Showing papers in "International Archives of Otorhinolaryngology in 2013"
TL;DR: Laryngoscopy and pH monitoring have failed as reliable tests for the diagnosis of LPR and further research is needed to develop a definitive diagnostic test for LPR.
Abstract: Introduction Laryngopharyngeal reflux (LPR) is a highly prevalent disease and commonly encountered in the otolaryngologist's office. Objective To review the literature on the diagnosis and treatment of LPR. Data Synthesis LPR is associated with symptoms of laryngeal irritation such as throat clearing, coughing, and hoarseness. The main diagnostic methods currently used are laryngoscopy and pH monitoring. The most common laryngoscopic signs are redness and swelling of the throat. However, these findings are not specific of LPR and may be related to other causes or can even be found in healthy individuals. Furthermore, the role of pH monitoring in the diagnosis of LPR is controversial. A therapeutic trial with proton pump inhibitors (PPIs) has been suggested to be cost-effective and useful for the diagnosis of LPR. However, the recommendations of PPI therapy for patients with a suspicion of LPR are based on the results of uncontrolled studies, and high placebo response rates suggest a much more complex and multifactorial pathophysiology of LPR than simple acid reflux. Molecular studies have tried to identify biomarkers of reflux such as interleukins, carbonic anhydrase, E-cadherin, and mucin. Conclusion Laryngoscopy and pH monitoring have failed as reliable tests for the diagnosis of LPR. Empirical therapy with PPIs is widely accepted as a diagnostic test and for the treatment of LPR. However, further research is needed to develop a definitive diagnostic test for LPR.
99 citations
TL;DR: Hearing loss was the first symptom reported in almost all cases, and tumor size was not proportional to the impairment of the auditory threshold, so the retrolabyrinthine route proved useful in small tumors, with 50% preservation of hearing.
Abstract: Introduction: Acoustic nerve tumors have been recognized as a clinico-pathologic entity for at least 200 years, and they represent 90% of cerebellopontine angle diseases. Histologically, the tumors are derived from Schwann cells of the myelin sheath, with smaller tumors consisting of elongated palisade cells, while in large tumors, cystic degeneration can be found in the central areas, possibly due to deficient vascularization. We retrospectively reviewed 825 cases of vestibular schwannomas, reported between January 1984 and August 2006, in which the patients underwent surgery to remove the tumor. Objective: To evaluate signs, symptoms, aspects of clinical diagnosis, including the results of audiological and imaging studies, and surgical techniques and complications. Methods: A retrospective chart review. The medical records of all patients undergoing surgical treatment for schwannoma during the period indicated were reviewed. Results and Conclusion: Hearing loss was the first symptom reported in almost all cases, and tumor size was not proportional to the impairment of the auditory threshold. The surgical techniques allowed safe preservation of facial function. In particular, the retrolabyrinthine route proved useful in small tumors, with 50% preservation of hearing.
41 citations
TL;DR: In this paper, the authors describe a case of remote fitting between two cities, with revision of the literature, and describe how three audiologists were remotely trained on how to fit the hearing aids.
Abstract: Introduction: Currently, the Brazilian government has certificated nearly 140 specialized centers in hearing aid fittings through the Brazilian National Health System (SUS). Remote fitting through the Internet can allow a broader and more efficient coverage with a higher likelihood of success for patients covered by the SUS, as they can receive fittings from their own homes instead of going to the few and distant specialized centers. Aim: To describe a case of remote fitting between 2 cities, with revision of the literature. Method: Computer gears, a universal interface, and hearing aids were used. Case study: An audiologist located in a specialized center introduced a new hearing aid and its fitting procedure to a remote center (200 km away). The specialized center helped the remote center in fitting a hearing aid in 2 patients, and performed fitting in one of its own patients. The whole process was done through the Internet with audio and video in real time. Results: Three patients were fitted remotely. Three audiologists were remotely trained on how to fit the hearing aids. Conclusions: Remote fitting of hearing aids is possible through the Internet, as well as further supplying technical training to a remote center about the fitting procedures. Such a technological approach can help the government advance public policies on hearing rehabilitation, as patients can be motivated about maintaining their use of hearing aids with the option to ask for help in the comfort of their own homes.
28 citations
TL;DR: Facial asymmetries are very common in patients seeking rhinoplasty, and special attention should be paid to these aspects both for surgical planning and for counseling of patients.
Abstract: INTRODUCAO: Proporcoes antropometricas e simetria sao consideradas determinantes de beleza. Tais parâmetros tem importância significativa em cirurgia plastica facial, notadamente na Rinoplastia. Sendo o nariz o orgao central da face, ele tem especial importância na determinacao da simetria facial, tanto atraves da percepcao de um nariz torto quanto atraves da determinacao do crescimento facial. A avaliacao da presenca de assimetrias faciais tem grande relevância no pre-operatorio, tanto para planejamento cirurgico quanto aconselhamento. OBJETIVO: Avaliar e documentar a presenca de assimetria facial em pacientes com plano de Rinoplastia e correlacionar as medidas antropometricas com percepcao de assimetria ou simetria facial, avaliando se ha uma maior prevalencia de assimetria facial entre esses pacientes em comparacao com voluntarios sem queixa nasal. METODO: trabalho prospectivo, realizado atraves de comparacao de fotografias, em pacientes com Pre-operatorio de Rinoplastia e voluntarios (controles), n=201, atraves de controle de medidas antropometricas tomadas de uma linha passando pelo centro da face, ate: tragus, canto medial, canto lateral, margem alar, e comissura oral, de cada lado da face, por meio de testes estatisticos (teste Z e Odds ratio). RESULTADOS: Nenhum dos pacientes ou voluntarios apresentou valores totalmente simetricos. Subjetivamente, 59% dos pacientes foram percebidos como assimetricos, contra 54%dos voluntarios. Objetivamente, mais de 89% dos pesquisados tiveram medidas assimetricas. Os pacientes apresentaram RLMTr (Razao Linha Media Tragus) mais assimetrica que os voluntarios, com diferenca estatisticamente significativa. DISCUSSAO/CONCLUSAO: assimetrias faciais sao muito frequentes em pacientes que procuram Rinoplastia, portanto, especial atencao deve ser dada a estes aspectos, tanto para o planejamento cirurgico, quanto para orientacao aos pacientes.
