RESUMO
OBJECTIVES: To evaluate the applicability of magnetic resonance imaging (MRI) as a method for monitoring the activity of otospongiotic lesions before and after clinical treatment. STUDY DESIGN: Prospective, randomized, controlled, double-blind study. SETTING: One single tertiary care institution in a large, cosmopolitan city. METHODS: Twenty-six patients (n = 42 ears) with clinical, audiometric, and tomographic diagnosis of otosclerosis were enrolled. If computed tomography (CT) demonstrated active lesions, these patients underwent MRI to detect otospongiotic foci, seen as areas of gadolinium enhancement. Patients were divided into 3 groups and received treatment with placebo, sodium alendronate, or sodium fluoride for 6 months. After this period, clinical and audiometric evaluations and a second MRI were performed. Each MRI was evaluated by both a neuroradiologist and an otolaryngologist in a subjective (visual) and objective (using specific eFilm Workstation software) manner. RESULTS: Otospongiosis was most predominantly identified in the region anterior to the oval window, and this site was reliable for comparing pre- and posttreatment scans. The patients in the alendronate and sodium fluoride groups had MRI findings that suggested a decrease in activity of otospongiotic lesions, more relevant in the alendronate group. These findings were statistically significant for both subjective and objective MRI evaluations. CONCLUSIONS: MRI shows higher sensitivity than clinical or audiometric assessment for detecting reduction in activity of otospongiosis. The objective MRI evaluation based on software analysis was the most accurate method of monitoring clinical treatment response in otospongiosis.
Assuntos
Alendronato/administração & dosagem , Imageamento por Ressonância Magnética/métodos , Fluoreto de Sódio/administração & dosagem , Adulto , Idoso , Audiometria/métodos , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Valores de Referência , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
The classical surgical technique for the resection of vestibular schwannomas (VS) has emphasized the microsurgical anatomy of cranial nerves. We believe that the focus on preservation of the arachnoid membrane may serve as a safe guide for tumor removal. Method The extracisternal approach is described in detail. We reviewed charts from 120 patients treated with this technique between 2006 and 2012. Surgical results were evaluated based on the extension of resection, tumor relapse, and facial nerve function. Results Overall gross total resection was achieved in 81% of the patients. The overall postoperative facial nerve function House-Brackmann grades I-II at one year was 93%. There was no recurrence in 4.2 years mean follow up. Conclusion The extracisternal technique differs from other surgical descriptions on the treatment of VS by not requiring the identification of the facial nerve, as long as we preserve the arachnoid envelope in the total circumference of the tumor.
Assuntos
Aracnoide-Máter/cirurgia , Nervo Facial , Microcirurgia/métodos , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Tratamentos com Preservação do Órgão/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Traumatismos do Nervo Facial/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/patologia , Complicações Pós-Operatórias , Período Pós-Operatório , Estudos Retrospectivos , Espaço Subaracnóideo/cirurgia , Resultado do Tratamento , Carga Tumoral , Adulto JovemRESUMO
The classical surgical technique for the resection of vestibular schwannomas (VS) has emphasized the microsurgical anatomy of cranial nerves. We believe that the focus on preservation of the arachnoid membrane may serve as a safe guide for tumor removal. Method The extracisternal approach is described in detail. We reviewed charts from 120 patients treated with this technique between 2006 and 2012. Surgical results were evaluated based on the extension of resection, tumor relapse, and facial nerve function. Results Overall gross total resection was achieved in 81% of the patients. The overall postoperative facial nerve function House-Brackmann grades I-II at one year was 93%. There was no recurrence in 4.2 years mean follow up. Conclusion The extracisternal technique differs from other surgical descriptions on the treatment of VS by not requiring the identification of the facial nerve, as long as we preserve the arachnoid envelope in the total circumference of the tumor. .
A técnica cirúrgica clássica para ressecção de schwannomas vestibulares enfatiza a anatomia microcirúrgica dos nervos cranianos. Acreditamos que o foco na preservação da membrana aracnóide pode servir como parâmetro seguro para a remoção do tumor. Método A abordagem extracisternal é descrita em detalhe. Analisamos o prontuário de 120 pacientes tratados com esta técnica entre 2006 e 2012. Os resultados cirúrgicos foram baseados em extensão de ressecção, recorrência tumoral e função do nervo facial. Resultados Ressecção total foi obtida em 81% dos pacientes. O resultado global da função do nervo facial (House-Brackmann graus I-II) após um ano da cirurgia foi de 93%. Não houve recidiva em um seguimento médio de 4,2 anos. Conclusão A técnica extracisternal difere de outras descrições cirúrgicas no tratamento de schwannoma vestibular pois não requer a identificação do nervo facial, contanto que o plano de aracnóide seja preservado em toda circunferência do tumor. .
