"Step-up"surgical treatment strategy for patulous Eustachian tube / 临床耳鼻咽喉头颈外科杂志

Patients with patulous Eustachian tubes(PET) usually suffer from annoying symptoms, such as tinnitus, autophony and aural fullness, due to the excessive opening of the Eustachian tube. There is no uniform standard of treatment, and conservative therapy combined with"Stepup"surgical intervention strategy is the main treatment. In this article, we reviewed various surgical treatments of patulous Eustachian tube in recent years, including key points of surgical operation, effectiveness, safety and complications. Full communication and evaluation are needed to establish appropriate patients' expectations preoperatively. A "Stepup" treatment strategy will be carried out, including conservative treatment, tympanic membrane surgery, Eustachian tube pharyngeal orifice constriction surgery, Eustachian tube tympanic orifice plug surgery and Eustachian tube muscle surgery, which aims to maintain normal Eustachian tube function and good middle ear ventilation.

Resultados de la dilatación de la trompa de Eustaquio en adultos con disfunción tubárica crónica / Results of Eustaquian tube dilation in adults with chronic tubal disfunction

Introducción: la dilatación endoscópica con balón ha mostrado ser una herramienta terapéutica y efectiva para el tratamiento de la disfunción de la trompa de Eustaquio. Al momento se desconocen los resultados en la población colombiana. Objetivos: determinar la mejoría clínica de la dilatación de la trompa de Eustaquio en pacientes adultos con disfunción tubárica crónica, en un centro de IV nivel de atención en Bogotá. Diseño: estudio observacional retrospectivo con componente analítico. Métodos: se revisaron los registros clínicos de pacientes intervenidos con la dilatación endoscópica de la trompa de Eustaquio; se describen los cambios objetivos y subjetivos en el posoperatorio. Resultados: se obtuvieron 22 pacientes entre los 18 y 66 años con seguimiento de 6 a 22 meses. Al 84,5 % se les realizó la intervención bilateral y al 15,8 % la unilateral, para un total de 38 oídos intervenidos. El 60 % lograron la normalización del timpanograma. Hubo una mejoría de las presiones del oído medio de -102,5 a -3,5 daPa (p = 0,005). Se alcanzó una mejoría estadísticamente significativa en 6/7 síntomas según la escala de severidad y reducción del gap aéreo-óseo en 7 dB y 4 dB del promedio de tonos puros por vía aérea (PTA) (p = 0,249; p = 0,711). Además, se generó un impacto positivo promedio de +32 en la escala de calidad de vida según el Glasgow Benefit Inventory (GBI). Conclusión: la dilatación de trompa de Eustaquio resulta ser una terapéutica segura y eficaz en población adulta, con mejoras estadísticamente significativas en la severidad de los síntomas y en las presiones del oído medio, lo cual genera un impacto positivo en la escala de calidad de vida según el GBI.

Introduction: Endoscopic balloon dilation has been shown to be a therapeutic and effective tool for the treatment of eustachian tube dysfunction. Now, the results in the Colombian population are unknown. Aim: Describe the clinical improvement of eustachian tube dilation in adult patients with chronic tubal dysfunction, in a 4th level complexity hospital in Bogotá. Design: Retrospective observational study with analytical component. Methods: The clinical records of patients undergoing endoscopic dilatation of the Eustachian tube were reviewed. Objective and subjective changes in the postoperative period are described. Results: 22 patients were obtained between 18 and 66 years and follow-up from 6 to 22 months. 84.5 % underwent bilateral intervention and 15.8 % unilaterally for a total of 38 operated ears. 60 % achieved tympanogram normalization. There was improvement of middle ear pressures from -102.5 to -3.5 daPa (p = 0.005). Statistically significant improvement in 6/7 symptoms according to the severity scale and reduction of air-bone Gap in 7 dB and 4 dB of airway PTA (p = 0.249; p = 0.711). Generating an average positive impact of +32 on the quality-of-life scale according to the Glasgow Benefit Inventory (GBI). Conclusions: Eustachian tube dilation proves to be a safe and effective therapy in an adult population with statistically significant improvements in the severity of symptoms, and in middle ear pressures. Generating a positive impact on the scale of quality of life according to the GBI.