26 citations
TL;DR: This new variation of the VEMP procedure may supplement conventional testing in difficult to test populations and may also be possible to use this technique to evaluate previously inaccessible information on the vestibular system.
Abstract: Introduction Diagnostic testing of the vestibular system is an essential component of treating patients with balance dysfunction. Until recently, testing methods primarily evaluated the integrity of the horizontal semicircular canal, which is only a portion of the vestibular system. Recent advances in technology have afforded clinicians the ability to assess otolith function through vestibular evoked myogenic potential (VEMP) testing. VEMP testing from the inferior extraocular muscles of the eye has been the subject of interest of recent research. Objective To summarize recent developments in ocular VEMP testing. Results Recent studies suggest that the ocular VEMP is produced by otolith afferents in the superior division of the vestibular nerve. The ocular VEMP is a short latency potential, composed of extraocular myogenic responses activated by sound stimulation and registered by surface electromyography via ipsilateral otolithic and contralateral extraocular muscle activation. The inferior oblique muscle is the most superficial of the six extraocular muscles responsible for eye movement. Therefore, measurement of ocular VEMPs can be performed easily by using surface electrodes on the skin below the eyes contralateral to the stimulated side. Conclusion This new variation of the VEMP procedure may supplement conventional testing in difficult to test populations. It may also be possible to use this technique to evaluate previously inaccessible information on the vestibular system.
25 citations
TL;DR: Mixed loss was the most common type of hearing loss among the studies; however, there was no consensus among studies regarding the degree of the hearing loss.
Abstract: Introduction Branchio-oto-renal (BOR) syndrome is an autosomal-dominant genetic condition with high penetrance and variable expressivity, with an estimated prevalence of 1 in 40,000. Approximately 40% of the patients with the syndrome have mutations in the gene EYA1, located at chromosomal region 8q13.3, and 5% have mutations in the gene SIX5 in chromosome region 19q13. The phenotype of this syndrome is characterized by preauricular fistulas; structural malformations of the external, middle, and inner ears; branchial fistulas; renal disorders; cleft palate; and variable type and degree of hearing loss. Aim Hearing loss is part of BOR syndrome phenotype. The aim of this study was to present a literature review on the anatomical aspects and audiological profile of BOR syndrome. Data Synthesis Thirty-four studies were selected for analysis. Some aspects when specifying the phenotype of BOR syndrome are controversial, especially those issues related to the audiological profile in which there was variability on auditory standard, hearing loss progression, and type and degree of the hearing loss. Mixed loss was the most common type of hearing loss among the studies; however, there was no consensus among studies regarding the degree of the hearing loss.
23 citations
TL;DR: The human cadaveric temporal bone is ideal simulator for training in otology because a novice surgeon not only needs exposure to surgical anatomy and it's variations but also needs to develop hand-eye coordination skills to gain expertise.
Abstract: Introduction Traditionally, surgical training in otology, is imparted by dissecting harvested human cadaveric temporal bones. However, maintenance of a cadaveric temporal bone laboratory is expensive and carries risk of exposure to infection. In recent times, other modalities of training are gaining ground and are likely to eventually replace cadaveric temporal bone dissection altogether. Objectives Other alternative methods of training are emerging. New technology like simulation and virtual reality as high-fidelity, safer alternatives, are making rapid strides as teaching tools. Other options are the use of animal temporal bones as teaching tools. The advantages of these are compared. Data Synthesis None of these modalities can replicate the innumerable anatomical variations which are a characteristic feature of the human temporal bone. A novice surgeon not only needs exposure to surgical anatomy and it's variations but also needs to develop hand-eye coordination skills to gain expertise. Conclusion Deliberate practice on human cadaveric temporal bones only, will confer both mastery in anatomy and surgical technique. The human cadaveric temporal bone is ideal simulator for training in otology.
22 citations
TL;DR: BAHA is a better treatment option than reconstructive surgery for patients with bilateral deafness and is a relatively simple surgical procedure with few complications and good hearing results.
Abstract: Introduction: The bone-anchored hearing aid (BAHA) is a bone conduction hearing device that transmits sound directly into the inner ear. It is mainly used in patients with conductive hearing loss associated with aural atresia, but it is also used in those with mixed and sensorineural hearing loss. Goals: To review the main indications for BAHA, to analyze the audiometric results and its benefits for patients and compare them with other treatment modalities, and to compare the literature data with our sample of 13 patients. Method: The research was performed using a database covering works in English, Spanish, and Portuguese, with no limitations in the years when the procedures were performed. We compared the literature data with our results for the 13 patients who underwent BAHA implantation between the years 2000 and 2009. Results: Most of the studies showed that BAHA has great advantages over reconstructive surgery in terms of hearing results, complications, and disease recurrence. The postoperative results for our 13 patients were satisfactory and comparable with the results from the literature, with closure of the air-bone gap in 7 patients and achieving an air-bone gap of 10 dB in 6 patients. No postoperative complications were observed. Conclusion: BAHA is a better treatment option than reconstructive surgery for patients with bilateral deafness. It is a relatively simple surgical procedure with few complications and good hearing results. Recent studies have examined its use in conductive and unilateral sensorineural hearing loss.
