Celso Gonçalves Becker

Prevalence and impact of chronic otitis media in school age children in Brazil. First epidemiologic study concerning chronic otitis media in Latin America

OBJECTIVE The first epidemiological study carried out in Latin America to investigate the prevalence of otological disease and its impact in a representative random sample of the school children population. METHODS A cross sectional epidemiological survey to investigate the epidemiology of otitis in a representative random sample of 1119 children and adolescents from a total of 486166 elementary and high-school students, aged 6-18 years, regularly registered in one of the 521 public and private schools of the city of Belo Horizonte, in the state of Minas Gerais, southern Brazil. The interviews were conducted individually, in the school, by an otolaryngologist or a pediatrician. The interview included all of the personal data and also detailed questions regarding otological disorders and hearing. The otological examination was carried out with Mini-Heine otoscopes and the audiometric evaluation with the AudioScope 3 with 25dB intensity. The questionnaire and basic procedures for medical examination had been previously tested through a pilot test in two schools. RESULTS The prevalence of chronic otitis media was 0.94%. Impacted wax was found in 12.3% of the students. The prevalence of abnormalities (excluding wax) in the otoscopy examination was 10.5%. It was found that 8.3% of students had a past history of otitis and 7.7% had a past history of otorrhea. These two special groups presented statistically significant associations with chronic otitis media, hearing loss and otolaryngological surgeries (when compared with the other school children). Parents and school children seemed significantly able to identify a special group of children with past history of otitis during childhood.

Hearing loss in cystic fibrosis

OBJECTIVES To verify the prevalence of hearing loss in cystic fibrosis patients and whether the use of aminoglycosides affects hearing and also to analyze whether the distortion product otoacoustic emissions test is suitable to assess sensorineural hearing loss in cystic fibrosis. METHODS In this descriptive study 120 cystic fibrosis patients aged five months to 18 years were assessed through questionnaires, audiometric tests and analysis of the distortion product otoacoustic emissions. Assessment of previous use of aminoglycosides was performed by collecting data in medical charts. RESULTS Audiometric tests show a 4-11% prevalence of sensorineural hearing loss. 89.2% of the patients succeeded in the otoacoustic emissions test, and 42% had used intravenous and/or inhaled aminoglycosides. There was no statistically significant (p=0.48) relation between the use of aminoglycosides and hearing loss. CONCLUSION Pure tone audiometry and analysis of the distortion product otoacoustic emissions revealed that there was a high prevalence of hearing loss, which makes cystic fibrosis patients a high-risk group which needs periodic assessment by an otorhinolaryngologist. Comparison of the groups with and without aminoglycosides use showed that there was no statistically significant difference among them in analyses, which suggests that the use of aminoglycosides is not the only causal factor for hearing loss in cystic fibrosis.

Surgical treatment of otosclerosis in medical residency training

UNLABELLED The number of patients with stapes otosclerosis compared to the number of otorhinolaryngologists has declined over the past several years. As a result a controversy has arisen in the literature, whether or not stapes surgery should be included in residency programs. AIM the objective of the present study is to evaluate the results and complications of estapedotomies performed by residents between January, 1997 and January, 2000, and consequently study the feasibility of including estapedotomies in residency programs. STUD DESIGN: retrospective review of prospectively collected audiometric data. MATERIALS AND METHODS fifty charts of patients that were submitted to a total of 51 primary stapedotomies were reviewed mainly for complications and audiological results. RESULTS there was closure of the air-bone gap within 10 dB HL in 70.5% of ears and closure to within 20 dB HL in 86.3% of ears. There was one ear with total hearing loss (2%). CONCLUSION From the results and complications seen in the present study, and analyzing papers from the literature, it is possible to conclude that stapedotomy is a procedure that can be included in residency programs, if there are surgical cases for the residents.

