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1.
Harefuah ; 159(1): 93-97, 2020 Feb.
Artigo em Hebraico | MEDLINE | ID: mdl-32048487

RESUMO

BACKGROUND: After cochlear implantation (CI) there is concern regarding the potential risks of spread of middle ear infection along the electrode array into the cochlea and central nervous system and regarding late sequela of otitis media (OM): eardrum perforation, atelectasis and cholesteatoma. The age for implantation in children overlaps the peak age incidence of acute OM (AOM) and secretory OM (SOM) and delay of implantation reduces the potential benefit from the intervention. Therefore, control of OM by inserting ventilating tubes (VT) is widely performed in pediatric CI candidates who also suffer from otitis media. OBJECTIVES: To refine indications for VT insertion in candidates for cochlear implantation who also suffer from OM. METHODS: Of 200 children referred for CI and implanted one after another, 126 were classified as OM-prone, 98 due to AOM and 28 due to SOM. The rate of development of late sequela of middle ear disease was compared between the two subgroups of OM-proneness. RESULTS: A total of 15 children (7.5%) developed late sequela of middle ear disease; all belonged to the SOM group; 3.5% developed eardrum perforation; 3.5% atelectasis and 0.5% cholesteatoma. CONCLUSIONS: Pre-CI VT insertion in children with SOM who underwent CI did not prevent development of late sequela of middle ear disease; VT insertion with the object of preventing late sequela of middle ear disease in CI candidates who suffer from SOM only is not required; in otitis-prone children a long term oto-microscopic follow-up is needed in order to identify late sequela of middle ear disease.


Assuntos
Implante Coclear , Implantes Cocleares , Otite Média , Criança , Humanos , Ventilação da Orelha Média , Otite Média com Derrame
2.
Int J Pediatr Otorhinolaryngol ; 125: 187-191, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31369930

RESUMO

OBJECTIVES: To characterize the clinical presentation of pediatric patients who, upon AM diagnosis, also had imaging-diagnosed ICCs (ID-ICCs); to define the group of AM patients at risk of developing ID-ICCs; and to update knowledge about organisms causing AM. STUDY DESIGN: Analysis of all AM patients admitted between 1997 and 2018 and treated according to an obligatory protocol including both brain imaging and sampling for bacterial culture upon clinical diagnosis of AM. RESULTS: Of 166 admitted patients (0.5-19 years old) 22 (13%) already had ID-ICCs. In patients who, on admission, had already received antibiotics for acute otitis media (AOM) and also had CRP (C-reactive protein) levels above 93.5 mg/L, the risk of ID-CC was increased by 22.5-fold (P < 0.0001). Bacterial culture results were available for all patients and were positive in 115 (69%). Organisms most commonly found in patients without prior antibiotic treatment were group A Streptococcus pyogenes (53%), Streptococcus pneumoniae (23%), and Haemophylus influenzae (11%), while with prior antibiotic treatment they were Fusobacterium necrophorum (21%), Streptococcus pyogenes (18%) and Pseudomonas aeruginosa (18%). CONCLUSIONS: Since the risk of ID-ICC in patients with the abovementioned CRP and prior antibiotic treatment was significantly higher than in the others, these high-risk patients should undergo diagnostic imaging on admission. Antibiotic treatment prior to AM development may promote growth of non-AOM pathogen.


Assuntos
Antibacterianos/uso terapêutico , Mastoidite/diagnóstico , Mastoidite/terapia , Doença Aguda , Adolescente , Criança , Pré-Escolar , Protocolos Clínicos , Feminino , Fusobacterium necrophorum , Hospitalização , Humanos , Lactente , Masculino , Mastoidite/microbiologia , Otite Média/tratamento farmacológico , Otite Média/microbiologia , Pseudomonas aeruginosa , Estudos Retrospectivos , Streptococcus pneumoniae , Streptococcus pyogenes , Resultado do Tratamento , Adulto Jovem
3.
Laryngoscope ; 122(12): 2813-7, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22961223

RESUMO

OBJECTIVES/HYPOTHESIS: Brain CT is performed in patients presenting with acute mastoiditis (AM) to identify intracranial complications (ICC). Recently, however, the need for CT scans in such patients has been questioned owing to concerns regarding long-term effects of brain irradiation, with some clinicians claiming that the decision to scan should be based on a patient's clinical presentation. This study was aimed at characterizing the typical clinical presentation of patients who already have ICCs when diagnosed with AM, and to compare it to that of AM patients presenting without ICCs. STUDY DESIGN: Prospective case series. METHODS: All patients hospitalized with AM between July 1997 and December 2009 in an otologic tertiary referral center were divided into those with and those without ICCs on presentation. Prereferral clinical characteristics and the signs, symptoms, and inflammatory indexes at presentation were compared between the two groups. RESULTS: Of 71 patients presenting with AM, 10 had at least one ICC (sigmoid sinus thrombosis [nine patients], perisinus empyema [five patients], subdural abscess [one patient], and epidural abscess [one patient]). Patients with and without ICCs did not differ regarding most clinical characteristics or presenting signs and symptoms. None presented with neurological signs or cranial nerve deficits. CONCLUSIONS: It is not possible to define an evidence-based index of suspicion for ICCs in patients with AM. Diagnostic imaging at presentation accordingly remains mandatory.


