Arthur Octávio Kós

Nasal foreign bodies: description of types and complications in 420 cases

UNLABELLED Nasal cavities foreign bodies are common accidents in children, sometimes leading, in accordance with the literature, to complications such as epistaxis and bronchoaspiration. Diagnosis is often made with anterior rhinoscopy, but sometimes nasal fibroendoscopy and imaging may be useful. AIM To evaluate 420 cases of nasal foreign bodies removed in ENT Service of Souza Aguiar Hospital, Rio de Janeiro, as related to sex, age, type of foreign body and complications. MATERIALS AND METHOD 420 cases of nasal foreign bodies removed in the ENT service of Souza Aguiar Hospital between December 1992 and December 1998 were evaluated according to the parameters related above. RESULTS We found higher incidence between 0 and 4 years of age, and the most frequently found foreign bodies were foam fragments, plastic pieces of little toys, beans and paper fragments. Complications occurred in 9.05% of the cases, epistaxis and vestibulitis being the commonest. CONCLUSION Nasal foreign bodies are especially found between the ages of 0 and 4 years. In our study, foam fragments and small plastic objects were the most frequent foreign bodies found. Complications were found in 9.05% of the cases, headed by epistaxis and nasal vestibulitis.

Corpos estranhos de fossas nasais: descrição de tipos e complicações em 420 casos

Corpos estranhos de fossas nasais sao acidentes comuns em criancas, podendo, de acordo com a literatura, levar a complicacoes supurativas e bronco-aspiracao do corpo estranho. O diagnostico e feito quase sempre pela rinoscopia anterior, mas a nasofibroscopia e exames radiologicos podem ser uteis. OBJETIVO: Analisar um total de 420 casos de corpos estranhos de fossas nasais removidos no servico de ORL-EPO do Hospital Municipal Souza Aguiar quanto a varios parâmetros como sexo, idade, tipo e complicacoes. MATERIAL E METODO: 420 casos de corpos estranhos de fossas nasais removidos no servico de Otorrinolaringologia e Endoscopia Per-oral (ORL-EPO) do Hospital Municipal Souza Aguiar, no periodo de dezembro de 1992 a dezembro de 1998, quanto aos parâmetros acima referidos. RESULTADOS: Foi encontrada uma maior incidencia na faixa etaria de 0 a 4 anos, sendo os mais comuns, pela ordem fragmentos de espuma, fragmentos de material plastico, graos de feijao e fragmentos de papel. As complicacoes ocorreram em 9,05% dos casos, sendo as mais comuns a epistaxe e a vestibulite. CONCLUSAO: Os corpos estranhos de fossas nasais sao acidentes encontrados principalmente na faixa etaria de 0 a 4 anos, sendo os mais comuns, em nossa casuistica, os fragmentos de espuma e pequenos artefatos de plastico. Complicacoes nao sao frequentes, sendo as mais encontradas a epistaxe e vestibulite nasal.

Complications of ent foreign bodies: a retrospective study

UNLABELLED Foreign bodies are one of the most common ENT (Ear, Nose and Throat) urgencies. Serious complications may occur, like tympanic perforations and bronchoaspiration, but they are uncommon. AIM To analyze a 1356 foreign body series and establish causes for the complications, looking at prevention. MATERIALS AND METHODS 1356 patients with ear, nose and throat foreign bodies from the ENT Department of Souza Aguiar Hospital, in Rio de Janeiro, between 1992 and 2000, were analyzed in a retrospective study for parameters like age, gender, type and localization of the foreign body, time span between introduction and removal of the foreign body and complications. RESULTS The most common foreign bodies were beans and the most frequent age was between 1 and 4 years old. Ear foreign bodies were the most common, followed by nasal foreign bodies. Complications were statistically related to time, childs age and practical experience of the physician. CONCLUSION Most of the situations related to ENT foreign bodies are avoidable. Improvements in Public Health Assistance and otolaryngologists training are essential to avoid serious complications.

Avaliação da influência da idade no potencial evocado auditivo de tronco encefálico

Auditory brainstem response (ABR) is a simple, objective, and not invasive method of hearing pathway evaluation, which can be done at any age and which detects the electric activity from inner ear to inferior colliculus. ABR is formed by 7 waves (I - VII), but in general, waves I, III and V are its most important components. The level of sensation is a stimulus unit which is based on the personal phsycoacustic threshold and adding to it a constant intensity of stimulus in decibel (dB) giving the same amount of acoustic energy in case of asymmetric hearing loss. AIM: Evaluate how age influences ABR in men, using level of sensation as a stimulus unit. STUDY DESIGN: Observacional cohort with transversal cut. MATERIAL AND METHOD: Fifteen men with ages between 20 and 30 years old and 15 men above 60 years were examined and submitted to a clinical selection criteria in order to avoid any other factor that could influence in the results. The absolute latency of waves I, III and V and the interpeak latencies I-III, III-V and I-V were established in the 2 groups and values evaluated statistically. RESULTS: Absolute and interpeak latencies of ABR were similar in the 2 groups. CONCLUSION: In the analysed age group and in the prearranged conditions used in this study, the age was not an influence factor in ABR findings.

