Oswaldo Laércio Mendonça Cruz

Intracranial complications of otitis media: 15 years of experience in 33 patients:

OBJECTIVES: Complications in the central nervous system (CNS) from acute otitis media (AOM) and chronic otitis media (COM) are becoming fewer, although they still represent a challenge for early recognition, adequate treatment, and satisfactory results. This retrospective study analyzed clinical data and therapeutic options in 33 patients with intracranial involvement resulting from otitis media. Important clinical features of intracranial complications and the sequence of the most efficient therapeutic maneuvers are discussed. METHODS: Charts of six patients with AOM and 27 patients with COM associated with CNS complications were analyzed for clinical presentation, imaging, and therapeutic approach. RESULTS: Ages ranged from 6 months to 79 years, with no gender predilection. Persistent fever, headache, and purulent otorrhea were the main symptoms. Proteus mirabilis, Enterococcus, and Pseudomonas aeruginosa were the most common microorganisms in COM, and Pneumococus and Haemophilus were the most common microorganisms in AOM. Nineteen patients (58%) presented with more than 1 CNS complication, resulting in a total of 56 complications, including 26 cases of otogenic brain abscess, 21 cases of meningitis, 5 cases of lateral sinus thromboses, two cases of subdural empyemas, 1 case of epidural empyema, and 1 case of meningocele. Surgical interventions included craniotomy and drainage of the abscess (n = 17), open mastoidectomy with abscess drained through the mastoid (n = 10), open mastoidectomy alone (n = 8), and closed mastoidectomy (n = 2). Twelve patients who underwent craniotomy had subsequent mastoidectomy for recurrent abscess. At the 6-month, 66% of patients presented without sequelae, 24% presented with sequelae, and 9% died. CONCLUSION: Early identification and prompt clinical and surgical intervention with mandatory drainage of the middle ear (primary disease), was essential for better outcome.

Multiprofessional committee on auditory health: COMUSA

Created in 2007, COMUSA is a multiprofessional committee comprising speech therapy, otology, otorhinolaryngology and pediatrics with the aim of debating and countersigning auditory health actions for neonatal, lactating, preschool and school children, adolescents, adults and elderly persons. COMUSA includes representatives of the Brazilian Audiology Academy (Academia Brasileira de Audiologia or ABA), the Brazilian Otorhinolaryngology and Cervicofacial Surgery Association (Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial or ABORL), the Brazilian Phonoaudiology Society (Sociedade Brasileira de Fonoaudiologia or SBFa), the Brazilian Otology Society (Sociedade Brasileira de Otologia or SBO), and the Brazilian Pediatrics Society (Sociedade Brasileira de Pediatria or SBP).

Quedas em idosos com Vertigem Posicional Paroxística Benigna

UNLABELLED Benign Paroxysmal Positional Vertigo (BPPV) can cause falls, especially in the elderly. AIM to study whether or not elderly patients with BPPV have a reduction on their falls after the particle repositioning maneuver (PRM). MATERIALS AND METHODS retrospective study including elderly with BPPV who had fall(s) during the last year. All patients were submitted to the PRM according to the affected semicircular canal (SCC). After the abolition of positioning vertigo and nystagmus, the patients were submitted to a 12 month follow-up and were investigated about the number of fall(s). Wilcoxons test was performed to compare the number of fall(s) before and after 12 months of the PRM. RESULTS One hundred and twenty one patients were included in the study. One hundred and one patients presented involvement of the posterior SCC, 16 of the lateral and four of the anterior. We noticed a reduction on the number of falls, with statistically significant difference when all the patients were analyzed together (p<0.001), the posterior canal BPPV patients (p<0,001) and the lateral canal VPPB patients (p=0.002). We also found a tendency of statistically significant difference for the anterior canal BPPV patients (p=0.063). CONCLUSION BPPV elderly patients had indeed a reduction on the number of falls after the PRM.

