Rafael da Costa Monsanto

Epitympanum volume and tympanic isthmus area in temporal bones with retraction pockets

To compare the volume of the epitympanic space, as well as the area of the tympanic isthmus, in human temporal bones with retraction pockets to those with chronic otitis media without retraction pockets and to those with neither condition.

A three-dimensional analysis of the endolymph drainage system in Ménière disease

To measure the volume of the endolymph drainage system in temporal bone specimens with Ménière disease, as compared with specimens with endolymphatic hydrops without vestibular symptoms and with nondiseased specimens

Treatment and Prognosis of Facial Palsy on Ramsay Hunt Syndrome: Results Based on a Review of the Literature

Introduction Ramsay Hunt syndrome is the second most common cause of facial palsy. Early and correct treatment should be performed to avoid complications, such as permanent facial nerve dysfunction. Objective The objective of this study is to review the prognosis of the facial palsy on Ramsay Hunt syndrome, considering the different treatments proposed in the literature. Data Synthesis We read the abstract of 78 studies; we selected 31 studies and read them in full. We selected 19 studies for appraisal. Among the 882 selected patients, 621 (70.4%) achieved a House-Brackmann score of I or II; 68% of the patients treated only with steroids achieved HB I or II, versus 70.5% when treated with steroids plus antiviral agents. Among patients with complete facial palsy (grades V or VI), 51.4% recovered to grades I or II. The rate of complete recovery varied considering the steroid associated with acyclovir: 81.3% for methylprednisolone, 69.2% for prednisone; 61.4% for prednisolone; and 76.3% for hydrocortisone. Conclusions Patients with Ramsay-hunt syndrome, when early diagnosed and treated, achieve high rates of complete recovery. The association of steroids and acyclovir is better than steroids used in monotherapy.

Progression of changes in the sensorial elements of the cochlear and peripheral vestibular systems: The otitis media continuum

&NA; Our study aimed to evaluate pathologic changes in the cochlear (inner and outer hair cells and stria vascularis) and vestibular (vestibular hair cells, dark, and transitional cells) sensorial elements in temporal bones from donors who had otitis media. We studied 40 temporal bones from such donors, which were categorized in serous otitis media (SOM), serous‐purulent otitis media (SPOM), mucoid/mucoid‐purulent otitis media (MOM/MPOM), and chronic otitis media (COM); control group comprised 10 nondiseased temporal bones. We found significant loss of inner and outer cochlear hair cells in the basal turn of the SPOM, MOM/MPOM and COM groups; significant loss of vestibular hair cells was observed in the MOM/MPOM and COM groups. All otitis media groups had smaller mean area of the stria vascularis in the basal turn of the cochlea when compared to controls. In conclusion, our study demonstrated more severe pathologic changes in the later stages of the continuum of otitis media (MOM/MPOM and COM). Those changes seem to progress from the basal turn of the cochlea (stria vascularis, then inner and outer hair cells) to the middle turn of the cochlea and to the saccule and utricle in the MOM/MPOM and COM stages. HighlightsCochlear changes preceded vestibular changes in the otitis media groups.The basal turn of the cochlea was the most affected area of the inner ear.Cochlear outer hair cells were more affected by otitis media than inner hair cells.Strial intermediate cells are more affected by otitis media than marginal cells.Vestibule and apical turn of the cochlea were affected in later stages of the continuum.

Pathologic Changes of the Peripheral Vestibular System Secondary to Chronic Otitis Media

Objective To evaluate the histopathologic changes of dark, transitional, and hair cells of the vestibular system in human temporal bones from patients with chronic otitis media. Study Design Comparative human temporal bone study. Setting Otopathology laboratory. Subjects and Methods To compare the density of vestibular dark, transitional, and hair cells in temporal bones with and without chronic otitis media, we used differential interference contrast microscopy. Results In the chronic otitis media group (as compared with the age-matched control group), the density of type I and type II hair cells was significantly decreased in the lateral semicircular canal, saccule, and utricle (P < .05). The density of type I cells was also significantly decreased in the chronic otitis media group in the posterior semicircular canal (P = .005), but that of type II cells was not (P = .168). The mean number of dark cells was significantly decreased in the chronic otitis media group in the lateral semicircular canal (P = .014) and in the posterior semicircular canal (P = .002). We observed no statistically significant difference in the density of transitional cells between the 2 groups (P > .1). Conclusion The findings of our study suggest that the decrease in the number of vestibular sensory cells and dark cells could be the cause of the clinical symptoms of imbalance of some patients with chronic otitis media.

