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1.
Rev Med Suisse ; 20(878): 1173-1177, 2024 Jun 12.
Artigo em Francês | MEDLINE | ID: mdl-38867563

RESUMO

Complex ear reconstruction requires specialized multidisciplinary care. Most patients present with microtia, often associated with hearing disorders. The management of these disorders is a priority, and reconstruction of the external ear remains optional. Nowadays, auricular reconstruction is based on the subcutaneous implantation of either autologous cartilage or an allogeneic implant. Autologous reconstruction requires highly specialized surgical expertise and involves harvesting rib cartilage but carries a lower risk of exposure compared to allogeneic implants. Both techniques yield good results with a high success rate and have a positive impact on the social functioning and daily life of patients.


La reconstruction complexe du pavillon auriculaire nécessite une prise en charge multidisciplinaire spécialisée. La majorité des patients nécessitant ce geste présentent une microtie, souvent associée à des troubles de l'audition. La prise en charge de ceux-ci est prioritaire et la reconstruction du pavillon reste facultative. Aujourd'hui, la reconstruction du pavillon se base sur l'implantation sous-cutanée d'une maquette de cartilage autologue ou d'un implant allogène. La reconstruction autologue demande une expertise chirurgicale hautement spécialisée et nécessite un prélèvement de cartilage costal mais présente un risque d'exposition inférieur par rapport à l'implant allogène. Les deux techniques permettent d'atteindre de bons résultats avec un taux de réussite élevé et un effet positif sur le fonctionnement social et le quotidien des patients.


Assuntos
Procedimentos de Cirurgia Plástica , Humanos , Procedimentos de Cirurgia Plástica/métodos , Orelha Externa/anormalidades , Orelha Externa/cirurgia , Microtia Congênita/cirurgia , Microtia Congênita/terapia , Transplante Autólogo/métodos , Cartilagem/transplante , Próteses e Implantes
2.
Arch. argent. pediatr ; 122(3): e202310178, jun. 2024. ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1555003

RESUMO

La histiocitosis de células de Langerhans es una expresión de células dendríticas mieloides, asociada a un componente inflamatorio significativo y compromiso sistémico variado. La edad más frecuente de presentación es entre 1 y 4 años, y predomina en el sexo masculino. Se comunica el caso de un niño de 5 años de edad cuya forma de presentación fue una lesión granulomatosa con fístula perianal, afectación pulmonar y de oído externo. El abordaje interdisciplinario permitió llegar al diagnóstico, realizar las intervenciones necesarias e iniciar el tratamiento adecuado.


Langerhans cell histiocytosis is an expression of myeloid dendritic cells, associated with a significant inflammatory component and varied systemic involvement. The most common age at presentation is between 1 and 4 years, and it prevails among male subjects. Here we describe the case of a 5-year-old boy who presented with a granulomatous lesion with perianal fistula and lung and external ear involvement. An interdisciplinary approach helped to make a diagnosis, provide the necessary interventions, and start an adequate treatment.


Assuntos
Humanos , Masculino , Pré-Escolar , Histiocitose de Células de Langerhans/complicações , Histiocitose de Células de Langerhans/diagnóstico , Diagnóstico Diferencial
3.
Br J Hosp Med (Lond) ; 85(5): 1-5, 2024 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-38815968

