Daniel Mochida Okada

O uso da acupuntura para alívio imediato do zumbido

O zumbido, definido como percepcao consciente de um som originado nas orelhas ou no sistema nervoso do paciente, representa ate os dias atuais um grande desafio no que concerne seu tratamento, baseia-se na estimulacao com agulhas de pontos especificos definidos sobre a anatomia humana. A utilizacao da Acupuntura (ACP) em sintomas como o zumbido assemelha-se ao modelo aplicado nos quadros algicos, ja que ambos estao relacionados como experiencia sensorial e emocional subjetiva e desagradavel. OBJETIVO: Estudar a eficacia da acupuntura no alivio sintomatico de forma aguda no zumbido. FORMA DE ESTUDO: Clinico prospectivo. MATERIAL E METODO: Foi realizado um estudo prospectivo, randomizado e duplo-cego em 76 pacientes atendidos no Ambulatorio de Zumbido do Departamento de Otorrinolaringologia e Cirurgia de Cabeca e Pescoco da UNIFESP-EPM no periodo compreendido entre abril e junho de 2005. Todos os pacientes tinham queixa de zumbido e foram submetidos a anamnese clinica, exame fisico e exames subsidiarios a fim de se investigar sua etiologia. Os pacientes eram entao encaminhados a um primeiro pesquisador que determinou um valor numerico subjetivo inicial do zumbido atraves de Escala Visual Analogica (EVA), variando de 0 a 10 pontos. Apos isto, foram encaminhados para outra sala na qual um medico acupunturista, que nao tinha acesso a avaliacao inicial, separou os pacientes em Grupo Controle e Grupo Estudo de acordo com a ordem de atendimento, de maneira alternada. O ponto de ACP utilizado nos pacientes do Grupo Estudo situa-se a 6,5cm acima do apice do pavilhao auditivo na regiao temporo-parietal. O ponto utilizado no Grupo Controle situa-se 3cm acima do ponto anterior, na mesma linha vertical. Foram entao encaminhados a sala inicial para uma nova avaliacao pelo primeiro pesquisador, onde foram orientados a redefinir o escore subjetivo do zumbido. RESULTADOS: Dos 76 pacientes estudados, 29 eram do sexo masculino (38,2%) e 47 do sexo feminino (61,8%), com idade media 56,9 + 12,0 anos. Os Grupos Estudo e Controle contaram com 38 pacientes cada. Atraves do teste Anova foi constatado que houve diferenca significante (p<0,001) entre os momentos pre e pos-agulhamento e que no grupo Estudo essa melhora e bem maior (p = 0,0127). O teste t-independente mostrou que houve uma diferenca significante (p=0,017) entre os escores pre e pos-agulhamento nos grupos Estudo e Controle. CONCLUSAO: Concluimos que houve reducao significante da contagem dos momentos pre e pos-agulhamento em ambos os grupos (controle e estudo), sendo que no grupo estudo a reducao e maior que no grupo controle.

Acupuncture for tinnitus immediate relief

The treatment of tinnitus, which is defined as conscientious perception of a sound originated in the ears or nervous system, represents until the current days a great challenge. The use of Acupuncture (ACP) is based on the stimulation with needles of specific points on the human anatomy. A prospective, randomized and double-blinded study was carried through in 76 patients taken care of in the Clinic of Tinnitus of the Department of Otorhinolaryngology and Head and Neck Surgery of the UNIFESP-EPM in the period understood between April and June of 2005. All the patients had humming complaint and had been submitted to clinical anamnese, physical examination and subsidiary exams in order to investigate its etiology. The patients then were directed to a first researcher that determined an initial numeric value of the humming through Visual Analoge Scale(VAS), varying from 0 to 10 points. After this, had been directed for another room in which an acupuncturist doctor, who did not have access to the initial evaluation, separated the patients in Group Control and Group Study according to the attendance order, in alternating way. The ACP point used in patients of the Group Study places 6,5 cm above of the apex of the auditory pavilion in the parietal region. The point used in the Group Control places 3 cm above of the previous point, in the same vertical line. Then they had been sent back to the initial room for a new evaluation by the first researcher, where they had been guided to redefine the subjective score of the humming. Among the 76 studied patients, 29 were male (38,2%) and 47 female (61,8%), with average age 56,9 + 12,0 years. The Groups Study and Control had counted on 38 patients each. Through the Anova test it was evidenced that it had significant difference (p<0,001) between the moments pre and post needling and that in the group Study this improvement is more evident (p=0,0127). The t-independent test showed that it had a significant difference (p=0,017) between the two moments in the groups Study and Control. We conclude that there was significant reduction of the counting of the moments pre and post needling in both the groups, and in the group study the reduction is greater that in the group control.

Simulador cirúrgico para treinamento de dissecção do osso temporal

UNLABELLED Temporal bone dissection plays an important role in the training of surgeons; however, they are difficult to obtain. AIM To develop a synthetic replica of the temporal bone for dissection training. STUDY DESIGN Experimental. MATERIALS AND METHODS An acrylic synthetic resin replica was obtained from a human temporal bone. For the evaluation of the method, we selected five ear surgeons to dissect the model in a laboratory of experimental surgery. A questionnaire was filled, assessing external appearance, the simulation of procedures (placement of ventilation tube, mastoidectomy, decompression of the facial nerve and translabyrinthine access to the internal auditory canal) and their final conclusion. RESULTS The evaluation indicated satisfaction in using the model (80%), being more evident concerning the dissection of the mastoid segment of the facial nerve and translabyrinthine access to the internal auditory canal. The placement of a ventilation tube was reasonable for 60% and satisfactory for 40% of them. Mastoidectomy was satisfactory for 60% and fully satisfactory for 40%. CONCLUSION Dissection in this simulator does not replace otologic training in cadaveric temporal bones. However, given the increasing difficulty in obtaining the latter, the development of new teaching tools should be encouraged to continuously improve surgeons.

