Aracy Pereira Silveira Balbani

Ear and nose foreign body removal in children

The removal of foreign bodies in children is very common in the otolaryngologists daily routine. We present a prospective series of 187 cases of ear and nose foreign bodies removed from children aged 0-12 years old in a 6-month period--95 females (50.8%) and 92 males (49.2%); 78 children (41.71%) aged from 1 to 2 years, 66 (35.29%) from 3 to 5 years. There were 93 cases (49.73%) of ear foreign bodies, in which a bean was the most common (24.73%), and 94 cases (50.27%) of nose foreign bodies, in which sponge fragments predominated (36.17%). In 82 cases (45.85%), the removal was performed within the first 24 h after the foreign body insertion, and 86 (45.98%) of the patients had previous attempts to remove it. Thirteen cases with complications (external ear canal lacerations, tympanic membrane perforation) were observed in patients in whom these previous attempts had been made, but there were no sequelae. This corresponds to one of the largest reports of ear and nose foreign body removal in children in the literature; we conclude that younger children are more prone to insert foreign bodies, which are objects usually found at home. Complications may occur as a result of attempts to remove the foreign body without the help of specialised personnel or proper conditions.

Impact of otitis media on language acquisition in children

OBJETIVO: A incidencia das otites medias em criancas tem aumentado consideravelmente nos ultimos 20 anos. O objetivo deste trabalho foi revisar artigos sobre o impacto das otites medias sobre a aquisicao da linguagem em criancas. FONTES DOS DADOS: Foram selecionados artigos catalogados na base Medline com os descritores otite media, linguagem, audicao e crianca. SINTESE DOS DADOS: A revisao de literatura mostrou que a perda auditiva observada nas otites medias pode ser resultante de: (1) alteracoes estruturais na orelha media, (2) lesoes ultra-estruturais e anormalidades bioquimicas na coclea, ou (3) alteracoes nas vias auditivas centrais. Cerca de 50% dos casos de otite media secretora, por exemplo, sao acompanhados de perda auditiva leve e flutuante. Os dados de literatura apontam que os tres primeiros anos de vida sao criticos para o desenvolvimento da linguagem, e criancas com otites medias, nesse periodo, tem maior risco de apresentar disturbios na aquisicao da linguagem, no comportamento e, futuramente, no aprendizado escolar. CONCLUSOES: As principais consequencias das otites medias e da perda auditiva sobre a linguagem nessas criancas sao erros foneticos e de articulacao da fala, bem como dificuldade para compreensao da leitura.OBJECTIVE To review the literature concerning the impact of otitis media on language acquisitions in children. SOURCES OF DATA Medline. The following keywords were used for searching: otitis media, hearing, language and children. SUMMARY OF THE FINDING: The hearing loss observed in otitis media may be a result of: 1) structural disorders in the middle ear; 2) ultrastructural lesions and biochemical anomalies in the cochlea or 3) abnormalities in the central auditory pathways. About 50% of cases of secretory otitis media, for instance, are accompanied by mild fluctuating hearing loss. According to the literature, since the first three years of life are critical for language development, children affected by otitis media in this period are at risk for presenting disturbances in language acquisition, behavior and later academic achievement. CONCLUSIONS The main consequences of otitis media and hearing loss on language acquisition are phonetic and speech articulation problems, as well as impairment of reading comprehension.

Lidocaine test in patients with tinnitus: rationale of accomplishment and relation to the treatment with carbamazepine

OBJECTIVES There is strong evidence in the literature about the effect of local anesthetics such as lidocaine in controlling tinnitus; these agents act by stabilizing hair cell membrane and cochlear nerve fibers. However, the effect of intravenous lidocaine is transient, and its oral analog (tocainide) does not have the same efficacy for long-term treatment in patients with tinnitus. Some oral anti-epileptic drugs (carbamazepine, for instance) have been used alternatively in several studies. The aim of this work is to evaluate the response to intravenous lidocaine in patients with intractable tinnitus and the effect of oral carbamazepine in long-term maintenance of tinnitus relief. PATIENTS AND METHODS We studied prospectively 50 patients (28 females and 22 males; mean age 50.9 years) who underwent the lidocaine test, performed by a 3-min intravenous infusion of 2% lidocaine chloridrate. The patients who experienced any relief after the test started treatment with oral carbamazepine in ascending dosages (50-600 mg/day). RESULTS The results were classified as tinnitus abolition (18%), marked relief (32%), partial relief (26%), unchanged (22%), or worsening (2%). The lidocaine test showed favorable results in 76% of patients, especially those with bilateral tinnitus (P < 0.001). Afterwards, 50% of patients treated with carbamazepine maintained the improvement of tinnitus (P = 0.0034). CONCLUSION The authors conclude that intravenous lidocaine is effective in reducing intractable tinnitus and that there is a close association between lidocaine and oral carbamazepine effects. Therefore, carbamazepine can be used for the treatment of tinnitus when the patient achieves improvement of symptom after the lidocaine test.

