Sudden hearing loss: a ten-year outpatient experience.

The aim of this study was to determine the effects of various treatment modalities employed for patients with sudden sensorineural hearing loss (SHL). We retrospectively evaluated the records of patients treated in the sudden hearing loss section of the Otolaryngology Department at Clinic Hospital, School of Medicine, University of São Paulo, Brazil, between 1996 and 2006. Our study included patients with SHL of sudden onset (occurring over a 72-hour period) at equal to or greater than 30 dB at three consecutive frequencies. We divided patients into five groups by profile and treated them with dextran, dexamethasone, acyclovir, nicotinic acid, and papaverine hydrochloride (with or without vitamin A). We performed audiometry at baseline and on days 30, 90, 120, and 180 of treatment. We determined outcome as the difference between day-0 and day-180 pure-tone averages (PTAs). Among the 139 patients evaluated, baseline PTA was similar in all groups. We observed significant improvements in PTAs after 180 days of treatment and noted a significant linear correlation between time from SHL onset to initial visit and recovery. However, no significant difference was evident among the treatment groups. In the treatment of SHL, dextran provided no more benefit than did dexamethasone or acyclovir. Earlier initiation of treatment improves the prognosis for patients with SHL.

Surdez súbita: experiência terapêutica de dez anos / Sudden hearing loss: ten years' treatment experience

Observar a evolução da surdez súbita em pacientes incluidos em diferentes grupos de tratamento, de acordo com o tempo de evolução da doença e com as contra-indicações para uso de medicações...

Determine the follow-up between patients sudden sensorineural hearin loss treated in five different groups according of disease and the drugs used for treatment...

Improvement of bruxism after T & A surgery.

UNLABELLED: Bruxism or tooth grinding is an oral habit that frequently occurs during sleep. Some authors suggest it is associated to sleep apnea. OBJECTIVES: The main goal of this study is compare the incidence of bruxism before and after adenotonsillectomy (T & A surgery) in children with sleep-disordered breathing. METHODS: This is a prospective study in which we evaluated 69 consecutive children from the Otolaryngology Department of the University of São Paulo Medical School in pre- and post-surgical periods of adenotonsillectomy. Before and after surgery parents answered a questionnaire about sleep-disturbed breathing and bruxism. Children were submitted to E.N.T. examination and speech pathologist evaluation. The orthodontist inspected malocclusion. Before surgery all the 69 children presented sleep apnea and 45.6% presented bruxism. Malocclusion could be found in 60.71%. Three months after surgery none of the children presented breathing problems and only 11.8% presented bruxism. There was no difference in malocclusion. CONCLUSIONS: This study suggests that there is a positive correlation between sleep-disordered breathing and bruxism. There was an important improvement of bruxism after T & A surgery. Otolaryngologists must be aware that this pernicious sleep disorder is associated to airway obstruction and so, it must be considered when evaluating T & A hyperplasia.

Crescimento pôndero-estatural de crianças após adenoamigdalectomia / Weight and height development in children after adenotonsillectomy

A hiperplasia adenoamigdaliana é a principal causa de obstruçäo das vias aéreas superiores em crianças, sendo muitas vezes associada à apnéia do sono. Esta, por sua vez, resulta em uma série de comprometimentos: baixo rendimento escolar, cor pulmonale, distúrbios de comportamento näo específicos, hiperatividade, sonolência diurna, distraçäo e atrasos de desenvolvimento, sendo o déficit pôndero-estatural o mais grave. A adenoamigdalectomia é o tratamento de escolha. O objetivo deste trabalho é mensurar o crescimento e desenvolvimento das crianças antes e depois da adenoamigdalectomia através da comparaçäo dos percentis pré e pós operatórios. FORMA DE ESTUDO: Clínico prospectivo randomizado. MATERIAL E MÉTODO: Cinquenta e cinco crianças de 2 a 12 anos, com história de obstruçäo das vias aéreas superiores por hiperplasia adenoamigdaliana foram submetidas a exame antropométrico (peso e altura), antes e 6 meses após a adenoamigdalectomia. Os dados foram transformados em percentil para peso e altura, de acordo com a idade e comparados através de análise estatística. RESULTADOS: No pré-operatório, encontramos a seguinte distribuiçäo para o percentil altura: 78,2 por cento, abaixo de p75 e para peso 70,9 por cento abaixo de p50. No pós-operatório observou-se melhor distribuiçäo das crianças: para altura 34,6 por cento abaixo de p75, 32,8 por cento entre p75-95 e 32,6 por cento para p95 e acima e para peso: 35,5 por cento abaixo de p50, 36,4 por cento para p50-95 e 29,1 por cento acima de p95. CONCLUSÄO: Observou-se uma melhora considerável do desenvolvimento pôndero-estatural das crianças após a adenoamigdalectomia

Sudden deafness and Lyme disease.