Disfunción del conducto faringotimpánico. El ETDQ-7 como herramienta para el diagnóstico clínico / Pharyngothympanic tube dysfunction. The ETDQ-7 as a tool for clinical diagnosis

RESUMEN En la actualidad se hace referencia en la bibliografía a una gran variedad de métodos para evaluar la disfunción del conducto faringotimpánico (DCFT), la gran mayoría de ellos requiere de instrumental de alta complejidad y personal altamente capacitado. Pese a lo mencionado, ninguno de dichos métodos ha sido validado como herramienta gold standard para el diagnóstico de esta patología. En este contexto, se presenta una herramienta complementaria para el diagnóstico de la DCFT, el Eustachian Tube Dysfunction Questionnaire -7 ítemes (ETDQ-7); cuestionario autoadministrado que considera 7 preguntas en base a una escala de Likert, fue creado para evaluar la sintomatología asociada a la disfunción del conducto con una puntuación que va desde lo más leve (1 punto) a lo más grave (7 puntos) de acuerdo con los síntomas percibidos, y posee un puntaje máximo de 49 puntos, correspondiente a una disfunción severa. La presente revisión tiene como objetivo buscar, organizar, clasificar y describir la información disponible en publicaciones científicas indexadas sobre el ETDQ-7 como herramienta para el diagnóstico clínico complementario de la DCFT. Se incluyeron 11 artículos científicos que hacen referencia al uso del ETDQ-7 en diferentes países. Los resultados recabados sugieren que el ETDQ-7 sería una valiosa herramienta, de alta sensibilidad, especificidad y validez clínica, que permitiría discriminar la presencia de la DCFT. No se encontró evidencia respecto a la aplicación o validación de este cuestionario en nuestro país.

ABSTRACT At present, great variety of methods are described to evaluate the dysfunction of the pharyngotympanic duct (DCFT), the vast majority of them require highly complex instruments and highly trained personnel. Despite this, none of these methods has been validated as the gold standard for the diagnosis of this pathology. In this context, a complementary tool for the diagnosis of the DCFT is presented. The Eustachian Tube Dysfunction Questionnaire-7 items (ETDQ-7), a self-administered questionnaire that includes 7 questions based on a Likert scale, was created to evaluate the symptomatology associated with the dysfunction of the duet. It is scored ranging from the mildest symptomatology (1 point) to the most severe (7 points), according to the perceived symptoms, with a maximum score of 49 points, corresponding to a severe dysfunction. The present review aims to search, organize, classify and describe the available information in scientific indexed journals about the ETDQ-7 as a tool for complementary diagnosis of the DCFT. Eleven scientific articles were included, referred to the use of ETDQ-7 in different countries, describing it as a valid tool which allows to discriminate the presence of a DCFT.

Prevalence of Mild Hearing Loss in Schoolchildren and its Association with their School Performance

Abstract Introduction Hearing is important for the proper development of every child, especially for those younger than 5 years of age, because it helps in the development of language and speech. Emotional and social problems, as well as issues with academic performance, can result from hearing loss even of mild degree. Early diagnosis and management can overcome those negative impacts. Objective To determine the prevalence of mild hearing loss in primary-school children and its association with their school performance. Methods A comparative cross-sectional study was conducted at a regular school. The study included the random selection of 120 apparently normal students (aged 6-9 years) who were considered as having normal hearing by their parents. A total of 20 students were excluded from the study due to the presence of wax in their ears. Finally, the study was conducted with 100 students. All participants were subjected to a basic audiological evaluation, and the Screening Instrument for Targeting Educational Risk (SIFTER) question- naire was given to their teachers to evaluate their school performance. Results From a total of 100 students, we confirmed that 23 (23%) had mild hearing loss, 17 (17%) had bilateral conductive hearing loss, and 6 (6%) had bilateral sensorineural hearing loss. The students who had low attention and communication performance were significantly associated with mild hearing loss. Conclusion The prevalence of mild hearing loss was of 23% (23 cases). This problem had an effect on the communication and attention in school; and it might affect academic performance later in life. A hearing assessment is highly recommended for every child, especially those who have a low rate of academic performance.

