Inês Gambôa

Vestibular Disorders after Stapedial Surgery in Patients with Otosclerosis

Introduction and Objectives. Vertigo is a described complication of stapedial surgery. Many studies have been conducted to assess the improvement of hearing loss, but there are few studies that assess vestibular function after stapedial surgery. The aim of this study was to evaluate the presence and characterize the vertigo after stapedial surgery. Methods. We conducted a prospective observational study. Patients undergoing stapedial surgery in our hospital between October 2013 and December 2014 were invited to participate. The vertigo was assessed before and 4 months after surgery, using the Dizziness Handicap Inventory. Results. We included 140 patients in the study. 12 patients (8.6%) reported vertigo before surgery, and all of them denied vertigo after surgery. 36 patients (25.7%) reported vertigo four months after surgery, and none of them had vertigo before surgery. Postoperative total scores in patients with vertigo ranged between 2 and 18 points. Conclusion. The study shows that vestibular disorders may remain after the immediate postoperative period and reinforces the need for clarification of the patient in the informed consent act.

Patologia do Ouvido Interno Imunomediada

Immune-mediated inner ear disease may occur as an organ-specific pathology - autoimmune inner ear disease - or in the context of a systemic autoimmune disease. This is because the inner ear can create a local immune response with vestibulocochlear damage that may occur due to autoantibody damage, immune complex deposition or vasculitis with microcirculation ischemia. The etiology of autoimmune inner ear disease is not yet clearly defined but the damage is presumed to be due to autoantibodies directed to inner ear proteins, the most studied being the anti-68 kDa, anti-Hsp70 and anti-cochlin proteins. The challenge in diagnosing this type of pathology arises not only because of the absence of specific analytical markers, but also because of the wide variety of systemic pathologies that may manifest with audiovestibular symptoms. However, early treatment is preponderant since hearing loss may be reversible.

Nontraumatic Parapharyngeal Haematoma: A Rare Lesion

Nontraumatic haematoma of parapharyngeal space is very rare and may cause dysphagia and dyspnea. The authors present a case report of a 74-year-old woman with sudden nontraumatic neck swelling without dyspnea and with left pharyngeal bulging and endolaryngeal displacement. Parathyroid hormone elevation and imaging exams confirmed bleeding from a parathyroid adenoma. Symptoms and signs resolved after one week of conservative treatment. There are few cases of parapharyngeal haematomas caused by parathyroid adenomas. Most patients can be managed without emergent surgery, but close airway monitoring is fundamental.