Fábio André Selaimen

Avaliação tomográfica das orelhas contralaterais de pacientes com otite média crônica grave

UNLABELLED Some studies indicate a bilateral tendency of chronic otitis media. It is believed that the contralateral ear can provide evidences of the route of formation of ear disease in the most affected, be a parameter of Eustachian tube function and predict successful treatment. The CT scan is an excellent test to evaluate the structures of the temporal bone and the changes resulting from otitis media. OBJECTIVE To evaluate Temporal Bone Computed Tomography of patients with chronic otitis media and describe abnormalities in the contralateral ear. METHOD Cross-sectional study. Evaluation of CT scans of 75 patients with chronic otitis media from a tertiary referral hospital in Brazil by a neuroradiologist. RESULTS Population was consisted of 50.6% males with a mean age of 36 years. We found 54.7% of changes in contralateral ear clearly associated with chronic otitis media. CONCLUSION The prevalence of radiographic changes in the contralateral ears of patients with chronic otitis media corroborates with clinical, histopathological and functional resources developed by the same group that this disease has a bilateral feature.

The Role of Tympanic Membrane Retractions in Cholesteatoma Pathogenesis

Objective To analyze the contralateral ear (CLE) of patients with cholesteatoma and to correlate the cholesteatoma growth pattern in the affected ear with the findings in the CLE. Methods Videotoscopy of both ears in 432 patients with cholesteatomas classified as posterior epitympanic (PEC), posterior mesotympanic (PMC), two routes, or undetermined. Tympanic membrane (TM) retractions were classified by location and severity and TM perforations according to signs of previous TM retraction. Results TM retraction was the most prevalent alteration in the CLE (42.6%). Cholesteatoma was observed in 17.4%. In patients with PEC, the retraction in the CLE was more frequent in the PF (66.7%) than in the PT (1.4%), and in those with two-route cholesteatoma, the retraction in the CLE most frequently involved both the PT and PF (65.6%; p < 0.0001). Conclusion Our results confirm the essential role of TM retraction at least in the earlier phases of cholesteatoma pathogenesis.

Characteristics of 419 patients with acquired middle ear cholesteatoma.

INTRODUCTION Cholesteatoma is a destructive lesion that can result in life-threatening complications. Typically, it presents with hypoacusis and continuous otorrhea as symptoms. Because it is a rare disease, there are few studies in Brazil describing the characteristics of patients with the disease. OBJECTIVE This study aimed to determine the prevalence of cholesteatoma in patients with chronic otitis media and describe clinical, audiological and surgical characteristics of patients with acquired middle ear cholesteatoma treated at a referral hospital in the public health system. METHODS Cross-sectional and prospective cohort study, including 1710 patients with chronic otitis media, treated between August 2000 and June 2015, without prior surgery. Detailed clinical history, videotoscopy, and audiometry were performed, in addition to review of medical records to search for surgical data. Cholesteatomas were classified according to their route of formation. RESULTS Of the patients with chronic otitis media, 419 (24.5%) had cholesteatoma; mean age of 34.49 years; 53.5% female and 63.8% adults. Bilateral cholesteatoma was observed in 17.1%. Anterior epitympanic cholesteatoma corresponded to 1.9%; posterior epitympanic, 32.9%; posterior mesotympanic, 33.7%; two routes, 14.8%; and indeterminate, 16.7%. The mean air-bone gap was 29.84dB and did not differ between routes of formation. There were no correlations between gap size and patient age or duration of symptoms. Of the surgical cases, 16.8% underwent closed tympanomastoidectomy and 75.2% open tympanomastoidectomy. CONCLUSION The prevalence of cholesteatoma in patients with chronic otitis media was 24.5% and it was more common in adults than in children. Posterior mesotympanic cholesteatoma was more frequent, with no difference in mean air-bone gap between the different routes of formation. In patients undergoing surgery, open tympanomastoidectomy was the procedure most frequently chosen.