Translation, validation and cultural adaptation of "The Eustachian Tube Dysfunction Questionnaire-7" (ETDQ-7) to Brazilian Portuguese (BR) / Tradução, validação e adaptação cultural do questionário "The Eustachian Tube Dysfunction Questionnaire-7" (ETDQ-7) para o português brasileiro (BR)

Abstract Introduction: Chronic Eustachian tube dysfunction can cause several symptoms and middle ear conditions that can impact patient quality of life. It is estimated to be relatively frequent, affecting approximately 5% of adults. The diagnostic tools for this condition are still inadequate. In 2012, McCoul et al. published a questionnaire for the evaluation of Eustachian tube dysfunction named ETDQ-7. They established its replicability and validity. The cutoff point for the diagnosis of chronic Eustachian tube dysfunction was equal to or greater than 14.5, with 100% sensitivity and 100% specificity. Objective: To translate, adapt and validate the ETDQ-7 questionnaire to Brazilian Portuguese. Methods: We translated the questionnaire into Brazilian Portuguese and applied it to 50 patients, 20 of whom had chronic Eustachian tube dysfunction, and 30 controls. Results: The results obtained with the North-American questionnaire were confirmed in its Brazilian version. The cut-off point for the diagnosis of chronic Eustachian tube dysfunction was ≥14, also exhibiting high sensitivity and specificity, very similar to that of ETDQ-7. Conclusion: It is recommended that ETDQ-7 be used to complement the clinical history of patients with chronic Eustachian tube dysfunction; it can also be used as an important tool for diagnosis, patient follow-up and treatment management.

Resumo Introdução: A disfunção crônica da tuba auditiva pode causar diversos sintomas e doenças de orelha média e impactar a qualidade de vida dos pacientes. Estima-se que é uma morbidade relativamente frequente, acomete cerca de 5% dos adultos. Os instrumentos diagnósticos para essa afecção ainda são insuficientes. Em 2012 McCoul et al. publicaram um questionário para a avaliação da disfunção da tuba auditiva denominado ETDQ-7. Eles demonstraram sua reprodutibilidade e validade. O ponto de corte para o diagnóstico de disfunção de disfunção crônica da tuba auditiva foi de maior ou igual a 14,5 com 100% de sensibilidade e 100% de especificidade. Objetivo: Traduzir, adaptar e validar o questionário ETDQ-7 para o português brasileiro. Método: Traduzimos o questionário para o português do Brasil e o aplicamos em 50 pacientes, 20 com disfunção crônica da tuba auditiva e 30 controles. Resultados: Os resultados obtidos no questionário americano foram confirmados na versão brasileira. O ponto de corte para o diagnóstico de disfunção crônica da tuba auditiva foi maior ou igual a 14, também com alta sensibilidade e especificidade, muito semelhante ao ETDQ-7. Conclusão: Recomenda-se que o ETDQ-7 seja usado como um complemento na história clínica do paciente com disfunção crônica da tuba auditiva e pode ser usado também como uma importante ferramenta para fins de diagnóstico, seguimento de pacientes e manejos no tratamento.

Wideband acoustic absorbance in children with Down syndrome / Absorvância acústica de banda larga em crianças com síndrome de Down

Abstract Introduction: Tympanometry is currently the most frequently used tool for assessing the status of the middle ear, commonly assessed using a single 226 Hz tone. However, the use of the Acoustic Immittance Measures with a wideband stimulus is a promising high-resolution evaluation, especially in individuals known to have middle ear alterations, such as Down syndrome patients. Objective: The aim of this study was to analyze the acoustic absorbance measurements in children with Down syndrome. Methods: Cross-sectional study, approved by the institution's ethics committee. Data were collected from 30 children, with a mean age of 8.4 years, 15 with Down syndrome (DS-study group) and 15 children with typical development and no hearing complaints (control group). Energy absorbance was measured at frequencies of 226-8000 Hz at ambient pressure and at peak pressure as a function of frequency using TITAN equipment. Statistical analysis was performed using the established level of statistical significance of 5%. Results: With the 226 Hz probe tone, 30 ears of the control group and 22 of the study group exhibited Type A tympanograms, whereas Type B was observed in eight children in the study group. The mean acoustic absorbance ratio of the study group was lower than that of the control group at frequencies centered at 2520 Hz (p = 0.008) for those with normal tympanometry results, and 226-4000 Hz (p < 0.03) for those with a Type B tympanometry curve. Conclusion: The low energy absorption in the presence of normal tympanograms in children with Down syndrome may suggest middle ear abnormalities.

