Mário Sérgio Lei Munhoz

The outcome of patients with ménière’s disease

Summary Meniere’s disease is a frequent vestibular disease that occurs predominantly in the fourth decade of life. Diagnosis is mostly medical and is based on findings of vertigo, sensorineural hearing loss, tinnitus and aural fullness. Aim: To study the clinical findings of Meniere’s disease: age, duration of vertigo, tinnitus, hearing loss and aural fullness, and unilateral or bilateral involvement. Method: a retrospective study included 39 patients with a diagnosis of Meniere’s disease confirmed by electrocochleography, who were seen at a neuro-otology referral centre. Patients underwent a clinical examination, audiometry and bilateral transtympanic electrocochleography. Patients were separated into 2 groups: bilateral Meniere’s disease and unilateral Meniere’s disease. Results: The mean age was 42.9 years; 72.5% were female. Fluctuation of hearing loss occurred in 54.5% of cases, and 65.7% had frequent attacks of vertigo. Bilateral disease was observed in 33.3%. The onset of the disease was earlier in the bilateral group (33.7 years) compared to the unilateral group (p= 0.0013). Duration of disease, tinnitus, hearing loss and aural fullness were similar between groups. Conclusion: Patients with bilateral Meniere’s disease had symptoms earlier than patients with unilateral disease. There was no difference between the groups in duration of disease and associated symptoms.

Contribuição do Mismatch Negativity na avaliação cognitiva de indivíduos portadores de esclerose múltipla

Mismatch Negativity is a functional index of the supratemporal auditory cortex. AIM: The aim of the present study on Mismatch Negativity (MMN) in multiple sclerosis (MS) patients was to evaluate if the MMN can be correlated with cognitive deficits assessed by the Paced Auditory Addition Task - PASAT. METHOD: a clinical study in forty females and 20 males separated in two groups: control individuals and those with a definite diagnosis of MS underwent a duration and frequncy MMN. The MMN latencies and negative amplitudes obtained from the MS group were compared to the ones from the control group. The scores from the Paced Auditory Addition Task were correlated either with the presence or the absence of MMN. RESULTS: MMN was found in 60% of the individuals with multiple sclerosis within the auditory stimulation protocol with varied durations, and in 45 % within the auditory stimulation protocol with frequency variations. There were no statistically significant differences in latencies and amplitudes when compared to controls. We found a statistically significant correlation for the lack of MMN wave together with cognitive disorder asserted by the PASAT. CONCLUSIONS: The MMN correlated to the cognitive deficit assessed by the PASAT.

Optimizing the pharmacological component of integrated balance therapy

UNLABELLED Drug treatment is an important option for the treatment of peripheral vestibular diseases. AIM To identify the drug component associated with optimal integrated balance therapy (IBT) for Ménières disease or other peripheral vestibular disorders. MATERIALS AND METHODS Analysis of a series of patients with Ménières disease patients or patients with other peripheral vestibular disorders that received IBT involving either no medication or betahistine, cinnarizine, clonazepam, flunarizine or Ginkgo biloba during 120 days. RESULTS In Ménières disease, significant differences were observed for all drug therapies (60 days) versus no medication; betahistine was significantly more effective than all other drugs at 60 and 120 days. For non-Ménières disorders, significant differences were observed among betahistine, cinnarizine, clonazepam and flunarizine and no medication after 60 days; all drug therapies were significantly more effective than no medication after 120 days; betahistine, cinnarizine or clonazepam were equally effective and betahistine was more effective than flunarizine and EGb 761. All treatment options were well tolerated. CONCLUSIONS Drug therapies were more effective than no medication in the IBT for patients with Ménières disease or other peripheral vestibular disorders. Betahistine was the most effective medication for patients with Ménières disease and was as effective as cinnarizine and clonazepam for other peripheral vestibular disorders.