OBJECTIVES/HYPOTHESIS: Otolaryngological manifestations are common in Lyme disease, affecting up to 75% of patients. One of these symptoms is sudden deafness. Hearing loss has been frequently described in Lyme disease; on the other hand, titers seropositive for, the causal agent of this disease, have been found in almost 20% of cases of sudden deafness. No consensual information exists on the outcome of Borrelia-seropositive patients or on the importance of determining Borrelia antibody titers. The present study aimed to determine the prevalence of seropositivity for Borrelia in sudden deafness, describing clinical characteristics and outcomes. STUDY DESIGN: This was a prospective observational study. METHODS: Forty-seven consecutive patients with sudden deafness were enrolled in the study. Demographic data, the presence of tinnitus and vertigo, and low- and high-frequency pure-tone averages were recorded. The percentage of hearing recovery was determined. Data obtained from Borrelia-seropositive patients were described and compared with those from the seronegative group. RESULTS: Titers positive for antibodies were present in 21.3% of the cases. Seropositive and seronegative groups of patients were homogeneous concerning age, sex distribution, the presence of tinnitus and vertigo, and high- and low-frequency hearing thresholds. Hearing outcome was not significantly different between the groups of patients. CONCLUSIONS: No distinctive clinical characteristic was found between seropositive and seronegative subjects. The hearing outcome of treated Borrelia-seropositive patients was similar to that of the seronegative group.

Prevalência das alteraçöes metabólicas em pacientes portadores de queixas vestibulares / Prevalency of metabolic disorders in dizzy patients

FORMA DE ESTUDO: Clínico prospectivo. MATERIAL E MÉTODO: Os autores avaliam a prevalência de alteraçöes metabólicas em 325 pacientes que procuraram o Setor de Otoneurologia do Hospital das Clínicas da FMUSP com queixas vestibulares. Os pacientes foram consecutivamente atendidos entre janeiro de 1997 e janeiro de 2002. Foram avaliados os primeiros exames referentes ao protocolo clássico de investigaçäo das tonturas, que compreende a dosagem de LDL colesterol, TSH, T3 e T4 e glicemia de jejum. As alteraçöes encontradas foram entäo comparadas às observadas na populaçäo geral. As alteraçöes mais significativas encontradas foram a elevaçäo dos níveis de LDL colesterol, a presença de níveis alterados de hormônios tireoideanos e a maior freqüência do diabetes mellitus na populaçäo estudada. CONCLUSÄO: Conclui-se que é válida a investigaçäo destes dados, visto que säo mais freqüentes na populaçäo de risco e que a correta abordagem dessas alteraçöes melhora o prognóstico e o controle da tontura

Psammomatoid ossifying fibroma.

Psammomatoid ossifying fibroma (POF) represents a unique subtype of fibro-osseous lesions. We describe a case of POF involving the orbit and the sinonasal tract, in a 13-year-old white female. Diagnosis depends on the histological, radiological and clinical features. Complete excision by endoscopic nasal surgery was the treatment of choice. Five years later the patient was free from symptoms and tumour recurrence. Differential diagnoses are discussed.

Nistagmo de privaçäo vértebro-basilar e doppler no diagnóstico de insuficiência vértebro-basilar / Nistagmus of vertebrobasilar privation and doppler in the diagnosis of vertebrobasilar insufficiency

Introduçäo: A insuficiência vértebro-basilar (IVB) é causa freqüente de vertigem, especialmente em idosos, que comumente sofrem de aterosclerose e espondiloartrose cervical. Nos últimos 10 anos, temos utilizado o nistagmo de privaçäo vértebro-basilar (NPVB) para diagnosticar IVB. O objetivo do nosso estudo é avaliar a utilidade do método duplex scan para detectar compressäo da artéria vertebral em pacientes com sintomas de IVB e NPVB positivo. Material e método: Um total de 21 pacientes com sintomas de IVB e NyPVB positivo foi avaliado. Exames com duplex scan (7,5 MHz, SD 800 Philips) foram realizados para avaliar as artérias vertebrais (21 pacientes) e artérias carótidas (15 pacientes). Resultados: Compressäo de artéria vertebral foi encontrada em quatro (19 por cento) pacientes: três compressöes extrínsicas e uma intrínseca. O diagnóstico foi baseado na diminuiçäo ou ausência de fluxo evidenciada pelo duplex scan após uma rotaçäo de cabeça do paciente. Conclusäo: O NPVB e relativamente freqüente em pacientes com sintomas de IVB. Apesar da história e do exame físico, o método: duplex scan mostrou poucos casos de IVB (19 por cento), o que pode ser explicado pela limitaçäo dele em avaliar regiöes anatômicas de difícil acesso, como as artérias vertebrais. Concluímos que o NPVB é mais útil que o duplex scan no diagnóstico de IVB