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Showing papers in "Revista Brasileira De Otorrinolaringologia in 2006"


Journal ArticleDOI
TL;DR: The eventual presence of antibodies against the inner ear suggests that sudden hearing loss pathogenesis may be of autoimmune nature, but the difficulty in establishing the correlation of its morphological and clinical aspects to the hearing loss also do not help to support this statement.
Abstract: Several factors have been postulated to elicit the etiology of idiopathic sudden sensorineural hearing loss. Through a bibliographic review, we made a critical analysis of the different etiopathogenic aspects of its clinical manifestation. The most recent studies concerning the possible causes of sudden hearing loss suggest vascular disorders, rupture of the inner ear membrane and autoimmune diseases; however, viral infections have received a great deal of attention in recent years. Little is known about the mechanism of sudden hearing loss. Viruses can cause sudden hearing loss in an acute infection, however the latent form, and its possible reactivation have also been considered as explanations of the cochlear injury mechanism. Even though hearing loss can be explained by a blood viscosity change, experimental and clinical studies do not show any evidence of labyrinthine fibrosis and new bone formation, or labyrinthine membrane breaks. These findings are not in agreement with vascular and rupture membrane factors, respectively. The eventual presence of antibodies against the inner ear suggests that sudden hearing loss pathogenesis may be of autoimmune nature, but the difficulty in establishing the correlation of its morphological and clinical aspects to the hearing loss also do not help to support this statement. Sudden hearing loss is still a controversial and obscure subject in several aspects.

110 citations


Journal ArticleDOI
TL;DR: A multidisciplinary treatment, including physicians, dentists, speech therapists, nutritionists, and psychologists, is the best alternative to minimize, or even prevent, side effects of radiotherapy treatment in the head and neck region.
Abstract: Summary Radiotherapy is a treatment modality largely used for head and neck malignancies. However, high doses of radiation in large areas, including the oral cavity, maxilla, mandible and salivary glands may result in several undesired reactions. Mucositis, candidosis, disgeusia, radiation caries, osteoradionecrosis, soft tissue necrosis and xerostomia are some of radiotherapy's complications. Aim The aim of this study is to briefly review the side effects that may be seen in the oral cavity during or after radiotherapy treatment in the head and neck region. Basic method used Review of relevant literature. Study design Literature review. Results Radiotherapy is still associated with several side effects, significantly affecting patients’ quality of life. Conclusions A multidisciplinary treatment, including physicians, dentists, speech therapits, nutritionists, and psychologists, is the best alternative to minimize, or even prevent such reactions.

108 citations


Journal ArticleDOI
TL;DR: In oral benign lesions associated with HPV, a prevalence of HPV 6 and 11 was observed in squamous cell papilloma (SCP) and condylomas acuminatum, while HPV 2 and 57 were more prevalent in verruca vulgaris lesions.
Abstract: The prevalence of human papillomavirus (HPV) in the oral cavity and oropharynx has not yet been as well studied as its infection of the vaginal tract. However, new study are emerge after the development of molecular biology techniques. The objective of this study is to show the prevalence of HPV in the oral cavity and the oropharynx. An ample bibliographic review was done showing a prevalence of HPV 6, 11 in a normal oral mucous membrane (latent infection). In oral benign lesions associated with HPV, a prevalence of HPV 6 and 11 was observed in squamous cell papilloma (SCP) and condylomas acuminatum, while HPV 2 and 57 were more prevalent in verruca vulgaris lesions. As for focal epithelial hyperplasia (FEH) and oral cancer, especially squamous cell carcinoma (SCC), the prevalence was of HPV 13 and 32, and HPV 16, respectively. The last findings are, nonetheless, controversial. The last findings are, nonetheless, controversial. Showed also discrepancy result the prevalence of human papillomavirus (HPV) in normal oral mucous (latent infection) and in oral cancer, however evidenced confirmatory result in oral benign lesions associated with virus.

99 citations


Journal ArticleDOI
TL;DR: Functional balance in the elderly with chronic vestibular disorders evaluated by the BBS is worse when associated with aging, with a more advanced age group (80 years or more), increasing number of illnesses, presence of five or more illnesses, use of multiple medications, recurrent falls, tendency to fall, central Vestibular syndromes, daily dizziness, mobility and gait impairments.
Abstract: Daily activities can be challenging for the elderly. AIM: To study the association between functional balance, evaluated by the Berg Balance Scale (BBS), sociodemographics, clinical and mobilility (Timed up and go test - TUGT, Dynamic Gait Index - DGI) variables in the elderly with chronic vestibular disorder. MATERIALS AND METHODS: A series study with one hundred and twenty elderly with chronic vestibular disorder. We performed the Mann-Whitney test, the Kruskal-Wallis test followed by Dunn test and the Spearman Coefficient (). RESULTS: Statistically significant associations and correlations were observed between total BBS score and age (=-0.354; p<0.001), age group (p<0.001), number off illnesses (p=0.030), number of illnesses (=-0.287; p=0.001), number of medications (p=0.014), number of medications (=-0.274; p=0.002), recurrent falls (p=0.010), tendency to fall (p=0.002), topographic diagnosis of central vestibular disorder (p<0.001) and periodicity of dizziness (p=0.039), TUGT (=-0.709; p<0.001) and DGI (=-0.748; p<0.001). CONCLUSIONS: Functional balance in the elderly with chronic vestibular disorders evaluated by the BBS is worse when associated with aging, with a more advanced age group (80 years or more), increasing number of illnesses, presence of five or more illnesses, use of multiple medications, recurrent falls, tendency to fall, central vestibular syndromes, daily dizziness, mobility and gait impairments.