Resumo Introdução: A timpanometria é a ferramenta mais usada para avaliar o status da orelha média, comumente avaliada por meio de uma única frequência com o tom de 226 Hz. No entanto, o uso da medida de imitância acústica com estímulo de banda larga é uma avaliação de alta resolução promissora, especialmente em pacientes conhecidos por frequentemente apresentar alterações da orelha média, como na síndrome de Down. Objetivo: Analisar as medidas de absorvância acústica em crianças com síndrome de Down. Método: Estudo transversal, aprovado pelo comitê de ética da instituição. Foram coletados dados de 30 crianças, com idade média de 8,4 anos, sendo 15 com síndrome de Down (SD-grupo de estudo) e 15 crianças desenvolvimento típico e sem queixas auditivas (grupo controle). A absorvância de energia foi medida nas frequências de 226-8.000 Hz à pressão ambiente e no pico de pressão em função da frequência, usou-se o equipamento Titan. A análise estatística foi feita com o nível de significância estatística adotado de 5%. Resultados: Com o tom de sonda de 226 Hz foram observadas 30 orelhas do grupo controle e 22 do grupo estudo com timpanometria Tipo A e o Tipo B foi observado apenas em oito crianças do grupo estudo. A razão média de absorvância acústica do grupo estudo foi menor do que a do controle nas frequências centradas em 2.520 Hz (p = 0,008) para aqueles com resultados timpanométricos normais e de 226-4.000 Hz (p < 0,03) para aqueles com curva timpanométrica Tipo B. Conclusão: A baixa absorção de energia na presença de timpanogramas normais nas crianças com síndrome de Down pode sugerir anormalidades na orelha média.

Otologic Findings Based on no Complaints in a Pediatric Examination

Abstract Introduction the otological evaluation is highly significant in those branches of medicine in which the general evaluation of the patient is conducted by general practitioners and pediatricians. Objectives To investigate the otologic findings and their incidences in the sample, which consisted of patients who presented to the pediatric outpatient clinic with nonotologic complaints. Methods Patients, aged between 2 and 16 years, who had neither otorhinolaryngological complaints nor history of surgery by the otolaryngology (ear, nose and throat, ENT) department were included in the present study. The findings detected in the external auditory system and in the tympanic membranes as well as the otorhinolaryngologists' otologic examination findings of the referred patients were recorded from the files of each patient along with the applied medical and surgical treatments, and diagnostic investigations. Results Of a total of 973 patients evaluated, 129 (13.2%) were referred to the ENT outpatient clinic due to any otologic pathology. In the otorhinolaryngological examinations, false positivity was detected in 12 (1.2%) patients, and pathological findings were detected in 117 (12%) patients who received the following diagnoses: 68 (6.9%) had otitis media with effusion(OME); 37 (3.8%) had cerumen impactions; 8 (0.8%) had acute otitismedia (AOM); 2 (0.2%) had ticks in the external auditory canal; 2 (0.2%) had a retraction pocket in tympanic membrane; 1 (0.1%) had unilateral central dry perforation of the tympanic membrane; and 1(0.1%) had congenital cholesteatoma. Conclusion Any complications and sequelae that may develop due to any pathologies and predominantly infections can be prevented by an early diagnosis, which can be made by means of a simple examination, performed merely with an otoscope. Pediatricians and general practitioners should be in close contact with otorhinolaryngologists regarding the pathologies they identify. (AU)

Temporomandibular disorder: otologic implications and its relationship to sleep bruxism / Disfunção temporomandibular: implicações otológicas e sua relação com o bruxismo do sono

Abstract Introduction: Temporomandibular disorder is an umbrella term for various clinical problems affecting the muscles of mastication, temporomandibular joint and associated structures. This disorder has a multifactor etiology, with oral parafunctional habits considered an important co-factor. Among such habits, sleep bruxism is considered a causal agent involved in the initiation and/or perpetuation of temporomandibular disorder. That condition can result in pain otologic symptoms. Objective: The aim of the present study was to investigate the relationship between temporomandibular disorder and both otologic symptoms and bruxism. Methods: A total of 776 individuals aged 15 years or older from urban areas in the city of Recife (Brazil) registered at Family Health Units were examined. The diagnosis of temporomandibular disorder was determined using Axis I of the Research Diagnostic Criteria for temporomandibular disorders, addressing questions concerning myofascial pain and joint problems (disk displacement, arthralgia, osteoarthritis and osteoarthrosis). Four examiners had previously undergone training and calibration exercises for the administration of the instrument. Intra-examiner and inter-examiner agreement was determined using the Kappa statistic. Individuals with a diagnosis of at least one of these conditions were classified as having temporomandibular disorder. The diagnosis of otologic symptoms and bruxism was defined using the same instrument and a clinical exam. Results: Among the individuals with temporomandibular disorder, 58.2% had at least one otologic symptom and 52% exhibited bruxism. Statistically significant associations were found between the disorder and both otologic symptoms and bruxism (p < 0.01 for both conditions; OR = 2.12 and 2.3 respectively). Otologic symptoms and bruxism maintained statistical significance in the binary logistic regression analysis, which demonstrated a 1.7 fold and twofold greater chance of such individuals have temporomandibular disorder, respectively. Conclusion: The logistic regression analysis demonstrated strong associations between the disorder and both otologic symptoms and bruxism when analyzed simultaneously, independently of patient age and gender.

