Otalgia como forma de presentación atípica de Chikungunya: Serie de casos / Atypical Otalgia Presentation of Chikungunya: A Case Series

Introducción: La otalgia no se reporta como una manifestación frecuente de Chikungunya en la literatura. Se reportan casos de otalgia en el contexto de Chikungunya y se expone su manejo. Casos clínicos: Se presentan dos casos de mujeres de 26 y 32 años que acudieron con cuadro febril, exantema, artralgias y otalgia unilateral con tumoración preauricular. Ambas tuvieron anticuerpos IgM anti-Chikungunya positivos y adenopatías intraparotídeas en ecografía. Se trataron con AINES y corticoides con buena respuesta. Discusión: La adenitis cervical por Chikungunya se reporta con frecuencia variable, pero no como síntoma dominante. La otalgia unilateral permite descartar otitis. Su manejo es conservador con buenos resultados. Conclusión: Se presentó una serie de casos de otalgia refleja unilateral por adenitis intraparotídea en Chikungunya, destacando su diagnóstico diferencial y manejo.

Introduction: Otalgia is not reported as a frequent manifestation of Chikungunya in the literature. Cases of otalgia in the context of Chikungunya are reported and their management is exposed. Clinical cases: Two cases of women aged 26 and 32 years who presented with fever, rash, arthralgias and unilateral otalgia with preauricular tumor are presented. Both had positive anti-Chikungunya IgM antibodies and intraparotid lymphadenopathy on ultrasound. They were treated with NSAIDs and corticosteroids with good response. Discussion: Cervical adenitis due to Chikungunya is reported with variable frequency, but not as a dominant symptom. Unilateral otalgia allows to rule out otitis. Its management is conservative with good results. Conclusion: A series of cases of unilateral reflex otalgia due to intraparotid adenitis in Chikungunya was presented, highlighting its differential diagnosis and management.

Role of the Surgical Approach in the Treatment of Eagle Syndrome.

Introduction Eagle syndrome is a rare and an often misdiagnosed entity in otorhinolaryngology. Objective To determine the efficacy of the surgical treatment for Eagle syndrome. Methods The present prospective study included 25 patients who presented with complaints of pain in the throat, ear, and neck, as well as difficulty and/or pain while swallowing; they were assessed for Eagle syndrome. As per patient profile, we performed a clinical assessments along with orthopantomograms (OPGs), three-dimensional computed tomography (3D CT) scans, and cone beam computed tomography (CBCT). Pain was assessed pre- and postoperatively through the Numerical Rating Scale-11 (NRS-11), whose score ranges from 0 to 10. Microscopic tonsillo-styloidectomy was performed in cases in which the conservative treatment failed to relieve pain. Results The mean age of the entire study population was of 36.08 ± 7.19 years, and the male-to-female ratio was of 1.08:1. Referred otalgia was the commonest (44%) complaint. Radiologically, out of 25 patients, 20 patients presented elongated styloid processes. The longest symptomatic styloid process measured radiographically was of 64.7 mm while the shortest was of 28.2 mm. Out of 20 patients, 12 underwent surgery. The postoperative pain assessment through the NRS-11 was performed on day 0 (3.83 ± 0.83), day 7 (1.5 ± 0.52), week 4 (0.5 ± 0.52), and week 12 (0.41 ± 0.51). By 12 weeks, 7 patients were symptom-free, while 5 patients still reported mild pain. Conclusion Eagle syndrome associated with an elongated styloid process is not a rarity, but it often goes undiagnosed. Microscopic tonsillo-styloidectomy shows excellent results in the management of patients with Eagle syndrome.

Subtypes of temporomandibular disorders in patients diagnosed with otalgia: observational study / Subtipos de desordem temporomandibular em pacientes diagnosticados com otalgia: estudo observacional

ABSTRACT BACKGROUND AND OBJECTIVES: Temporomandibular disorder (TMD) has complex symptoms that involve the orofacial region, such as otalgia. Considering the difficult differential diagnoses for associating otological symptoms with TMD. The aim of this study was to verify the diagnosis of TMD in patients with otalgia. METHODS: This is a cross-sectional and descriptive study, where 75 patients diagnosed with otalgia were evaluated. The European Academy of Craniomandibular Disorders's (EACD) screening questionnaire was initially applied, and those who answered affirmatively to at least one question were evaluated by the Research Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), with a final sample of 50 patients. Data were tabulated and ANOVA verified whether there was a statistical difference between TMD subtypes classified by DC/TMD, considering confidence intervals with 95% significance. RESULTS: The mean age of the participants was 39.9±14.1 years, with a predominance of females (76%) (p<0.0001). Among those diagnosed with TMD, females also predominated, with a higher percentage in all evaluated subtypes, with emphasis on arthralgia (82%) and myofascial pain with limited opening (81.8%), followed by myofascial pain (74%) and disc displacement with reduction (72.7%). When observing the distribution of TMD subtypes between genders, there was a predominance of myofascial pain in males (75%) and females (68%), but no statistical significance was observed in this variable and in the others studied. CONCLUSION: Patients with otalgia had one or more TMD subtypes, and the myofascial subtype TMD was the most prevalent among study participants.

