RESUMO
OBJECTIVE: The aim of this study is to evaluate the sensitivity parameters of the percentage of time the pH is <4 and >7, as well as the total number of laryngopharyngeal reflux episodes in 24 hours, in patients with suspected laryngopharyngeal reflux disease. STUDY DESIGN: Retrospective controlled study. SETTING: University hospital. SUBJECTS AND METHODS: The study was conducted on 46 patients with laryngopharyngeal reflux disease and 58 healthy controls. Patients and controls underwent 24 hours of dual-probe pH monitoring of the distal and cervical esophagus. Patients completed a Reflux Symptom Index questionnaire and underwent esophageal manometry. Data concerning the percentage of time the pH was <4 and >7 and the number of reflux episodes registered at the cervical esophagus were collected and evaluated. RESULTS: The percentage of time the pH is <4 and the number of laryngopharyngeal reflux episodes seem to be a reliable diagnostic laryngopharyngeal reflux criterion reaching satisfactory sensitivity (81% and 83%, respectively). Although the pH >7 parameter appeared statistically different between the 2 groups (P < .001), the sensitivity of the test appeared to be poor (55%). CONCLUSION: Our study demonstrates the importance of the absolute number of laryngopharyngeal reflux episodes in 24 hours in the diagnosis of patients with suspected laryngopharyngeal reflux, proposing it as a new diagnostic criterion.
Assuntos
Refluxo Laringofaríngeo/diagnóstico , Adulto , Estudos de Casos e Controles , Diagnóstico Diferencial , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Inquéritos e QuestionáriosAssuntos
Carcinoma Mucoepidermoide/patologia , Meato Acústico Externo/patologia , Neoplasias da Orelha/patologia , Osso Temporal/patologia , Adulto , Audiometria de Tons Puros , Carcinoma Mucoepidermoide/cirurgia , Cistos/patologia , Diagnóstico Diferencial , Meato Acústico Externo/cirurgia , Epitélio/patologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Procedimentos Cirúrgicos Otológicos , Otoscopia , Glândula Parótida/patologia , Osso Temporal/cirurgia , Tomografia Computadorizada por Raios XAssuntos
Meato Acústico Externo/patologia , Nevo Pigmentado/patologia , Neoplasias Cutâneas/patologia , Adulto , Meato Acústico Externo/cirurgia , Feminino , Perda Auditiva/etiologia , Humanos , Nevo Pigmentado/complicações , Nevo Pigmentado/cirurgia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/cirurgia , Resultado do TratamentoRESUMO
Self-injurious behavior (SIB) associated with Tourette's syndrome (TS) is a severe neuropsychiatric condition that causes significant distress and can impair social functioning. The current treatment options for the condition include pharmacological, physical and psychosocial interventions. However, given the need for more effective interventions, especially for those patients who are unresponsive and/or intolerant to standard medications, further exploration of novel treatments is imperative. In this report, we present a case of SIB-TS that was successfully treated with pregabalin. The patient received 1-year of follow-up and was noted to have considerable improvement in symptoms. Although rigorous controlled studies are required, based on our case study, pregabalin may be a potential treatment option in some cases of SIB with TS.
Assuntos
Anticonvulsivantes/uso terapêutico , Comportamento Autodestrutivo/tratamento farmacológico , Síndrome de Tourette/complicações , Ácido gama-Aminobutírico/análogos & derivados , Anticonvulsivantes/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Boca/lesões , Pregabalina , Comportamento Autodestrutivo/fisiopatologia , Índice de Gravidade de Doença , Resultado do Tratamento , Ácido gama-Aminobutírico/administração & dosagem , Ácido gama-Aminobutírico/uso terapêuticoRESUMO
OBJECTIVES: We evaluated the incidence of facial nerve dehiscence in a group of patients with cholesteatoma who underwent otologic surgery. METHODS: We performed a retrospective study in a tertiary referral hospital of 336 patients (298 adults, 38 children) with cholesteatoma who underwent surgery in the years 1998 to 2008. Using intraoperative findings, we assessed the incidence of facial nerve dehiscence in a group of patients with cholesteatoma. We quantified, in adult versus pediatric patients and in primary versus revision surgeries, the occurrence of facial nerve dehiscence, the predisposed anatomic sites, and the coexistence of semicircular canal fistula. In a selected group of 67 patients, preoperative 0.55-mm collimation computed tomography (CT) scans were compared with the intraoperative findings. RESULTS: The frequency of facial nerve dehiscence in this group of patients was 27.1%. The dehiscence was detected in 29.5% of the adults, but in only 7.8% of the patients 16 years and younger. Dehiscence was present in 42.3% of the patients who underwent revision surgery. The most common site of dehiscence (92.3%) was the tympanic segment. The sensitivity and specificity of CT were 69% and 87%, respectively. CONCLUSIONS: Dehiscence of the facial nerve was found in 27.1% of patients with cholesteatoma, with a significant difference between patients of pediatric and adult ages. A dehiscent facial nerve was more commonly seen during revision surgery and more frequent in patients older than 16 years. The site of dehiscence most frequently involved by cholesteatoma was the tympanic segment. The presence of a semicircular canal fistula increases the risk of facial nerve dehiscence. Finally, the results of preoperative CT scans are encouraging for the use of CT in predicting facial nerve dehiscence.