Ricardo Ferreira Bento

Perfil diagnóstico do idoso portador de desequilíbrio corporal: resultados preliminares

STUDY DESIGN: This study aimed to determine the prevalence of the different aspects of older patients presenting with dizziness. MATERIAL AND METHODS: Fifty-five patients who complained of disequilibrium and/or dizziness from the Ambulatorio de Otoneurologia Geriatrica do Hospital das Clinicas do HCFMUSP, between august/2001 and mars/2003 were analyzed. The authors characterized these population about sex, age, etiological factors of the complaints about equilibrium, adopted treatments and its results. RESULTS: Disequilibrium in older people has multiple different causes in 51% of the subjects, and the more frequent etiologies are: Vertebro Basilar Insufficiency - VBI (40%), Cholesterol and Sugar alterations (40%), Age-related Deterioration of Vestibular System (30%), Benign paroxysmal postural vertigo BPPV (14,5%), Cervical Syndrome (7,2%) and Hormonal alterations (5,4%). CONCLUSION: Disequilibrium in older people is commonly due to two or more etiologies. These findings suggest that a multidisciplinary evaluation is fundamental when the objective is to treat the older patient with dizziness or balance problems.

The Influence of Voluntary Muscle Contractions upon the Onset and Modulation of Tinnitus

Objective: To evaluate the frequency of tinnitus onset (in normal subjects) and modulation (in tinnitus patients) during muscle contractions, estimating possible risk factors. Material and Method: This case-control study enrolled 121 tinnitus patients and 100 healthy volunteers who underwent medical history, ENT examination and 16 maneuvers of muscular contraction (head, neck and limbs). Modulation data were compared between patients with and without normal audiometry, well-defined diagnosis and symptoms of craniomandibular disorders. Results: The ability to modulate tinnitus (65.3%) was significantly higher than that to originate tinnitus (14.0%). The head and neck musculature was significantly more efficient than that of the limbs. Audiometric pattern, well-defined etiology and symptoms of craniomandibular disorders showed no relation to tinnitus modulation. Conclusions: Somatic modulation is a characteristic aspect of tinnitus.

Zumbido em pacientes com audiometria normal: caracterização clínica e repercussões

Pacientes com zumbido e audiometria normal constituem um grupo importante, pois seus achados nao sofrem influencia da perda auditiva. Apesar disso, este grupo e pouco estudado e nao sabemos se suas caracteristicas clinicas e repercussoes sao semelhantes as dos individuos com perda auditiva. OBJETIVOS: Comparar as caracteristicas clinicas do zumbido e sua interferencia nas atividades diarias em pacientes com e sem perda auditiva. FORMA DE ESTUDO: coorte historica. MATERIAL E METODO: Entre 744 pacientes atendidos no Grupo de Pesquisa em Zumbido do HCFMUSP, avaliou-se retrospectivamente com um corte transversal os 55 individuos com audiometria tonal normal. O grupo controle correspondeu a 198 pacientes com zumbido e perda auditiva atendidos sob o mesmo protocolo. Analisou-se os dados dos pacientes, as caracteristicas clinicas do zumbido e sua repercussao na vida do paciente. RESULTADOS: A idade media no grupo de estudo (43,1 ± 13,4 anos) foi significantemente menor do que a do grupo controle (49,9 ± 14,5 anos). Em ambos os grupos houve predominio do sexo feminino e o zumbido foi predominantemente bilateral, unico e constante, porem sem diferenca entre os grupos. A interferencia na concentracao e no equilibrio emocional foi significantemente menor no grupo de estudo (25,5% e 36,4%) do que no controle (46% e 61,6%), porem sem diferenca quanto a interferencia no sono e na atividade social. CONCLUSOES: O grupo de pacientes com zumbido e audicao normal apresentou caracteristicas clinicas semelhantes em relacao ao grupo com perda auditiva. Entretanto, a faixa etaria acometida e a interferencia sobre a concentracao e o equilibrio emocional foram significantemente menores nestes.

