José Faibes Lubianca Neto

Chronic Secretory Otitis Media: Negative Bacteriology

There is disagreement on the role of bacteria in the genesis and maintenance of chronic secretory otitis media (CSOM). Extensive studies from other countries report up to 40% of middle ear cultures with bacterial growth. For the present study, material was collected from 94 ears of children with both clinical and tympanometric diagnoses of CSOM. The samples were sent for bacteriological analysis, in there it was stained according to Grams method and put into growing media: MacConkey (for gram-negative bacteria) and blood agar (for gram-positive bacteria) for 24 h, at 37 degrees C. If germs were identified by Grams method, antibiograms would be carried out as well, with the Mueller Hington medium. No cultures were made for anaerobes. Only one ear had grown bacteria (Staphylococcus epidermidis), which was deemed contamination. No other ear studied bore bacteria. The possible causes for this disagreement between our study and the literature are discussed.

Lateral sinus thrombosis and cervical abscess complicating cholesteatoma in children: Case report and review

To call attention to complications of chronic otitis media, the case of a patient who simultaneously developed lateral sinus thrombosis and Bezolds abscess is reported. A 7 year old boy presented with fever, drowsiness, cervical mass and otorrhea not responding to medical management. Work-up revealed lateral sinus thrombosis and cervical abscess secondary to right ear cholesteatoma. After treatment with surgery and antibiotics, he had a favorable outcome. We review the literature regarding the diagnosis and management of these complications and concluded that although less frequent they remain a clinical challenge.

O efeito da adenotonsilectomia na saturação de oxigênio em crianças com distúrbios respiratórios do sono

OBJECTIVE To evaluate the effect of adenotonsillectomy on oxygen saturation measured through nocturnal pulse oximetry in children with sleep disordered breathing. METHODS A pre- and post-intervention study was carried out using nocturnal pulse oximetry. The study involved 31 children who were suspected of having sleep disordered breathing and had been referred for adenotonsillectomy. RESULTS A total of 27 children completed the study. The mean age was 5.2 +/- 1.8 years, and 18 (66.7%) of them were male. Upon physical examination, 23 (85.2%) of the children presented class III or class IV hyperplasia of the palatine tonsils. There was significant improvement in the post-operative period over the pre-operative period in terms of the oxygen desaturation rate (OR = 0.65; 95% CI: 0.5-1.3 vs. OR = 1.63; 95% CI: 1.1-2.4; p < 0.001). CONCLUSION Adenotonsillectomy significantly improved oxygen saturation, as measured through nocturnal pulse oximetry, in children with sleep disordered breathing.

Air gun dart injury in paranasal sinuses left alone

Patients with paranasal sinus foreign body are not commonly seen in otolaryngological practice and papers dealing with this issue are rare in the English literature. One case of penetrating sinus injury due to air gun dart is presented to illustrate the potentially serious consequences of air gun injuries. The clinical presentation, diagnostic pitfalls and the treatment aspects are discussed.

Intracranial complications of chronic suppurative otitis media in children

UNLABELLED In spite of significant decrease after antibiotic advent, intracranial complications of otitis media still represent a challenging situation owing to its high mortality rate (36%). The most common presentations are meningitis, cerebral abscess, extradural abscess and lateral sinus thrombophlebitis. For early management, it is necessary to have a high index of suspicion. It is important to identify non-typical cases because they might be masqueraded by antibiotic use. AIM We present six cases of intracranial complications due to otitis media in children and adolescents at Complexo Hospitalar Santa Casa de Porto Alegre for the past two years. STUDY DESIGN Series review.

Complicações intracranianas das otites médias crônicas supurativas em crianças

In spite of significant decrease after antibiotic advent, intracranial complications of otitis media still represent a challenging situation owing to its high mortality rate (36%). The most common presentations are meningitis, cerebral abscess, extradural abscess and lateral sinus thrombophlebitis. For early management, it is necessary to have a high index of suspicion. It is important to identify non-typical cases because they might be masqueraded by antibiotic use. AIM: We present six cases of intracranial complications due to otitis media in children and adolescents at Complexo Hospitalar Santa Casa de Porto Alegre for the past two years. STUDY DESIGN: series review.

Achados clínicos e endoscópicos em crianças com estridor

Introduction: Abnormalities of the airway often present with stridor. The main cause in neonates and infants are the congenital defects of the larynx. The specific etiologic diagnose can be just obtained through fibronasolaryngobroncoscopy, which is necessary for the correct management of this children. Study design: Clinical prospective and descriptive cross-sectional study. Aim: To describe the main causes and associated clinical findings of stridor in children presenting to our hospital. Material and Method: A prospective investigation was performed from March 2000 to April 2001 to study all children evaluated at the Department of Pediatric Othorrinolaryngology of Hospital da Crianca Santo Antonio with the inclusion criterion of stridor. These patients were examined according to a priori defined protocol, which includes besides questions about history, physical examination and associated comorbities, a standard fibronasolaryngobroncoscopy examination. Results: A group of 125 children (69 male and 56 female) were evaluated. The mean age at inclusion was 19 months. Most patients came from intensive care unit. Almost all cases had comorbidities, long-term endotracheal intubation been the most common finding. The most frequent diagnose were laryngomalacia (n=51, 40.8%) and subglottic stenosis (n=22, 17.6%). Conclusions: Even in the presence of a more select sample than the great international series, we also found congenital anomalies of the larynx as the main cause of stridor. It was difficult to differentiate between congenital and acquired subglottic stenosis in some cases with a history of endotracheal intubation. The presence of comorbidities is frequent and may help to select the patients who will need endoscopic evaluation.

