Paulo Roberto Lazarini

Idiopathic sudden sensorineural hearing loss: etiopathogenic aspects

Several factors have been postulated to elicit the etiology of idiopathic sudden sensorineural hearing loss. Through a bibliographic review, we made a critical analysis of the different etiopathogenic aspects of its clinical manifestation. The most recent studies concerning the possible causes of sudden hearing loss suggest vascular disorders, rupture of the inner ear membrane and autoimmune diseases; however, viral infections have received a great deal of attention in recent years. Little is known about the mechanism of sudden hearing loss. Viruses can cause sudden hearing loss in an acute infection, however the latent form, and its possible reactivation have also been considered as explanations of the cochlear injury mechanism. Even though hearing loss can be explained by a blood viscosity change, experimental and clinical studies do not show any evidence of labyrinthine fibrosis and new bone formation, or labyrinthine membrane breaks. These findings are not in agreement with vascular and rupture membrane factors, respectively. The eventual presence of antibodies against the inner ear suggests that sudden hearing loss pathogenesis may be of autoimmune nature, but the difficulty in establishing the correlation of its morphological and clinical aspects to the hearing loss also do not help to support this statement. Sudden hearing loss is still a controversial and obscure subject in several aspects.

Surdez súbita idiopática: aspectos etiológicos e fisiopatogênicos

Several factors have been postulated to elicit the etiology of idiopathic sudden sensorineural hearing loss. Through a bibliographic review, we made a critical analysis of the different etiopathogenic aspects of its clinical manifestation. The most recent studies concerning the possible causes of sudden hearing loss suggest vascular disorders, rupture of the inner ear membrane and autoimmune diseases; however, viral infections have received a great deal of attention in recent years. Little is known about the mechanism of sudden hearing loss. Viruses can cause sudden hearing loss in an acute infection, however the latent form, and its possible reactivation have also been considered as explanations of the cochlear injury mechanism. Even though hearing loss can be explained by a blood viscosity change, experimental and clinical studies do not show any evidence of labyrinthine fibrosis and new bone formation, or labyrinthine membrane breaks. These findings are not in agreement with vascular and rupture membrane factors, respectively. The eventual presence of antibodies against the inner ear suggests that sudden hearing loss pathogenesis may be of autoimmune nature, but the difficulty in establishing the correlation of its morphological and clinical aspects to the hearing loss also do not help to support this statement. Sudden hearing loss is still a controversial and obscure subject in several aspects.

Herpes Simplex Virus in the saliva of peripheral Bell's palsy patients

UNLABELLED The first herpes virus to be described was types 1 and 2, whose denomination is herpes simplex 1 and 2 or HSV-1 and HSV-2. These viruses have specific biological characteristics, such as the ability to cause different kinds of diseases, as well as to establish hosts latent or persistent lifetime infections and also of being reactivated, causing lesions that can be located at the same site of the initial primary infection or close to it. It is suggested that this virus reactivation in the geniculate ganglion may be related to Bells palsy. In this situation, the viruses that would be latent in this ganglion, would suffer reactivation and replication, then be diffused through the facial nerve and its branches, among them the chorda tympani nerve, which by stimulating salivary secretion would enable the identification of the viral DNA in the patients saliva. Until recently, a great number of patients was diagnosed as holders of this kind of paralysis, named idiopathic or Bells palsy. With the introduction of the technique studying the viral DNA by Polymerase Chain Reaction (PCR), several authors have found herpes simplex virus type I DNA in the cerebrospinal fluid, in the lachrymal secretion, in the saliva and in the geniculate ganglia of patients with Bells palsy. AIM observe the occurrence of herpes simplex type I virus using PCR technique in the saliva of patients with Bells palsy and relating it to the clinical evolution of these cases. METHODOLOGY We evaluated 38 patients with Bells palsy submitted to anamnesis, clinical and ENT examination and saliva sampling for viral DNA detection by PCR technique. The control group was ten normal adults. RESULTS We found positive viral DNA in 11 cases out of the 38, which corresponded to 29% of the sample. This result was statistically significant if compared to the control group, in which we did not find any positive case. CONCLUSION The end result was that the presence of HSV-1 in the saliva of patients with Bells palsy indicating that the viral reactivation can be the etiology of this disease. The detection of the virus in these patients saliva does not influence the disease prognosis.

