Mariana Magnus Smith

Brazilian Portuguese Language version of the "Tinnitus Handicap Inventory": validity and reproducibility

UNLABELLED Tinnitus can greatly impact an individuals life quality and it is very difficult to quantify. AIM To determine the reproducibility and validity of a Brazilian Portuguese version of the Tinnitus Handicap Inventory (THI), a self-applicable questionnaire which assesses tinnitus impact on patients life quality. MATERIALS AND METHODS This was a prospective transversal study. The questionnaire was translated into Portuguese and cross-culturally adapted to the Brazilian environment according to internationally recommended methods. The Portuguese version of the THI was answered by 180 patients who complained of tinnitus. Reproducibility was assessed using the Cronbachs Alpha Calculation; and the validity was assessed by means of the Beck Depression Inventory (BDI), calculating the Pearson correlation coefficient. RESULTS The Portuguese version of the THI showed high internal validity, comparable to the original version. A high correlation was observed between the THI and the BDI. CONCLUSION The Brazilian Portuguese version of THI is a valid and reproducible tool used to quantify how tinnitus impacts the life quality of those Brazilian patients who complain of this symptom.

Laringoplastia com balão em crianças com estenose subglótica em evolução: experiência de um hospital terciário

UNLABELLED Management of subglottic stenosis (SGS) in children is still a challenge to Otorhinolaryngologists. Balloon laryngoplasty (BLP) is an endoscopic procedure, first described in 1984 for the treatment of airway stenosis. It shows promising results and seems to be more effective than other procedures. AIM To present our experience with BLP in children with SGS. MATERIAL AND METHOD Prospective study of children diagnosed with acute subglottic stenosis, i.e., stenosis with granulation tissue. They underwent direct laryngoscopy under general anesthesia and dilatation of the stenotic segment with angioplasty balloon. They were followed up and a second laryngoscopy was performed one week later. RESULTS Eight children were included in this study between June 2009 and October 2010. Four had Grade 3 SGS, three had Grade 2 SGS and one had Grade 1 SGS. By the second examination, two children presented with asymptomatic Grade 1 SGS, while the other six presented with normal airway and remained asymptomatic. CONCLUSION BLP seems to be an effective treatment for acute SGS. We need more studies to refine our knowledge concerning efficacy rates, safety and indications for balloon dilatation.

Estudo da orelha contralateral na otite média crônica: "Efeito Orloff ®"

Introducao: A otite media cronica (OMC) representa entidade de alta prevalencia e distribuicao mundial. Apesar da grande quantidade de estudos publicados a respeito, ainda nao ha, na literatura pertinente, consenso sobre a patogenese da OMC. Uma das hipoteses e a do continuum, que apresenta a otite media cronica como uma serie de eventos continuos, onde insultos iniciais desencadeiam uma cascata de alteracoes. Partindo entao da ideia de continuum, pesquisamos a orelha contralateral (OCL) de individuos com diagnostico de OMC, descrevendo as alteracoes encontradas. Forma de estudo: Clinico prospectivo randomizado. Material e Metodos: Foram selecionados 108 pacientes com diagnostico de OMC nao-colesteatomatosa (OMC NC) ou colesteatomatosa (OMC C) acompanhados no ambulatorio do Grupo de Pesquisa em Patologia da Orelha Media do Hospital de Clinicas de Porto Alegre. Nestes, foi realizada otoendoscopia com fibra optica bilateral. A orelha mais estavel foi considerada contralateral (OCL), sendo classificada como normal ou alterada (e as alteracoes descritas). Resultados: Dentre os pacientes avaliados, 59,2% portavam OMC NC e 40,8% OMC C. 46,3% de todos os pacientes apresentaram alteracoes significativas na OCL. Dos pacientes com OMC C, 57% apresentavam alteracao na OCL, sendo que 39% dos pacientes com OMC NC tinham OCL alterada. A alteracao mais frequentemente encontrada foi retracao de MT, em ambos os grupos. Conclusoes: Os dados encontrados sugerem que pacientes que apresentam OMC tem maior probabilidade de apresentarem patologia na OCL, o que corrobora a ideia que a OMC se trata de um evento constitucional e nao isolado da orelha media.