RESUMO

An elderly male with type 2 diabetes presented with a 2-month history of otalgia and severe headaches. He was diagnosed with malignant otitis externa (MOE) and was commenced on empirical treatment with oral ciprofloxacin. Pseudomonas is the most common cause of MOE. A baseline CT scan was undertaken that demonstrated skull base osteomyelitis (SBO) due to findings of bone erosion at the mastoid tip and an infiltrating soft tissue mass eroding the clivus. Eight weeks later, he returned with worsening and bilateral symptoms of otitis externa, hearing loss, temporomandibular pain and dysfunction. Worsening and now bilateral malignant otitis externa were confirmed with an MRI scan that also demonstrated a small fluid collection in his left temporal region. The collection was aspirated and grew scedosporium apiospermum. He was diagnosed with fungal SBO and was commenced on treatment with the antifungal voriconazole, with significant improvement in symptoms and radiological findings. Fungal osteomyelitis is more likely in immunosuppressed patients, particularly those with type 2 diabetes. Fungal aetiology should be suspected in patients with progressive symptoms, despite treatment. A microbiology diagnosis of fungal SBO or MOE can be challenging to obtain and can lead to diagnostic delay. A sampling of the external auditory canal can aid in diagnosing MOE; however, scedosporium may also be isolated as a commensal organism. Aspirations from accessible fluid collections, infratemporal fossa needle sample and bone biopsy can provide material for diagnosis. Scedosporium is a rare cause of disease in humans, however, fungal infections are increasing in humans, due to an increase in susceptible populations. Scedosporium apiospermum is a rare cause of SBO and should be considered in patients not responding to standard treatment.


Assuntos
Antifúngicos , Osteomielite , Otite Externa , Scedosporium , Base do Crânio , Humanos , Otite Externa/microbiologia , Otite Externa/diagnóstico , Osteomielite/microbiologia , Osteomielite/diagnóstico , Masculino , Base do Crânio/microbiologia , Antifúngicos/uso terapêutico , Scedosporium/isolamento & purificação , Diabetes Mellitus Tipo 2/complicações , Tomografia Computadorizada por Raios X , Voriconazol/uso terapêutico , Idoso , Imageamento por Ressonância Magnética , Micoses/diagnóstico , Micoses/complicações
6.
Aesthetic Plast Surg ; 48(11): 2034-2041, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38676769

RESUMO

BACKGROUND: As a rare auricular deformity, despite numerous surgical procedures for correcting moderate-to-severe question mark ears described in past studies, there remains a need to explore a more cost-effective approach. The optimal utilization of ear cartilage and surrounding skin while achieving superior outcomes continues to pose a significant challenge. METHODS: From 2018 to 2023, twenty-four patients with unilateral question mark ear were enrolled in this study. Seven of them were severe type deformities (absence of lower part of auricle), and seventeen were moderate (only cleft between helix and lobule). All patients were treated with new method using local cartilage and flap without damage in unaffected area. RESULTS: All patients were satisfied with significant improvement of question mark ear and the overall symmetrical appearance. The surgical scar was not obvious. No complications were observed. The follow-up period revealed that the corrective procedure kept producing the symmetrical and cosmetic results. CONCLUSION: Our new method enables optimal utilization of deformed tissue and surrounding skin, rendering this method effective and reliable for correcting moderate-to-severe question mark ears. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
Cartilagem da Orelha , Estética , Procedimentos de Cirurgia Plástica , Retalhos Cirúrgicos , Humanos , Feminino , Retalhos Cirúrgicos/transplante , Masculino , Cartilagem da Orelha/cirurgia , Cartilagem da Orelha/transplante , Procedimentos de Cirurgia Plástica/métodos , Adulto Jovem , Adulto , Adolescente , Resultado do Tratamento , Estudos Retrospectivos , Estudos de Coortes , Seguimentos , Satisfação do Paciente/estatística & dados numéricos , Criança , Medição de Risco , Orelha Externa/cirurgia , Orelha Externa/anormalidades , Pavilhão Auricular/cirurgia , Pavilhão Auricular/anormalidades
7.
J Plast Reconstr Aesthet Surg ; 93: 9-17, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38603996

