RESUMO
OBJECTIVE: To distinguish the patterns of inner ear changes between meningogenic and otogenic routes in meningitis cases. Our hypothesis is that pinpointing distinct patterns linked to each route could aid in the development of diagnostic strategies and targeted therapies. METHODS: Temporal bones (TBs) from patients with a history of meningitis and histopathological evidence of labyrinthitis were divided into two groups (otogenic and meningogenic). Inner ear histopathological examination was performed to identify qualitative and semi-quantitative changes. This assessment encompassed inflammation patterns, indications of early ossification, hair cell loss, and alterations in the lateral wall, round window membrane, cochlear aqueduct and vestibular aqueduct. RESULTS: Thirty-six TBs were included in the study (otogenic, 21; meningogenic, 15). Generalized labyrinthitis was more common in otogenic cases (100% vs. 53%, p < 0.001). Early signs of cochlear ossification were exclusively observed in otogenic cases (9 TBs). The spiral ligament of otogenic cases has shown a uniform loss of fibrocytes across all cochlear turns, while meningogenic cases showed more severe loss in the apical turn. Otogenic cases exhibited a higher prevalence of severe inflammation of the cochlear aqueduct and endolymphatic sac. Meningogenic cases showed more severe loss of vestibular hair cells in the otolithic organs. CONCLUSION: Otogenic cases displayed a higher prevalence of changes in the spiral ligament and signs of early ossification, whereas meningogenic cases were associated with a higher degree of vestibular damage. Our findings emphasize the importance of considering the infection route and its implications for timely diagnosis and development of pathology-oriented treatment strategies. LEVEL OF EVIDENCE: NA Laryngoscope, 2024.
RESUMO
Introducción: las complicaciones por otitis media aguda tienen una incidencia menor a un 1%. Aun así, se describe en literatura una mortalidad de un 5%. Actualmente existe escasa evidencia sobre estas complicaciones en nuestra realidad local. Objetivo: describir las de complicaciones de otitis media aguda según tipo, sexo, síntomas de ingreso, exámenes solicitados y tratamiento. Material y Métodos: estudio descriptivo retrospectivo de revisión de fichas clínicas que incluyó pacientes que ingresaron al Hospital Clínico de la Pontificia Universidad Católica de Chile con diagnóstico de otitis media aguda entre el 1 enero de 2000 hasta el 30 de julio de 2022. Resultados: se obtuvieron 71 pacientes ingresados por complicación de otitis media aguda. La edad media fue de 26,79 años, con 46 mujeres y 25 hombres. Se observaron complicaciones extracraneales, intracraneales y complicaciones simultáneas. Las complicaciones más frecuentes fueron la laberintitis y mastoiditis sin reportar casos de mortalidad. Discusión: actualmente existe escasa información sobre complicaciones de otitis media aguda y su epidemiología a nivel local. Las complicaciones extracraneales fueron más frecuentes: de ellas, la laberintitis y la mastoiditis agudas. El diagnóstico es clínico con apoyo de exámenes tanto de laboratorio, audiovestibulares e imágenes. Con respecto al tratamiento quirúrgico, se debe evaluar caso a caso y debe incluir miringotomía con o sin instalación de tubo de ventilación y mastoidectomía en casos refractarios. Es importante la sospecha y la derivación precoz
Introduction: Complications due to acute otitis media have an incidence of less than 1%. Nevertheless, it is described in the literature as having a 5% mortality rate. Currently, there is little evidence of these complications in our local reality. Objective: Describe the complications of acute otitis media based on its type, patient gender, admission symptoms, requested exams, and treatment. Material and Methods: Retrospective and descriptive study of patients' medical records admitted at the "Hospital Clínico de la Pontificia Universidad Católica de Chile" who were diagnosed with acute otitis media from January 1st, 2000, to July 30th, 2022. Results: There were 71 patients admitted due to complications of acute otitis media. On average, they were 26.29 years old; 46 were women, and 25 were men. Extracranial, intracranial, and simultaneous complications were observed. The most frequent ones were labyrinthitis and mastoiditis, without any mortality cases reported. Discussion: Currently, there is scarce information about the complications of acute otitis media and its local epidemiology. Extracranial complications were the most frequent: acute labyrinthitis and mastoiditis. The clinical diagnosis is supported by laboratory, audiovestibular, and image tests. Regarding surgical treatment, each patient must be evaluated independently. It should include myringotomy with or without a ventilation tube and mastoidectomy in refractory cases. It is crucial to detect it early and proceed with a medical referral.
