Las biopelículas y su interrelación con la patología crónica del oído medio / Biofilms and their relationship with chronic middle ear pathology

El concepto de biopelículas ha surgido de forma paulatina durante un largo período; se presentan como estructuras tridimensionales compuestas por células sésiles de microorganismos que crecen y se adhieren irreversiblemente a superficies, tanto vivas como inertes. Su capacidad de desarrollarse, tanto en superficies bióticas como abióticas, es una característica que los relaciona directamente con la salud humana. Distintas infecciones óticas se han inculpado a la presencia de biopelículas en las mucosas como en la otitis media con efusión, de igual forma se manifiestan en la aparición y persistencia de la otitis media crónica. Las biopelículas afines con otitis media, generalmente, contienen uno o múltiples especies de bacterias otopatógenas primarias. La comprensión de la biopelicula auxiliará el progreso de nuevas terapias y estrategias de control, al evitar enfermedades infecciosas ya que las bacterias formadoras de biopelículas son una seria amenaza para la salud pública debido a su alta resistencia a los antimicrobianos.

The concept of biofilms has emerged gradually over a long period; they appear as three-dimensional structures composed of sessile cells of microorganisms that grow and adhere irreversibly to surfaces, both living and inert. Their ability to develop, both on biotic and abiotic surfaces, is a characteristic that directly relates them to human health. Different ear infections have been blamed on the presence of biofilms on the mucous membranes, such as otitis media with effusion, in the same way they manifest themselves in the appearance and persistence of chronic otitis media. Otitis media-related biofilms generally contain one or multiple species of primary otopathogenic bacteria. The understanding of the biofilm will help us refine new therapies and control strategies, by avoiding infectious diseases since biofilm-forming bacteria are a serious threat to public health due to their high resistance to antimicrobials.

Barotrauma inducido por vuelo en otorrinolaringología: Una revisión de la literatura / Flight-induced barotrauma in otorhinolaryngology: A literature review

Barotrauma se define como el daño tisular generado por diferencias de presión entre un espacio no ventilado dentro del cuerpo y el gas o fluido circundante. La causa más frecuente de barotrauma es el viaje en avión y se espera un aumento progresivo de los casos en el tiempo. Los órganos habitualmente comprometidos son el oído, cavidades paranasales y nervio facial. La fisiopatología del barotrauma por vuelo se fundamenta en la exposición a cambios bruscos de altitud y presión asociados a infecciones respiratorias altas y/o disfunción de la tuba auditiva. Los síntomas más frecuentes son otalgia, hipoacusia, tinnitus, vértigo y parálisis facial periférica. Muchas formas de barotrauma son autolimitadas y prevenibles mediante técnicas simples como la deglución de líquidos o maniobras de Valsalva durante las fases de ascenso o descenso. El tratamiento del barotrauma puede ser conservador, médico o quirúrgico, la decisión será individualizada de acuerdo con las características del paciente, gravedad del cuadro y recurrencias. Esto incluye el uso de descongestionantes orales y tópicos, dispositivos de autoinflación, técnicas quirúrgicas, entre otros. La mayoría de estas intervenciones se basan en recomendaciones de expertos y algoritmos extrapolados de guías clínicas para el manejo de otras patologías similares. Esta revisión presenta los principales hallazgos fisiopatológicos y clínicos, las opciones de tratamiento y las medidas preventivas para el barotrauma otorrinolaringológico inducido por el vuelo, en base a la evidencia disponible.

Barotrauma is defined as tissue damage caused by pressure differences between an unventilated space within the body and the surrounding gas or fluid. The most frequent cause of barotrauma is air travel, and a progressive increase in cases over time is expected. The most frequently affected organs are the ear, paranasal sinuses, and facial nerve. The pathophysiology of flight-induced barotrauma is based on exposure to sudden changes in altitude and pressure associated with upper respiratory tract infections and/or Eustachian tube dysfunction. The most frequent symptoms are otalgia, hypoacusis, tinnitus, dizziness, and peripheral facial palsy. Many forms of barotrauma are self-limiting and preventable through simple techniques such as swallowing fluids or performing Valsalva maneuvers during ascent or descent phases. The treatment of barotrauma can be either conservative, medical or surgical, according to patient's characteristics, severity of the condition, and recurrence. This includes the use of oral and topical decongestants, auto-inflation devices, surgical techniques, among others. Most of these interventions are based on expert recommendations and algorithms extrapolated from clinical guidelines for the management of other similar pathologies. This review presents key pathophysiologic and clinical findings, treatment options, and preventive measures for flight-induced otorhinolaryngologic barotrauma, based on available evidence.

Dichotic Sentences Test Performance of Adults with communication complaints. / Desempenho no Teste Dicótico de Sentenças em Adultos com queixa comunicativa.

PURPOSE: To analyze the performance of normal-hearing adults with communication complaints in the Dichotic Sentences Test. METHODS: We selected from the database 15 normal-hearing participants with normal results in the Digits Dichotic Test, aged between 19 and 44 years, right-handed, who reported communicative complaints. The Dichotic Sentences Test was applied using two protocols consisting of four different combinations of lists called sequences 1 and 2, in the following order: training, divided attention step, right and left directed attention steps. RESULTS: In the first application sequence, the average performance in the divided attention step was 84.7% for the right ear and 60.67% for the left, with statistical difference between ears. The asymmetry between ears varied from -50% to 60%. In the directed attention step, the average performance was 99.33% for the right ear and 98% for the left, with no statistical difference. In the second application sequence, there was a tendency for better results, more pronounced for the left ear, with no statistical significance, with the performance variation and asymmetry between ears remaining high. In the comparison between the sequences, in the divided attention step, it was found that, for the right ear, 40% of the individuals did not vary, 33% performed worse, and 26.7% performed better; for the left ear, 6.6% did not vary, 20% performed worse, and 73.33% performed better. There was result stability in the directed attention step. CONCLUSION: The normal-hearing adults with communication complaints presented a heterogeneous profile, especially in the divided attention step, with a marked difference between ears and response variability.

