Brazilian Society of Otology task force - Otosclerosis: evaluation and treatment

Abstract Objectives: To review and provide evidence-based recommendations for the diagnosis and treatment of otosclerosis. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on otosclerosis were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: 1) Diagnosis - audiologic and radiologic; 2) Treatment - hearing AIDS, pharmacological therapy, stapes surgery, and implantable devices - bone-anchored devices, active middle ear implants, and Cochlear Implants (CI). Conclusions: The pathophysiology of otosclerosis has not yet been fully elucidated, but environmental factors and unidentified genes are likely to play a significant role in it. Women with otosclerosis are not at increased risk of worsening clinical condition due to the use of contraceptives or during pregnancy. Drug treatment has shown little benefit. If the patient does not want to undergo stapedotomy, the use of hearing aids is well indicated. Implantable systems should be indicated only in rare cases, and the CI should be indicated in cases of profound deafness.

Brazilian Society of Otology task force - Otosclerosis: evaluation and treatment.

OBJECTIVES: To review and provide evidence-based recommendations for the diagnosis and treatment of otosclerosis. METHODS: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on otosclerosis were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS: The topics were divided into 2 parts: 1) Diagnosis - audiologic and radiologic; 2) Treatment - hearing AIDS, pharmacological therapy, stapes surgery, and implantable devices - bone-anchored devices, active middle ear implants, and Cochlear Implants (CI). CONCLUSIONS: The pathophysiology of otosclerosis has not yet been fully elucidated, but environmental factors and unidentified genes are likely to play a significant role in it. Women with otosclerosis are not at increased risk of worsening clinical condition due to the use of contraceptives or during pregnancy. Drug treatment has shown little benefit. If the patient does not want to undergo stapedotomy, the use of hearing aids is well indicated. Implantable systems should be indicated only in rare cases, and the CI should be indicated in cases of profound deafness.

Task force of the Brazilian Society of Otology - evaluation and management of peripheral facial palsy.

OBJECTIVE: To review key evidence-based recommendations for the diagnosis and treatment of peripheral facial palsy in children and adults. METHODS: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on peripheral facial palsy were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS: The topics were divided into 2 main parts: (1) Evaluation and diagnosis of facial palsy: electrophysiologic tests, idiopathic facial palsy, Ramsay Hunt syndrome, traumatic peripheral facial palsy, recurrent peripheral facial palsy, facial nerve tumors, and peripheral facial palsy in children; and (2) Rehabilitation procedures: surgical decompression of the facial nerve, facial nerve grafting, surgical treatment of long-term peripheral facial palsy, and non-surgical rehabilitation of the facial nerve. CONCLUSIONS: Peripheral facial palsy is a condition of diverse etiology. Treatment should be individualized according to the cause of facial nerve dysfunction, but the literature presents better evidence-based recommendations for systemic corticosteroid therapy.

Bilateral facial paralysis secondary to temporal bone trauma: A case report and literature review.

When temporal bone fractures are associated with facial palsy (FP) evolution the medical team have no much time to make a decision: to do or not to do a surgical approach? How to evaluate the necessity? When to do it and when is the correct time?

Conservative management of petrous apex abscess and Gradenigo's syndrome in a diabetic patient: Case report and literature review.

The case reported evidences the possibility of nonsurgical treatment in patients with abscesses located in regions difficult to reach surgically due to surgical limitations or possible sequelae related to surgical procedure.

How do medical students defend themselves against anxiety?

OBJETIVO: A formação médica é geradora de ansiedade, tornando os estudantes de medicina vulneráveis a transtornos psiquiátricos, em particular os transtornos de ansiedade. Para lidar com a ansiedade o estudante de medicina lança mão de vários mecanismos de defesa. Objetivou-se avaliar a associação entre a presença de sintomas de ansiedade e o estilo defensivo em alunos de uma escola médica pública federal. MÉTODO: Trata-se de um estudo observacional transversal, de uma amostra de estudantes de medicina, do primeiro e sexto ano, devidamente matriculados e frequentando regularmente as aulas. No presente estudo utilizou-se um questionário sócio-demográfico, o Inventário Beck de Ansiedade e o questionário de estilo defensivo (DSQ-40). RESULTADOS: Responderam aos questionários 232 alunos, 110 do primeiro ano e 122 do sexto, representando 67,4% do total de alunos matriculados. Em relação aos mecanismos de defesa na amostra, as analises multivariadas mostraram que mecanismos de defesa neuróticos e imaturos estavam associados à presença de ansiedade (p < 0,001). CONCLUSÃO: Os dados encontrados no estudo apontam que alunos do curso médico que apresentaram sintomas de ansiedade utilizaram significativamente mais mecanismos de defesa neurótiocos e imaturos do que os que não tinham esses sintomas. Planos de prevenção, atenção e estratégias de apoio psicológico deveriam ser desenvolvidos para esse grupo, pois os mecanismos de defesa não parecem ser adaptativos em estudantes de medicina enfrentando ansiedade.(AU)

OBJECTIVE: Medical training is a generator of anxiety, making medical students vulnerable to psychiatric disorders. To deal with anxiety, medical students make use of several defense mechanisms. The aim was to assess the association between the presence of symptoms of anxiety and the defense style in students of a federal public medical school. METHOD: This is a cross-section observational study, of a sample of medical students, of the first and sixth years, duly enrolled and regularly attending classes. For the present study a socio-demographic questionnaire, the Beck Anxiety Inventory and the Defense Style Questionnaire (DSQ-40) were used. RESULTS: The questionnaires were answered by 232 students, 110 from the first year and 122 of the sixth year, representing 67.4% of the total amount of students. In relation to the defense mechanisms in the sample, the multivariate analysis showed that neurotic and immature defense mechanisms were associated with the presence of anxiety (p<0.001). CONCLUSION: The data found in this study indicate that medical students who showed symptoms of anxiety, used more neurotic or immature defense mechanisms than students who did not present these symptoms. Prevention and attention plans, as well as psychological support strategies should be developed for this group, because defense mechanisms do not appear to be adaptive in medical students experiencing anxiety.(AU)

Stress and coping in a sample of medical students in Brazil

Background Medical training is a stressing situation, making medical students vulnerable to psychiatric disorders, such as depression and anxiety. Objective The study aimed to assess the prevalence of stress and coping in students of a public medical school in Brazil, comparing the groups from the first and sixth years of training. Methods Through a cross-sectional, observational study, a sample of 232 first and sixth-year regularly registered medical students has been evaluated. Students filled a socio-demographic questionnaire, the Lipp Inventory of Stress Symptoms (ISSL), and the Coping Strategies Inventory (CSI). Results From the total sample of 232 students, 110 were first-year students and 122 sixth-year students. Stress symptoms were significantly higher in first-year students (49.1%) than in the sixth-year group (33.6%; p = 0.018). Variables significantly associated with stress were: year of the training (1st year > 6th year), income (lower > higher income), satisfaction with the training (dissatisfied > satisfied) and the use of escape/avoidance copying strategy (positive association). Discussion Considering the higher stress symptoms among first-year medical students and the positive association of the escape/avoidance copying strategy with stress, strategies must be developed to enable students starting medical school to be better at coping with this stressful situations.