Tratamento cirúrgico da otite média com efusão: tubo de ventilação versus aplicação tópica de mitomicina C

The insertion of the ventilation tube (VT), which is the surgical treatment for otitis media with effusion (OME), is not free from complications and also limits social life because of the need of abandoning immersion baths. Mitomycin C is an antineoblastic that delays fibrosis and avoids stenosis in scars by its topical use. It permitted a longer ventilation of the middle ear in guinea pigs by delaying tympanostomies closure similarly to the ventilation tubes. STUDY DESIGN: Prospective clinical trial. AIM: Observe and compare the efficacy of tympanostomy, effusion suction and insertion of the ventilation tube (VT group) versus results of tympanostomy, effusion suction and topic application of mitomycin C(MMC group), and also the duration of tympanotomy and incidence of complications in both groups. RESULTS: MMC group showed a significant lower efficacy (52% versus 80%) than that of VT group (p=0,34). The occurrence of type B curve in the tympanometry and tube pharyngeal ostium free from adenoid tissue in the preoperative period represent poor prognosis factors. The topic application of mitomycin on the tympanostomy permitted a patency period of two to three weeks. On the VT group, otorrhea was observed in 13,3 % of the patients. On the MMC group, despite its smaller efficacy, there were no complications or need of missing immersion baths. CONCLUSION: We concluded that VT showed better efficacy than mitomycin on this trial. However more study is needed specially focusing on higher mitomycin C concentrations, longer periods of application or its serial use, for the treatment of otitis media with effusion.

Absence of nasal air flow and maxillary sinus development

UNLABELLED Paranasal sinuses development mechanisms are not well known. Nasal air flow, according to one of the proposed theories, would be fundamental to the growth and healthy development of paranasal sinuses. AIM The aim of this study was to evaluate the maxillary sinus growth and health in the presence and absence of postnasal air flow through a unique model. MATERIALS AND METHODS Retrospective study of a series of cases; preoperative CT scans of 7 patients with unilateral choanal atresia, average age was 16.28 years (+/- 5.024). This study was done in a tertiary hospital, with patients treated between 1994 and 2004. The area of the maxillary sinuses was measured with the aid an Auto-Cad software. Kruskal-Wallis test was used in the statistical analysis. RESULTS Symmetrical or even bigger maxillary sinuses were found in the same side of the choanal atresia in 85.71% of the cases. There was no significant statistic difference between compared sides. CT Scan signs of sinus disease were not seem in these patients. DISCUSSION These findings oppose the commonly accepted theory about the role of nasal air flow in health and development of paranasal cavities.

Reproducibility of the three-dimensional endoscopic staging system for nasal polyposis

UNLABELLED Nasal polyposis is a chronic inflammatory process of the nasal mucosa, characterized by multiple and bilateral nasal polyps. Different drugs have been used in its treatment. In order to study the results of different treatment modalities it is necessary to have some kind of staging. AIM to present a new endoscopic staging method, based on nasal endoscopy and on the three-dimensional nasal polyp assessment; and compare its reproducibility with that from two other systems already established in the literature. STUDY DESIGN Cohort study. MATERIAL AND METHODS Three experts assessed the exams of 20 patients with nasal polyposis at different times, before, at 15 and at 30 days after the start of oral prednisone, 1 mg/kg/day, during 7 days. We assessed the agreement rate among the experts, using Kappa for statistic analysis. RESULTS The three methods were reproducible, and the method hereby proposed had the least agreement among the examiners. CONCLUSIONS the three-dimensional staging system proposed proved reproducible, despite showing less agreement among the examiners than the other as the other two methods.

Ausência de fluxo aéreo nasal e desenvolvimento dos seios maxilares

Paranasal sinuses development mechanisms are not well known. Nasal air flow, according to one of the proposed theories, would be fundamental to the growth and healthy development of paranasal sinuses. AIM: The aim of this study was to evaluate the maxillary sinus growth and health in the presence and absence of postnasal air flow through a unique model. MATERIALS AND METHODS: Retrospective study of a series of cases; preoperative CT scans of 7 patients with unilateral choanal atresia, average age was 16.28 years (± 5.024). This study was done in a tertiary hospital, with patients treated between 1994 and 2004. The area of the maxillary sinuses was measured with the aid an Auto-Cad software. Kruskal-Wallis test was used in the statistical analysis. RESULTS: Symmetrical or even bigger maxillary sinuses were found in the same side of the choanal atresia in 85.71% of the cases. There was no significant statistic difference between compared sides. CT Scan signs of sinus disease were not seem in these patients. DISCUSSION: These findings oppose the commonly accepted theory about the role of nasal air flow in health and development of paranasal cavities.

