Fábio Tadeu Moura Lorenzetti

Bilateral congenital choanal atresia in a 13-year-old patient

Congenital choanal atresia (CCA) is the developmental failure of the nasal cavity to communicate with the nasopharynx. Surgical repair is recommended in the first weeks of life in bilateral cases, because in newborns this is a life-threatening situation. This is a case report of a 13-year-old patient complaining of long-term bilateral nasal obstruction and rhinorrea, in whom bilateral choanal atresia was diagnosed by endoscopic exploration and CT scan, and who was treated by an endonasal endoscopic surgical technique. Bilateral choanal atresia is a life-threatening disease in newborns; however, it can be diagnosed in adults with bilateral nasal obstruction and rhinorrea.

Treatment and Prognosis of Facial Palsy on Ramsay Hunt Syndrome: Results Based on a Review of the Literature

Introduction Ramsay Hunt syndrome is the second most common cause of facial palsy. Early and correct treatment should be performed to avoid complications, such as permanent facial nerve dysfunction. Objective The objective of this study is to review the prognosis of the facial palsy on Ramsay Hunt syndrome, considering the different treatments proposed in the literature. Data Synthesis We read the abstract of 78 studies; we selected 31 studies and read them in full. We selected 19 studies for appraisal. Among the 882 selected patients, 621 (70.4%) achieved a House-Brackmann score of I or II; 68% of the patients treated only with steroids achieved HB I or II, versus 70.5% when treated with steroids plus antiviral agents. Among patients with complete facial palsy (grades V or VI), 51.4% recovered to grades I or II. The rate of complete recovery varied considering the steroid associated with acyclovir: 81.3% for methylprednisolone, 69.2% for prednisone; 61.4% for prednisolone; and 76.3% for hydrocortisone. Conclusions Patients with Ramsay-hunt syndrome, when early diagnosed and treated, achieve high rates of complete recovery. The association of steroids and acyclovir is better than steroids used in monotherapy.

A proposition for a new term: "Rhonchoplastic Injection"

1 Specialist by the Associacao Brasileira de Doutor em Ciencias, Medical School of the Universidade de Sao Paulo (FMUSP). Clinical supervisor of the Otorrinolaringologia Unit of the Hospital das Clinicas, FMUSP. 2 Otorhinolaryngology and Cervicofacial Surgery. Title of Sleep Medicine, Associacao Brasileira de Sono. Doctoral student in Otorhinolaryngology, Faculdade de Medicina (Medical School), Universidade de Sao Paulo (FMUSP). 3 Doctor in Sciences, Faculdade de Medicina (Medical School), Universidade de Sao Paulo (FMUSP). Collaborating professor, FMUSP, and assistant physicians in the Hospital das Clinicas, FMUSP. Hospital das Clinicas, Faculdade de Medicina (Medical School) da Universidade de Sao Paulo. Address for correspondence: Fabio Tadeu Moura Lorenzetti Av. Pres. Juscelino Kubitschek de Oliveira 789 Sala 28 Vergueiro 18035-060 Sorocaba SP. E-mail: drfabiootorrino@yahoo.com.br This paper was submitted to the RBORL-SGP (Publishing Manager System) on 26 November 2007. code 5597. The article was accepted on 1 February 2008

Complicações orbitárias em pacientes com sinusite aguda

Introducao: As complicacoes orbitarias das sinusites permanecem como topico importante dentro da otorrinoloringologia, a despeito do decrescimo de sua prevalencia observado apos o advento da antibioticoterapia. Objetivo: Tendo por objetivo determinar as caracteristicas clinicas e terapeuticas nos casos de sinusites complicadas. Forma de estudo: Clinico prospectivo randomizado. Material e metodo: Realizamos um estudo retrospectivo de 128 pacientes internados nos ultimos 15 anos na Divisao de Clinica Otorrinolaringologica do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo. A maior parte destes pacientes eram criancas ou adultos jovens (82,81% dos pacientes tinham menos de 30 anos de idade) e 57,81% eram do sexo masculino. Todos os pacientes apresentaram evolucao satisfatoria, sem sequelas tardias. Conclusao: Observamos que o diagnostico precoce destas patologias e importante, bem como o e a instituicao de terapeutica adequada e agressiva (clinica ou cirurgica). E a acao conjunta destes dois fatores que ira promover uma diminuicao da morbimortalidade destas afeccoes.

Otologic manifestations of Larsen syndrome

OBJECTIVE To describe and discuss otologic manifestations of Larsen syndrome, based on a case report and a systematic review of the literature. MATERIALS AND METHODS We performed a PubMED database search, and we selected studies reporting otolaryngologic manifestations secondary to Larsen syndrome. The selected articles were read in full, and three researchers independently extracted data from the studies. In parallel, we report the case of a 14-year-old patient who had hearing loss secondary to Larsen syndrome. RESULTS Fifteen studies met our selection criteria. Seven studies reported hearing loss in patients with Larsen syndrome (4 had conductive hearing loss and 3 had mixed hearing loss). The conductive hearing loss may be secondary to ossicular malformations and/or middle ear effusions. Other causes for conductive hearing loss are mesenchymal remnants in the middle ear, Eustachian tube dysfunction, and cleft palate. Surgical management of the hearing loss is possible in selected cases, although the surgical and anesthetic risks should be considered. Hearing aids seem to be safe and effective treatment options for the hearing loss secondary to Larsen syndrome. CONCLUSION Although rare, patients with Larsen syndrome may have hearing loss. The most frequent type of deficit is conductive, either secondary to malformation of the ossicles or middle ear effusion. Possible surgical correction of these abnormalities should be weighed against the anesthetic risks of these patients.