RESUMO JUSTIFICATIVA E OBJETIVOS: A disfunção temporomandibular (DTM) possui sintomas complexos que envolvem a região orofacial, como a otalgia. Considerando os difíceis diagnósticos diferenciais para associar sintomas otológicos com DTM. O objetivo deste estudo foi verificar o diagnóstico de DTM em pacientes com otalgia. MÉTODOS: Este é um estudo transversal e descritivo, com uma avaliação de 75 pacientes diagnosticados com otalgia. O questionário de triagem da Academia Europeia de Disfunções Craniomandibulares (EACD) foi aplicado inicialmente, e aqueles que responderam afirmativamente a pelo menos uma questão foram avaliados pelo Critério Diagnóstico de Pesquisa para Disfunções Temporomandibulares (DC/TMD), com amostra final de 50 pacientes. Os dados foram tabulados e por meio da ANOVA foi verificado se havia diferença estatística entre os subtipos de DTM classificados pelo DC/TMD, considerando intervalos de confiança com 95% de significância. RESULTADOS: A idade média dos participantes foi de 39,9±14,1 anos. Além disso, predominou-se o sexo feminino (76%) (p<0,0001), com maior percentual em todos os subtipos avaliados, destacando-se a artralgia (82%) e a dor miofascial com limitação de abertura (81,8%), seguida da dor miofascial (74%) e deslocamento de disco com redução (72,7%). Quando observada a distribuição dos subtipos de DTM entre os sexos, notou-se predominância de dor miofascial no sexo masculino (75%) e feminino (68%), mas não foi observada significância estatística nessa variável e nas demais estudadas. CONCLUSÃO: Os pacientes com otalgia manifestaram mais de um dos subtipos de DTM, sendo o subtipo de dor miofascial o mais prevalente entre os participantes do estudo.

Otalgia secundaria o referida, lo que el clínico debe saber

Resumen La otalgia es un motivo de consulta frecuente en otorrinolaringología que se puede clasificar en dos tipos: primaria y secundaria. La otalgia primaria es una consecuencia de una enfermedad otológica mientras que la secundaria o referida, surge de procesos patológicos que se originan en estructuras distintas del oído, pero que comparten vías neuronales comunes. Estas vías la componen los nervios craneales V, VII, IX y X y los nervios cervicales C2 y C3. Las causas más comunes de otalgia secundaria son la patología musculoesquelética como la disfunción de la articulación temporomandibular y el síndrome miofascial, la patología dental y las infecciones orofaríngeas. Para encontrar la etiología de la otalgia secundaria, en la mayoría de los casos, una historia clínica y examen físico acucioso resultarán suficientes, sin embargo, existe un grupo de pacientes con factores de riesgo que pudiesen requerir estudios adicionales. El objetivo de esta revisión es otorgar herramientas al lector para comprender los distintos procesos involucrados en la otalgia secundaria, conocer las patologías más relevantes relacionadas y de esta forma entregar al clínico una pauta para enfrentar este motivo de consulta.

Abstract Otalgia is a common reason for consultation in otolaryngology and can be classified into two types: primary or secondary otalgia. Primary otalgia is a consequence of an otological disease while secondary otalgia arises from pathological processes that originate in other structures different than the ears, but share common neuronal pathways. These pathways involve cranial nerves V, VII, IX and X and cervical nerves C2 and C3. The most common causes of secondary otalgia are musculoskeletal pathology such as temporomandibular joint dysfunction and myofascial syndrome, dental pathology and oropharyngeal infections. To find the etiology of secondary otalgia, in most cases a medical history and physical examination will be sufficient, however there is a group of patients with risk factors that may require additional studies. The objective of this review is to give the reader tools to understand the different processes involved in secondary otalgia, know the most relevant related pathologies and thus give the clinician a guide to deal with this problem.

Stylohyoid Ligament Calcification: A Greater-Than-Expected Cause of Otalgia in Turner Syndrome.