OBJETIVO: Analisar o desempenho de adultos normo-ouvintes com queixa comunicativa no Teste Dicótico de Sentenças. MÉTODO: Selecionou-se em banco de dados, 15 participantes normo-ouvintes com resultados normais no Teste Dicótico de Dígitos, idades entre 19 a 44 anos, destros, que referiram queixa comunicativa. O Teste de Dicótico de Sentenças foi aplicado por meio de dois protocolos compostos por quatro diferentes combinações de listas denominados de sequências 1 e 2, de acordo com a seguinte ordem: treino, etapa de atenção dividida, etapas de atenção direcionada à direita e à esquerda. RESULTADOS: Na sequência de aplicação 1, a média de desempenho na etapa de atenção dividida foi 84,67% na orelha direita e 60,67% na esquerda, com diferença estatística entre orelhas, com assimetria entre orelhas variando de -50% a 60%. Na etapa de atenção direcionada, a média de desempenho foi 99,33% na orelha direita e 98% na esquerda, sem diferença estatística. Na sequência de aplicação 2, houve tendência de melhores resultados, mais acentuada na orelha esquerda, sem significância estatística, mantendo elevadas a variação de desempenho e a assimetria entre orelhas. Verificou-se na comparação entre as sequências, na etapa de atenção dividida, que na orelha direita 40% dos indivíduos não variaram, 33% pioraram, 26,7% melhoraram; na orelha esquerda, 6,6% não variaram, 20% pioraram e 73,33% melhoraram. Na etapa de atenção direcionada houve estabilidade nos resultados. CONCLUSÃO: Os adultos normo-ouvintes, com queixas comunicativas, apresentaram um perfil heterogêneo, especialmente na etapa de atenção dividida, com acentuada diferença entre as orelhas e variabilidade de respostas.

Study of aged central auditory function using the auditory middle latency response.

OBJECTIVE: Investigate the auditory function of the elderly using the middle latency potentials. METHODOLOGY: Group 1 (G1): 20 healthy individuals of both genders, older than 60 years, without hearing loss. Group 2 (G2): 20 healthy individuals of both sexes, older than 60 years, with hearing loss in frequencies from 4 to 8 kHz. Potential recording was performed with unilateral and bilateral stimulation and the Binaural Interaction Component was calculated. RESULTS: Na latency in C3A1 was greater in the stimulation of the right ear in G2 and the amplitude of Na-Pa was greater in the stimulation of the right ear and recording in C3A1 in G1. The latency of the Pa component was higher in the stimulation of the right ear recorded in C4A2. The Pb component in G2 by bilateral stimulation and recorded in C4A2 had higher latency. The first and second negative and positive peaks presented greater amplitude in G1. In C3A1, the 1st negative peak was more negative in G1 and the 2nd positive peak showed greater amplitude in C4A2 in both groups. CONCLUSION: The transmission of auditory information to the primary auditory cortex is impaired with aging, especially in unilateral stimulation, reinforced by losses in elderly people with peripheral hearing loss, such as in the binaural interaction at the cortical and subcortical levels. Thus, the AMLR has shown to be a sensitive examination to investigate neuroauditory disorders in the elderly, especially related to high-frequency hearing loss and primary auditory cortex dysfunctions caused by the aging process.

Presentación simultánea de quiste epidermoide del ángulo pontocerebeloso y colesteatoma infiltrante del oído medio. Reporte de caso y revisión de literatura / Simultaneous presentation of an epidermoid cyst of the cerebellopontine angle and infiltrating cholesteatoma of the middle ear. Case report and literature review

Introducción: los quistes epidermoides son el tercer tumor más común del ángulo pontocerebeloso (APC). Es infrecuente detectar simultáneamente un colesteatoma infiltrativo del oído medio (OM). Caso clínico: paciente de 51 años acude a urgencias por cefalea hemicraneal intensa, pulsátil secundaria a hidrocefalia aguda, requirió ventriculostomía. En la resonancia magnética nuclear (RMN) cerebral contrastada se reporta una masa en el APC sugestivo de quiste epidermoide y simultáneamente un colesteatoma infiltrativo del OM. La paciente fue intervenida primero con resección de colesteatoma del OM; en un segundo tiempo resección del quiste epidermoide del APC por vía translaberíntica. El posoperatorio la evolución clínica fue satisfactoria. Discusión: los quistes epidermoides del APC son histopatológicamente idénticos al colesteatoma del OM y pueden ser secundarios a estos. Conclusión: se debe individualizar el manejo sin descartar la posibilidad de tener las dos enfermedades de manera simultánea.

Introduction: cysts are the third most common tumor of the cerebellopontine angle (CPA). It is rare to simultaneously detect an infiltrative cholesteatoma of the middle ear (OM). Clinical case: a 51-year-old patient attended the emergency department due to intense throbbing hemicranial headache secondary to acute hydrocephalus, requiring ventriculostomy. Contrast-enhanced cerebral magnetic resonance imaging (MRI) reported a mass in the APC suggestive of an epidermoid cyst and simultaneously an infiltrative cholesteatoma of the OM. The patient underwent first surgery with resection of the OM cholesteatoma; in a second stage, resection of the epidermoid cyst of the APC through a translabyrinthine approach. The postoperative clinical evolution was satisfactory. Discussion: APC epidermoid cysts are histopathologically identical to OM cholesteatoma and may be secondary to them. Conclusion: management must be individualized without ruling out the possibility of having both diseases simultaneously.

