Marcos Rabelo de Freitas

Gastroesophageal reflux and obstructive sleep apnea in childhood

OBJECTIVES To examine the relationship between gastroesophageal reflux (GER) and obstructive sleep apnea syndrome (OSAS) with polysomnographic alterations and symptom severity. PATIENTS AND METHODS Eighteen children aged from 6 to 12 years (8.14+/-1.75) with adenotonsillar hypertrophy and OSAS were evaluated with the OSA-18 questionnaire nasofibrolaringoscopy and full overnight polysomnography performed simultaneously with esophageal pH monitoring. RESULTS OSAS (Apnea-index (AI)>or=1/hour) was present in all cases. Reflux parameters did not correlate to OSAS severity and a temporal relationship between GER and apnea-hypopnea events was not observed. Body mass index was lower than 18 in 9 cases (52.9%) and 7 children (41.1%) presented a history of abnormal behavior during sleep. In most cases oxygen desaturation and reduction of sleep efficiency were mild. Sleep architecture was similar to the young adult pattern. Seven children (41.1%) presented pH monitoring values below 4 during more than 10% of total sleep time. pH monitoring values were correlated to emotional distress (p=0.008) and to daytime problems (p=0.03) as evaluated by the OSA-18. CONCLUSIONS GER is frequent and should be assessed in children from 6 to 12 years with OSAS. Emotional distress and daytime problems are correlated to increased GER severity.

Resultados na qualidade de vida em longo prazo de crianças submetidas à adenoidectomia/adenotonsilectomia por distúrbios obstrutivos do sono

Os Disturbios Obstrutivos do Sono (DOS) afetam significativamente a populacao pediatrica. Neste grupo, sua principal etiologia e a hiperplasia adenotonsilar, sendo adenoidectomia ou adenotonsilectomia indicadas para tratamento, reversao de sequelas e melhora na qualidade de vida. OBJETIVO: Avaliar qualidade de vida de criancas com DOS apos adenoidectomia/adenotonsilectomia. CASUISTICA E METODO: Realizou-se estudo tipo prospectivo com 48 criancas, entre 2 e 11 anos, apresentando DOS e hiperplasia adenotonsilar obstrutiva com indicacao cirurgica. Aplicou-se o questionario OSA18 sobre qualidade de vida aos cuidadores destas criancas antes da cirurgia, cerca de trinta dias e com pelo menos onze meses apos o procedimento. Pontuacoes elevadas no escore significam pior qualidade de vida. RESULTADOS: No pre-operatorio, o escore OSA18 medio foi 82,83 (DP=12,57), com nota global media para a qualidade de vida de 6,04 (DP=1,66). Na avaliacao pos-operatoria inicial, obteve-se escore OSA18 de 34,3(DP=9,95) e nota global de 9,6 (DP=0,81), ambos tendo reducao significativa (p<0,001). Na avaliacao pos-operatoria tardia, entre 11 e 30 meses (media=16,85,DP=5,16), trinta e quatro (70,83%) criancas foram reavaliadas, obtendo-se escore OSA18 de 35,44(DP=19,95) e nota global de 9,28 (DP=1,78). Nao houve diferenca significativa entre as avaliacoes pos-operatorias. CONCLUSAO: A cirurgia promoveu melhora na qualidade de vida das criancas com DOS, mantendo-se esta em longo prazo.

The role of apoptosis in cisplatin-induced ototoxicity in rats

UNLABELLED Cisplatin is a chemotherapy agent frequently used to treat different types of neoplasia. Ototoxicity is one of the side-effects which cause significant morbidity and limits its use. This study aimed at assessing the role of apoptosis in cisplatin-induced ototoxicity. DESIGN experimental study. MATERIALS AND METHODS male Wistar rats were treated with intraperitoneal cisplatin, in the doses of 24 and 16 mg/kg. The animals were assessed by means of distortion product evoked otoacoustic emissions (DPEOAE) or brainstem evoked auditory potentials (BEAP) in the third (D3) and fourth (D4) days after drug infusion onset. Following that, their cochleas were removed for immunohistochemical studies of apoptosis - TUNEL method. RESULTS the group treated with 24 mg/kg showed a significant reduction in DPEOAE amplitude, and such fact was not seen with the 16 mg/kg. Both doses caused an increase in BEAP electrophysiological threshold in D3 and D4. Apoptosis was the injury mechanism responsible for the cisplatin-induced ototoxicity - 16 mg/kg dose, when the animals were assessed on D3. CONCLUSION apoptosis may be involved in the cisplatin-induced ototoxicity, depending on the dose and time of injury assessment.