Excipientes de medicamentos e as informações da bula

OBJETIVO: Avaliar a presenca de conservantes, corantes, adocantes e aromatizantes em 73 apresentacoes farmaceuticas de 35 medicamentos para uso oral, e as informacoes da bula sobre excipientes. METODOS: Selecionamos 35 medicamentos, de venda livre ou sob prescricao medica, comercializados no Brasil. A amostra incluiu: analgesicos/antitermicos, antimicrobianos, mucoliticos, antitussigenos, descongestionantes, anti-histaminicos, broncodilatadores, corticosteroides, antiinflamatorios e suplementos vitaminicos. Foram analisadas 73 apresentacoes desses farmacos, anotando-se as informacoes da bula sobre conservantes, corantes, adocantes e aromatizantes. RESULTADOS: A bula de um medicamento (1,3%) nao mencionava os ingredientes inativos. Os conservantes mais encontrados nos medicamentos foram metilparabeno e propilparabeno (43% e 35,6% respectivamente). Os adocantes mais usados foram: sacarose (acucar) (53,4%), sacarina sodica (38,3%) e sorbitol (36,9%). Vinte e um produtos (28,7%) continham dois adocantes. Predominaram os medicamentos sem corante (43,8%), seguidos pelos coloridos por amarelo crepusculo (amarelo FD&C no. 6) (15%). Cinco produtos (6,8%) continham mais de um corante. A tartrazina (amarelo FD&C no. 5) foi encontrada em sete formulacoes (9,5%). Os aromatizantes mais usados foram os de frutas (83%). Constatamos a frequente omissao das bulas sobre o teor exato de acucar dos produtos (77%). Duas das quatro bulas de medicamentos contendo aspartame nao mencionavam as precaucoes no uso por fenilcetonuricos. CONCLUSOES: A omissao e a imprecisao das informacoes da bula sobre os excipientes farmaceuticos expoem os individuos suscetiveis ao risco de reacoes adversas dos conservantes e corantes. Tambem podem ocorrer complicacoes do uso inadvertido de medicamentos contendo acucar pelos pacientes diabeticos, ou de farmacos adocados com aspartame pelos fenilcetonuricos.

Pharmaceutical excipients and the information on drug labels

AIM to evaluate the presence of preservatives, dyes, sweeteners and flavouring substances in 73 pharmaceutical preparations of 35 medicines for oral administration, according to drug labeling information about the excipients. METHODS 35 medications were selected, both over-the-counter and prescription drugs, marketed in Brazil. The sample included: analgesic/antipyretic, antimicrobial, mucoregulatory, cough and cold, decongestant, antihistamine, bronchodilator, corticosteroid, antiinflammatory and vitamin medications. We collected data on 73 preparations of these drugs, according to drug labeling information regarding preservatives, dyes, sweeteners and flavourings. RESULTS Methylparaben and propylparaben were the most common preservatives found (43% and 35.6% respectively). The most common sweeteners were: sucrose (sugar) (53.4%), sodium saccharin (38.3%) and sorbitol (36.9%). Twenty-one medicines (28,7%) contained two sweeteners. Colourless medicines predominated (43.8%), followed by those with sunset yellow dye (FD&C yellow no. 6) (15%). Five products (6.8%) contained more than one colour agent. Tartrazine (FD&C yellow no. 5) was present in seven preparations (9.5%). Fruit was the most common flavouring found (83%). Labelings of drugs which contained sugar frequently omitted its exact concentration (77%). Of the four labelings of medicines which contained aspartame, two did not warn patients regarding phenylketonuria. CONCLUSION Omission and inaccuracy of drug labeling information on pharmaceutical excipients may expose susceptible individuals to adverse reactions caused by preservatives and dyes. Complications of inadvertent intake of sugar-containing medicines by diabetics, or aspartame intake by patients with phenylketonuria may also occur.

