Sebastião Diógenes Pinheiro

Antrochoanal polyp: a review of sixteen cases

INTRODUCTION An Antrochoanal polyp, or Killians polyp is a benign solitary polypoid lesion that affects mainly children and young adults. Studies demonstrate that Killians polyp generally represents 4-6% of all nasal polyps. However, in the pediatric population this percentage reaches 33%. It originates from a hypertrophy of the mucous membrane on the maxillary sinus antrum, and it grows for unknown reasons, through the maxillary sinus ostium towards the nasal cavity and the choana--the posterior portion of the pharynx. AIM To evaluate the result of the surgical treatment on patients assisted in the Department of Otorhinolaryngology of the Walter Cantídio University Hospital-Medical School of the Federal University of Ceará, mainly on the surgical technique employed and the efficacy of each technique in controlling the disease. MATERIALS AND METHODS Retrospective study, accomplished through a chart analysis from the patients submitted to polypectomy because of Killians polyps or other nasal polyps, operated from March 1st, 1991 to April 30th of 2001, in the Department of Otorhinolaryngology of the Medical School of the Walter Cantídio University Hospital of the Federal University of Ceará. RESULTS Nine patient (56.6%) were males and 7 (43.8%) were females. Eleven (68.75%) patients were between 8 and 20 years of age. Predominant symptoms were unilateral nasal obstruction (81.3%) and purulent rhinorrhoea (43.8%). The most common procedure employed was the combined approach: external and endonasal, in 87.5% of the cases. Antrochoanal polyp removal procedure accounted for 21.6% of all the surgical procedures accomplished in the same period for the removal of nasal polyps. Postoperative recurrence was of 12.5%. CONCLUSIONS Antrochoanal polyp was an affection that prevailed among children and young adults. The combined external and endonasal approach was the one most used. Despite maxillary sinus approach to the polyp origin, postoperative recurrence is a possibility.

Bilateral antrochoanal polyps in an adult

Medical doctor, Ceara Fedral University. Medical resident in the Otorhinolaryngology Unit of the Walter Cantidio University Hospital, Medical School, Ceara Federal University.Send correspondence to: David Weber Sampaio Sousa - Rua Senador Paula Pessoa, 725, Bairro Cambeba, Fortaleza - CE, Brazil. CEP: 60822-200.Paper submitted to the BJORL-SGP (Publishing Management System – Brazilian Journal of Otorhinolaryngology) on May 4, 2010; and accepted on August 25, 2010. cod. 7066

Eficácia e segurança de Sultamicilina (Ampicilina/Sulbactam) e Amoxacilina/Clavulanato no tratamento das infecções de via aéreas superiores em adultos: um estudo multicêntrico, aberto e randomizado

Upper respiratory tract infections are the most common causes of medical visits in children and adults, demanding massive use of antibiotics. Bacterial resistance caused by beta-lactamase is one of the most serious problems in this matter. Sultamicillin, a double pro-drug of Ampicillin/Sulbactan, is a potent beta-lactamase inhibitor which can face this challenge. AIM: evaluate efficacy, safety and tolerability of Ampicillin/Sulbactan compared to Amoxicillin/Clavulanate in upper respiratory tract infections in adults. METHODS: 102 patients were enrolled and randomized to receive Ampicillin/Sulbactan or Amoxicillin/Clavulanate during 10 days. They were evaluated 10 and 30 days after treatment to learn about the therapeutic response. RESULTS: There were no differences between the two groups respecting cure at the end of treatment (visit 2) or at the end of the study (visit 3). Cure ratio was 61.7% and 93.2% (visits 2 and 3) in the Amoxicillin/Clavulanate group compared to 64.4% and 97.4%, respectively, in Ampicillin/Sulbactan group. The adverse events ratio for the two groups was the same (p=0.940). The number of patients with diarrhea was greater in the group of patients receiving Amoxicillin/Clavulanate (70.6%) than in the group receiving Ampicillin/Sulbactan (29.4%) (p=0.0164). CONCLUSIONS: Ampicillin/Sulbactan is as safe and efficient as Amoxicillin/Clavulanate in the empiric treatment of upper respiratory infections in adults. The low occurrence of diarrhea in the group receiving Ampicillin/Sulbactan needs confirmation in other studies.