RESUMO
Resumen Objetivo: Describir los hallazgos en resonancia magnética (RM) en lesiones intralaberínticas. Methods: Se incluyeron pacientes evaluados entre enero de 2012 y marzo de 2019 que se sometieron a una RM del oído interno. Se recogieron datos demográficos y de imagen. Las RM incluyeron secuencias ponderadas en T2 de alta resolución (T2 AR), secuencias ponderadas en T1 sin contraste (T1 SC) y secuencias ponderadas en T1 con contraste (T1 CC). Resultados: Se analizaron las imágenes de RM de 23 pacientes con una mediana de edad de 60 años (rango: 43-73). Encontramos 8 (34,8%) pacientes con neurinoma intralaberíntico, 7 (30,4%) con laberintitis inflamatoria, 5 (21,7%) con laberintitis osificante y 3 (13%) con hemorragia intralaberíntica. Todos los pacientes con neurinoma intralaberíntico tenían una baja señal en la secuencias T2 AR, ligera hiperseñal en las secuencias T1 SC y realce poscontraste. Tres pacientes (42,5%) con laberintitis inflamatoria tenían baja señal en las secuencias T2 AR y 5 (71%) tenían realce en las secuencias T1 CC. Los pacientes con laberintitis osificante tenían una baja señal en las secuencias T2 AR y los pacientes con hemorragia tenían una señal alta en las secuencias T1 SC. Los pacientes con neurinoma intralaberíntico tenían señal más baja en T2 AR que los pacientes con laberintitis inflamatoria (p = 0,026). Conclusiones: Existen diferentes condiciones que pueden alterar la señal del laberinto en la RM. El patrón radiológico permite establecer su diagnóstico. La investigación proporciona información relevante para la interpretación de las alteraciones de la señal del laberinto membranoso en la RM.
Abstract Objective: The objective of this investigation is to describe the findings in magnetic resonance imaging (MRI) in intralabyrinthine lesions. Method: We included patients evaluated between January 2012 and March 2019 who underwent an MRI of the inner ear. Demographic and image data were collected. MRI included high-resolution T2 (HR-T2), non-contrast T1 (NC-T1) and contrast-enhanced T1 (CE-T1). Results: MRI images of 23 patients were analyzed. The median age was 60 years (range: 43-73). We found 8 (34.8%) patients with intra-labyrinthine neurinoma, 7 (30.4%) patients with inflammatory labyrinthitis, 5 (21.7%) with ossifying labyrinthitis and 3 (13%) with intra-labyrinthine hemorrhage. All patients with intra-labyrinthine neurinoma had a low signal in HR-T2, a slight high signal in NC- T1 and post-contrast enhancement. Three patients with inflammatory labyrinthitis (42.5%) had low signal in HR-T2 and 5 patients (71%) had enhancement with CE-T1. Patients with ossifying labyrinthitis had a low signal in HR-T2 and patients with hemorrhage had high signal in NC-T1. Patients with intra-labyrinthine neurinoma had a lower signal in HR-T2 than patients with inflammatory labyrinthitis (p = 0.026). Conclusions: There are multiple entities that can alter the labyrinth signal in MRI. The radiological pattern allows establishing their diagnosis. The research provides relevant information for the interpretation of the alterations of the membranous labyrinth signal in MRI.
RESUMO
ABSTRACT INTRODUCTION: Suppurative labyrinthitis continues to result in significant hearing impairment, despite scientific efforts to improve not only its diagnosis but also its treatment. The definitive diagnosis depends on imaging of the inner ear, but it is usually clinically presumed. OBJECTIVE: To analyze the clinical factors and hearing outcomes in patients with labyrinthitis secondary to middle ear infections and to discuss findings based on imaging test results. METHODS: Retrospective cohort study, based on the charts of patients admitted with middle ear infection-associated labyrinthitis. RESULTS: We identified 14 patients, eight (57%) of whom were females and six (43%) males. Mean age was 40 years. Cholesteatomatous chronic otitis media was diagnosed in six patients (43%), acute suppurative otitis media in six (43%), and chronic otitis media without cholesteatoma was diagnosed in two patients (14%). Besides labyrinthitis, 24 concomitant complications were identified: six cases (25%) of labyrinthine fistula, five cases (21%) of meningitis, five cases (21%) of facial paralysis, five cases (21%) of mastoiditis, two cases (8%) of cerebellar abscess, and one case (4%) of temporal abscess. There was one death. Eight (57%) individuals became deaf, while six (43%) acquired mixed hearing loss. CONCLUSION: Suppurative labyrinthitis was often associated with other complications; MRI played a role in the definitive diagnosis in the acute phase; the hearing sequel of labyrinthitis was significant.