97 citations


Journal ArticleDOI
TL;DR: Both fo and NHR female measures were significantly higher than their male counterparts, therefore, it is important to standardize the program in use.
Abstract: Summary Studies have established that normative data is necessary for acoustic analysis. The aim of the present study is to standardize fundamental frequency measures (fo), jitter, shimmer and harmonic-noise ratio (HNR) for young adults with normal voice. Method 20 males and 20 females, between 20 and 45 years, without signs and symptoms of vocal problems; CSL-4300 Kay-Elemetrics; vowels /a/ and /e/. Results for females, vowels /a/ and /e/ had average measures of: fo 205.82 Hz and 206.56 Hz; jitter of 0.62% and 0.59%; shimmer of 0.22 dB and 0.19 dB; PHR of 10.9 dB and 11.04 dB, respectively. For males, vowel /a/ and /e/ had average measures of: fo 119.84 Hz and 118.92 Hz; jitter of 0.49% and 0.5%; shimmer of 0.22 dB and 0.21 dB; HNR 9.56 dB and 9.63 dB, respectively. Both fo and NHR female measures were significantly higher than their male counterparts. Conclusion our results differ from the literature; therefore, it is important to standardize the program in use.

86 citations


Journal ArticleDOI
TL;DR: In this article, a presente estudo e normatizar as medidas de frequencia fundamental (fo), jitter, shimmer and proporcao harmonico-ruido (PHR) for adultos jovens com voz normal.
Abstract: Pesquisas tem estabelecido que cada servico deve estabelecer seus padroes normativos para a analise acustica. O objetivo do presente estudo e normatizar as medidas de frequencia fundamental (fo), jitter, shimmer e proporcao harmonico-ruido (PHR) para adultos jovens com voz normal. METODO: Participaram deste estudo 20 homens e 20 mulheres, de 20 a 45 anos de idade, sem sinais e sintomas de problemas vocais, produzindo as vogais sustentadas /a/ e /e/, analisadas pelo programa CSL- 4300 Kay-Elemetrics. RESULTADOS: Para as mulheres, respectivamente para a vogal /a/ e /e/ os valores medios foram: fo de 205,82Hz e 206,56Hz; jitter de 0,62% e 0,59%; shimmer de 0,22dB e 0,19dB; PHR de 10,9 dB e 11,04 dB. Para os homens, respectivamente para a vogal /a/ e /e/, os valores medios foram: fo de 119,84Hz e 118,92Hz; jitter de 0,49% e 0,5%; shimmer de 0,22 dB e 0,21 dB; PHR de 9,56 dB e 9,63dB. As medidas de fo e PHR foram significativamente maiores para as mulheres em comparacao aos homens. CONCLUSAO: As diferencas entre os nossos resultados e os dos outros autores confirmam a necessidade de se realizar a normatizacao para cada programa a ser utilizado.

79 citations


Journal ArticleDOI
TL;DR: Hearing loss in the population under study suggests that hypertension is an accelerating factor of degeneration of the hearing apparatus due to aging, and can allow for an integrated work of cardiologists, nephrologists, otorhinolaryngologists, audiologists and other health professionals concerned with alterations caused by blood hypertension.
Abstract: Summary Aim To identify likely association between blood hypertension and hearing loss. Design: A non-paired case-control study. Setting: Institutional work carried out at Universidade Norte do Parana, in South Brazil. Material and Method 154 cases and 154 controls, both genders, aged 45 to 64, included in the research after sample estimation. Methodology: Hypertension was verified through blood pressure readings and by a systematized questionnaire about hypertension and the use of medication for blood pressure. Hearing was assessed through tonal threshold audiometrics and audiologic anamneses. Non-conditional logistic regression was used in order to control likely confusion or modification of effect of other variables on interest associations. Results There is a significant association between blood hypertension and hearing loss. Hearing loss in the population under study suggests that hypertension is an accelerating factor of degeneration of the hearing apparatus due to aging. Conclusions The results in this research, through evidence of association between blood hypertension and hearing loss, can allow for an integrated work of cardiologists, nephrologists, otorhinolaryngologists, audiologists and other health professionals concerned with alterations caused by blood hypertension.

79 citations


Journal ArticleDOI
TL;DR: The jaw was the most affected place, followed by zygoma and by the nose, though most patients presented a single facial fracture, and accidents with automobiles and accidental fall s were the most common causes.
Abstract: Facial trauma has presented an increasing occurrence in the last four decades, due especially to the growth of accidents with automobiles as well as to the urban violence. Both of which continue being the main cause of such traumas. AIM: To evaluate the features of the population victim of facial trauma as to gender, age, occupation, origin, type of fracture and its cause. DESIGN STUDY: retrospective clinical with transversal cohort. MATERIAL AND METHOD: Retrospective study consulting hospital registers of 513 patients victims of the facial trauma. RESULTS: There was a higher incidence of facial trauma on men (84,9%), white (82,7) and with an average age of 29. Regarding occupation, the trauma was mostly occurred to students (16,6%) and Masons (11,2%). The jaw was the most affected place (35%), followed by zygoma (24%) and by the nose (23%), though most patients presented a single facial fracture (82,5%). Among the causes, accidents with automobiles (28,3%), aggression (21%) and accidental fall s (19,5%) were the most common. CONCLUSIONS: Accidents with automobiles continue being the main cause of facial trauma, especially of multiple fractures due to the great transmission of kinetic energy. Language: pt

