Raquel Mezzalira

Ewing's sarcoma of the head and neck

CONTEXT Ewings sarcoma is a rare neoplasm, which usually arises in long bones of the limbs and in flat bones of the pelvis, with the involvement of head and neck bones being very unusual. CASE REPORT a case of Ewings sarcoma occurring in the mandible of a 35-year-old female. Pain and swelling of the tumor were the main complaints. The early hypothesis was an undifferentiated malignant neoplasm, possibly a sarcoma. The CT scan depicted an expansive lesion, encapsulated, with septa and characteristics of soft tissue, involving the left side of the mandible and extending to the surrounding tissues. The patient underwent surgical excision of the lesion, the definitive diagnosis of Ewings sarcoma was established, and the patient commenced on radiotherapy.

Study of the relationship between the degree of tinnitus annoyance and the presence of hyperacusis

Introduction: Hyperacusis can be defined as a manifestation of an increased of central auditory pathways gain and can be considered a pre-tinnitus state. In some cases tinnitus can be caused by such increased gain. Aim: To evaluate the prevalence of hyperacusis in patients with tinnitus and its relation to the annoyance of tinnitus. Materials and methods: Retrospective study with patients from the neurotology service complaining of tinnitus in the first consultation were submitted to clinical evaluation, a questionnaire and audiological evaluation of tinnitus and hyperacusis. The degree of annoyance of tinnitus and hyperacusis was measured using a visual analog scale. Results: We analyzed medical records of 309 patients, 169 (54.7%) females and 140 (45.3%) males. The mean age was 53 years. The median degree of tinnitus annoyance was 7. Hyperacusis was present in 57 (18.4%) patients, with a median degree of 5. The degree of annoyance due to tinnitus patients with hyperacusis was similar to that of patients without hyperacusis. Conclusion: Hyperacusis was present in 18.4% of patients with tinnitus. The degree of annoyance due to tinnitus had no correlation with the presence of hyperacusis.INTRODUCTION Hyperacusis can be defined as a manifestation of an increased of central auditory pathways gain and can be considered a pre-tinnitus state. In some cases tinnitus can be caused by such increased gain. AIM To evaluate the prevalence of hyperacusis in patients with tinnitus and its relation to the annoyance of tinnitus. MATERIALS AND METHODS Retrospective study with patients from the neurotology service complaining of tinnitus in the first consultation were submitted to clinical evaluation, a questionnaire and audiological evaluation of tinnitus and hyperacusis. The degree of annoyance of tinnitus and hyperacusis was measured using a visual analog scale. RESULTS We analyzed medical records of 309 patients, 169 (54.7%) females and 140 (45.3%) males. The mean age was 53 years. The median degree of tinnitus annoyance was 7. Hyperacusis was present in 57 (18.4%) patients, with a median degree of 5. The degree of annoyance due to tinnitus patients with hyperacusis was similar to that of patients without hyperacusis. CONCLUSION Hyperacusis was present in 18.4% of patients with tinnitus. The degree of annoyance due to tinnitus had no correlation with the presence of hyperacusis.

Estudo da relação entre o grau de incômodo de pacientes com zumbido e a presença de hiperacusia

Introduction: Hyperacusis can be defined as a manifestation of an increased of central auditory pathways gain and can be considered a pre-tinnitus state. In some cases tinnitus can be caused by such increased gain. Aim: To evaluate the prevalence of hyperacusis in patients with tinnitus and its relation to the annoyance of tinnitus. Materials and methods: Retrospective study with patients from the neurotology service complaining of tinnitus in the first consultation were submitted to clinical evaluation, a questionnaire and audiological evaluation of tinnitus and hyperacusis. The degree of annoyance of tinnitus and hyperacusis was measured using a visual analog scale. Results: We analyzed medical records of 309 patients, 169 (54.7%) females and 140 (45.3%) males. The mean age was 53 years. The median degree of tinnitus annoyance was 7. Hyperacusis was present in 57 (18.4%) patients, with a median degree of 5. The degree of annoyance due to tinnitus patients with hyperacusis was similar to that of patients without hyperacusis. Conclusion: Hyperacusis was present in 18.4% of patients with tinnitus. The degree of annoyance due to tinnitus had no correlation with the presence of hyperacusis.INTRODUCTION Hyperacusis can be defined as a manifestation of an increased of central auditory pathways gain and can be considered a pre-tinnitus state. In some cases tinnitus can be caused by such increased gain. AIM To evaluate the prevalence of hyperacusis in patients with tinnitus and its relation to the annoyance of tinnitus. MATERIALS AND METHODS Retrospective study with patients from the neurotology service complaining of tinnitus in the first consultation were submitted to clinical evaluation, a questionnaire and audiological evaluation of tinnitus and hyperacusis. The degree of annoyance of tinnitus and hyperacusis was measured using a visual analog scale. RESULTS We analyzed medical records of 309 patients, 169 (54.7%) females and 140 (45.3%) males. The mean age was 53 years. The median degree of tinnitus annoyance was 7. Hyperacusis was present in 57 (18.4%) patients, with a median degree of 5. The degree of annoyance due to tinnitus patients with hyperacusis was similar to that of patients without hyperacusis. CONCLUSION Hyperacusis was present in 18.4% of patients with tinnitus. The degree of annoyance due to tinnitus had no correlation with the presence of hyperacusis.

