Maria Claudia Mattos Soares

Facial paralysis associated with acute otitis media

UNLABELLED Acute otitis media with facial paralysis is not a very frequent association. AIM The goal of the present investigation was to asses the evolution of facial paralysis caused by acute otitis media. STUDY FORMAT: Clinical-retrospective. MATERIALS AND METHODS We studied 40 patients with this association, from a total of 2758 cases of facial paralysis seen during this time in the department of facial nerve disorders. All the patients were clinically assessed and had epidemiological data, prognostics and evolution. RESULTS AND CONCLUSION The paralysis was of sudden onset in 95% of the cases. Recovery was of 85% for grade I (House-Brackman) and 15% for grade II (House-Brackman). Treatment was clinical, with antibiotics and steroids - yielding good results. In those patients with electrical bad prognosis, facial nerve decompression turned their evolution into a favorable one.

Use of Muller's maneuver in the evaluation of patients with sleep apnea: literature review

Sleep apnea-hypopnea syndrome was described twenty years ago, and since then there have been doubts and controversies regarding it. Fiberoptic nasopharyngosc...

Systematic Evaluation of the Upper Airway in the Adult Population of São Paulo, Brazil

Objectives. To study the prevalence of otorhinolaryngologic symptoms and findings of physical examination of the upper airway (UA) of a representative sample of the adult population of São Paulo, Brazil, and the association between these findings. Study Design. Cross-sectional survey. Setting. Population sample. Methods. A total of 1101 randomly selected volunteers representing the adult population of São Paulo according to sex, age, and socioeconomic class were included in this study. Otorhinolaryngological evaluation included investigation of nasal complaints, physical examination of the UA, and a facial inspection. Results. A total of 993 volunteers (53.9% women), with a mean age of 41.8 ± 0.89 years, underwent otorhinolaryngologic examination. The most prevalent symptoms were the following: symptoms suggestive of rhinitis (44.9%), snoring (42.8%), mouth breathing (39.3%), and nasal obstruction (33.3%). In physical examination, the most common findings were a web palate (redundant posterior pillar; 62.9%), septum deviation (56.9%), and inferior turbinate hypertrophy (37.7%). Significant associations were found between nasal obstruction and septum deviations, inferior turbinate hypertrophy, high-arched palate, and class II dental occlusion; between symptoms of rhinitis and inferior turbinate hypertrophy; and between snoring and obstructive deviated septum, modified Mallampatti grades III and IV, increased neck circumference, and age greater than or equal to 50 years. Conclusions. The prevalence of otorhinolaryngologic symptoms and alterations in physical examination of the UA were high in the adult population of São Paulo, Brazil. The snoring and nasal symptoms were significantly associated with findings from UA physical examination and inspection of the facial skeleton.

Paralisia facial associada à otite média aguda

Universidade Federal de Sao Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Otorrinolaringologia e Cirurgia de Cabeca e Pescoco

Prevalence of Streptococcus pyogenes as an oropharynx colonizer in children attending daycare: a comparative study of different regions in Brazil

UNLABELLED Thirty percent of acute pharyngotonsillitis is caused by Streptococcus pyogenes, which increased the risk of glomerulonephritis and rheumatic fever. Children attending daycare centers have a higher incidence of these infections. AIM to identify and compare the prevalence of Streptococcus pyogenes in the oropharynx of children who are enrolled and who are not enrolled in daycare centers in different regions of Brazil. MATERIALS AND METHODS A prospective study of two hundred children from Sao Paulo/SP and Porto Velho/RO. Children from each city were divided into two groups: those attending, and those not attending daycare centers. Swabs of the oropharynx were taken for bacteriological culture and identification. RESULTS The prevalence of Streptococcus pyogenes in the Sao Paulo groups were 8% and 2% for daycare and control groups, which was statistically significant (p=0.02). The prevalence in children from Porto Velho/RO was 24% and 16% for daycare and control groups, which was statistically significant (p=0.015). Statistical analysis also showed a significant difference between the corresponding groups in the two locations (p<0.01). CONCLUSION These results show that daycare attendance is a risk factor for oropharyngeal streptococcal colonization; this was seen in different populations, but was statistically significance in only one of the two samples.