79 citations


Journal ArticleDOI
TL;DR: High mouth breathing prevalence without significant statistical difference between genders, age and type of mouth breathing, and there was no association between behavior characteristics andtype of breathing.
Abstract: OBJETIVO: Determinar prevalencia de criancas portadoras de respiracao oral inscritas no Projeto Santo Amaro/ ESEF/ UPE e verificar as principais alteracoes faciais e comportamentais associadas. FORMA DE ESTUDO: Estudo transversal. MATERIAL E METODO: Amostra de 150 criancas de 8 a 10 anos. Dados coletados mediante aplicacao de questionario e exames clinicos. Para o diagnostico da respiracao foram feitos dois testes. Teste 1, observado no espelho, vapor decorrente da respiracao, e teste 2, a permanencia de agua na boca com os labios em contato pelo tempo de 3 minutos. RESULTADOS: Prevalencia de respiracao oral foi de 53,3%. Nao se comprovou diferenca significante entre genero, faixa etaria, tipo de respiracao. As alteracoes faciais da respiracao oral foram: selamento labial inadequado (58,8% x 5,7%), olhos caidos (40,0% x 1,4%), palato ogival (38,8% x 2,9%), mordida aberta anterior (60,0% x 30,0%), labios hipotonicos (23,8% x 0,0%) e olheiras (97,5% x 77,1%). CONCLUSAO: Prevalencia de respiracao oral elevada sem diferenca estatistica entre os generos, faixa etaria e tipo de respiracao oral. Nao houve associacao entre caracteristicas comportamentais e o tipo de respiracao. Houve diferenca significante entre as caracteristicas fisicas e o padrao de respiracao.

75 citations


Journal ArticleDOI
TL;DR: The Dynamic Gait Index was culturally adjusted to Brazilian Portuguese and proved to be a reliable tool in intra and interobserver assessments.
Abstract: The Dynamic Gait Index (DGI) is a useful test to evaluate balance and gait. AIMS: The objectives of this study were to culturally adjust the DGI to the Portuguese language and to assess its reliability. METHODS: The method proposed by Guillemin et al. (1993) was used for a cultural adaptation of this tool. A prospective study was performed with 46 patients that were assessed in the cultural adaptation phase. The items that not understood by 20% or more patients were reworded and reapplied. The final Portuguese version of DGI was applied to 35 elderly in order to check intra and interobserver reliability. The Spearman rank coefficient was used to correlate intra and interobserver scores and the Wilcoxon test was applied to compare these scores. Internal consistency was analyzed by the Cronbach alpha coefficient. RESULTS: There were statistically significant correlations among the scores for intra and interobserver assessments for all items (p<0.001), which were classified as good and very strong correlations (ranging from r=0.655 to r=0.951). The DGI demonstrated high internal consistency in intra and interobserver assessments (varying from µ=0.820 to µ=0.894). CONCLUSION: The DGI was culturally adjusted to Brazilian Portuguese and proved to be a reliable tool.

75 citations


Journal ArticleDOI
TL;DR: Accidents with automobiles continue being the main cause of facial trauma, especially of multiple factures due to the great transmission of kinetic energy.
Abstract: O trauma facial apresenta incidencia crescente nas ultimas quatro decadas, principalmente devido ao aumento dos acidentes automobilisticos e da violencia urbana, que continuam sendo as principais causas desses traumatismos em individuos jovens. OBJETIVO: Estudar as caracteristicas da populacao vitima de trauma facial atraves das variaveis sexo, idade, profissao, tipo de fratura e suas causas. FORMA DE ESTUDO: clinico retrospectivo com coorte transversal. MAETERIAL E METODO: Estudo retrospectivo por consulta a prontuarios de 513 pacientes vitimas de trauma facial. RESULTADOS: Houve maior incidencia de trauma de face em homens (84,9%), brancos (82,7%) e com idade media de 29 anos. Quanto a profissao, estudantes (16,6%) e pedreiros (11,2%) foram os mais acometidos. A mandibula foi o local mais afetado (35%), seguido do zigoma (24%) e do nariz (23%), sendo que a maioria dos pacientes tinha fratura unica de face (81,5%). Dentre as causas, destacaram-se os acidentes automobilisticos (28,3%), agressoes (21%) e as quedas acidentais (19,5%). CONCLUSOES: Os acidentes automobilisticos continuam sendo a principal causa de trauma de face, principalmente de fraturas multiplas devido a grande transmissao de energia cinetica.

Journal ArticleDOI
TL;DR: The eventual presence of antibodies against the inner ear suggests that sudden hearing loss pathogenesis may be of autoimmune nature, but the difficulty in establishing the correlation of its morphological and clinical aspects to the hearing loss also do not help to support this statement.
Abstract: Varios fatores tem sido postulados como causa da surdez subita idiopatica. Por meio de uma revisao bibliografica foi feita uma analise critica quanto aos aspectos etiologicos e fisiopatogenicos desta manifestacao clinica. Estudos atuais sugerem que os disturbios vasculares, a ruptura de membranas da orelha interna e as doencas auto-imunes sao possiveis causas, mas a afeccao viral tem recebido maior atencao nos ultimos anos, embora ainda pouco se conheca sobre os mecanismos da surdez subita idiopatica. Os virus podem causar a perda subita da audicao na infeccao aguda, mas a forma latente, com uma possivel reativacao viral, tambem tem sido considerada no mecanismo de agressao a coclea. Apesar de uma alteracao da viscosidade sanguinea poder explicar a perda auditiva, estudos experimentais e clinicos nao mostram sinais de ossificacao e de fibrose na coclea ou de ruptura de membranas do labirinto. Estes fatos contrapoem, respectivamente, a teoria vascular e a da fistula labirintica. A eventual presenca de anticorpos contra a orelha interna sugere que a surdez subita idiopatica possa ser de natureza auto-imune, fato este tambem nao confirmado pela falta de relacao entre os aspectos clinicos e morfologicos da doenca auto-imune e da perda auditiva. A surdez subita idiopatica e, ainda, um tema controverso e obscuro em diversos aspectos.