Surgical results of transcutaneous bone-anchored hearing aid comparing the C-shaped and linear incision techniques.

PURPOSE: The aim of the study is to compare the operative time and postoperative complication outcomes for bone-anchored hearing aid (BAHA) implants using two different techniques: the C-shaped incision technique and the linear incision technique. METHODS: An analysis was carried out of 38 patients implanted with transcutaneous BAHAs during a 4-year period in a single otolaryngology department. RESULTS: The implantation was carried out under general anesthesia. Operative time was significant lower with the linear technique compared to the C-shaped technique (76.55 min, SD 16.75 vs. 93.17 min, SD 19.82; p = 0.007). There was no difference in postoperative complications between the two techniques. CONCLUSIONS: The use of linear incision for transcutaneous BAHA system implantation is associated with a reduced surgery time compared to the C-shaped technique, with no increase in postoperative complications.

Experimental cholesteatoma: a comparison between spontaneous and induced models.

OBJECTIVE: To compare the incidence and the histopathological aspect of spontaneous and two induced Mongolian gerbils' models of cholesteatoma: External Auditory Canal (EAC) obliteration model and the Auditory Tube (AT) cauterization model. METHODS: Fifty-four ears of 27 animals were divided into EAC obliteration, AT cauterization, and control groups and histologically assessed for cholesteatoma incidence and classification at intervals of 2, 4, 8, and 16 weeks. RESULTS: Cholesteatoma was diagnosed in 30 of the 53 ears evaluated with a significantly higher incidence in groups that received some type of intervention (p<0.0001). It was not possible to histologically distinguish cholesteatomas of the same stage between the study groups. CONCLUSION: Although we observed a significant increase in cholesteatoma incidence with the two methods used when compared to the control group, all developed cholesteatomas were apparently identical from a histological point of view.

Aural hematomas in small ruminants - clinical features, surgical treatment and outcome

Background: Aural or auricular hematoma is an important and prevalent surgical condition in small animals practice, and commonly reported in companion pets. The condition is characterized by blood accumulation between the pinnae's dermal surface and the underlying perichondrium. In farm animals, most cases present surgical treatment with drainage of serosanguineous fluid from acute cases with clinical evolution ranging from 1 to 5 days. Therefore, the present work reports the clinical features, surgical treatment and outcome of aural hematomas in 3 small ruminants with a chronic evolution (7 to 20 days), detailing the post-surgical complications, such as wound infection and recurrence, and final cosmetic appearance of the pinnae. Cases: Upon physical examination, all animals were alert and presenting a good body condition score. Clinical alteration was restricted to a bilateral (Case 1) or unilateral (Cases 2 & 3) painless, and fluid-filled swelling, presenting doughy consistency masses within the fluid during pinna manipulation. The fluid-filled swellings were located on the concave (Case 1 - left ear & Case 2) and convex (Case 1 - right ear & Case 3) surface of the pinna. No primary pruritic disorders of the pinna were detected, and a diagnosis of traumatic aural hematoma was proposed. Due to the chronicity of the cases, surgical approach was advisable. The small ruminants underwent general anesthesia, and a linear incision over the skin overlying the hematoma was performed (Cases 1 & 2). After removal of blood and fibrin clots, the cavity was flushed and captonated size 0 nylon mattress sutures were performed on either side of the incision, in order to obliterate the dead space. Due to recurrence after 14 days, Case 2 was submitted to a modified surgical approach using a S-shaped incision combined to multiple drainage holes (MDH) using a disposable 6 mm biopsy punch. The same approach has performed in Case 3. Then, size 0 nylon mattress sutures followed by a tight protective pressure and absorbent bandage combined with an Elizabethan collar was applied. Postoperatively, Case 1 presented surgical site infection and the antibiotic was changed after bacterial culture and antibiogram results. Hospital discharge varied from 14 to 19 days' post-surgery. All animals presented some degree of ear retraction and a linear or S-shaped scar on the affected ear, but final cosmetic appearance was satisfactory to all owners. Discussion: Aural or auricular hematomas are a frequent disorder in dogs and cats clinical practice. In sheep, the few reported cases have been associated with pruritic disorders of the pinna, such as ticks infestation and sarcoptic mange. Whilst in goats, traumatic injuries, such as ear tagging and trauma from others goats, are considered the main cause, especially in breeds with pendulous ear. In our cases with chronic evolution (> 7 days), the most important clinical feature was the presence of doughy consistency masses within the fluid, suggesting matured blood and fibrin clots. A linear incision with captonated size 0 nylon mattress sutures was associated to post-surgical complications, such as wound infection and aural hematoma recurrence. Therefore, a S-shaped incision associated to creation of MDH, in order to achieve better drainage, was the chosen approach in the second surgery (Case 2) and on the subsequent patient (Case 3). To the best of our knowledge, this is the first report using the MDH approach in farm animals, that appears to be an effective treatment for chronic aural hematomas in small ruminants.