Endoscopic transeptal surgery for choanal atresia with a stentless folded-over-flap technique

OBJECTIVE: To analyze long-term results of a new stentless surgical technique for choanal atresia that also used no packing. STUDY DESIGN: Prospective study. METHODS: Ten patients (3 bilateral and 7 unilateral), with ages ranging from 4 days to 30 years, were operated on. The follow-up was 6 months to 36 months. This approach allowed resection of the posterior portion of the vomer, atretic plate, and part of the medial pterygoid process. Flaps were fashioned from septal, nasal, and pharyngeal mucosa from the atretic plates and fixed with fibrin glue. Postoperative control included nasal endoscopy and computerized tomography (CT). RESULTS: Adequate functional nasal breathing was maintained during follow-up. CONCLUSIONS: This technique was satisfactory and safe, allowing fast recovery in a one-step surgery, using neither stents nor nasal packing. Long-term patency with no reduction in functional quality was also observed.

Clinical, etiological and progression factors of hearing in sudden deafness

UNLABELLED Out of the many forms of therapy for sudden deafness, some require hospitalization and present significant risks. AIM This prospective study analyzes etiology and evolution in cases of sudden deafness (SD) where outpatient oral treatment was used. STUDY DESIGN Clinical with transversal cohort. MATERIAL AND METHOD Forty cases of sudden hearing loss were followed for at least one year. All were submitted to initial clinical evaluation, auditory tests, routine blood analysis, and magnetic resonance imaging. All received initial treatment with pentoxifylline and prednisone. RESULTS 45% (n=18) presented normal auditory thresholds, 40% (n=16) showed some improvement in hearing, 15% (n=6) maintained initial hearing level. Nine cases (22.5%) presented clinical conditions possibly implicated in hearing loss (viral infection, immunomediated hearing loss, vascular disorders, and so on); three (7.5%) had cerebellopontine tumors. Evolution of hearing in these 12 cases with presumed etiology presented no differences from hearing in the 28 cases without any known etiological factor. Clinical treatment within the first seven days was the only statistically significantly different condition in patients who improved hearing. CONCLUSIONS An objective search for etiological bases should be conducted in any case of acute sensorineural hearing loss. The presence of cerebellopontine tumors in 7.5% of cases of SD, among other treated causes, justifies a thorough clinical investigation in these patients. Overall good evolution of hearing was observed in 67.5% of cases of SD, regardless of its etiology. Therapy within the first seven days of SD was significantly related to better outcomes in hearing.

The value of prognostic clinical data in Bell's palsy

UNLABELLED Electroneurography (ENoG) and clinical staging are currently the methods of choice to indicate prognosis in Bells palsy, although ENoG is an electrophysiological test not universally available. AIM Identify other options of prognostic evaluation based upon clinical aspects and minimal electrical stimulation test allowing prognostic measurement in almost any circumstances. STUDY DESIGN Historic cohort. MATERIAL AND METHOD Chart review of 1,521 cases of IPFP, analyzing the following clinical aspects: gender, age, paralyzed side, installation mode, previous symptoms, associated symptoms and minimal electrical stimulation test (Hilger test) and its statistical correlation to facial palsy evolution after 6 months. RESULTS Data indicated that patients above 60 years old had worse prognosis in comparison with patients under 30 years old. A progressive mode of paralysis installation, absence of previous symptoms, concomitant vertigo and response superior to 3.5 mA at minimum electrical stimulation test were also related to worse prognosis. On the other hand, the absence of concomitant symptoms, diminished tearing and sudden onset were related to better prognosis. CONCLUSION Clinical factors and Hilgers test can accurately indicate the prognosis in cases of Bells palsy when ENoG is not available.