Efficacy and safety of Sultamicillin (Ampicillin/Sulbactan) and Amoxicillin/Clavulanic Acid in the treatment of upper respiratory tract infections in adults: an open-label, multicentric, randomized trial

UNLABELLED Upper respiratory tract infections are the most common causes of medical visits in children and adults, demanding massive use of antibiotics. Bacterial resistance caused by beta-lactamase is one of the most serious problems in this matter. Sultamicillin, a double pro-drug of Ampicillin/Sulbactan, is a potent beta-lactamase inhibitor which can face this challenge. AIM Evaluate efficacy, safety and tolerability of Ampicillin/Sulbactan compared to Amoxicillin/Clavulanate in upper respiratory tract infections in adults. METHODS 102 patients were enrolled and randomized to receive Ampicillin/Sulbactan or Amoxicillin/Clavulanate during 10 days. They were evaluated 10 and 30 days after treatment to learn about the therapeutic response. RESULTS There were no differences between the two groups respecting cure at the end of treatment (visit 2) or at the end of the study (visit 3). Cure ratio was 61.7% and 93.2% (visits 2 and 3) in the Amoxicillin/Clavulanate group compared to 64.4% and 97.4%, respectively, in Ampicillin/Sulbactan group. The adverse events ratio for the two groups was the same (p=0.940). The number of patients with diarrhea was greater in the group of patients receiving Amoxicillin/Clavulanate (70.6%) than in the group receiving Ampicillin/Sulbactan (29.4%) (p=0.0164). CONCLUSIONS Ampicillin/Sulbactan is as safe and efficient as Amoxicillin/Clavulanate in the empiric treatment of upper respiratory infections in adults. The low occurrence of diarrhea in the group receiving Ampicillin/Sulbactan needs confirmation in other studies.

Nasal endoscopy and localization of the bleeding source in epistaxis: last decade's revolution.

UNLABELLED Epistaxis remains one of the most common otolaryngology emergencies. Despite considerable interest in the subject, there is still no consensus on the most appropriate primary therapeutic modality. AIM The purpose of this study was to evaluate the bleeding source of acute or recurrent epistaxis in adults. STUDY DESIGN Clinical prospective. MATERIAL AND METHOD Thirty adults patients with acute or recurrent epistaxis were evaluated through the use of frontal light and endoscope for identification of the bleeding source in the nasal cavity. RESULTS Use of the nasal endoscope allowed diagnosis of the bleeding site in all patients. CONCLUSION A careful examination of the posterior nasal cavity allows identification of the bleeding source in most patients and should be a routine procedure.

Endoscopia nasal e a localização do sítio de sangramento na epistaxe: a revolução da última década

Epistaxis remains one of the most common otolaryngology emergencies. Despite considerable interest in the subject, there is still no consensus on the most appropriate primary therapeutic modality. AIM: The purpose of this study was to evaluate the bleeding source of acute or recurrent epistaxis in adults. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: Thirty adults patients with acute or recurrent epistaxis were evaluated through the use of frontal light and endoscope for identification of the bleeding source in the nasal cavity. RESULTS: Use of the nasal endoscope allowed diagnosis of the bleeding site in all patients. CONCLUSION: A careful examination of the posterior nasal cavity allows identification of the bleeding source in most patients and should be a routine procedure.

Sinonasal inverted papilloma involving the middle ear and the mastoid.

Titulo de especialista em Otorrinolaringologia pela Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial (Medico Assistente do Servico de Otorrinolaringologia do Hospital Universitario Walter Cantidio da Faculdade de Medicina da Universidade Federal do Ceara).Endereco para correspondencia: Jonatas Lopes Barbosa. Rua Marcondes Pereira, no 987, Dionisio Torres. Fortaleza - CE. CEP: 60130-060.Este artigo foi submetido no SGP (Sistema de Gestao de Publicacoes) da BJORL em 17 de outubro de 2011. cod. 8846.Artigo aceito em 1 de julho de 2012.

