Maurício S. Miura

Intracranial complications of chronic suppurative otitis media in children

UNLABELLED In spite of significant decrease after antibiotic advent, intracranial complications of otitis media still represent a challenging situation owing to its high mortality rate (36%). The most common presentations are meningitis, cerebral abscess, extradural abscess and lateral sinus thrombophlebitis. For early management, it is necessary to have a high index of suspicion. It is important to identify non-typical cases because they might be masqueraded by antibiotic use. AIM We present six cases of intracranial complications due to otitis media in children and adolescents at Complexo Hospitalar Santa Casa de Porto Alegre for the past two years. STUDY DESIGN Series review.

Complicações intracranianas das otites médias crônicas supurativas em crianças

In spite of significant decrease after antibiotic advent, intracranial complications of otitis media still represent a challenging situation owing to its high mortality rate (36%). The most common presentations are meningitis, cerebral abscess, extradural abscess and lateral sinus thrombophlebitis. For early management, it is necessary to have a high index of suspicion. It is important to identify non-typical cases because they might be masqueraded by antibiotic use. AIM: We present six cases of intracranial complications due to otitis media in children and adolescents at Complexo Hospitalar Santa Casa de Porto Alegre for the past two years. STUDY DESIGN: series review.

Tympanostomy tubes and water

OBJECTIVE An in vitro study was conducted to set the necessary pressure in fluids that could break resistance and cross the opening of a tympanostomy tube. METHODS A water column model was created and graduated in centimeters from base to top. We adapted three sorts of tympanostomy tubes. In each model, fluids were tested (tap water, seawater, river water, soapy water and eardrops). The column was filled with fluid until a threshold was reached, flowing through the tube opening. The threshold was registered and represented the pressure in cmH2O. RESULTS The results show that pressure is necessary so that a fluid can cross the opening of a ventilation tube. CONCLUSION In spite of limitations of our in vitro study, the literature suggests that no ear protection is needed during shower, since there is neither direct flow of water nor pressure in the ear. Bathing with soapy water is potentially dangerous due to the reduction in surface tension. The direct relation of pressure and surface tension through the opening of tympanostomy tubes indicates the need to decrease pressure when diving and to avoid strong head movements in the water.

Tubos de ventilação e Água

Objetivo: Foi realizado pelos autores um estudo in vitro, com o proposito de determinar a pressao necessaria de diferentes tipos de liquido para vencer a resistencia a passagem pelo orificio do tubo de ventilacao. Metodos: Foi criado um modelo de coluna de agua graduado em centimetros a partir da base. Foram adaptados 3 tipos de tubo de ventilacao. Em cada um dos modelos, foi colocado agua da torneira, do mar, da piscina, do rio, agua da torneira com sabao e gota otologica. Preenchia-se o recipiente com microgotas, formando uma coluna liquida ate ocorrer escape. Anotava-se a altura da coluna de agua quando isso ocorria, sendo equivalente a pressao em centimetros de agua (cmH2O). Resultados: Os resultados obtidos mostram que e necessario uma determinada pressao para que liquidos atravessem o orificio dos tubos de ventilacao. Conclusao: Apesar das limitacoes dos resultados in vitro, a literatura atual demonstra que nao ha razao para proteger a orelha durante banho de chuveiro, onde a agua cai de forma indireta e sem pressao. Banheira com agua e sabao e potencialmente perigoso devido a reducao da tensao superficial do liquido. A relacao direta entre pressao dos liquidos versus a tensao superficial sobre o orificio do tubo de ventilacao implica na necessidade de diminuir de alguma forma esta pressao durante os mergulhos em qualquer meio liquido e evitar movimentos bruscos da cabeca dentro da agua