Graphic angle measure as an electrocochleography evaluation parameter.

UNLABELLED: To improve electrocochleography's diagnostic sensitivity in Meniére's disease - new assessment methods are being studied. AIM: To determine whether or not graphic angle measurement is sensitive and specific to Menière's disease laboratorial diagnosis and if there is an increase in the electrocochleography's sensitivity and specificity when graphic angle measurements are associated with Summating Potential-Action Potential ratio (SP/AP ratio). METHODS: Electrocochleography's was used to analyze 71 ears from 55 subjects: 41 patients with clinical diagnosis of Menière's disease (MD group), and 14 healthy individuals as control (Group C). Graphic results were analyzed initially to obtain the SP/AP ratio; afterwards, through another program graphic angle measurements were calculated. RESULTS: Sensitivity and specificity values of angle measures, SP/AP ratio, and the association between them varied according to the cutoff point, the highest equilibrium between sensitivity and specificity was observed with the values of 166.25 for angle measurement and 27% for SP/AP relation; 62.79% / 60.71% and 74.42% / 67.86%, respectively. The association between measurements showed a sensitivity increase due to the specificity decrease; 88.37% and 50%, respectively. CONCLUSION: Angle graphic measurement is not sensitive and specific enough for the laboratorial diagnosis of MD. Angle graphic measurement and SP/AP ratio association proved to be higher in sensitivity, in detriment of exam specificity.

Graphic angle measure as an electrocochleography evaluation parameter / A medida angular gráfica como parâmetro de avaliação da eletrococleografia

To improve electrocochleography's diagnostic sensitivity in Meniére's disease - new assessment methods are being studied. AIM: To determine whether or not graphic angle measurement is sensitive and specific to Menière's disease laboratorial diagnosis and if there is an increase in the electrocochleography's sensitivity and specificity when graphic angle measurements are associated with Summating Potential-Action Potential ratio (SP/AP ratio). METHODS: Electrocochleography's was used to analyze 71 ears from 55 subjects: 41 patients with clinical diagnosis of Menière's disease (MD group), and 14 healthy individuals as control (Group C). Graphic results were analyzed initially to obtain the SP/AP ratio; afterwards, through another program graphic angle measurements were calculated. RESULTS: Sensitivity and specificity values of angle measures, SP/AP ratio, and the association between them varied according to the cutoff point, the highest equilibrium between sensitivity and specificity was observed with the values of 166.25 for angle measurement and 27 percent for SP/AP relation; 62.79 percent / 60.71 percent and 74.42 percent / 67.86 percent, respectively. The association between measurements showed a sensitivity increase due to the specificity decrease; 88.37 percent and 50 percent, respectively. CONCLUSION: Angle graphic measurement is not sensitive and specific enough for the laboratorial diagnosis of MD. Angle graphic measurement and SP/AP ratio association proved to be higher in sensitivity, in detriment of exam specificity.

Para melhorar a sensibilidade diagnóstica da eletrococleografia na doença de Ménière têm-se estudado novos métodos de mensuração. OBJETIVOS: Verificar se a técnica da medida angular gráfica é sensível e específica para o diagnóstico laboratorial da doença de Ménière e se existe incremento na sensibilidade e especificidade da eletrococleografia, quando da associação da medida angular gráfica com o valor da relação SP/AP. CASUÍSTICA E MÉTODO: Foram analisadas a eletrococleografia de 71 orelhas: 41 pacientes com diagnóstico clínico de doença de Ménière e 14 controles sadios. Os traçados foram analisados inicialmente para a obtenção do valor da relação SP/AP, posteriormente foi calculada a medida angular gráfica. RESULTADOS: O valor da sensibilidade e especificidade da medida angular, da relação SP/AP e da associação de ambas variou de acordo com o ponto de corte, os valores 166,25 para a medida angular e 27 por cento para SP/AP foram os que demonstraram maior equilíbrio entre sensibilidade e especificidade, 62,79 por cento / 60,71 por cento e 74,42 por cento / 67,86 por cento, respectivamente. A associação das medidas mostrou incremento da sensibilidade à custa da diminuição da especificidade, 88,37 por cento e 50 por cento, respectivamente. CONCLUSÕES: A medida angular gráfica não é sensível e específica suficiente para o diagnóstico laboratorial DM. A associação da relação SP/AP e medida angular gráfica apresentou melhora da sensibilidade em detrimento da especificidade do exame.

Sudden hearing loss caused by labyrinthine hemorrhage.

Sudden sensorineural hearing loss is relatively frequent. In most cases, the etiology is not discovered. One of the possible causes for sudden deafness is inner labyrinth bleeding, which was difficult to diagnose before the advent of magnetic resonance imaging. The purpose of this paper is to report a case of sudden hearing loss caused by a labyrinthine hemorrhage, and to present a review of the literature on this topic.

Surdez súbita causada por hemorragia intralabiríntica / Sudden hearing loss caused by labyrinthine hemorrhage

A surdez súbita sensorioneural é uma perda auditiva súbita ou rapidamente progressiva. Na maioria dos casos a etiologia não é descoberta. Uma das causas possíveis de surdez súbita é a hemorragia intralabiríntica que, antes do surgimento da ressonância magnética, não era corretamente diagnosticada. O objetivo deste trabalho é relatar um caso de surdez súbita causada por hemorragia intralabiríntica e realizar uma revisão da literatura sobre este assunto.