Topical use of adrenaline in different concentrations for endoscopic sinus surgery

UNLABELLED The ideal adrenaline concentration remains unknown. AIM Compare topical adrenaline solutions in different concentrations. STUDY DESIGN Prospective, double blind, randomized trial. PATIENTS AND METHODS 49 patients divided in 3 groups underwent endoscopic sinus surgery, using only topical solutions of adrenaline in different concentrations (1:2,000, 1:10,000 and 1:50,000). We compared the duration of surgery, intra-operative bleeding, plasmatic levels of catecholamines, hemodynamic parameters and changes in heart rhythm. RESULTS Surgery time was shorter in the group using adrenaline 1:2,000, which also showed less bleeding in all evaluations (objective and subjective - p < 0.0001). Plasmatic levels of epinephrine rose in all groups, more sharply in the 1:2,000 group. There was a trend towards elevation of blood pressure in the groups using adrenaline 1:2,000 and 1:10,000, with a greater occurrence of hypertensive peaks. DISCUSSION We found a very significance bleeding difference favoring the 1:2,000. The blood pressure elevation in the 1:2,000 and 1:10,000 groups was progressive but very slow throughout the procedure, which could be associated with the anesthesia technique. CONCLUSION We favor the use of topical adrenalin 1:2,000 due to a clear superiority in hemostasis. Further investigation is needed to corroborate our findings.

Uso tópico da adrenalina em diferentes concentrações na cirurgia endoscópica nasal

A concentracao ideal de adrenalina topica a promover hemostasia adequada sem toxicidade ainda e motivo de controversia. OBJETIVO: Comparar solucoes topicas de adrenalina em diferentes concentracoes. DESENHO DO ESTUDO: Prospectivo, duplo-cego, selecao aleatoria. MATERIAIS E METODOS: 49 pacientes submetidos a cirurgia endoscopica nasal, divididos em 3 grupos usando exclusivamente adrenalina topica, nas concentracoes de 1:2000, 1:10.000 e 1:50.000. Comparou-se o tempo operatorio, o sangramento, as concentracoes plasmaticas de adrenalina e noradrenalina e a variacao dos parâmetros cardiovasculares. RESULTADOS: O tempo operatorio por procedimento foi menor no grupo que utilizou adrenalina 1:2000, assim como o sangramento (p < 0,0001). As concentracoes plasmaticas de adrenalina subiram em todos os 3 grupos, porem mais no grupo que utilizou adrenalina 1:2000. Houve uma tendencia de aumento dos niveis tensionais nos pacientes que usaram adrenalina 1:2000 e 1:10.000, com maior ocorrencia de picos hipertensivos. Discussao: Os beneficios do uso da solucao de adrenalina mais concentrada foram evidentes, principalmente em relacao ao sangramento. A tendencia de aumento dos niveis tensionais pode ter ocorrido por nao termos utilizado tecnica anestesica intravenosa exclusiva. CONCLUSAO: Analisando os pros e contras, sugerimos o uso de solucao de adrenalina topica 1:2000; mais pesquisas que corroborem nossos achados sao necessarias.

Otite média tuberculosa

This paper is the result of a literature review since the beginning of the 20th century about Tuberculous Otitis Media (TOM). It includes historic, epidemiologic, physiopatologic, clinical, diagnostic and treatment aspects, emphasizing their evolution throughout time considering the several modifications of the population and medicine. It also reinforces the predominance of extrapulmonary forms of tuberculosis, as TOM, in HIV infected patients, which, in present times, is of great interest.

Eficácia e segurança de Sultamicilina (Ampicilina/Sulbactam) e Amoxacilina/Clavulanato no tratamento das infecções de via aéreas superiores em adultos: um estudo multicêntrico, aberto e randomizado

Upper respiratory tract infections are the most common causes of medical visits in children and adults, demanding massive use of antibiotics. Bacterial resistance caused by beta-lactamase is one of the most serious problems in this matter. Sultamicillin, a double pro-drug of Ampicillin/Sulbactan, is a potent beta-lactamase inhibitor which can face this challenge. AIM: evaluate efficacy, safety and tolerability of Ampicillin/Sulbactan compared to Amoxicillin/Clavulanate in upper respiratory tract infections in adults. METHODS: 102 patients were enrolled and randomized to receive Ampicillin/Sulbactan or Amoxicillin/Clavulanate during 10 days. They were evaluated 10 and 30 days after treatment to learn about the therapeutic response. RESULTS: There were no differences between the two groups respecting cure at the end of treatment (visit 2) or at the end of the study (visit 3). Cure ratio was 61.7% and 93.2% (visits 2 and 3) in the Amoxicillin/Clavulanate group compared to 64.4% and 97.4%, respectively, in Ampicillin/Sulbactan group. The adverse events ratio for the two groups was the same (p=0.940). The number of patients with diarrhea was greater in the group of patients receiving Amoxicillin/Clavulanate (70.6%) than in the group receiving Ampicillin/Sulbactan (29.4%) (p=0.0164). CONCLUSIONS: Ampicillin/Sulbactan is as safe and efficient as Amoxicillin/Clavulanate in the empiric treatment of upper respiratory infections in adults. The low occurrence of diarrhea in the group receiving Ampicillin/Sulbactan needs confirmation in other studies.