Journal ArticleDOI
TL;DR: Fear and tendency to fall are referred by the majority of chronically dizzy elderly and the number of falls is significantly associated with activity restrictions after the last fall and with the causes for falling (slipping and dizziness).
Abstract: AIM: To investigate the circumstances and consequences of falls in the chronically dizzy elderly and to correlate them with the number of falls (one/two and more). METHOD: Transversal descriptive analytic study with 64 patients aged 65 or over, with history of falls and diagnostic of chronic vestibular dysfunction. We performed a descriptive analysis and Qui-Square test (<0.05). RESULTS: The sample was constituted by a female majority (76.6%) with a mean age of 73.62±5.69 years. The vestibular examination showed peripheral vestibulopathy in 81.5% of the cases and the most prevalent diagnostic hypothesis were benign paroxysmal positional vertigo (43.8%) and metabolic inner ear disease (42.2%). Recurrent falls were seen in 35 elderly (53.1%). In relation to the last fall, 39.1% of the patients had fallen in their homes, 51.6% of them occurred during the morning, 51.6% with some propulsion mechanism, 53.1% when walking, 25.0% caused by dizziness and 23.4% by stumbling. Activity restriction was significantly greater in patients that have already had two and more falls, when compared with those who had fallen only once (p=0.031). We found a significant association between the number of falls and their causes (p<0.001). Falls that have happened by slipping were more frequent in the elderly that reported one fall (p=0.0265) and falls that had happened because of dizziness were more frequent in the elderly that complained of two or more falls (p=0.0012). CONCLUSION: Fear and tendency to fall are referred by the majority of chronically dizzy elderly. Fall are more frequent in the morning, in the home and during walking. The propulsion direction is mentioned by half of the elderly and the most common cause for falls are dizziness and stumbling. The number of falls is significantly associated with activity restrictions after the last fall and with the causes for falling (slipping and dizziness).

Journal ArticleDOI
TL;DR: Dizziness is a chronic symptom in elderly patients and the association of two diseases, metabolic and vascular labyrinth conditions, are common.
Abstract: A tontura de origem vestibular e comum entre idosos. OBJETIVO: Caracterizar idosos com disfuncao vestibular cronica em relacao aos dados sociodemograficos, clinico-funcionais e otoneurologicos. MATERIAL E METODO: Estudo de casos que incluiu 120 idosos com disfuncao vestibular cronica. Foram realizadas analises descritivas simples. RESULTADOS: A 5,77±amostra apresentou maioria feminina (68,3%), com media etaria de 73,40 1,84±anos. O numero medio de doencas associadas ao quadro vestibular foi de 3,83 e o numero medio de medicamentos foi de 3,86±2,27. O exame vestibular evidenciou vestibulopatia periferica deficitaria unilateral (29,8%) e as hipoteses diagnosticas prevalentes foram labirintopatia metabolica (40,0%) e vertigem posicional paroxistica benigna (36,7%). Para 52 (43,3%) pacientes, a tontura comecou ha mais de 5 anos. Em relacao a queda, 64 idosos (53,3%) apresentaram pelo menos uma queda no ultimo ano e 35 (29,2%) referiram quedas recorrentes. CONCLUSOES: A amostra foi representada por maioria feminina e media etaria elevada, com doencas associadas ao quadro vestibular e polifarmacoterapia. As vestibulopatias e a topografia mais frequentes foram, respectivamente, labirintopatia metabolica e vascular e sindrome periferica deficitaria unilateral. A tontura e uma condicao cronica e a associacao de vestibulopatias e comum. A ocorrencia de quedas e prevalente na populacao de idosos com disfuncao vestibular cronica.

Journal ArticleDOI
TL;DR: Os resultados da presente pesquisa, atraves da constatacao da associacao entre hipertensao e perda auditiva, servirao de base a uma integracao ent between cardiologistas, nefrologistas, otorrinolaringologistas, fonoaudiologos e outros profissionais da area de com alteracoes provenientes da hiperTensao.
Abstract: OBJETIVO: Identificar possivel associacao entre hipertensao arterial e perda auditiva. Foi realizado um estudo do tipo caso-controle nao pareado, na Universidade Norte do Parana, no Sul do Brasil. MATERIAL E METODO: 154 casos e 154 controles, de ambos os sexos com idade variando de 45 a 64 anos foram incluidos na pesquisa apos o calculo da amostra. A hipertensao foi verificada por medicao da pressao arterial e de questionario sistematizado sobre hipertensao e uso de medicamentos para pressao arterial. A audicao foi avaliada por audiometria e anamnese audiologica. A tecnica de regressao logistica nao-condicional foi utilizada com o objetivo de controlar a possivel acao de confusao ou modificacao de efeito exercida por outras variaveis sobre as associacoes de interesse. RESULTADOS : Pode-se verificar que existe associacao significativa entre hipertensao arterial e presenca de perda auditiva e que a perda auditiva observada nesta populacao sugere que a hipertensao arterial age como fator de aceleracao da degeneracao do aparelho auditivo proveniente da idade. CONCLUSOES: Os resultados da presente pesquisa, atraves da constatacao da associacao entre hipertensao e perda auditiva, servirao de base a uma integracao entre cardiologistas, nefrologistas, otorrinolaringologistas, fonoaudiologos e outros profissionais da area de com alteracoes provenientes da hipertensao.