Apoptosis in eosinophilic nasal polyps treated in vitro with mitomycin C

UNLABELLED The etiopathogenesis of eosinophilic nasal polyps is yet to be explained. Eosinophils are key components in the inflammatory infiltrate and are related to the perpetuation of the inflammatory process in chronic rhinosinusitis with nasal polyps. OBJECTIVE This paper aims to evaluate the in vitro action of mitomycin upon the apoptotic index of nasal polyps. MATERIALS AND METHODS This is a self-paired prospective experimental study using biopsy fragments from 15 patients with eosinophilic nasal polyps. Biopsy fragments were divided into two groups. In the case group, the fragments were treated with 400 µg/ml of mitomycin for five minutes. The control group fragments were treated with culture medium. The pair of fragments contained in the two first compartments - control and case - were immediately sent to the histopathologist. The other pair of samples containing control and case fragments was incubated for 12 hours. The fragments were then taken to the histopathologist for testing. The apoptotic index was determined by the morphometry in hematoxylin and eosin staining and DNA fragmentation analysis (TUNEL reaction). RESULTS The comparison between the two groups showed a statistically significant difference (p < 0,001) in the apoptotic index of the 12-hour incubated cultures. CONCLUSION Mitomycin acts in vitro upon the eosinophilic nasal polyps inducing the rise of the eosinophilic apoptotic index.

Reprodutibilidade do estadiamento endoscópico tridimensional da polipose nasal

A polipose nasossinusal e um processo inflamatorio cronico da mucosa nasal, caracterizado pela presenca de polipos nasais multiplos e bilaterais. Varios tipos de medicacoes tem sido usados no seu tratamento. Para estudar o resultado de diferentes formas de tratamento, e preciso alguma forma de estadiamento. OBJETIVOS: Apresentar um novo metodo endoscopico de estadiamento, baseado na endoscopia nasal e na avaliacao tridimensional dos polipos, comparar sua reprodutibilidade entre outros dois metodos ja difundidos. FORMA DE ESTUDO: Estudo de coorte historica com corte transversal. MATERIAL E METODO: Tres examinadores avaliaram exames de 20 pacientes portadores de polipose nasossinusal em diferentes momentos, antes e 15 e 30 dias apos o inicio de um tratamento com prednisona, na dose de 1 mg/kg/dia por 7 dias. Foi avaliado o grau de concordância entre os examinadores para cada metodo, utilizando-se o Kappa multiplo para analise estatistica. RESULTADOS: Os tres metodos mostraram-se reprodutiveis, sendo que o metodo proposto apresentou menor concordância entre os examinadores. CONCLUSAO: O estadiamento proposto mostrou-se reprodutivel, apesar de apresentar menor concordância do que os outros dois estadiamentos.

Tratamento cirúrgico da otosclerose na residência médica

The number of patients with stapes otosclerosis compared to the number of otorhinolaryngologists has declined over the past several years. As a result a controversy has arisen in the literature, whether or not stapes surgery should be included in residency programs. AIM: the objective of the present study is to evaluate the results and complications of estapedotomies performed by residents between January, 1997 and January, 2000, and consequently study the feasibility of including estapedotomies in residency programs. STUD DESIGN: retrospective review of prospectively collected audiometric data. MATERIALS AND METHODS: fifty charts of patients that were submitted to a total of 51 primary stapedotomies were reviewed mainly for complications and audiological results. RESULTS: there was closure of the air-bone gap within 10 dB HL in 70.5% of ears and closure to within 20 dB HL in 86.3% of ears. There was one ear with total hearing loss (2%). CONCLUSION: From the results and complications seen in the present study, and analyzing papers from the literature, it is possible to conclude that stapedotomy is a procedure that can be included in residency programs, if there are surgical cases for the residents.