Sudden sensorineural hearing loss is relatively frequent. In most cases, the etiology is not discovered. One of the possible causes for sudden deafness is inner labyrinth bleeding, which was difficult to diagnose before the advent of magnetic resonance imaging. The purpose of this paper is to report a case of sudden hearing loss caused by a labyrinthine hemorrhage, and to present a review of the literature on this topic.

Bilateral inverted papilloma: case report and literature review.

The inverted papilloma is an uncommon unilateral nasosinusal benign tumor. The clinical picture presents nonspecific signs and symptoms, such as unilateral nasal obstruction, anosmia and headache. The diagnosis is established by anamnesis, physical exam, computed tomography and magnetic resonance imaging. Treatment is essentially surgical. This report has the objective of presenting an uncommon bilateral inverted nasal papilloma and making a literature review.

Pediatric otosclerosis: case report and literature review.

Otospongiosis is an osteodystrophy of the temporal bone, characterized by disordered neoformation and deposition of bone, characterized by the presence of a progressive conductive, sensorineural or mixed hearing loss and tinnitus. Typically, otospongiosis presents as a slowly progressive conductive hearing loss in the third to fourth decade of life. Uncommonly children and adolescents may also have conductive or sensorineural hearing loss caused by otosclerosis. We describe a case of an 11-year-old patient, with progressive unilateral conductive hearing loss for 5 years. The otoscopic examination revealed a positive Schwartz's sign in the left ear. Audiometry, impedanciometry and CT scan showed characteristics that suggested otospongiosis. We reviewed clinical aspects, diagnosis and the therapeutic approach for otospongiosis in children.

Papiloma invertido bilateral: relato de caso e revisão da literatura / Bilateral inverted papilloma: case report and literature review

O papiloma invertido é um raro tumor nasossinusal benigno e unilateral. As manifestações clínicas são inespecíficas, como obstrução nasal unilateral, rinorréia, epistaxe, hiposmia e cefaléia. O diagnóstico é realizado por meio de anamnese detalhada, exame otorrinolaringológico e exames complementares. A tomografia computadorizada e a ressonância magnética são exames fundamentais na elucidação diagnóstica, no tratamento e no acompanhamento do paciente. O tratamento é essencialmente cirúrgico. Este trabalho tem como objetivo relatar um caso de papiloma invertido bilateral e realizar uma revisão da literatura.

The inverted papilloma is an uncommon unilateral nasosinusal benign tumor. The clinical picture presents nonspecific signs and symptoms, such as unilateral nasal obstruction, anosmia and headache. The diagnosis is established by anamnesis, physical exam, computed tomography and magnetic resonance imaging. Treatment is essentially surgical. This report has the objective of presenting an uncommon bilateral inverted nasal papilloma and making a literature review.

Otosclerose infantil: relato de caso e revisão da literatura / Pediatric otosclerosis: case report and literature review

A otospongiose é uma osteodistrofia do osso temporal caracterizada pela reabsorção e neoformação óssea desordenada. Clinicamente, caracteriza-se por disacusia condutiva, neurossensorial, e/ou mista, progressiva e zumbidos. O início dos sintomas ocorre entre 30 e 40 anos de idade sendo rara sua manifestação na infância. Descrevemos o caso de um paciente de 11 anos de idade, com quadro de hipoacusia unilateral progressiva há 5 anos. O exame otorrinolaringológico revelou mancha rubra de Schwartze em orelha esquerda. A audiometria, imitanciometria e a tomografia computadorizada demonstraram características sugestivas de otospongiose. Realizamos uma revisão dos aspectos clínicos, diagnósticos e da conduta terapêutica da otospongiose na infância.

Otospongiosis is an osteodystrophy of the temporal bone, characterized by disordered neoformation and deposition of bone, characterized by the presence of a progressive conductive, sensorineural or mixed hearing loss and tinnitus. Typically, otospongiosis presents as a slowly progressive conductive hearing loss in the third to fourth decade of life. Uncommonly children and adolescents may also have conductive or sensorineural hearing loss caused by otosclerosis. We describe a case of an 11-year-old patient, with progressive unilateral conductive hearing loss for 5 years. The otoscopic examination revealed a positive Schwartz's sign in the left ear. Audiometry, impedanciometry and CT scan showed characteristics that suggested otospongiosis. We reviewed clinical aspects, diagnosis and the therapeutic approach for otospongiosis in children.

The outcome of patients with Ménières disease.

