Andy de Oliveira Vicente

Computed tomography in the diagnosis of otosclerosis

OBJECTIVES: To identify the main tomographic findings of otosclerosis and to evaluate the usefulness of high-resolution computed tomography as a diagnostic method for this osteodystrophy. STUDY DESIGN AND SETTING: A prospective and multi-center study consisting of computed tomography (CT) of the temporal bone was conducted on 54 patients with a clinical and surgical diagnosis of otosclerosis. Twenty-two patients were included in the control group. RESULTS: The CT scan was positive in 87% of the patients. The tomographic findings were mainly bilateral and fenestral foci were more prevalent. CONCLUSIONS: CT showed a high rate of positivity, mainly for fenestral lesions. Foci anterior to the oval window were the most prevalent in this population. SIGNIFICANCE: CT is useful as a diagnostic method and therapeutic indicator of otosclerosis.

Colesteatoma causando paralisia facial

Facial paralysis caused by cholesteatoma is uncommon. The portions most frequently involved are horizontal (tympanic) and second genu segments. When cholesteatomas extend over the anterior epitympanic space, the facial nerve is placed in jeopardy in the region of the geniculate ganglion. The aetiology can be related to compression of the nerve followed by impairment of its blood supply or production of neurotoxic substances secreted from either the cholesteatoma matrix or bacteria enclosed in the tumor. AIM: To evaluate the incidence, clinical features and treatment of the facial palsy due cholesteatoma. STUDY DESIGN: Clinical retrospective. MATERIAL AND METHOD: Retrospective study of 10 cases of facial paralysis due cholesteatoma selected through a survey of 206 decompressions of the facial nerve due various aetiologies realized in the last 10 years in UNIFESP-EPM. RESULTS: The incidence of facial paralysis due cholesteatoma in this study was 4,85%, with female predominance (60%). The average age of the patients was 39 years. The duration and severity of the facial palsy associated with the extension of lesion were important for the functional recovery of the facial nerve. CONCLUSION: Early surgical approach is necessary in these cases to improve the nerve function more adequately. When disruption or intense fibrous replacement occurs in the facial nerve, nerve grafting (greater auricular/sural nerves) and/or hypoglossal facial anastomosis may be suggested.

Magnetic resonance imaging in the evaluation of clinical treatment of otospongiosis: a pilot study.

Objectives To evaluate the applicability of magnetic resonance imaging (MRI) as a method for monitoring the activity of otospongiotic lesions before and after clinical treatment. Study Design Prospective, randomized, controlled, double-blind study. Setting One single tertiary care institution in a large, cosmopolitan city. Methods Twenty-six patients (n = 42 ears) with clinical, audiometric, and tomographic diagnosis of otosclerosis were enrolled. If computed tomography (CT) demonstrated active lesions, these patients underwent MRI to detect otospongiotic foci, seen as areas of gadolinium enhancement. Patients were divided into 3 groups and received treatment with placebo, sodium alendronate, or sodium fluoride for 6 months. After this period, clinical and audiometric evaluations and a second MRI were performed. Each MRI was evaluated by both a neuroradiologist and an otolaryngologist in a subjective (visual) and objective (using specific eFilm Workstation software) manner. Results Otospongiosis was most predominantly identified in the region anterior to the oval window, and this site was reliable for comparing pre- and posttreatment scans. The patients in the alendronate and sodium fluoride groups had MRI findings that suggested a decrease in activity of otospongiotic lesions, more relevant in the alendronate group. These findings were statistically significant for both subjective and objective MRI evaluations. Conclusions MRI shows higher sensitivity than clinical or audiometric assessment for detecting reduction in activity of otospongiosis. The objective MRI evaluation based on software analysis was the most accurate method of monitoring clinical treatment response in otospongiosis.

Pediatric otosclerosis: case report and literature review.

Otospongiosis is an osteodystrophy of the temporal bone, characterized by disordered neoformation and deposition of bone, characterized by the presence of a progressive conductive, sensorineural or mixed hearing loss and tinnitus. Typically, otospongiosis presents as a slowly progressive conductive hearing loss in the third to fourth decade of life. Uncommonly children and adolescents may also have conductive or sensorineural hearing loss caused by otosclerosis. We describe a case of an 11-year-old patient, with progressive unilateral conductive hearing loss for 5 years. The otoscopic examination revealed a positive Schwartzs sign in the left ear. Audiometry, impedanciometry and CT scan showed characteristics that suggested otospongiosis. We reviewed clinical aspects, diagnosis and the therapeutic approach for otospongiosis in children.

Otosclerose infantil: relato de caso e revisão da literatura

Otospongiosis is an osteodystrophy of the temporal bone, characterized by disordered neoformation and deposition of bone, characterized by the presence of a progressive conductive, sensorineural or mixed hearing loss and tinnitus. Typically, otospongiosis presents as a slowly progressive conductive hearing loss in the third to fourth decade of life. Uncommonly children and adolescents may also have conductive or sensorineural hearing loss caused by otosclerosis. We describe a case of an 11-year-old patient, with progressive unilateral conductive hearing loss for 5 years. The otoscopic examination revealed a positive Schwartzs sign in the left ear. Audiometry, impedanciometry and CT scan showed characteristics that suggested otospongiosis. We reviewed clinical aspects, diagnosis and the therapeutic approach for otospongiosis in children.

