Roberto Campos Meirelles

Laryngo-pharyngeal Tuberculosis

UNLABELLED Tuberculosis of the Larynx and pharynx only is rare. However, in the last few years, the number of tuberculosis cases in general have had a dramatic increase, thus increasing the possibility of isolated laryngo-pharyngeal lesions. AIM To report a case of isolated laryngo-pharyngeal tuberculosis in a pregnant, immunocompetent host. CASE REPORT A 30- year-old pregnant female had complained of odynophagia for the last ten months. There were no other respiratory or systemic symptoms. An oro-pharyngeal granulomatous lesion was found, and the biopsy revealed acid-fast bacilli. There were no clinical or radiologic pulmonary findings. She was submitted successfully to an tuberculosis treatment protocol for nine months. CONCLUSIONS The authors point out the epidemiological importance of tuberculosis and the need for a higher degree of suspicion when dealing with uncommon upper airway lesions to make an early diagnosis.

Condutas terapêuticas para tratamento da Síndrome da Apnéia e Hipopnéia Obstrutiva do Sono (SAHOS) e da Síndrome da Resistência das vias Aéreas Superiores (SRvAS) com enfoque no Aparelho Anti-Ronco (AAR-ITO)

The authors present a literature review of the surgical and non-surgical treatment alternatives to the Obstructive Sleep Apnea and Hypopnea Syndrome (OSAHS) and snoring with focus in the mechanism of action and progress of mandibular advancement devices mainly in the dynamic action mechanism of the Mandibular Advancement Device® (MAD-ITO).

Manifestações otorrinolaringológicas em pacientes com dengue

Dengue is an acute fever disease caused by an arbovirus, and transmitted by the mosquito Aedes aegypti. Clinical picture usually starts with classic manifestations such as fever, myalgia, epistaxis, sore throat, vertigo and tinnitus. This disease has became a serious health public problem, reaching incidence rates of 50 to 70% in Rio de Janeiro State. AIM: Our objective was to evaluate patients with dengue, presenting otolaryngological symptoms as the first clinical manifestation. STUDY DESIGN: Longitudinal Cohort. MATERIAL AND METHOD: Thirty patients with serologically confirmed Dengue were included in this prospective study. RESULTS: The most important otolaryngological signs and symptoms were sore throat (60%), hyaline rhinorrhea (50%), nasal obstruction (46.6%), earache (36.6%), vertigo (20%), epistaxis (13.3%), tinnitus (6.6%), salivary gland diseases (6.6%) and bleeding gum (3.3%). CONCLUSIONS: In an epidemic situation, dengue must be suspected by the otolaryngologist, since this disease generally is followed by many otolaryngological manifestations.

Brazilian Academy of Rhinology position paper on topical intranasal therapy

This documents aims at educating those who treat sinonasal diseases - both general practitioners and specialists - about topical nasal treatments. By means of scientific evidence reviews, the Brazilian Academy of Rhinology provides its practical and updated guidelines on the most utilized topical nasal medication, except for the drugs that have topical antibiotics in their formulas.

Carcinoma folicular tireoideo metastático para ducto tireoglosso

The authors present a case of a female. 43-year-old patient. with a neck mass suggestive of a thyroglossal duct cyst. During the operation. a hard and adherent mass was found and the pathological findings demonstrated a metastatic follicular carcinoma. Despite of the negative image, total thyroidectomy was performed and a small primary tumor of 0,2cm was found in the left inferior lobe. There were only three of these cases reported.

