José Carlos Nardi

Estudo das latências das ondas dos potenciais auditivos de tronco encefálico em indivíduos normo-ouvintes

Brainstem Evoked Response Audiometry (BERA) is an objective and non-invasive method of hearing assessment which detects electrical activity from the inner ea...

Rendu-Osler-Weber Syndrome: case report and literature review

Hereditary Hemorrhagic Telangiectasia or Rendu-Osler-Weber Disease is a rare fibrovascular dysplasia that makes vascular walls vulnerable to trauma and rupture, causing skin and mucosa bleeding. It is of dominant autosomal inheritance, characterized by recurrent epistaxis and telangiectasia on the face, hands and oral cavity; visceral arteriovenous malformations and positive family history. Epistaxis is often the first and foremost manifestation. Its associated to arteriovenous malformations in several organs. There are possible hematologic, neurologic, pulmonary, dermatologic and gastrointestinal complications. Treatment is supportive and helps prevent complications. This study is a case report of a patient with this syndrome who came to the ENT Outpatient Ward of the Faculdade de Medicina de Marília; and we have done a bibliographic review of the diseases etiopathogenesis, clinical manifestations and clinical-surgical treatment options.

Brainstem evoked response audiometry in normal hearing subjects

UNLABELLED Brainstem Evoked Response Audiometry (BERA) is an objective and non-invasive method of hearing assessment which detects electrical activity from the inner ear to the inferior colliculus. AIM To assess the hearing pathway in normal hearing individuals and compare differences associated with gender, age and ear side (left and right). STUDY DESIGN A retrospective study. MATERIALS AND METHODS Sixty normal hearing individuals, aged between 09 and 66 years old, were subjected to clinical ENT examination and audiologic tests. RESULTS Wave latencies differed significantly between males and females, although there were no differences regarding right or left ear sides. Comparing latency averages regarding age and gender we noticed important differences. By the same token, significant differences were also seen comparing this study with the information present in the handbook of the BERA device used and results published by Fukuda, in another study. CONCLUSION Knowing the great importance of BERA, it is crucial that each service develops its own standards in order to enhance the accuracy of the electrophysiological diagnosis of the hearing pathway.

Síndrome de Rendu-Osler-Weber: relato de caso e revisão de literatura

Hereditary Hemorrhagic Telangiectasia or Rendu-Osler-Weber Disease is a rare fibrovascular dysplasia that makes vascular walls vulnerable to trauma and rupture, causing skin and mucosa bleeding. It is of dominant autosomal inheritance, characterized by recurrent epistaxis and telangiectasia on the face, hands and oral cavity; visceral arteriovenous malformations and positive family history. Epistaxis is often the first and foremost manifestation. Its associated to arteriovenous malformations in several organs. There are possible hematologic, neurologic, pulmonary, dermatologic and gastrointestinal complications. Treatment is supportive and helps prevent complications. This study is a case report of a patient with this syndrome who came to the ENT Outpatient Ward of the Faculdade de Medicina de Marilia; and we have done a bibliographic review of the diseases etiopathogenesis, clinical manifestations and clinical-surgical treatment options.

Spontaneus tonsillar hemorrhage

Spontaneous tonsillar hemorrhage is a rare event; most of these cases have been the result of infectious tonsillitis.1 There are reported cases of spontaneous tonsillar hemorrhage in medical literature associated with bacterial infection, measles virus infection, infectious mononucleosis, peritonsillar, parapharyngeal and retropharyngeal abscesses and, less frequently, vascular malformation, aneurisms or pseudoaneurisms of the carotid and superficial temporal arteries, von Willebrand’s disease and local or regional cancer. In a review of literature, Lourenço et al. found 21 cases of spontaneous tonsillar hemorrhage resulting from acute tonsillitis. Cases of spontaneous hemorrhage have been reported in peritonsillar abscesses, mostly when spontaneous drainage occurred during the pre-antibiotic era. The prevalence of hemorrhage associated with infectious mononucleosis is 3 to 6.9%; of these, 2.2% presented oropharyngeal hemorrhage. Thrombocytopenia is associated with this condition, but hemorrhage may result only due to local inflammation, necrosis and erosion of superficial tonsillar blood vessels. In measles, hemorrhagic complications are uncommon. However, there is a rare variant known as hemorrhagic measles that affects mostly immunocompromised patients. Tonsillar hemorrhage is a rare finding in von Willebrand’s disease. There are 2 cases reported in literature where tonsillar hemorrhage was the first manifestation of this disease. An explanation of the pathophysiology of this type of hemorrhage is that acute inflammation results in increased blood flow to the tonsils, secondary edema, and vascular congestion; during the local inflammatory process, superficial dilated blood vessels undergo necrosis and bleed. In the pre-antibiotic era these hemorrhages were fatal; they were commonly due to erosion of major vessels, secondary do deep abscesses. Currently, most tonsillar hemorrhages are mild and result from the bleeding of superficial peripheral blood vessels. We report the following case to discuss the etiology and clinical strategies in spontaneous tonsillar hemorrhage.

The importance of the auditory evoked potential in acoustic neuromas

Hearing loss, frequently with tinnitus, is the main symptom of acoustic neuromas (ANs), which compress the cochlear nerve and affect the cochlear blood supply. This vascular mechanism explains why atypical, fluctuating deafness, with audiometric features of retrocochlear involvement, may occur in this condition. An early diagnosis of ANs is essential for a good prognosis. Physicians should recognize the clinical signs of neurinomas, particularly in individuals aged just over 40 years; this is true even in cases of symmetrical sensorineural hearing loss. The brainstem auditory evoked potential (BAEP) is an objective, non-invasive method for a neurophysiological analysis of auditory pathways from the inner ear to the high brainstem. It is a short latency potential that generates a wave series (from I to VII) that appears within the first 10 ms after a sound stimulus is presented. These waves are generated due to the sequential activation of auditory pathway structures, and are picked up by electrodes placed on the skin.