RESUMO

BACKGROUND: Congenital ear anomalies are regular but often overlooked occurrences. The golden standard of treatment has been to surgically correct these anomalies at a minimum age of 5 to 7 years. As of the last century, ear molding has developed to be a safe, reliable, and effective treatment method. Different treatment methods are still under investigation. This study aims to investigate the use of the EarWell Infant Corrective System in the Dutch population. METHODS: Children aged 0-12 weeks were included in the Zuyderland Medical Center to be treated with the EarWell Infant Corrective System in case of ear deformations. Every 2 weeks, the system was replaced and correction was evaluated by both physician and parents. RESULTS: Seventy-three participants were included, of whom 123 ears in total were treated. Age at initiation was 35.5 days on average; treatment lasted an average of 59 days. Parents and physicians both reported an amelioration of all ear anomalies after treatment, scoring the correction grade an 8.8. Overall satisfaction with the treatment method was 9 or higher for both groups. CONCLUSIONS: The EarWell Infant Corrective System is a safe, reliable, and effective treatment method for the correction of ear anomalies in infants.


Assuntos
Orelha Externa , Humanos , Países Baixos , Lactente , Masculino , Feminino , Recém-Nascido , Orelha Externa/anormalidades , Orelha Externa/cirurgia , Resultado do Tratamento , Procedimentos de Cirurgia Plástica/métodos , Satisfação do Paciente
8.
Medicine (Baltimore) ; 103(15): e37691, 2024 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-38608109

RESUMO

To describe the epidemiology of congenital malformations of the external ear (CMEE). Data were obtained from the Birth Defects Surveillance System in Hunan Province, China, 2016 to 2020. The prevalence of CMEEs is defined as the number of cases per 1000 fetuses (births and deaths at 28 weeks of gestation and beyond) (unit: ‰). Prevalence and 95% confidence intervals (CI) were calculated by the log-binomial method. Chi-square trend tests (χ2trend) were used to determine trends in prevalence by year. P < .05 was considered statistically significant. Crude odds ratios (ORs) were calculated to examine the association of sex, residence, and maternal age with CMEEs. Our study included 847,755 fetuses, and 14,459 birth defects were identified, including 1227 CMEEs (accounted for 8.49% of birth defects). The prevalences of birth defects and CMEEs were 17.06‰ (95%CI: 16.78-17.33) and 1.45‰ (95%CI: 1.37-1.53), respectively. A total of 185 microtia-anotias were identified, accounting for 15.08% of CMEEs, with a prevalence of 0.22‰ (95%CI: 0.19-0.25). And 1042 other CMEEs were identified, accounting for 84.92% of CMEEs. From 2016 to 2020, the prevalences of birth defects were 18.20‰, 18.00‰, 16.31‰, 16.03‰, and 16.47‰, respectively, showing a downward trend (χ2trend =8.45, P < .01); the prevalences of CMEEs were 1.19‰, 1.62‰, 1.80‰, 1.21‰, and 1.35‰, respectively, with no significant trend (χ2trend =0.09, P = .77). CMEEs were more common in males than females (1.60‰ vs 1.27‰, OR = 1.26, 95%CI: 1.12-1.41), in urban areas than in rural areas (1.77‰ vs 1.23‰, OR = 1.45, 95%CI: 1.29-1.62). The prevalences of CMEEs for maternal age < 20, 20-24, 25-29, 30-34, and ≥ 35 were 1.75‰, 1.27‰, 1.44‰, 1.47‰, and 1.58‰, respectively, with no significant difference (P > .05, reference: 25-29). Most CMEEs were diagnosed by clinical examinations (92.34%), and most CMEEs were diagnosed postpartum (within 7 days) (96.25%). In summary, we have presented the epidemiology of CMEEs in Hunan Province, China. CMEEs were more common in males than females, in urban areas than rural areas, whereas there was no significant difference in prevalence of CMEEs by maternal age. We inferred that CMEEs may be mainly related to genetics, and the mechanism needs to be examined in the future.


