José Ricardo Gurgel Testa

Voice and vocal self-assessment after thyroidectomy

Voice alterations after thyroidectomy can be found even with preserved function of laryngeal nerves. The purpose of this study was to evaluate voice before and after thyroid surgery and the role of orotracheal intubation on voice changes.

Vocal fold immobility after thyroidectomy with intraoperative recurrent laryngeal nerve monitoring.

CONTEXT AND OBJECTIVE Intraoperative nerve monitoring has emerged as a valuable tool to facilitate recurrent laryngeal nerve identification during thyroid surgery, thereby avoiding its injury. The aim was to evaluate vocal fold mobility in patients who underwent thyroidectomy with intraoperative nerve monitoring. DESIGN AND SETTING Cohort formed by a consecutive series of patients, at a tertiary cancer hospital. METHODS The subjects were patients who underwent thyroidectomy using intraoperative laryngeal nerve monitoring, between November 2003 and January 2006. Descriptive analysis of the results and comparison with a similar group of patients who did not undergo nerve monitoring were performed. RESULTS A total of 104 patients were studied. Total thyroidectomy was performed on 65 patients. Vocal fold immobility (total or partial) was detected in 12 patients (6.8% of the nerves at risk) at the first postoperative evaluation. Only six (3.4% of the nerves at risk) continued to present vocal fold immobility three months after surgery. Our previous series with 100 similar patients without intraoperative nerve monitoring revealed that 12 patients (7.5%) presented vocal fold immobility at the early examination, and just 5 (3.1%) maintained this immobility three months after surgery, without significant difference between the two series. CONCLUSION In this series, the use of intraoperative nerve monitoring did not decrease the rate of vocal fold immobility.

Standardization of techniques used in facial nerve section and facial movement evaluation in rats

AIM Standardization of the technique to section the extratemporal facial nerve in rats and creation of a scale to evaluate facial movements in these animals before and after surgery. STUDY DESIGN Experimental. METHOD twenty Wistar rats were anesthetized with ketamine xylazine and submitted to sectioning of the facial nerve near its emergence through the mastoid foramen. Eye closure and blinking reflex, vibrissae movement and positioning were observed in all animals and a scale to evaluate these parameters was then created. RESULTS The facial nerve trunk was found between the tendinous margin of the clavotrapezius muscle and the auricular cartilage. The trunk was proximally sectioned as it exits the mastoid foramen and the stumps were sutured with a 9-0-nylon thread. An evaluation and graduation scale of facial movements, independent for eye and vibrissae, was elaborated, together with a sum of the parameters, as a means to evaluate facial palsy. Absence of eye blinking and closure scored 1; the presence of orbicular muscle contraction, without blinking reflex, scored 2; 50% of eye closure through blinking reflex, scored 3, 75% of closure scored 4. The presence of complete eye closure and blinking reflex scored 5. The absence of movement and posterior position of the vibrissae scored 1; slight shivering and posterior position scored 2; greater shivering and posterior position, scored 3 and normal movement with posterior position, scored 4; symmetrical movement of he vibrissae, with anterior position, scored 5. CONCLUSION The rat anatomy allows easy access to the extratemporal facial nerve, allowing its sectioning and standardized suture. It was also possible to establish an evaluation and graduation scale of the rat facial movements with facial palsy based on the clinical observation of these animals.

Medidas de imitância acústica em lactentes com 226hz e 1000hz: correlação com as emissões otoacústicas e o exame otoscópico

