Felippe Felix

Laryngocele: a cause of upper airway obstruction

Laryngoceles are abnormal dilatations of the laryngeal saccule, which rises between the ventricular folds, the base of the epiglottis and the inner surface of the thyroid cartilage. Clinical symptoms are rare, and the find of asymptomatic laryngoceles in pathology studies are frequent. Sometimes it is presented as cervical swelling causing airway obstruction in need of emergency intervention. In this study, we report a case of upper airway obstruction due to laryngocele treated by emergency tracheotomy and we review of the literature. Laryngocele complications include infection (pyocele formation), pathogens aspirations with subsequent bronchitis and pneumonia and upper airway obstruction, as in the case reported. Despite being benign tumors, laryngoceles cause relevant airway obstruction. Correct diagnosis and proper treatment can preclude emergencies as it happened to our patient hereby reported.

Evaluation of the utility of histopathologic exam as a routine in tonsillectomies

UNLABELLED Tonsillectomy is one of the most commonly performed procedures of the head and neck. It is performed for a wide variety of indications in both adults and children. It is common to send the material achieved in the surgery to routine histopathologic exam, as to analyze suspected material or for a medical-legal documentation. OBJECTIVE Analyze the utility and cost of routine histopathologic diagnosis for tonsillectomy. METHODOLOGY retrospective study of the histopathologic result of all tonsillectomies between 1978 and 2004 in a university hospital and analyzed the files of the patients with cancer. RESULTS 2103 results of histopathologic exams were analyzed. Of these, only four cases presented any case of malignancy, being all of these non-Hodgkin lymphoma and already suspected before the surgery. DISCUSSION The world literature has encountered similar results and each time more the histopathologic analysis of all cases is questioned. The cost of the exam is high and your results, in the case of malignancy were already knew before the surgery. CONCLUSION Histopathologic analysis of all tonsillectomies is not indicated. The risks factors established by Beaty should guide the solicitation of the exam, to try to low the costs with unnecessary exams.

Avaliação da utilidade do exame histopatológico como rotina em tonsilectomias

Tonsillectomy is one of the most commonly performed procedures of the head and neck. It is performed for a wide variety of indications in both adults and children. It is common to send the material achieved in the surgery to routine histopathologic exam, as to analyze suspected material or for a medical-legal documentation. OBJECTIVE: Analyze the utility and cost of routine histopathologic diagnosis for tonsillectomy. METHODOLOGY: retrospective study of the histopathologic result of all tonsillectomies between 1978 and 2004 in a university hospital and analyzed the files of the patients with cancer. RESULTS: 2103 results of histopathologic exams were analyzed. Of these, only four cases presented any case of malignancy, being all of these non-Hodgkin lymphoma and already suspected before the surgery. DISCUSSION: The world literature has encountered similar results and each time more the histopathologic analysis of all cases is questioned. The cost of the exam is high and your results, in the case of malignancy were already knew before the surgery. CONCLUSION: Histopathologic analysis of all tonsillectomies is not indicated. The risks factors established by Beaty should guide the solicitation of the exam, to try to low the costs with unnecessary exams.

Nasal histoplasmosis in the acquired immunodeficiency syndrome

Disseminated histoplasmosis is a disease with a high case-fatality rate, especially in patients with the acquired immunodeficiency syndrome (AIDS). The disease can occur in various sites, such as the lungs, eyes, oral cavity, larynx, nervous system, gastrointestinal tract and, more rarely, the nasal sinus region. It is a cosmopolitan mycosis with a high prevalence in Brazil. Nasal manifestation of the disease is rare, with only three cases reported in the literature, but it is part of the differential diagnosis for other granulomatous diseases, such as Wegeners granulomatosis, tegumentary leishmaniasis and nasal lymphoma. The authors of this study present a literature review and report a case of nasal histoplasmosis in a patient with AIDS. No record of such an aggressive presentation has been reported previously in the literature.

Laringocele: uma causa de obstrução de vias aéreas superiores

Laryngoceles are abnormal dilatations of the laryngeal saccule, which rises between the ventricular folds, the base of the epiglottis and the inner surface of the thyroid cartilage. Clinical symptoms are rare, and the find of asymptomatic laryngoceles in pathology studies are frequent. Sometimes it is presented as cervical swelling causing airway obstruction in need of emergency intervention. In this study, we report a case of upper airway obstruction due to laryngocele treated by emergency tracheotomy and we review of the literature. Laryngocele complications include infection (pyocele formation), pathogens aspirations with subsequent bronchitis and pneumonia and upper airway obstruction, as in the case reported. Despite being benign tumors, laryngoceles cause relevant airway obstruction. Correct diagnosis and proper treatment can preclude emergencies as it happened to our patient hereby reported.

Painful tongue leiomyoma

Leiomyomas are benign tumors that originate on the smooth muscle, usually found in the uterus, gastrointestinal tract and skin. This type of tumor rarely occurs in the oral cavity, specially because of the lack of smooth muscle in this area1. Its most frequent location in this region, by decreasing order of appearance is: lips, palate, tongue and oral mucosa. It is usually asymptomatic; however it may be painful in some cases. Our goal with this paper is to report on a case of a patient with a painful tongue leiomyoma.