Comparison between Fibrin Tissue Adhesive, Epineural Suture and Natural Union in Intratemporal Facial Nerve of Cats: Part II

Our objective was to study intratemporal anastomosis of the facial nerve in cats. Clinical, electrophysiological and histological results of the use of fibrin tissue adhesive, epineural suture and natural adhesion were compared. The 30 adult cats studied had undergone mastoidectomy exposure, and section of the facial nerve 1 cm before its exit from the stylomastoid foramen. Anastomosis was then undertaken, using epineural suture combined with stabilization through fibrinic tissue adhesive, and union of the stumps without stabilizing them. Each type of anastomosis was carried out in 10 animals. Clinical, electrophysiological and histological assessments of both the site of anastomosis and the ventral branch of the facial nerve followed the aforementioned procedures. By means of statistical analysis, the authors reached the following conclusions: 1) Considering the clinical assessment per se, both groups with fibrinic tissue adhesive and suture showed similar features and results, which in both cases were better than those following natural union. 2) Considering the electrophysiological results per se, the use of fibrin tissue adhesive was superior to any other method used. 3) Considering the histological examination per se, both groups with fibrin tissue adhesive and suture revealed similar features which were more favourable than those shown by natural union. 4) In the overall comparison of the various parameters in the three groups, the use of fibrin tissue adhesive achieved better results than any other method. Based on the results of this study, the authors conclude that the use of fibrin tissue adhesive has technical advantages, and that the results of this use outweigh those achieved with both epineural suture and natural union. The authors recommend this technique as the most beneficial to be resorted to, for intrapetrous anastomosis of the facial nerve.

Prevalence of chronic rhinosinusitis in Sao Paulo

BACKGROUND Glucocorticoids (GCs) are considered drugs of choice for treating nasal polyps (NPs). However, a subset of patients shows a limited clinical response even to high doses of GCs. Altered expression of glucocorticoid receptors (GRs), namely GR-alpha; and GR-beta;, is a potential mechanism underlying GC insensitivity. GCs modulate the expression of several cytokines, including transforming growth factor-beta (TGF-beta), which may contribute to cellular proliferation in NPs. The study investigates some biomolecular features of GC-resistant NPs, and examines possible differences from normal mucosa (NM). METHODOLOGY Radioligand binding assay (binding) was used to determine GR-alpha; binding capacity; Western blotting was used to evaluate GR-alpha;, GR-beta;, and TGF-beta; expression and GR-alpha; subcellular distribution. NPs were sampled in 32 patients during ethmoidectomy; NM was taken from 15 healthy patients during rhinoplasty. RESULTS GR-alpha; was present in NPs and NM, with lower affinity for the ligand in NPs. GR-alpha; was prevalent in the cytosol of NPs that were GR-alpha-negative to the binding assay. GR-beta was expressed in NPs and absent in the majority of NM. TGF-beta1 expression was higher in NPs than in NM. CONCLUSIONS GR-beta and TGF-beta1 might be involved in NP pathogenesis, but their role in modulating GC sensitivity is still unclear.INTRODUCTION Studies designed to investigate chronic rhinosinusitis (CRS) epidemiology play an important role to assess population`s distribution and risk factors to result in the development and promotion of public health policies. METHOD This study design is a survey carried out with a complex two-stage cluster sampling plan. Personal interviews were carried out with 2,003 individuals. The questionnaire included the epidemiological criteria for CRS. Demographic data, history of physician-diagnosed respiratory diseases (asthma, sinusitis, rhinitis), smoking, family income, educational attainment, and household characteristics were also evaluated. RESULTS The overall response rate was 93.9% of the households. Mean age was 39.8 +- 21 years; 45.33% were male. The overall prevalence of CRS in the city of Sao Paulo was 5.51%. We found a significant association between diagnosis of CRS and diagnosis of asthma and CRS and diagnosis of rhinitis and a significant association between presence of CRS and belonging to the low-income subgroup. CONCLUSION The municipality of Sao Paulo has an urban population of 11 million. According to the present study, the prevalence of CRS is 5.51%, which represents more than 500,000 individuals affected by this condition in the city.

