Cristina Dornelles

Sensorineural hearing loss in patients with chronic otitis media.

Chronic otitis media is generally associated with some degree of hearing loss, which is often the patient’s chief complaint. This hearing loss is usually conductive, resulting from tympanic membrane rupture and/or changes in the ossicular chain due to fixation or erosion caused by the chronic inflammatory process. When cholesteatoma or granulation tissue is present in the middle ear cleft, the degree of ossicular destruction is even greater. An issue that has recently gained attention is additional sensorineural hearing loss due to chronic otitis media. While the conductive loss can be minimized through surgery, sensorineural hearing loss constitutes a permanent after effect, attenuated only through the use of a hearing aid. However, a few groups have reported a decrease in sensorineural function in these patients as well. This survey study performed at a referral center evaluates the occurrence of sensorineural hearing loss in ambulatory patients with this disease. We reviewed the files of patients with unilateral chronic otitis media. One hundred and fifty patients met the inclusion criteria: normal otoscopy and normal hearing in the contralateral ear. Main outcome measure: bone-conduction threshold averages were calculated for frequencies of 500, 1,000, 2,000, 3,000 and 4,000 Hz, with comparison between the normal ear and the ear with chronic otitis media. Thresholds were examined separately for each frequency. The bone-conduction threshold averages for the normal side were lower than those for the ear with chronic otitis media. The threshold shift was statistically significant for each frequency (P < 0.0001, Student’s t test). There were differences between the groups when analyzed for age (500 and 1,000 Hz) or the presence of cholesteatoma (1,000 Hz). This study shows that chronic otitis media is associated with a decrease in cochlear function.

Some considerations about acquired adult and pediatric cholesteatomas

Authors debate about cholesteatomas, from the first time this word was employed, by Muller, in 1838, until the recent updates. They dissert about its definition, etiology and pathology and present basic concepts about its biology. They also make a wide review about pediatric cholesteatoma, its epidemiology and biology, and compare it with adult cholesteatoma. Finally, they describe some articles about ossicle chain erosion and its correlation with cholesteatoma perimatrix, collagen and collagenase.

The contralateral ear in chronic otitis media: a series of 500 patients.

OBJECTIVE To study the contralateral ear of patients with chronic otitis media (COM). DESIGN Transversal. SETTING Tertiary referral center. PATIENTS A total of 500 consecutive patients who had been diagnosed as having COM with or without cholesteatoma. INTERVENTIONS Digital otoendoscopy was performed on both ears. MAIN OUTCOME MEASURE Pathologic alterations in the contralateral ear. RESULTS In 75.2% of the patients, the contralateral ear was found to have some structural abnormalities; 60.4% of the patients presented with COM without cholesteatoma, and in this group, 69.9% had an abnormal contralateral ear. In those with cholesteatoma, the contralateral ear was found to be abnormal in 83.3%. The most frequent finding in both groups was retraction of the tympanic membrane. CONCLUSIONS Patients with COM in 1 ear have a high chance of presenting with some degree of disease in the contralateral side. We believe that our findings suggest that COM should be ideally approached not as a static pathological incident affecting 1 ear but rather as an on-going process that may affect both ears.

Contralateral Ear in Chronic Otitis Media: A Histologic Study†

Objective: The objective of this study is to determine the prevalence of the contralateral ear changes in human temporal bones of donors with chronic otitis media.

Histologic description of acquired cholesteatomas: comparison between children and adults

UNLABELLED Cholesteatoma is constituted of matrix, perimatrix and cystic content. Some authors affirm that, in children, its clinical behavior is more aggressive of the than in adults. AIMS Histologic compared cholesteatomas of children and adults. METHODOLOGY 74 cholesteatomas been analyzed, being 35 of pediatrics patients (<18 years). The average number of cellular layers and hyperplasia in the matrix had been evaluated; thickness, delimitante epithelium, fibrosis, inflammation and granuloma in the perimatrix. The analysis statistics was carried through with program SPSS 10.0, using the coefficients of Pearson and Spearman, test of chi-square and t test. The number of cellular layers in the matrix was of 8.2+/-4.2. The hyperplasia appears in 17%, fibrosis in 65%, granuloma in 12% and the delimitante epithelium in 21%. The perimatrix presented a medium one of 80 micrometers (37 the 232), minimum value zero and maximum value 1.926. The histological degree of inflammation was considered of moderate the accented one in 60%. When applying the coefficient of Spearman enters the inflammation degree and average of cellular layers of the matrix with the variables of the measure of thickness of the perimatrix we find correlations, significant, with moderate magnitudes of the great ones (rs=0.5 and P<0.0001). CONCLUSION Adults colesteatomas of and child had not been identified to morphologic differences between. We find correlation enters the intensity of the inflammation and of the average of cellular layers of the matrix with the thickness of the perimatrix, what it can predict its aggressiveness, more studies are necessary to define the paper of this finding in pathogenesis of cholesteatoma.