Caracterización de la cirugía electiva de oído en tiempos de Covid 19 en el Hospital Universitario Clínica San Rafael / Characterization of elective ear surgery in Covid 19 times at Hospital Universitario Clínica San Rafael

Introducción: La pandemia por COVID-19 ha afectado la forma del ejercicio profesional médico en Colombia debido a la suspensión de las consultas y los procedimientos quirúrgicos no urgentes o prioritarios. Por este motivo, las cirugías electivas de oído se han tenido que postergar, afectando las necesidades de los pacientes con patologías otológicas. El objetivo del estudio fue evaluar la presencia de signos y/o síntomas sospechosos de infección por SARS-Cov2 en pacientes llevados a cirugía electiva de oído en HUCSR. METODOLOGÍA: Estudio observacional retrospectivo. RESULTADOS: Se realizaron 67 cirugías de oído entre el primero de septiembre del 2020 al 31 de diciembre de 2020, 64.17% fueron por oído crónico, 32.8% fueron llevados a rehabilitación auditiva con implante coclear o dispositivo de conducción ósea, tres pacientes tenían como antecedente patológico hipertensión arterial y un paciente enfermedad pulmonar obstructiva crónica, ningún paciente presentó síntomas sugestivos de COVID el día de la cirugía, ni a las 48 horas, siete y 14 días postoperatorio. CONCLUSIÓN: Los pacientes llevados a cirugía de oído en el Hospital Universitario Clínica San Rafael no presentaron signos o síntomas compatibles con infección por COVID en el tiempo comprendido del estudio, se requieren más estudios analiticos que demuestren si este tipo de procedimientos son un factor de riesgo para adquirir la infección.

Introduction: The COVID-19 pandemic has affected the form of professional medical practice in Colombia due to the suspension of consultations and non-urgent or priority surgical procedures. For this reason, elective ear surgeries have had to be postponed, affecting the needs of patients with otological pathologies. The objetive of study was to evaluate the presence of suspicious signs and/or symptoms of SARS-Cov2 infection in patients undergoing elective ear surgery in HUCSR. METHODOLOGY: Retrospective study. RESULTS: 67 ear surgeries were performed between September 1, 2020 and December 31, 2020, 64.17% were for chronic ear, 32.8% were taken to hearing rehabilitation with a cochlear implant or bone conduction device, 3 patients had a history of pathological arterial hypertension and one patient chronic obstructive pulmonary disease, no patient presented symptoms suggestive of COVID on the day of surgery, nor at 48 hours, 7 days and 14 days postoperatively. CONCLUSION: The patients taken to ear surgery at the Hospital Universitario Clínica San Rafael did not present signs or symptoms compatible with COVID infection during the study period, more analytical studies are required to show if this type of procedure is a risk factor. to acquire the infection.

Perforación timpánica y colesteatoma, una patología de niños y adultos / Tympanic perforation and cholesteatoma, a pathology of children and adults

INTRODUCCIÓN. La patología de oído es una enfermedad frecuente en nuestro medio, asociada a infecciones a repetición del oído, con la presencia de perforación timpánica y colesteatoma, que determinará la presencia de lesiones mucho más acentuadas en cuanto a la evolución auditiva o complicaciones locales o sistémicas. OBJETIVO. Determinar la asociación existente entre la presencia de colesteatoma y perforación timpánica en pacientes con otitis media crónica. MATERIALES Y MÉTODOS. Estudio epidemiológico analítico retrospectivo. Población de 4 733 y muestra de 75 pacientes para casos y 75 para controles basados en historias clínicas tomadas del sistema informático AS 400, que acudieron a la consulta externa de torrinolaringología del Hospital de Especialidades Carlos Andrade Marín en el periodo de enero de 2018 a diciembre de 2019; Criterios de inclusión para grupo de casos: Hombres y mujeres de 20 a 65 años de edad, diagnóstico de otitis media crónica, diagnóstico de colesteatoma ótico. Criterios de inclusión para grupo controles: Hombres y mujeres de 20 a 65 años de edad, no presentar diagnóstico de colesteatoma. RESULTADOS. Se observó una relación fuerte entre el poseer perforación timpánica y el desarrollo de colesteatoma con un valor de OR 33,14 con un IC al 95% de 31,94 ­ 34,34, con lo que se comprobó la hipótesis del estudio. Se determinó que la perforación timpánica es un factor de riesgo asociado con el desarrollo de colesteatoma en pacientes con otitis media crónica, la prevalencia de colesteatoma en relación a la edad estuvo en un 72% en pacientes de 41 a 65 años, con mayor predominancia en mujeres en un 57,3%. DISCUSIÓN. La presencia de perforación timpánica de acuerdo a lo observado es un factor de riesgo para el desarrollo de colesteatoma, ligado en su mayoría a cuadros de Otitis Media Crónica. CONCLUSIONES. Se confirmó que la perforación timpánica, es un factor de riesgo en el desarrollo del colesteatoma en los pacientes que tienen otitis media crónica, lo que demuestra la necesidad de manejo actualizado y continuo en pacientes con esta patología de oído. Se requieren estudios con muestras más amplias para determinar otros factores de riesgo como sexo, nivel de educación y edad que podrían influir en el desarrollo de colesteatoma.

