Ana Margarida Amorim

Vértigo posicional paroxístico benigno: revisión de 101 casos

INTRODUCTION AND OBJECTIVE Benign paroxysmal positional vertigo is one of the most common vestibular disorders, with a lifetime prevalence of 2.4%. This study aimed to assess age, gender, lesion type and site, association with other vestibular diseases, progression and recurrence in a Portuguese population. METHODS This was a retrospective observational study of 101 patients diagnosed with benign paroxysmal positional vertigo by the same senior doctor, in a tertiary academic hospital, between January 2009 and May 2011. RESULTS A total of 101 cases were pooled, with a mean age of 56.57±15.33 years (15-90 years). From these, 72.3% were women. The posterior canal was affected in 72.3%, the lateral in 24.7%, the anterior in 2% and multiple canals in 1%. Unilateral canal and left labyrinth involvement were more frequent. The therapeutic maneuver used most was Epleys. Recurrence was observed in 10.9% of the cases. It was idiopathic in 83.2% of cases. No association was found between the number of maneuvers necessary to treat benign paroxysmal positional vertigo and etiology. CONCLUSION Benign paroxysmal positional vertigo is more frequent in female subjects, in the 6th decade and involves preferably the posterior semicircular canal of the right labyrinth. In most cases it is idiopathic and treatment with repositioning maneuvers has a mean success of 90%. Our results were in accordance with the literature; nevertheless, in this study the left labyrinth was most affected and the follow-up period was variable.

Complications of ear mold impressions: two case reports.

An 8-year-old male, with a past history of right chronic otitis media, with tympanic membrane perforation was advised to use an external auditory canal protector for preventing the entrance of water in the ear. This was a measure to prevent the occurrence of infections before further surgery. During the process of impression taking, the patient experienced extreme pain and worsening of hearing loss and the ear mold was impossible to remove. He was referred to the ENT emergency department where in otoscopy, it was possible to see a foreign material under the tympanic membrane (Fig. 1). Audiometry evidenced a conductive hearing loss with an air bone GAP of 45 dB (Fig. 2a). The computerized tomography (CT) demonstrated the filling of the middle ear and antrum, with a soft tissue density material, without bone erosion (Fig. 2b). A right atticotomy with type I tympanoplasty, with removal of the foreign material was performed. The postoperative period held uneventful.

Sarcoma mieloide del hueso temporal

A 69-year-old male previously diagnosed with acute myeloblastic leukemia secondary to myelodysplastic syndrome (LMA with dysplasia, karyotype 46XY, and no cytogenetics abnormalities) refractory to treatment (hydroxyurea, cytarabine, mitoxantrone, and azacitidine) presented with right-side otalgia, otorrhea, and deafness with 2 months progression. He had been treated with oral ciprofloxacin, eardrops with dexamethasone + neomycin + polymyxin B and ibuprofen without success. Otoscopy showed polypoid tissue in the concha of the auricle, otorrhea, and tympanic membrane purple bulging (Fig. 1). Patient was hospitalized with the suspicion of malignant external otitis, and intravenous ciprofloxacin, ceftazidime, and meropenem were prescribed. Investigations revealed hemoglobin 8.6 g/dL, leucocytes 43.2 × 10 g/L, platelets of 24 × 10 g/L, and negative blood cultures. Head computerized tomography (CT) demonstrated tissue fullness of right antrum, mastoid, and

Type II and Type III Tympanoplasties: A 10-Year Revision

Objective: Portmann’s type II (T2) and III (T3) tympanoplasties are often performed for the treatment of chronic ear pathology. This study aims to assess the epidemiological and functional differences between type II and III tympanoplasties, trying to find functional predictors of success. Method: Observational retrospective study of 171 patients undergoing a T2 or T3 surgery in a tertiary hospital between 2000 and 2009. Age, gender, side, surgical technique, type of prosthesis, disease activity, malleus presence, type and use of cartilage, preoperative and postoperative air-bone gap (ABG), and pure tone average (PTA) were recorded. Results: A total of 171 cases (119 T2 and 52 T3) were pooled with a mean age of 38.6 ± 16.0 years. T2 had a preoperative ABG of 28.1 ± 8.5 dB and PTA of 47.1 ± 15.2 dB, while T3 showed a 32.8 ± 8.0 dB ABG and a 51.4 ± 20 dB PTA (P < .05), suggesting that preoperative ABG and PTA are predictors of the type of surgery to perform. The average improvement was 9.69 ± 13.8 dB and 7.0 ± 11.8 dB for tympanoplasty type II and III, respectively (P < .05). Functional success was significantly different between T2 (82%) and T3 (63%, P < .05). We found no predictors of functional success relatively to epidemiological factors or otological characteristics in the multivariate analysis. Conclusion: Our data suggest that the preoperative ABG and PTA are predictors of the type of what tympanoplasty to perform as well as predictors of functional success in both T2 and T3. Functional success is greater in T2 rather than T3.