Oculomotricidade na infância: o padrão de normalidade é o mesmo do adulto?

estudo da oculomotricidade se da atraves da avaliacao detres sistemas: movimentos oculares sacadicos (MOS), nistagmooptocinetico (NO) e movimentos oculares de rastreio lento (MORL).A atuacao conjunta destes tres sistemas permite a estabilizacao docampo visual nas diversas situacoes de movimento as quais o indi-viduo e submetido.

Glucose metabolism disorders and vestibular manifestations: evaluation through computerized dynamic posturography

INTRODUCTION Global sugar consumption has increased in the past 50 years; its abusive intake is responsible for peripheral insulin resistance, which causes the metabolic syndrome - obesity, diabetes mellitus, hypertension, and coronary heart disease. OBJECTIVE To evaluate the effect of a fractionated diet without glucose as treatment for labyrinthine disorders associated with glucose-insulin index. METHODS The study design was a prospective randomized controlled trial. Fifty-one patients were divided into two groups: the diet group (DG), which comprised subjects treated with a fractionated diet with glucose restriction, and the control group (CG), in which individuals were not counseled regarding diet. Patients underwent computerized dynamic posturography (CDP) and visual analog scale (VAS) on the first and 30th days of the study. RESULTS There was improvement in the assessed posturographic conditions and VAS self-assessment in the DG group after 30 days when compared to the control group. CONCLUSION The fractionated diet with glucose restriction was effective for the treatment of vestibular dysfunction associated with glucose metabolism disorders.

Otoneurological evaluation: current good practice

Atualmente, a otoneurologia é entendida como o estudo e avaliação do equilíbrio corporal. Sendo assim, as avaliações de outrora foram complementadas por uma série de exames e procedimentos que, em conjunto, avaliam o complexo sistema de equilíbrio. A audiometria e a imitanciometria são partes integrantes da avaliação otoneurológica, ao lado da avaliação vestibular. A avaliação vestibular clássica consta de três etapas: 1. Anamnese; 2. Testes de observação direta, que compreendem o equilíbrio estático e dinâmico, as provas de coordenação e os testes do reflexo vestíbulo ocular (impulso cefálico, desvio da linha do olhar, nistagmo espontâneo e semiespontâneo); 3. Oculografia, avaliação monitorizada por eletrodos ou óculos de infravermelho, que compreendem o nistagmo espontâneo, semiespontâneo e fixação ocular; a oculomotricidade (sacadas, rastreio e nistagmo optocinético); os testes posicionais e de posicionamento e a prova calórica (PC) bilateral quente e fria, com intervalos adequados entre as estimulações. A parte técnica da oculografia não possui significado clínico sem a anamnese e o exame físico do doente, pois a interpretação deste depende da avaliação conjunta e da interação entre sintoma e sinal oculográfico. Portanto, a participação do médico é condição necessária para uma conclusão adequada. A execução da avaliação otoneurológica completa tem a duração aproximada de uma hora, na ausência de intercorrências. A PC fornece informação a respeito do funcionamento do canal semicircular lateral após estímulo térmico e costuma estar alterada nos casos de falência vestibular periférica uni ou bilateral. O exemplo clássico de alteração da prova calórica é a neurite vestibular, em que observamos a hiporreflexia pós-estimulação. No entanto, a PC pode estar normal em várias vestibulopatias. Entre os diagnósticos otoneurológicos que podem apresentar PC normal estão a migrânea, a vertigem posicional paroxística benigna (VPPB), a tontura crônica subjetiva ou doenças em que ocorra flutuação da função vestibular (como a Doença de Menière em seu período de remissão). Portanto, a prova calórica como exame isolado pode não diagnosticar várias doenças do sistema vestibular. É necessária a avaliação médica para que sejam formuladas hipóteses claras e fundamentadas com a finalidade de emitir laudos e indicar exames complementares que confirmem a doença em questão. Entre esses outros exames estão a posturografia, os testes eletrofisiológicos, o videoteste do impulso cefálico, a cadeira pendular e os exames de imagem.