A avaliacao audiologica do lactente deve ser composta pela verificacao das condicoes de orelha media (medidas de imitância acustica e otoscopia) e pela avaliacao coclear (Emissoes Otoacusticas). OBJETIVO: Verificar qual tom teste da timpanometria (226Hz ou 1000Hz) tem maior correlacao com o exame otoscopico e com o resultado das Emissoes Otoacusticas por estimulo transiente. METODO: Realizou-se emissoes otoacusticas nos 60 lactentes da amostra, com idade entre de zero e quatro meses. Foram distribuidos em dois grupos, sendo o grupo I 30 lactentes com EOA presente e o grupo II 30 lactentes com EOA ausente. Foram submetidos a timpanometria de multiplas frequencias, com tom teste de 226Hz e 1000Hz e avaliacao otoscopica. RESULTADOS: Na timpanometria, o tom teste de 1000Hz apresentou mais sensibilidade para identificar as alteracoes de orelha media. Nas criancas com curva timpanometrica dentro da normalidade, ambos os tons-teste (226 e 1000Hz) apresentaram alta especificidade. Todas as correlacoes foram significantes com o tom teste de 1000Hz. CONCLUSAO: O tom teste de 1000Hz apresentou maior correlacao estatisticamente significante com as EOA e com a avaliacao otoscopica para lactentes de zero a quatro meses.

Padronização das técnicas de secção do nervo facial e de avaliação da mímica facial em ratos

AIM: standardization of the technique to section the extratemporal facial nerve in rats and creation of a scale to evaluate facial movements in these animals before and after surgery. STUDY DESIGN: Experimental. METHOD: twenty Wistar rats were anesthetized with ketamine xylazine and submitted to sectioning of the facial nerve near its emergence through the mastoid foramen. Eye closure and blinking reflex, vibrissae movement and positioning were observed in all animals and a scale to evaluate these parameters was then created. RESULTS: The facial nerve trunk was found between the tendinous margin of the clavotrapezius muscle and the auricular cartilage. The trunk was proximally sectioned as it exits the mastoid foramen and the stumps were sutured with a 9-0-nylon thread. An evaluation and graduation scale of facial movements, independent for eye and vibrissae, was elaborated, together with a sum of the parameters, as a means to evaluate facial palsy. Absence of eye blinking and closure scored 1; the presence of orbicular muscle contraction, without blinking reflex, scored 2; 50% of eye closure through blinking reflex, scored 3, 75% of closure scored 4. The presence of complete eye closure and blinking reflex scored 5. The absence of movement and posterior position of the vibrissae scored 1; slight shivering and posterior position scored 2; greater shivering and posterior position, scored 3 and normal movement with posterior position, scored 4; symmetrical movement of he vibrissae, with anterior position, scored 5. CONCLUSION: The rat anatomy allows easy access to the extratemporal facial nerve, allowing its sectioning and standardized suture. It was also possible to establish an evaluation and graduation scale of the rat facial movements with facial palsy based on the clinical observation of these animals.

The value of prognostic clinical data in Bell's palsy

UNLABELLED Electroneurography (ENoG) and clinical staging are currently the methods of choice to indicate prognosis in Bells palsy, although ENoG is an electrophysiological test not universally available. AIM Identify other options of prognostic evaluation based upon clinical aspects and minimal electrical stimulation test allowing prognostic measurement in almost any circumstances. STUDY DESIGN Historic cohort. MATERIAL AND METHOD Chart review of 1,521 cases of IPFP, analyzing the following clinical aspects: gender, age, paralyzed side, installation mode, previous symptoms, associated symptoms and minimal electrical stimulation test (Hilger test) and its statistical correlation to facial palsy evolution after 6 months. RESULTS Data indicated that patients above 60 years old had worse prognosis in comparison with patients under 30 years old. A progressive mode of paralysis installation, absence of previous symptoms, concomitant vertigo and response superior to 3.5 mA at minimum electrical stimulation test were also related to worse prognosis. On the other hand, the absence of concomitant symptoms, diminished tearing and sudden onset were related to better prognosis. CONCLUSION Clinical factors and Hilgers test can accurately indicate the prognosis in cases of Bells palsy when ENoG is not available.