RESUMO INTRODUÇÃO: Labirintite permanece resultando em deficiência auditiva significativa, apesar dos esforços científicos para melhorar não só o diagnóstico, como também o tratamento. O diagnóstico definitivo é dependente de imagens da orelha interna, mas geralmente é presumido clinicamente. OBJETIVO: Analisar os fatores clínicos e os resultados auditivos em pacientes com labirintite secundária à otite média e discutir os achados dos exames de imagem. MÉTODO: Estudo de coorte retrospectivo, com base nos prontuários de pacientes diagnosticados com labirintite associada à infecção da orelha média. RESULTADOS: Foram identificados 14 pacientes, oito (57%) do sexo feminino e seis (43%) masculino. Média etária de 40 anos. Otite média crônica colesteatomatosa foi diagnosticada em seis pacientes (43%), otite média aguda em seis pacientes (43%) e otite média crônica sem colesteatoma em dois pacientes (14%). Foram identificadas 24 complicações concomitantes: seis casos (25%) de fístula labiríntica, cinco casos (21%) de meningite, cinco (21%) de paralisia facial, cinco (21%) de mastoidite, dois casos (8%) de abscesso cerebelar e um caso (4%) de abcesso temporal. Houve uma morte. Oito (57%) indivíduos tornaram-se anacústicos, enquanto seis (43%) evoluíram para perda auditiva mista. CONCLUSÃO: Labirintite foi frequentemente associada a outras complicações; RNM auxiliou no diagnóstico definitivo da labirintite na sua fase aguda; a sequela auditiva da labirintite foi significativa.
Assuntos
Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Perda Auditiva/etiologia , Labirintite/diagnóstico , Labirintite/etiologia , Otite Média Supurativa/complicações , Doença Crônica , Estudos de Coortes , Espectroscopia de Ressonância Magnética , Otite Média Supurativa/classificação , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Suppurative labyrinthitis continues to result in significant hearing impairment, despite scientific efforts to improve not only its diagnosis but also its treatment. The definitive diagnosis depends on imaging of the inner ear, but it is usually clinically presumed. OBJECTIVE: To analyze the clinical factors and hearing outcomes in patients with labyrinthitis secondary to middle ear infections and to discuss findings based on imaging test results. METHODS: Retrospective cohort study, based on the charts of patients admitted with middle ear infection-associated labyrinthitis. RESULTS: We identified 14 patients, eight (57%) of whom were females and six (43%) males. Mean age was 40 years. Cholesteatomatous chronic otitis media was diagnosed in six patients (43%), acute suppurative otitis media in six (43%), and chronic otitis media without cholesteatoma was diagnosed in two patients (14%). Besides labyrinthitis, 24 concomitant complications were identified: six cases (25%) of labyrinthine fistula, five cases (21%) of meningitis, five cases (21%) of facial paralysis, five cases (21%) of mastoiditis, two cases (8%) of cerebellar abscess, and one case (4%) of temporal abscess. There was one death. Eight (57%) individuals became deaf, while six (43%) acquired mixed hearing loss. CONCLUSION: Suppurative labyrinthitis was often associated with other complications; MRI played a role in the definitive diagnosis in the acute phase; the hearing sequel of labyrinthitis was significant.
Assuntos
Perda Auditiva/etiologia , Labirintite/diagnóstico , Labirintite/etiologia , Otite Média Supurativa/complicações , Adolescente , Adulto , Idoso , Criança , Doença Crônica , Estudos de Coortes , Feminino , Humanos , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Otite Média Supurativa/classificação , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
A tontura é um sintoma associado a inúmeras condições clínicas e recruta a necessidade de investigação diagnóstica minuciosa e abordagem terapêutica individualizada. Muitas vezes associada ao zumbido, mais frequentemente relaciona-se a distúrbios do sistema vestibular periférico. Constituinte sintomático de um rol significativo de doenças, apresenta interface em várias especialidades médicas, o que denota a real necessidade de amplo conhecimento das condições a ela associadas. O presente estudo apresenta, sob a óptica de opinião de especialistas, uma abordagem relacionada ao diagnóstico e tratamento da tontura, considerando as necessidades dos médicos clínicos.