A rare case of chronic stridor and dysphonia in an adult patient

1 MD (resident). Graduated at the Federal University of Ceará (Resident at the ENT service of the Walter Cantídio University Hospital of the Federal University of Ceará). 2 PhD in Medicine at the Medical School of the University of São Paulo (Adjunct Professor in the Department of Surgery of the Medical School of the Federal University of Ceará). 3 Specialist in Head and Neck Surgery, Peroral Endoscopy, and Otorhinolaryngology (Assistant Professor in the Department of Surgery of the Medical School of the Federal University of Ceará and Head of the ENT Service of the Walter Cantídio University Hospital). 4 PhD in Medicine at the Medical School of the University of São Paulo (Associate Professor in the Department of Surgery of the Medical School of the Federal University of Ceará). Send correspondence to: Rua Barbosa de Freitas, 1824, apto 601. Bairro Aldeota. Fortaleza CE. CEP: 60170021. Paper submitted to the BJORL-SGP (Publishing Management System – Brazilian Journal of Otorhinolaryngology) on December 13, 2010; and accepted on January 4, 2011. Cod. 7466. CASE REPORT Braz J Otorhinolaryngol. 2012;78(2):135. BJORL

Mastoidectomy: anatomical parameters x surgical difficulty

Introduction: The lowered temporal meninges and/ or anterior sigmoid sinus are contiditions that can determine surgical difficulties in performing mastoidectomy. Objective: To correlate in the tomography the extent of the prolapse of the sigmoid sinus and of temporal meninges with the surgical difficulty in the mastoidectomy. Method: The tomographic measurements of prolapse sigmoid and of temporal meninges were correlated with the presence or non-presence of the surgical difficulty observed during the mastoidectomy procedure in patients with ostomatoiditis chronic (n = 30). Form of study: Contemporary cohort transverse. Results: In 10 patients were observed surgical difficulty distributed as: due to prolapse of the sigmoid sinus (n = 2) or temporal meninges prolapse (n = 7) or both (n = 1). In patients in which the surgical difficulty was due to sigmoid sinus prolapse, the tomography distance of the anterior border of the sigmoid sinus to posterior wall of external auditory canal was lower than 9 mm. In patients in which surgical difficulty was due to temporal meninges prolapse, the tomographic distance to the upper plane of the petrous bone was 7 mm. Conclusion: The computerized tomography distance between the temporal meninges and the upper plane of the petrous bone 7 mm and the distance of the anterior border of the sigmoid sinus to posterior wall of external auditory canal was lower than 9 mm are predictive to the surgical difficulties to perform mastoidectomy.INTRODUCTION: The lowered temporal meninges and/ or anterior sigmoid sinus are contiditions that can determine surgical difficulties in performing mastoidectomy. OBJECTIVE: To correlate in the tomography the extent of the prolapse of the sigmoid sinus and of temporal meninges with the surgical difficulty in the mastoidectomy. METHOD: The tomographic measurements of prolapse sigmoid and of temporal meninges were correlated with the presence or non-presence of the surgical difficulty observed during the mastoidectomy procedure in patients with ostomatoiditis chronic (n=30). FORM OF STUDY: Contemporary cohort transverse. RESULTS: In 10 patients were observed surgical difficulty distributed as: due to prolapse of the sigmoid sinus (n = 2) or temporal meninges prolapse (n = 7) or both (n = 1). In patients in which the surgical difficulty was due to sigmoid sinus prolapse, the tomography distance of the anterior border of the sigmoid sinus to posterior wall of external auditory canal was lower than 9 mm. In patients in which surgical difficulty was due to temporal meninges prolapse, the tomographic distance to the upper plane of the petrous bone was 7 mm. CONCLUSION: The computerized tomography distance between the temporal meninges and the upper plane of the petrous bone 7 mm and the distance of the anterior border of the sigmoid sinus to posterior wall of external auditory canal was lower than 9 mm are predictive to the surgical difficulties to perform mastoidectomy.

Case ReportSinonasal inverted papilloma involving the middle ear and the mastoid

Titulo de especialista em Otorrinolaringologia pela Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial (Medico Assistente do Servico de Otorrinolaringologia do Hospital Universitario Walter Cantidio da Faculdade de Medicina da Universidade Federal do Ceara).Endereco para correspondencia: Jonatas Lopes Barbosa. Rua Marcondes Pereira, no 987, Dionisio Torres. Fortaleza - CE. CEP: 60130-060.Este artigo foi submetido no SGP (Sistema de Gestao de Publicacoes) da BJORL em 17 de outubro de 2011. cod. 8846.Artigo aceito em 1 de julho de 2012.