Facial nerve dysfunction after superficial parotidectomy with or without continuous intraoperative electromyographic neuromonitoring: a prospective randomized pilot study.

PURPOSE: There are no randomized trials comparing the incidence or severity of facial nerve dysfunction after superficial parotidectomy with or without continuous intraoperative electromyographic neuromonitoring. This pilot study aimed to assess the variability in outcomes to help determine the needs and possible ethical issues in a full-scale study. METHODS: Prospective randomized pilot study comparing the incidence and grade of facial nerve dysfunction among 106 patients subjected to superficial parotidectomy with or without continuous four channels electromyographic neuromonitoring (52 monitored patients and 54 controls). RESULTS: The incidences of immediate (38.3% vs. 51.8%, p = 0.1) and late facial dysfunction, up to 180 days following surgery, (3.8% vs. 5.5%, p = 0.4) were similar between monitored patients and controls. Immediate facial nerve dysfunction with a House-Brackmann ≥ grade III was more frequent among the non-monitored patients (57.8% vs. 30%, p = 0.2), and outcomes were significantly poorer in this group (mean sum score of 68.7 vs. 81.5, p = 0.002), when assessed with the regional Sunnybrook scale. A full-scale prospective randomized study to detect a significant reduction in the incidence of immediate facial nerve dysfunction with the use of continuous intraoperative electromyographic neuromonitoring, with 80% power and a 5% significant level, would require 560 patients allocated to the monitored and control groups. Considering a mean rate of 30 patients/year/center, such a study would require the participation of five centers for 4 years. CONCLUSIONS: In the present pilot study, the incidences of immediate and late facial nerve dysfunction were similar between patients with benign parotid tumors subjected to superficial parotidectomy with or without continuous intraoperative electromyographic neuromonitoring. However, immediate facial dysfunction was more severe among the non-monitored patients.

Translation, cultural adaptation and validation of the facial disability index into Brazilian Portuguese.

INTRODUCTION: Facial paralysis may occur due to a variety of causes. It is associated to the impairment of some basic daily activities such as eating, drinking, speaking and social communication, which affects the quality of life of these patients. The facial disability index is a short form auto reported outcome questionnaire used to assess patient with facial paralysis. It has been validated and proved to be superior to other general health related quality of life questionnaires. OBJECTIVE: We aim to do the cultural adaptation and validate the facial disability index into Brazilian Portuguese. METHODS: Translation and cultural-adaptation following the stages recommended by the International Society of Pharmacoeconomics Outcomes Research task force. The questionnaire was administered to 100 patients for evaluation of reliability and validation. RESULTS: The reliability of the Portuguese version of the facial disability index was found to be adequate, with a Cronbach's alfa coefficient of 0.73 for the complete scale. Intra-class correlation was 0.79 (95% CI: 0.71-0.85) and 0.85 (95% CI: 0.78-0.89) for the physical and social well-being subscales. There was a significant correlation between the social well-being subscale of the Portuguese version of the facial disability index and the social function and mental health components of the SF-36. There was also a correlation between the facial disability index and the degree of facial dysfunction according to the House-Brackmann global scale. CONCLUSION: This adapted version of the facial disability index provides a valid and reliable instrument to assess the physical and psychosocial impact of facial nerve dysfunction in Brazilian-speaking patients.

The effects of otitis media with effusion on the measurement of auditory evoked potentials.

OBJECTIVE: The aim of this study was to explore the impact of otitis media on auditory evoked potentials in children with a history of otitis media in comparison to a control group. DESIGN: 90 children, with normal hearing and middle ear status at time of assessment, aged between 8 and 14 years (44 boys and 46 girls) were enrolled in this study. 50 children (28 boys and 22 girls) had a documented history of Otitis Media. The control group consisted of 40 children (17 boys and 23 girls) with no documented history of otitis media. All children completed the auditory evoked potentials tasks of Auditory Brainstem Response (ABR) and P300. RESULTS: Auditory Evoked Potentials results demonstrated significantly increased latencies and decreased amplitudes in the otitis media group. ABR showed significantly latency delay of waves III and V by 0.1 msec (p < 0.001) and reduced amplitude (0.06 µV, p = 0.002 and 0.05 µV, p = 0.008, respectively) in the otitis media group compared to control group. P300 also showed significant latency delays (13,41 ms, p = 0.008) in otitis media group. No significant difference was seen for amplitude between CG and otitis media group for P300. CONCLUSION: The results demonstrate the negative effects of otitis media on auditory evoked potentials in children with a history of middle ear disease as can be seen by changes on the ABR and P300 measures.

Translation, cultural adaptation and validation of the facial disability index into Brazilian Portuguese / Tradução, adaptação cultural e validação do facial disability index para o português falado no Brasil

Abstract Introduction: Facial paralysis may occur due to a variety of causes. It is associated to the impairment of some basic daily activities such as eating, drinking, speaking and social communication, which affects the quality of life of these patients. The facial disability index is a short form auto reported outcome questionnaire used to assess patient with facial paralysis. It has been validated and proved to be superior to other general health related quality of life questionnaires. Objective: We aim to do the cultural adaptation and validate the facial disability index into Brazilian Portuguese. Methods: Translation and cultural-adaptation following the stages recommended by the International Society of Pharmacoeconomics Outcomes Research task force. The questionnaire was administered to 100 patients for evaluation of reliability and validation. Results: The reliability of the Portuguese version of the facial disability index was found to be adequate, with a Cronbach's alfa coefficient of 0.73 for the complete scale. Intra-class correlation was 0.79 (95% CI: 0.71-0.85) and 0.85 (95% CI: 0.78-0.89) for the physical and social well-being subscales. There was a significant correlation between the social well-being subscale of the Portuguese version of the facial disability index and the social function and mental health components of the SF-36. There was also a correlation between the facial disability index and the degree of facial dysfunction according to the House-Brackmann global scale. Conclusion: This adapted version of the facial disability index provides a valid and reliable instrument to assess the physical and psychosocial impact of facial nerve dysfunction in Brazilian-speaking patients.