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Aracnoide-Máter/cirurgia , Nervo Facial , Microcirurgia/métodos , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Tratamentos com Preservação do Órgão/métodos , Traumatismos do Nervo Facial/prevenção & controle , Neuroma Acústico/patologia , Complicações Pós-Operatórias , Período Pós-Operatório , Estudos Retrospectivos , Espaço Subaracnóideo/cirurgia , Resultado do Tratamento , Carga TumoralRESUMO
CONCLUSION: We conclude that facial nerve injury induced by compression is associated with a reasonable time window (4 weeks) that allows possible neurotrophic effects to be analyzed. Additionally, there are no hints of cross-innervation by the contralateral facial nerve or parallel innervation by other nerves in the hemiface ipsilateral to the injured nerve. OBJECTIVE: The aim of this work was to develop an experimental model of facial nerve injury in nonhuman primates (Callithrix sp.). METHODS: In this study, individuals of the non-human primate species Callithrix sp. were subjected to three different types of facial nerve injury, and they were observed for 27 days after surgery by video to record their facial movements. RESULTS: Two types of nerve compression caused severe initial facial paralysis followed by gradual recovery until normal levels were reached at the end of the evaluation period. Injury induced by nerve resection was followed by a complete lack of facial movement recovery.
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Callithrix , Modelos Animais de Doenças , Traumatismos do Nervo Facial , Paralisia Facial , Animais , Feminino , MasculinoRESUMO
UNLABELLED: Tinnitus is a common symptom, defined as a sound perception in absence of a sound stimulus. AIM: Evaluate if Trazodone, an antidepressant drug, which modulates serotonin at central neuronal pathways, is effective in controlling tinnitus. STUDY DESIGN: Prospective, double blind, randomized, placebo-controlled. MATERIALS AND METHODS: Study performed with patients presenting tinnitus. 85 patients were analyzed between February and June of 2005. 43 received trazodone and 42 placebo, for 60 days. The clinical criteria of analysis were tinnitus intensity, discomfort and life quality impact by tinnitus, using an analogue scale varying between 0 and 10, scored by patients before and after drug or placebo use. RESULTS: There was a significant improvement in intensity, discomfort and life quality in both groups after treatment; however, there was no significant difference between the drug and placebo groups. Patients with age equal or over 60 years presented better results after treatment. CONCLUSION: Trazodone was not efficient in controlling tinnitus in the patients evaluated under the doses utilized.
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Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Zumbido/tratamento farmacológico , Trazodona/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Índice de Gravidade de DoençaRESUMO
O zumbido é um sintoma freqüente, definido como percepção sonora auditiva na ausência de estímulo sonoro. OBJETIVO: Avaliar se a Trazodona, antidepressivo modulador da serotonina nas vias neuronais centrais, atua positivamente no controle do zumbido. Forma de Estudo: Prospectivo, duplo-cego, randomizado, controlado com placebo. MATERIAL E MÉTODO: estudo realizado com pacientes com zumbido. Oitenta e cinco pacientes foram avaliados entre fevereiro e junho de 2005, sendo que 43 pacientes receberam droga e 42, placebo, pelo período de 60 dias. Os critérios de análise foram intensidade, efeito sobre a qualidade de vida e grau de incômodo devido ao zumbido, através de escala analógica com notas de 0 a 10 dadas pelos pacientes antes e após o uso da trazodona ou placebo. RESULTADOS: Em ambos os grupos houve melhora da intensidade, qualidade de vida e incômodo após o tratamento, porém não houve diferença significativa entre os grupos droga e placebo. Quando se avaliou os critérios clínicos na faixa etária maior ou igual a 60 anos, obteve-se melhora nos níveis de intensidade, incômodo e efeito sobre a qualidade de vida após o tratamento. CONCLUSÃO: A trazodona não foi eficiente no controle do zumbido dos pacientes avaliados na dose utilizada.
