Celso Dall'Igna

Brazilian Portuguese Language version of the "Tinnitus Handicap Inventory": validity and reproducibility

UNLABELLED Tinnitus can greatly impact an individuals life quality and it is very difficult to quantify. AIM To determine the reproducibility and validity of a Brazilian Portuguese version of the Tinnitus Handicap Inventory (THI), a self-applicable questionnaire which assesses tinnitus impact on patients life quality. MATERIALS AND METHODS This was a prospective transversal study. The questionnaire was translated into Portuguese and cross-culturally adapted to the Brazilian environment according to internationally recommended methods. The Portuguese version of the THI was answered by 180 patients who complained of tinnitus. Reproducibility was assessed using the Cronbachs Alpha Calculation; and the validity was assessed by means of the Beck Depression Inventory (BDI), calculating the Pearson correlation coefficient. RESULTS The Portuguese version of the THI showed high internal validity, comparable to the original version. A high correlation was observed between the THI and the BDI. CONCLUSION The Brazilian Portuguese version of THI is a valid and reproducible tool used to quantify how tinnitus impacts the life quality of those Brazilian patients who complain of this symptom.

The use of high‐frequency audiometry increases the diagnosis of asymptomatic hearing loss in pediatric patients treated with cisplatin‐based chemotherapy

Cisplatin may cause permanent cochlear damage by changing cochlear frequency selectivity and can lead to irreversible sensorineural hearing loss. High‐frequency audiometry (HFA) is able to assess hearing frequencies above 8,000 Hz; hence, it has been considered a high‐quality method to monitor and diagnose early and asymptomatic signs of ototoxicity in patients receiving cisplatin.

Fungal rhinosinusitis in patients with chronic sinusal disease

AIM Fungal rhinosinusitis in patients with chronic sinusal disease study. In the past decades, there has been an increase in fungal infections, and fungal rhinosinusitis (FRS) has been diagnosed more frequently. Knowing the fungal flora, its prevalence and symptomatic presentation in patients with chronic rhinosinusitis (CRS) will allow a better understanding of this disease, permitting a correct diagnosis, and treatment and formulating its prognosis. STUDY DESIGN clinical retrospective with transversal cohort. MATERIAL AND METHOD 62 patients diagnosed with FRS were selected among 890 cases of CRS undergoing endoscopic surgery. We assessed clinical history otolaryngologic examination with nasal videoendoscopy, CT scan, microbiologic and histopatologic tests. RESULTS The prevalence of FRS was 6.7% and the fungal type most frequently found was the gender Aspergillus. Fungal ball was found in more than half the cases, and allergic fungal rhinosinusitis (AFRS) in more than one third of the patients. Evolution after endoscopic sinus surgery was more favorable in patients with fungus ball, with a minor number of recurrences. CONCLUSIONS The symptomatic evolution following endoscopic surgery was more favorable in patients with fungal ball, who require a lower number of re-interventions.

Rinossinusite fúngica em pacientes com infecção nasossinusal crônica

AIM: Fungal rhinosinusitis in patients with chronic sinusal disease study. In the past decades, there has been an increase in fungal infections, and fungal rhinosinusitis (FRS) has been diagnosed more frequently. Knowing the fungal flora, its prevalence and symptomatic presentation in patients with chronic rhinosinusitis (CRS) will allow a better understanding of this disease, permitting a correct diagnosis, and treatment and formulating its prognosis. STUDY DESIGN: clinical retrospective with transversal cohort. MATERIAL AND METHOD: 62 patients diagnosed with FRS were selected among 890 cases of CRS undergoing endoscopic surgery. We assessed clinical history otolaryngologic examination with nasal videoendoscopy, CT scan, microbiologic and histopatologic tests. RESULTS: The prevalence of FRS was 6.7% and the fungal type most frequently found was the gender Aspergillus. Fungal ball was found in more than half the cases, and allergic fungal rhinosinusitis (AFRS) in more than one third of the patients. Evolution after endoscopic sinus surgery was more favorable in patients with fungus ball, with a minor number of recurrences. CONCLUSIONS: The symptomatic evolution following endoscopic surgery was more favorable in patients with fungal ball, who require a lower number of re-interventions.