Impacto do uso do telefone celular na saúde de crianças e adolescentes

Objective: To study the biological effects of electromagnetic fields, details of microwave electromagnetic field energy absorption in children, effects of pre and post-natal exposure to those fields, and the impact of mobile phones use on the central nervous system and behavior in children. Data source: Articles written in English published from 2004 to 2009 and indexed on PubMed under the keywords: “children”, “mobile phones”, and “microwaves”. Data synthesis: Mobile phones emit radiofrequency in the microwave range, with possible thermal (tissue heating) or non-thermal (oxidative stress and chromatin conformation alteration) biological effects. Experimental research suggests that the dissipation of radiofrequency energy in tissues might be higher in children than in adults. Pre-natal exposure of rats to radiofrequency in non-thermal levels has not resulted in teratogenesis, mutagenesis, increased blood-brain barrier

Análise retrospectiva da toxicidade de gotas otológicas, medicamentos tópicos nasais e orofaríngeos registrada na Grande São Paulo

BACKGROUND: Retrospective analysis of human toxicity files involving topical medicines for treatment of upper airways diseases (eardrops, topical nasal medicines, lozenges, drops and sprays for oropharyngeal affections). METHODS: Thirty-four brands of eardrops, 48 of topical nasal medicines and 22 of tablets, lozenges and sprays for oropharyngeal affections were selected, from a total of 104 products available in Brazil. We analyzed the registries in the electronic database from the Poison Control Centre of Sao Paulo (CCI-Jabaquara), Brazil, for the period from January 1996 through December 2000. The cases related to selected pharmaceuticals were collected. RESULTS: 10,823 cases of human toxicity caused by medicines were voluntarily reported to CCI-Jabaquara. Topical medicines for treatment of upper airways diseases accounted for 291 cases (2.68%), from which 240 (82.5%) represented poisoning; 12 (4.1%) involved ear drops, 268 (92%), topical nasal medicines and 11 (3.9%), topical medicines for oropharyngeal affections. Among topical nasal medicines, vasoconstrictors predominated (233 cases), and among medicines for oropharyngeal affections, it was tetracaine (four cases). Considering age distribution, toxicity predominated significantly in children aged from 1 to 4 years (p=0.0003). The main causes of toxicity were: accidental intake of medicines (43%) and error in drug administration (14.8%). Hypereflexia and vomiting were the most frequent symptoms related to toxicity. CONCLUSIONS: There was significant incidence of systemic toxicity due to eardrops, topical nasal and oropharyngeal medicines in children 1 to 4 years-old, whose main cause was accidental intake of these medicines.

Ethics is the best professional policy

he editorial ‘‘The Future . . . to whom it belongs?’’1 raises wo considerations on our professional practice. The first one, stimulated by our colleague Marcio brahão, refers to the Brazilian tax burden. The National nion of Attorneys of the National Treasury estimates that he cost of the crime of tax evasion in Brazil in 2015 alone as more than R

Síndrome de Young: infecções respiratórias de repetição e azoospermia

420 billion -seven times more than the nnual cost of corruption. Therefore, there is no way to ttain significant relief to the pockets of honest taxpayers ithout tax reform, repression of tax evasion and punishent of tax evaders.2 If individuals and businesses do not vade taxes, it will be possible to reduce tax rates and he tax burden will weigh less on each of us. Therefore, e endorse the editorial on the role of medical institutions n the national political scenario, because society’s revulion against crime gets a stronger voice through prestigious rganizations, such as the ABORL-CCF. There is nothing more ppropriate for our Association to do than to start or join a ublic campaign to combat tax evasion. The second consideration concerns the ethical and umanitarian nature of Medicine. It is incontestable that e need to demand a fair and decent remuneration for all orkers, including doctors. In parallel, the current crises n economic and moral values bring us doctors another

Média dos limiares tonais na audiometria de alta frequencia em individuos normais de 4 a 60 anos

INTRODUCTION Youngs syndrome is part of primary ciliary dyskinesia, characterized by repeated airway infections and congenital epididymis obstruction. CASE REPORT The authors present the case of a 28-year old male with recurrent rhinosinusitis and pneumonia. Sweat and immunologic tests fell within the normal range. Sperm analyses revealed absence of spermatozoa although spermatogenesis was normal according to the findings in testis biopsy. DISCUSSION The final diagnosis was Youngs syndrome the first case of the disease reported in Brazilian literature. CONCLUSIONS The authors emphasize the need for appropriate diagnosis and genetic counselling as well as differential diagnosis with cystic fibrosis in these cases.INTRODUCAO: A sindrome de Young e uma variante da discinesia ciliar primaria, caracterizada pela ocorrencia de infeccoes respiratorias de repeticao e obstrucao congenita do epididimo. APRESENTACAO DO CASO: Os autores apresentam um caso de rinossinusite e pneumonias de repeticao em um paciente de 28 anos do sexo masculino. Dosagem de sodio e cloro no suor e pesquisa de imunodeficiencias celulares e humorais resultaram negativas. O espermograma revelou azoospermia, embora a espermatogenese estivesse mantida, conforme achado na biopsia de testiculo. DISCUSSAO: O diagnostico foi de sindrome de Young, sendo este o primeiro caso relatado no Brasil. CONCLUSAO: Os autores alertam para a importância desse diagnostico, dadas suas implicacoes para aconselhamento genetico, alem do diagnostico diferencial a ser feito com a fibrose cistica.