Jeanne da Rosa Oiticica Ramalho

Zumbido em pacientes com audiometria normal: caracterização clínica e repercussões

Pacientes com zumbido e audiometria normal constituem um grupo importante, pois seus achados nao sofrem influencia da perda auditiva. Apesar disso, este grupo e pouco estudado e nao sabemos se suas caracteristicas clinicas e repercussoes sao semelhantes as dos individuos com perda auditiva. OBJETIVOS: Comparar as caracteristicas clinicas do zumbido e sua interferencia nas atividades diarias em pacientes com e sem perda auditiva. FORMA DE ESTUDO: coorte historica. MATERIAL E METODO: Entre 744 pacientes atendidos no Grupo de Pesquisa em Zumbido do HCFMUSP, avaliou-se retrospectivamente com um corte transversal os 55 individuos com audiometria tonal normal. O grupo controle correspondeu a 198 pacientes com zumbido e perda auditiva atendidos sob o mesmo protocolo. Analisou-se os dados dos pacientes, as caracteristicas clinicas do zumbido e sua repercussao na vida do paciente. RESULTADOS: A idade media no grupo de estudo (43,1 ± 13,4 anos) foi significantemente menor do que a do grupo controle (49,9 ± 14,5 anos). Em ambos os grupos houve predominio do sexo feminino e o zumbido foi predominantemente bilateral, unico e constante, porem sem diferenca entre os grupos. A interferencia na concentracao e no equilibrio emocional foi significantemente menor no grupo de estudo (25,5% e 36,4%) do que no controle (46% e 61,6%), porem sem diferenca quanto a interferencia no sono e na atividade social. CONCLUSOES: O grupo de pacientes com zumbido e audicao normal apresentou caracteristicas clinicas semelhantes em relacao ao grupo com perda auditiva. Entretanto, a faixa etaria acometida e a interferencia sobre a concentracao e o equilibrio emocional foram significantemente menores nestes.

Healing of Subacute Tympanic Membrane Perforations in Chinchillas Treated with Epidermal Growth Factor and Pentoxifylline

Hypothesis: The aims of the present study were to determine the effect of epidermal growth factor (EGF) and pentoxifylline on subacute tympanic membrane (TM) perforations and to quantify the healing rate of such perforations treated with these drugs alone or in combination. Background: It is known that EGF modulates in vitro and in vivo proliferation of epithelial and endothelial cells. Pentoxifylline is a methylxanthine that has been used to treat experimental skin flaps and venous leg ulcers. Data in the literature regarding this subject are contradictory, and quantitative data regarding the effects of EGF and pentoxifylline on TM perforation healing are scarce. Methods: We studied 50 chinchillas submitted to TM perforation. On postoperative Day 30, eight were selected for histologic analysis. Of the remaining 42, those presenting little or no healing were distributed into four groups: control, EGF, pentoxifylline, and EGF combined with pentoxifylline. Results: Histologic analysis showed that the observation period adopted was sufficient to consider the TM perforations subacute. We found significant differences between the study groups and the control group in the healing rate of subacute TM perforations during a 30-day period (analysis of variance; p < 0.001), which was 30.3% for the EGF group, 3.6% for the pentoxifylline group, 16.5% for the EGF-pentoxifylline group, and 8.7% for the control group. Conclusions: The use of EGF promoted healing of subacute TM perforations in chinchillas, and the use of pentoxifylline did not. The combination of the two had no synergistic effect on the healing of these perforations.

Laryngeal Herpes: A Case Report

Herpetic laryngitis is a rare inflammatory disease caused by herpes simplex or herpes zoster virus. The propensity for spreading along peripheral nerves and within the central nervous system, with frank herpetic meningoencephalitis, is a rare complication. We present one case of herpetic laryngitis by reactivation of varicella zoster, with central nervous system spreading, and discuss the relevant literature on the pathophysiology, diagnosis, evaluation, and management of this disease.

Critical analysis of vestibular rehabilitation outcome according to dizziness etiology

UNLABELLED Vestibular rehabilitation (VR) is an excellent therapy for dizziness patients. However, despite well managed, sometimes results are not suitable. AIM evaluate VR outcome between patients according to dizziness etiology. STUDY DESIGN Retrospective review of medical records. METHOD Patients records were analyzed between January 2002 and December 2004. As for inclusion criteria, patients should have had finished VR therapy and an established diagnosis. Patients were included in three VR outcome groups and compared according to etiology. RESULTS according to VR outcome 13 patients had no improvement, 24 had partial improvement and 22 complete improvement. The main etiologies were cervical syndrome, trauma, metabolic disorders, central nervous system disorders, anxiety and mood disorders, autoimmune disease and orthostatic intolerance. Patients with metabolic disorders showed better VR outcome than the others. CONCLUSION VR therapy combined with clinical etiology treatment is an excellent approach for dizziness patients.

Arreflexia pós-calórica bilateral: aplicabilidade clínica da reabilitação vestibular

Bilateral vestibular loss is a rare diagnosis among patients with dizziness and imbalance. Nevertheless, symptoms are often disabling and therapy is yet to be establish. AIM: To evaluate and describe the clinical outcome of patients with imbalance due to bilateral vestibular loss after caloric test, treated with An analog visual scale was used to evaluated clinical results. Vestibular Rehabilitation. STUDY DESIGN: Retrospective case report. METHOD: Pre and post treatment outcomes were evaluated in 8 individuals suffering from post caloric bilateral vestibular paresis whose were submitted to vestibular rehabilitation. RESULTS: After Vestibular Rehabilitation, 7 (87,5%) of 8 patients had clinical improvement. CONCLUSION: Although is not expected entirely compensation for bilateral vestibular loss, the vestibular rehabilitation may be use as a therapeutic method for these patients.

Tinnitus in normal hearing patients: An uncommon group

Objectives: Tinnitus usually appears in patients with some degree of hearing loss. Just a few papers studied tinnitus in normal hearing patients, usually involving less than 20 cases. The objective of this study is to describe the main characteristics of a significant sample of tinnitus patients with normal pure tone audiometry. Methods: The files of 744 tinnitus patients following the same medical audiological protocol were reviewed, excluding those with hearing thresholds above 25dBHL in at least one frequency. Thus, 66 (8.8%) files belonging to patients with tinnitus and normal audiometry were enrolled in this study, analyzing their main characteristics (sex, gender, laterality, severity, laboratories alterations). Results: There was a high prevalence of female patients in 71.2% of the cases. The mean age was 42 ± 13 years (minimum 7, maximum 72). Tinnitus was a single tone in 71.2%. There were 11 patients with pulsatile tinnitus. Bilateral in 51.5% and constant in 66.7%. According to the visual analogue scale, the tinnitus severity was mild in 6 cases, moderate in 27 and severe in 32. Caffeine abuse was detected in 45.4%, sweet compulsion in 45.4%, and lipid disturbances in 36.3%. Blood glucose and thyroid hormones levels were altered in 27.3% and 13.6%, respectively. Conclusion: Tinnitus in normal hearing patients may also evoke an important annoyance and showed an association with metabolic disorders. Trying to find the main characteristics of these patients and other possible etiologies can be fundamental for therapeutic approach.