Potencial evocado auditivo tardio relacionado a eventos (P300) na síndrome de Down

UNLABELLED Down syndrome is caused by a trisomy of chromosome 21 and is associated with central auditory processing deficit, learning disability and, probably, early-onset Alzheimers disease. AIM To evaluate the latencies and amplitudes of evoked late auditory potential related to P300 events and their changes in young adults with Downs syndrome. MATERIALS AND METHODS Prospective case study. P300 test latency and amplitudes were evaluated in 17 individuals with Downs syndrome and 34 healthy individuals. RESULTS The P300 latency (N1, P2, N2 and P3) was longer and the N2-P3 amplitude was lower in individuals with Down syndrome when compared to those in the control group. CONCLUSION In young adults with Down syndrome, N1, P2, N2 and P3 latencies of late auditory evoked potential related to P300 events were prolonged, and N2 - P3 amplitudes were significantly reduced, suggesting integration impairment between the auditory association area and cortical and subcortical areas of the central nervous system.

Avaliação dos potenciais evocados auditivos do tronco encefálico na esclerose múltipla

The aim of this study was to evaluate the incidence of auditory and neurotological disorders in multiple sclerosis (MS). Twenty female and 9 male with a definite diagnosis of multiple sclerosis without signs of involvement of the brain stem underwent an audiological and an early auditory evoked potentials (EAEP). The wave forms were classified according to Jergers (1986) classification. In 58 EAEP it was found 55% of type I (normal response) according to Jergers classification in both sexes. Considering as an abnormal response the EAEP classified in type II, III, IV or V according to Jerger in at least one side, it was found 60% of abnormalities in females and 56% in males, totalizing 58,62% of all the studied subjects. The authors emphasize the use of EAEP in MS.The aim of this study was to evaluate the incidence of auditory and neurotological disorders in multiple sclerosis (MS). Twenty female and 9 male with a definite diagnosis of multiple sclerosis without signs of involvement of the brain stem underwent an audiological and an early auditory evoked potentials (EAEP). The wave forms were classified according to Jergers (1986) classification. In 58 EAEP it was found 55% of type I (normal response) according to Jergers classification in both sexes. Considering as an abnormal response the EAEP classified in type II, III, IV or V according to Jerger in at least one side, it was found 60% of abnormalities in females and 56% in males, totalizing 58,62% of all the studied subjects. The authors emphasize the use of EAEP in MS.

Evolução clínica de pacientes com doença de Ménière

Meniere`s disease is a frequent vestibular disease that occurs predominantly in the fourth decade of life. Diagnosis is mostly medical and is based on findings of vertigo, sensorineural hearing loss, tinnitus and aural fullness. AIM: To study the clinical findings of Meniere`s disease: age, duration of vertigo, tinnitus, hearing loss and aural fullness, and unilateral or bilateral involvement. METHOD: a retrospective study included 39 patients with a diagnosis of Meniere`s disease confirmed by electrocochleography, who were seen at a neuro-otology referral centre. Patients underwent a clinical examination, audiometry and bilateral transtympanic electrocochleography. Patients were separated into 2 groups: bilateral Meniere`s disease and unilateral Meniere`s disease. RESULTS: The mean age was 42.9 years; 72.5% were female. Fluctuation of hearing loss occurred in 54.5% of cases, and 65.7% had frequent attacks of vertigo. Bilateral disease was observed in 33.3%. The onset of the disease was earlier in the bilateral group (33.7 years) compared to the unilateral group (p= 0.0013). Duration of disease, tinnitus, hearing loss and aural fullness were similar between groups. CONCLUSION: Patients with bilateral Meniere`s disease had symptoms earlier than patients with unilateral disease. There was no difference between the groups in duration of disease and associated symptoms.

Sudden Sensorioneural Hearing Loss and Autoimmune Systemic Diseases

Introduction  Several authors have demonstrated the relationship between sudden sensorineural hearing loss (SNHL) and systemic autoimmune diseases (SAD). Immune-mediated SNHL can rarely present as unilateral sudden SNHL and manifests itself in the contralateral ear only after years. It presents clinical relevance for being one of the few SNHL that may be reversible given that early and appropriate treatment is applied. Objective  The objective of this study is to describe the clinical presentations and audiological findings from patients with idiopathic sudden SNHL and SAD associated with a probable diagnosis of immune-mediated SNHL. Furthermore, we strive to estimate the prevalence of SAD in patients with sudden SNHL. Methods  This is an observational retrospective cohort. We have selected and studied patients with SAD. Revision of available literature on scientific repositories. Results  We evaluated 339 patients with sudden SNHL. Among them, 13 (3.83%) patients suffered from SAD. Three patients had bilateral involvement, a total of 16 ears. We evaluate and describe various clinical, epidemiological, and audiological aspects of this sample. Conclusion  In our sample of patients with sudden SNHL, the prevalence of SAD was found relevant. The majority had tinnitus and dizziness concomitant hearing loss, unilateral involvement and had experienced profound hearing loss at the time of the installation. In spite of instituted treatment, most cases showed no improvement in audiometric thresholds. Apparently, patients with sudden SNHL and SAD have a more severe initial impairment, higher percentage of bilateral, lower response to treatment, and worse prognosis than patients with sudden SNHL of unknown etiology.