21 citations
TL;DR: There are peculiarities in the patients' swallowing with chronic cough that, although not presenting complaints relating to swallowing, it presents an important aspiration risk due to the presence of changes in breathing pattern that can intervene in the coordination between breathing and swallowing, which is essential to protect the lower airway.
Abstract: Introduction: The act of swallowing depends on a complex and dynamic process which uses common structures to the act of breathing; respiratory problems can cause swallowing difficulties. Aim: To assess the swallowing pharyngeal phase in patients with chronic cough. Method: Retrospective study with 15 patients of both genders, patients with chronic cough and risk factors for aspiration defined by the pneumologic diagnosis. The patients were submitted to anamnesis on complaints related to swallowing, chewing and breathing, or related to food and to videofluoroscopic examination. Results: It was observed that 33.3% had normal and functional swallowing, being the last one of most prevalence. The mild dysphagia was observed in 20% of the patients, the mild to moderate dysphagia in 6.7% of them. In relation to the Rosenbek scale, 73.3% of patients presented degree 1, 6.7% presented degrees 2 and 3, and 13.3% presented degree 8. The most found pathology was the chronic cough with 40%, followed by asthma with 20%; 69.2% of patients presented stasis and of these, five used protection maneuvers, of these, seven were effective and only three were used in the presence of stasis. The most used maneuver was the multiple swallowing, being effective in 100%. Conclusion: There are peculiarities in the patients' swallowing with chronic cough that, although not presenting complaints relating to swallowing, it presents an important aspiration risk due to the presence of changes in breathing pattern that can intervene in the coordination between breathing and swallowing, which is essential to protect the lower airway.
20 citations
TL;DR: Considering that PAIR is preventable, justifies the importance of coordinated and multidisciplinary involving not only health teams and safety, but also the institutions involved in preserving the health of workers, as the team SESMET, unions or prosecutors.
Abstract: Introduction: Work-related hearing loss is one of the most common occupational illness progresses over the years of noise exposure associated with the work environment, may cause damage to undertake physical activity, the individual's physiological and mental besides causing hearing damage irreversible interfering with communication and quality of life. With high prevalence of male evaluates which is the second leading cause of hearing loss. Since there is no medical treatment for this type of hearing loss, it is evident the importance of preventive and conferences aimed at preserving hearing and health as a whole. Objective: To assess the prevalence of hearing loss in audiometry admission of drivers. Methods: Retrospective study. By 76 charts of professional drivers in leased transport companies. We analyzed data from specific interview and pure tone audiometry. Results: The prevalence of abnormal tests was 22.36% with the lowest thresholds for tritonal average of 3,000, 4,000 and 6,000 Hz. The higher the age, the higher thresholds. Conclusion: This study has highlighted the occurrence of hearing in the absence of complaints. Considering that PAIR is preventable, justifies the importance of coordinated and multidisciplinary involving not only health teams and safety, but also the institutions involved in preserving the health of workers, as the team SESMET, unions or prosecutors.
20 citations
TL;DR: Dysphagia was prevalent when a lesion was located in the cerebral cortex and was of the ischemic type and in the clinical evaluation of dysphagia in patients with stroke in relation to the type and location of stroke.
Abstract: 1) Speech Therapist. Student Doctorate in Internal Medicine from the Universidade Federal do Parana (HC-UFPR). Professor of the Specialization Course on Dysphagiaand Voice of the University Tuiuti do Parana – Curitiba/PR.2) Geriatrician. Doctor of Sciences from the UNIFESP / EPM. Professor of Masters and Doctorate in Communication Disorders at the University Tuiuti - Curitiba/PR.3) Speech Therapist. Student Doctorate in Internal Medicine from the Universidade Federal do Parana (HC-UFPR). Professor of Mast ers and Doctorate in CommunicationDisorders at the University Tuiuti - Curitiba/PR.4) Speech Therapist. Doctor in Human Communication Disorders from the Federal University of Sao Paulo. Professor of Speech Patho logy, Federal University of SantaCatarina/SC.5) Speech Therapist. Doctor in Linguistics from the Universidade Federal do Parana (UFPR). Professor of Masters and Doctorate in Communication Disorders at the UniversityTuiuti - Curitiba/PR.6) Speech Therapist. Student Master in Internal Medicine from the Universidade Federal do Parana (HC-UFPR) - Curitiba/PR.7) Neurologist. Doctor in Internal Medicine from the Universidade Federal do Parana (HC-UFPR) - Curitiba/PR.Institution: Universidade Tuiuti do Parana.Curitiba/PR - Brazil.Mailing address: Maria Cristina de Alencar Nunes - Travessa Capitao Clementino Parana, 130 - Apt. 171 - Bloco B - Bairro Agua V erde - Curitiba/PR - Brazil - Zip code:80620-180 - E-mail: mcrisnunes@yahoo.com.brArticle received in October 8, 2011. Article approved in May 8, 2012.
TL;DR: Based on several studies, cochlear implants were demonstrated to be the best current alternative for bilateral severe or profound hearing loss, achieving better results in speech perception and development in prelingual children when compared to conventional hearing aids.
