RESUMO
This is a 3.5-year retrospective review on the insertion of 210 Goode T tubes into 182 ears of 93 patients. Otorrhea was noted postoperatively in 35.2% of the ears treated, with chronic drainage lasting longer than 4 months developing in more than 7% of the cases. Perforations were found in 34 ears (18.7%) following removal or extrusion of the T tubes; in 13 (7.1%) of these patients, chronic perforations requiring tympanoplasties developed. The literature was screened for additional studies addressing the complications associated with tympanostomy tubes. The documented incidence of perforations between conventional tubes and Goode T tubes was emphasized, and comparisons were made. Our findings indicate that, even with the immediate placement of paper patches following removal of all Goode T tubes, the percentage of tympanic membrane perforations resulting from the use of Goode T tubes is significantly greater than previously reported.
Assuntos
Ventilação da Orelha Média/efeitos adversos , Ventilação da Orelha Média/instrumentação , Adolescente , Adulto , Infecções Bacterianas/etiologia , Criança , Pré-Escolar , Otopatias/etiologia , Seguimentos , Humanos , Lactente , Otite Média/terapia , Recidiva , Estudos Retrospectivos , Supuração/etiologia , Membrana Timpânica/lesõesRESUMO
Chondrosarcoma of the nose and paranasal sinuses is extremely rare. We report a case of a child with a massive chondrosarcoma of the sphenoethmoid complex who presented with a change of visual acuity. Clinical and histologic characteristics of this lesion are discussed, along with treatment options and factors affecting prognosis.
Assuntos
Condrossarcoma/patologia , Seio Etmoidal/patologia , Neoplasias Nasais/secundário , Neoplasias Orbitárias/secundário , Neoplasias dos Seios Paranasais/patologia , Seio Esfenoidal/patologia , Criança , Condrossarcoma/secundário , Condrossarcoma/cirurgia , Seio Etmoidal/cirurgia , Humanos , Masculino , Cavidade Nasal , Neoplasias Nasais/diagnóstico , Neoplasias Nasais/cirurgia , Neoplasias Orbitárias/complicações , Neoplasias Orbitárias/diagnóstico , Neoplasias Orbitárias/cirurgia , Neoplasias dos Seios Paranasais/secundário , Neoplasias dos Seios Paranasais/cirurgia , Seio Esfenoidal/cirurgia , Baixa Visão/etiologiaRESUMO
Differential diagnosis of cervical masses varies with the age of the patient. In children, neck masses are most likely to be inflammatory or congenital, and evaluation may include routine laboratory evaluation, skin tests, chest films, computed tomography and/or magnetic resonance imaging of the neck, and, possibly, fine-needle aspiration of the mass. The workup in young adults is similar to that in children. In older patients (greater than 40 years), however, the likelihood of malignant disease increases significantly. These patients should have formal endoscopy with biopsy of any suspicious lesions before an open biopsy of the neck mass is performed.
Assuntos
Envelhecimento/patologia , Carcinoma de Células Escamosas/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico , Adolescente , Adulto , Biópsia por Agulha , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/patologia , Criança , Diagnóstico Diferencial , Neoplasias de Cabeça e Pescoço/etiologia , Neoplasias de Cabeça e Pescoço/genética , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Pescoço/anatomia & histologiaRESUMO
Technological advances in neuroradiology and the development of skull base surgery in neurotology have improved diagnosis and management of lesions eroding the tegmen tympani. The diagnosis of brain hernia is to be suspected in patients with a history of complicated chronic ear surgery and a slowly developing pulsatile mass with CSF leak. Patients are best evaluated in the upright position, with an otomicroscope and by magnetic resonance imaging (MRI). Over 6 years, our group has treated seven patients with eight space-occupying lesions eroding the tegmen. Five of the lesions were repaired with a temporalis muscle flap, 2 with fascia and bone, and 1 with Marlex. A review of new technology in the diagnosis of brain hernia and a modification of previous techniques is given.
Assuntos
Orelha Média/cirurgia , Encefalocele/cirurgia , Polipropilenos , Adolescente , Adulto , Otorreia de Líquido Cefalorraquidiano/diagnóstico , Criança , Encefalocele/diagnóstico , Feminino , Humanos , Masculino , Polietilenos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Retalhos CirúrgicosRESUMO
Because of the controversy regarding the benefits of the lateral neck and chest radiographs in the evaluation of croup and epiglottitis, a two-part retrospective study was initiated. Part I consisted of a retrospective chart review of 44 patients with a final diagnosis of croup and epiglottitis. Part II consisted of the 42 lateral neck and chest x-rays from patients in part I presented to six radiologists who knew only the patients age and the history of respiratory distress. Two hundred forty-six responses were obtained. The results of the part I study showed that 64% of patients with documented epiglottitis had a positive radiologic diagnosis. Only 33% of patients with croup had a positive radiologic diagnosis and importantly 27% had a diagnosis of possible epiglottitis. The results of part II showed 38% of the documented epiglottitis patients had a positive lateral neck radiograph. The croup patients had a lateral neck and/or chest x-ray positive in 38%. Of interest, 24% had readings consistent with possible epiglottitis. Based on this two-part study, it is our conclusion that the lateral neck and chest x-ray may be unreliable and inaccurate in the diagnosis of croup and epiglottitis. Caution and good clinical judgement should be utilized when interpreting these x-rays.
