Sady S. da Costa

Some considerations about acquired adult and pediatric cholesteatomas

Authors debate about cholesteatomas, from the first time this word was employed, by Muller, in 1838, until the recent updates. They dissert about its definition, etiology and pathology and present basic concepts about its biology. They also make a wide review about pediatric cholesteatoma, its epidemiology and biology, and compare it with adult cholesteatoma. Finally, they describe some articles about ossicle chain erosion and its correlation with cholesteatoma perimatrix, collagen and collagenase.

Prevalência de bactérias em crianças com otite média com efusão

OBJETIVOS: 1) Determinar a prevalencia do Streptococcus pneumoniae, Haemophilus influenzae e Moraxella catarrhalis nas efusoes de orelha media de criancas com otite media com efusao que foram submetidas a miringotomia; 2) comparar os resultados obtidos por cultura e PCR; e 3) determinar o perfil de resistencia a penicilina dos germes isolados. METODOS: Analisaram-se 128 amostras de efusoes de orelha media de 75 criancas entre 11 meses e 10 anos de idade (media = 34,7 meses). Pacientes com otite media recorrente tinham efusao documentada por > 6 semanas e aqueles com otite media com efusao cronica, por > 3 meses. Os pacientes nao tinham sinais de otite media aguda ou infeccao do trato respiratorio e nao estavam sob antibioticoterapia no momento do procedimento. A aspiracao do material foi realizada por timpanocentese, utilizando-se um coletor de Alden-Senturia. Os estudos bacteriologicos foram iniciados menos de 15 minutos apos a obtencao da efusao, e uma parte da amostra foi armazenada a -20 oC para analise posterior pela PCR. Utilizou-se um metodo de PCR simultânea para a deteccao de tres patogenos. A analise estatistica foi efetivada com o teste c2 de McNemar. RESULTADOS: Cultivaram-se bacterias em 32 (25,1%) das 128 amostras e os patogenos principais foram encontrados em 25 (19,6%). A PCR identificou bacterias em 73 (57,0%) das amostras, e os resultados positivos foram: 50 (39,1%) para H. influenzae, 16 (12,5%) para S. pneumoniae e 13 (10,2%) para M. catarrhalis. Todas as amostras positivas por cultura foram positivas pela PCR, mas 48 (65,7%) das efusoes com resultado positivo pela PCR foram negativas por cultura para os germes estudados. A PCR foi significativamente mais sensivel que a cultura (p < 0,001). Quanto ao perfil de resistencia, 100% das M. catarrhalis, 62,5% dos S. pneumoniae e 23% dos H. influenzae eram resistentes a penicilina. CONCLUSOES: A prevalencia das bacterias na otite media com efusao em um grupo de criancas brasileiras e semelhante aquelas relatadas em outros paises, sendo o H. influenzae o mais encontrado dentre os patogenos principais da orelha media. Essa prevalencia sugere que bacterias podem desempenhar um papel na patogenese da otite media com efusao. Os resultados mostram que a PCR e mais sensivel na deteccao de bacterias na efusao da orelha media quando comparada com cultura. A resistencia a penicilina por parte do pneumococo e da moraxela e semelhante a relatada em outros paises, ao passo que a producao de b-lactamase pelo hemofilo e mais baixa que aquela referida em bacterias isoladas em amostras de efusoes de otite media com efusao.

Contralateral Ear in Chronic Otitis Media: A Histologic Study†

Objective: The objective of this study is to determine the prevalence of the contralateral ear changes in human temporal bones of donors with chronic otitis media.

A computational method for the semi-automated quantitative analysis of tympanic membrane perforations and tympanosclerosis

Tympanic membrane pathological findings such as perforations and tympanosclerotic plaques (along with conductive hearing loss and purulent drainage) are the most typical trademarks of either active or burned-out chronic otitis media. These findings are normally evaluated by an expert using visual subjective analysis. In this work, we present a computational semi-automated method to quantify these pathologies. We also present a validation study of the method using a subset of 39 cases randomly extracted from a set of more than 2000 cases (perforations and tympanosclerosis) of the Hospital de Clínicas de Porto Alegre. The validation was performed using Ground Truth images, generated by experts, and has shown promising results.

Computational Techniques for Accompaniment and Measuring of Otology Pathologies

The following article presents a computational methodology to assist the assessment of tympanic pathologies, particularly chronic otitis media, based on digital otoscopic images. A computational system which implements the methodology is described. This approach does not impose additional effort to the acquisition protocol and diagnosis of tympanic pathologies. In preliminary tests, it has shown precision and easiness of use. The presented methodology and system were tested by the Otitis Media Center of Brazil (Com.Br) with a case base of 660 patients, resulting in 1320 bilateral tympanic images.

Punção aspirativa por agulha fina em tumores cervicais

Introduction: countless diseases can initially present as a neck lump, what turns its diagnosis not always easy. The fine-needle aspiration biopsy (FNAB) is a simple, safe and effective method in helping the diagnosis of neck lumps. Aim: evaluate the diagnostic performance of FNAB in neck lumps accomplished in the Otorhinolaryngology Department of the Hospital de Clinicas de Porto Alegre (HCPA). Study design: Retrospective, clinical, not randomized. Material and method: a retrospective study of 72 patients submitted to FNAB in SORL of HCPA between July, 1998 and December 1999. Patients1 submitted to thyroid FNAB2,with incomplete data3 without follow-up and4 without definitive diagnosis of the lesion were excluded. The results of FNAB were compared with the definitive diagnosis, established by histopathologic exam (group I) or for clinical evolution or laboratory exams (group II). Results: 70 patients were included in the study, 7% presented unsatisfactory FNAB and, among the satisfactory materials, there were 88,6% of correct diagnosis. In group I it was found 8% of unsatisfactory FNAB and 88,2% of correct diagnosis, while in group II, 6% and 87,1%, respectively. The total index of success, including the unsatisfactory FNAB was 81,5%. Discussion: results confirm the high index of success diagnosis of FNAB described in the literature, confirming that this is a helpful method in diagnostic of neck lump. Like this, we are encouraged ourselves to follow using such procedure as a routine.