Endoscopic endonasal transsphenoidal approach for pituitary adenomas: technical aspects and report of casuistic

OBJECTIVE Analyse technical aspects, effectiveness and morbidity of the endoscopic endonasal transphenoidal approach for pituitary adenomas. METHOD From January 2005 to September 2008, 30 consecutive patients underwent endoscopic endonasal resection of pituitary adenomas with a follow up from 3 to 36 months. Their medical charts were retrospectively analysed. RESULTS There were 18 women and 12 men, mean age 44 years (range 17-65 yr). Among the 30 patients, 23 had macroadenomas and 7 microadenomas. Twelve patients had non-functioning tumors, 9 had ACTH-secreting tumors, 8 had GH-secreting tumors and 1 prolactinoma. Complete resection and hormonal control was achieved in all microadenomas. Macroadenomas were completely removed in 6 patients, subtotal resection in 6 and partial resection in 11. Three patients had diabetes insipidus and 5 had CSF leaks treated with lumbar drainage. CONCLUSION The endonasal endoscopic approach for pituitary tumors is effective and has low morbidity.

Pesquisa do vírus herpes simples na saliva de pacientes com paralisia facial periférica de Bell

Os primeiros herpes-virus a serem descritos foram os tipos 1 e 2, cuja denominacao e herpes simplex 1 e 2 ou HSV-1 e HSV-2. Estes virus possuem caracteristicas biologicas particulares, tais como a capacidade de causar diferentes tipos de doencas, assim como estabelecer infeccoes latentes ou persistentes por toda a vida dos hospedeiros e de serem reativados causando lesoes que podem se localizar no sitio da infeccao primaria inicial ou proxima a ele. Postula-se que a reativacao deste virus no gânglio geniculado esteja relacionada com a paralisia de Bell. Nesta situacao, os virus, que estariam latentes neste gânglio, sofreriam reativacao e replicacao difundindo-se pelo nervo facial e seus ramos, dentre eles o nervo corda do timpano, que ao estimular a secrecao salivar possibilitaria a identificacao do DNA viral na saliva dos pacientes. Ate recentemente, um grande numero de pacientes eram diagnosticados como portadores de uma forma desta paralisia, chamada de idiopatica ou de paralisia de Bell. Com o advento da tecnica de estudo do DNA viral pelo metodo da reacao da polimerase em cadeia (PCR), diversos autores encontraram DNA do virus herpes simplex tipo I no liquido cefalorraquidiano, na secrecao lacrimal, na saliva e nos gânglios geniculados de pacientes com paralisia de Bell. OBJETIVO: observar a prevalencia do virus herpes simplex tipo I pela tecnica de PCR, na saliva de pacientes com PFP de Bell, relacionando-a com a evolucao clinica destes casos. METODOLOGIA: Avaliamos 38 pacientes portadores de Paralisia Facial Periferica de Bell, que foram submetidos a anamnese, exame medico geral e otorrinolaringologico e coleta de saliva para deteccao do DNA viral pela tecnica de PCR. O grupo controle correspondeu a 10 adultos normais. RESULTADOS: Obtivemos positividade para o DNA viral em 11 casos dos 38 avaliados, o que corresponde a 29% da amostra. Este resultado foi estatisticamente significante se comparado ao grupo controle, no qual nao foi obtido nenhum caso de positividade. CONCLUSAO: Concluiu-se que a presenca do HSV-1 na saliva de pacientes portadores de PFP de Bell indica que a reativacao viral pode ser a etiologia desta doenca. A deteccao do virus na saliva destes pacientes nao influencia o prognostico da doenca.

Paralisia Facial Periférica por comprometimento do tronco cerebral: A propósito de um caso clínico

It is presented a clinical case of a patient with a peripheral facial paralysis with hemifacial compromise. During the clinical investigation it was expected that the topographic compromise of the facial nerve would arise out of the emergence of the nerve from the pons. After some image examinations, an expansive brain trunk lesion was evidenced. Thus, the classification of facial paralysis - either peripheral or central - is not applicable to this case. The use of a classification having the facial nerve nucleus as reference could be more adequate in the clinical investigation of the paralysis.

