Maurício Noschang Lopes da Silva

Avaliação tomográfica das orelhas contralaterais de pacientes com otite média crônica grave

UNLABELLED Some studies indicate a bilateral tendency of chronic otitis media. It is believed that the contralateral ear can provide evidences of the route of formation of ear disease in the most affected, be a parameter of Eustachian tube function and predict successful treatment. The CT scan is an excellent test to evaluate the structures of the temporal bone and the changes resulting from otitis media. OBJECTIVE To evaluate Temporal Bone Computed Tomography of patients with chronic otitis media and describe abnormalities in the contralateral ear. METHOD Cross-sectional study. Evaluation of CT scans of 75 patients with chronic otitis media from a tertiary referral hospital in Brazil by a neuroradiologist. RESULTS Population was consisted of 50.6% males with a mean age of 36 years. We found 54.7% of changes in contralateral ear clearly associated with chronic otitis media. CONCLUSION The prevalence of radiographic changes in the contralateral ears of patients with chronic otitis media corroborates with clinical, histopathological and functional resources developed by the same group that this disease has a bilateral feature.

Characteristics of 419 patients with acquired middle ear cholesteatoma.

INTRODUCTION Cholesteatoma is a destructive lesion that can result in life-threatening complications. Typically, it presents with hypoacusis and continuous otorrhea as symptoms. Because it is a rare disease, there are few studies in Brazil describing the characteristics of patients with the disease. OBJECTIVE This study aimed to determine the prevalence of cholesteatoma in patients with chronic otitis media and describe clinical, audiological and surgical characteristics of patients with acquired middle ear cholesteatoma treated at a referral hospital in the public health system. METHODS Cross-sectional and prospective cohort study, including 1710 patients with chronic otitis media, treated between August 2000 and June 2015, without prior surgery. Detailed clinical history, videotoscopy, and audiometry were performed, in addition to review of medical records to search for surgical data. Cholesteatomas were classified according to their route of formation. RESULTS Of the patients with chronic otitis media, 419 (24.5%) had cholesteatoma; mean age of 34.49 years; 53.5% female and 63.8% adults. Bilateral cholesteatoma was observed in 17.1%. Anterior epitympanic cholesteatoma corresponded to 1.9%; posterior epitympanic, 32.9%; posterior mesotympanic, 33.7%; two routes, 14.8%; and indeterminate, 16.7%. The mean air-bone gap was 29.84dB and did not differ between routes of formation. There were no correlations between gap size and patient age or duration of symptoms. Of the surgical cases, 16.8% underwent closed tympanomastoidectomy and 75.2% open tympanomastoidectomy. CONCLUSION The prevalence of cholesteatoma in patients with chronic otitis media was 24.5% and it was more common in adults than in children. Posterior mesotympanic cholesteatoma was more frequent, with no difference in mean air-bone gap between the different routes of formation. In patients undergoing surgery, open tympanomastoidectomy was the procedure most frequently chosen.

[One case, two lessons: an aberrant internal carotid artery causing acquired cholesteatoma].

Otomicroscopy revealed an extremely infected left ear,a posterior mesotympanic cholesteatoma, and erosion ofthe long process of the incus and the suprastructure of stapes. The TM was intact anterior to manubrium, but pulsatile brownish bulge was noticed filling the anterior The appearance of this finding resembled cholesterol granuloma or a superiorly displaced jugular The contralateral ear was completely normal. Audio- confirmedapureconductivehearinglossintheleftear normality in the right side. High-resolution axial com- tomography scan showed an abnormal course of thepetrous portionoftheleftinternalcarotidartery,protrudinginto the tympanic cavity through a complete dehiscence in carotid plate (Fig. 1). The displaced artery completelyfilled the bony lumen of the eustachian tube, expanding filling the protympanum. The mastoid was sclerotic, TM severely retracted, and the mucosa markedly thick- in the posterior recesses (Fig. 1). The patient was to inside-out wall-down mastoidectomy, withoutcomplications.