Ciríaco Cristóvão Tavares Atherino

Laryngo-pharyngeal Tuberculosis

UNLABELLED Tuberculosis of the Larynx and pharynx only is rare. However, in the last few years, the number of tuberculosis cases in general have had a dramatic increase, thus increasing the possibility of isolated laryngo-pharyngeal lesions. AIM To report a case of isolated laryngo-pharyngeal tuberculosis in a pregnant, immunocompetent host. CASE REPORT A 30- year-old pregnant female had complained of odynophagia for the last ten months. There were no other respiratory or systemic symptoms. An oro-pharyngeal granulomatous lesion was found, and the biopsy revealed acid-fast bacilli. There were no clinical or radiologic pulmonary findings. She was submitted successfully to an tuberculosis treatment protocol for nine months. CONCLUSIONS The authors point out the epidemiological importance of tuberculosis and the need for a higher degree of suspicion when dealing with uncommon upper airway lesions to make an early diagnosis.

Audiometria de altas frequências em bombeiros militares com audiometria normal expostos ao ruído

UNLABELLED The study of high frequencies has proven its importance for detecting inner ear damage. In some cases, conventional frequencies are not sensitive enough to pick up early changes to the inner ear. AIM To analyze the results of threshold high frequency analysis of individuals exposed to noise with normal conventional audiometry. MATERIALS AND METHODS This was a retrospective cross-sectional cohort study, in which we studied 47 firefighters of the Fire Department of Rio de Janeiro, based on Santos Dumont airport and 33 military men without noise exposure. They were broken down into two age groups: 30-39years and 40-49years. The high frequencies were studied immediately after conventional audiometry. RESULTS The results were most significant in the 40 to 49 years of age range, where the experimental group showed significantly higher threshold values than the control group 14000Hz (p = 0.008) and 16,000Hz (p = 0.0001). CONCLUSIONS We concluded that noise interfered with high frequency thresholds, where all the mean values found in the experimental group were higher than those in the control group. We suggest that these data reinforce the importance of studying high frequencies, even with normal conventional audiometry in the early detection of noise-induced hearing loss.

Limiares de audibilidade em altas freqüências em crianças com história de otite média secretora bilateral

Existem achados na literatura de limiares elevados em altas frequencias em criancas com historia de otite media secretora. OBJETIVO: Caracterizar os limiares de audibilidade nas altas frequencias em criancas normo-ouvintes com historia de multiplos episodios de otite media secretora bilateral. MATERIAL E METODO: Constituiu-se uma amostra de 31 criancas de ambos os sexos, sendo 14 com ate 3 episodios de otite media secretora bilateral (Grupo 1) e 17 com quatro ou mais episodios (Grupo 2). Foi realizada a audiometria tonal por via aerea para as frequencias de 9.000 a 18.000Hz. FORMA DE ESTUDO: Transversal prospectivo. RESULTADOS: Nao houve diferenca entre os limiares de audibilidade das orelhas direitas e esquerdas dos individuos de ambos os grupos para todas as frequencias, porem, houve entre os limiares de audibilidade das orelhas direitas e esquerdas do Grupo 2 em relacao ao Grupo 1 para todas as frequencias avaliadas. CONCLUSOES: 1- Houve uma elevacao dos limiares de audibilidade com o aumento das frequencias apresentadas. 2- A audiometria de altas frequencias mostrou-se capaz de separar, em grupos, individuos com historia de otite media secretora denotando que quatro episodios de otite media ja sao suficientes para determinar diferencas estatisticamente significantes nos limiares de audibilidade das altas frequencias.

Cervical vestibular evoked myogenic potentials in children.

INTRODUCTION Cervical vestibular evoked myogenic potential is a test used in neurotological examination. It verifies the integrity of vestibular function through a muscular response evoked by an acoustic stimulation which activates the saccular macula. Normal standards in adults have been established, however, there are few published data on the normal responses in children. OBJECTIVE To establish normal standards for vestibular myogenic responses in children without neurotological complaints. METHODS This studys design is a cohort with cross-sectional analysis. The sample consisted of 30 subjects, 15 females (50%) and 15 males (50%). RESULTS The age of the subjects ranged between 8 and 13 years, with a mean of 10.2 (± 1.7). P1 peak showed an average latency of 17.26 (± 1.78)ms and a mean amplitude of 49.34 (± 23.07)μV, and the N2 peak showed an average latency of 24.78 (± 2.18)ms and mean amplitude of 66.23 (± 36.18)μV. P1-N2 mean amplitude was 115.6 (± 55.7)μV. There were no statistically significant differences when comparing by gender or by laterality. CONCLUSION We established normal values of cervical myogenic vestibular responses in children between 8 and 13 years without neurotological complaints.Introduction Cervical vestibular evoked myogenic potential is a test used in neurotological examination. It verifies the integrity of vestibular function through a muscular response evoked by an acoustic stimulation which activates the saccular macula. Normal standards in adults have been established, however, there are few published data on the normal responses in children.

