Guilherme Machado de Carvalho

Clinical manifestations in children with tonsillar lymphoma: A systematic review

BACKGROUND The lymphoma is the most common childhood malignancy in the head and neck. Approximately 15% of head and neck lymphomas in children affect the Waldeyers ring. Early diagnosis and treatment are of great importance in the prognosis of tonsillar lymphoma patients. OBJECTIVES To realize a systematic review of the literature on the clinical manifestations present at diagnosis of tonsillar lymphoma in pediatric patients. DATE SOURCE Articles in English, Spanish or Portuguese in the last 15 years about lymphoma in palatine tonsil in children from PubMed/Medline, LILACS, IBECS, Cochrane, SCIELO, BIREME and Scopus. STUDY ELIGIBILITY CRITERIA It was included articles and case reports that covered the pediatric age group, up to 18 years old and that contained information of the clinical manifestations of tonsillar lymphoma at diagnosis. RESULTS We found 87 articles of which 18 were included; there were 66 cases of lymphoma of palatine tonsils. The most common clinical manifestations found in children with lymphoma in palatine tonsils were unilateral tonsillar enlargement (72.7%), alteration in appearance of the tonsil (45.4%) and cervical lymphadenopathy (30.3%). The presence of B symptoms occurred in only 16% of the patients. Burkitt was the most common type of lymphoma found. CONCLUSION The most common clinical manifestations of lymphoma in palatine tonsil are the tonsils asymmetry, alteration in the appearance of the mucous and cervical lymphadenopathy. A detailed description of cases of lymphoma in palatine tonsils and the use of criteria for classification of tonsillar asymmetry are important for future revisions.

Study of the relationship between the degree of tinnitus annoyance and the presence of hyperacusis

Introduction: Hyperacusis can be defined as a manifestation of an increased of central auditory pathways gain and can be considered a pre-tinnitus state. In some cases tinnitus can be caused by such increased gain. Aim: To evaluate the prevalence of hyperacusis in patients with tinnitus and its relation to the annoyance of tinnitus. Materials and methods: Retrospective study with patients from the neurotology service complaining of tinnitus in the first consultation were submitted to clinical evaluation, a questionnaire and audiological evaluation of tinnitus and hyperacusis. The degree of annoyance of tinnitus and hyperacusis was measured using a visual analog scale. Results: We analyzed medical records of 309 patients, 169 (54.7%) females and 140 (45.3%) males. The mean age was 53 years. The median degree of tinnitus annoyance was 7. Hyperacusis was present in 57 (18.4%) patients, with a median degree of 5. The degree of annoyance due to tinnitus patients with hyperacusis was similar to that of patients without hyperacusis. Conclusion: Hyperacusis was present in 18.4% of patients with tinnitus. The degree of annoyance due to tinnitus had no correlation with the presence of hyperacusis.INTRODUCTION Hyperacusis can be defined as a manifestation of an increased of central auditory pathways gain and can be considered a pre-tinnitus state. In some cases tinnitus can be caused by such increased gain. AIM To evaluate the prevalence of hyperacusis in patients with tinnitus and its relation to the annoyance of tinnitus. MATERIALS AND METHODS Retrospective study with patients from the neurotology service complaining of tinnitus in the first consultation were submitted to clinical evaluation, a questionnaire and audiological evaluation of tinnitus and hyperacusis. The degree of annoyance of tinnitus and hyperacusis was measured using a visual analog scale. RESULTS We analyzed medical records of 309 patients, 169 (54.7%) females and 140 (45.3%) males. The mean age was 53 years. The median degree of tinnitus annoyance was 7. Hyperacusis was present in 57 (18.4%) patients, with a median degree of 5. The degree of annoyance due to tinnitus patients with hyperacusis was similar to that of patients without hyperacusis. CONCLUSION Hyperacusis was present in 18.4% of patients with tinnitus. The degree of annoyance due to tinnitus had no correlation with the presence of hyperacusis.

Schwannoma of the nasal septum: evaluation of unilateral nasal mass

1 Medico (Medico residente de Otorrinolaringologia da UNICAMP). 2 Mestre em medicina (Medico Otorrinolaringologista (fellow em otologia na UNICAMP)). 3 Mestre em ciencias medicas (Medica otorrinolaringologista do Servico de Otorrinolaringologia do Hospital Estadual de Sumare, Disciplina de Otorrinolaringologia, Cabeca e Pescoco, UNICAMP). 4 Doutora em ciencias medicas (Medica otorrinolaringologista, Chefe do Servico de Rinologia, Disciplina de Otorrinolaringologia, Cabeca e Pescoco, UNICAMP). Disciplina de Otorrinolaringologia, Cabeca e Pescoco. Hospital das Clinicas (HC) Faculdade de Ciencias Medicas (FCM) Universidade Estadual de Campinas (UNICAMP) Campinas, Sao Paulo, Brasil. Endereco para correspondencia: Henrique Furlan Pauna. Rua Aldo de Oliveira Barbosa, no 170. Parque das Universidades. Campinas SP. Brasil. CEP: 13086-030. E-mail: h_pauna@hotmail.com Este artigo foi submetido no SGP (Sistema de Gestao de Publicacoes) do BJORL em 21 de abril de 2012. cod. 9165. Artigo aceito em 20 de outubro de 2012. CASE REPORT Braz J Otorhinolaryngol. 2013;79(3):403.

