm excursion (right side diaphragm: p = 0.001; left side diaphragm: p = 0.001). The mouth breathing group exhibited reduced cervical lordosis, increased thoracic kyphosis, increased lumbar lordosis and the position of the pelvis was tilted forward. The distance traveled outwards by the diaphragm muscles of mouth breathing children was shorter than that traveled by the muscles of nose breathing children. The relationship between the behavior of spinal curvatures and diaphragm excursion had no statistical significance. CONCLUSION: There was no relationship between spinal curvatures and diaphragm excursion in the groups studied here.

Cheyne-Stokes respiration in patients with congestive heart failure: causes and consequences.

Cheyne-Stokes respiration is a form of periodic breathing in which central apneas and hypopneas alternate with periods of hyperventilation, producing a waxing and waning pattern of tidal volume. This review focuses on the causes and consequences of Cheyne-Stokes respiration in patients with congestive heart failure, in whom the prevalence is strikingly high and ranges from 30% to 50%. Several factors have been implicated in the genesis of Cheyne-Stokes respiration, including low cardiac output and recurrent hypoxia. The key pathophysiological mechanism triggering Cheyne-Stokes respiration is hyperventilation and low arterial CO2 (PaCO2) that when below the apneic threshold triggers a central apnea. Hyperventilation is associated with pulmonary congestion, and Cheyne-Stokes respiration is more prone to occur during sleep, when the respiratory system is mainly dependent on chemical control. It is associated with recurrent dips in oxygen saturation and arousals from sleep, with oscillations in blood pressure and heart rate, sympathetic activation and increased risk of ventricular tachycardia. Cheyne-Stokes respiration is an independent marker of poor prognosis and may participate in a vicious cycle, further stressing the failing heart.

Cheyne-Stokes respiration in patients with congestive heart failure: causes and consequences

A respiração de Cheyne-Stokes é uma forma de respiração periódica na qual apnéias e hipopnéias se alternam com períodos de hiperpnéias que apresentam um padrão crescendo e decrescendo de volume corrente. Esta revisão enfoca as causa e conseqüências da respiração de Cheyne- Stokes em pacientes com insuficiência cardíaca congestiva na qual a prevalência é extremamente alta e varia entre 30 a 50%. Vários fatores foram implicados na gênese da respiração de Cheyne-Stokes, incluindo baixo debito cardíaco e hipoxia recorrente. Hiperventilacão e baixos níveis de CO2 arterial (PaCO2), que quando abaixo do limiar de apnéia desencadeiam apnéia central são os mecanismos fisiopatológicos chave na gênese da respiração de Cheyne-Stokes. Hiperventilação está associada com congestão pulmonar, e a respiração de Cheyne-Stokes tem uma tendência maior de ocorrer durante o sono, quando o centro respiratório é dependente principalmente do controle químico. A respiração de Cheyne-Stokes está associada a quedas recorrentes da saturação de oxigênio e ao despertar do sono, com oscilações recorrentes na freqüência cardíaca, pressão arterial, aumento da atividade simpática e risco aumentado de taquicardia ventricular. A respiração de Cheyne-Stokes é um marcador independente de mau prognostico e provavelmente participa de um ciclo vicioso que contribui para a deterioração cardíaca.

Hemangioendotelioma epitelióide de pleura / Epithelioid hemangioendothelioma of the pleura

Relata-se o caso de um paciente exposto profissionalmente a asbesto por dez anos e portador de um tumor pleural muito raro, o hemangioendotelioma epitelióde. O paciente apresentava derrame pleural serohemorrágico, sem evidência de células neoplásicas e com predomínio de linfócitos. A biópsia pleural por agulha revelou processo inflamatório crônico inespecífico, com áreas de tecido mixóide. A videotoracoscopia mostrou nódulos difusos nas pleuras parietal e visceral. A biópsia revelou neoplasia mesenquimal e eram semelhantes às áreas focais observadas na primeira biópsia. O estudo imunohistoquímico demonstrou a presença dos marcadores vasculares CD31, CD34 e Fator VIII, caracterizando a origem vascular do tumor. O paciente foi tratado com cisplatina e ectoposide, tendo o óbito ocorrido três meses após o diagnóstico.