Efficacy and safety of Sultamicillin (Ampicillin/Sulbactan) and Amoxicillin/Clavulanic Acid in the treatment of upper respiratory tract infections in adults: an open-label, multicentric, randomized trial

UNLABELLED Upper respiratory tract infections are the most common causes of medical visits in children and adults, demanding massive use of antibiotics. Bacterial resistance caused by beta-lactamase is one of the most serious problems in this matter. Sultamicillin, a double pro-drug of Ampicillin/Sulbactan, is a potent beta-lactamase inhibitor which can face this challenge. AIM Evaluate efficacy, safety and tolerability of Ampicillin/Sulbactan compared to Amoxicillin/Clavulanate in upper respiratory tract infections in adults. METHODS 102 patients were enrolled and randomized to receive Ampicillin/Sulbactan or Amoxicillin/Clavulanate during 10 days. They were evaluated 10 and 30 days after treatment to learn about the therapeutic response. RESULTS There were no differences between the two groups respecting cure at the end of treatment (visit 2) or at the end of the study (visit 3). Cure ratio was 61.7% and 93.2% (visits 2 and 3) in the Amoxicillin/Clavulanate group compared to 64.4% and 97.4%, respectively, in Ampicillin/Sulbactan group. The adverse events ratio for the two groups was the same (p=0.940). The number of patients with diarrhea was greater in the group of patients receiving Amoxicillin/Clavulanate (70.6%) than in the group receiving Ampicillin/Sulbactan (29.4%) (p=0.0164). CONCLUSIONS Ampicillin/Sulbactan is as safe and efficient as Amoxicillin/Clavulanate in the empiric treatment of upper respiratory infections in adults. The low occurrence of diarrhea in the group receiving Ampicillin/Sulbactan needs confirmation in other studies.

The problem of waiting lines for otorhinolaryngology surgeries in public services

According to Article 196 of the Brazilian Constitution “Health is a right of all citizens and a duty of the State”. The constitution is supplemented by the organic Act 8080, dated from 1990, which sets the guidelines for the Brazilian universal health service, SUS (in Portuguese Sistema Único de Saúde), ensuring universal access to health services. In spite of the legislation’s theoretical excellence, it is common knowledge that access to public services is one of the most serious problems in our society. The factors leading to this scenario are, unquestionably, absence of an efficient and hierarchical structure, scarce financial resources for health and not enough investments in hospitals, health professionals and technology. Waiting lines are lists of patients requiring the same treatment or medical services whose demand is larger than the supply. Metaphorically speaking, patients in this line are kept in a virtual room, waiting for the same procedure, and are called on a one-by-one basis, according to order of arrival. The waiting line for elective surgery is a reality in many general hospitals throughout Brazil, which can be longer or shorter in terms of number of patients and time in wait. Although an integral part of the daily routine of surgeons working in public service facilities, the waiting line issue is not frequently tackled by the medical-scientific community, owing perhaps to the fact that this seems to be a discussion that does not belong in the academic sphere and that should be circumscribed to governmental instances. However, it must be highlighted that equitable, fair and universal access to health services must be a constant concern not only of governments but also of all professionals involved with the public service network. There is a lot that can be done locally to mitigate waiting lines. This article tries to discuss this issue from our specialty’s perspective, bringing up some points that we consider to be of great relevance. Waiting lines for surgery: The tip of the iceberg Before being submitted to otorhinolaryngologic surgeries in the public network, patients must actually sit on several consecutive waiting lists. The waiting time for surgery —representing the time between surgical indication and its actual performance— is but the last, and many times the shortest, of these waiting lines. Total real wait-time covers many other previous time-spans, starting at symptom onset and ending when specialized treatment is finally delivered. Each one of the steps is characterized by its own difficulties and delays (Figure 1). The phases prior to treatment at the otorhinolaryngology service are much more difficult to size, but are not less important. All different phases are worthy of special and knowledgeable attention so that obstacles may be identified, feasible solutions may be found and the flow of patients may be optimized. First of all, one can see that there is a time lag between the onset of the disease and the action of seeking medical help (arrow 1 in Figure 1). This is partly due to lack of information on otorhinolaryngologic diseases and the most important presentations requiring medical attention. Information campaigns on Voice and Hearing, such as the ones supported by the Brazilian Society of Otorhinolaryngology are instrumental for changing this scenario. Next we have the difficulty in obtaining medical services (arrow 2), a consequence of the problems in our health policy, its faulty structure and the lack of resources for health care in Brazil.