Assuntos
Microtia Congênita , Feminino , Masculino , Humanos , China/epidemiologia , Orelha Externa , Feto , Idade Materna
9.
Top Companion Anim Med ; 60: 100876, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38631427

RESUMO

This study was conducted to evaluate the prevalence of otitis externa (OE) in cats using cytology, direct otoscopic examination, and parasitological examination through swabs and curettage, and to compare the accuracy between collection methods for parasitological examination. Direct otoscopic evaluation of the external auditory canal (right and left), swabs for cytological examination of the external auditory canal, and collection of cerumen for parasitological examination through swabs and curettage of 137 cats from a veterinary hospital care were conducted between March 2021 and March 2022. The influences of age, sex, habitat, street access, and the presence of fleas on OE were evaluated. Cytological evidence of OE was observed in 25.5 % of cats and was statistically associated with flea and mite parasitism. Otodectes cynotis was found in 13.9 % of the cats. Cocci and Bacilli were the secondary factors in 34.3 % and 22.9 % of cats with OE, respectively. The Malassezia genus was a secundary factor in 57.1 % of the cats with OE. The frequency of OE was high in cats receiving hospital care. O. cynotis was a frequent primary cause of OE in cats. The curette sampling method is a great option for diagnosing O. cynotis infestation due to its ease of use.


Assuntos
Doenças do Gato , Otite Externa , Animais , Gatos , Otite Externa/veterinária , Otite Externa/epidemiologia , Otite Externa/microbiologia , Doenças do Gato/epidemiologia , Doenças do Gato/parasitologia , Prevalência , Feminino , Brasil/epidemiologia , Masculino , Otoscopia/veterinária , Cerume , Malassezia/isolamento & purificação , Infestações por Ácaros/veterinária , Infestações por Ácaros/epidemiologia , Infestações por Ácaros/diagnóstico
10.
J Acoust Soc Am ; 155(4): 2769-2785, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38662609

RESUMO

Assuming plane waves, ear-canal acoustic quantities, collectively known as wideband acoustic immittance (WAI), are frequently used in research and in the clinic to assess the conductive status of the middle ear. Secondary applications include compensating for the ear-canal acoustics when delivering stimuli to the ear and measuring otoacoustic emissions. However, the ear canal is inherently non-uniform and terminated at an oblique angle by the conical-shaped tympanic membrane (TM), thus potentially confounding the ability of WAI quantities in characterizing the middle-ear status. This paper studies the isolated possible confounding effects of TM orientation and shape on characterizing the middle ear using WAI in human ears. That is, the non-uniform geometry of the ear canal is not considered except for that resulting from the TM orientation and shape. This is achieved using finite-element models of uniform ear canals terminated by both lumped-element and finite-element middle-ear models. In addition, the effects on stimulation and reverse-transmission quantities are investigated, including the physical significance of quantities seeking to approximate the sound pressure at the TM. The results show a relatively small effect of the TM orientation on WAI quantities, except for a distinct delay above 10 kHz, further affecting some stimulation and reverse-transmission quantities.


Assuntos
Meato Acústico Externo , Análise de Elementos Finitos , Pressão , Membrana Timpânica , Humanos , Membrana Timpânica/fisiologia , Meato Acústico Externo/fisiologia , Som , Acústica , Estimulação Acústica , Simulação por Computador , Modelos Anatômicos , Emissões Otoacústicas Espontâneas/fisiologia , Orelha Média/fisiologia , Testes de Impedância Acústica/métodos
12.
BMC Vet Res ; 20(1): 130, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38561827