Tinnitus is a common symptom, defined as a sound perception in absence of a sound stimulus. AIM: Evaluate if Trazodone, an antidepressant drug, which modulates serotonin at central neuronal pathways, is effective in controlling tinnitus. STUDY DESIGN : Prospective, double blind, randomized, placebo-controlled. Materials and Methods: Study performed with patients presenting tinnitus. 85 patients were analyzed between February and June of 2005. 43 received trazodone and 42 placebo, for 60 days. The clinical criteria of analysis were tinnitus intensity, discomfort and life quality impact by tinnitus, using an analogue scale varying between 0 and 10, scored by patients before and after drug or placebo use. RESULTS: There was a significant improvement in intensity, discomfort and life quality in both groups after treatment; however, there was no significant difference between the drug and placebo groups. Patients with age equal or over 60 years presented better results after treatment. CONCLUSION: Trazodone was not efficient in controlling tinnitus in the patients evaluated under the doses utilized.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Zumbido/tratamento farmacológico , Trazodona/uso terapêutico , Método Duplo-Cego , Estudos Prospectivos , Qualidade de Vida , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To analyze long-term results of a new stentless surgical technique for choanal atresia that also used no packing. STUDY DESIGN: Prospective study. METHODS: Ten patients (3 bilateral and 7 unilateral), with ages ranging from 4 days to 30 years, were operated on. The follow-up was 6 months to 36 months. This approach allowed resection of the posterior portion of the vomer, atretic plate, and part of the medial pterygoid process. Flaps were fashioned from septal, nasal, and pharyngeal mucosa from the atretic plates and fixed with fibrin glue. Postoperative control included nasal endoscopy and computerized tomography (CT). RESULTS: Adequate functional nasal breathing was maintained during follow-up. CONCLUSIONS: This technique was satisfactory and safe, allowing fast recovery in a one-step surgery, using neither stents nor nasal packing. Long-term patency with no reduction in functional quality was also observed.
Assuntos
Atresia das Cóanas/cirurgia , Endoscopia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Septo Nasal , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Estudos Prospectivos , Retalhos Cirúrgicos , Tomografia Computadorizada por Raios XRESUMO
Com o advento dos testes eletrofisiológicos, a avaliação clínica parece ter perdido interesse na paralisia de Bell. A eletroneuronografia (ENoG) associada ao estadiamento clínico da doença é o método mais freqüentemente utilizado para mensurar o prognóstico da paralisia de Bell. Entretanto, a ENoG constitui-se em um teste eletrofisiológico ainda não universalmente disponível, especialmente nos serviços de emergência. OBJETIVO: Estudar a medida do prognóstico da paralisia de Bell com base nos dados clínicos e no teste de estimulação elétrica mínima, teste de Hilger, permitindo assim uma previsão de prognóstico segura e factível na maioria dos serviços. FORMA DE ESTUDO: coorte historica. MATERIAL E MÉTODO: Estudo coorte retrospectivo, analisando 1521 casos de paralisia de Bell, correlacionando-se os dados clínicos sexo, idade, lado da paralisia, modo de instalação, sintomas prévios, sintomas associados e os resultados do teste de estimulação elétrica mínima (Hilger), com a evolução da paralisia após 6 meses. RESULTADO: O estudo desses dados indicou que pacientes acima de 60 anos apresentaram prognóstico pior em comparação com pacientes com idade abaixo de 30 anos; o modo de instalação progressiva, a ausência de sintomas prévios, a presença de vertigem concomitante à paralisia e resposta acima de 3,5 mm no teste de Hilger estiveram relacionados com mau prognóstico. Por outro lado, a ausência de sintomas concomitantes, a diminuição do lacrimejamento e o início súbito foram relacionados com bom prognóstico. CONCLUSÃO: A análise de fatores clínicos, associada ao teste de Hilger, pode indicar o prognóstico da paralisia facial com reduzida margem de erro, sendo uma alternativa bastante interessante especialmente quando não há disponibilidade da ENoG.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Paralisia de Bell/diagnóstico , Distribuição por Idade , Fatores Etários , Progressão da Doença , Distribuição de Qui-Quadrado , Estudos de Coortes , Estimulação Elétrica , Prognóstico , Paralisia de Bell/fisiopatologia , Estudos RetrospectivosRESUMO