INTRODUCTION. Ear pathology is a frequent disease in our environment, associated with repeated ear infections, with the presence of tympanic perforation and cholesteatoma, which will determine the presence of much more accentuated lesions in terms of auditory evolution or local or systemic complications. OBJECTIVE. To determine the association between the presence of cholesteatoma and tympanic perforation in patients with chronic otitis media. MATERIALS AND METHODS. Retrospective analytical epidemiological study. Population of 4 733 and sample of 75 patients for cases and 75 for controls based on clinical histories taken from the AS 400 computer system, who attended the Otorhinolaryngology outpatient clinic of the Carlos Andrade Marín Specialties Hospital in the period from January 2018 to December 2019; Inclusion criteria for case group: Men and women aged 20 to 65 years, diagnosis of chronic otitis media, diagnosis of otic cholesteatoma. Inclusion criteria for controls group: men and women aged 20 to 65 years, no diagnosis of cholesteatoma. RESULTS. A strong relationship was observed between having tympanic perforation and the development of cholesteatoma with an OR value of 33,14 with a 95% CI of 31,94 - 34,34, thus proving the study hypothesis. It was determined that tympanic perforation is a risk factor associated with the development of cholesteatoma in patients with chronic otitis media, the prevalence of cholesteatoma in relation to age was 72% in patients aged 41 to 65 years, with greater predominance in women in 57,3%. DISCUSSION. The presence of tympanic perforation according to what was observed is a risk factor for the development of cholesteatoma, mostly linked to Chronic Otitis Media. CONCLUSIONS. It was confirmed that tympanic perforation is a risk factor in the development of cholesteatoma in patients with chronic otitis media, which demonstrates the need for updated and continuous management in patients with this ear pathology. Studies with larger samples are required to determine other risk factors such as sex, education level and age that could influence the development of cholesteatoma.

Fistula Salival: presentación atípica en parotiditis bacteriana, a propósito de un caso / Salival Fistula, atypical presentation of bacterial parotiditis, by the purpose of a case

Introducción: La fístula salival es la comunicaciónde la glándula salival o el conducto parotídeo hacia la piel,debido a una lesión traumática del parénquima o del conducto deexcreción; no suele ser una complicación frecuente en parotiditisaguda. El objetivo de este trabajo es destacar la presentaciónatípica de un caso de parotiditis bacteriana asociado a fistulasalival hacia el conducto auditivo externo y cavidad oral, y aparálisis facial periférica. Caso clínico: Paciente masculino de15 años de edad, quien consulta por otalgia y otorrea derechaasociado a aumento de volumen en región parotídea ipsilateralde 5 días de evolución. Al examen físico se evidencia, caraasimétrica con desviación de comisura labial hacia la izquierda ycierre palpebral completo sin esfuerzo, con aumento de volumende parótida derecha con signos de flogosis, otorrea purulentaderecha . solución de continuidad en tercio medio de pisode conducto auditivo externo. Ecosonograma de piel y partesblandas, reveló cambios inflamatorios en glándula parótida concolección de 112 cc., Los hallazgos tomográficos de oído medioy mastoides corroboraron hallazgos del ecosonograma. se realizódrenaje quirúrgico del absceso y se trató con Clindamicina600 mg vía endovenosa cada 6 horas y Penicilina Cristalina200 mg/kg/ peso cada 6 horas y su evolución fue satisfactoria.Conclusión:Los abscesos parotídeos pueden presentarse demanera atípica o en raras ocasiones con drenaje a través delconducto auditivo externo(AU)

Introduction: Salivary fistula is the communicationof the salivary glands or the parotid duct to the skin, due toa traumatic injury to the parenchyma or the excretion duct; Itis not usually a frequent complication in acute parotitis. the eobjective of this work is to highlight the atypical presentation of acase of bacterial parotitis associated with salivary fistula towardsthe external auditory canal and oral cavity, and peripheralfacial paralysis. Clinical case: A 15-year-old male patient, whoconsulted due to otalgia and right otorrhea associated with anincrease in volume in the ipsilateral parotid region of 5 days ofevolution. On physical examination, an asymmetrical face withdeviation of the lip corner to the leth and complete palpebralclosure without effort, with increased volume of the rightparotid gland with signs of phlogosis, right purulent otorrhea and continuity solution in the middle third of the external auditory canal are evident. Ultrasound of the skin and so the tissues revealed inflammatory changes in the parotid glands with a collection of 112 cc. yhe tomographic findings of the middle ear and mastoids corroborated the findings of the echosonogram; Surgical drainage of the abscess was performed and he was treated with clindamycin 600 mg intravenously every 6 hours and crystalline penicillin 200 mg/kg/weight every 6 hours, and his evolution was satisfactory. Conclusion: Parotid abscesses can present atypically or rarely with drainage through the external auditory canal(AU)

AudBility: test-retest reliability in typically developing children aged 6 to 7 years. / AudBility: confiabilidade teste-reteste em crianças com desenvolvimento típico de 6 e 7 anos.

PURPOSE: to investigate the test-retest reliability of the AudBility program in typically developing children aged six-seven years. METHODS: 29 children, male and female, right-handed, native Portuguese speakers and adequate school performance for the age group studied, underwent previous meatoscopy, immittance measurements and the AudBility program was applied, composed of a self-perception questionnaire and auditory tasks, being analyzed the abilities of sound localization, auditory closure, figure-ground, dichotic digits test, temporal resolution, and temporal ordering of frequency and duration. The program was designed and reapplied with an interval of one week under the same conditions. The performance in each task was presented from central tendency and dispersion data and was conducted using the Intraclass Correlation Coefficient (ICC), based on the 95% confidence interval (CI). RESULTS: The analyses showed a positive and significant ICC (p<0.01) for the questionnaire and auditory tasks, except for auditory closure, in the right and left ears and figure-ground in the left ear. The questionnaire mean ICC was 0.742 and ranged from -0.012 to 0.698 for the auditory tasks. CONCLUSION: Based on mean results and upper limit of the CI, the findings showed agreement between moments, classified as good for the questionnaire and moderate to good for five of the seven auditory analyzed tasks (ICC>0.05 and <0.9). The results of the reliability study represent an important parameter for validating the program for the studied age group.

