RESUMO

A randomized, prospective trial was carried out to compare the rate of hemorrhagic complications after removal of nasal packing left for 24 and 48 hours. A total of 104 patients underwent nasal surgery and were randomly assigned to 1 of 2 groups: group 1, 24 hours of nasal packing; group 2, 48 hours of nasal packing. No statistical difference was observed between the groups in terms of occurrence of hemorrhagic complications. Hypertension was the only prognostic factor for postoperative bleeding. The routine use of 48-hour postoperative nasal packing after nasal surgery is not justified because of the low incidence of bleeding and the potential associated morbidity. At the end of the procedure, surgeons should evaluate the risk of postoperative bleeding (ie, presence of hypertension) and decide whether 24-hour nasal packing is enough.

Assuntos

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OBJECTIVE: To report clinical manifestations, diagnosis, and epidemiologic characteristics of laryngeal paracoccidioidomycosis. DESIGN: Case series. SETTINGS: Tertiary care institutional hospital. PATIENTS: We reviewed the hospital records of 7 patients with laryngeal paracoccidioidomycosis diagnosed by histopathological examination. MAIN OUTCOME MEASURE: Clinical manifestations of laryngeal paracoccidioidomycosis. RESULTS: All patients were men and were middle-aged (range, 43-65 years), and most (86% [6/7]) were farm workers. All 7 patients regularly used tobacco, but only (43% [3/7]) were alcohol users. Clinical manifestations were dysphonia (86% [6/7]), dyspnea (71% [5/7]), dysphagia (43% [3/7]), and cough (29% [2/7]). Laryngeal examination revealed ulcerative lesions with a mulberrylike appearance in 3 patients and vegetative lesions in 4 patients. Many had multiple laryngeal lesions with involvement of the true and false vocal cords, the epiglottis, and the arytenoid and interarytenoid areas. The first diagnostic impression was carcinoma in all patients. CONCLUSIONS: Laryngeal paracoccidioidomycosis may be a difficult diagnosis for the unsuspecting clinician to make. Examination of the larynx can reveal lesions similar to laryngeal cancer; therefore, diagnosis of carcinoma must be ruled out by histopathological examination or culture of a specimen.

Assuntos

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To call attention to complications of chronic otitis media, the case of a patient who simultaneously developed lateral sinus thrombosis and Bezold's abscess is reported. A 7 year old boy presented with fever, drowsiness, cervical mass and otorrhea not responding to medical management. Work-up revealed lateral sinus thrombosis and cervical abscess secondary to right ear cholesteatoma. After treatment with surgery and antibiotics, he had a favorable outcome. We review the literature regarding the diagnosis and management of these complications and concluded that although less frequent they remain a clinical challenge.

Assuntos

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OBJECTIVE: To study the sensitivity and specificity of otoscopy and tympanometry in the diagnosis of secretory otitis media. METHODS: A prospective study was performed in 98 children (196 ears) with indication of myringotomy with placement of tympanostomy tube because of the diagnosis of secretory otitis media. All these patients had conductive hearing loss and/or delay of speech and/or low school performance. To evaluate the diagnostic power of the tests, both otoscopy and tympanometry were performed. Myringotomy was established as the gold-standard. The statistical analysis was done using the chi-square test, being significant a p<0.05.RESULTS: The mean age of the patients was 6.02 years (sd: 2.93 years). The otoscopy presented sensitivity of 87.5% and specificity of 61.1% and the tympanometry presented sensitivity of 93.75% and specificity of 72.2%. CONCLUSIONS: There was no statistically significant difference in sensitivity between otoscopy and tympanometry for the diagnosis of secretory otitis media, however, tympanometry was significantly more specific than otoscopy (p< 0.01).

RESUMO

OBJECTIVE: To focus on two rare complications of cholesteatomatous chronic otitis media. METHODS: A case of two simultaneous complications of cholesteatoma (lateral sinus thrombophlebitis and Bezold's cervical abscess) in a 7 year-old boy is reported. Thereafter, a review of the international literature about both complications is carried out. RESULTS: A 7 year-old white male patient was referred for assessment with high fever, obnubilation, cervical mass and otorrhea, being non-responsive to the clinic treatment, with the diagnostic hypothesis of infectious parotitis. The clinical examination and radiologic study demonstrated lateral sinus thrombophlebitis and cervical abscess due to cholesteatoma in the right ear. After being submitted to surgery and prolonged intravenous antibiotic therapy, the patient presented a favorable outcome, with little morbidity. CONCLUSION: Despite the incidence of complications of otitis had decreased in the last decades, they are still a challenge for the clinician, especially because of the insidious manner of presentation, usually hidden with the indiscriminate use of antibiotics.