Journal ArticleDOI
TL;DR: Italian rye grass (Lolium multiflorum) pollen of the Poaceae family cultivated in Southern Brazil has been considered a major sensitizing agent in patients with pollinosis and mixed grass extracts are commonly used for diagnosis and immunotherapy of grass pollen allergy.
Abstract: Summary Patients with grass pollen allergy, commonly called pollinosis, often present reactivity to pollen allergens from a number of grass species due to cross-reactivity of IgE antibodies to pollen proteins present in pollen grasses. In this context, Italian rye grass (Lolium multiflorum) pollen of the Poaceae family cultivated in Southern Brazil has been considered a major sensitizing agent in patients with pollinosis. In this region, Italian rye grass is capable of producing a great amount of pollen. In addition to L. multiflorum, other Poaceae grasses are naturally grown as weed in Southern Brazil, but with no clinical relevance. Pollen extracts derived from homologous or heterologous grasses are often used for both diagnosis and treatment of seasonal allergy. However, no standardized L. multiflorum pollen extract is commercially available in Brazil and mixed grass extracts are commonly used for diagnosis and immunotherapy of grass pollen allergy. Further studies are required to better characterize the cross-reactivity between L. multiflorum and other grass pollen allergens for improving the diagnosis and immunotherapy to L. multiflorum pollen allergy.

Journal ArticleDOI
TL;DR: A multidisciplinary treatment, including physicians, dentists, speech therapits, nutritionists, and psychologists, is the best alternative to minimize, or even prevent, side effects during or after radiotherapy treatment in the head and neck region.
Abstract: A radioterapia e uma forma terapeutica amplamente utilizada para o tratamento das neoplasias malignas da cabeca e pescoco. Porem, altas doses de radiacao em extensos campos que irao incluir a cavidade bucal, maxila, mandibula e glândulas salivares frequentemente resultam em diversas reacoes indesejadas. Dentre as complicacoes da radioterapia estao a mucosite, candidose, disgeusia, carie por radiacao, osteorradionecrose, necrose do tecido mole e xerostomia. OBJETIVO: O objetivo deste artigo e fazer uma breve revisao das reacoes adversas que podem ser detectadas durante o tratamento radioterapico em regiao de cabeca e pescoco. METODO: A literatura pertinente que trata do assunto foi revisada. FORMA DE ESTUDO: Revisao de literatura. RESULTADOS: A radioterapia ainda esta associada a diversas reacoes adversas, que afetam de forma significativa a qualidade de vida dos pacientes. CONCLUSOES: O tratamento multidisciplinar, incluindo a equipe medica, o cirurgiao-dentista, o fonoaudiologo, o nutricionista e o psicologo e a melhor alternativa para minimizar ou mesmo prevenir tais complicacoes.

Journal ArticleDOI
TL;DR: Os resultados desta pesquisa mostraram uma prevalencia do HPV 16 na mucosa oral normal (infeccao latente) e no câncer oral, enquanto nas lesoes benignas associadas ao virus, os resultados foram confirmatorios.
Abstract: A prevalencia do papilomavirus humano (HPV) na cavidade oral e na orofaringe ainda nao esta bem esclarecida como nos estudos do trato genital, na qual e bem definida. Entretanto, novas pesquisas estao surgindo apos o aparecimento dos exames de biologia molecular. Neste estudo foi realizada uma revisao da literatura com o objetivo de verificar a prevalencia do papilomavirus humano na cavidade oral e na orofaringe. Os resultados desta pesquisa mostraram uma prevalencia do HPV 16 na mucosa oral normal (infeccao latente). Ja nas lesoes benignas orais associadas ao HPV mostraram uma prevalencia do HPV 6 e 11 em papilomas de celulas escamosas e condilomas, e, nas verrugas, uma prevalencia do HPV 2 e 57, enquanto na hiperplasia epitelial focal prevaleceram os HPVs 13 e 32, e no câncer oral, principalmente, no carcinoma de celulas escamosas (CCE), foi evidenciada uma alta prevalencia do HPV 16, o que sugere sua participacao na carcinogenese oral, apesar de ser um assunto controverso. Constatou-se tambem uma enorme discrepância nos resultados da prevalencia do papilomavirus humano (HPV) na mucosa oral normal (infeccao latente) e no câncer oral, enquanto nas lesoes benignas associadas ao virus, os resultados foram confirmatorios.

Journal ArticleDOI
TL;DR: In this article, the authors investigate the circumstances and consequences of falls in the chronically dizzy elderly and to correlate them with the number of falls (one/two and more) and the most common cause for falls are dizziness and stumbling.
Abstract: Summary Aim To investigate the circumstances and consequences of falls in the chronically dizzy elderly and to correlate them with the number of falls (one/two and more). Method Transversal descriptive analytic study with 64 patients aged 65 or over, with history of falls and diagnostic of chronic vestibular dysfunction. We performed a descriptive analysis and Qui-Square test ( Results The sample was constituted by a female majority (76.6%) with a mean age of 73.62±5.69 years. The vestibular examination showed peripheral vestibulopathy in 81.5% of the cases and the most prevalent diagnostic hypothesis were benign paroxysmal positional vertigo (43.8%) and metabolic inner ear disease (42.2%). Recurrent falls were seen in 35 elderly (53.1%). In relation to the last fall, 39.1% of the patients had fallen in their homes, 51.6% of them occurred during the morning, 51.6% with some propulsion mechanism, 53.1% when walking, 25.0% caused by dizziness and 23.4% by stumbling. Activity restriction was significantly greater in patients that have already had two and more falls, when compared with those who had fallen only once (p=0.031). We found a significant association between the number of falls and their causes (p Conclusions Fear and tendency to fall are referred by the majority of chronically dizzy elderly. Fall are more frequent in the morning, in the home and during walking. The propulsion direction is mentioned by half of the elderly and the most common cause for falls are dizziness and stumbling. The number of falls is significantly associated with activity restrictions after the last fall and with the causes for falling (slipping and dizziness).