Abstract: Introduction: The majority of patients with hearing loss, including those with severe hearing loss, benefits from the use of hearing aids The cochlear implant is believed to achieve better results in a child with hearing loss in cases where the severity of disability renders hearing aids incapable of providing adequate sound information, as they require sufficient cochlear reserve so that acoustic detention occurs Objective: To assess if cochlear implants provide more benefit than conventional hearing aids in prelingually deaf patients Summary of the findings: The study was a systematic review of scientific papers selected by a search of the SciELO, Cochrane, MEDLINE, and LILACS-BIREME databases Among the 2169 articles found, 12 studies proved relevant to the issue and presented an evidence strength rating of B No publications rated evidence strength A Seven of the studies analyzed were prospective cohorts and 5 were cross-sectional studies Conclusion: Based on several studies, cochlear implants were demonstrated to be the best current alternative for bilateral severe or profound hearing loss, achieving better results in speech perception and development in prelingual children when compared to conventional hearing aids
TL;DR: V Vestibular rehabilitation was an effective method for the treatment of patients with BPPV and MD; it improves quality of life and shows the maximal influence on physical aspect scores, regardless of age or gender.
Abstract: Introduction: Vertigo is a symptom that impacts the patients' quality of life and may force them to cease performing activities of daily living. Here, we discuss benign paroxysmal positional vertigo (BPPV) and Meniere's disease (MD), which show exacerbated symptoms when they appear in association. Vestibular rehabilitation (VR) is an effective treatment in reducing vertigo, especially in conjunction with other therapies. Aim: To evaluate the quality of life of patients with BPPV and MD before and after VR. Method: We conducted a descriptive observational qualitative and quantitative case study with 12 patients aged 35 to 86 years. All patients diagnosed with BPPV and MD received treatment in the ENT clinic. The Brazilian DHI questionnaire, which assesses the quality of life with a focus on physical, emotional, and functional aspects, was used for data collection, and was completed by patients before the first session and after the fifth session of VR. Data were tested using the Shapiro-Wilk normality test, followed by Wilcoxon, Friedman, and Spearman correlation tests (p Results: There were significant improvements in scores for all aspects, with median changes ranging from 12 to 0 in the physical, 6 to 1 in the emotional, and 11 to 1 in the functional aspect. There were no correlations between the scores and sample characteristics. Conclusion: VR was an effective method for the treatment of patients with BPPV and MD; it improves quality of life and shows the maximal influence on physical aspect scores, regardless of age or gender.
TL;DR: The 1,000-Hz tone test has greater sensitivity and specificity for the correct identification of tympanometric curve changes, however, it is necessary to clarify the doubts that still exist regarding the use of this test frequency.
Abstract: Introduction For infants under 6 months, the literature recommends 1,000-Hz tympanometry, which has a greater sensitivity for the correct identification of middle ear disorders in this population. Objective To systematically analyze national and international publications found in electronic databases that used tympanometry with 226-Hz and 1,000-Hz probe tones. Data Synthesis Initially, we identified 36 articles in the SciELO database, 11 in the Latin American and Caribbean Literature on the Health Sciences (LILACS) database, 199 in MEDLINE, 0 in the Cochrane database, 16 in ISI Web of Knowledge, and 185 in the Scopus database. We excluded 433 articles because they did not fit the selection criteria, leaving 14 publications that were analyzed in their entirety. Conclusions The 1,000-Hz tone test has greater sensitivity and specificity for the correct identification of tympanometric curve changes. However, it is necessary to clarify the doubts that still exist regarding the use of this test frequency. Improved methods for rating curves, standardization of normality criteria, and the types of curves found in infants should be addressed.
TL;DR: In this opinion, unilateral and bilateral cases involve distinct patients (taking into account the related malformations), have diverging clinical presentations, and show discrepant restenosis rates and therefore could be considered in different groups of analysis.
Abstract: Introduction Although it has been more than 250 years since the first description of choanal atresia (CA), there are still doubts about this abnormality. The differences between unilateral and bilateral forms are seldom discussed. Objectives Aggregate data from patients diagnosed with CA, grouping patients with unilateral and bilateral forms. Methods Retrospective study. Results Eighteen patients were included: 12 (66.6%) presented bilateral atresia, of which 77.8% were mixed bony-membranous type and 22.2% were pure bony type. From the 12 patients with bilateral atresia, 10 presented related malformations, 3 of whom had CHARGE syndrome (coloboma, heart defects, choanal atresia, retardation of growth and development, genitourinary problems, ear abnormalities). From the remaining 6 patients with unilateral atresia, only 2 showed malformations, 1 renal and 1 cardiac. All patients with unilateral atresia needed only 1 surgical procedure, and patients with the bilateral form needed a median of 2.85 interventions ( p = 0.003). The median age of surgical procedure in the unilateral group was 6 years, ranging from 6 months to 18 years, and in the bilateral group was 25 days, ranging from 6 days to 6 years ( p = 0.003). The median interval between diagnosis and surgery was 9 months in the unilateral group, ranging from 1 month to 18 years, and in the bilateral group was 1 day, ranging from 1 day to 2 months ( p = 0.001). Discussion and Conclusions Success rates with the endoscopic approach vary from 62 to 100%. Nonetheless, most of these reports present results without considering the number of compromised sides. In our opinion, unilateral and bilateral cases involve distinct patients (taking into account the related malformations), have diverging clinical presentations, and show discrepant restenosis rates and therefore could be considered in different groups of analysis.
TL;DR: It is shown that only a small number of studies used language tests in children with UHL or addressed language alterations resulting from this type of impairment, and the importance of investments in new studies on this subject is emphasized to provide better explanations related to language difficulties presented by children withUHL.