Effect of improved nasal airflow after adenoidectomy on nasal erectile tissue.

OBJECTIVE To determine the effect of improved nasopharyngeal airflow after adenoidectomy on nasal turbinate erectile tissue in pediatric patients. DESIGN Clinical, prospective, before-and-after study. SETTING Pediatric Otolaryngology Clinic at Hospital da Criança Santo Antônio de Porto Alegre (Complexo Hospitalar Santa Casa de Porto Alegre). PATIENTS Twenty-one 5- to 11-year-old children diagnosed as having severe nasal obstruction, with an indication for adenoidectomy. INTERVENTION Adenoidectomy. MAIN OUTCOME MEASURES Acoustic rhinometry data before and 90 days after surgery. To specifically monitor erectile tissue behavior, only the volume of the nasal turbinate region was considered (depth, 2.20-5.40 cm). RESULTS The volume of the turbinate region varied from 6.03 cm(3) in the preoperative evaluation to 6.99 cm(3) in the postoperative evaluation, representing an increase of 16% (P < .04). Multiple linear and logistic regressions did not reveal any factors other than adenoidectomy that could explain this change. CONCLUSIONS Because the only possible explanation for the observed erectile tissue changes was improvement in nasal airflow, we can assume that adenoidectomy favorably affects the behavior of nasal erectile structures and is associated with a decrease in turbinate size. Combined turbinate reduction and adenoidectomy should not be the rule because children may benefit from adenoidectomy alone.

Association between congenital nasolacrimal duct cyst and bilateral choanal atresia

1 MD Federal University of Rio Grande do Sul UFRGS (1991); ENT Residency at Hospital de Clinicas de Porto Alegre (1992-1993), MSc (1997) and PhD (2000) in Medicine: Medical Sciences UFRGS. Fellowship at the Pediatric ENT Division at the Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, USA (1997-1998) (Adjunct Professor IV Of the Federal University of Health Sciences Porto Alegre, Professor at the Graduate Program in Medical Sciences UFRGS, Director of the Pediatric ENT Division at Hospital da Crianca Santo Antonio do Complexo Hospitalar Santa Casa de Porto Alegre; Scientific director of the Associacao Gaucha de Otorrinolaringologia; Chairman of the ENT committee of the Pediatric Otorhinolaryngology Socity of RS and member of the Management Core of the ENT Department of the Brazial Association of Pediatrics; Board Member at the Brazilian Association of Otorhinolaryngology and Neck and Facial Surgery, in the International Relations and Teaching, Residency and Training Departments. 2 MD University of Coimbra (1973), MD Universidade de Caxias do Sul (1977) Medical Residency at the Hospital de Clinicas de Porto Alegre (1979) . Assistant Professor III Federal University of Rio Grande do Sul; Other Founding Partner of the Brazilian Association of Laryngology and Voice and aide at the Society of Otorhinolaryngology of Rio Grande do Sul. 3 MD Pontificia Universidade Catolica do Rio Grande do Sul (1994); MD Universidade Federal do Rio Grande do Sul (2000) and Medical Residency at the Hospital de Clinicas de Porto Alegre (2004) (Effective Member of the Brazilian Association of Otorhinolaryngology and Special Graduate Student at the Hospital de Clinicas de Porto Alegre. Experienced in Medicine, with enphasis in Otorhinolaryngology). 4 MD Universidade Federal de Pelotas (2006). Resident Physician at Santa Casa de Misericordia de Porto Alegre. 5 MDUniversidade Federal de Ciencias da Saude de Porto Alegre (2009). Paper submitted to the BJORL-SGP (Publishing Management System – Brazilian Journal of Otorhinolaryngology) on October 04, 2009; and accepted on October 01, 2010. cod. 6692 cAsE REPORT Braz J Otorhinolaryngol. 2011;77(2):267. BJORL

Laryngeal malformations in the Richieri Costa and Pereira syndrome with airway obstruction

1 Physician, medical resident at the Otorhinolaryngology Unit, Health Science Federal University of Porto Alegre (Universidade Federal de Ciencias da Saude de Porto Alegre UFCSPA). Hospital system of the Porto Alegre Holy House of Mercy (Santa Casa de Porto Alegre CHSCPA). 2 Physician, medical resident at the Otorhinolaryngology Unit, Professor Edmundo Vasconcelos Hospital, SP. 3 Master’s degree in medicine, UFCSPA. Otorhinolaryngologist of the Pediatric Otorhinolaryngology Unit, HCSA. 4 Craniomaxillofacial plastic surgeon, doctor in medicine and surgery, Barcelona University (Universidad de Barcelona), professor of the graduate course of medicine, Rio Grande do Sul Federal University (Universidade Federal do Rio Grande do Sul). 5 Doctorate degree, Rio Grande do Sul Federal University, adjunct professor of otorhinolaryngology, Department of Surgery, UFCSPA. Head of the Pediatric Otorhinolaryngology Unit, HCSA, CHSCPA. Health Science Federal University of Porto Alegre (Universidade Federal de Ciencias da Saude de Porto Alegre UFCSPA). Hospital system of the Porto Alegre Holy House of Mercy (Santa Casa de Porto Alegre CHSCPA). Patricia Barcelos Ogando patiogando@hotmail.com Paper submitted to the BJORL-SGP (Publishing Management System – Brazilian Journal of Otorhinolaryngology) on December 28, 2009; and accepted on February 24, 2010. cod. 6856 CASE REPORT Braz J Otorhinolaryngol. 2011;77(1):138. BJORL