RESUMO

BACKGROUND: Growing antibiotic resistance has made treating otitis externa (OE) increasingly challenging. On the other hand, local antimicrobial treatments, especially those that combine essential oils (EOs) with nanoparticles, tend to be preferred over systemic ones. It was investigated whether Ajwain (Trachyspermum ammi) EO, combined with chitosan nanoparticles modified by cholesterol, could inhibit the growth of bacterial pathogens isolated from OE cases in dogs. In total, 57 dogs with clinical signs of OE were examined and bacteriologically tested. Hydrogels of Chitosan were synthesized by self-assembly and investigated. EO was extracted (Clevenger machine), and its ingredients were checked (GC-MS analysis) and encapsulated in chitosan-cholesterol nanoparticles. Disc-diffusion and broth Micro-dilution (MIC and MBC) examined its antimicrobial and therapeutic properties. RESULTS: Staphylococcus pseudintermedius (49.3%) was the most common bacteria isolated from OE cases, followed by Pseudomonas aeruginosa (14.7%), Escherichia coli (13.3%), Streptococcus canis (9.3%), Corynebacterium auriscanis (6.7%), Klebsiella pneumoniae (2.7%), Proteus mirabilis (2.7%), and Bacillus cereus (1.3%). The investigation into the antimicrobial properties of Ajwain EO encapsulated in chitosan nanoparticles revealed that it exhibited a more pronounced antimicrobial effect against the pathogens responsible for OE. CONCLUSIONS: Using chitosan nanoparticles encapsulated with EO presents an effective treatment approach for dogs with OE that conventional antimicrobial treatments have not cured. This approach not only enhances antibacterial effects but also reduces the required dosage of antimicrobials, potentially preventing the emergence of antimicrobial resistance.


Assuntos
Ammi , Anti-Infecciosos , Quitosana , Doenças do Cão , Óleos Voláteis , Otite Externa , Cães , Animais , Óleos Voláteis/farmacologia , Quitosana/farmacologia , Otite Externa/tratamento farmacológico , Otite Externa/veterinária , Otite Externa/microbiologia , Testes de Sensibilidade Microbiana/veterinária , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Anti-Infecciosos/uso terapêutico , Bactérias , Escherichia coli , Colesterol , Doenças do Cão/tratamento farmacológico , Doenças do Cão/microbiologia
13.
J Plast Reconstr Aesthet Surg ; 92: 237-243, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38574570

RESUMO

BACKGROUND: The presence of polyotia in individuals with microtia is a rare deformity. Due to the intricate structure of the auricle, uncertain etiology, and challenging corrective techniques, it has always been a focal point in the field of plastic surgery. The present study presents a technique for correcting the combination of polyotia and microtia by utilizing residual ear tissue as graft material. METHODS: The retrospective study included 23 patients with polyotia and microtia from 2018 to 2022. The residual ear tissue was used to rectify auricular deformities in all patients. The patients were instructed to evaluate the satisfaction of the auricle shape using a visual analog scale (VAS) both before and 6 months after the surgical procedure. The esthetic outcomes of auricle subunits were simultaneously assessed by a senior physician pre- and postoperatively. RESULTS: The mean duration of follow-up in this study was 8.73 months. The preoperative VAS satisfaction score was recorded as 2.26 ± 0.86, while the post-operative VAS score significantly increased to 7.86 ± 0.86. The preoperative auricle esthetic outcomes score was recorded as 9.95 ± 1.74, while the post-operative score significantly increased to 24.04 ± 2.16. The follow-up period did not present any cases of flap necrosis, hematoma, infection, or wound dehiscence. CONCLUSION: The study demonstrates that comprehensive utilization of residual auricular tissue can lead to optimal outcomes in correcting polyotia with concha-type microtia. The utilization of residual ear tissue can be maximized to streamline the operation, minimize bodily harm, and enhance patient satisfaction.


Assuntos
Microtia Congênita , Pavilhão Auricular , Procedimentos de Cirurgia Plástica , Humanos , Microtia Congênita/cirurgia , Masculino , Estudos Retrospectivos , Feminino , Procedimentos de Cirurgia Plástica/métodos , Criança , Adolescente , Pavilhão Auricular/cirurgia , Pavilhão Auricular/anormalidades , Satisfação do Paciente , Estética , Adulto Jovem , Adulto , Orelha Externa/cirurgia , Orelha Externa/anormalidades
14.
Artigo em Chinês | MEDLINE | ID: mdl-38686486