Resultados auditivos com o implante coclear multicanal em pacientes submetidos a cirurgia no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Complete hearing loss is a very important handicap resulting in sensory deprivation and affecting an individuals personality, relationships and life style. Individuals with profound deafness are unable to hear environmental sounds as doorbells, telephones, traffic noises and sirens that are an important alert for dangerous situations in the daily life. They are also unable to hear their own voices and for this people with profound deaf do not modulate their voices. The hearing aids are the first choice to treat deafness, but there are patients with severe damage of the auditory systems who cannot receive a useful hearing from normal hearing aids. The cochlear implant is the alternative for patients that cannot have good discriminatory ability wearing a powerful hearing aid and wish or need a better hearing. AIM: To study the hearing results of the adult patients who are using a multichannel cochlear implant system at the Department of Otolaryngology - University of Sao Paulo. STUDY DESIGN: Series study. MATERIAL AND METHOD: We selected 61 patients with a severe bilateral hearing loss that have been using the cochlear implant for at least six months. The hearing evaluation performed after using the device for six months included word and sentence recognition tests. RESULTS: The PTA of four patients reached 38.7 dB. Speech perception tests showed 713% recognition of open set sentences, 86.5% of vowels and 52.60% of monosyllabic. Most of our patients are able to speak on the telephone. CONCLUSION: Most of patients showed excellent results in open-set sentence and word tests.A surdez profunda e uma deficiencia que afeta a personalidade, o relacionamento e todo o estilo de vida do paciente. Incapacita os individuos de escutarem sons ambientes como sirenes e alarmes que constituem alerta em situacoes da vida diaria e nao permite a modulacao vocal, tornando a voz esteticamente ruim. A protese auditiva convencional e eficiente no tratamento de grande parte das deficiencias auditivas, porem existem pacientes que nao conseguem obter discriminacao de palavras e sentencas mesmo com uma protese auditiva potente. O implante coclear e a alternativa atual para estes pacientes. OBJETIVO: Avaliar o resultado auditivo dos pacientes adultos implantados com o implante coclear multicanal pelo Grupo de Implante Coclear da Disciplina de Otorrinolaringologia da Faculdade de medicina da Universidade de Sao Paulo. FORMA DE ESTUDO: Estudo de serie. CASUISTICA E METODO: Foram selecionados 61 pacientes com surdez profunda bilateral que utilizam o implante coclear multicanal por pelo menos seis meses e estudados os resultados auditivos atraves de testes de reconhecimento de palavras e sentencas. RESULTADOS: O PTA medio obtido pelos pacientes foi 38.7 dB NPS. A media em reconhecimento de sentencas em formato aberto foi de 71.3%, vogais em 86.5%, monossilabos em 52.60% e consoante medial em 52.6%. A maioria dos pacientes esta apta ao uso do telefone. CONCLUSAO: A avaliacao auditiva obtida seis meses apos a primeira programacao do implante demonstra que pacientes de lingua portuguesa obtem excelentes resultados em testes de reconhecimento de palavras e sentencas em apresentacao aberta, readquirindo uma audicao util.

Somatic Modulation of Tinnitus: Test Reliability and Results after Repetitive Muscle Contraction Training:

Objectives: We sought to study the reliability of tinnitus modulation by muscle contractions and to observe the effect of their prolonged repetition. Methods: Thirty-eight patients with tinnitus underwent 9 maneuvers of muscle contractions in test and retest situations. After a 2-month training period of repeating the maneuvers, tinnitus modulation and daily perception were evaluated. Results: There was no difference between the occurrence of tinnitus modulation in test (57.9%) and retest (63.2%) situations. After 2 months, the occurrence of modulation during the maneuvers was similar (55.3%), but a new pattern showed an increase in tinnitus improvement and a decrease in tinnitus worsening. The daily perception of tinnitus was unchanged. Conclusions: Maneuvers of head and neck muscle contractions evoked tinnitus modulation in a frequent and reliable manner. Also, the repetition of such maneuvers for 2 months altered the pattern of modulation.