Impact of acupuncture on otoacoustic emissions in patients with tinnitus.

UNLABELLED The treatment of tinnitus is still a challenge. Acupuncture is recommended for the relief of tinnitus in traditional Chinese Medicine, although scientific evidence is lacking. AIM The aim of this study was to assess the effect of acupuncture on the cochlear function in patients with tinnitus by analyzing otoacoustic emissions. METHODS Thirty eight patients with tinnitus were included in the prospective clinical study. Measures of transitory otoacoustic emissions and suppression of otoacoustic emissions were obtained from all subjects before and after acupuncture. Patients were assigned to one of two groups: intervention group 1 (n=19), in which needle acupuncture was applied at the temporoparietal point corresponding to the vestibulocochlear area, and intervention group 2 (n=19), in which the needle was applied 3 cm cranially to this area (which is not a recognized acupuncture point). RESULTS There was a significant difference between the amplitude of otoacoustic emissions assessed before and after acupuncture in intervention group 1. No difference was observed in intervention group 2. CONCLUSION Acupuncture had a significant effect on otoacoustic emissions in patients with tinnitus.

Efeito da acupuntura sobre as emissões otoacústicas de pacientes com zumbido

The treatment of tinnitus is still a challenge. Acupuncture is recommended for the relief of tinnitus in traditional Chinese Medicine, although scientific evidence is lacking. AIM: The aim of this study was to assess the effect of acupuncture on the cochlear function in patients with tinnitus by analyzing otoacoustic emissions. METHODS: Thirty eight patients with tinnitus were included in the prospective clinical study. Measures of transitory otoacoustic emissions and suppression of otoacoustic emissions were obtained from all subjects before and after acupuncture. Patients were assigned to one of two groups: intervention group 1 (n=19), in which needle acupuncture was applied at the temporoparietal point corresponding to the vestibulocochlear area, and intervention group 2 (n=19), in which the needle was applied 3cm cranially to this area (which is not a recognized acupuncture point). RESULTS:There was a significant difference between the amplitude of otoacoustic emissions assessed before and after acupuncture in intervention group 1. No difference was observed in intervention group 2. CONCLUSION: Acupuncture had a significant effect on otoacoustic emissions in patients with tinnitus.

Anatomical study of a temporal bone from a non-human primate (Callithrix sp)

UNLABELLED The search for experimental (animal) models is essential to the development of clinical studies. AIM To demonstrate, by means of micro dissection techniques, the anatomical structures of temporal bones from the primate Callithrix sp. STUDY DESIGN Experimental. METHODS Dissection of temporal bone structures of Callithrix sp and photographic documentation. RESULTS We identified the main constituents of the temporal bone (external, medium and inner ear and facial nerve). CONCLUSION The non-human primate Callithrix sp. is an adequate experimental model for the studies of temporal bone structures given its close anatomical similarities to that found in humans.

Estudo anatômico do osso temporal de um primata não-humano (Callithrix sp)

The search for experimental (animal) models is essential to the development of clinical studies. AIM: To demonstrate, by means of micro dissection techniques, the anatomical structures of temporal bones from the primate Callithrix sp. STUDY DESIGN: Experimental. METHODS: Dissection of temporal bone structures of Callithrix sp and photographic documentation. RESULTS: We identified the main constituents of the temporal bone (external, medium and inner ear and facial nerve). CONCLUSION: The non-human primate Callithrix sp. is an adequate experimental model for the studies of temporal bone structures given its close anatomical similarities to that found in humans.

Intracanalicular meningioma: diagnostic by immunohistochemistry

The meningioma (ME) was originally described by Virchow in 1863 as a tumor originating from meningothelial cells that are usually found within leptomeninges and the choroid plexi of the ventricles, with a preference for the supratentorial area. Any area that is covered by the leptomeninges, however, is potentially a site of origin for meningiomas. The first report of an exclusively intracanalicular (IC) ME has been attributed to Singh et al. in 1975. Since then, about 15 ICME have been described in the English medical literature.

Ototoxicity in Guinea Pigs: NO Levels in Cochlear Fluids

Problem Ototoxicity continues to be the most common side effect of gentamicin, and its physiopathology is still unclear. Currently the main accepted theory relates the ototoxicity with over production of free radicals, like nitric oxide (NO). Objective: To analyze the NO levels in the cochlear fluids of guinea pigs exposes to gentamicin and its relation with ototoxicity and propose an experimental model to study ototoxicity and drugs that may prevent it. Methods Six guinea pigs were used, divided in two groups: a) Study – submitted to intraperitoneal injections of gentamicin, (135mg/kg/day) for 14days; b) Control - submitted to intraperitoneal injections of distilled water, daily, for 14days; the hearing loss was evaluated with Preyers reflex. On 14 day the guinea pigs were sacrificed and the cochlear fluids were collected for dosage of the nitric oxide through the chemiluminescence method (NOA-TM 280). Results The Preyers reflex was absent at the end of the experiment in the Study group, what did not happen in the control group. The average of the nitric oxide levels of the guinea pigs of the study group was 26.2μ and the Control group 11.26μM. Conclusion It was possible to measure nitric oxide levels in guinea pigs cochlear fluids. The results reinforce the role of nitric oxide in ototoxicity induced by gentamicin. Significance Experimental study (Level 2).