Carlos Eduardo Cesário de Abreu

Rhinolithiasis as cause of oronasal fistula

Rhinolithiasis is a disease caused by deposition of organic and inorganic compounds in the nasal cavity, leading to unilateral nasal obstruction, fetid rhinorrhea, epistaxis, and it may cause complications. The authors present a case of rhinolithiasis with oronasal fistula and literature review.

Rinolitíase como causa de fístula oronasal

Rhinolithiasis is a disease caused by deposition of organic and inorganic compounds in the nasal cavity, leading to unilateral nasal obstruction, fetid rhinorrhea, epistaxis, and it may cause complications. The authors present a case of rhinolithiasis with oronasal fistula and literature review.

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.

Estudo comparativo entre achados radiológicos e cirúrgicos na otite média crônica

INTRODUCTION: The chronic otitis media (COM) is a prevalent disease and the most frequent cause of indication to mastoidectomy. Many studies have evaluated the use of tomography (CT) of temporal bones for preoperative evaluation of COM and its indication in the preoperative approach is still controversial nowadays. OBJECTIVE: To evaluate the sensitivity of the clinical and radiological findings of COM according to the intraoperative surgical results and histopathological findings. METHOD: Transversal retrospective study through collection of record data of patients with COM submitted to mastoidectomy in the period from 2007 through 2008 in our service. RESULTS: From a total of 82 ears, 40.24% had cholesteatoma. The CT presented 72.73% of sensitivity in the identification of cholesteatoma, 56.67% in the identification of changes to the ossicular chain and 100% in that of erosion of the lateral semicircular canal. CONCLUSION: The clinical and radiological findings showed a high level sensitivity with intraoperative findings as regards to the presence of cholesteatoma, large changes of the ossicular chain and erosion of the lateral semicircular canal. For minor changes to the ossicular chain, the facial nerve canal and the tympanic tegmen they described low sensitivity.

Vestibular Schwannoma: spontaneous tumor involution

The natural history of Vestibular Schwannomas (VS) is yet not totally known, but most of them have the tendency to slow growth, sometimes without any kind of symptoms during the individuals entire time. About 69% of diagnosed VS do not grow at all and 16% of these can even regress. Considering tumors that grow, about 70% have grown less than 2mm an year. Advanced radiological diagnosis, especially magnetic resonance imaging with gadolinium helps us diagnose small and less symptomatic tumors. Treatment of choice still is complete tumor resection. Surgical approaches have improved considerably and have helped preserve facial nerve function and hearing. Considering VSs natural history, there is a possibility for conservative treatment for these tumors, because their growth in the first year after diagnosis predicts tumor growth behavior in the next years. Surgery should be done in cases of tumor growth, patients desire or symptoms worsening. Moreover, in terms of postoperative sequelae, there is no difference between patients who underwent surgery immediately after diagnosis and those who underwent initial conservative treatment for these tumors.

Schwannoma vestibular: involução tumoral espontânea

A historia natural dos schwannomas vestibulares ainda nao esta totalmente elucidada, mas sua maioria tende a apresentar crescimento lento, muitos permanecendo sem sintomas durante toda a vida do paciente. Cerca de 69% deste tipo de tumor diagnosticados nao apresentam crescimento e, destes, 16% chegam a apresentar regressao tumoral. Considerando os tumores que apresentam crescimento, cerca de 70% crescem menos de 2 mm ao ano. O avanco nos metodos de diagnostico por imagem, particularmente a ressonância magnetica com contraste de gadolinio, permite o diagnostico cada vez mais de lesoes com sintomas minimos e tamanhos menores. O tratamento de escolha para estes tumores ainda e a resseccao completa do tumor. As tecnicas cirurgicas apresentaram grande avanco nas ultimas decadas, o que possibilitou diminuicao da mortalidade. Assim, a cirurgia, que antes tinha como objetivo apenas a resseccao completa do tumor, agora visa tambem a preservacao da audicao e da funcao do nervo facial. Consideracoes finais: Considerando-se sua historia natural, abre-se a possibilidade de uma conduta conservadora ja que o ritmo de crescimento no primeiro ano apos o diagnostico prediz o comportamento do tumor nos proximos anos. A conduta conservadora nao implica em repudio a cirurgia, devendo ser utilizada em casos de aumento tumoral, piora dos sintomas ou desejo do paciente. Alem disso, em relatos de literatura nao ha diferenca estatisticamente significante entre os pacientes submetidos a cirurgia logo apos o diagnostico ou apos conduta conservadora inicial, no que diz respeito as sequelas pos-operatorias.

Fístula labiríntica na otite média crônica colesteatomatosa

The chronic otitis media with cholesteatoma (COMC) may evoluate to intracranial and extra cranial complications, including the labyrithine fistulae. In this study, we present the evolution of our patients with labyrinthine fistulae. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: Ten out 82 patients with COMC had labyrinthine fistulae and underwent surgery from January/2001 to April/2002. They were assessed by clinical exam, computed tomography scans, and pre and postoperative audiogram. RESULTS: Hearing loss, otorrhea, tinnitus and dizziness were present in 100%, 90%,80%, and 40% of the cases. In one patient the fistulae was seen only in the coronal CT-scan, in another patient the fistulae was not seen neither in coronal nor axial images. Among the patients who had tinnitus, 66% referred improvement of this complaint after surgery. DISCUSSION: in the cases without invasion of the perilymphatic space, we noticed a tendency of improvement of the postoperative audiogram pattern and clinical outcome. In the extensive fistulae, on the other hand, there were no clinical changes. CONCLUSION: The CT-scan remains the best exam to assess the COMC with 90% of sensitivity for labyrinthine fistulae. In the stage II we had a good postoperative outcome.

Disacusia neurossensorial imunomediada

A disacusia neurossensorial imunomediada (DNSI) e caracterizada geralmente por uma disacusia neurossensorial bilateral, progressiva e assimetrica, acompanhada ou nao por outros sintomas da orelha interna. Tres pacientes com DNSI cujo quadro clinico e audiometrico eram sugestivos de doenca auto-imune, e apresentaram resposta positiva a terapia imunossupressora ou pesquisa positiva de anticorpo anti hsp-70 68kD, foram estudados com relacao as caracteristicas clinicas, testes diagnosticos, alternativas terapeuticas e evolucao da doenca. Dois pacientes apresentaram quadro de disacusia neurossensorial rapidamente progressiva, associado a quadro vestibular, e outro, quadro de surdez subita unilateral. Nenhum paciente apresentou positividade as provas reumatologicas, e apenas um paciente apresentou aumento na velocidade de hemossedimentacao. Nenhum paciente obteve resposta adequada sustentada a corticoterapia, mas dois deles melhoraram com outras terapias imunossupressoras. O diagnostico da DNSI e clinico e baseado na resposta positiva ao teste terapeutico com imunossupressores. A pesquisa de anticorpo anti-hsp70 de 68 kD pelo Western Blot e o unico exame laboratorial especifico para seu diagnostico, possuindo sensibilidade de 42% e especificidade de 90%. Apenas 1 paciente apresentou positividade para este teste e nao respondeu a terapia imunossupressora. Os dois pacientes com teste negativo responderam satisfatoriamente ao tratamento. A baixa sensibilidade do Western Blot e seu alto custo dificultam sua difusa utilizacao em nosso meio. A introducao precoce do tratamento e de suma importância por auxiliar no diagnostico e por proporcionar um melhor prognostico auditivo.