Gilberto Ulson Pizarro

Ocorrência da síndrome da apneia obstrutiva do sono (SAOS) em crianças respiradoras orais

UNLABELLED It is well known that mouth breathing is associated with adenotonsillar hypertrophy - which is the main cause of obstructive sleep apnea among children. Despite the importance of this matter, there are only a handful of studies showing the relationship between OSAS and mouth breathing. AIM to determine the prevalence of obstructive sleep disorders in mouth breathing children and study its correlation with otorhinolaryngological findings. STUDY DESIGN Retrospective cohort study. METHOD Data analysis from 248 medical charts of mouth breathing children seen at the Pediatric Otolaryngologic Division of a large medical institution between the years of 2000 and 2006. All patients had nasofibroscopy and or Cavum radiographs and polysomnographic exams. According to the Apnea index, patients were classified as primary snorers (AI<1); and as OSAS (>1). RESULTS From 248 patients included in the study, 144 (58%) were primary snorers and 104 (42%) had OSAS. The most prevalent otorhinolaryngological findings were adenotonsillar hypertrophy (n=152; 61.2%), tonsilar hypertrophy (n=17; 6.8%), adenoid hypertrophy (n=37; 14.9%), rhinitis (n=155; 62.5%) and secretory otitis (n=36; 14.5%). CONCLUSIONS primary snoring and OSAS are frequent findings in mouth breathing children. The most frequent otorhinolaryngological disorder in children with OSAS is adenotonsillar hypertrophy with or without rhinitis.

Auditory processing assessment in children with obstructive sleep apnea syndrome

INTRODUCTION The obstructive sleep apnea syndrome (OSAS) is a respiratory disorder that occurs during sleep and it is relatively common in children. AIM The goal of this paper is to verify if there is a relationship between the obstructive sleep apnea syndrome (OSAS) and auditory processing. METHODS In order to do that, three groups of children ranging in age from 5 to 11 were studied, including a normal group. Twenty subjects who made up the study group were submitted to ear, nose and throat (ENT) exams and to polysomnography (PSG), and were divided in two groups: GROUP I (RO) comprised of 10 children who presented oral breathing and displayed normal PSG, and GROUP II (SAS) comprised of 10 children who presented oral breathing and displayed abnormal PSG. Their performance was compared to the performance of the third group--GROUP III (REN) comprised of 10 children who did not refer ENT difficulties. All the subjects completed a basic audiometric assessment as well as an auditory processing diagnosis. RESULTS The analyses of the results revealed a statistically significant difference in ENT exams related to the turbinate and the palatine tonsils. Group II presented a higher incidence of turbinate hypertrophy levels II and III (p<0.001) and palatine tonsils hypertrophy grades III and IV (p 0.007). Regarding the auditory processing assessment, a statistically significant difference (p<0.001) was obtained in the dichotic digits test. Group II performed worse than group III. Also, for the non-verbal sequence memory test, Group II obtained a worse result (p<0.022) than Group I. CONCLUSION Subjects with OSAS obtained worse results in auditory processing tests.

Avaliação do processamento auditivo em crianças com síndrome da apnéia/hipopnéia obstrutiva do sono

INTRODUCTION: The obstructive sleep apnea syndrome (OSAS) is a respiratory disorder that occurs during sleep and it is relatively common in children. AIM: The goal of this paper is to verify if there is a relationship between the obstructive sleep apnea syndrome (OSAS) and auditory processing. METHOD: In order to do that, three groups of children ranging in age from 5 to 11 were studied, including a normal group. Twenty subjects who made up the study group were submitted to ear, nose and throat (ENT) exams and to polysomnography (PSG), and were divided in two groups: GROUP I (RO) comprised of 10 children who presented oral breathing and displayed normal PSG, and GROUP II (SAS) comprised of 10 children who presented oral breathing and displayed abnormal PSG. Their performance was compared to the performance of the third group - GROUP III (REN) comprised of 10 children who did not refer ENT difficulties. All the subjects completed a basic audiometric assessment as well as an auditory processing diagnosis. RESULTS: The analyses of the results revealed a statistically significant difference in ENT exams related to the turbinate and the palatine tonsils. Group II presented a higher incidence of turbinate hypertrophy levels II and III (p < 0.001) and palatine tonsils hypertrophy grades III and IV (p 0.007). Regarding the auditory processing assessment, a statistically significant difference (p < 0.001) was obtained in the dichotic digits test. Group II performed worse than group III. Also, for the non-verbal sequence memory test, Group II obtained a worse result (p < 0.022) than Group I. CONCLUSIONS: Subjects with OSAS obtained worse results in auditory processing tests.

Polisomnographic findings on children with laryngopathies

UNLABELLED Polysomnography is the goldstandard exam for child OSAS. When possible, polysomnography clearly distinguishes between those with isolated primary snoring and patients with sleep apnea (obstructive, central and mixed). The most common cause of OSAS in childhood is adenotonsillar hypertrophy. Laryngomalacia is the most common cause of stridor in childhood, though its physiopathology remains unknown. Among the most prominent theories are immaturity of the cartilaginous framework of the larynx and/or neuromuscular immaturity. OBJECTIVE Our proposal was to describe polysomnographic findings in children with laryngomalacia or other isolated laryngeal alterations, that is, without other alterations in the upper airways. METHODS The sample included 29 children with exclusively laryngeal alterations. All of them underwent an otorhinolaryngological exam, nasofibrolaryngoscopy and polysomnography. Information was recorded concerning age, nasofibrolaryngoscopy and polysomnography. For analysis, the children were divided into two groups: those with laryngomalacia and those with other laryngeal diseases. RESULTS Among the 18 children with a diagnosis of laryngomalacia, 18 had central breathing events, knowing that the majority had showed desaturation of oxihemoglobin and bradycardia. In this same group, 3 children had obstructive events. On the other hand, 11 children with other laryngeal alterations showed no predominance of one type or another of apnea. Of these, 4 had central type breathing events and 2 obstructive type. CONCLUSION The majority of patients with laryngomalacia showed a central type apnea. Patients with various laryngeal diseases did not present a predominant type of apnea.