Research publications in the field of health: omission of hypotheses and presentation of common-sense conclusions

CONTEXT AND OBJECTIVE Medical literature should consist of knowledge applicable to professional education; nevertheless, the profusion of articles in databases provokes disquiet among students. The authors considered the premise that scientific production in the field of health follows a mechanical description of phenomena without the clarity of motivating questions. The aim was to interpret material from expert reports, applied by medical students to analyze articles from renowned journals. DESIGN AND SETTING This research project was exploratory, searching for latent meanings regarding methodological problems in a sample of papers. It was performed in a Brazilian medical school. METHODS The sample was intentionally built, consisting of articles related to original research in the field of health, published over the previous five years. The results came from text content analysis, performed by a professor and his medical students. RESULTS (1) Failure to state a hypothesis is an equivocal practice: articles did not show clarity of hypothesis to demonstrate that their authors had epistemological knowledge of the methods chosen. (2) There is a certain belief that in normal scientific practice, hypotheses are unnecessary: studies without explicit hypotheses led to suppositions that they merely repeat dominant models. (3) Presentation of common sense as scientific conclusions: research brings together what would have mobilized the researchers initially. CONCLUSIONS Absence of formal hypotheses leaves scientific production vulnerable when put under epistemological discussion. Conclusions from scientific articles are often confounded with common-sense statements. Quantitative research is suggested, for studying the frequency of occurrence of these dubious methodological points.

Estudo da relação entre o grau de incômodo de pacientes com zumbido e a presença de hiperacusia

Introduction: Hyperacusis can be defined as a manifestation of an increased of central auditory pathways gain and can be considered a pre-tinnitus state. In some cases tinnitus can be caused by such increased gain. Aim: To evaluate the prevalence of hyperacusis in patients with tinnitus and its relation to the annoyance of tinnitus. Materials and methods: Retrospective study with patients from the neurotology service complaining of tinnitus in the first consultation were submitted to clinical evaluation, a questionnaire and audiological evaluation of tinnitus and hyperacusis. The degree of annoyance of tinnitus and hyperacusis was measured using a visual analog scale. Results: We analyzed medical records of 309 patients, 169 (54.7%) females and 140 (45.3%) males. The mean age was 53 years. The median degree of tinnitus annoyance was 7. Hyperacusis was present in 57 (18.4%) patients, with a median degree of 5. The degree of annoyance due to tinnitus patients with hyperacusis was similar to that of patients without hyperacusis. Conclusion: Hyperacusis was present in 18.4% of patients with tinnitus. The degree of annoyance due to tinnitus had no correlation with the presence of hyperacusis.INTRODUCTION Hyperacusis can be defined as a manifestation of an increased of central auditory pathways gain and can be considered a pre-tinnitus state. In some cases tinnitus can be caused by such increased gain. AIM To evaluate the prevalence of hyperacusis in patients with tinnitus and its relation to the annoyance of tinnitus. MATERIALS AND METHODS Retrospective study with patients from the neurotology service complaining of tinnitus in the first consultation were submitted to clinical evaluation, a questionnaire and audiological evaluation of tinnitus and hyperacusis. The degree of annoyance of tinnitus and hyperacusis was measured using a visual analog scale. RESULTS We analyzed medical records of 309 patients, 169 (54.7%) females and 140 (45.3%) males. The mean age was 53 years. The median degree of tinnitus annoyance was 7. Hyperacusis was present in 57 (18.4%) patients, with a median degree of 5. The degree of annoyance due to tinnitus patients with hyperacusis was similar to that of patients without hyperacusis. CONCLUSION Hyperacusis was present in 18.4% of patients with tinnitus. The degree of annoyance due to tinnitus had no correlation with the presence of hyperacusis.

Hearing preservation and cochlear implants according to inner ear approach: multicentric evaluation.