Abstract: Introduction Childhood is a critical period for language development and maturation of the central auditory system. Unilateral hearing loss (UHL) is considered a minimal impairment, and little is discussed regarding its impact on the development of language, communication, and school performance. Objectives A bibliographical survey of scientific articles published from 2001 to 2011 was performed to verify which language disorders can occur in children with UHL and which tests were performed to identify them. Data Synthesis Three databases were used: PubMed, Lilacs, and The Cochrane Library. As inclusion criteria, the articles should have samples of children with UHL, without other impairments, aged between 3 months and 12 years, and reference to language tests applied in this population. Out of 236 papers initially selected, only 5 met the inclusion criteria. In the articles studied, 12 tests were used for language assessment in children with UHL, out of which 9 were directed toward expressive language, and 3 toward receptive language. Children with UHL demonstrated lower scores on receptive and expressive language tests when compared with children with normal hearing. However, they obtained better scores on expressive language tests than children with bilateral hearing loss. Conclusion The findings of this survey showed that only a small number of studies used language tests in children with UHL or addressed language alterations resulting from this type of impairment. Therefore we emphasize the importance of investments in new studies on this subject to provide better explanations related to language difficulties presented by children with UHL.
TL;DR: The present study demonstrated that the resonance frequency increased in the first months of life of newborns, with a mean resonance value of 250 Hz for both ears.
Abstract: SUMMARY Introduction: The resonant frequency is the probe frequency in which susceptance is 0 due to the neutralization of the forces of mass and stiffness components that control the middle ear. This frequency can be evaluated by multifrequency tympanometry, and the normality value for adults ranges 800-1,200 Hz. Studies about resonant frequency in children are scarce. Aim: Identify the variation of the resonant frequency in infants between the first days after birth and the third month of life. Method: Prospective study. Thirty newborns were evaluated at 2 different times: at the neonatal phase up to 12 days of life, and between 72 and 84 days of life. In the first evaluation, we carried out otoacoustic emissions and identified the resonant frequency, and identified the resonant frequency again in the second evaluation. Results: In the first evaluation, we determined a mean resonance value of 250 Hz for both ears, while that in the second evaluation was 385 Hz. In both assessments, we found no significant differences between the ears. There was a significant difference between the first and second evaluation. Conclusion: The middle ear resonant frequency in infants is lower in the first days of life due to the influence of the mass component. The present study demonstrated that the resonance frequency increased in the first months of life.
TL;DR: Nasal septum deviation should be corrected early to provide the harmonious growth of the face and to enable normal development of the child, without the occurrence of nasal deformity.
Abstract: Introduction Septum deviation in children may alter the early physiologic process of breathing, causing obligatory oral breathing and consequently changing craniofacial development and even intellect. Because of these consequences, septoplasty should be performed as early as possible. Materials and Methods The retrospective study reviewed the results of septoplasty in 40 children under 12 years old who had follow-up after surgery for a maximum period of 7 years. The research was submitted to the ethics committee and approved with protocol number 10331912.0.0000.0058. Results Forty patients underwent septoplasty, 39 (97.5%) had cauterization of inferior turbinate and associated procedure, 20 (50%) had adenotonsillectomy, and 17 (42.5%) had adenoidectomy. Conclusion Nasal septum deviation should be corrected early to provide the harmonious growth of the face and to enable normal development of the child, without the occurrence of nasal deformity.
TL;DR: The experience presented here is that of balloon laryngoplasty post–orotracheal intubation SGS with very satisfactory results at a tertiary care pediatric hospital, which corroborates other studies that demonstrate the efficacy and safety of balloon dilatation in the treatment of SGS.
Abstract: Introduction In recent years, there has been a reduction in mortality rates in neonatal intensive care units (NICUs) due to the impact of modern technological advances in the perinatal field. As a consequence, prolonged orotracheal intubation is used more frequently, and there has been an increase in acquired subglottic stenosis (SGS) in children. Subglottic stenosis is a narrowing of the endolarynx and one of the most common causes of stridor and respiratory distress in children. The laryngoplasty balloon has proven effective in dealing with stenosis both as primary and secondary treatments, after open surgery, with the added advantage of being less invasive and not requiring external access. Materials and Methods This study involved children from pediatric intensive care units or NICUs suffering from respiratory distress and who presented an endoscopic diagnosis of Myer and Cotton grade I to III SGS. These patients underwent balloon laryngoplasty with different numbers of interventions depending on the response in each individual case. Results All the patients responded satisfactorily to the balloon laryngoplasty. None required tracheostomy after treatment and all remained asymptomatic even after 6-month follow-up. One patient required just 1 dilation, 4 required 2, 3 underwent the procedure 3 times, and another had 5 dilations. Conclusion The experience presented here is that of balloon laryngoplasty post–orotracheal intubation SGS with very satisfactory results at a tertiary care pediatric hospital. Although the number of patients is limited, our incidence corroborates other studies that demonstrate the efficacy and safety of balloon dilatation in the treatment of SGS.
TL;DR: The silent sinus syndrome is a special form of CMA used to describe those cases with spontaneous enophthalmos, hypoglobus, and/or midfacial deformity in the absence of nasosinusal symptoms.