Paralisia facial periférica bilateral na leucemia linfóide aguda: relato de caso

The facial mimic is very important to the human expression and communication, which depend on the integrity of the facial nerve. So, the peripheric facial palsy (PFP) can leave esthetics, functional and psychological sequelae. The more common etiology is Bells palsy (50 to 80%) and most of the patients show a unilateral manifestation. The simultaneous bilateral PFP is rare, and the leukemia is the neoplasia that can often that kind of manifestation. We present a clinical case of an 18-year-old patient with acute lymphoid leukemia and simultaneous bilateral facial palsy, who did not recover after the chemotherapy treatment, and died five months after the initial manifestation of the facial palsy. Important considerations were accomplished about the physiopathology of PFP in acute lymphoid leukemia, besides literature review.

Computed tomography in the diagnosis of retrofenestral otosclerosis

Objetivo: Identificar os principais achados tomográficos da otosclerose retrofenestral. Método: Estudo prospectivo multicêntrico com tomografia computadorizada (TC) de ossos temporais em 54 pacientes com diagnóstico clínico e cirúrgico de otosclerose. Foi realizada uma análise tomográfica, em que foi avaliada a utilidade da TC no diagnóstico radiológico da otosclerose retrofenestral, sendo verificados os principais sítios de lesões dessa doença. Foram incluídos neste estudo 22 pacientes submetidos à TC de ossos temporais para investigação de outras afecções otológicas, que constituíram o grupo controle. Resultados: Os achados tomográficos foram bilaterais na maioria dos casos e o foco retrofenestral mais prevalente foi o foco pericoclear. Conclusões: A TC monstrou-se útil na identificação dos focos retrofenestrais. A evidência tomográfica desses focos juntamente com o envolvimento endosteal da cóclea podem sugerir uma maior atividade da doença. Andy de Oliveira Vicente, Norma de Oliveira Penido, Hélio K. Yamashita, Pedro Luiz Mangabeira Albernaz Tomografia computadorizada no diagnóstico da otosclerose retrofenestral

Tomografia computadorizada no diagnóstico da otosclerose fenestral

AIM: To identify the main tomographic findings of retrofenestral otosclerosis. METHODS: A prospective and multicentric study using computed tomography (CT) of the temporal bone in 54 patients with a clinical and surgical diagnosis of otosclerosis. A tomographic analysis has been performed to evaluate the utility of CT scans in diagnosing retrofenestral otosclerosis, verifying the sites of predilection for otosclerotic lesions. In this study, 22 patients undergone CT scans of temporal bones have been included in order to investigate other otologic diseases and have constituted the control group. RESULTS: The tomographic findings were mostly bilateral and the retrofenestral focus more prevalent was the pericochlear focus. CONCLUSIONS: The CT scan was useful in the identification of the retrofenestral focuses. The evidence of this focuses and the presence of the endosteal involvement of the cochlea can suggest a higher activity of the disease.

Magnetic Resonance Imaging as a Useful Tool in the Evaluation of Clinical Treatment of Otospongiosis

Objectives: Evaluate the applicability of magnetic resonance imaging (MRI) as a method for monitoring the activity of otospongiotic lesions before and after clinical treatment. Methods: Prospective, randomized, controlled, double- blind study involving 31 patients with clinical, audiometric, and tomographic diagnosis of otosclerosis. If computed tomography (CT) demonstrated active lesions, these patients underwent (MRI) in order to detect otospongiotic foci, seen as areas of gadolinium enhancement. Patients were divided into three groups and received treatment with placebo, alendronate sodium, or sodium fluoride for 6 months. After this period, clinical and audiometric evaluations and a second MRI were performed. The MRIs were evaluated by both a neuroradiologist and an otolaryngologist in a subjective (visual) and objective (using specific eFilm Workstation software) manner. Outcomes were assessed by comparing the MRI, clinical, and audiometric evaluations in the pre- and post-treatment periods. Results: Otospongiosis was most predominantly identified in the region anterior to the oval window (RAOW), and this site was reliable for comparing pre- and post-treatment scans. The patients in the alendronate and sodium fluoride groups had MRI findings that suggested a decrease in activity of otospongiotic lesions, more relevant in the alendronate group. These findings were statistically significant for both subjective and objective MRI evaluations. Conclusions: MRI shows higher sensitivity for detecting reduction in inflammatory activity of otospongiosis compared to clinical and audiometric findings. The objective MRI evaluation was the most accurate method of monitoring clinical treatment response in otospongiosis.

MRI in Evaluation of Clinical Treatment of Otospongiosis

OBJECTIVE: Bacteria living in biofilms are extremely resistant to antibiotic therapy. Recurrent acute otitis media appears to be a disease process related to biofilm formation. The goal of this study is to determine if middle ear irrigations with saline or baby shampoo could significantly reduce or eradicate mucosal biofilms in an animal model of acute otitis media. METHOD: After an ABR was performed to assess baseline hearing, the middle ears of ten adult chinchillas were inoculated with 10 5 colony forming units of biofilm-forming H. influenzae. Five days after inoculation, the right middle ear was irrigated with 1% baby shampoo and the left ear with normal saline as a control. Two days following irrigations, a final ABR was obtained to assess post-intervention hearing. The animals were then euthanized and middle ear mucosa of each animal harvested. All specimens were analyzed by a blinded microscopist using scanning electron microscopy (SEM). RESULTS: Biofilm densities of middle ear mucosa are similar after 1% baby shampoo or saline irrigations. The hearing thresholds on auditory brainstem responses at frequencies 16 kHz, four kHz, one kHz and 500 Hz are unchanged two days after baby shampoo irrigations when compared to the baseline ABR. CONCLUSION: 1) Preliminary results indicate that middle ear irrigations with 1% baby shampoo in normal saline do not lead to significant decrease in biofilm density when compared to normal saline alone. 2) Baby shampoo is non-ototoxic and can be safely used in middle ears. 3) More chinchillas will be examined for a total of 28 animals to reach statistical significance.