UNLABELLED: Ménière;s disease is a frequent vestibular disease that occurs predominantly in the fourth decade of life. Diagnosis is mostly medical and is based on findings of vertigo, sensorineural hearing loss, tinnitus and aural fullness. AIM: To study the clinical findings of Ménière;s disease: age, duration of vertigo, tinnitus, hearing loss and aural fullness, and unilateral or bilateral involvement. METHOD: a retrospective study included 39 patients with a diagnosis of Ménière;s disease confirmed by electrocochleography, who were seen at a neuro-otology referral centre. Patients underwent a clinical examination, audiometry and bilateral transtympanic electrocochleography. Patients were separated into 2 groups: bilateral Ménière;s disease and unilateral Ménière;s disease. RESULTS: The mean age was 42.9 years; 72.5% were female. Fluctuation of hearing loss occurred in 54.5% of cases, and 65.7% had frequent attacks of vertigo. Bilateral disease was observed in 33.3%. The onset of the disease was earlier in the bilateral group (33.7 years) compared to the unilateral group (p= 0.0013). Duration of disease, tinnitus, hearing loss and aural fullness were similar between groups. CONCLUSION: Patients with bilateral Ménière;s disease had symptoms earlier than patients with unilateral disease. There was no difference between the groups in duration of disease and associated symptoms.

Evolução clínica de pacientes com doença de Ménière / The outcome of patients with ménières disease

A doença de Ménière é vestibulopatia freqüente e manifesta-se após a 4ª década de vida. Diagnóstico é clínico e caracteriza-se por vertigem, perda auditiva neurossensorial, zumbido e plenitude aural. OBJETIVO: Estudar a evolução da doença de Ménière em função do tempo de evolução da vertigem, do zumbido, da plenitude aural, da perda auditiva, idade e acometimento unilateral ou bilateral. CASUíSTICA E MÉTODO: Estudo retrospectivo. Avaliados 39 pacientes com diagnóstico clínico definido de doença de Ménière, confirmado pela eletrococleografia, em centro de referência. Foram submetidos ao exame clínico, audiometria e eletrococleografia transtimpânica bilateral. Foram divididos em 2 grupos: doença de Ménière bilateral e doença de Ménière unilateral. RESULTADOS: Idade média de 42,9 com predominância feminina (72,5 por cento). Flutuação da audição ocorreu em 54,5 por cento e 65,7 por cento apresentavam crises vertiginosas freqüentes. Envolvimento bilateral foi observado em 33,3 por cento. A doença iniciou mais cedo (33,7 anos) no grupo bilateral que no grupo unilateral (p= 0,0013). Não houve diferença da duração da doença, zumbido, plenitude aural e perda auditiva entre os grupos. CONCLUSÃO: Pacientes com doença de Ménière bilateral apresentam sintomas mais precocemente que aqueles com doença unilateral, mas não diferem em relação ao tempo de evolução da doença e dos sintomas associados.

Ménière`s disease is a frequent vestibular disease that occurs predominantly in the fourth decade of life. Diagnosis is mostly medical and is based on findings of vertigo, sensorineural hearing loss, tinnitus and aural fullness. AIM: To study the clinical findings of Ménière`s disease: age, duration of vertigo, tinnitus, hearing loss and aural fullness, and unilateral or bilateral involvement. METHOD: a retrospective study included 39 patients with a diagnosis of Ménière`s disease confirmed by electrocochleography, who were seen at a neuro-otology referral centre. Patients underwent a clinical examination, audiometry and bilateral transtympanic electrocochleography. Patients were separated into 2 groups: bilateral Ménière`s disease and unilateral Ménière`s disease. RESULTS: The mean age was 42.9 years; 72.5 percent were female. Fluctuation of hearing loss occurred in 54.5 percent of cases, and 65.7 percent had frequent attacks of vertigo. Bilateral disease was observed in 33.3 percent. The onset of the disease was earlier in the bilateral group (33.7 years) compared to the unilateral group (p= 0.0013). Duration of disease, tinnitus, hearing loss and aural fullness were similar between groups. CONCLUSION: Patients with bilateral Ménière`s disease had symptoms earlier than patients with unilateral disease. There was no difference between the groups in duration of disease and associated symptoms.

Mucocele frontoetmoidal: relato de casos e revisão da literatura / Frontoethmoidal mucocele: a case report and literature review

As mucoceles dos seios paranasais são lesões císticas de revestimento epitelial com conteúdo mucóide, que apresentam crescimento lento com características expansivas e de reabsorção óssea. Eventualmente, podem comprometer as estruturas nobres adjacentes como a órbita e a cavidade intracraniana. Acredita-se que sua etiologia esteja ligada à obstrução do óstio de drenagem do seio paranasal envolvido. Podem causar dor facial, cefaléia, obstrução nasal, diplopia, diminuição da acuidade visual, deslocamento do globo ocular, edema facial ou até mesmo meningite, dependendo da área anatômica comprometida. Acomete mais freqüentemente os seios frontal e etmoidal anterior, sem prevalência de sexo. O diagnóstico é realizado através de exames de imagem, sendo a tomografia computadorizada o exame de eleição, embora em algumas ocasiões a ressonância magnética esteja indicada. Atualmente a abordagem endoscópica paranasal é o acesso cirúrgico de primeira escolha, por ser menos invasiva e apresentar menor morbidade. Este estudo relata dois casos de mucocele frontoetmoidal com extensão orbitária, abordados por via endoscópica endonasal. Os resultados comprovaram a segurança e eficiência deste acesso cirúrgico.