Effects of hyperbaric oxygen therapy on facial nerve regeneration

Conclusion. Hyperbaric oxygen treatment (HBOT) promoted an increase of the mean axonal diameter in the group evaluated 2 weeks after lesion induction, which suggests a more advanced regeneration process. However, the number of myelin nerve fibers of the facial nerve of the rabbits was similar when compared to the control and treatment groups, in both evaluation periods. Objective. To evaluate the effect of HBOT on the histological pattern of the facial nerve in rabbits exposed to a nerve crush injury. Materials and methods. Twenty rabbits were exposed to facial nerve crush injury. Ten rabbits received HBOT, 10 rabbits comprised the control group. The rabbits were sacrificed 2 and 4 weeks after the trauma. Qualitative morphological analysis, measurement of the external axonal diameters and myelin fiber count were carried out in an area of 185 000 µm2. Results. There was an increase in the area of the axons and thicker myelin in the 2 weeks treatment group in comparison with the control group. The mean diameter of the axons was of 2.34 µm in the control group and of 2.81 µm in the HBOT group, with statistically significant differences. The 2 week control group had a mean number of myelin fibers of 1865.2±664, and the HBOT group had a mean number of 2026.3±302; this was not statistically significant. The 4 week control group presented a mean of 2495.1±479 fibers and the HBOT group presented a mean of 2359.9±473; this was not statistically significant.CONCLUSION Hyperbaric oxygen treatment (HBOT) promoted an increase of the mean axonal diameter in the group evaluated 2 weeks after lesion induction, which suggests a more advanced regeneration process. However, the number of myelin nerve fibers of the facial nerve of the rabbits was similar when compared to the control and treatment groups, in both evaluation periods. OBJECTIVE To evaluate the effect of HBOT on the histological pattern of the facial nerve in rabbits exposed to a nerve crush injury. MATERIALS AND METHODS Twenty rabbits were exposed to facial nerve crush injury. Ten rabbits received HBOT, 10 rabbits comprised the control group. The rabbits were sacrificed 2 and 4 weeks after the trauma. Qualitative morphological analysis, measurement of the external axonal diameters and myelin fiber count were carried out in an area of 185 000 microm2. RESULTS There was an increase in the area of the axons and thicker myelin in the 2 weeks treatment group in comparison with the control group. The mean diameter of the axons was of 2.34 microm in the control group and of 2.81 microm in the HBOT group, with statistically significant differences. The 2 week control group had a mean number of myelin fibers of 1865.2 +/- 664, and the HBOT group had a mean number of 2026.3 +/- 302; this was not statistically significant. The 4 week control group presented a mean of 2495.1 +/- 479 fibers and the HBOT group presented a mean of 2359.9 +/- 473; this was not statistically significant.

Postoperative otorhinolaryngologic complications in transnasal endoscopic surgery to access the skull base.

INTRODUCTION The large increase in the number of transnasal endoscopic skull base surgeries is a consequence of greater knowledge of the anatomic region, the development of specific materials and instruments, and especially the use of the nasoseptal flap as a barrier between the sinus tract (contaminated cavity) and the subarachnoid space (sterile area), reducing the high risk of contamination. OBJECTIVE To assess the otorhinolaryngologic complications in patients undergoing endoscopic surgery of the skull base, in which a nasoseptal flap was used. METHODS This was a retrospective study that included patients who underwent endoscopic skull base surgery with creation of a nasoseptal flap, assessing for the presence of the following post-surgical complications: cerebrospinal fluid leak, meningitis, mucocele formation, nasal synechia, septal perforation (prior to posterior septectomy), internal nasal valve failure, epistaxis, and olfactory alterations. RESULTS The study assessed 41 patients undergoing surgery. Of these, 35 had pituitary adenomas (macro- or micro-adenomas; sellar and suprasellar extension), three had meningiomas (two tuberculum sellae and one olfactory groove), two had craniopharyngiomas, and one had an intracranial abscess. The complications were cerebrospinal fluid leak (three patients; 7.3%), meningitis (three patients; 7.3%), nasal fossa synechia (eight patients; 19.5%), internal nasal valve failure (six patients; 14.6%), and complaints of worsening of the sense of smell (16 patients; 39%). The olfactory test showed anosmia or hyposmia in ten patients (24.3%). No patient had mucocele, epistaxis, or septal perforation. CONCLUSION The use of the nasoseptal flap has revolutionized endoscopic skull base surgery, making the procedures more effective and with lower morbidity compared to the traditional route. However, although mainly transient nasal morbidities were observed, in some cases, permanent hyposmia and anosmia resulted. An improvement in this technique is therefore necessary to provide a better quality of life for the patient, reducing potential complications.