Achados polissonográficos em crianças portadoras de laringopatias

O exame diagnostico padrao-ouro para SAOS na infância e a polissonografia. Quando pode ser efetuado, a polissonografia separa com clareza portadores de ronco primario de pacientes com apneia (obstrutiva, central e mista) do sono. A causa mais frequente da SAOS na infância e a hipertrofia adenoamigdaliana. Laringomalacia e a causa mais comum de estridor na infância, porem sua fisiopatologia permanece desconhecida. Entre as teorias mais aceitas estao a imaturidade do arcabouco cartilaginoso da laringe e/ou a imaturidade neuromuscular. OBJETIVO: Nossa proposta foi descrever os achados polissonograficos de criancas portadoras de laringomalacia e outras alteracoes laringeas isoladas, ou seja, sem alteracoes nas vias aereas superiores. METODOS: Foram selecionadas 29 criancas portadoras de alteracoes laringeas exclusivas. Todas foram submetidas a exame otorrinolaringologico, nasofibrolaringoscopia e polissonografia. Foram tabulados dados relativos a idade, nasofibrolaringoscopia e polissonografia. Para analise, as criancas foram separadas em 2 grupos: portadores de laringomalacia e portadores de outras doencas laringeas. RESULTADOS: Dentre as 18 criancas com diagnostico de laringomalacia, 18 apresentaram eventos respiratorios do tipo central, sendo a maioria dos episodios associados a dessaturacao de oxigenio e alguns a bradicardia. Nesse mesmo grupo, 3 criancas apresentaram apneia do tipo obstrutivo. Por outro lado, as 11 criancas portadoras de outras alteracoes laringeas nao apresentaram predominância entre um tipo ou outro de apneia, 4 apresentaram eventos respiratorios do tipo central, 2 do tipo obstrutivo. CONCLUSAO: A maioria dos pacientes acometidos por laringomalacia apresentou eventos respiratorios do tipo central quando avaliados pela polissonografia. Ja os pacientes com outras doencas laringeas nao apresentaram predominância entre um tipo ou outro de apneia.

Cartilagem tragal com pericondrio em timpanoplastias

Introduction: the cartilage tympanoplasty began to be use by Jansen in 1963 and has advocated for advanced middle ear problems. The cartilage had excellent survival capacity and tolerate retractions pockets. In 1998 Eavey describe the use of the cartilage butterfly technique with a inlay method. Study design: clinical prospective randomized. Material and method: There were 100 patients with chronic otites media and ear drum perforations with margins and submitted a ear plug tympanoplasty. The perforations ranged in size and approximately 40% of the surface area of the tympanic membrane. The average preoperative conductive hearing loss was 28.3 dB and 9.8 dB postoperative. Results: Total closure of the tympanum occurred in 95,0%. Conclusion: Finally, studying the results it is important to emphasize that the method is easy, with low complications, good audiological results and better anatomical results. It is a good option for the otologist to solve the chronic otites sequelae.

Tympanic paragangliomas: case reports

Glomus tumors, also called paragangliomas, originate from nonchromaffin cells. The tumor is typically vascular and grows from capillary and pre-capillary vessels in-between epithelial cells. It is worth mentioning that the most common symptoms are pulsating tinnitus and hearing loss. Imaging studies (CT and MRI) are necessary for diagnosis. This paper shows five patients seen at the Hospital between 1995 and 2001 presenting glomus tympanicum. Women were most commonly affected, and the age ranged from 48 to 60 years (mean age of 50 years). The most common complaints were pulsating tinnitus and hearing loss. All patients were treated surgically.

Mioepitelioma de glândula salivar menor em base de língua: relato de caso

This study reports a case of myoepithelioma of minor salivary gland on the base of the tongue of a 58 year-old patient. This theme is discussed because it is a rare tumor, and in this case, it was located in an uncommon position. The diagnosis was given by the pathologic and immunohistochemical study of the excised tumor. The course is usually benign, and the cure is possible if it is completely excised.

Paragangliomas timpânicos: relato de casos

Os tumores glomicos, tambem chamados de paragangliomas, sao formados por celulas nao cromafins. O tumor e tipicamente vascular formado por vasos capilares e pre-capilares, interposto por celulas epiteliais. Para a sua abordagem inicial, deve-se ressaltar que os sintomas mais comumentes encontrados sao o zumbido pulsatil e hipoacusia. A investigacao atraves de imagem (tomografia computadorizada e ressonância magnetica) se faz necessaria. Apresentaremos neste trabalho 5 pacientes portadores de paragangliomas timpânicos atendidos no Hospital (de 1995 a 2001). O sexo predominante foi o feminino, a idade variou de 48 a 60 anos, com media de 50 anos. A queixa predominante foi o zumbido pulsatil e a hipoacusia. A conduta foi cirurgica em todos os casos.