Abstract: Introduction Chronic maxillary atelectasis (CMA) is characterized by a persistent decreaseinthemaxillarysinusvolumeduetoinwardbowingofitswalls.Accordingtoits severity, it may be classified into three clinical-radiological stages. Objective To report a case of stage II CMA associated with subclinical visual field defect. Case Report A 34-year-old woman presented with a 15-year history of recurrent episodes of sinusitis and intermittent right facial discomfort for the past 5 years. She denied visual complaints, and no facial deformities were observed on physical exami- nation. Paranasal sinus computed tomography (CT) demonstrated a completely opacified right maxillary sinus with inward bowing of its walls, suggesting the diagnosis of stage II CMA. A computerized campimetry (CC) disclosed a scotoma adjacent to the blind spot of the right eye, indicating a possible damage to the optic nerve. The patient was submitted to functional endoscopic sinus surgery, with drainage of a thick mucous fluid from the sinus. She did well after surgery and has been asymptomatic since then. Postoperative CT was satisfactory and CC was normal. Discussion CMA occurs because of a persistent ostiomeatal obstruction, which creates negative pressure inside the sinus. It is associated with nasosinusal symptoms but had never beendescribedinassociationwithany visual field defect. It can be divided into stage I (membranous deformity), stage II (bony deformity), and stage III (clinical deformity). The silent sinus syndrome is a special form of CMA. This term should only be used to describe those cases with spontaneous enophthalmos, hypoglobus, and/or midfacial deformity in the absence of nasosinusal symptoms.
TL;DR: There was no statistically significant difference between groups, but it was observed that MIP and MEP were slightly higher in the non-asthmatic group than in the asthmatic group.
Abstract: Introduction: Changes in the respiratory system of asthmatics are also due to the mechanical disadvantage caused by the increased airway resistance. Objective: The study aims to evaluate the respiratory muscle strength and nutritional status of asthmatic children. Method: This is a prospective descriptive and transversal study with 50 children aged 7 to 12 years, who were placed into 2 groups, asthmatic and non-asthmatic. Respiratory muscle strength was evaluated on the basis of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). The nutritional status was evaluated by measuring the anthropometric data, including height, weight, and body mass index (BMI). The findings were subjected to analysis of variance, chi-square, and Student's t test, and p-values Results: In our comparisons, we observed statistically significantly lower values for age, weight, and height in asthmatic patients: 8.52 ± 1.49 years, 30.62 ± 7.66 kg, and 129.85 ± 10.24 cm, respectively, vs. non-asthmatic children(9.79 ± 1.51 years, 39.92 ± 16.57 kg, and 139.04 ± 11.62 cm, respectively). There was no significant increase in MIP and MEP between the groups: MIP was -84.96 ± 27.52 cmH 2 O for the asthmatic group and -88.56 ± 26.50 cmH 2 O for the non-asthmatic group, and MEP was 64.48 ± 19.23 cmH 2 O for asthmatic children and +66.72 ± 16.56 cmH 2 O for non-asthmatics. Conclusion: There was no statistically significant difference between groups, but we observed that MIP and MEP were slightly higher in the non-asthmatic group than in the asthmatic group.
TL;DR: Even with a constantly increasing cerebral palsy population, few studies include (re)habilitation in the treatment of oropharyngeal dysphagia in these children, with emphasis on the pursuit of research using the Bobath concept, the Castillo Morales concept, oral sensorimotor therapy, and continuing education.
Abstract: Introduction: There are an estimated 30,000–40,000 new cases of cerebral palsy per year in Brazil. Motor disorders caused by cerebral palsy can lead to dysphagia as they may alter the preparatory, oral, pharyngeal, and esophageal phases. Aim: To identify existing rehabilitation methods of swallowing disorders in cerebral palsy, with emphasis on the pursuit of research using the Bobath concept, the Castillo Morales concept, oral sensorimotor therapy, and continuing education. Summary of the findings: We performed a systematic review of the medical and speech therapy literature on the rehabilitation of oropharyngeal dysphagia in children with cerebral palsy spanning 1977–2010 and from all languages and nations. Among the 310 articles retrieved, only 22 (7.09%) addressed therapeutic rehabilitation of oropharyngeal dysphagia in children with cerebral palsy. Of the 22 reports, 12 (54.5%) were from Canada, 3 (13.6%) were from Japan, 2 (9%) were from Brazil, 2 (9%) were from Germany, 1 (4.5%) was from the USA, 1 (4.5%) was from the United Kingdom, and 1 (4.5%) was from Poland. Of these reports, 63.6% used oral sensorimotor therapy as a therapeutic method, 36.3% reported continuing education as a therapeutic approach, and only 18.1% and 9% used the Bobath concept and Castillo Morales concept, respectively. Conclusion: Even with a constantly increasing cerebral palsy population, few studies include (re)habilitation in the treatment of oropharyngeal dysphagia in these children.
TL;DR: The otoneurologic complaints were frequent in the population studied to verify the importance of allowing labyrinth exams and the need for adopting preventive measures relating to noise exposure as well as carbon monoxide exposure, because they can cause and/or enhance various manifestations of labyrinthine vestibular impairment that can affect the quality of life of these workers.
Abstract: Introduction Fishing, one of the oldest productive activities, is an important sector of the national and world economy. Aim To evaluate the vestibular behavior in a population of fishermen. Methods In a retrospective and cross-sectional study, 13 fishermen (mean 45.0), between 33 and 62 years of age, were submitted to anamnesis, otorhinolaryngological evaluation, and vestibular exam through the vector electronystagmography. Results The most evidentotoneurologic symptoms werehearing loss (76.9%), tinnitus (61.7%), dizziness (46.1%), and headache (46.1%). The most evident clinical symptoms were fatigue (46.1%), depression (23.0%), anxiety (15.3%), insomnia (7.7%), and agitation during sleep (7.7%). There were alterations in the vestibular exam in 5 fishermen (38.5%) discovered in the caloric test. There was a prevalence of alteration in the peripheral vestibular system. There was a major frequency of the peripheral vestibular irritative syndrome. Conclusion The otoneurologic complaints were frequent in the population studied to verify the importance of allowing labyrinth exams and the need for adopting preventive measures relating to noise exposureas well as carbon monoxide exposure, because they can cause and/or enhance various manifestations of labyrinthine vestibular impairment that can affect the quality of life of these workers.