Antrochoanal polyp: a review of sixteen cases

INTRODUCTION An Antrochoanal polyp, or Killians polyp is a benign solitary polypoid lesion that affects mainly children and young adults. Studies demonstrate that Killians polyp generally represents 4-6% of all nasal polyps. However, in the pediatric population this percentage reaches 33%. It originates from a hypertrophy of the mucous membrane on the maxillary sinus antrum, and it grows for unknown reasons, through the maxillary sinus ostium towards the nasal cavity and the choana--the posterior portion of the pharynx. AIM To evaluate the result of the surgical treatment on patients assisted in the Department of Otorhinolaryngology of the Walter Cantídio University Hospital-Medical School of the Federal University of Ceará, mainly on the surgical technique employed and the efficacy of each technique in controlling the disease. MATERIALS AND METHODS Retrospective study, accomplished through a chart analysis from the patients submitted to polypectomy because of Killians polyps or other nasal polyps, operated from March 1st, 1991 to April 30th of 2001, in the Department of Otorhinolaryngology of the Medical School of the Walter Cantídio University Hospital of the Federal University of Ceará. RESULTS Nine patient (56.6%) were males and 7 (43.8%) were females. Eleven (68.75%) patients were between 8 and 20 years of age. Predominant symptoms were unilateral nasal obstruction (81.3%) and purulent rhinorrhoea (43.8%). The most common procedure employed was the combined approach: external and endonasal, in 87.5% of the cases. Antrochoanal polyp removal procedure accounted for 21.6% of all the surgical procedures accomplished in the same period for the removal of nasal polyps. Postoperative recurrence was of 12.5%. CONCLUSIONS Antrochoanal polyp was an affection that prevailed among children and young adults. The combined external and endonasal approach was the one most used. Despite maxillary sinus approach to the polyp origin, postoperative recurrence is a possibility.

Long term results in the life quality of children with obstructive sleep disorders

Summary Obstructive Sleep Disorders (OSD) affect mostly the pediatric population. Within this group, its main etiology is adenotonsillar hyperplasia, being adenoidectomy or adenotonsillectomy the best treatment option for quality of life improvement. Aim To asses quality of life of children with OSD after adenoidectomy/adenotonsillectomy. Method A prospective study was carried out with 48 children, between 2 and 11 years, with clinical manifestations of OSD and obstructive adenotonsillar hyperplasia. The OSA18 questionnaire was answered by the parents to evaluate their children’s quality of life before surgery; at about thirty days and at least eleven months after the procedure. A higher score meant a worse quality of life. Results Before surgery, the average OSA18 score was 82.83(SD=12.57), with an average global score for quality of life of 6.04(SD=1.66). Within thirty days after surgery, the average OSA18 score was 34.3 (SD=9.95) with an average global score of 9.6(SD=0.81), both showing significant reduction (p Conclusion surgery improves the quality of life of children with OSD, and such improvement maintains for the long run.

The role of different types of grafts in tympanoplasty

In 1878, Emil Berthold was the first to describe the surgical procedure of myringoplasty, using a free skin graft from the forearm,1 although Edward Ely argued in a later publication that he had been the pioneer in this procedure.2 But it was only in the 1950s that tympanoplasty-related articles reappeared in the literature. The fundamental principles of the surgical procedure were described by Wullstein3 in 1952, using a free skin graft, and Zoellner4 in 1955, using a pedicle graft. Since then, several types of materials have been used to reconstruct the tympanic membrane. Among the autologous grafts, the following can be mentioned: temporalis fascia, fascia lata, periosteum, perichondrium, cartilage with and without perichondrium, veins, fatty tissue, and skin.5,6 Several allografts are mentioned in the literature and include: dura mater, pericardium, temporalis fascia, amniotic membrane, skin, cornea, peritoneum, veins, and aortic valve.6 Recently, alloplastic grafts such as paper, absorbable gelatin sponge, and acellular dermal matrix have also been used.7 The trend toward increasingly less invasive medical procedures, with shorter hospitalization stay, has led to a demand for materials to replace autologous grafts. Theoretical advantages include the elimination of morbidity related to graft harvesting, faster healing, no visible scarring, less pain, and less risk of infection, in addition to a faster procedure and early discharge. These grafts, however, make the procedure more expensive and have shown no real advantages so far.7 The fascia temporalis is the most commonly used graft, with success rates between 93% and 97% in primary tympanoplasty, especially in well-aerated middle ears.5,8 In the last decade, however, there has been an increasing interest in using cartilage grafts as the primary alternative to its use. The stiffness and strength of cartilage confer greater stability to the graft and have a key role in the resistance against shrinkage. There is some concern, however, that