INTRODUCTION Electroacoustic stimulation is an excellent option for people with residual hearing in the low frequencies, who obtain insufficient benefit with hearing aids. To be effective, the subjects residual hearing should be preserved during cochlear implant surgery. OBJECTIVES To evaluate the hearing preservation in patients that underwent implant placement and to compare the results in accordance with the approach to the inner ear. METHODS 19 subjects underwent a soft surgical technique, and the electrode MED-EL FLEX™ EAS, designed to be atraumatic, was used. We evaluated pre- and postoperative tonal audiometric tests with an average of 18.4 months after implantation, to measure the rate of hearing preservation. RESULTS 17 patients had total or partial preservation of residual hearing; 5 had total hearing preservation and two individuals had no preservation of hearing. The insertion of the electrode occurred through a cochleostomy in 3 patients, and in 2 of these there was no hearing preservation; the other 16 patients experienced electrode insertion through a round window approach. All patients benefited from the cochlear implant, even those who are only using electrical stimulation. CONCLUSION The hearing preservation occurred in 89.4% of cases. There was no significant difference between the forms of inner ear approach.

Digisonic SP® Binaural cochlear implant: the coronal tunneled approach.

UNLABELLED Cochlear implants represent a significant breakthrough in the treatment of hearing loss. Evidence indicates bilateral hearing brings significant benefits to patients, particularly when binaural hearing is offered. OBJECTIVE To describe the first case of implantation of a Digisonic SP® Binaural Neurelec device in Brazil (the third implant placed in the Americas, after Mexico and Colombia) and the chosen surgical approach. METHOD Description of a surgical approach. RESULTS The procedure was successfully completed. DISCUSSION The squelch effect, binaural summation, location of the sound source, and the shadow effect of the head are listed among the reasons to explain the superiority of binaural rehabilitation. Cost of treatment must be considered in the development of public health policies. CONCLUSION The cost of cochlear implants has been one of the main impediments to bilateral rehabilitation. The Digisonic SP® Binaural Neurelec device addresses this issue and exposes patients to less risk through a minimally invasive implantation procedure.

Association between unilateral tonsillar enlargement and lymphoma in children: A systematic review and meta-analysis.

Lymphoma is the most common head and neck malignancy in children, and palatine tonsils asymmetry is the most frequent clinical manifestation of tonsillar lymphoma. However, several studies with children with tonsillar asymmetry found no case of lymphoma, showing that the relationship of tonsillar asymmetry with lymphoma is unclear. In this review, we aimed to identify the association between tonsillar asymmetry and tonsillar lymphoma in children by conducting systematic reviews of the literature on children with palatine tonsil lymphoma and tonsillar asymmetry. Articles comprising the paediatric age group (up to 18 years) with information concerning clinical manifestations of tonsillar lymphoma or the diagnosis of the tonsillar asymmetry were included. The main cause of asymmetry of palatine tonsils was lymphoid hyperplasia, followed by lymphoma and nonspecific benign changes. The asymmetry of tonsils was present in 73.2% of cases of lymphoma. There was an association between asymmetric palatine tonsils and lymphoma, with a likelihood ratio of 43.5 for children with asymmetry of palatine tonsils and 8938.4 for children with asymmetry of tonsils and other signs of suspicion for malignancy. We also provide recommendations on the management of suspicious cases of palatine tonsil lymphoma.

Histologic correlation of expression of Ki-67 in squamous cell carcinoma of the glottis according to the degree of cell differentiation

INTRODUCTION Squamous cell carcinoma is the most common neoplasm of the larynx and glottis, and its prognosis depends on the size of the lesion, level of local invasion, cervical lymphatic spread, and presence of distant metastases. Ki-67 (MKI67) is a protein present in the core, whose function is related to cell proliferation. AIM To evaluate the expression of marker Ki-67 in squamous cell carcinoma of the larynx and glottis and its correlation to pathological findings. METHODS Experimental study with immunohistochemistry analysis of Ki-67, calculating the percentage of the cell proliferation index in glottic squamous cell carcinomas. RESULTS Sixteen cases were analyzed, with six well-differentiated and 10 poorly/moderately differentiated tumors. There was a correlation between cell proliferation index and degree of cell differentiation, with higher proliferation in poorly/moderately differentiated tumors. CONCLUSION The cell proliferation index, as measured by Ki-67, may be useful in the characterization of histological degree in glottic squamous cell tumors.

Electro acoustic stimulation of the auditory system: UNICAMP's surgical approach

UNLABELLED A new era has arrived in auditory rehabilitation with the introduction of new technologies such as electroacoustic stimulation (EAS). EAS is indicated for patients with residual hearing at low frequencies and severe or profound hearing loss at high frequencies. These patients have no indication for conventional cochlear implant and have difficulties in adapting to individual sound amplification devices. Preservation of hearing is vital in this process; the surgical technique must be based on this concept. OBJECTIVES To present the cochlear implant surgical technique with MED-EL Mand FlexEAS to preserve hearing in patients with hearing loss at high frequencies and to maintain low frequency hearing. We are the first institution to carry out this treatment in Brazil. METHODS A case report of the surgical technique carried out in four patients; the procedure was carried out by the cochlear implant group of a specialized clinical hospital. RESULTS The procedures were successful and uneventful. CONCLUSION We described the technique used at our institution for implants using EAS; the surgical technique is complex and includes steps for preservation of hearing.