Resumo Introdução: A disfunção temporomandibular é um termo que engloba vários problemas clínicos que afetam os músculos da mastigação, a articulação temporomandibular e estruturas associadas. Esse distúrbio tem uma etiologia multifatorial, com hábitos parafuncionais orais considerados um importante cofator. Entre esses hábitos, o bruxismo do sono é considerado um agente causador envolvido no desenvolvimento e/ou na perpetuação de disfunção temporomandibular. Esse problema pode resultar em sintomas otológicos dolorosos. Objetivo: Investigar a relação entre disfunção temporomandibular e os sintomas otológicos e bruxismo. Método: Foram examinados 776 indivíduos com idade igual ou superior a 15 anos de áreas urbanas da cidade de Recife (Brasil) registrados nas Unidades de Saúde da Família. O diagnóstico da disfunção foi determinado utilizando o Eixo I dos Critérios de Diagnóstico de Pesquisa para Distúrbios Temporomandibulares, abordando questões relativas a dor miofascial e problemas articulares (luxação discal, artralgia, osteoartrite e osteoartrose). Quatro examinadores foram treinados para a administração do instrumento. A concordância intraexaminador e interexaminador foi determinada usando a estatística Kappa. Os indivíduos com diagnóstico de pelo menos uma dessas condições foram classificados como tendo disfunção temporomandibular. O diagnóstico de sintomas otológicos e bruxismo foi definido utilizando o mesmo instrumento de diagnóstico e exame clínico. Resultados: Entre os indivíduos com a disfunção, 58,2% apresentaram pelo menos um sintoma otológico e 52% apresentaram bruxismo. Foram encontradas associações estatisticamente significativas entre a disfunção temporomandibular e ambos os sintomas otológicos e bruxismo (p < 0,01 para ambos os problemas, OR = 2,12 e 2,3, respectivamente). Os sintomas otológicos e o bruxismo mantiveram significância estatística na análise de regressão logística binária, o que demonstrou uma probabilidade de 1,7 e 2 vezes maior chance de que esses indivíduos tenham disfunção temporomandibular, respectivamente. Conclusão: A análise de regressão logística demonstrou associações fortes entre disfunção temporomandibular e sintomas otológicos e bruxismo quando analisados simultaneamente, independentemente da idade e do sexo do paciente.

Turkish validity and reliability of Eustachian tube dysfunction questionnaire-7 / Validade e confiabilidade do Eustachian tube dysfunction questionnaire-7 no idioma turco

Abstract Introduction During clinical evaluations, in order to interpret patients' complaints caused by Eustachian tube dysfunction and to monitor the success of the treatment, standardized and disease-related scales are necessary. Objective The aim of this study was to investigate the validity and reliability of the Turkish version of Eustachian tube dysfunction questionnaire-7. Methods Forty patients diagnosed with Eustachian tube dysfunction and 40 healthy individuals were enrolled for the study. After language validation of the Eustachian tube dysfunction questionnaire-7 for Turkish, a scale was completed by the both Eustachian tube dysfunction and control groups. Two weeks after the first evaluation, 15 of the cases filled out the scale again without any treatment intervention. Known-groups method was used in validity analysis. Floor-ceiling effect, test-retest method, item-total score correlation and internal consistency analysis were used in reliability analyses. Results Cronbach's alpha coefficient was 0.714 for the entire questionnaire. The test-retest reliability coefficient for the total scale was determined as 0.792, indicating correlation between the two questionnaires completed by the same patient over time. In the Eustachian tube dysfunction group, total and each item scores were found significantly higher than the control group (p < 0.001). Conclusion The Turkish version of Eustachian tube dysfunction questionnaire-7 was found to be highly valid and reliable. This scale is recommended to use for screening of Eustachian tube dysfunction and evaluating treatment outcome.