Craniofacial morphology and otitis media with effusion in children.

Otitis media with effusion (OME) affects 28-38% of pre-school children, and it occurs due to the dysfunction of the auditory tube. Anatomical development of the auditory tube depends on the craniofacial growth and development. Deviations of normal craniofacial morphology and growth using cephalometric studies, may predict the evolution of otitis. Our goal in this paper is to determine if there are differences in craniofacial morphology between children with adenoid enlargement, with and without otitis media with effusion. This is a prospective study in which the sample consisted of 67 children (male and female) from 5 to 10 years old. All patients presented chronic upper airway obstruction due to tonsil and adenoid enlargement (>80% degree of obstruction). Thirty-three patients presented otitis media with effusion, for more than 3 months and 34 did not. The latter composed the control group. Standardized lateral head radiographs were obtained for all subjects. Radiographs were taken with patient positioned by a cephalostat and stayed with mandibles in centric occlusion and lips at rest. Radiographs were digitalized and specific landmarks were identified using a computer program Radiocef 2003, 5th edition. Measurements, angles and lines were taken of the basicranium, maxilla and mandible according to the modified Ricketts analysis. In addition, facial height and facial axis were determined. Children with otitis media with effusion present differences in the morphology of the face, regarding these measures: N-S (anterior cranial base length), N-ANS (upper facial height), ANS-PNS (size of the hard palate), Po-Or.N-Pog (facial depth), Ba-N.Ptm-Gn (facial axis), Go-Me (mandibular length) and Vaia--Vaip (inferior pharyngeal airway).

Sudden Deafness and Lyme Disease

Objectives/Hypothesis Otolaryngological manifestations are common in Lyme disease, affecting up to 75% of patients. One of these symptoms is sudden deafness. Hearing loss has been frequently described in Lyme disease; on the other hand, titers seropositive for Borrelia burgdorferi, the causal agent of this disease, have been found in almost 20% of cases of sudden deafness. No consensual information exists on the outcome of Borrelia‐seropositive patients or on the importance of determining Borrelia antibody titers. The present study aimed to determine the prevalence of seropositivity for Borrelia in sudden deafness, describing clinical characteristics and outcomes.

Surgical complications in 550 consecutive cochlear implantation

UNLABELLED Cochlear implantation is a safe and reliable method for auditory restoration in patients with severe to profound hearing loss. OBJECTIVE To describe the surgical complications of cochlear implantation. MATERIALS AND METHODS Information from 591 consecutive multichannel cochlear implant surgeries were retrospectively analyzed. All patients were followed-up for at least one year. Forty-one patients were excluded because of missing data, follow-up loss or middle fossa approach. RESULTS Of 550 cochlear implantation analyzed, 341 were performed in children or adolescents, and 209 in adults. The mean hearing loss time was 6.3 ± 6.7 years for prelingual loss and 12.1 ± 11.6 years for postlingual. Mean follow-up was 3.9 ± 2.8 years. Major complications occurred in 8.9% and minor in 7.8%. Problems during electrode insertion (3.8%) were the most frequent major complication followed by flap dehiscence (1.4%). Temporary facial palsy (2.2%), canal-wall lesion (2.2%) and tympanic membrane lesion (1.8%) were the more frequent minor complications. No death occurred. CONCLUSION There was a low rate of surgical complications, most of them been successfully managed. These results confirm that cochlear implant is a safe surgery and most surgical complications can be managed with conservative measures or minimal intervention.