CONTEXT: Otitis is common in patients with Turner syndrome (TS) and may be misdiagnosed in the presence of other causes of otalgia. OBJECTIVE: We hypothesized that stylohyoid ligament calcification (SLC), named Eagle syndrome (ES), is a common cause of otalgia in TS. DESIGN: Cohort of 1-year data collection. SETTING: We analyzed all consecutive women with Turner syndrome (TW). PATIENTS: Ninety-six TW and 55 age-paired normal control women (CW). INTERVENTION: Participants were asked about current or past otalgia and had bilateral tonsillar palatine palpated by the same physician. MAIN OUTCOME MEASURES: When otalgia or cervicalgia plus painful palatine tonsil palpation was positive, participants underwent facial X-ray or three-dimensional cranial CT. If SLC was >25 mm, ES was confirmed. RESULTS: Thirty-four TW (35%) had clinical signs and 27/34 (79%) had radiologically confirmed ES. Of the TW with confirmed ES (27/96; 28%), 14 (51.9%) were inadvertently treated for recurrent otitis as a presumed cause of otalgia. Eleven of the TW with ES (26.1%) were below age 21. There was no association with karyotype, age, body mass index, or growth hormone use. Ten CW (18.2%) complained of symptoms of ES, but only 4 (7.3%) were radiologically confirmed (CW vs TW, P < 0.01), and none were <21 years old. ES occurred more at younger ages in TW (P < 0.002). CONCLUSION: ES is more prevalent in TW than in controls and occurs at younger ages. ES must be assessed as a common comorbidity of TS at any age, especially during childhood, as a differential diagnosis of otalgia.

Otitis media aguda y crónica, una enfermedad frecuente y evitable / Chronic acute otitis media, a frequent and avoidable disease

Las infecciones de oído son frecuentes en la edad pediátrica, son resultado de la afectación de las vías respiratorias superiores, y una de las principales causas de atención médica. La otalgia, otorrea e hipoacusia son los signos y síntomas predominantes cuya atención no sólo reducirá la morbilidad, además evita complicaciones y secuelas. La hipoacusia es la causal más importante de sordos en nuestro país. Su conocimiento, atención y prevención evitarán complicaciones que pongan en riesgo no sólo la función auditiva, sino la vida, situación que puede ser evitada en su totalidad. El tratamiento oportuno de la hipoacusia ofrece una reducción de la morbimortalidad y una mejor calidad de vida.

Ear infections are frequent in children, as a consequence of disease in the upper airway; and also are one of the main causes for medical care. Otalgia, otorrhea and hypoacusis are the predominant signs and symptoms, whose treatment not only will decrease morbidity, but also avoid complications and sequelae such as hearing impairment, the most important cause for deafness in our country. Knowledge, care and prevention will prevent complication that threaten not only function but also life itself; situation that may be completely helped. Timely treatment reduces morbid-mortality and improves quality of life.

Dimensión vertical en edentados: relación con síntomas referidos / Vertical dimension on edentulous patient: relationship with symptoms reported

La dimensión vertical es una medida aproximada de las relaciones fisiológicas intermaxilares. Su obtención es un proceso sensible y metódico que produce efectos craneofaciales colaterales cuando es erróneamente lograda. Los conceptos individualistas de su obtención deben ser cambiados e interiorizados de una manera colectiva debido a la complejidad de la dinámica masticatoria que exige una perspectiva más amplia de esta noción. La correspondencia entre la dimensión vertical y lo funcional-disfuncional cráneo-cervical es innegable y va mas allá de una relación exclusivamente dental. Esta revisión busca situar al lector en una realidad estomatognática y no solo odontológica, que exige mayores esfuerzos y un cambio de perspectiva en la conceptualización de la importancia de la dimensión vertical en el normal funcionamiento del sistema estomatognático y de estructuras vecinas en el paciente edentado.

Vertical dimension is an approximate measure of the physiological inter-maxillary relations. Its register is a sensitive and methodical process with craniofacial side effects when wrongly achieved. Single concepts for vertical dimension register should be changed and understood in a collective manner. The complexity of the masticatory dynamics requires a broader view of this notion. The correspondence between the vertical dimension and the functional-dysfunctional cranio-cervical relations is undeniable and goes beyond an exclusively dental relation. This review seeks to place the reader in a stomatognathic functional perspective, which requires greater efforts of the prosthodontics operator. Normal functioning of the stomatognathic system and surrounding structures in the edentulous patient depends on the conceptualization about the importance of vertical inter-maxillary relations.

