Henrique Furlan Pauna

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.

Epitympanum volume and tympanic isthmus area in temporal bones with retraction pockets

To compare the volume of the epitympanic space, as well as the area of the tympanic isthmus, in human temporal bones with retraction pockets to those with chronic otitis media without retraction pockets and to those with neither condition.

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.

A three-dimensional analysis of the endolymph drainage system in Ménière disease

To measure the volume of the endolymph drainage system in temporal bone specimens with Ménière disease, as compared with specimens with endolymphatic hydrops without vestibular symptoms and with nondiseased specimens

Pathologic Changes of the Peripheral Vestibular System Secondary to Chronic Otitis Media

Objective To evaluate the histopathologic changes of dark, transitional, and hair cells of the vestibular system in human temporal bones from patients with chronic otitis media. Study Design Comparative human temporal bone study. Setting Otopathology laboratory. Subjects and Methods To compare the density of vestibular dark, transitional, and hair cells in temporal bones with and without chronic otitis media, we used differential interference contrast microscopy. Results In the chronic otitis media group (as compared with the age-matched control group), the density of type I and type II hair cells was significantly decreased in the lateral semicircular canal, saccule, and utricle (P < .05). The density of type I cells was also significantly decreased in the chronic otitis media group in the posterior semicircular canal (P = .005), but that of type II cells was not (P = .168). The mean number of dark cells was significantly decreased in the chronic otitis media group in the lateral semicircular canal (P = .014) and in the posterior semicircular canal (P = .002). We observed no statistically significant difference in the density of transitional cells between the 2 groups (P > .1). Conclusion The findings of our study suggest that the decrease in the number of vestibular sensory cells and dark cells could be the cause of the clinical symptoms of imbalance of some patients with chronic otitis media.

Advanced Bionics Cochlear Implants in Patients with Prelingual Hearing Loss

Introduction: Cochlear Implants (CI) have become standard in the treatment of prelingual, postlingual and perilingual deafness in children. Bilateral implants are considered standard for bilaterally affected children. Studies also find that the CI provides better access to speech for most children, and this access results in improved speech perception. In earlier times children who did not react to acoustic stimuli and were neither able to understand speech nor to acquire it spontaneously encountered severe discrimination, being dismissed as simple-minded or worse. Different studies broadly agree that one or two of every 1000 newborns have a hearing impairment that on current evidence warrants treatment or observation, i.e., permanent hearing loss with a lowering of the absolute threshold of hearing for speech perception by at least 35 dB. Approximately 50% of severe hearing impairments arising in the inner ear are thought to be hereditary in origin. When new Cochlear Implant (CI) sound processors are being introduced by the manufacturers, usually the newest generation implants benefit first from the new technology in order to release the full potential of the new hardware. Objective: Evaluate the improvement of speech language and sound perception in patients with prelingual deafness that underwent cochlear implant using Advanced Bionics® device. Method: Retrospective study of the medical records of the patients fitted with Advanced Bionics® cochlear implant in our institution between 2011 and 2012. Results: Sixteen patients underwent to cochlear implantation using Advanced Bionics® devices. There were 43,75% prelingual and 43,75% postlingual patients with bilateral hearing loss. Mean age at implantation in the prelingual group was 3.6 years (ranged from 2 to 6 years). There was one case with medical history of deafness in family. All prelingual patients used hearing devices before the cochlear implant. The hearing levels improved after CI in all patients. Conclusion: This study evaluated patients with pre-lingual deafness using the Advanced Bionics® cochlear implants demonstrated significant gains in neural stimulation and language development in children.

Evidence against the mucosal traction theory in cholesteatoma: Ciliated Cells in the Middle Ear Cleft

To investigate the distribution of ciliated epithelium in the human middle ear and its potential role in the formation of cholesteatoma.

Non Hodgkin Lymphoma in Supraglottis: Case Report

Introduction: Lymphoma represents less than 1% of malignant laryngeal tumors. and the main site in larynx is in supraglottis. The symptoms are very interspecific and the diagnosis is a challenge. Case: A 23 years old man, healthy, referring dysphonia and globus for 2 months. CT and nasofibrolaryngoscopy showed a supraglottic mass without any specific features. Patient was underwent to biopsy which diagnosed non- Hodgkins large cell B lymphoma. Conclusion: The diagnosis of non-Hodgkin lymphoma laryngeal is a challenge to the otolaryngologist, since, usually, patients present with nonspecific complaints or systemic signs suggestive of this condition and the diagnosis is done only by biopsy

Changes in the inner ear structures in cystic fibrosis patients

OBJECTIVE Although prolonged use of antibiotics is very common in cystic fibrosis (CF) patients, no studies have assessed the changes in both cochlear and peripheral vestibular systems in this population. METHODS We used human temporal bones to analyze the density of vestibular dark, transitional, and hair cells in specimens from CF patients who were exposed to several types of antibiotics, as compared with specimens from an age-matched control group with no history of ear disease or antibiotic use. Additionally, we analyzed the changes in the elements of the cochlea (hair cells, spiral ganglion neurons, and the area of the stria vascularis). Data was gathered using differential interference contrast microscopy and light microscopy. RESULTS In the CF group, 83% of patients were exposed to some ototoxic drugs, such as aminoglycosides. As compared with the control group, the density of both type I and type II vestibular hair cells was significantly lower in all structures analyzed; the number of dark cells was significantly lower in the lateral and posterior semicircular canals. We noted a trend toward a lower number of both inner and outer cochlear hair cells at all turns of the cochlea. The number of spiral ganglion neurons in Rosenthals canal at the apical turn of the cochlea was significantly lower; furthermore, the area of the stria vascularis at the apical turn of the cochlea was significantly smaller. CONCLUSIONS Deterioration of cochlear and vestibular structures in CF patients might be related to their exposure to ototoxic antibiotics. Well-designed case-control studies are necessary to rule out the effect of CF itself.

The surgical challenge of carotid artery and Fallopian canal dehiscence in chronic ear disease: a pitfall for endoscopic approach

Endoscopic procedures are becoming common in middle ear surgery. Inflammation due to chronic ear disease can cause bony erosion of the carotid artery and Fallopian canals, making them more vulnerable during surgery. The objective of this study was to determine whether or not chronic ear disease increases dehiscence of the carotid artery and Fallopian canals.