OBJETIVO: investigar a confiabilidade teste-reteste do programa AudBility em crianças com desenvolvimento típico de seis a sete anos. MÉTODO: 29 crianças, sexo masculino e feminino, destros, falantes nativos do Português e desempenho escolar adequado para a faixa etária estudada de acordo com o professor foram submetidas aos procedimentos de meatoscopia, imitanciometria e foi aplicado o programa AudBility, composto por questionário de autopercepção e tarefas auditivas. As tarefas incluíram localização sonora, fechamento auditivo, figura fundo, escuta dicótica, resolução temporal e ordenação temporal de frequência e duração. O programa foi reaplicado com um intervalo de 1 semana sob as mesmas condições de avaliação. O desempenho em cada tarefa foi apresentado a partir de dados de tendência central e dispersão e a confiabilidade a partir do Cálculo do Coeficiente intra-classe (CCI), com base no intervalo de confiança (IC) de 95%. RESULTADOS: As análises demonstraram CCI positivo e significante para o questionário e tarefas auditivas, exceto fechamento auditivo, nas orelhas direita e esquerda e figura-fundo na orelha esquerda. O CCI médio do questionário foi de 0,742 e variou de -0,012 a 0,698 para as tarefas auditivas. CONCLUSÃO: Com base no resultado médio e no limite superior do IC, os achados demonstraram concordância entre os momentos de grau bom para o questionário, e de grau bom a moderado para cinco das sete variáveis auditivas analisadas (CCI>0,05 e < 0,9). Os achados do estudo de confiabilidade representam um parâmetro importante de validação do programa para a faixa etária estudada.

Plasmocitoma extramedular de canal auditivo externo: caso clínico / Extramedullary plasmacytoma of external auditory canal: a case report

Resumen El plasmocitoma extramedular es una neoplasia de células plasmáticas poco frecuente, que se ubica en 80% a 90% de los casos en la cabeza o cuello. Esta neoplasia representa menos del 1% de toda la patología maligna de cabeza y cuello. Dada la poca frecuencia de la patología y la escasez de casos publicados, esta entidad presenta una gran dificultad clínica y terapéutica. El diagnóstico se basa en el análisis histológico con inmunohistoquímica de la muestra obtenida, y el tratamiento varía según la ubicación, donde se puede realizar radioterapia o cirugía. En este artículo presentamos el caso de una paciente de 56 años, con antecedentes de otorrea de larga data en oído derecho, al examen físico presentaba un tumor que obstruía todo el conducto auditivo externo. Se realizó exéresis tumoral y la biopsia evidenció un plasmocitoma.

Abstract Extramedullary plasmacytoma is a rare plasma cell neoplasm, affecting 80% to 90% of the head or neck. This neoplasm represents less than 1% of all malignant head and neck pathology. Given the infrequency of the pathology and the scarcity of published cases, this entity presents great clinical and therapeutic difficulty. Diagnosis is based on histology and immunohistochemistry and treatment varies depending on the location, where radiation therapy or surgery can be performed. In this article, we present the case of a 56-year-old patient with a history of long-standing otorrhea in the right ear. Physical examination presented a tumor that obstructed the entire external auditory canal. Tumor excision was performed, and the biopsy revealed a plasmacytoma.

VGGFace-Ear: An Extended Dataset for Unconstrained Ear Recognition.

Recognition using ear images has been an active field of research in recent years. Besides faces and fingerprints, ears have a unique structure to identify people and can be captured from a distance, contactless, and without the subject's cooperation. Therefore, it represents an appealing choice for building surveillance, forensic, and security applications. However, many techniques used in those applications-e.g., convolutional neural networks (CNN)-usually demand large-scale datasets for training. This research work introduces a new dataset of ear images taken under uncontrolled conditions that present high inter-class and intra-class variability. We built this dataset using an existing face dataset called the VGGFace, which gathers more than 3.3 million images. in addition, we perform ear recognition using transfer learning with CNN pretrained on image and face recognition. Finally, we performed two experiments on two unconstrained datasets and reported our results using Rank-based metrics.

New locus underlying auriculocondylar syndrome (ARCND): 430 kb duplication involving TWIST1 regulatory elements.

BACKGROUND: Auriculocondylar syndrome (ARCND) is a rare genetic disease that affects structures derived from the first and second pharyngeal arches, mainly resulting in micrognathia and auricular malformations. To date, pathogenic variants have been identified in three genes involved in the EDN1-DLX5/6 pathway (PLCB4, GNAI3 and EDN1) and some cases remain unsolved. Here we studied a large unsolved four-generation family. METHODS: We performed linkage analysis, resequencing and Capture-C to investigate the causative variant of this family. To test the pathogenicity of the CNV found, we modelled the disease in patient craniofacial progenitor cells, including induced pluripotent cell (iPSC)-derived neural crest and mesenchymal cells. RESULTS: This study highlights a fourth locus causative of ARCND, represented by a tandem duplication of 430 kb in a candidate region on chromosome 7 defined by linkage analysis. This duplication segregates with the disease in the family (LOD score=2.88) and includes HDAC9, which is located over 200 kb telomeric to the top candidate gene TWIST1. Notably, Capture-C analysis revealed multiple cis interactions between the TWIST1 promoter and possible regulatory elements within the duplicated region. Modelling of the disease revealed an increased expression of HDAC9 and its neighbouring gene, TWIST1, in neural crest cells. We also identified decreased migration of iPSC-derived neural crest cells together with dysregulation of osteogenic differentiation in iPSC-affected mesenchymal stem cells. CONCLUSION: Our findings support the hypothesis that the 430 kb duplication is causative of the ARCND phenotype in this family and that deregulation of TWIST1 expression during craniofacial development can contribute to the phenotype.