Resumo Introdução No intuito de interpretar as queixas dos pacientes causadas por disfunções na tuba auditiva durante uma avaliação clínica, e para monitorar o sucesso do tratamento, há necessidade de escalas padronizadas relacionadas à doença. Objetivo Investigar a validade e a confiabilidade da versão turca do Eustachian tube dysfunction questionnaire-7. Método Quarenta pacientes diagnosticados com disfunção da tuba auditiva e 40 indivíduos saudáveis foram incluídos no estudo. Após a validação do Eustachian tube dysfunction questionnaire-7 para o idioma turco, o questionário foi aplicada aos grupos disfunção da tuba auditiva e controle. Duas semanas após a primeira avaliação, 15 pacientes preencheram o questionário novamente sem qualquer tratamento. O método de grupos conhecidos foi utilizado na análise de validade. Os efeitos teto e chão, o método teste-reteste, a correlação se escore de item-total e a análise de consistência interna foram utilizados nas análises de confiabilidade. Resultados O coeficiente alfa de Cronbach foi de 0,714 para todo o questionário. O coeficiente de confiabilidade teste-reteste para a escala total foi determinado como 0,792, indicando correlação entre os dois questionários preenchidos pelo mesmo paciente ao longo do tempo. No grupo disfunções da tuba auditiva, foi observado que os escores total e de cada item foram significativamente maiores do que no grupo controle (p < 0,001). Conclusão A versão no idioma turco do Eustachian tube dysfunction questionnaire-7 foi considerada altamente válida e confiável. Recomenda-se a utilização dessa escala para a triagem de disfunções da tuba auditiva e avaliação do resultado do tratamento.

Lobomycosis: a therapeutic challenge

Abstract: Lobomycosis or lacaziosis is a chronic granulomatous fungal infection caused by Lacazia loboi. Most cases are restricted to tropical regions. Transmission is believed to occur through traumatic inoculation in the skin, mainly in exposed areas. It is characterized by keloid-like nodules. There are only a few hundred cases reported. The differential diagnoses include many skin conditions, and treatment is difficult. The reported case, initially diagnosed as keloid, proved to be refractory to surgical treatment alone. It was subsequently approached with extensive surgery, cryotherapy every three months and a combination of itraconazole and clofazimine for two years. No signs of clinical and histopathological activity were detected during follow-up.

Keratosis obturans y colesteatoma del conducto auditivo externo: caso clínico y revisión de la literatura / Keratosis obturans and external auditory canal cholesteatoma: case report and review of the literature

La keratosis obturans y el colesteatoma del conducto auditivo externo son dos condiciones caracterizadas por la acumulación patológica de material queratinizado en el oído externo. El primero se presenta con un crecimiento circunferencial que ocluye y remodela el conducto, usualmente sin erosionarlo, mientras que el segundo se caracteriza por erosionar un área del conducto, con necrosis y secuestro óseo. El diagnóstico diferencial entre estas dos entidades es importante, ya que difieren en la presentación clínica, el comportamiento biológico y las complicaciones asociadas. Esto puede verse reflejado en cambios en el manejo terapéutico de estos pacientes.

Keratosis obturans and external auditory canal cholesteatoma are two conditions characterized by the pathological accumulation of keratinized debris in the external ear. The former shows a circumferential growth that occludes and remodels the canal, usually without erosion, whereas the latter is characterized by erosion of part of the canal, with necrosis and bone sequestration. Establishing a differential diagnosis between both diseases is important, because they differ in clinical presentation, biological behavior and associated complications. This can be reflected in the therapeutic management of these patients.

Amiloidosis asociada a diálisis en el conducto auditivo externo, presentación de un caso clínico y revisión de la literatura / Oialysis related amiloydosis of the external auditory canal, case report and review of the literature

La amiloidosis asociada a diálisis es una patología causada por depósito de fibrillas amiloides constituidas por la proteína beta 2 microglobulina1-5. Es una complicación seria y excepcional que ocurre en pacientes sometidos a hemodiálisis de larga data. El caso que presentamos corresponde a un paciente de 56 años en hemodiálisis hace 36 añ os, con amiloidosis del conducto auditivo externo bilateral. Sólo 13 casos de amiloidosis en el conducto auditivo externo, incluido éste han sido reportados en la literatura66-14. Este corresponde al tercercaso de amiloidosis asociada a diálisis del conducto auditivo externo reportado en la literaturaf6,10.