[One case, two lessons: an aberrant internal carotid artery causing acquired cholesteatoma].

Otomicroscopy revealed an extremely infected left ear,a posterior mesotympanic cholesteatoma, and erosion ofthe long process of the incus and the suprastructure of stapes. The TM was intact anterior to manubrium, but pulsatile brownish bulge was noticed filling the anterior The appearance of this finding resembled cholesterol granuloma or a superiorly displaced jugular The contralateral ear was completely normal. Audio- confirmedapureconductivehearinglossintheleftear normality in the right side. High-resolution axial com- tomography scan showed an abnormal course of thepetrous portionoftheleftinternalcarotidartery,protrudinginto the tympanic cavity through a complete dehiscence in carotid plate (Fig. 1). The displaced artery completelyfilled the bony lumen of the eustachian tube, expanding filling the protympanum. The mastoid was sclerotic, TM severely retracted, and the mucosa markedly thick- in the posterior recesses (Fig. 1). The patient was to inside-out wall-down mastoidectomy, withoutcomplications.

Ossicular Erosion and Air-Bone Gap in Attic and Tensa Cholesteatomas

Objectives: (1) Compare the air-bone gap between patients with posterior epitympanic (attic) and posterior mesotympanic (tensa) cholesteatomas. (2) Correlate the air-bone gap and intraoperative ossicular chain findings. Methods: Cross-sectional study. In total, 262 patients with attic and tensa cholesteatomas treated at a tertiary hospital were included. Audiometry was performed, and the pure tone average air-bone gap (PTA-ABG) was compared between the 2 groups. In addition, ossicles were classified as normal, eroded, or absent based on intraoperative evaluation. Data were compared using the Mann-Whitney and Chi-square tests, and statistical analysis was performed using SPSS. Results: Attic cholesteatoma was diagnosed in 51.1% of patients and tensa cholesteatoma in 48.9%. The mean patient age was 33 ± 18.7 years, and 52.3% were male patients. The PTA-ABG was higher in tensa cholesteatoma cases than in attic cholesteatoma (30.25 ± 12.82 dB and 26.73 ± 13.08 dB, respectively, P = .031). There were no differences in the malleus erosion or absence prevalence and the stapes suprastructure prevalence (P = .09 and P = .17, respectively). The incus was normal in 17.6% of the attic and 6.3% of tensa cholesteatoma cases; eroded in 79.4% of tensa and 48.6% of attic cases; and absent in 33.8% of attic and 14.3% of tensa cholesteatoma cases (P < .01). Conclusions: The PTA-ABG was higher in tensa cholesteatoma cases and correlated with a lower normal incus prevalence and a higher eroded incus prevalence compared to attic cholesteatoma cases.

Cholesteatoma Growth Patterns: Are There Audiometric Differences between Posterior Epitympanics and Mesotympanics?

Objectives: Verify if there are differences in hearing impairment between posterior epitympanic and posterior mesotympanic cholesteatomas. Methods: This cross-sectional study evaluated 278 ears with cholesteatoma and no previous surgery between August 2000 and January 2013. Otoendoscopy and pure tone audiometry were performed at the first evaluation. The video-otoscopys were later analyzed and classified between the two main possible routes involved in cholesteatoma formation (posterior epitympanic and posterior mesotympanic). To compare the audiometric thresholds, we employed the Student t test. Results: The mean age was 33.7 years old, and 51.1% were male. The posterior epitympanic cholesteatoma was found in 51.4%. There were no differences in air and bone conduction thresholds between the two groups (P > 0.05). When the air-bone gaps were compared, however, the posterior mesotympanics had greater thresholds in 500 Hz, 2000Hz, and tritonal mean (P = 0.003, P = 0.03, and P = 0.02, respectively) Conclusions: The posterior mesotympanic cholesteatomas had greater air-bone gap thresholds in the speech frequencies when compared with posterior epitympanic cholesteatomas. However, the two growth patterns were very similar in the other audiometric parameters.