Assuntos
Abscesso Encefálico/diagnóstico por imagem , Empiema Subdural/diagnóstico por imagem , Abscesso Epidural/diagnóstico por imagem , Mastoidite/complicações , Trombose dos Seios Intracranianos/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Adolescente , Abscesso Encefálico/etiologia , Criança , Pré-Escolar , Diagnóstico Diferencial , Empiema Subdural/etiologia , Abscesso Epidural/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Mastoidite/diagnóstico por imagem , Estudos Prospectivos , Reprodutibilidade dos Testes , Trombose dos Seios Intracranianos/etiologia
4.
Ear Nose Throat J ; 91(5): E16-8, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22614562

RESUMO

A concha bullosa is a common anatomic variant that represents an aerated turbinate, usually the middle turbinate. It is usually asymptomatic. When extensively pneumatized, a large concha bullosa may cause significant problems, including headache, nasal obstruction, and blockage of sinus drainage. We report a case of a large concha bullosa mucopyocele that manifested as recurring migraine headaches. It was successfully treated with surgical excision. We also review the available literature.


Assuntos
Transtornos de Enxaqueca/etiologia , Mucocele/complicações , Doenças Nasais/complicações , Conchas Nasais/patologia , Enfisema/complicações , Empiema/complicações , Endoscopia , Seio Etmoidal/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Mucocele/diagnóstico , Doenças Nasais/cirurgia , Recidiva , Tomografia Computadorizada por Raios X , Conchas Nasais/anormalidades , Conchas Nasais/cirurgia
7.
Laryngoscope ; 121(2): 358-60, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21271588

RESUMO

Hearing loss in Paget's disease, a metabolic bone disease, has been reported in as many as 60% of cases, and is presumably related to changes in mineral density of the otic capsule. We describe a 59-year-old man with Paget's disease who had severe to profound hearing loss and was referred to us for cochlear implantation. Preoperative evaluation revealed poor communication skills despite significant residual hearing, raising concerns about postimplantation outcome. Nevertheless, implantation was successful. As our literature search yielded only one report of cochlear implantation in Paget's disease, we record our clinical experience and discuss the hearing rehabilitation dilemmas in this case.


Assuntos
Implante Coclear , Perda Auditiva/cirurgia , Osteíte Deformante/cirurgia , Perda Auditiva/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteíte Deformante/complicações
8.
Ear Nose Throat J ; 89(5): E17-8, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20461671

RESUMO

Injury to the internal carotid artery during routine pharyngeal surgery is a rare and potentially catastrophic complication. Aberrations of the cervical blood vessels that might cause lethal post-tonsillectomy bleeding are clearly important but largely unpredictable, even when associated with pediatric head and neck syndromes. We describe a patient in whom aberrant cervical carotid artery was an incidental finding prior to a scheduled tonsillectomy.


Assuntos
Artérias Carótidas/anormalidades , Artérias Carótidas/cirurgia , Hemorragia Pós-Operatória/fisiopatologia , Cuidados Pré-Operatórios , Tonsilectomia , Adulto , Artérias Carótidas/diagnóstico por imagem , Evolução Fatal , Humanos , Masculino , Tomografia Computadorizada por Raios X
12.
Ann Otol Rhinol Laryngol ; 117(7): 528-30, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18700429

RESUMO

Visual loss following routine nasal surgery is an extremely rare and devastating complication. We report a case of unilateral blindness due to orbital apex syndrome following septoplasty. We also review the literature and discuss probable causes. To the best of our knowledge, this is only the second published report of this complication.


Assuntos
Cegueira/etiologia , Septo Nasal/cirurgia , Adulto , Humanos , Masculino , Doenças Orbitárias/etiologia , Complicações Pós-Operatórias , Procedimentos de Cirurgia Plástica
13.
Int J Pediatr Otorhinolaryngol ; 72(9): 1445-8, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18635270

RESUMO

A jugular bulb diverticulum (JBD) is considered to be a rare venous anomaly. In exceptional cases it extends into the middle ear cavity with no bony covering, and slight oozing to massive bleeding might be encountered during routine middle ear surgical procedures. We report a case of massive bleeding from a dehiscent jugular bulb diverticulum that appeared during myringotomy and was successfully managed by endovascular embolization. This report emphasizes the value of interventional neuroradiology in otosurgical cases in which preoperative control of blood vessels or vascular malformations is crucial to avoid severe complications.


Assuntos
Divertículo/congênito , Divertículo/terapia , Embolização Terapêutica/métodos , Hemorragia/etiologia , Hemorragia/terapia , Veias Jugulares/anormalidades , Criança , Endoscopia , Feminino , Humanos , Complicações Intraoperatórias , Membrana Timpânica/cirurgia
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