Pathophysiology and Diagnosis of Vertebrobasilar Insufficiency: A Review of the Literature

Introduction  Vertebrobasilar insufficiency is defined as transitory ischemia of the vertebrobasilar circulation. Dizziness, vertigo, headaches, vomit, diplopia, blindness, ataxia, imbalance, and weakness in both sides of the body are the most common symptoms. Objective  To review the literature regarding the three available diagnostic testing in patients with dizziness complaints secondary to vertebrobasilar insufficiency (VBI): magnetic resonance angiography; transcranial Doppler ultrasound; and vertebrobasilar deprivation testing. Data Synthesis  We selected 28 studies that complied with our selection criteria for appraisal. The most frequent cause of the hemodynamic changes leading to VBI is atherosclerosis. The main clinical symptoms are dizziness, vertigo, headaches, vomit, diplopia, blindness, ataxia, imbalance, and weakness in both sides of the body. Even though arteriography is considered the most important exam to diagnose the disease, the inherent risks of this exam should be taken into consideration. The magnetic resonance angiography has been widely studied and is a good method to identify and localize any occlusions and stenosis in both neck and intracranial great vessels. Conclusion  Each patient with a suspected diagnosis of VBI should be individually evaluated and treated, taking in consideration the pros and cons of each diagnostic testing and treatment option.

Evidence against the mucosal traction theory in cholesteatoma: Ciliated Cells in the Middle Ear Cleft

To investigate the distribution of ciliated epithelium in the human middle ear and its potential role in the formation of cholesteatoma.

Changes in the inner ear structures in cystic fibrosis patients

OBJECTIVE Although prolonged use of antibiotics is very common in cystic fibrosis (CF) patients, no studies have assessed the changes in both cochlear and peripheral vestibular systems in this population. METHODS We used human temporal bones to analyze the density of vestibular dark, transitional, and hair cells in specimens from CF patients who were exposed to several types of antibiotics, as compared with specimens from an age-matched control group with no history of ear disease or antibiotic use. Additionally, we analyzed the changes in the elements of the cochlea (hair cells, spiral ganglion neurons, and the area of the stria vascularis). Data was gathered using differential interference contrast microscopy and light microscopy. RESULTS In the CF group, 83% of patients were exposed to some ototoxic drugs, such as aminoglycosides. As compared with the control group, the density of both type I and type II vestibular hair cells was significantly lower in all structures analyzed; the number of dark cells was significantly lower in the lateral and posterior semicircular canals. We noted a trend toward a lower number of both inner and outer cochlear hair cells at all turns of the cochlea. The number of spiral ganglion neurons in Rosenthals canal at the apical turn of the cochlea was significantly lower; furthermore, the area of the stria vascularis at the apical turn of the cochlea was significantly smaller. CONCLUSIONS Deterioration of cochlear and vestibular structures in CF patients might be related to their exposure to ototoxic antibiotics. Well-designed case-control studies are necessary to rule out the effect of CF itself.

The surgical challenge of carotid artery and Fallopian canal dehiscence in chronic ear disease: a pitfall for endoscopic approach

Endoscopic procedures are becoming common in middle ear surgery. Inflammation due to chronic ear disease can cause bony erosion of the carotid artery and Fallopian canals, making them more vulnerable during surgery. The objective of this study was to determine whether or not chronic ear disease increases dehiscence of the carotid artery and Fallopian canals.

Histopathology of Meniere’s Disease

Meniere’s Disease is a pathologic condition of the inner ear characterized by the presence of sudden bouts of vertigo, fluctuating hearing loss, tinnitus, and/or aural fullness. Although much has been discovered on this disease since the first description by Prosper Meniere, the pathophysiology of the events leading to the clinical symptoms of the disease is still under debate. This study aims to perform an up-to-date review on Meniere’s Disease, focusing on histopathology, pathophysiology, genetics, and causative mechanisms.