Fatores clínicos, etiológicos e evolutivos da audição na surdez súbita

Out of the many forms of therapy for sudden deafness, some require hospitalization and present significant risks. AIM: This prospective study analyzes etiology and evolution in cases of sudden deafness (SD) where outpatient oral treatment was used. STUDY DESIGN: clinical with transversal cohort. MATERIAL AND METHOD: Forty cases of sudden hearing loss were followed for at least one year. All were submitted to initial clinical evaluation, auditory tests, routine blood analysis, and magnetic resonance imaging. All received initial treatment with pentoxifylline and prednisone. RESULTS: 45% (n=18) presented normal auditory thresholds, 40% (n=16) showed some improvement in hearing, 15% (n=6) maintained initial hearing level. Nine cases (22.5%) presented clinical conditions possibly implicated in hearing loss (viral infection, immunomediated hearing loss, vascular disorders, and so on); three (7.5%) had cerebellopontine tumors. Evolution of hearing in these 12 cases with presumed etiology presented no differences from hearing in the 28 cases without any known etiological factor. Clinical treatment within the first seven days was the only statistically significantly different condition in patients who improved hearing. CONCLUSIONS: An objective search for etiological bases should be conducted in any case of acute sensorineural hearing loss. The presence of cerebellopontine tumors in 7.5% of cases of SD, among other treated causes, justifies a thorough clinical investigation in these patients. Overall good evolution of hearing was observed in 67.5% of cases of SD, regardless of its etiology. Therapy within the first seven days of SD was significantly related to better outcomes in hearing.

Behavioral and histologic experimental model of facial nerve regeneration in rats.

UNLABELLED To setup an experimental model is the first step to study neural regeneration. AIM Setting up an experimental model on facial nerve regeneration. MATERIAL AND METHODS Wistar rats with complete sectioning and suturing of the extratemporal facial nerve trunk; with a behavioral and histological analysis for 9 weeks. STUDY DESIGN Experimental prospective study. RESULTS Progressive clinical and histological recovery of the animals. CONCLUSION Our method is acceptable to study facial nerve regeneration in rats.

Valor prognóstico de dados clínicos em paralisia de Bell

Com o advento dos testes eletrofisiologicos, a avaliacao clinica parece ter perdido interesse na paralisia de Bell. A eletroneuronografia (ENoG) associada ao estadiamento clinico da doenca e o metodo mais frequentemente utilizado para mensurar o prognostico da paralisia de Bell. Entretanto, a ENoG constitui-se em um teste eletrofisiologico ainda nao universalmente disponivel, especialmente nos servicos de emergencia. OBJETIVO: Estudar a medida do prognostico da paralisia de Bell com base nos dados clinicos e no teste de estimulacao eletrica minima, teste de Hilger, permitindo assim uma previsao de prognostico segura e factivel na maioria dos servicos. FORMA DE ESTUDO: coorte historica. MATERIAL E METODO: Estudo coorte retrospectivo, analisando 1521 casos de paralisia de Bell, correlacionando-se os dados clinicos sexo, idade, lado da paralisia, modo de instalacao, sintomas previos, sintomas associados e os resultados do teste de estimulacao eletrica minima (Hilger), com a evolucao da paralisia apos 6 meses. RESULTADO: O estudo desses dados indicou que pacientes acima de 60 anos apresentaram prognostico pior em comparacao com pacientes com idade abaixo de 30 anos; o modo de instalacao progressiva, a ausencia de sintomas previos, a presenca de vertigem concomitante a paralisia e resposta acima de 3,5 mm no teste de Hilger estiveram relacionados com mau prognostico. Por outro lado, a ausencia de sintomas concomitantes, a diminuicao do lacrimejamento e o inicio subito foram relacionados com bom prognostico. CONCLUSAO: A analise de fatores clinicos, associada ao teste de Hilger, pode indicar o prognostico da paralisia facial com reduzida margem de erro, sendo uma alternativa bastante interessante especialmente quando nao ha disponibilidade da ENoG.

Serotonin Reuptake Inhibitors in Auditory Processing Disorders in Elderly Patients: Preliminary Results

Objective/Hypothesis: One mechanism associated with degeneration in the elderly is the decrease of neurotransmitters. In the central auditory pathway serotonin, can be found from cochlear nucleus to the auditory cortex, and it constitutes one of the most important neuromodulatory circuits in hearing processing. The present study analyzed the action of citalopram, a selective inhibitor of serotonin reuptake, in aged patients with normal to moderate sensorineural hearing loss (HL) and low performance on auditory processing.