Radiation therapy for glomus tumors of the temporal bone

UNLABELLED The treatment of glomic tumors has been controversial since its first description. It can be done with surgery, radiotherapy or just expectation. AIM The objective of this paper was to evaluate the effectiveness and complications of radiotherapy. STUDY DESIGN clinical with transversal cohort. MATERIAL AND METHOD It was made a retrospective review in the charts of the patients with glomus jugulare tumors treated with radiotherapy. Disease control was determined by (1) no progression of symptoms or cranial nerve dysfunction or (2) no progression of the lesion in radiological follow-up. It was also evaluated the follow-up period and the sequelae of the treatment. RESULTS Twelve patients were included, 8 of then women. The follow-up period was from 3 to 35 years, with a media of 11,6 years. The main symptoms were: hearing loss, pulsate tinnitus, dizziness and vertigo. The signs were pulsate retrotympanic mass, facial palsy and cofosis. The tumors were staged using Fischs classification. The radiotherapy was performed with linear accelerator with dose ranging from 4500-5500 in 4-6 weeks. In the follow-up period were possible to identify sequelaes like dermatitis, meatal stenosis, cofosis and facial palsy. DISCUSSION The signs and symptoms were the same found in the medical literature. The type and dosages of the radiotherapy were also the same of others reports. All patients had improvement of the symptoms and only one was not considered as having disease controlled. Complications were, in general, minor complications, with exception of the cofosis and facial palsy. CONCLUSION Radiotherapy is a viable alternative to treatment of these tumors because their good response and low level of complications. It should be considered specially in advanced tumors where a surgical procedure could bring a high level of morbidity.

Pitch and Loudness from Tinnitus in Individuals with Noise-induced Hearing Loss

Introduction  Tinnitus is one of the symptoms that affects individuals suffering from noise induced hearing loss. This condition can be disabling, leading the affected individual to turn away from work. Objective  This literature review aims to analyze the possible association between gender and tinnitus pitch and loudness, the degree of hearing loss and the frequencies affected in subjects with noise-induced hearing loss. Methods  This contemporary cohort study was conducted through a cross-sectional analysis. The study sample consisted of adults with unilateral or bilateral tinnitus, who had been diagnosed with noise-induced hearing loss. The patients under analysis underwent an otorhinolaryngological evaluation, pure tone audiometry, and acuphenometry. Results  The study included 33 subjects with noise-induced hearing loss diagnoses, of which 22 (66.7%) were men. Authors observed no statistical difference between gender and loudness/pitch tinnitus and loudness/pitch in subjects with bilateral tinnitus. Authors found an inverse relation between tinnitus loudness with intensity greater hearing threshold and the average of the thresholds and the grade of hearing loss. The tinnitus pitch showed no association with higher frequency of hearing threshold. Conclusion  Data analysis shows that, among the individuals evaluated, the greater the hearing loss, the lower the loudness of tinnitus. We did not observe an association between hearing loss and tinnitus pitch.

Cocleostomia transcanal: resultados em longo prazo de um estudo de coorte

UNLABELLED The combined approach technique (CAT) is a variation of the classical the mastoidectomy-posterior tympanotomy technique (MPTA) that combines a transcanal approach to cochleostomy with a reduced posterior tympanotomy for insertion of electrodes. AIM To compare and evaluate long-term safety and effectiveness outcomes obtained with the CAT and with MPTA approach in patients submitted to cochlear implant (CI) surgery. DESIGN series study. METHODS Patients who underwent CI using CAT or MPTA at a Brazilian center were followed in a cohort study. Main outcomes were complications,audiometric performance and radiological evaluation of electrode position. RESULTS Fourty-four patients were implanted using CAT and 31 MPTA. There were no cases of facial nerve paralysis, mastoiditis, cholesteatoma or cerebrospinal fluid leaks after 3.4±1.0 years. Radiological evaluation of electrode position revealed that the median number of electrodes outside the cochlea was 0 in CAT and 3 in MPTA groups (p < 0.001). There were no differences between both surgical approaches in terms of mean pure-tone thresholds with CI at all frequencies. CONCLUSION Long-term follow-up data showed that the transcanal route to cochleostomy, combined with a reduced posterior tympanotomy, is a safe alternative approach in cochlear implant surgery, with no related major complications and fewer cases of electrode migration when compared with the MPTA. These findings encourage the use of the transcanal route to cochleostomy as an alternative approach option.