Sigmoid Sinus thrombosis associated to chronic otitis media

UNLABELLED Otogenous lateral sinus thrombosis (OLST) is a rare disease and presents a controversial treatment. AIM Clinical aspects and treatment were reported based on our experience. METHODS Retrospective study. Six cases of OLST were treated in our institution in the last ten years. Clinical and imaging data were analyzed. RESULTS All six patients had the lateral sinus thrombosis detected during image evaluation for other symptoms related to chronic otitis media (COM) complications. Fever, headache and facial paralysis were the main clinical manifestation related to mastoiditis, meningitis and cerebellar abscess. We could not identify, in any case, specific features of lateral sinus thrombosis. In all cases a mastoidectomy was associated with large spectrum antibiotics maintained for 3 months. In three cases anticoagulation therapy was introduced and in three cases anticoagulation was not indicated. All cases presented a good clinical evolution, without sequelae. CONCLUSIONS OLST is almost always associated with other complications of COM. It is diagnosed almost by accident during the investigative image study. We believe such disease is underestimated. In our experience, OLST presents a benign course, and mastoidectomy with antibiotics is the treatment of choice.

Mismatch Negativity contribution in Multiple Sclerosis patients

UNLABELLED Mismatch Negativity is a functional index of the supratemporal auditory cortex. AIM The aim of the present study on Mismatch Negativity (MMN) in multiple sclerosis (MS) patients was to evaluate if the MMN can be correlated with cognitive deficits assessed by the Paced Auditory Addition Task--PASAT. METHOD a clinical study in forty females and 20 males separated in two groups: control individuals and those with a definite diagnosis of MS underwent a duration and frequency MMN. The MMN latencies and negative amplitudes obtained from the MS group were compared to the ones from the control group. The scores from the Paced Auditory Addition Task were correlated either with the presence or the absence of MMN. RESULTS MMN was found in 60% of the individuals with multiple sclerosis within the auditory stimulation protocol with varied durations, and in 45 % within the auditory stimulation protocol with frequency variations. There were no statistically significant differences in latencies and amplitudes when compared to controls. We found a statistically significant correlation for the lack of MMN wave together with cognitive disorder asserted by the PASAT. CONCLUSIONS The MMN correlated to the cognitive deficit assessed by the PASAT.

Trombose do seio sigmóide associada à otite média crônica

trombose septica do seio sigmoide (TSSS) e uma doenca rara de tratamento controverso. Objetivo: Relatarmos nossa experiencia, ressaltando os aspectos clinicos e terapeuticos. Material e Metodo: Estudo retrospectivo de seis casos de TSSS tratados nos ultimos 10 anos. O diagnostico foi confir-mado atraves de angiorressonância com acompanhamento de seis meses a seis anos. Resultados: O diagnostico da TSSS so foi suspeitado durante a analise de imagem solicitada para avaliacao de outras complicacoes de otite media cronica. Febre, cefaleia e paralisia facial foram as principais manifes-tacoes clinicas relacionadas aos diagnosticos de mastoidite, meningite e abscesso cerebelar. Nao foi possivel identificar nenhum sintoma especifico de trombose do seio sigmoide. Em todos os pacientes foi realizado mastoidectomia com antibioticoterapia de largo espectro sendo mantido por tres meses. Em tres casos foi realizada anticoagulacao e nos outros tres nao foi indicado este tipo de terapia. Todos os pacientes evoluiram bem sem sequelas. Conclusao: O diagnostico de TSSS tem sido realizado inesperadamente em pacientes com otites medias cronica com outras complicacoes associadas. Acreditamos que esta doenca esteja sendo subdiagnosticada. Apesar de grave, o prognostico clinico tem sido bom, apenas com mastoidectomia e antibioticoterapia.Norma de Oliveira Penido