Gastroesophageal Reflux in patients with Recurrent Laryngeal Papillomatosis

UNLABELLED Evidence of a relation between gastroesophaeal reflux and pediatric respiratory disorders increases every year. Many respiratory symptoms and clinical conditions such as stridor, chronic cough, and recurrent pneumonia and bronchitis appear to be related to gastroesophageal reflux. Some studies have also suggested that gastroesophageal reflux may be associated with recurrent laryngeal papillomatosis, contributing to its recurrence and severity. AIM the aim of this study was to verify the frequency and intensity of gastroesophageal reflux in children with recurrent laryngeal papillomatosis. MATERIAL AND METHODS ten children of both genders, aged between 3 and 12 years, presenting laryngeal papillomatosis, were included in this study. The children underwent 24-hour double-probe pH-metry. RESULTS fifty percent of the patients had evidence of gastroesophageal reflux at the distal sphincter; 90% presented reflux at the proximal sphincter. CONCLUSION the frequency of proximal gastroesophageal reflux is significantly increased in patients with recurrent laryngeal papillomatosis.

Behavioral and histologic experimental model of facial nerve regeneration in rats.

UNLABELLED To setup an experimental model is the first step to study neural regeneration. AIM Setting up an experimental model on facial nerve regeneration. MATERIAL AND METHODS Wistar rats with complete sectioning and suturing of the extratemporal facial nerve trunk; with a behavioral and histological analysis for 9 weeks. STUDY DESIGN Experimental prospective study. RESULTS Progressive clinical and histological recovery of the animals. CONCLUSION Our method is acceptable to study facial nerve regeneration in rats.

Valor prognóstico de dados clínicos em paralisia de Bell

Com o advento dos testes eletrofisiologicos, a avaliacao clinica parece ter perdido interesse na paralisia de Bell. A eletroneuronografia (ENoG) associada ao estadiamento clinico da doenca e o metodo mais frequentemente utilizado para mensurar o prognostico da paralisia de Bell. Entretanto, a ENoG constitui-se em um teste eletrofisiologico ainda nao universalmente disponivel, especialmente nos servicos de emergencia. OBJETIVO: Estudar a medida do prognostico da paralisia de Bell com base nos dados clinicos e no teste de estimulacao eletrica minima, teste de Hilger, permitindo assim uma previsao de prognostico segura e factivel na maioria dos servicos. FORMA DE ESTUDO: coorte historica. MATERIAL E METODO: Estudo coorte retrospectivo, analisando 1521 casos de paralisia de Bell, correlacionando-se os dados clinicos sexo, idade, lado da paralisia, modo de instalacao, sintomas previos, sintomas associados e os resultados do teste de estimulacao eletrica minima (Hilger), com a evolucao da paralisia apos 6 meses. RESULTADO: O estudo desses dados indicou que pacientes acima de 60 anos apresentaram prognostico pior em comparacao com pacientes com idade abaixo de 30 anos; o modo de instalacao progressiva, a ausencia de sintomas previos, a presenca de vertigem concomitante a paralisia e resposta acima de 3,5 mm no teste de Hilger estiveram relacionados com mau prognostico. Por outro lado, a ausencia de sintomas concomitantes, a diminuicao do lacrimejamento e o inicio subito foram relacionados com bom prognostico. CONCLUSAO: A analise de fatores clinicos, associada ao teste de Hilger, pode indicar o prognostico da paralisia facial com reduzida margem de erro, sendo uma alternativa bastante interessante especialmente quando nao ha disponibilidade da ENoG.

Alterações condutivas em neonatos que falharam na triagem auditiva neonatal

UNLABELLED In newborn hearing screening little importance is attributed to changes in the middle ear. Children with secretory otitis in the neonatal period are at risk for developing otitis media in the first year of life. AIM To determine if children who failed the hearing screening because of conductive hearing loss have more episodes of conductive hearing impairment during their first years of life. MATERIALS AND METHODS The study group comprised 62 children who failed the screening for conductive impairment. The control was made up of 221 who passed. Both had audiologic and otolaryngological assistance and were compared regarding the occurrence of conductive disorder. Were used the Fishers Exact test for statistical analysis and logistic regression models. The study was prospective and retrospective. RESULTS Children who failed the screening by conductive disorder had more episodes of otitis media during the first year of life than those who did not fail, with statistically significant difference. CONCLUSION Infants who failed the screening in the first month of life for conductive alteration are more likely to experience otitis in the first year of life. The high incidence of otitis indicates the need for joint action with otolaryngologist for diagnosis of such changes.