Tratamento radioterápico dos tumores glômicos do osso temporal

The treatment of glomic tumors has been controversial since its first description. It can be done with surgery, radiotherapy or just expectation. AIM: The objective of this paper was to evaluate the effectiveness and complications of radiotherapy. STUDY DESIGN: clinical with transversal cohort. MATERIAL AND METHOD: It was made a retrospective review in the charts of the patients with glomus jugulare tumors treated with radiotherapy. Disease control was determined by (1) no progression of symptoms or cranial nerve dysfunction or (2) no progression of the lesion in radiological follow-up. It was also evaluated the follow-up period and the sequelae of the treatment. RESULTS: Twelve patients were included, 8 of then women. The follow-up period was from 3 to 35 years, with a media of 11,6 years. The main symptoms were: hearing loss, pulsate tinnitus, dizziness and vertigo. The signs were pulsate retrotympanic mass, facial palsy and cofosis. The tumors were staged using Fischs classification. The radiotherapy was performed with linear accelerator with dose ranging from 4500-5500 in 4-6 weeks. In the follow-up period were possible to identify sequelaes like dermatitis, meatal stenosis, cofosis and facial palsy. DISCUSSION: The signs and symptoms were the same found in the medical literature. The type and dosages of the radiotherapy were also the same of others reports. All patients had improvement of the symptoms and only one was not considered as having disease controlled. Complications were, in general, minor complications, with exception of the cofosis and facial palsy. CONCLUSION: Radiotherapy is a viable alternative to treatment of these tumors because their good response and low level of complications. It should be considered specially in advanced tumors where a surgical procedure could bring a high level of morbidity.

Pitch and loudness tinnitus in individuals with presbycusis

Introduction Tinnitus is a symptom that is often associated with presbycusis. Objective This study aims to analyze the existence of association among hearing thresholds, pitch, and loudness of tinnitus in individuals with presbycusis, considering the gender variable. Methods Cross-sectional, descriptive, and prospective study, whose sample consisted of individuals with tinnitus and diagnosis of presbycusis. For the evaluation, we performed anamnesis along with otoscopy, pure tone audiometry, and acuphenometry to analyze the psychoacoustic characteristics of tinnitus individuals. Results The sample consisted of 49 subjects, with a mean age of 69.57 ± 6.53 years, who presented unilateral and bilateral tinnitus, therefore, a sample of 80 ears. In analyzing the results, as for acuphenometry, the loudness of tinnitus was more present at 0dB and the pitch was 6HKz and 8HKz. Regarding the analysis of the association between the frequency of greater hearing threshold and tinnitus pitch, no statistical significance (p = 0.862) was found. As for the association between the intensity of greater hearing threshold and tinnitus loudness, no statistical significance (p = 0.115) was found. Conclusion There is no significant association between the hearing loss of patients with presbycusis and the pitch and loudness of tinnitus.

Resultados da cirurgia para otospongiose com dois tipos de prótese em procedimentos realizados por residentes

Stapes surgery is one of the approaches indicated to treat conductive hearing loss secondary to otosclerosis. The procedures requires skill and experience from the surgeon and is part of medical residency training. AIMS: To assess which type of prosthesis (Teflon or metal/steel) presents the best results in surgeries performed by residents and the incidence of complications. MATERIALS AND METHODS: we retrospectively assessed 189 interventions that counted on the active participation of resident physicians, and we compared the two types of prosthesis used. Audiometric results were analyzed following the guidelines from the Committee on Hearing and Equilibrium and also according to the Amsterdam Hearing Evaluation Plots. RESULTS: Bone-air gap reduced in an average value of 21.90 dB (p<0.05) after the surgery in the group that received the Teflon prosthesis and 21.37 dB (p<0.05) in the group that received the mixed prosthesis, and gain in SRI was of 22.33 and 26.10 dB (p<0.05), and the air-bone gap was below 20 dB in 80.6% and 85.04%, respectively. CONCLUSIONS: We did not see differences in the audiometry and in the incidence of complications when we compared the type of prosthesis used. We believe it is valid to continue teaching this procedure in medical residency training programs, regardless of the type of prosthesis.