Profile of patients assessed for cochlear implants

INTRODUCTION Knowledge of the characteristics related to profound hearing loss is a matter of great importance, as it allows for the etiological and prognostic identification and strategic planning for public health interventions. OBJECTIVE To assess the different etiologies of hearing loss, age at diagnosis of the hearing loss, its relation to language acquisition, and the age at the first consultation in this service for cochlear implant assessment. METHODS This was a historical cohort, cross-sectional study, using retrospective analysis of the records of 115 patients with confirmed sensorineural hearing loss, who were followed in a university hospital, based on gender, age of hearing loss, age at the first consultation, language, and hearing loss etiology. RESULTS AND CONCLUSION The majority of patients assessed for cochlear implants attend the first consultation when they are older than one year (an alarming mean of 3.8 years in the prelingual group) in spite of the early diagnosis of hearing loss. This reflects an already deficient health care system, in terms of referral. The idiopathic cause remains the most frequently identified. Among the known causes, the most prevalent are perinatal causes and meningitis.

Cholesteatoma as a late complication of paraganglioma surgery: the role of diffusion-weighted MR imaging

Departaments of Radiology and Otorhinolaryngology, Federal University of Rio de Janeiro School of Medicine, Rio de Janeiro RJ, Brazil: MD, Resident of the Department of Radiology; MD, Resident of Department of Otorhinolaringology; MD, Staff of the Department of Otorhinolaringology; MD, PhD, Associated Professor of the Department of Radiology. Paraganglioma jugulotympanic (PJT) are originated by extension of paranglioma jugulare along the course of Jacobson`s nerve and are composed by cells of the extra-adrenal neuroendocrine system. Acquired cholesteatomas are non-neoplastic keratinising lesions filled by desquamation debris seen more commonly in the temporal bone that may develop from various mechanisms. The association between these entities is extremely rare and to the best of our knowledge, only one previous series mentioned the development of cholesteatoma in the postoperative of paraganglioma. We report a case of cholesteatoma presenting as a late complication of PJT resection, emphasizing the importance of diffusion-weighted magnetic resonance (MR) imaging (DWI) for the diagnosis of this rare association.

P185: Positive Cottle Test in Randomly Selected Volunteers:

to patients on the internet for endoscopic sinus surgery. METHODS: Study design: Review of 250 web sites on endoscopic sinus surgery (top 50 web pages on each of the five most commonly used search engines: Google, Yahoo, MSN, AOL, Ask Jeeves). Assessment of quality and readability using clinical criteria and Flesch-Kincaid reading grade. Setting: Department of Otolaryngology, Bradford Teaching Hospitals, UK. Main outcome measure: Identification of web sites with inadequate or misleading information or containing a commercial interest. RESULTS: Out of 250 web sites reviewed, 142 contained information on ESS. Only 13 (5.2%) were found to have adequate good-quality information after excluding duplicates for all search engines. Twenty-eight (11.2%) were found to have a commercial interest. The information required a higher grade of education to understand (Flesch – Kincaid Reading Grade average 11.26). Of all search engines, Google was found to be the most commonly used by web users and identified most of the good quality web sites. The position of good sites on Google was 1, 3, 6, 12, 18, 37, 48. CONCLUSIONS: Patient information on the internet is dominated by U.S. sites. Information from the ENT-UK web site is not on the listing by all search engines. There are few good quality web sites that explain the nature and risks of ESS, which may help patients in making decisions regarding treatment. Most of the information on the sites relates to postoperative care. A higher ranked web site is no indication of reliability.

P151: Severity of Hearing Loss in Congenital Rubella Infection

OBJECTIVES: To characterize the phenotype of neonatal variant of Bartter’s syndrome with deafness (BSND). METHODS: A 20-year period follow-up of 17 patients with BSND, from a Bedouin Arab tribe from the south of Israel. The disease was due to a single mutation (G28A mutation in exon 1). Relevant clinical data from neonatal intensive care unit, renal and blood chemistry at birth and during childhood were included. All patients underwent an audiological work-up in the first year of life. Two patients underwent high-resolution CT scan of the temporal bone (TBHRCT). RESULTS: All pregnancies were complicated by polyhydramnion and premature birth. Nine infants developed serious bacterial infections (urinary tract infection, 3; bacterial sepsis, 6). The average length of hospital stay after birth was 9.3 3.1 weeks. Two infants died of respiratory failure and sepsis. Hypokalemia was common during follow-up visits (as low as 1.8 mmol/L), in spite of potassium chloride supplementation. All children had been treated with indomethacin (2 mg/kg/day) and potassium supplementation (1.5-3 meq/kg/day). The current average serum creatinine and calculated creatinine clearance from the older group (n 8; mean age: 8.8 1.4 years) is 60.8 16.5 mmol/L and 95 20 ml/min/1.73m2, respectively. CONCLUSIONS: Profound SNHL was diagnosed in all but one case. The latter exhibited flat audiogram with thresholds of around 70dB and developed normal speech. TBHRCTs were completely normal. Profound SNHL is evident in almost all patients with BSND. This finding is mostly attributed to the genetic effects on cochlear development and possibly also to additional postnatal insults to the cochlea.