Dizziness is a symptom associated with numerous medical conditions and it recruits detailed diagnostic investigation and individualized therapeutic approach. It is often associated with tinnitus and related to disorders of peripheral vestibular system. It is present in a significant number of diseases and its occurrence in various medical specialties became essential the real need for extensive knowledge of the conditions associated with it. This study presents the viewpoint of expert opinion, an approach related to the diagnosis and treatment of dizziness, considering the necessities of physicians.
RESUMO
JUSTIFICATIVA E OBJETIVOS: O acidente vascular encefálico vértebro-basilar é uma entidade difícil de ser reconhecida através de dados semiológicos, pois pode se apresentar clinicamente semelhante a uma labirintopatia. O objetivo deste estudo foi alertar sobre os sintomas apresentados pelo paciente com vertigem central para se fazer um diagnóstico precoce. A justificativa baseia-se no quadro de um paciente com vertigem e vômitos, avaliado como uma labirintopatia, chamando atenção de dados semiológicos úteis na distinção entre a vertigem central e a periférica. RELATO DO CASO: Paciente do sexo masculino, 69 anos, hipertenso foi atendido em pronto-atendimento com vertigem, vômitos e mal estar. Medicado com metoclopramida, dimenidrinato, clonazepam. Alta com melhora parcial do quadro, suspeitando labirintite. Orientado consulta com otorrinolaringologia. No dia seguinte evoluiu com incapacidade de marcha, vertigem, vômitos, rebaixamento do nível de consciência e descerebração bilateral. Submetido à intubação orotraqueal. Tomografia computadorizada de crânio (TCC) revelou sinal de hiperdensidade da artéria basilar sugerindo trombose,confirmada pela angiografia. Tendo-se em vista quadro neurológico e tempo de evolução impreciso, optou-se por não utilizar trombolítico. No dia seguinte, o paciente apresentava-se em coma (Glasgow = 3),TCC revelando acidente vascular encefálico isquêmico (AVEI) agudo vértebro-basilar extenso evoluindo para óbito 72 horas após. CONCLUSÃO: A distinção entre vertigem central ou periférica é um desafio semiológico. O diagnóstico precoce do AVEI por TCC é limitado. O conhecimento de dados semiológicos é uma ferramenta indispensável para o reconhecimento do AVE vértebro-basilar em unidades de PA.
BACKGROUND AND OBJECTIVES: Vertebrobasilar strokeis a difficult entity to be recognized through semiological data, because it can be clinically similar to a labyrinthopathy. This study aims at alerting about the symptoms of patients with central vertigo to make an early diagnosis, as the clinical picture of vertigo and vomiting can be diagnosed as a labyrinthopathy; it also aims at drawing attention to semiological data useful for distinguishing between the peripheral and central vertigo. CASE REPORT: Male patient, 69 years, hypertensive, was seen in an emergency service with dizziness, vomiting, malaise. He was given metoclopramide, dimenhydrinate, and clonazepam. He was discharged with partial improvement of his condition and suspicion of labyrinthitis. He was referred to an otorhinolaryngologist. The next day he progressed with inability to walk, dizziness, vomiting, decreased level of consciousness and bilateral decerebration. He underwent orotracheal intubation. Computed tomography (CT) revealed hyperdensity sign of basilar artery suggestive of thrombosis, confirmed by angiography. Due to the neurological symptoms and inaccurate time course, we chose not to use thrombolytic therapy. The next day, the patient was in coma (Glasgow= 3), with CT revealing extensive acute vertebrobasilar ischemic stroke (AIS) that progressed to death in 72 hours. CONCLUSION: The distinction between central or peripheral vertigo is a semiological challenge. Early diagnosis of AIS by brain TC is limited. The knowledge of semiological data is an indispensable tool for the recognition of vertebrobasilar stroke in emergency care.
Assuntos
Humanos , Masculino , Idoso , Artéria Basilar , Trombose Intracraniana , Labirintite , Tomografia Computadorizada por Raios X , VertigemRESUMO
A tontura é um sintoma associado a inúmeras condições clínicas e recruta a necessidade de investigação diagnóstica minuciosa e abordagem terapêutica individualizada. Muitas vezes associada ao zumbido, mais frequentemente se relaciona a distúrbios do sistema vestibular periférico. Constituinte sintomático de um rol significativo de doenças, apresenta interface em várias especialidades médicas, o que denota a real necessidade de amplo conhecimento das condições a ela associadas. O presente estudo apresenta, sob a óptica de opinião de especialistas, uma abordagem relacionada ao diagnóstico e tratamento da tontura.