Original articleCervical vestibular evoked myogenic potentials in childrenPotencial evocado miogênico vestibular cervical em crianças

INTRODUCTION Cervical vestibular evoked myogenic potential is a test used in neurotological examination. It verifies the integrity of vestibular function through a muscular response evoked by an acoustic stimulation which activates the saccular macula. Normal standards in adults have been established, however, there are few published data on the normal responses in children. OBJECTIVE To establish normal standards for vestibular myogenic responses in children without neurotological complaints. METHODS This studys design is a cohort with cross-sectional analysis. The sample consisted of 30 subjects, 15 females (50%) and 15 males (50%). RESULTS The age of the subjects ranged between 8 and 13 years, with a mean of 10.2 (± 1.7). P1 peak showed an average latency of 17.26 (± 1.78)ms and a mean amplitude of 49.34 (± 23.07)μV, and the N2 peak showed an average latency of 24.78 (± 2.18)ms and mean amplitude of 66.23 (± 36.18)μV. P1-N2 mean amplitude was 115.6 (± 55.7)μV. There were no statistically significant differences when comparing by gender or by laterality. CONCLUSION We established normal values of cervical myogenic vestibular responses in children between 8 and 13 years without neurotological complaints.Introduction Cervical vestibular evoked myogenic potential is a test used in neurotological examination. It verifies the integrity of vestibular function through a muscular response evoked by an acoustic stimulation which activates the saccular macula. Normal standards in adults have been established, however, there are few published data on the normal responses in children.

Audibility threshold for high frequencies inchildren with medical history of multiples episodes of bilateral secretory otitis media

UNLABELLED Relatively poorer audibility threshold for high frequency was found in children with medical history of multiples episodes of secretory otitis media. AIM to characterize the audibility threshold for high frequencies in normal-hearing children with medical history of multiples episodes of bilateral secretory otitis media. MATERIALS AND METHODS a sample of 31 children, from both genders, was divided in two groups: 14 subjects who had not more than 3 episodes of bilateral secretory otitis media (Group 1) and 17 subjects that experienced at least 4 episodes of this condition (Group 2). Pure-tone air conduction audiometry was tested at frequencies 9,000 to 18,000 Hz. STUDY DESIGN transversal prospective. RESULTS there was no difference between audibility thresholds comparing right and left ears of subjects of both Group 1 and Group 2 in all tested frequencies. However, there was difference between audibility thresholds between subjects of Group 2 compared to Group 1 in all tested frequencies. CONCLUSION 1- There was an increase in audibility thresholds with the increase in frequency . 2- High frequency audiometry separates subjects with history of at least four episodes of secretory otitis media, suggesting that these episodes are sufficient to promote statistically significant difference in high frequency thresholds.

P084: Nasal Obstruction and Vocal Nodules: A Possible Relationship

OBJECTIVES: To (1) compare the prevalence of hyperkinetic laryngeal features before and after successful correction in patients with unilateral vocal cord paralysis (UVCP), and (2) understand the glottal closure symptoms after surgical correction for UVCP. METHODS: Eighty-six patients with UVCP who had a successful surgical correction were enrolled in 2005 at Tri-Service general hospital. Preoperative and postoperative videolarygostroboscopic (VLS) pictures were analyzed and the muscle tension patterns (MTPs) were rated according to the MorrisonRammage classification. The incidence of MTPs was compared between patients before and after operation for UVCP. RESULTS: The four-item glottal closure index (vocal fatigue, voice crack, throat discomfort, and effortful speaking) was used for each patient on study entry. Data from 40 normal subjects were collected as the control group. The scores were obtained for two groups and compared with t-student test. There was no significant difference in MTPs prevalence before (57%) and after (55%) surgical correction for UVCP. Although the glottal closure symptoms were tremendously improved through surgical medialization for UVCP, they persisted and were more prevalent than those in normal individuals. CONCLUSIONS: Muscle tension patterns in patients with UVCP cannot be eliminated by successful medialization of the paralyzed cord. Persistence of MTPs after correction of UVCP may be due to intractable vocal habit or a psychogenic factor. The vocal fatigue cannot be completely eradicated through complete medialization of the paralyzed cord.

Corpos estranhos de seio maxilar

The authors present five cases of maxillary sinus foreign bodies, four of them (80%) originated from surgical problems. They discuss their findings, enphasizing the difficulty and the importance of early diagnosis and treatment. They recommend the use of tied gauze in the surgical procedures in the maxillary sinus.

Sinusite recorrente de causa incomum

The authors present a case of chronic recurrent sinusitis of rare etiology in a man submitted previously to a facial peeling. The computed tomography and the sinusal endoscopy revealed periorbital fat in the maxilary sinus. There was a history of old orbital floor fracture.

Nasal septal abscess due to dental prosthesis

Objectives: Lemierres syndrome is characterized by thrombophlebitis of the internal jugular vein as a complication of anaerobic sepsis from an intraoral infection. Necrobacillosis is the term used to describe Lemierres syndrome when caused by the bacillus Fusobacterium necrophorum. Rare cases of Lemierres syndrome have been reported in the postantibiotic era, but blood cultures have seldom isolated this organism. Methods: We report a case of classic Lemierres syndrome in a 15-year-old girl who developed necrobacillosis as a complication of pharyngitis. Blood cultures grew F necrophorum. The patient developed further complications from this disease, including pulmonary effusions and decreased mental status. Results: The patient was treated conservatively with intravenous antibiotics and without anticoagulation. Although critically ill, she was able to completely recover from this illness without suffering permanent morbidity. We review the clinical considerations and treatment options for this case and Lemierres syndrome in general. Conclusion: Although quite rare, Lemierres syndrome and necrobacillosis represent life-threatening complications of common clinical conditions seen by the general otolaryngologist. Familiarity with the pathophysiology and etiology of this disease will aid in its treatment. Advances in diagnostic imaging and interventional technologies bring new potential therapies for this old-time disease.