Tympanic membrane perforations: a critical analysis of 1003 ears and proposal of a new classification based on pathogenesis.

PURPOSE: To present a large series ears with tympanic membrane perforations (TMP), to describe their characteristics, and to propose a new classification system based on the pathogenesis of TMP. METHODS: This cross-sectional study was conducted at a tertiary university hospital with 1003 ears (792 consecutive patients with TMP in at least 1 ear). Otoendoscopy and audiometry were performed. Perforation measurements and their locations were digitally assessed. TMP with no suggestive signs of previous retraction were classified as Group 1, and those with possible previous retraction were classified as Group 2. Signs of retraction previous to the TMP, symptom length, perforation size and location, status of the contralateral ear, and hearing status were compared. RESULTS: Group 1 comprised 63.5% of the included ears. Compared to Group 2, Group 1 presented a higher rate of central perforations (99% vs. 53%), a shorter duration of symptoms, smaller perforations (mean area: 18.5% vs. 41.4%), a higher rate of perforations in the anterior quadrants, better hearing levels (mean tritonal gap: 23.9 dB vs. 29.2 dB), and a lower rate of abnormal contralateral ears (28% vs. 66%). CONCLUSION: The classification of TMP into two groups based on signs of previous retractions is feasible and indicates two different levels of disease severity. While the group without previous signs of retraction comprises ears with more limited disease, membranes with previous retraction seem to show more severe disease and, consequently, a less functional middle ear.

Relevant anatomical details in rats regarding otologic research / Detalles anatómicos relevantes en ratas para la investigación otológica

SUMMARY: The objective of the study was to provide a detailed anatomical description of the rat's ear anatomy that will prove insightful to different experimental otologic surgical procedures regardless of scope. Three male Wistar rats were enrolled in the study. Candidates were screened for systemic and otologic pathology. External ear canal endoscopy was carried out with a 30˚ rigid endoscope through an image capture system. Middle ear anatomical elements were analyzed under stereomicroscopy. 3D computer tomography image reconstruction was realized with a micro-CT to describe the anatomy. Image data from all three rats were analyzed. Anatomical annotations and surgical exposure recommendations were added for key elements. The most relevant images from all three rats were selected for representation. Detailed visualization of the structural elements of the tympanic cavity were clearly visible: promontory, round window, stapedial artery, stapes, incus, and tympanic membrane were all constant findings. We describe a step wise ventral surgical approach of the middle and inner ear for which we found that the clavotrapezius muscle was a reliable landmark. For the transtympanic approach the endoscopic transcanal access was an easy and reliable method for which a detailed anatomical representation was depicted. Further, anatomical similarities to humans were observed by stereomicroscopy and Micro-CT imaging reiterating that the rat model is suitable for otologic research. The endoscopic approach to the tympanic membrane is comfortable and less expensive than a microscope. The tendon of the clavotrapezius muscle can be a reliable landmark for discovering the tympanic bulla when considering a ventral approach. 3D Micro-CT reconstruction allows intact evaluation of the samples, simultaneously being a diagnostic and also a learning tool.

RESUMEN: El objetivo de este trabajo fue proporcionar una descripción anatómica detallada de la anatomía del órgano vestíbulococlear de la rata que resultará útil para diferentes procedimientos quirúrgicos otológicos experimentales, independientemente del alcance. En el estudio se usaron tres ratas Wistar macho. Los ejemplares fueron evaluados por patología sistémica y otológica. La endoscopía del meato acústico externo se realizó con un endoscopio rígido de 30˚ a través de un sistema de captura de imágenes. Los elementos anatómicos del oído medio se analizaron bajo estereomicroscopía. La reconstrucción de la imagen de tomografía computarizada en 3D se realizó con un micro-CT para describir la anatomía. Se analizaron los datos de imagen de las tres ratas. Se agregaron anotaciones anatómicas y recomendaciones de exposición quirúrgica para elementos clave. Las imágenes más relevantes de las tres ratas fueron seleccionadas para su representación. La visualización detallada de los elementos estructurales de la cavidad timpánica era claramente visible: promontorio timpánico, ventana coclear, arteria estapedial, estapedio, yunque y membrana timpánica eran hallazgos constantes. Describimos un abordaje quirúrgico ventral escalonado del oído medio e interno para el cual encontramos que el músculo clavotrapecio era un punto de referencia confiable. Para el abordaje transtimpánico, el acceso transcanal endoscópico fue un método fácil y confiable para el cual se describió una representación anatómica detallada. Además, se observaron similitudes anatómicas con los humanos mediante estereomicroscopía e imágenes Micro-CT, lo que reitera que el modelo de rata es adecuado para la investigación otológica. El abordaje endoscópico de la membrana timpánica es cómodo y menos costoso que un microscopio. El tendón del músculo clavotrapecio puede ser un punto de referencia fiable para descubrir la bulla timpánica cuando se considera un abordaje ventral. La reconstrucción 3D Micro- CT permite la evaluación intacta de las muestras, siendo simultáneamente una herramienta de diagnóstico y también de aprendizaje.