Varicella zoster virus in Bell's palsy: a prospective study

UNLABELLED Although Bells palsy is the major cause of acute peripheral facial palsy, its pathogenesis remains unknown. Reactivation of the varicella zoster virus has been implicated as one of the main causes of Bells palsy, however, studies which investigate the varicella zoster virus reactivation in Bells palsy patients are mostly Japanese and, therefore, personal and geographic characteristics are quite different from our population. AIMS To determine varicella zoster virus frequency in saliva samples from patients with Bells palsy, using PCR. MATERIAL AND METHOD One hundred seventy one patients with acute peripheral facial palsy were prospectively enrolled in this study. One hundred twenty were clinically diagnosed with Bells palsy, within one week of onset of the disease and no previous anti-viral therapy. We had 20 healthy adults as controls. Three saliva samples were collected from patients and controls at initial examination and at one and two weeks later. The detection of the varicella zoster virus DNA was performed using PCR. RESULTS Varicella zoster virus was detected in two patients (1.7%). The virus was not identified in saliva samples from the controls. CONCLUSIONS Varicella zoster virus was detected in 1.7% of saliva samples from patients with Bells palsy, using PCR.Embora a paralisia de Bell seja o tipo mais frequente de paralisia facial periferica,sua causa ainda e objeto de inumeros questionamentos. A reativacao do virus varicela zoster tem sido considerada uma das principais causas da paralisia de Bell, porem, os poucos trabalhos que estudam a prevalencia do VVZ como agente etiologico da PB sao japoneses, o que determina caracteristicas geograficas e populacionais bastante dispares de nossa populacao. OBJETIVOS: Verificar a frequencia do virus varicela zoster em saliva de individuos com PB, pela tecnica de PCR. MATERIAL E METODO: Estudo prospectivo com 171 pacientes com PFP, sendo 120 pacientes portadores de paralisia de Bell, com ate uma semana de evolucao, sem uso previo de drogas antivirais. O grupo controle foi composto de 20 adultos sadios. Nestes individuos foram coletadas tres amostras de saliva em semanas consecutivas, para pesquisa de DNA viral pela tecnica de PCR. RESULTADOS: O virus varicela zoster foi encontrado em amostras de saliva de dois pacientes com paralisia de Bell (1,7%). Nenhum virus foi identificado no grupo controle. CONCLUSAO: Foi verificada frequencia de 1,7% para virus varicela zoster em amostras de saliva de pacientes com paralisia de Bell, pela tecnica de PCR.

Posttraumatic facial nerve regeneration in rabbits

UNLABELLED Posttraumatic facial paralysis is a frequent disease. This work studies posttraumatic regeneration of the facial nerve in rabbits. Functional and histological analysis compared injured and normal nerves on opposite sides. The left facial nerve trunk of twenty rabbits were subjected to compression lesion, and sacrificed after two (subgroup AL), four (BL) and six (CL) weeks. Comparison between groups was made by analysing total and partial densities of myelinated axons. STATISTICAL ANALYSIS Tukey Method (p<0.05). RESULTS There was partial functional recovery after two weeks, and complete recovery after five weeks. Qualitative analysis demonstrated a degenerative pattern in the AL group, with an increased tissue inflammatory process. Evident regeneration signs were observed in the BL group, and almost complete regeneration was seen in the CL group. Normal nerves (N) had an average TD of 15705.59 and average PD of 21800.75. The BL group had an average TD of 10818.55 and an average PD of 15340.56. The CL group had an average TD of 13920.36 and an average PD of 16589.15. The BL group had an average TD of N equal to 68.88%, and the CL group had an average TD of N equal to 88,63% (statistically significant). N showed a significant higher PD than injured nerves. However, this was not statistically different between BL and CL subgroups. Nerve DT was a more reliable method than PD in this study.