RESUMO

Trichoblastoma(TB) is a rare germ cell skin adnexal tumor of the hair, and it is a rare follicular tumor of the skin that differentiates from the hair germ epithelium and is often regarded as a benign skin tumorHowever, it is poorly confined and has a local infiltrative growth pattern. tb occurs in the head and neck region, especially in the face, and presents clinically as a slow growing, well-defined and elevated nodule. TB is routinely treated surgically. Due to the lack of universally accepted treatment guidelines or protocols, the recurrence rate after surgery is high, which makes clinical cure more difficult. In this study, a 65-year-old female patient was found to have a swelling with recurrent rupture and pus flow from the right external auditory canal opening and the auricular cavity. After initial misdiagnosis as otitis externa, she was treated with conventional anti-infective therapy, but her symptoms did not resolve and gradually worsened before coming to our hospital. The condition presented in this case is relativelyrare,therepre,timely and accurate diagnosis and treatment are crucial for prognosis improvement of such diseases.


Assuntos
Neoplasias Cutâneas , Humanos , Feminino , Idoso , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias da Orelha/patologia , Neoplasias de Anexos e de Apêndices Cutâneos/patologia , Neoplasias de Anexos e de Apêndices Cutâneos/diagnóstico , Meato Acústico Externo/patologia
15.
BMJ Case Rep ; 17(3)2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38429058

RESUMO

A young adult male developed a left-sided pinna haematoma after a rugby injury. The haematoma reaccumulated after multiple attempts at drainage under local anaesthetic in emergency rooms and required incision and drainage in the theatre under general anaesthetic. Intraoperatively, multiple venous bleeding points were identified and these were controlled with bipolar diathermy. The wound was closed and dressed with bolster and crepe bandage. On day 7 postoperatively, the sutures and dressings were removed and the haematoma had not recurred. He returned to playing rugby on day 21 postoperatively and sustained another blunt impact to his left ear. He noticed new swelling over the posterior aspect of the same ear. This was drained via needle aspiration and there was no further reaccumulation of the pinna haematoma.


Assuntos
Pavilhão Auricular , Rugby , Adulto Jovem , Humanos , Masculino , Orelha Externa/lesões , Anestésicos Locais , Hematoma/etiologia , Hematoma/cirurgia
16.
BMJ Case Rep ; 17(3)2024 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-38471700

RESUMO

Haemifacial microsomia is an asymmetrical congenital tissue malformation developed from the first and second branchial arches with or without multi-system involvement. Alternatively recognised as Goldenhar syndrome or oculoauriculovertebral spectrum (OAVS), it is an aetiologically heterogeneous group of disorders showing dominant trends in inheritable form.We present a case of a boy in early childhood with concomitant craniofacial features of craniofacial microsomia with Loeys-Dietz syndrome. He had a unilateral hypoplastic face, asymmetrical ear malformations and multiple preauricular tags with epibulbar dermoid (features suggestive of Goldenhar syndrome). On detailed clinical evaluation, he met Beighton's criteria and was diagnosed with arterial tortuosity. Further molecular testing confirmed the diagnosis of Loeys-Dietz syndrome type II.Loeys-Dietz syndrome is characterised by aortic root enlargement or type A dissection with or without other vascular malformations and facial midline defects. Molecular testing is required to establish the diagnosis because of overlapping features with other connective tissue disorders.


Assuntos
Doenças do Tecido Conjuntivo , Síndrome de Goldenhar , Síndrome de Loeys-Dietz , Dermatopatias Genéticas , Masculino , Humanos , Pré-Escolar , Síndrome de Goldenhar/diagnóstico , Síndrome de Loeys-Dietz/complicações , Orelha Externa/anormalidades , Doenças do Tecido Conjuntivo/complicações , Dermatopatias Genéticas/complicações
17.
Otol Neurotol ; 45(5): 542-548, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38511274