34 self-inflicted foreign bodies in the maxillary sinus

Foreign bodies (FB) are a common occurrence in the realm of ENT practice. The most commonly involved sites are nasal cavities, ears, and pharynx. Foreign bodies are accompanied by site-related symptoms and do not pose much of a challenge to well-trained physicians. Foreign bodies may be introduced willingly by the patient or by accident. Paranasal sinus foreign bodies are rarely seen, and most of them are introduced accidentally (25%) or iatrogenically (60%). The latter may occur as a consequence of dental, ophthalmic, and otorhinolaryngological procedures. The maxillary sinus is more frequently involved (75%), followed by the frontal sinus (18%). Only a few cases of self-inoculated paranasal sinus foreign body have been reported in the literature. This paper reports a case of chronic sinusitis secondary to the inoculation of multiple foreign bodies in the maxillary sinus.

EditorialThe role of different types of grafts in tympanoplastyO papel dos diferentes tipos de enxertos nas timpanoplastias

In 1878, Emil Berthold was the first to describe the surgical procedure of myringoplasty, using a free skin graft from the forearm,1 although Edward Ely argued in a later publication that he had been the pioneer in this procedure.2 But it was only in the 1950s that tympanoplasty-related articles reappeared in the literature. The fundamental principles of the surgical procedure were described by Wullstein3 in 1952, using a free skin graft, and Zoellner4 in 1955, using a pedicle graft. Since then, several types of materials have been used to reconstruct the tympanic membrane. Among the autologous grafts, the following can be mentioned: temporalis fascia, fascia lata, periosteum, perichondrium, cartilage with and without perichondrium, veins, fatty tissue, and skin.5,6 Several allografts are mentioned in the literature and include: dura mater, pericardium, temporalis fascia, amniotic membrane, skin, cornea, peritoneum, veins, and aortic valve.6 Recently, alloplastic grafts such as paper, absorbable gelatin sponge, and acellular dermal matrix have also been used.7 The trend toward increasingly less invasive medical procedures, with shorter hospitalization stay, has led to a demand for materials to replace autologous grafts. Theoretical advantages include the elimination of morbidity related to graft harvesting, faster healing, no visible scarring, less pain, and less risk of infection, in addition to a faster procedure and early discharge. These grafts, however, make the procedure more expensive and have shown no real advantages so far.7 The fascia temporalis is the most commonly used graft, with success rates between 93% and 97% in primary tympanoplasty, especially in well-aerated middle ears.5,8 In the last decade, however, there has been an increasing interest in using cartilage grafts as the primary alternative to its use. The stiffness and strength of cartilage confer greater stability to the graft and have a key role in the resistance against shrinkage. There is some concern, however, that

Sensorineural hearing loss in acromegalic patients under treatment

UNLABELLED Acromegaly is a rare endocrine disease. Few studies have evaluated its association with hearing loss (HL) and the results are conflicting. AIM To evaluate the prevalence and features of HL in a group of patients being treated for acromegaly. To analyze peripheral and central auditory transmission. METHODS Cross-sectional study. A group of 34 patients with acromegaly were submitted to metabolic evaluation, tonal audiometry and brainstem auditory evoked potentials. HL was considered when pure tone average was > 25 DBHL for low frequencies (250, 500, 1000 and 2000 Hz) or high frequencies (3000, 4000, 6000 and 8000 Hz). The patients were divided in group A (with HL) and B (without HL). RESULTS Twelve patients (35.3%) had sensorineural HL (Group A), being 8 bilateral and 4 unilateral. No one had mixed or conductive HL. The prevalence of diabetes/impaired glucose tolerance was similar between the groups. The frequencies 3000, 4000, 6000 and 8000 Hz were the most affected and with a similar pattern in both ears. CONCLUSION sensorineural HL was found in 38.9% of cases. Neither clinical nor metabolic differences were noted between the groups, as well as in regards to peripheral and central auditory transmission.

Papel da apoptose na ototoxicidade por cisplatina em ratos

isplatina e um agente quimioterapico frequentemente usado para o tratamento de varias linhagens de neoplasias. A ototoxicidade e um dos efeitos colaterais causadores de significativa morbidade e que limita sua utilizacao. Este estudo teve por objetivo avaliar o papel da apoptose na ototoxicidade por cisplatina.