Journal ArticleDOI
TL;DR: The Brazilian Portuguese version of the Tinnitus Handicap Inventory (THI), a self-applicable questionnaire which assesses tinnitus impact on patient's life quality, showed high internal validity, comparable to the original version.
Abstract: Summary Tinnitus can greatly impact an individual’s life quality and it is very difficult quantify. Aim: To determine the reproducibility and validity of a Brazilian Portuguese version of the Tinnitus Handicap Inventory (THI), a self-applicable questionnaire which assesses tinnitus impact on patients’ life quality. Materials and Methods: This was a prospective transversal study. The questionnaire was translated into Portuguese and cross-culturally adapted to the Brazilian environment according to internationally recommended methods. The Portuguese version of the THI was answered by 180 patients who complained of tinnitus. Reproducibility was assessed using the Cronbach’s Alpha Calculation; and the validity was assessed by means of the Beck Depression Inventory (BDI), calculating the Pearson correlation coefficient. Results: The Portuguese version of the THI showed high internal validity, comparable to the original version. A high correlation was observed between the THI and the BDI. Conclusion: The Brazilian Portuguese version of THI is a valid and reproducible tool used to quantify how tinnitus impact the life quality of those Brazilian patients who complain of this symptom.

Journal ArticleDOI
TL;DR: Nasal foreign bodies are especially found between the ages of 0 and 4 years, and the most frequently found foreign bodies were foam fragments, plastic pieces of little toys, beans and paper fragments.
Abstract: Summary Nasal cavities foreign bodies are common accidents in children, sometimes leading, in accordance with the literature, to complications such as epistaxis and bronchoaspiration. Diagnosis is often made with anterior rhinoscopy, but sometimes nasal fibroendoscopy and imaging may be useful. Aim To evaluate 420 cases of nasal foreign bodies removed in ENT Service of Souza Aguiar Hospital, Rio de Janeiro, as related to sex, age, type of foreign body and complications. Materials and method 420 cases of nasal foreign bodies removed in the ENT service of Souza Aguiar Hospital between December 1992 and December 1998 were evaluated according to the parameters related above. Results We found higher incidence between 0 and 4 years of age, and the most frequently found foreign bodies were foam fragments, plastic pieces of little toys, beans and paper fragments. Complications occurred in 9.05% of the cases, epistaxis and vestibulitis being the commonest. Conclusion Nasal foreign bodies are especially found between the ages of 0 and 4 years. In our study, foam fragments and small plastic objects were the most frequent foreign bodies found. Complications were found in 9.05% of the cases, headed by epistaxis and nasal vestibulitis.

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TL;DR: There is scientific evidence showing good efficacy of Epley's maneuver in the treatment of Benign Paroxysmal Positional Vertigo.
Abstract: Summary Benign Paroxysmal Positional Vertigo (BPPV) is one of the most frequent diseases of the vestibular system and it is characterized by episodes of recurrent vertigo triggered by head movements or position changes. There are several approaches for treatment, but efficacy is still being discussed. Aim To asses the effectiveness of the specific maneuvers available to the treatment of BPPV. Methodology An electronic search at the main databases, including MEDLINE, LILACS, PEDro, Cochrane Collaborations Database was performed, and we selected only randomized clinical trials studying adults with diagnosis of BPPV confirmed by the Dix-Hallpike test. The trials should have included physical maneuvers such as Epley and Semont. The main outcome was Dix-Hallpike negative test and the changes to subjective complaints. The trials were assessed using Jadad's scale and only studies with quality scores equal or above 3 were pooled on a meta-analyses to assess their effectiveness. Results We found five controlled clinical trials phase I comparing the Epley's maneuver with controls or placebo. The metaanalysis showed positive evidence of Epley's maneuver to the posterior semicircular canal (effect size = 0.11 [CI 95% 0.05, 0.26] of objective improvement [Dix-Halpike] within one week, 0.24 [CI 95% 0.13, 0.45] within one month and 0.16 [CI 95% 0.08, 0.33] of improvement reported by the patients within one week. There are no studies about the efficacy of Semont's maneuver. Conclusion There is scientific evidence showing good efficacy of Epley's maneuver in the treatment.

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TL;DR: The timpanoplasty must be considerate in the treatment of the COMNC, as the graft, technique and access used were not significantly to repair tympanic membrane perforations.
Abstract: Summary Chronic otitis media has a high prevalence on the population and their treatment continuous to be a challenge for the otorhinolaryngologists. Aim: To demonstrate the factors that could interfere in the tympanoplasty success and the surgical results during 2002. Study Design: Clinical prospective. Material and Method: were included 37 patients with chronic otitis media non cholesteatoma (COMNC) undergo to tympanoplasty (in lay or underlay, with homologous graft). All the patients were submitted to a survey pre and postoperative include clinical, physical examinations, flexible nasal endoscope and audiometry. Results: The age, the dimension and localization of the tympanic membrane perforation; the condition of middle ear mucosa; number of otorrhea/year; smoking; parents history of otorrhea and hearing loss; personals history of otological surgery; monthly family income; the graft, technique and access used were not significantly to repair tympanic membrane perforations. The closure rate was 65% and the gain in air-bone gap was 100%. Conclusion: The timpanoplasty must be considerate in the treatment of the COMNC.