Estudo da participação de sinais e sintomas de disfunção temporomandibular (DTM) e sintomas otológicos em pacientes portadores de zumbido subjetivo / A cross-sectional study of the influence of signs and symptoms of temporomandibular disorders and otologic symptoms in tinnitus patients

A presença de sintomas otológicos em pacientes com Disfunção Temporomandibular (DTM) é uma constante. Apesar de ainda não existir um consenso sobre a origem desses sintomas, a literatura apresenta uma série de trabalhos que comprovam essa associação. O presente estudo avaliou a prevalência de DTM em pacientes portadores de zumbido e a associação deste com outros sintomas otológicos, como otalgia, plenitude auricular, tontura/vertigem, hipoacusia e hiperacusia. Também foi estudada a prevalência de perda auditiva entre os portadores de zumbido, com e sem DTM. Além disso, foi avaliado índice de depressão dos pacientes e a influência do zumbido na qualidade de vida dos mesmos. Foram selecionados 200 pacientes, 100 portadores de zumbido e 100 sem zumbido. Para avaliar a presença de sintomas otológicos, os pacientes foram avaliados por um Otorrinolaringologista através da utilização do Protocolo de Zumbido e Hiperacusia do HC-FMUSP. Os pacientes responderam a questionários e foram submetidos à anamese, exames clínico e físico. Para classificar os pacientes em portadores de DTM ou não, foi utilizado o Research Diagnostic Criteria for Temporomadibular Disorders (RDC/TMD). Para avaliar o índice de depressão foi utilizado o questionário Eixo II do RDC/TMD. A severidade da DTM também foi determinada através de um questionário. Para avaliar o impacto do zumbido na qualidade de vida dos pacientes, foi utilizado o Tinnitus Handicap Inventory (THI), validado para a língua portuguesa. A avaliação audiológica foi feita em 48 dos pacientes com zumbido e realizada por um Fonoaudiólogo. Os dados obtidos foram submetidos à análise estatística (Quiquadrado, Mann-Whitney, Spearman) com um nível de significância de 5%. Dos 100 pacientes portadores de zumbido subjetivo 84 eram mulheres e 16 homensque tinham idade média de 39,16 anos. Os outros 100 pacientes não possuíam zumbido, eram 65 mulheres e 35 homens, com idade média de 34,33 anos.

A prevalência de DTM no grupo de pacientes com zumbido foi de 85% e no grupo sem zumbido de 55% e essa diferença foi estatisticamente significante (p=0,001). A prevalência dos sintomas otológicos foi avaliada e todos foram estatisticamente associados (p=0,001) com a presença de zumbido: otalgia 27%; tontura/vertigem 52%; plenitude auricular 61%; hipoacusia 62% e hiperacusia 26%. A severidade da DTM foi associada positivamente com a presença de zumbido (p=0,001). A prevalência de DTM na amostra total foi de 70% (n=140). Para todos os sintomas otológicos houve uma associação estatisticamente significante com a presença de DTM (p=0,05). Não houve diferença entre as médias dos valores do THI entre os pacientes com e sem DTM do grupo com zumbido (p=0,67). Também não houve correlação estatisticamente significante entre o tempo de zumbido e qualidade de vida (p=0,73). Os pacientes com zumbido apresentaram maiores níveis de depressão (p=0,001). A prevalência de perda auditiva entre os pacientes com zumbido foi de 4,17% e nos pacientes portadores de DTM foi de 2,63%. A presença de DTM parece não influenciar os resultados dos exames audiológicos.

The aim of this study was to determinate the prevalence of signs and symptoms of TMD and otologic symptoms in tinnitus patients. The association between the severity of TMD and tinnitus and the influence of tinnitus in patient´s quality of life and the level of depression were also addressed. Audiologic evaluation in tinnitus patients was performed in order to verify the association of hearing loss and TMD. Two hundred patients participated on this study, divided into two groups by an experimented Otolaryngologist. The experimental group was comprised of 100 tinnitus patients and control group was comprised of 100 individuals without tinnitus. All subjects were evaluated using RDC/TMD in order to determinate the presence of TMD. The severity of the TMD was determinated by using a self-reported anamnestic questionnaire. The influence of tinnitus in quality of life was determinated by the Tinnitus Handicap Inventory (THI). Depression level was determinate by the SCL-90 from RDC/TMD axis II. Audiologic evaluation was performed in 48 tinnitus patients with and without TMD. Chi-square, Mann-Whitney and Spearman tests were used in statistical analysis, with a 5% significance level. The prevalence of signs and symptoms of TMD in tinnitus patients was 85% and statistical association was found (p=0.001). Stuffy sensations were found in 61% of patients (p=0.001), dizziness in 52% of patients (p=0.001), otalgia in 27% of patients (p=0.001), hypoacusis and hyperacusis in 62% and 27% of patients (p=0.001), respectively. The severity of TMD was positively associated with tinnitus (p=0.001). The mean THI value for TMD was 33.38 while for non-TMD patients was 34.93, with no statistical difference (p=0.67) between them.

Depression levels for tinnitus patients were statistically higher than non-tinnitus patients (p=0.001). The prevalence of hearing loss in tinnitus patients was 4.17% and among TMD patients was 2.63%. It was concluded that tinnitus isassociated with TMD, as well as with higher depression levels. On the other hand, hearing loss was not associated with TMD.