TL;DR: There is a need for multidisciplinary interventions that aim to minimize the entrapment of negative impact on these people communication among these patients, and important limitations of a personal and social nature due to poor communication with their peers are showed.
Abstract: Introduction: Among people affected by cancer, the impairment of quality of life of people affected by cancer can cause have devastating effects. The self-image of patients after post-laryngectomyzed patients may be find themselves compromised, affecting the quality of life in this population. Objective: To characterize quality of life in related to communication in people who have undergone went total laryngectomy surgery. Methods: This is an observational study, with a cross-sectional and descriptive series. Design of series study. The sample were comprised 15 patients interviewed the period from January to February of 2011. We used the Quality Protocol for Life Communication in Post-laryngectomy adapted from Bertocello (2004); which this questionnaire contains 55 questions. The protocol was organized from the nature of using responses classified as positive and negative aspects, proposals in with respect to five 5 communication domains: family relationships, social relationships, personal analysis; morphofunctional aspect, and use of writing. To promote and guarantee the autonomy of the respondents, was examiners made use of used assistive technology with the Visual Response Scale. Results: The responses that total laryngectomy compromises the quality of life in communication amounted to 463 occurrences (65.7%), and that who responses suggesting good quality of life were represented with amounted to 242 occurrences (34.3%), from a total of 705 occurrencesresponses. From Among the five 5 Communication domains, four 4 had percentages of above 63% for occurrences of negative content for impact on communication. Appearance Morphofunctional appearance gave the had the highest percentage of negative content, amounting to 77.3% of cases. Conclusions: The results showed important limitations of a personal and social nature due to poor communication with their peers. Thus, there is a need for multidisciplinary interventions that aim to minimize the entrapment of negative impact on these people communication among these patients.
TL;DR: Not only do aspects of health and the voice interfere with its production, the external environment and habits influence the vocal symptoms of this population as well.
Abstract: INTRODUCTION: Studies to understand the vocal profile of a population are important to plan collective health measures. The prevalence of vocal symptoms can be indicative of vocal disorder and must be investigated to support measures to prevent vocal diseases. AIM: To characterize vocal symptoms in college students and their possible causes, and to analyze the association between hoarseness, vocal fatigue, phlegm, and burning in the throat with the possible causes mentioned. METHOD: Prospective study of 517 students who answered a questionnaire about their general heath and vocal symptoms and causes. We used the study of proportions, measures of central tendency, and a chi-square test to associate the presence of symptoms and possible causes. RESULTS: Symptoms most often mentioned: dry mouth (21%), dry throat (18.2%), phlegm (17.9%). Causes most often cited: high respiratory disease (39%), intense voice use (24%), smoking (24%). Hoarseness was associated with heavy use of voice and high respiratory disease; vocal fatigue with intense voice use, stress, and digestive problems; burning in the throat with intensive voice use, high respiratory disease, and pollution; phlegm with smoking, and upper respiratory and digestive problems. CONCLUSION: Not only do aspects of health and the voice interfere with its production, the external environment and habits influence the vocal symptoms of this population as well.
TL;DR: Extramedullary Plasmocytoma must be considered in the differential diagnosis of rare tumors of the larynx, essential after the diagnosis of multiple myeloma research and a “follow up” appropriate.
Abstract: INTRODUCAO: O plasmocitoma extramedular e uma das formas localizadas das doencas malignas das celulas plasmaticas, que tem o mieloma multiplo como principal diagnostico. Tem como principal sitio a regiao da cabeca e do pescoco, porem com rara apresentacao na laringe. OBJETIVO: Descrever um caso de plasmocitoma extramedular de laringe, com revisao da literatura. RELATO DE CASO: Paciente feminino, 49 anos, referindo disfonia intermitente ha 01 ano com piora progressiva, associada a esforco fonatorio e fadiga vocal, apresentando lesao avermelhada, bordos lisos em prega ventricular esquerda ao exame endoscopico. Sendo submetida a biopsia excisional com diagnostico hitopatologico plasmocitoma extramedular. CONCLUSAO: Plasmocitoma extramedular deve ser considerado no diagnostico diferencial dos tumores raros da laringe. E fundamental apos o diagnostico a pesquisa do Mieloma Multiplo e um "follow up" adequado.
TL;DR: The epidemiologic characteristics of oral cleft cases at Specialized Society Attending Cleft Patient in Sergipe State found that early treatment is a reality in SEAFESE, and consequently the chances of successful integration of the child to society will be better.
Abstract: Introduction The nonsyndromic orofacial cleft is the fourth most common birth defect, but in Brazil, data about the cleft epidemiology are not accurate. Objective This study aimed to describe the epidemiologic characteristics of oral cleft cases at Specialized Society Attending Cleft Patient in Sergipe State. Methods Data were obtained from patients' medical records in relation to the following characteristics: age; gender; race; origin; cleft type; additional malformations and/or complications; prenatal accomplishment; treatment applied. For diagnosis analysis, it was noted if mothers had received prenatal care and if they had ultrasonography performed and if the cleft was viewed in it. Results We observed a prevalence of male gender (54%). Age between 0 and 4 years old was most prevalent (53%), and pheoderma race was observed in 47%. Transincisive foramen cleft was found in 52.3% of the individuals. The prevalence of pre- and transincisive foramen cleft was higher in men (66.3 and 55.7%), women accounted for 65.0% of postincisive foramen, and atypical facial cleft (0.3%) occurred in one case. Associated malformations and complications were present in 12% of patients. Prenatal care was reported by 48% of the mothers. Conclusion In this study male gender was the most affected, and 0 to 4 years was the most frequent age group. Transincisive foramen cleft type was most frequently encountered. Prenatal care was reported by most mothers. So, this study found that early treatment is a reality in SEAFESE (Service Specializing in Cleft Care of Sergipe), and consequently the chances of successful integration of the child to society will be better.