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TL;DR: A hearing monitoring protocol is suggested, considering the patients capability to respond to behavioral tests and monitoring timing (first test/follow up) and for cancer patients, hearing monitoring should be performed in the patients treatment venue.
Abstract: Summary Some pharmaceutical products are capable of damaging the human auditory system. Technological progress has provided numerous resources to monitor hearing but there still is some controversy regarding the selection of the most sensitive and specific tests. Objective: to analyze audiological procedures used in the auditory monitoring of individuals exposed to ototoxic medication. Methods: we searched the MEDLINE and LILACS literature databases, using terms pertinent to audiological monitoring, ototoxicity and cancer. The pertaining literature analysis identified two procedures often used worldwide for the early detection of auditory lesions induced by ototoxic pharmaceutical drugs: high-frequency audiometry and evoked otoacoustic emissions. Both allow early identification of hearing disorders before changes are seen in conventional pure-tone audiometry and, consequently, before speech understanding is compromised. Conclusion: we suggest a hearing monitoring protocol, considering the patient’s capability to respond to behavioral tests and monitoring timing (first test/follow up). For cancer patients, hearing monitoring should be performed in the patient’s treatment venue.

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TL;DR: The results of this morphometric study of sheep ear are an important contribution to the development of an animal model to be used for surgical training and experimental otologic surgeries.
Abstract: Summary Introduction Studies about the use of sheep in surgical training and experimental otologic surgery are rare. This study intends to contribute to the knowledge on this field. Aim To study sheep inner ear structures using computerized tomography and serial cross-sections to collect more accurate morphometric data to compare sheep and human ears. Material and methods This descriptive study compared the inner structures of sheep and human ears. Measurements were made using computerized tomography, and they were stored in a DICOM compact disc for later analysis and manipulation, with a program used for medical image analysis (Osiris 4.16). Results Mean measures for sheep and human ears were found to be similar in this morphological study. Most structures (10 out of 15) maintained the 2/3 ratio of sheep to human ear. Conclusion The results of this morphometric study of sheep ear are an important contribution to the development of an animal model to be used for surgical training and experimental otologic surgeries.

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TL;DR: The rat anatomy allows easy access to the extratemporal facial nerve, allowing its sectioning and standardized suture, and it was also possible to establish an evaluation and graduation scale of the rat facial movements with facial palsy based on the clinical observation of these animals.
Abstract: Summary Aim standardization of the technique to section the extratemporal facial nerve in rats and creation of a scale to evaluate facial movements in these animals before and after surgery. Study design Experimental. Method twenty Wistar rats were anesthetized with ketamine xylazine and submitted to sectioning of the facial nerve near its emergence through the mastoid foramen. Eye closure and blinking reflex, vibrissae movement and positioning were observed in all animals and a scale to evaluate these parameters was then created. Results The facial nerve trunk was found between the tendinous margin of the clavotrapezius muscle and the auricular cartilage. The trunk was proximally sectioned as it exits the mastoid foramen and the stumps were sutured with a 9-0-nylon thread. An evaluation and graduation scale of facial movements, independent for eye and vibrissae, was elaborated, together with a sum of the parameters, as a means to evaluate facial palsy. Absence of eye blinking and closure scored 1; the presence of orbicular muscle contraction, without blinking reflex, scored 2; 50% of eye closure through blinking reflex, scored 3, 75% of closure scored 4. The presence of complete eye closure and blinking reflex scored 5. The absence of movement and posterior position of the vibrissae scored 1; slight shivering and posterior position scored 2; greater shivering and posterior position, scored 3 and normal movement with posterior position, scored 4; symmetrical movement of he vibrissae, with anterior position, scored 5. Conclusion The rat anatomy allows easy access to the extratemporal facial nerve, allowing its sectioning and standardized suture. It was also possible to establish an evaluation and graduation scale of the rat facial movements with facial palsy based on the clinical observation of these animals.

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TL;DR: Most of the sample included females with associated diseases, and using many different drugs, and the most prevalent vestibular diseases were metabolic and vascular labyrinth conditions.
Abstract: Summary Dizziness is common among the elderly. Aim To characterize social, demographic, clinical, functional and otoneurological data in elderly patients with chronic vestibular disorder. Method A sequential study of 120 patients with chronic vestibular disorder. Simple descriptive analyses were undertaken. Results Most of the patients were female (68.3%) with a mean age of 73.40±5.77 years. The average number of illnesses associated with the vestibular disorder was 3.83±1.84; the patients were taking on average 3.86±2.27 different medications. The most prevalent diagnosis on the vestibular exam was unilateral vestibular loss (29.8%) and the most prevalent etiology was metabolic vestibulopathy (40.0%) followed by benign paroxysmal positional vertigo (36.7%). Fifty-two patients (43.3%) had experienced dizziness for 5 years or more. Sixty-four patients (53.3%) had at least one fall in the last year and thirty-five (29.2%) had recurrent falls. Conclusions Most of the sample included females with associated diseases, and using many different drugs. The most prevalent vestibular diseases were metabolic and vascular labyrinth conditions. Dizziness is a chronic symptom in elderly patients. The association of two vestibular diseases is common. Falls are prevalent in chronic dizzy elderly patients.