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

Otoacoustic Emissions in Patients with Tinnitus and Normal Hearing

Objectives: Tinnitus is defined as a sound perception in the absence of a sonorous external stimulus. This symptom is highly associated to hearing loss, although about 10% of the patients with tinnitus have a normal hearing. We studied the otoacoustic emissions (OE) in patients with complaints of tinnitus and normal hearing. Methods: We evaluated 104 patients with tinnitus. Only 10 met the inclusion criterion that was to have thresholds of 20 dB or less in each frequency at tonal audiometry; 5 were men with average age of 36.1 years. OE was performed in each patient. History of occupational noise exposition was evaluated. Results: Sixty percent had OE absent or lowered in one or more frequencies; 60% of them had a positive history of occupational noise exposition (time average of 7.58 years); and 83% of them did not use individual protection equipment. Conclusion: One of the theories that try to explain the pathogenesis of tinnitus is the imbalance between external hairy cells (EHC) and internal hairy cells (IHC). The EHC are more prone to damage and, when it occurs, they fail to perform the inhibition over the ICH function. This lost of IHC inhibition results then in tinnitus. Our results agree with this theory mainly because our patients had alterations in the EHC demonstrated by the OE.

Punção aspirativa por agulha fina em tumores cervicais

Introduction: countless diseases can initially present as a neck lump, what turns its diagnosis not always easy. The fine-needle aspiration biopsy (FNAB) is a simple, safe and effective method in helping the diagnosis of neck lumps. Aim: evaluate the diagnostic performance of FNAB in neck lumps accomplished in the Otorhinolaryngology Department of the Hospital de Clinicas de Porto Alegre (HCPA). Study design: Retrospective, clinical, not randomized. Material and method: a retrospective study of 72 patients submitted to FNAB in SORL of HCPA between July, 1998 and December 1999. Patients1 submitted to thyroid FNAB2,with incomplete data3 without follow-up and4 without definitive diagnosis of the lesion were excluded. The results of FNAB were compared with the definitive diagnosis, established by histopathologic exam (group I) or for clinical evolution or laboratory exams (group II). Results: 70 patients were included in the study, 7% presented unsatisfactory FNAB and, among the satisfactory materials, there were 88,6% of correct diagnosis. In group I it was found 8% of unsatisfactory FNAB and 88,2% of correct diagnosis, while in group II, 6% and 87,1%, respectively. The total index of success, including the unsatisfactory FNAB was 81,5%. Discussion: results confirm the high index of success diagnosis of FNAB described in the literature, confirming that this is a helpful method in diagnostic of neck lump. Like this, we are encouraged ourselves to follow using such procedure as a routine.

Rock Around the Clock in the Middle Ear Cleft

INTRODUCTION Preoperative evaluation remains the cornerstone in the determination of an appropriate surgical procedure for the patient with otological disease. However, as every surgeon understands from experience, surgical exposure of pathological findings usually provides a better, more thorough understanding of the patient’s conditions. In this regard, wide exposure of the middle ear cleft and meticulous exploration of key anatomical landmarks and strategically located recesses cannot be overemphasized. The objective of the present report is to present details of a stepwise approach designed to methodically explore the contents of the middle ear and in this process to disclose, confirm, and often treat the disease encountered. The “around the clock” approach described consists of an analogy between the middle ear cleft and a time clock. During surgical exploration, critical landmarks are successively addressed and abnormalities are checked following a counterclockwise fashion at every corresponding hour (Fig. 1).

Laryngotracheoplasty in a low birth weight preterm newborn

Otorhinolaryngologist (Professor of the Rio Grande do Sul Federal University).Send correspondence to: Hospital de Clinicas de Porto Alegre, Avenida Joao Pessoa, 1051/ 408. Bairro Cidade Baixa. Porto Alegre-RS. CEP 90040-000.Paper submitted to the BJORL-SGP (Publishing Management System – Brazilian Journal of Otorhinolaryngology) on January 2, 2011; and accepted on February 2, 2011. cod. 7491

Adenotonsillectomy -- immediate post operative respiratory distress.

and its incidence is difficult to precise since most of the studies are case reports. Two distinct mechanisms have been described in the literature. Type I is the one that follows an acute airway obstruction, such as a la-ryngospasm, which can happen after any surgical procedure, being more common after otorhinolaryngological surgeries

Disfunção respiratória no pós-operatório imediato de adenoamigdalectomia

O edema pulmonar pós-obstrutivo, uma forma de edema pulmonar nãocardiogênico1, é uma patologia rara. Tal condição foi primeiramente descrita em humanos em 19732 e sua incidência é difícil de precisar já que a maioria dos estudos são relatos de caso. Dois mecanismos distintos têm sido descritos na literatura. O tipo I é aquele que segue uma obstrução aguda de via aérea, como laringoespasmo, que pode ocorrer após qualquer procedimento cirúrgico, sendo mais comum após cirurgias otorrinolaringológicas3. O tipo II ocorre após alívio de uma obstrução crônica da via aérea, sendo considerado menos comum que o tipo I4. Apresentamos relato de paciente submetido à adenoamigdalectomia que evoluiu com disfunção respiratória no pós-operatório imediato.