Hearing Impairment in 351 Middle Ear Cholesteatomas

Objectives: 1) Analyze the hearing loss in ears with cholesteatoma 2) Verify differences between children and adults. Methods: A cross sectional study involving 351 ears with middle ear cholesteatoma and no previous surgery submitted to pure tone audiometry between August 2000 and January 2013. The air and bone conduction thresholds and the air-bone gaps were compared. Statistical analysis was performed using student t test. Results: The mean age was 31.5 ± 18.1 years old. 53.4% were men and 65.3% adults. The tritonal air and bone conduction thresholds media were 43.2 ± 18.7dB and 14.3 ± 12.8dB, respectively. The tritonal air-bone gaps media was 28.9 ± 13.8dB. Profound hearing loss was found in only 3.4% (8 adults and 4 children). The air and bone conduction thresholds were significantly greater in adults in all frequencies (P < 0.001). When the air-bone gaps were compared between the two groups, however, children had greater values in 500Hz (P = 0.05). There were no other differences between the groups in the further frequencies. Conclusions: Middle ear cholesteatoma is associated with significant hearing impairment although profound hearing loss is rare. Adults have greater thresholds in air and bone conduction than children. The air bone gaps are similar between the groups but can be greater in children.

Cholesteatoma Localization in the Contralateral Ear

Objective: Acquired cholesteatoma has been extensively studied. Theories that involve previous tympanic membrane retractions in the cholesteatoma pathogenesis are the most accepted. However we do not know what happens in the contralateral ear. We want to evaluate and compare the localization of acquired cholesteatomas in patients with bilateral disease. Method: This is a transversal study. We evaluated 1,015 patients with chronic otitis media in at least one ear and no previous surgery between August 2000 and January 2011. Otoendoscopy was carried out and recorded on the affected ear just as in the contralateral, which was classified. Results: Two hundred and sixty patients with chronic otitis media with cholesteatoma were included. The mean age was 31.7 years, and 52.7% were male. Cholesteatoma was found in 17% of the contralateral ears. In the case of an epitympanic cholesteatoma in one ear, the cholesteatoma in the other ear was in the same site in 92% of patients. On the other hand, if it was mesotympanic posterior in one ear, the cholesteatoma in the contralateral ear was in the same location in 80%. Conclusion: The results suggest that patients with acquired cholesteatoma have a greater probability of having a cholesteatoma in the same site in the contralateral ear. This corroborates the idea that chronic otitis media with cholesteatoma is not only an isolated event but a constitutional process with a high prevalence of bilaterality.

The Contralateral Ear in Acquired Cholesteatoma

Objective: Acquired cholesteatoma has been extensively studied. Theories that involve previous tympanic membrane retractions in its pathogenesis are the most accepted. However we do not know what happened in the contralateral ear. Our objective is to evaluate the prevalence of significant alterations in the contralateral ear of patients with acquired cholesteatoma. Method: This is a transversal study. We evaluated 1015 patients with chronic otitis media in at least one ear and no previous surgery between August 2000 and January 2011. Otoendoscopy was carried out and recorded on the affected ear just as in the contralateral, which was classified as normal or abnormal. Results: Two hundred and sixty patients with chronic otitis media with cholesteatoma were included. The mean age was 31.7 years, and 52.7% were male. Only 35.6% of the contralateral ears were normal or had minimal alterations, such as tympanosclerosis, neotympanum, and mild tympanic membrane retraction. The most prevalent alterations were moderate and severe tympanic membrane retractions (42%), followed by cholesteatoma (17%). Conclusion: The results suggest that patients with acquired cholesteatoma have a greater probability of having some abnormality in the contralateral ear. The most common were eardrum retractions and cholesteatoma. This corroborates the idea that COM is not only an isolated event but a constitutional process with a high prevalence of bilaterality.