Neuroauriculotherapy: Framework and Remarks for a possible use in Voice Medicine / Neuroauriculoterapia: marco y observaciones para un posible uso en medicina de la voz

Aim. Neuroauriculotherapy (NAT) is a branch of medicine, which, thanks to its diagnostic and therapeutic value, is a powerful tool at the service of both physician and patient. In our experience, as it is discussed in this article, neuroauriculotherapy can have successful applications in voice science and in phoniatrics. The aim of this article is to open a discussion about possible applications of neuroauriculotherapy in voice medicine. Introduction. From the diagnostic point of view, it is possible to explore, with a palpeur (i.e., a tool that provides a constant pressure) or a "spot-hunter", the presence of a perturbation into a particular organ or area, and its return to normal during treatment. Indeed, at the level of the ear auricle, representations of an organ, its in-nervation, its muscular components, etc., are fixed. These spots or voxels correspond absolutely to the respective sensory, motor, visceral, among other spots. Therefore, if any abnormal potential comes from the periphery, it will illuminate the spots both at the cortical level and in the pavilion ­a real display with a constantly active touch screen. The spot can be treated with needles in the context of a neurophysiological strategy to send a message to the brain.Reflection. NAT appears to be a good method to improve the treatment of voice problems, enhancing the results of other therapies based on drugs or rehab and in-ducing relaxation. In neuroauriculotherapy, the ear is used to give the brain orders in a process which has a logical basis in neurophysiology.Conclusion. Diseases of the vocal tract can be dysfunctional or organic. According to our clinical experience, we can say that neuroauriculotherapy can be used in both cases. Neuroauriculotherapy is also extremely effective in voice therapy, both alone and in combination with other therapies, as there is no conflict among them

Objetivo. La neuroauriculoterapia (NAT) es una rama de la medicina que, gracias a su valor diagnóstico y terapéutico, constituye una poderosa herramienta al servicio del médico y del paciente. En nuestra experiencia, como se comenta en este artículo, la neuroauriculoterapia puede tener aplicaciones exitosas en la ciencia de la voz y en foniatría. El objetivo de este artículo es abrir una discusión sobre las posibles aplica-ciones de la neuroauriculoterapia en la medicina de la voz.Introducción. Desde el punto de vista del diagnóstico, es posible explorar, con un palpeur (i.e., una herramienta que proporciona una presión constante) o un "spot-hunter", la presencia de una perturbación en un órgano o área en particular, y su retorno a la normalidad durante el tratamiento. En efecto, a nivel del pabellón auricular se fijan representaciones de un órgano, su inervación, sus componentes musculares, etc. Estos puntos o vóxeles corresponden absolutamente a los respectivos puntos sensoriales, motores, viscerales, entre otros. Por lo tanto, si algún potencial anormal proviene de la periferia, iluminará los puntos tanto a nivel cortical como en el pabellón ­una pantalla real con una pantalla táctil constantemente activa. El punto se puede tratar con agujas en el contexto de una estrategia neurofisiológica para enviar un mensaje al cerebro.Reflexión. NAT parece ser un buen método para mejorar el tratamiento de los problemas de voz, potenciando los resultados de otras terapias basadas en fármacos o rehabilitación e induciendo a la relajación. En neuroauriculoterapia se utiliza el oído para dar órdenes al cerebro en un proceso que tiene una base lógica en la neurofisiología.Conclusión. Las enfermedades del tracto vocal pueden ser disfuncionales u orgáni-cas. Según nuestra experiencia clínica, podemos decir que la neuroauriculoterapia se puede utilizar en ambos casos. La neuroauriculoterapia también es extremadamente eficaz en la terapia de la voz, tanto sola como en combinación con otras terapias, ya que no existe conflicto entre ellas

Circadian rhythmicity on red ear syndrome in a patient with migraine: A case report.

BACKGROUND: Red ear syndrome (RES) was first described by Lance in 1994. It is characterized by recurrent attacks of redness of the ear, accompanied by burning pain, increased temperature, dysesthesia, and nosological relationship with headache. CASE: We report the case of a 43-year-old woman with migraine who developed RES. Redness episodes occurred at the same time of the day. She had a good therapeutic response to gabapentin. CONCLUSIONS: To the best of our knowledge, this is the first case of RES in which redness episodes occurred at the same time of the day.

Tacrolimus action pathways in an ointment base for hypertrophic scar prevention in a rabbit ear model

Abstract Background: Tacrolimus is used to prevent unaesthetic scars due to its action on fibroblast activity and collagen production modulation. Objectives: To evaluate the action pathways, from the histopathological point of view and in cytokine control, of tacrolimus ointment in the prevention of hypertrophic scars. Methods: Twenty-two rabbits were submitted to the excision of two 1-cm fragments in each ear, including the perichondrium. The right ear received 0.1% and 0.03% tacrolimus in ointment base twice a day in the upper wound and in the lower wound respectively. The left ear, used as the control, was treated with petrolatum. After 30 days, collagen fibers were evaluated using special staining, and immunohistochemistry analyses for smooth muscle actin, TGF-β and VEGF were performed. Results: The wounds treated with 0.1% tacrolimus showed weak labeling and a lower percentage of labeling for smooth muscle actin, a higher proportion of mucin absence, weak staining, fine and organized fibers for Gomori's Trichrome, strong staining and organized fibers for Verhoeff when compared to controls. The wounds treated with 0.03% tacrolimus showed weak labeling for smooth muscle actin, a higher proportion of mucin absence, strong staining for Verhoeff when compared to the controls. There was absence of TGF-β and low VEGF expression. Study limitations: The analysis was performed by a single pathologist. Second-harmonic imaging microscopy was performed in 2 sample areas of the scar. Conclusions: Both drug concentrations were effective in suppressing TGF-β and smooth muscle actin, reducing mucin, improving the quality of collagen fibers, and the density of elastic fibers, but only the higher concentration influenced elastic fiber organization.