RESUMO

OBJECTIVE: To compare recidivism rates, audiometric outcomes, and postoperative complication rates between soft-wall canal wall reconstruction (S-CWR) versus bony-wall CWR (B-CWR) with mastoid obliteration (MO) in patients with cholesteatoma. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary neurotologic referral center. PATIENTS: Ninety patients aged ≥18 years old who underwent CWR with MO, either S-CWR or B-CWR, for cholesteatoma with one surgeon from January 2011 to January 2022. Patients were followed postoperatively for at least 12 months with or without second-look ossiculoplasty. INTERVENTIONS: Tympanomastoidectomy with CWR (soft vs. bony material) and mastoid obliteration. MAIN OUTCOME MEASURES: Recidivism rates; conversion rate to CWD; pre- versus postoperative pure tone averages, speech reception thresholds, word recognition scores, and air-bone gaps; postoperative complication rates. RESULTS: Middle ear and mastoid cholesteatoma recidivism rates were not significantly different between B-CWR (17.3%) and S-CWR (18.4%, p = 0.71). There was no significant difference in pre- versus postoperative change in ABG (B-CWR, -2.1 dB; S-CWR, +1.6 dB; p = 0.91) nor in the proportion of postoperative ABGs <20 dB (B-CWR, 41.3%; S-CWR, 30.7%; p = 0.42) between B-CWR and S-CWR. Further, there were no significant differences in complication rates between B-CWR and S-CWR other than increased minor TM perforations/retractions in B-CWR (63% vs. 40%, p = 0.03). CONCLUSIONS: Analysis of recidivism rates, audiometric outcomes and postoperative complications between B-CWR with MO versus S-CWR with MO revealed no significant difference. Both approaches are as effective in eradicating cholesteatoma while preserving relatively normal EAC anatomy and hearing. Surgeon preference and technical skill level may guide the surgeon's choice in approach.


Assuntos
Colesteatoma da Orelha Média , Processo Mastoide , Mastoidectomia , Humanos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Colesteatoma da Orelha Média/cirurgia , Adulto , Processo Mastoide/cirurgia , Mastoidectomia/métodos , Resultado do Tratamento , Timpanoplastia/métodos , Complicações Pós-Operatórias/epidemiologia , Procedimentos de Cirurgia Plástica/métodos , Idoso , Meato Acústico Externo/cirurgia , Adulto Jovem , Audiometria de Tons Puros , Recidiva
18.
Aesthetic Plast Surg ; 48(10): 1906-1913, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38499875

RESUMO

BACKGROUND: Cauliflower ear deformity, a common sequela of auricular trauma, presents an esthetic and reconstructive challenge. Existing surgical techniques have limitations, including complexity, donor site morbidity, and variable long-term outcomes. MATERIALS AND METHODS: In this case series, we present a novel and minimally invasive surgical approach for the correction of cauliflower ear deformity that adapts the Valente otoplasty technique; it combines cartilage debulking with helical rim release and Mustardé mattress stitches to restore ear contour and reduce the risk of recurrence. The procedural steps include bielliptic post-auricular skin and soft tissue incision, release of the cartilaginous spring, removal of excess fibrocartilaginous tissue, cartilage reshaping with suture to restore contour, and tissue redistribution to promote adherence of skin to the cartilage framework. RESULTS: Outcomes were evaluated in 7 patients (9 ears) with cauliflower ear deformity, assessing surgical duration, complications, patient satisfaction, and esthetic outcomes at two years after surgery. The mean surgical duration per patient was 52 ± 17 minutes, including 2 bilateral procedures. Follow-up at 24 months showed favorable esthetic outcome in all patients with sustained improvements in auricular contour and symmetry with neither loss of the shape nor recurrence of deformity. Patients reported high satisfaction and improved quality of life, with mean Glasgow Children Benefit Questionnaire scores of 99.3 ± 6.3. CONCLUSIONS: This technique thus demonstrated lasting correction of cauliflower ear with favorable cosmetic outcomes, low risk of complications, and high patient satisfaction. Further investigations and longer-term follow-up are warranted to validate the technique's durability and expand its application to older and more diverse patient populations. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
Estética , Procedimentos de Cirurgia Plástica , Humanos , Criança , Feminino , Masculino , Seguimentos , Resultado do Tratamento , Procedimentos de Cirurgia Plástica/métodos , Deformidades Adquiridas da Orelha/cirurgia , Satisfação do Paciente/estatística & dados numéricos , Adolescente , Estudos Retrospectivos , Estudos de Coortes , Medição de Risco , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Fatores de Tempo , Pavilhão Auricular/cirurgia , Pavilhão Auricular/anormalidades , Orelha Externa/cirurgia , Orelha Externa/anormalidades
19.
Vet Rec ; 194(9): e3955, 2024 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-38462781