Dialysis related amyloidosis is a disorder caused by deposition of amyloid fibrils formed by beta-2 microglobulin1-5. It is a serious and exceptional complication in patients undergoing longterm hemodialysis. The present case involved a 56 years old man who had been on hemodialysis for 36 years with bilateral amyloidosis of the external auditory canal. Only 13 cases of amyloidosis in the ear canal, including the present case have been reported in the literature66-14. This is the third reported case of dialysis related amyloidosis of the ear canal6,10.

Chondrodermatitis nodularis chronica helicis - a review

Chondrodermatitis nodularis chronica helicis [CNCH] is a condition characterized by spontaneously evolving tender single or multiple nodules over the apex of helix or antihelix of the external ear. Various factors have been proposed to be the causative agents and different medical /surgical modalities of treatment have been devised. We review this disease in detail and present one such case which was managed on conservative lines.

First Feline Case of Otodectosis in the Republic of Korea and Successful Treatment with Imidacloprid/Moxidectin Topical Solution

In April 2010, pruritic symptoms were recognized in 3 privately-owned Siamese cats raised in Gwangju, Korea. Examination of ear canals revealed dark brown, ceruminous otic exudates that contain numerous live mites at various developmental stages. Based on morphological characteristics of adult mites in which caruncles were present on legs 1 and 2 in adult females and on legs 1, 2, 3, and 4 in adult males while the tarsus of leg 3 in both sexes was equipped with 2 long setae, the mite was identified as Otodectes cynotis. Ten ear mite-free domestic shorthaired cats were experimentally infected with O. cynotis to evaluate the efficacy of 10% imidacloprid/1% moxidectin spot-on. Live mites were recovered from 1 of 10 treated cats on day 9 post-treatment (PT) while no live mites were observed from the ear canals of treated cats on days 16 and 30 PT. The efficacy of 10% imidacloprid/1% moxidectin spot-on on O. cynotis in cats was, therefore, 90% on day 9 and 100% on days 16 and 30 PT. This is the first report of otodectosis in 3 cats naturally infested with O. cynotis in Gwang-ju, Korea. Both natural and experimental infestations were successfully treated with 10% imidacloprid/1% moxidectin spot-on.

A systematic review of mercury ototoxicity / Uma revisão sistemática da ototoxicidade do mercúrio

Mercury is neurotoxic, and numerous studies have confirmed its ototoxic effect. However, the diagnosis and follow-up of mercury exposure require understanding the pathophysiology of the chemical substance. Based on a systematic literature review, this study aimed to demonstrate whether mercury is ototoxic and to analyze its mechanism of action on the peripheral and central auditory system, in order to contribute to the diagnosis and follow-up of exposure. This was a systematic review of studies published on the effects of mercury exposure on the auditory system. The full text of the studies and their methodological quality were analyzed. The review identified 108 studies published on the theme, of which 28 met the inclusion criteria. All the articles in the analysis showed that mercury exposure is ototoxic and produces peripheral and/or central damage. Acute and long-term exposure produces irreversible damage to the central auditory system. Biomarkers were unable to predict the relationship between degree of mercury poisoning and degree of lesion in the auditory system.

O mercúrio é neurotóxico e muitas pesquisas confirmam sua ação ototóxica. Porém, para o diagnóstico e acompanhamento da exposição é necessário entender a fisiopatologia da substância química. O objetivo do trabalho, por meio da revisão sistemática, é evidenciar se o mercúrio é ou não ototóxico e, sendo assim, qual seria sua forma de atuação no sistema auditivo periférico e central, de forma a contribuir para o diagnóstico e acompanhamento da exposição. É uma revisão sistemática dos trabalhos publicados sobre os efeitos da exposição ao mercúrio no sistema auditivo. Analisaram-se os estudos contemplados na íntegra e também sua qualidade metodológica. A pesquisa identificou 108 artigos publicados sobre o tema, sendo que 28 se enquadraram nos critérios de inclusão. Todos os artigos analisados evidenciaram que a exposição ao mercúrio é ototóxico e induz ao dano periférico e/ou central. A exposição aguda e de longo prazo produzem danos irreversíveis ao sistema auditivo central. Os biomarcadores não puderam predizer a relação do grau de intoxicação com o grau de lesão do sistema auditivo.