A computational method for the semi-automated quantitative analysis of tympanic membrane perforations and tympanosclerosis

Tympanic membrane pathological findings such as perforations and tympanosclerotic plaques (along with conductive hearing loss and purulent drainage) are the most typical trademarks of either active or burned-out chronic otitis media. These findings are normally evaluated by an expert using visual subjective analysis. In this work, we present a computational semi-automated method to quantify these pathologies. We also present a validation study of the method using a subset of 39 cases randomly extracted from a set of more than 2000 cases (perforations and tympanosclerosis) of the Hospital de Clínicas de Porto Alegre. The validation was performed using Ground Truth images, generated by experts, and has shown promising results.

Algumas considerações sobre colesteatomas adquiridos pediátricos e adultos

Authors debate about cholesteatomas, from the first time this word was employed, by Muller, in 1838, until the recent updates. They dissert about its definition, etiology and pathology and present basic concepts about its biology. They also make a wide review about pediatric cholesteathoma, its epidemiology and biology, and compare it with adult cholesteatoma. Finally, they describe some articles about ossicle chain erosion and its correlation with cholesteatoma perimatrix, collagen and collagenase.

Estudo da orelha contralateral na otite média crônica: "Efeito Orloff ®"

Introducao: A otite media cronica (OMC) representa entidade de alta prevalencia e distribuicao mundial. Apesar da grande quantidade de estudos publicados a respeito, ainda nao ha, na literatura pertinente, consenso sobre a patogenese da OMC. Uma das hipoteses e a do continuum, que apresenta a otite media cronica como uma serie de eventos continuos, onde insultos iniciais desencadeiam uma cascata de alteracoes. Partindo entao da ideia de continuum, pesquisamos a orelha contralateral (OCL) de individuos com diagnostico de OMC, descrevendo as alteracoes encontradas. Forma de estudo: Clinico prospectivo randomizado. Material e Metodos: Foram selecionados 108 pacientes com diagnostico de OMC nao-colesteatomatosa (OMC NC) ou colesteatomatosa (OMC C) acompanhados no ambulatorio do Grupo de Pesquisa em Patologia da Orelha Media do Hospital de Clinicas de Porto Alegre. Nestes, foi realizada otoendoscopia com fibra optica bilateral. A orelha mais estavel foi considerada contralateral (OCL), sendo classificada como normal ou alterada (e as alteracoes descritas). Resultados: Dentre os pacientes avaliados, 59,2% portavam OMC NC e 40,8% OMC C. 46,3% de todos os pacientes apresentaram alteracoes significativas na OCL. Dos pacientes com OMC C, 57% apresentavam alteracao na OCL, sendo que 39% dos pacientes com OMC NC tinham OCL alterada. A alteracao mais frequentemente encontrada foi retracao de MT, em ambos os grupos. Conclusoes: Os dados encontrados sugerem que pacientes que apresentam OMC tem maior probabilidade de apresentarem patologia na OCL, o que corrobora a ideia que a OMC se trata de um evento constitucional e nao isolado da orelha media.

Descrição histológica de colesteatomas adquiridos: comparação entre amostras de crianças e de adultos

Cholesteatoma is constituted of matrix, perimatrix and cystic content. Some authors affirm that, in children, its clinical behavior is more aggressive of the than in adults. AIMS: Histologic compared cholesteatomas of children and adults. METHODOLOGY: 74 cholesteatomas been analyzed, being 35 of pediatrics patients (<18 years). The average number of cellular layers and hyperplasia in the matrix had been evaluated; thickness, delimitante epithelium, fibrosis, inflammation and granuloma in the perimatrix. The analysis statistics was carried through with program SPSS 10,0, using the coefficients of Pearson and Spearman, test of qui-square and t test. The number of cellular layers in the matrix was of 8,2±4,2. The hyperplasia appears in 17%, fibrosis in 65%, granuloma in 12% and the delimitante epithelium in 21%. The perimatrix presented a medium one of 80 micrometers (37 the 232), minimum value zero and maximum value 1.926. The histological degree of inflammation was considered of moderate the accented one in 60%. When applying the coefficient of Spearman enters the inflammation degree and average of cellular layers of the matrix with the variables of the measure of thickness of the perimatrix we find correlations, significant, with moderate magnitudes of the great ones (rs=0,5 and P<0,0001). CONCLUSION: Adults colesteatomas of and child had not been identified to morphologic differences between. We find correlation enters the intensity of the inflammation and of the average of cellular layers of the matrix with the thickness of the perimatrix, what it can predict its aggressiveness, more studies are necessary to define the paper of this finding in pathogenesis of cholesteatoma.

Correlation of cholesteatomas perimatrix thickness with patient's age.

UNLABELLED Cholesteatoma may occur either in children as in adults; in children, however, they have a more aggressive and extensive growth. OBJECTIVE To compare the thickness of the perimatrix, in microm, between adults (>18 years old) and children cholesteatomas. STUDY DESIGN transversal cohort. MATERIAL AND METHOD 74 cholesteatomas (35 of children) obtained from othologic surgeries were included, fixed in formol 10%. It was made laminas with HE and Picrossisius, with were studied at the optic microscope. We obtained digital images of the laminas at the Image Pro-Plus and we used Spearmans coefficient for data analysis. Differences were considered statistically significant if P.