RESUMO

BACKGROUND: A single-dose, in-clinic, veterinary professional-administered treatment for canine otitis externa was developed to improve compliance and canine welfare. METHODS: This multicentre, controlled, examiner-masked, randomised field trial was conducted in 316 dogs over 42 days. Dogs were treated once, on day 0, with the investigational product containing gentamicin, posaconazole and mometasone furoate (Mometamax Ultra [MU]) or twice (days 0 and 7) with a control product containing florfenicol, terbinafine and betamethasone acetate (CP). The primary endpoint was a composite otitis index score of 4 or less (of 12) on day 14 and 3 or less (of 12) on day 28. RESULTS: On day 28, treatment success was recorded in 128 of 143 MU-treated dogs (89.5%), significantly non-inferior to 116 of 133 (87.2%) CP-treated dogs (Farrington-Manning test, Z = 4.1351, p < 0.0001). For mixed cultures of Staphylococcus pseudintermedius and Malassezia pachydermatis, there was 100% treatment success in MU-treated dogs (n = 33), significantly non-inferior to 90.2% (37 of 41) in CP-treated dogs (Farrington-Manning test, Z = 3.1954, p = 0.0007). LIMITATIONS: Efficacy in chronic otitis externa cases was not investigated. Cytology was not used to aid in diagnosis or for identification of secondary pathogens. CONCLUSION: This unique combination, single-dose product is safe and effective in dogs with otitis externa. It offers enhanced compliance, canine welfare and quality of life by eliminating the owner burden of treating this painful condition.


Assuntos
Doenças do Cão , Gentamicinas , Furoato de Mometasona , Otite Externa , Triazóis , Animais , Cães , Doenças do Cão/tratamento farmacológico , Otite Externa/veterinária , Otite Externa/tratamento farmacológico , Otite Externa/microbiologia , Furoato de Mometasona/uso terapêutico , Furoato de Mometasona/administração & dosagem , Resultado do Tratamento , Feminino , Masculino , Triazóis/uso terapêutico , Triazóis/administração & dosagem , Gentamicinas/uso terapêutico , Gentamicinas/administração & dosagem , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Quimioterapia Combinada/veterinária , Antifúngicos/uso terapêutico , Antifúngicos/administração & dosagem , Suspensões
20.
Emerg Med Pract ; 26(4): 1-28, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38507217

RESUMO

Though the vast majority of conditions associated with otalgia are not life-threatening, there are nuances and controversies in the diagnosis and management of even the most common diseases, such as acute otitis media and otitis externa. For more severe disease processes, such as necrotizing otitis externa, acute mastoiditis, and perichondritis, early recognition and timely management are paramount in reducing morbidity and mortality. A systematic approach to the evaluation of these patients is key to establishing an accurate diagnosis, identifying patients who are at high risk for dangerous etiologies or complications, and providing optimal patient care. This issue summarizes the most recent guidelines and presents a systematic, evidence-based approach to the emergency department evaluation and management of patients with otalgia.


Assuntos
Otite Externa , Otite Média , Humanos , Dor de Orelha/diagnóstico , Dor de Orelha/etiologia , Dor de Orelha/terapia , Otite Externa/complicações , Otite Externa/diagnóstico , Otite Média/complicações , Serviço Hospitalar de Emergência , Doença Aguda
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