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.

Audiological Evaluation of the Contralateral Ear in Patients with Cholesteatoma

Objectives: Evaluate the contralateral ear (CLE) audiometric findings in patients with middle ear cholesteatoma. (2) Correlate the audiometric thresholds to videotoscopic findings. Methods: Cross-sectional study. Videotoscopies and audiometries of 300 patients with cholesteatoma at a tertiary hospital were analyzed. The CLE videotoscopy, bone conduction, air conduction, and air-bone gap pure tone average (PTA) were analyzed. Results: The mean patient age was 32.35 ± 19.26 years, and 52.2% were female. The CLE was abnormal in 60.8% of cases: 5.6% had perforation, 39.9% had moderate or severe retraction, and 15.6% had cholesteatoma. The CLE bone conduction PTA was 16.75 ± 16.1 dB, the air conduction PTA was 47.1 ± 22.8 dB, and the air-bone gap PTA was 32.2 ± 18.7 dB. The CLE prevalence of severe and profound sensorineural hearing loss was 1.7%. Severe hearing impairment did not occur in patients with a normal CLE, whereas it did occur in 2.7% of patients with an abnormal CLE (P = .02). Bone conduction PTA was similar between normal and abnormal CLE (P = .82), but the air conduction and air-bone gap PTA were higher in abnormal CLE (P < .001 and P < .001, respectively). Conclusions: In patients with cholesteatoma, the CLE had a high prevalence of abnormalities and hearing impairment. Severe and profound sensorineural hearing loss was only observed in abnormal CLE. The air bone gap and air conduction PTA were also higher in the abnormal CLE.

Cholesteatoma in Children: An Overview

Objectives: Describe in children: (1) cholesteatoma growth patterns; (2) conductive hearing loss severity; (3) contralateral ear (CLE) findings. Methods: Cross-sectional study. Videotoscopies of 129 pediatric patients at a tertiary care hospital were analyzed for cholesteatoma growth patterns, air-bone gap, and CLE otoscopic findings. Data were compared with the chi-squared test and analyzed using SPSS. Results: The mean patient age was 12.4 ± 4.36 years. The cholesteatoma growth patterns were anterior epitympanic cholesteatomas (5.4%), posterior epitympanic (21.7%), posterior mesotympanic (43.4%), 2 routes pattern (17.1%), and undetermined (12.4%). The pure tone average air-bone gap (PTA-ABG) was ≤20 dB in 8.7% of patients, between 20 to 40 dB in 43.4% of patients, and ≥40 dB in 47.9%. The CLE was normal in 34.9% of patients and had moderate or severe tympanic membrane (TM) retractions in 46.5%, TM perforation in 7.8%, and cholesteatoma in 10.9% of patients. The CLE disease prevalence was similar between the groups, except in anterior epitympanic group, which had normal CLE (P = .004). Conclusions: Posterior mesotympanic cholesteatomas were the most prevalent in the study population. Most patients had a PTA-ABG greater than 20 dB, and the most prevalent CLE abnormalities were moderate or severe TM retraction and cholesteatoma. The CLE of patients diagnosed with anterior epitympanic cholesteatoma were normal, suggesting a probable congenital origin.

Ossicular Erosion and Air-Bone Gap in Attic and Tensa Cholesteatomas

Objectives: (1) Compare the air-bone gap between patients with posterior epitympanic (attic) and posterior mesotympanic (tensa) cholesteatomas. (2) Correlate the air-bone gap and intraoperative ossicular chain findings. Methods: Cross-sectional study. In total, 262 patients with attic and tensa cholesteatomas treated at a tertiary hospital were included. Audiometry was performed, and the pure tone average air-bone gap (PTA-ABG) was compared between the 2 groups. In addition, ossicles were classified as normal, eroded, or absent based on intraoperative evaluation. Data were compared using the Mann-Whitney and Chi-square tests, and statistical analysis was performed using SPSS. Results: Attic cholesteatoma was diagnosed in 51.1% of patients and tensa cholesteatoma in 48.9%. The mean patient age was 33 ± 18.7 years, and 52.3% were male patients. The PTA-ABG was higher in tensa cholesteatoma cases than in attic cholesteatoma (30.25 ± 12.82 dB and 26.73 ± 13.08 dB, respectively, P = .031). There were no differences in the malleus erosion or absence prevalence and the stapes suprastructure prevalence (P = .09 and P = .17, respectively). The incus was normal in 17.6% of the attic and 6.3% of tensa cholesteatoma cases; eroded in 79.4% of tensa and 48.6% of attic cases; and absent in 33.8% of attic and 14.3% of tensa cholesteatoma cases (P < .01). Conclusions: The PTA-ABG was higher in tensa cholesteatoma cases and correlated with a lower normal incus prevalence and a higher eroded incus prevalence compared to attic cholesteatoma cases.