Avaliação ultrassonográfica do meato acústico em cães / Ultrasonographic evaluation of the external ear in dogs

O propósito deste trabalho foi determinar a viabilidade da ultrassonografia para avaliar o canal auditivo externo de cães, aferindo a espessura e arquitetura da parede do conduto auditivo e bula timpânica. Foram avaliados 10 cães da raça Retriever do Labrador não portadores de otite externa. O exame foi realizado com o aparelho de ultrassonografia bidimensional e transdutor linear de 14 MHz, com todos os animais sob efeito de anestesia geral. O exame foi efetivado antes e depois do conduto ser preenchido com solução salina, promovendo uma janela acústica anecóica. A artéria maxilar foi identificada com o Doppler colorido o que facilitou a localização da bula timpânica em todos os cães. A definição da imagem da parede proximal ao transdutor foi pior quando comparada à parede distal em todos os animais, isto devido à proximidade da parede com a face de leitura do transdutor. Nos cães que apresentavam uma maior quantidade de cerúmen a superfície do epitélio estava com uma camada hiperecóica mais evidente. A membrana timpânica não foi identificada em nenhum animal. Conclui-se que ultrassonografia é viável e deve ser mais pesquisada na contribuição diagnóstica das doenças óticas em cães.

The purpose of this study was to determine the viability of ultrasonographic evaluation of the external ear in dogs. The thickness and architecture of the ear wall and tympanic bulla of 10 Labrador Retrievers without ear disease was evaluated. The examination was performed with an ultrasound system and a 14 MHz bidimentional linear-array transducer and general anesthesia, before and after the infusion of saline solution into the ear canal. The maxillary artery was identified with color Doppler and helped to establish the location of the tympanic bulla in all dogs. The proximal wall was less well-defined when compared with the distal wall of the ear canal. Dogs with increased ceruminal content within the ear canal showed a hypoechoic epithelium. The tympanic membrane was not identified. It was concluded that ultrasound evaluation is feasible and needs to be explored as clinical diagnostic tool for the diagnosis of ear diseases in dogs.

Realidade virtual nas síndromes vestibulares / Virtual reality in vestibular syndromes

A tontura é queixa comum na prática médica, especialmente para otorrinolaringologistas. Pacientes com tontura podem descrevê-la como desequilíbrios, mal-estar, tendência a quedas, instabilidade, sensação de flutuação ou sensação rotatória acompanhada de náuseas, vômitos e sinais e sintomas neurovegetativos. A identificação de sua causa é de grande importância para um adequado planejamento terapêutico e a contribuição tecnológica tem-se mostrado muito valiosa para o manejo das vestibulopatias. Sistemas de realidade virtual provaram ser ótimas ferramentas auxiliares tanto no diagnóstico quanto no tratamento de pacientes com transtornos do equilíbrio.Este estudo pretende revisar e comentar a literatura científica recente a respeito dos métodos de realidade virtual direcionados para a avaliação e reabilitação das síndromes vestibulares.

Atresia aural congênita unilateral / Unilateral congenital aural atresia

A atresia do canal auditivo externo (ACAE) é uma disordem congênita rara. A ACAE unilateral é de 3 a 6 vezes mais comum que a atresia bilateral. Tradicionalmente, não se acreditava que a ACAE unilateral fosse limitante ao desenvolvimento da linguagem da criança. No entanto, terapias recentes para perda auditiva têm demonstrado a importância da audição bilateral para um ótimo desenvolvimento da fala e da linguagem. Além disso, a audição bilateral é importante na localização de ruídos. Por isso exige diagnóstico rápido, aconselhamento genético e avaliação precoce da audição. Deve-se aconselhar adequadamente e encaminhar essas crianças e suas famílias para que possam ser avaliadas as opções de tratamento e indicações para intervenção. Avaliação clínica, audiológica e com estudo tomográfico de alta resolução do osso temporal é essencial para obter resultados satisfatórios e prevenir complicações na seleção de candidatos adequados para a cirurgia ou para avaliação do paciente, opções de tratamento, época de tratamento cirúrgico, critérios de seleção cirúrgica, técnicas cirúrgicas, complicações, prognóstico e controvérsias atuais relacionadas à atresia aural congênita serão discutidos.