Does ear endoscopy provide advantages in the outpatient management of open mastoidectomy cavities?

OBJECTIVE: To evaluate the use of ear endoscopy in the postoperative management of open mastoidectomy cavities, and to test whether ear endoscopy improves inspection and cleaning compared with ear microscopy. METHODS: Prospective study. Thirty-two ears were divided into two groups: group 1, examination and cleaning of mastoid cavities under endoscopic visualization after microscopic standard ear cleaning; group 2, examination and cleaning of mastoid cavities under microscopic visualization after endoscope-assisted ear cleaning. We assessed the ability of each method to provide exposure and facilitate cleaning, comparing the benefits of microscopy and endoscopy when used sequentially and vice-versa. RESULTS: Endoscopy provided additional benefits for exposure in 61.1% of cases and cleaning in 66.7%. Microscopy provided no additional benefits in terms of exposure in any case, and provided added benefit for cleaning in only 21.4% of cases. DISCUSSION: For outpatient postoperative care of open mastoidectomy cavities, ear endoscopy provides greater benefit over ear microscopy than vice-versa. In over half of all cases, endoscopy was able to expose areas not visualized under the microscope. Furthermore, in two-thirds of cases, endoscopy enabled removal of material that could not be cleared under microscopy. Ear endoscopy was superior to microscopy in terms of enabling exposure and cleaning of hard-to-reach sites, due to its wider field of vision. CONCLUSION: Ear endoscopy is a feasible technique for the postoperative management of open mastoidectomy cavities. Ear endoscopy provided superior advantages in terms of exposure and aural cleaning compared with microscopy.

Hearing preservation in cochlear implant surgery.

In the past, it was thought that hearing loss patients with residual low-frequency hearing would not be good candidates for cochlear implantation since insertion was expected to induce inner ear trauma. Recent advances in electrode design and surgical techniques have made the preservation of residual low-frequency hearing achievable and desirable. The importance of preserving residual low-frequency hearing cannot be underestimated in light of the added benefit of hearing in noisy atmospheres and in music quality. The concept of electrical and acoustic stimulation involves electrically stimulating the nonfunctional, high-frequency region of the cochlea with a cochlear implant and applying a hearing aid in the low-frequency range. The principle of preserving low-frequency hearing by a "soft surgery" cochlear implantation could also be useful to the population of children who might profit from regenerative hair cell therapy in the future. Main aspects of low-frequency hearing preservation surgery are discussed in this review: its brief history, electrode design, principles and advantages of electric-acoustic stimulation, surgical technique, and further implications of this new treatment possibility for hearing impaired patients.

Sarcoma sinovial cervical / Neck Synovial Sarcoma

Introdução: O sarcoma sinovial (SS) é uma neoplasia rara e agressiva, sendo a região da cabeça e pescoço envolvida em 5% a 10% dos casos. A apresentação clínica é uma massa indolor de crescimento progressivo. As metástases ocorrem em 10% a 15% dos casos, principalmente por via hematogênica, para pulmões, linfonodos e medula óssea. O tratamento inclui exérese cirúrgica ampla e radioterapia. Ainda não existem dados que comprovem a eficácia da quimioterapia neste tipo de tumor; seu principal benefício consistiria na prevenção de metástases à distancia. A sobrevida em 5 anos varia de 40% a 50%. Objetivo: Relatar um caso de sarcoma sinovial cervical em mulher de 21 anos. Resultados: Paciente com história de tumor cervical de crescimento rápido há 05 meses, inicialmente indolor. Ao exame a lesão apresentava consistência fibroelástica, superfície lisa, aderida a planos profundos, comprometendo os níveis II, III, IV e V à direita e dor à palpação. Tomografia Computadorizada evidenciando grande tumor homogêneo com efeito de massa nos níveis II a V à direita e ocupando espaço parafaríngeo. Punção aspirativa (PAAF) sugestivo de sarcoma. Foi submetida à ressecção do tumor cervical e quimioterapia adjuvante. O anatomopatológico da lesão, com estudo imunohistoquímico, foi compatível com sarcoma sinovial cervical. Está no o 3º ano de seguimento pós-operatório e encontra-se sem sinais de lesão residual ou recidiva. Conclusão: o sarcoma sinovial cervical é uma neoplasia rara e agressiva que demanda ressecção cirúrgica ampla.

Introduction: The synovial sarcoma (SS) is a rare and aggressive neoplasm, with the head and neck involved in 5% to 10% of cases. The clinical presentation is a painless mass with progressive growth. Metastases occur in 10% to 15% of cases, mainly hematogenic to lungs, lymph nodes and bone marrow. Treatment includes wide surgical excision and radiotherapy. There are no data to prove the effectiveness of chemotherapy in this tumor type, but its main benefit would be the prevention of distant metastases. The 5-year survival ranges from 40% to 50%. Objective: To report a case of synovial sarcoma of the neck in a 21 years old female. Results: female with history of cervical tumor of rapid growth for 05 months, initially painless. On examination the lesion presented fibroelastic consistency, smooth surface, adhered to deep planes, compromising levels II, III, IV and V to the right. Computed tomography revealed a large homogenous tumor with mass effect on levels II to V and occupying the right parapharyngeal space. Needle aspiration were suggestive of sarcoma. Underwent resection of the cervical tumor and adjuvant chemotherapy. Histopathological examination of the lesion with immunohistochemical study was consistent with cervical synovial sarcoma. She is in the 3rd year of postoperative follow-up and found no signs of residual lesion or recurrence. Conclusion: synovial sarcoma of the neck is a rare and aggressive neoplasm that requires wide surgical resection.