Application of the Kushida morphometric model in patients with sleep-disordered breathing

UNLABELLED The morphometric model is a useful screening test to investigate the possibility of OSAS in patients during initial office visits. AIM To evaluate the clinical applicability of the Kushida morphometric model in a sample of patients with sleep-disordered breathing, and to define a cutoff value to differentiate patients with mild, moderate and severe apnea. METHOD A sample of 80 patients with sleep respiratory disorder was studied. Patients were aged between 18 and 75 years, of both genders and had been submitted previously to polysomnography. The model cutoff value to distinguish between patients with or without apnea is 70. RESULTS In this sample, the model cutoff value in all four groups was less than 70. It was impossible to establish a cutoff value according to the gravity of the condition, due to the proximity and the nonlinear increase in the values presented by the nonapneic group and those with mild and moderate apnea. CONCLUSION The Kushida morphometric model can be applied in clinical practice to a selected sample and it was impossible to establish a cutoff value to separate patients with obstructive sleep apnea-hypopnea syndrome according to severity.

Prevalência de Streptococcus pyogenes em orofaringe de crianças que freqüentam creches: estudo comparativo entre diferentes regiões do país

Thirty percent of acute pharyngotonsillitis is caused by Streptococcus pyogenes, which increased the risk of glomerulonephritis and rheumatic fever. Children attending daycare centers have a higher incidence of these infections. AIM: to identify and compare the prevalence of Streptococcus pyogenes in the oropharynx of children who are enrolled and who are not enrolled in daycare centers in different regions of Brazil. MATERIALS AND METHODS: A prospective study of two hundred children from Sao Paulo/SP and Porto Velho/RO. Children from each city were divided into two groups: those attending, and those not attending daycare centers. Swabs of the oropharynx were taken for bacteriological culture and identification. RESULTS: The prevalence of Streptococcus pyogenes in the Sao Paulo groups were 8% and 2% for daycare and control groups, which was statistically significant (p=0.02). The prevalence in children from Porto Velho/RO was 24% and 16% for daycare and control groups, which was statistically significant (p=0.015). Statistical analysis also showed a significant difference between the corresponding groups in the two locations (p<0.01). CONCLUSION: These results show that daycare attendance is a risk factor for oropharyngeal streptococcal colonization; this was seen in different populations, but was statistically significance in only one of the two samples.

Paralisia facial periférica bilateral na leucemia linfóide aguda: relato de caso

The facial mimic is very important to the human expression and communication, which depend on the integrity of the facial nerve. So, the peripheric facial palsy (PFP) can leave esthetics, functional and psychological sequelae. The more common etiology is Bells palsy (50 to 80%) and most of the patients show a unilateral manifestation. The simultaneous bilateral PFP is rare, and the leukemia is the neoplasia that can often that kind of manifestation. We present a clinical case of an 18-year-old patient with acute lymphoid leukemia and simultaneous bilateral facial palsy, who did not recover after the chemotherapy treatment, and died five months after the initial manifestation of the facial palsy. Important considerations were accomplished about the physiopathology of PFP in acute lymphoid leukemia, besides literature review.

Upper Airway in the Adult Population of São Paulo, Brazil

Objective: 1) Study the prevalence of otolaryngologic symptoms and findings of physical examination of upper airway of a representative sample of the adult population of São Paulo, Brazil. 2) Correlate subjective symptoms with physical findings. Method: A total of 1101 randomly selected volunteers representing the adult population of São Paulo according to gender, age, and socioeconomic class were included in this study. The sampling process was probabilistic, consisting of 3 stages. Otolaryngologic examination included investigation of nasal complaints, physical examination of the upper airway, and facial inspection. Results: A total of 993 volunteers (53.9% women) underwent otolaryngologic examination, with a mean age of 41.8 ± 0.89 years. The most prevalent symptoms were rhinitis (44.9%), snoring (42.8%), mouth breathing (39.3%), and nasal obstruction (33.3%). On physical examination, the most common findings were web palate (62.9%), septum deviation (56.9%), and inferior turbinate hypertrophy (37.7%). Significant correlations between symptoms and physical examination variables were nasal obstruction with septum deviation, inferior turbinate hypertrophy, high-arched palate, and class II dental occlusion; symptoms of rhinitis with inferior turbinate hypertrophy; and snoring with deviated septum obstruction, Mallampati III and IV, increased neck circumference, and age ≥ 50 years. Conclusion: The prevalence of otolaryngologic symptoms and changes in physical examination of the upper airway are high in the adult population of São Paulo, Brazil. There is a significant association between snoring and nasal obstruction with objective signs of physical examination of upper airway and inspection of the facial skeleton.