OBJECTIVES: Complications in the central nervous system (CNS) from acute otitis media (AOM) and chronic otitis media (COM) are becoming fewer, although they still represent a challenge for early recognition, adequate treatment, and satisfactory results. This retrospective study analyzed clinical data and therapeutic options in 33 patients with intracranial involvement resulting from otitis media. Important clinical features of intracranial complications and the sequence of the most efficient therapeutic maneuvers are discussed. METHODS: Charts of six patients with AOM and 27 patients with COM associated with CNS complications were analyzed for clinical presentation, imaging, and therapeutic approach. RESULTS: Ages ranged from 6 months to 79 years, with no gender predilection. Persistent fever, headache, and purulent otorrhea were the main symptoms. Proteus mirabilis , Enterococcus , and Pseudomonas aeruginosa were the most common microorganisms in COM, and Pneumococcus and Haemophilus were the most common microorganisms in AOM. Nineteen patients (58%) presented with more than 1 CNS complication, resulting in a total of 56 complications, including 26 cases of otogenic brain abscess, 21 cases of meningitis, 5 cases of lateral sinus thromboses, two cases of subdural empyemas, 1 case of epidural empyema, and 1 case of meningocele. Surgical interventions included craniotomy and drainage of the abscess (n = 17), open mastoidectomy with abscess drained through the mastoid (n = 10), open mastoidectomy alone (n = 8), and closed mastoidectomy (n = 2). Twelve patients who underwent craniotomy had subsequent mastoidectomy for recurrent abscess. At the 6-month, 66% of patients presented without sequelae, 24% presented with sequelae, and 9% died. CONCLUSION: Early identification and prompt clinical and surgical intervention with mandatory drainage of the middle ear (primary disease), was essential for better outcome.
Assuntos
Encefalopatias/etiologia , Otite Média/complicações , Adolescente , Adulto , Idoso , Encefalopatias/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de TempoRESUMO
UNLABELLED: Electroneurography (ENoG) and clinical staging are currently the methods of choice to indicate prognosis in Bell's palsy, although ENoG is an electrophysiological test not universally available. AIM: Identify other options of prognostic evaluation based upon clinical aspects and minimal electrical stimulation test allowing prognostic measurement in almost any circumstances. STUDY DESIGN: Historic cohort. MATERIAL AND METHOD: Chart review of 1,521 cases of IPFP, analyzing the following clinical aspects: gender, age, paralyzed side, installation mode, previous symptoms, associated symptoms and minimal electrical stimulation test (Hilger test) and its statistical correlation to facial palsy evolution after 6 months. RESULTS: Data indicated that patients above 60 years old had worse prognosis in comparison with patients under 30 years old. A progressive mode of paralysis installation, absence of previous symptoms, concomitant vertigo and response superior to 3.5 mA at minimum electrical stimulation test were also related to worse prognosis. On the other hand, the absence of concomitant symptoms, diminished tearing and sudden onset were related to better prognosis. CONCLUSION: Clinical factors and Hilger's test can accurately indicate the prognosis in cases of Bell's palsy when ENoG is not available.
Assuntos
Paralisia de Bell/diagnóstico , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Paralisia de Bell/fisiopatologia , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Estudos de Coortes , Progressão da Doença , Estimulação Elétrica , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos RetrospectivosRESUMO
OBJECTIVE/HYPOTHESIS: One mechanism associated with degeneration in the elderly is the decrease of neurotransmitters. In the central auditory pathway serotonin, can be found from cochlear nucleus to the auditory cortex, and it constitutes one of the most important neuromodulatory circuits in hearing processing. The present study analyzed the action of citalopram, a selective inhibitor of serotonin reuptake, in aged patients with normal to moderate sensorineural hearing loss (HL) and low performance on auditory processing. STUDY DESIGN/METHOD: Prospective, double-blind, randomized, placebo-controlled study. Thirty-eight selected patients were randomly divided into two groups. Nineteen patients made up group A and received placebo for 60 days. Nineteen patients of Group B received 20 mg per day of citalopram for 60 days. Hearing evaluation was performed initially and after 60 days and included pure-tone audiometry, speech discrimination test (SDT), emittanciometry (acoustic impedance audiometry), identification of synthetic sentences with an ipsilateral competitive message (SSI/ICM), tests of pitch-pattern sequences (PPS), and the staggered spondaic words test (SSW). RESULTS: Comparisons of tests of auditory processing pre- and posttreatment in each group showed a statistical improvement in performance on all tests in group B after 2 months of therapy. Comparisons pre- and posttreatment between groups showed that patients who received citalopram presented statistically significantly better results in the SSI/ICM test (P < .0001) after treatment. The same comparison in results for the PPS test and the SSW test revealed a tendency (P = .09 and 0.058, respectively) toward better performance in the group receiving citalopram. CONCLUSION: These preliminary results suggest that the use of citalopram can have a positive impact on auditory processes in elderly patients with low performance in auditory process.