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TL;DR: There is scientific evidence showing good efficacy of Epley’s maneuver in the treatment of BPPV, and there are no studies about the efficacy of Semont“s maneuver.
Abstract: A Vertigem Posicional Paroxistica Benigna (VPPB) e uma das mais frequentes patologias do sistema vestibular e e caracterizada por episodios de vertigens recorrentes desencadeados por movimentos da cabeca ou mudancas posturais. Ha varias opcoes para o seu tratamento, porem as efetividades terapeuticas das mesmas permanecem controversas. OBJETIVO: Avaliar a efetividade terapeutica das manobras especificas disponiveis para o tratamento da VPPB. METODOLOGIA: Realizou-se uma busca eletronica nas principais bases de dados, selecionando-se estudos clinicos randomizados envolvendo adultos com diagnostico de VPPB confirmado com o teste de Dix-Hallpike e tratamento com manobras especificas (Epley ou Semont, por exemplo). Considerou-se como desfecho clinico a negativacao do teste de Dix-Hallpike e a melhora das queixas subjetivas. Agruparam-se em metanalise os estudos com Escala de Jadad igual ou superior a tres. RESULTADOS: Cinco estudos clinicos preencheram os criterios de inclusao, ou seja, ensaios randomizados de fase I comparando a manobra de Epley com placebos e controles. A metanalise mostra evidencia dos efeitos beneficos da manobra de Epley para o tratamento do canal semicircular posterior (magnitude do efeito de 0,11 [IC 95% 0.05, 0.26] de melhora objetiva (Dix-Halpike) apos uma semana, 0.24 [IC 95% 0.13, 0.45] apos um mes e 0.16 [IC 95% 0.08, 0.33] de melhora referida pelos pacientes apos a primeira semana). CONCLUSAO: Evidencia-se boa eficacia clinica da manobra de Epley para o tratamento da VPPB do canal semicircular posterior. Contrariamente, trabalhos com a manobra de Semont e as propostas de manejo dos demais canais semicirculares nao obtiveram qualidade metodologica satisfatoria, nao sendo possivel demonstrar a efetividade dos mesmos.

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TL;DR: DPOAE may be useful in the identification of physiopathological hearing alterations caused by exposure to occupational noise, even in individuals with tonal audiometric responses within acceptable limits.
Abstract: A exposicao ao ruido ocupacional pode provocar lesoes em nivel da orelha interna, sendo que o registro das Emissoes Otoacusticas por Produtos de Distorcao (EOAPD) e capaz de identificar alteracoes auditivas iniciais relacionadas a tais lesoes, auxiliando no diagnostico precoce da PAIRO. OBJETIVO: Avaliar as EOAPD como metodo de diagnostico de alteracoes fisiopatologicas iniciais provocadas por exposicao ao ruido ocupacional. FORMA DE ESTUDO: Transversal. METODO: Foram avaliados 74 trabalhadores do sexo masculino, lotados no Campus Universitario da Universidade de Sao Paulo na capital, divididos em dois grupos pareados por idade e com exame de audiometria tonal dentro de limites aceitaveis: 37 individuos expostos ao ruido ocupacional e 37 nao-expostos. RESULTADOS: A estimativa do risco (Odds Ratio) de ausencia de resposta no registro das EOAPD foi 12 vezes maior para o grupo de expostos ao ruido ocupacional (IC 95% 3,1 - 45,9), nas frequencias de 3, 4 e 6 kHz agrupadas. CONCLUSAO: Os resultados sugerem que a exposicao ao ruido ocupacional pode provocar alteracoes nos registros das EOAPD, mesmo em individuos com exame de audiometria tonal dentro de limites aceitaveis, indicando que este exame pode ser importante como metodo de diagnostico precoce da PAIRO.

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TL;DR: The end result was that the presence of HSV-1 in the saliva of patients with Bell's palsy indicating that the viral reactivation can be the etiology of this disease.
Abstract: Summary The first herpes virus to be described was types 1 and 2, whose denomination is herpes simplex 1 and 2 or HSV -1 and HSV -2. These viruses have specific biological characteristics, such as the ability to cause different kinds of diseases, as well as to establish host's latent or persistent lifetime infections and also of being reactivated, causing lesions that can be located at the same site of the initial primary infection or close to it. It is suggested that this virus reactivation in the geniculate ganglion may be related to Bell's palsy. In this situation, the viruses that would be latent in this ganglion, would suffer reactivation and replication, then be diffused through the facial nerve and its branches, among them the chorda tympani nerve, which by stimulating salivary secretion would enable the identification of the viral DNA in the patients’ saliva. Until recently, a great number of patients was diagnosed as holders of this kind of paralysis, named idiopathic or Bell's palsy. With the introduction of the technique studying the viral DNA by Polymerase Chain Reaction (PCR), several authors have found herpes simplex virus type I DNA in the cerebrospinal fluid, in the lachrymal secretion, in the saliva and in the geniculate ganglia of patients with Bell's palsy. Aim observe the occurrence of herpes simplex type I virus using PCR technique in the saliva of patients with Bell's palsy and relating it to the clinical evolution of these cases. Methodology We evaluated 38 patients with Bell's palsy submitted to anamnesis, clinical and ENT examination and saliva sampling for viral DNA detection by PCR technique. The control group was ten normal adults. Results We found positive viral DNA in 11 cases out of the 38, which corresponded to 29% of the sample. This result was statistically significant if compared to the control group, in which we did not find any positive case. Conclusion The end result was that the presence of HSV -1 in the saliva of patients with Bell's palsy indicating that the viral reactivation can be the etiology of this disease. The detection of the virus in these patients’ saliva does not influence the disease prognosis.