Campanha Nacional de Prevenção a Quedas de Idosos Dia 27 de setembro: Dia de atendimento ao idoso com tontura

Universidade Federal de Sao Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Otorrinolaringologia e Cirurgia de Cabeca e Pescoco

Avaliação otoneurológica: a boa prática

Atualmente, a otoneurologia é entendida como o estudo e avaliação do equilíbrio corporal. Sendo assim, as avaliações de outrora foram complementadas por uma série de exames e procedimentos que, em conjunto, avaliam o complexo sistema de equilíbrio. A audiometria e a imitanciometria são partes integrantes da avaliação otoneurológica, ao lado da avaliação vestibular. A avaliação vestibular clássica consta de três etapas: 1. Anamnese; 2. Testes de observação direta, que compreendem o equilíbrio estático e dinâmico, as provas de coordenação e os testes do reflexo vestíbulo ocular (impulso cefálico, desvio da linha do olhar, nistagmo espontâneo e semiespontâneo); 3. Oculografia, avaliação monitorizada por eletrodos ou óculos de infravermelho, que compreendem o nistagmo espontâneo, semiespontâneo e fixação ocular; a oculomotricidade (sacadas, rastreio e nistagmo optocinético); os testes posicionais e de posicionamento e a prova calórica (PC) bilateral quente e fria, com intervalos adequados entre as estimulações. A parte técnica da oculografia não possui significado clínico sem a anamnese e o exame físico do doente, pois a interpretação deste depende da avaliação conjunta e da interação entre sintoma e sinal oculográfico. Portanto, a participação do médico é condição necessária para uma conclusão adequada. A execução da avaliação otoneurológica completa tem a duração aproximada de uma hora, na ausência de intercorrências. A PC fornece informação a respeito do funcionamento do canal semicircular lateral após estímulo térmico e costuma estar alterada nos casos de falência vestibular periférica uni ou bilateral. O exemplo clássico de alteração da prova calórica é a neurite vestibular, em que observamos a hiporreflexia pós-estimulação. No entanto, a PC pode estar normal em várias vestibulopatias. Entre os diagnósticos otoneurológicos que podem apresentar PC normal estão a migrânea, a vertigem posicional paroxística benigna (VPPB), a tontura crônica subjetiva ou doenças em que ocorra flutuação da função vestibular (como a Doença de Menière em seu período de remissão). Portanto, a prova calórica como exame isolado pode não diagnosticar várias doenças do sistema vestibular. É necessária a avaliação médica para que sejam formuladas hipóteses claras e fundamentadas com a finalidade de emitir laudos e indicar exames complementares que confirmem a doença em questão. Entre esses outros exames estão a posturografia, os testes eletrofisiológicos, o videoteste do impulso cefálico, a cadeira pendular e os exames de imagem.

Stapedial reflex and recruitment: What is the relationship with tinnitus?

Tinnitus is characterized by an auditory perception of sound, with no stimuli from the external environment. Tinnitus is an increasingly significant complaint, affecting 10-17% of the world population. As a symptom, it should always be considered with pathology in the auditory system. Our study aims to assess the relationship of this symptom with the presence of a stapedial reflex and the phenomenon of recruitment. Medical records of patients complaining of subjective tinnitus during their first consultation in the Outpatient Clinic of the Unicamp Teaching Hospital, in Brazil, between 2011 and 2012 were analyzed. We carried out a study with 65 non-randomized tinnitus individuals using questionnaires, clinical and audiological evaluations. The visual analogue scale was used to characterize the degree of disturbance caused by tinnitus. Statistical tests were performed using the IBM SPSS Statistics 19. No association was found between tinnitus and the presence of acoustic reflex or phenomenon of recruitment. We concluded that there is no relationship between tinnitus, the phenomenon of recruitment or the presence of an acoustic reflex.

Sensitivity of caloric test and video head impulse as screening test for chronic vestibular complaints

OBJECTIVE: This study compared the results of the caloric test with those of the video head impulse test obtained during the same session and evaluated whether the former can be used to screen for non-acute vestibular dysfunction. METHODS: A total of 157 participants complaining of dizziness with vestibular characteristics of varying durations and clinical courses completed the caloric test and video head impulse test. RESULTS: Significantly more caloric test results than video head impulse test results were abnormal. CONCLUSIONS: The results of the caloric test and video head impulse test are distinct but complement each other. Within our sample, the caloric test was more sensitive for vestibular dysfunction. Therefore, the video head impulse test is not a suitable screening tool of the vestibular system in patients with chronic complaints.