TL;DR: It is important for the otorhinolaryngologist and head and neck surgeon to be familiar with this aggressive tumor, which carries high mortality and morbidity and the appropriate diagnosis and treatment can improve prognosis and patient survival.
Abstract: Introduction Synovial sarcoma is a malignant tumor of mesenchymal pluripotent cells. Objectives We present a case of synovial sarcoma in the posterolateral wall of the oropharynx. Resumed report The patient, a 23-year-old woman, was admitted with a history of dysphagia and difficulty in breathing for 8 months, resulting in progressive deterioration and onset of snoring, muffled voice, and local pain. An oropharyngeal tumor in the left posterolateral wall touched the base of the ipsilateral tongue. The patient underwent endoscopic pharyngectomy to remove the lesion. Pathologic examination revealed synovial sarcoma with positive margins, and Mohs technique was proposed for margin control. The margins were disease-free, without the need for total laryngectomy. The pharynx was reconstructed with a microvascular forearm flap. The patient developed postoperative stability. Conclusion Despite its name, synovial sarcoma is rarely sourced directly from synovial membranes. It is most commonly found in the vicinity of large joints. The location at the head and neck, a location poor in synovial tissue, is unusual. Synovial sarcoma in the head and neck has an aggressive nature and poor prognosis. Resection with negative margins remains the foundation of therapy, which is not so easily achieved in the head and neck. It is important for the otorhinolaryngologist and head and neck surgeon to be familiar with this aggressive tumor, which carries high mortality and morbidity. The appropriate diagnosis and treatment can improve prognosis and patient survival.
TL;DR: After total laryngectomy, patients report that swallowing issues have moderate to severe impact in “communication,’ “fear,” and “eating duration” domains.
Abstract: INTRODUCAO: A laringectomia total pode ocasionar sequelas na degluticao e comprometer a qualidade de vida do paciente, em virtude dos impactos negativos na fisiologia e na vida social. OBJETIVO: Descrever o impacto da degluticao na qualidade de vida de laringectomizados totais. METODO: Foi aplicado o questionario Swallowing Quality of Life, composto por 44 perguntas que avaliam 11 dominios relacionados a qualidade de vida (fardo, duracao, desejo, frequencia de sintomas, selecao de alimentos, comunicacao, medo, saude mental, funcao social, sono e fadiga). A analise foi realizada atraves de estatistica descritiva, com medidas de tendencia central e de variabilidade. Estudo de series. RESULTADOS: A amostra foi composta por 15 voluntarios submetidos a laringectomia total e radioterapia adjuvante. 66,7% consideraram a saude boa e 73% nao referiram restricoes a consistencia dos alimentos. Os dominios "comunicacao" e "medo" representaram impacto severo e a "duracao da alimentacao" exerceu impacto moderado na qualidade de vida. Os itens com menores escores foram: maior tempo para comer do que outras pessoas (dominio "duracao da alimentacao"), tosse e tosse para retirar o liquido ou a comida para fora da boca quando estes estao parados (dominio "frequencia dos sintomas"), dificuldades em entender (dominio "comunicacao") e medo de engasgar e ter pneumonia (dominio "medo"). CONCLUSAO: Em laringectomizados totais, a degluticao exerceu impacto severo a moderado nos dominios "comunicacao", "medo" e "duracao da alimentacao".
TL;DR: The Glatzel method lacks sensitivity in detecting patient-reported improvements in breathing following rhinoplasty, which suggests that the method is a poor assessment tool to detect small, post-surgical changes in the nasal airways.
Abstract: SUMMARY Introduction: Objective evaluation of nasal function is a constant challenge for plastic surgeons, otolaryngologists, and allergists. The modified Glatzel mirror can evaluate nasal expiratory flow; however, there is little information on this method and its use in the measurement of nasal patency after surgical procedures. Objective: To compare, in a prospective study, the functional results before and after cosmetic rhinoplasty and evaluate the use of the Glatzel mirror as an objective method to assess nasal patency. Methods: To achieve this objective, we analyzed the functional results of surgery through a subjective questionnaire and objective evaluation through a modified Glatzel mirror, and evaluated the correlation between the 2 methods. Twenty patients (14 women and 6 men) underwent aesthetic rhinoplasty using spreader grafts. Pre- and postoperative evaluation (90-120 days) included a respiratory quality score (subjective) and modified Glatzel mirror test (objective). Subsequently, the Spearman test was used to compare the pre- and postoperative subjective and objective data. Results: The subjective evaluation demonstrated a statistical difference between pre- and postoperative scores (8 ± 2 and 9.4 ± 0.7, P< 0.001). There was no statistical difference in mean nasal patency by modified Glatzel mirror. No statistically significant correlation was observed when comparing the modified Glatzel mirror values with the subjective scores reported by patients pre- or postoperatively. Conclusion: The Glatzel method lacks sensitivity in detecting patient-reported improvements in breathing following rhinoplasty. This suggests that the method is a poor assessment tool to detect small, post-surgical changes in the nasal airways.