Assuntos
Citalopram/uso terapêutico , Perda Auditiva Neurossensorial/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Idoso , Audiometria de Tons Puros , Córtex Auditivo/efeitos dos fármacos , Limiar Auditivo/efeitos dos fármacos , Núcleo Coclear/efeitos dos fármacos , Método Duplo-Cego , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Testes de Discriminação da Fala , Teste do Limiar de Recepção da Fala , Resultado do TratamentoRESUMO
This article presents our results of surgical treatment of chronic otitis media (COM) and discusses its efficacy regarding the control of disease and hearing results. A retrospective chart review of 84 ears was performed. Forty-one ears with noncholesteatomatous COM underwent tympanomastoidectomy, 43 ears with cholesteatoma were managed according to the extension of the disease, closed mastoidectomy was indicated in 19 cases, and open mastoidectomy was performed in 24 ears. In the group without cholesteatoma, a stable ear with closed tympanic membrane was obtained in 85% of cases after the first procedure. The speech response threshold before and after surgery was 38 and 26 dB. In patients with cholesteatoma, a dry ear was achieved in 79% of cases on both techniques after the first intervention. The recurrence rate of cholesteatoma was 10% for the closed technique and 4% for the open technique. The mean preoperative and postoperative SRTs for the closed technique were 30 and 29 dB and for the open technique were 50 and 54 dB. The surgical treatment for COM can be a rewarding procedure if a correct technique is indicated. The surgery should be tailored regarding the clinical stage and intraoperative findings in each case.
Assuntos
Otite Média/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Colesteatoma da Orelha Média/epidemiologia , Colesteatoma da Orelha Média/etiologia , Doença Crônica , Feminino , Humanos , Masculino , Processo Mastoide/cirurgia , Pessoa de Meia-Idade , Otite Média/complicações , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Estudos Retrospectivos , Índice de Gravidade de Doença , Percepção da Fala/fisiologia , Teste do Limiar de Recepção da Fala , Resultado do Tratamento , Membrana Timpânica/cirurgiaRESUMO
Sob a designaçäo de osteodistrofias do osso temporal, podemos encontrar uma série de doenças que apresentam em comum a desorganizaçäo da arquitetura ou da composiçäo do tecido ósseo. A otospongiose é, com larga margem, a osteodistrofia mais comum nessa localizaçäo e suas alteraçöes, repercussöes clínicas e tratamentos säo amplamente discutidos na literatura. Entretanto, formas menos freqüentes, como a displasia fibrosa e a osteogênese imperfeita, näo säo entidades raras e merecem atençäo. Este artigo tem como objetivo discutir essas formas menos comuns de osteodistrofia do temporal através de uma revisäo sobre os conceitos atuais dessas entidades, da apresentaçäo de três exemplos clínicos e a discussäo sobre opçöes de tratamento
RESUMO
The purpose of this work was to stude the basic audiologic battery as a tool in the retrococler disorder diagnoses. We have tested 21 patients presenting acoustic neurinomam surgically confirmed. The pure tone audiometry has revealed unilateral sensory-neural hearing loss in 20 cases, six of them have had no below 60% in six patients, from l5 who the test was performed the rollover was detected in only half of the patients, what lead us to a 50% of false negative. The tone decay test, performed in eight patients, has revealed retococlear results in only 25%, i.e., a 75% rate of false-negative. At the impedance audiometry in 10 patients, seven have had an absence of responses of the acoustic reflex, and three showed a recruitment. We conclude with these results that the unilateral and/or assimetrical hearing loss in the pure tone audiometry and the absence of the acoustic reflex in the impedance audiometry are the most consistent findings in the basic audiologic attery for a retrococlear disorder