Hemorrhagic Bullous Angina: A Case Report and Review of the Literature

Hemorrhagic bullous angina (HBA) is described as the sudden onset of one or more bullous lesions in the oral cavity, not attributable to other vesiculobullous diseases, blood dyscrasias, or autoimmune and vascular diseases. These lesions occur almost exclusively in the oral cavity, particularly in the soft palate, and do not affect the masticatory mucosa. Here we present the case of a 57-year-old male who had a spontaneously ruptured hemorrhagic bulging in his soft palate diagnosed as HBA, along with discussion of the literature. In conclusion, HBA is a rare, benign, oral disease with low complication rates. Diagnosis is essentially clinical, and treatment consists of local hygiene and prevention of oral trauma.

Treatment and Prognosis of Facial Palsy on Ramsay Hunt Syndrome

Objectives: Review the prognosis of facial palsy on Ramsay Hunt syndrome after the treatments proposed by different authors, based on a review of the literature. Methods: A search was performed in LILACS, SciELO, and PUBMED databases. The key words used on the search were: prognosis OR evolution AND ramsay-hunt OR herpes zoster oticus AND facial palsy OR facial paralysis. Results: Studies showed 882 patients with facial palsy secondary to Ramsay Hunt syndrome. Six hundred and twenty one (70.4%) of those patients achieved improvement on the House-Brackmann grade, achieving a grade score of I or II. Among the patients treated only with steroids, 68% got the same results, versus 70.5% of the patients treated with steroids plus antiviral agents. Of patients classified on the House-Brackmann grade as V or VI before treatment, 51.4% improved facial nerve function, achieving I or II on the HB scale. The treatment with methylprednisolone associated with acyclovir showed better results when compared with acyclovir associated with prednisone, prednisolone or hydrocortisone (81.3% versus 69.2%, 61.4% and 76.3%, respectively). Conclusions: Patients with Ramsay Hunt syndrome may achieve a good rate of facial recovery. The steroid associated with better results was methylprednisolone, and the association of steroids and acyclovir achieved better results than the patients who did not receive the antiviral agent.

Indications, Results, and New Frontiers of Auditory Brainstem Implants in Children

Objectives: Review the literature regarding auditory brainstem implant (ABI) indications, surgical techniques, activation methods, and postsurgery follow-up in children. Methods: A search was performed in LILACS, MEDLINE, SciELO, and PubMed databases from January to March 2013, and the key words used in the search were brainstem AND implant OR implantation AND children OR child. Studies that referred to results of the ABI fitting process in children were selected. Results: Seventy-two studies that met the criteria were read in full; 17 studies referred to the ABI fitting process in children and were selected for appraisal. The studies showed the cases of 49 children (younger than 18 years old) fitted with ABIs. Evaluation after surgery showed that 47 (95.9%) of the patients improved in their ability to recognize environmental sounds and speech perception. Patients with tumors or those with cochlear or cochlear nerve malformations had good outcomes as well. Two of the children achieved no sound perception upon ABI activation. Conclusions: The US Food and Drug Administration (FDA) only approves the auditory brainstem implant for children older than 12 years old, but good outcomes in children younger than that age were achieved, improving environmental sound awareness and oral language development. The FDA only recently approved clinical trials for patients younger than 12 years old. We propose that the FDA auditory brainstem implant indications should be extended to patients with nontumoral diseases of the cochlea and cochlear nerve and younger than 12 years old.

Reiter's syndrome and hearing loss: a possible association?

Patient complained of hearing loss and tinnitus after the onset of Reiters syndrome. Audiometry confirmed the hearing loss on the left ear; blood work showed increased erythrocyte sedimentation rate and C3 fraction of the complement. Genotyping for HLA‐B27 was positive. Treatment with prednisolone did not improve the hearing levels.

Quality-of-Life Assessment before and after Uvulopalatopharyngoplasty Patients with Syndrome Diagnosis of OSA

Objectives: Quality of life is dependent on socioeconomic, cultural, and health variables. Obstructive sleep apnea syndrome (OSAS) is an important and prevalent disease associated with poor quality of life in many patients. There are few studies in the literature discussing the surgical treatment for OSA with quality of life. The Short Form-36 (SF-36) is an instrument for measuring quality of life. It has been applied in various situations with good sensitivity. 1) Describe the quality of life in patients with OSA before and after performing uvulopalatopharyngoplasty. 2) Extend the literature on the relationship between uvulopalatopharyngoplasty and quality of life of patients with OSA. Methods: A descriptive study, conducted between August and December 2012. We applied the SF-36 questionnaire before and after uvulopalatopharyngoplasty in 11 patients (10 males and 1 female) between 27 and 67 years old, diagnosed with mild, moderate, or severe OSA (believing in the positive influence of such surgery on quality of life of these patients). Results: 11 patients showed improvement in the overall assessment of quality of life. There was improvement in functional capacity in 6 (54.4%) patients; limitation on the physical aspects in 4 (36.36%), the pain in 7 (63.63%), the general state of health in 9 (81.81%), vitality in 5 (45.45%), social aspects in 5 (45.45%), emotional aspects in 5 (45.5%), and mental health in 5 (45.5%), and there was no worsening in any domain (P < 0.05 in all domains). Conclusions: In addition to polysomnographic analysis and the AHI, the questionnaires about quality of life may be relevant in assessing the therapeutic outcome for OSAS.