An Unexpected Subglottic Foreign Body Diagnosed Two Years after Aspiration

A 56-year-old patient came to our hospital seeking treatment for his long-lasting condition. He presented with marked stridor, use of accessory musculature for breathing, and difficulty sleeping due to dyspnea. Treatment for asthma that had been initiated approximately 2 years before had not improved his condition. Therefore, his previous physician ordered computed tomography of his trachea, which revealed submucosal thickening in the subglottic region and the cervical trachea and a high-density lesion that touched the wall and occupied the lumen (Fig. 1). The patient was referred for treatment with corticosteroids and antibiotics, which also did not improve his condition. Because he did not feel better, he had independently searched for other medical assistance over the preceding 18 months. Interestingly, the patient had been a heavy drinker for the past 30 years. He could not report the specific starting point of his symptoms but only that they had gradually worsened. Based on the time of onset, the history of alcohol intake, and the high endemic rates of tuberculosis in our country, a diagnosis of a granulomatous infection of the upper airway was formulated. Because the clinical picture of the patient was critical, we opted to perform a tracheotomy with local anesthesia to obtain samples for microbiological cultures and histopathologic studies and to allow posterior ventilation. During the procedure, a solid, fixed structure was identified in the posterior wall of the trachea above the tracheotomy. Mobilizing the object was very painful for the patient with only local anesthesia so we interrupted the procedure and contacted the thoracic team. While waiting, we interrogated the patient specifically about episodes of aspiration. Only then did he report that he had lost a dental prosthesis after an episode of heavy drinking about the same time the symptoms began. With the thoracic team in the operating room, a cuffed tube was placed in the tracheotomy so that the lower airway was protected. A rigid bronchoscope was then inserted, which encountered large granulomas

Condroma de laringe: apresentação atípica

The authors report a case of laryngeal chondroma , a rare benign larynx tumor in the cricoid and arytenoid cartilages. There are aproximately 250 cases previously described in literature. A male, 41 year-old patient, presented a severe and progressive dyspnea leading to tracheostomy. Direct microlaryngoscopy revealed arytenoid enlargement and subglottic stenosis and the endoscopical biopsy was inconclusive, since the tumor present a hard gnistency. We performed surgical excision by laringofissura and total resection of the tumor, with good result. The histopathological examination showed a chondroma with no malignance.

P084: Nasal Obstruction and Vocal Nodules: A Possible Relationship

OBJECTIVES: To (1) compare the prevalence of hyperkinetic laryngeal features before and after successful correction in patients with unilateral vocal cord paralysis (UVCP), and (2) understand the glottal closure symptoms after surgical correction for UVCP. METHODS: Eighty-six patients with UVCP who had a successful surgical correction were enrolled in 2005 at Tri-Service general hospital. Preoperative and postoperative videolarygostroboscopic (VLS) pictures were analyzed and the muscle tension patterns (MTPs) were rated according to the MorrisonRammage classification. The incidence of MTPs was compared between patients before and after operation for UVCP. RESULTS: The four-item glottal closure index (vocal fatigue, voice crack, throat discomfort, and effortful speaking) was used for each patient on study entry. Data from 40 normal subjects were collected as the control group. The scores were obtained for two groups and compared with t-student test. There was no significant difference in MTPs prevalence before (57%) and after (55%) surgical correction for UVCP. Although the glottal closure symptoms were tremendously improved through surgical medialization for UVCP, they persisted and were more prevalent than those in normal individuals. CONCLUSIONS: Muscle tension patterns in patients with UVCP cannot be eliminated by successful medialization of the paralyzed cord. Persistence of MTPs after correction of UVCP may be due to intractable vocal habit or a psychogenic factor. The vocal fatigue cannot be completely eradicated through complete medialization of the paralyzed cord.

Corpos estranhos de seio maxilar

The authors present five cases of maxillary sinus foreign bodies, four of them (80%) originated from surgical problems. They discuss their findings, enphasizing the difficulty and the importance of early diagnosis and treatment. They recommend the use of tied gauze in the surgical procedures in the maxillary sinus.

Sinusite recorrente de causa incomum

The authors present a case of chronic recurrent sinusitis of rare etiology in a man submitted previously to a facial peeling. The computed tomography and the sinusal endoscopy revealed periorbital fat in the maxilary sinus. There was a history of old orbital floor fracture.