ABSTRACT
INTRODUCTION: Otosclerosis is a common form of conductive hearing loss characterized by abnormal bone remodeling exclusively in the otic capsule. The prevalence of otosclerosis varies in racial populations and is described as being rare in black African populations. In this paper we aim to report five cases of clinical, and surgically confirmed, otosclerosis in black individuals, in São Tomé and Príncipe. MATERIAL AND METHODS: Since February 2011, Ear, Nose and Throat consultations and surgeries specialty have been carried out at Dr. Ayres de Menezes Hospital in cooperation with the project 'Health for all'. A retrospective analysis was undertaken of the records of all patients subjected either to stapedectomy or partial stapedectomy until February 2014. Information regarding clinical presentation, audiometric data and surgery reports was recorded. RESULTS: Five adult patients underwent stapedectomy or partial stapedectomy. All of them presented with normal otoscopy, conductive or mixed hearing loss on audiogram and normal tympanometry with absent stapedial reflexes. None of the patients had signs of infection or history of head trauma. Three cases showed improvement in the air-bone gap after surgery. The other two were lost to follow-up. DISCUSSION: We documented and surgically confirmed five cases of clinical otosclerosis in this population. A thematic review was carried out and concluded that, despite being described as a rare event in this race, available literature on this topic is not enough to state that there is lower prevalence of otosclerosis amongst the African population. CONCLUSION: Even if not common, otosclerosis cannot be disregarded as a possible cause for conductive hearing loss among the population of São Tomé and Principe.
Introdução: A otosclerose é uma causa frequente de hipoacusia de condução caracterizada pela alteração da remodelação óssea localizada exclusivamente à cápsula ótica. Diferenças rácicas são evidentes na literatura e, ao contrário dos caucasianos, as descrições na população de origem africana são raras. Neste trabalho pretende-se reportar cinco casos observados, e cirurgicamente confirmados, de otosclerose em indivíduos de raça negra, em São Tomé e Príncipe. Material e Métodos: Desde fevereiro de 2011, efetuam-se consultas e cirurgias de Otorrinolaringologia no Hospital Ayres de Menezes, em São Tomé e Príncipe, inseridas no projeto 'Saúde para todos Especialidades'. Neste trabalho realizou-se um estudo retrospetivo dos doentes submetidos a estapedotomia ou estapedectomia parcial durante estas missões até fevereiro de 2014. Recolheu-se informação relativa à apresentação clínica, resultados audiométricos e relatórios cirúrgicos. Resultados: Cinco doentes, adultos, foram submetidos a procedimento cirúrgico. Todos apresentavam otoscopia normal, ausência de história de traumatismo cranioencefálico ou quadro infecioso, audiograma com hipoacusia mista ou de condução e timpanograma tipo A, sem reflexos estapédicos. Em três doentes foi possível realizar audiograma pós-operatório, verificando-se melhoria do gap aero-ósseo. Discussão: Neste trabalho documentam-se cinco casos de otosclerose clínica, e cirurgicamente confirmada, na população negra de São Tomé e Príncipe. Efetuada uma revisão temática, constata-se que, apesar de a otosclerose ser considerada rara nesta raça, os dados disponíveis parecem insuficientes para determinar se, de facto, diferentes raças têm diferentes incidências da doença. Conclusão: Apesar de rara, a otosclerose não pode ser ignorada como uma possível causa de hipoacusia de condução em São Tomé e Príncipe.
Subject(s)
Hearing Loss, Conductive/congenital , Otosclerosis , Adult , Ankylosis/diagnosis , Ankylosis/surgery , Female , Hearing Loss, Conductive/diagnosis , Hearing Loss, Conductive/surgery , Humans , Male , Middle Aged , Otosclerosis/diagnosis , Otosclerosis/surgery , Retrospective Studies , Sao Tome and Principe , Stapes Surgery , Young AdultABSTRACT
The nasal dorsum framework plays a major role in nasal and facial harmony. This study presents a new approach to an already known technique, intermediate osteotomies, which can be used routinely in patients with cosmetically unpleasant changes in eyebrow-tip line features, allowing the acquisition of a natural, aesthetically agreeable and harmonious dorsum contour, while preserving nasal function. The approach was evaluated retrospectively in 50 consecutive patients at a tertiary referral hospital. Patients were asked to complete a survey to rate their satisfaction with the cosmetic outcome on a 5-point visual analog scale (VAS) and to compare the impact of nasal obstruction on their quality of life, pre- and postoperatively, by completing the validated Nasal Obstruction Symptom Evaluation (NOSE) scale. Satisfaction was scored as excellent (satisfaction level VAS average score, 4.4), with more than 50% of the patients completely satisfied with the aesthetic result, while NOSE scale scores demonstrated preservation of nasal function postoperatively. Typical complications of the upper third of the nose following osteotomies were not observed.
Subject(s)
Nasal Obstruction , Osteotomy/methods , Postoperative Complications , Quality of Life , Rhinoplasty , Adult , Female , Humans , Male , Middle Aged , Nasal Obstruction/diagnosis , Nasal Obstruction/etiology , Nasal Obstruction/psychology , Nose/surgery , Patient Satisfaction , Postoperative Complications/diagnosis , Postoperative Complications/psychology , Retrospective Studies , Rhinoplasty/adverse effects , Rhinoplasty/methods , Rhinoplasty/psychology , Surgery, Plastic/psychology , Surgery, Plastic/statistics & numerical data , Treatment Outcome , Visual Analog ScaleABSTRACT
OBJECTIVE: To document the anatomic relationship of the posterosuperior segment of the tympanic membrane. STUDY DESIGN: Point-prevalence study of postmortem material. SUBJECTS AND MATERIALS: One hundred seventy temporal bones from adults without history of otologic pathology were studied. The anatomic details of the tympanic membrane were observed, histology was documented on 30 sectioned bones, and, with the use of the scanning electron microscope, lamina propria was studied in 40 bones. RESULTS: We established that the posterosuperior quadrant was the largest, representing 28.7 percent of the total area of the eardrum. This feature implies that this quadrant is more likely than are the other quadrants to exhibit changes prompted by pressure challenges. We also verified that the posterosuperior part of tympanic sulcus, above the chorda tympanic nerve, lost its depth in an unexpected way in 60 percent of the cases. In association, we established that at this level there was a decrease in annulus caliber. In 25 percent of cases, by the absence of the circular fibers of lamina propria, the posterosuperior quadrant had only the radial fiber layer. CONCLUSIONS: Anatomic and morphologic details in posterosuperior quadrant were newly described and may explain the greater incidence of retraction pockets and marginal perforations that provide origin for the cholesteatoma.