Resumo Introdução: Paralisia facial periférica pode ocorrer devido a uma grande variedade de causas e está associada ao comprometimento de atividades diárias básicas, como comer, beber, falar e comunicação social, afeta a qualidade de vida dos pacientes. O facial disability index é um questionário autoaplicado desenvolvido especialmente para avaliar o impacto da disfunção facial sobre aspectos físicos e psicossociais dos pacientes. Embora tenha sido validado e se mostrado superior a outros questionários, ainda não fora submetido à adaptação transcultural e validação para a língua portuguesa. Objetivo: Realizar a tradução, adaptação cultural e validação do facial disability index para o português falado no Brasil. Método: A tradução e adaptação cultural do facial disability index foram realizadas em diferentes estágios conforme recomendações internacionais para adaptação de medidas de resultados. Para a verificação de confiabilidade e validação da versão em português, o facial disability index foi aplicado em 100 pacientes na forma de teste/reteste. Resultados: A confiabilidade da versão em português do facial disability index foi considerada adequada, com coeficiente alfa de Cronbach de 0,73. A avaliação de correlação intraclasse foi de 0,79 (95% IC 0,71-0,85 ) e de 0,85 (95% IC 0,78-0,89) para as subescalas física e de bem-estar social, respectivamente. Houve uma correlação significativa entre a escala de bem-estar social da versão em português do facial disability index e as dimensões de função social e saúde mental do questionário geral de qualidade de vida Short Form - 36. Também foi demonstrada uma correlação entre a versão em português do facial disability index e o grau de disfunção facial de acordo com a escala global de House-Brackmann. Conclusão: A versão adaptada do facial disability index para o português falado no Brasil se apresenta como um instrumento válido e confiável para avaliação do impacto da disfunção facial sobre aspectos físicos e psicossociais dos pacientes.

Intradural jugular foramen tumors.

Eleven patients with jugular foramen lesions with or without extradural extension were operated at University Hospital of Campinas (UNICAMP), in Campinas, Brazil, between 1998 and 2001. Neck dissection, mastoidectomy without transposition of the facial nerve and myofascial flap reconstruction of the cranial base with an especially developed technique were carried out in 7 patients. Four patients were operated using retrosigmoid craniectomy. Total excision was accomplished in 9 cases. All patients did not show evidence of disease progression at least after 2 years follow-up. There was no mortality. New lower cranial nerve deficits occurred in 5 patients. Nine maintain or improved their preoperative status based on Karnofsky and Glasgow Outcome Scale. A complex anatomy of this region demand wide exposures for treat those tumors. For this reason, an adequate approach for curative resection of most lesions and an efficient skull base reconstruction decreasing postoperative morbidity are essential.

Hearing Preservation after Cochlear Implantation: UNICAMP Outcomes.

Background. Electric-acoustic stimulation (EAS) is an excellent choice for people with residual hearing in low frequencies but not high frequencies and who derive insufficient benefit from hearing aids. For EAS to be effective, subjects' residual hearing must be preserved during cochlear implant (CI) surgery. Methods. We implanted 6 subjects with a CI. We used a special surgical technique and an electrode designed to be atraumatic. Subjects' rates of residual hearing preservation were measured 3 times postoperatively, lastly after at least a year of implant experience. Subjects' aided speech perception was tested pre- and postoperatively with a sentence test in quiet. Subjects' subjective responses assessed after a year of EAS or CI experience. Results. 4 subjects had total or partial residual hearing preservation; 2 subjects had total residual hearing loss. All subjects' hearing and speech perception benefited from cochlear implantation. CI diminished or eliminated tinnitus in all 4 subjects who had it preoperatively. 5 subjects reported great satisfaction with their new device. Conclusions. When we have more experience with our surgical technique we are confident we will be able to report increased rates of residual hearing preservation. Hopefully, our study will raise the profile of EAS in Brazil and Latin/South America.

Reconstruction of the cranial base in surgery for jugular foramen tumors.

OBJECTIVE: The surgical removal of a jugular foramen (JF) tumor presents the neurosurgeon with a complex management problem that requires an understanding of the natural history, diagnosis, surgical approaches, and postoperative complications. Cerebrospinal fluid (CSF) leakage is one of the most common complications of this surgery. Different surgical approaches and management concepts to avoid this complication have been described, mainly in the ear, nose, and throat literature. The purpose of this study was to review the results of CSF leakage prevention in a series of 66 patients with JF tumors operated on by a multidisciplinary cranial base team using a new technique for cranial base reconstruction. METHODS: We retrospectively studied 66 patients who had JF tumors with intracranial extension and who underwent surgical treatment in our institutions from January 1987 to December 2001. Paragangliomas were the most frequent lesions, followed by schwannomas and meningiomas. All patients were operated on using the same multidisciplinary surgical approach (neurosurgeons and ear, nose, and throat surgeons). A surgical strategy for reconstruction of the cranial base using vascularized flaps was carried out. The closure of the surgical wound was performed in three layers. A specially developed myofascial flap (temporalis fascia, cervical fascia, and sternocleidomastoid muscle) associated to the inferior rotation of the posterior portion of the temporalis muscle was used to reconstruct the cranial base with vascularized flaps. RESULTS: In this series of 66 patients, postoperative CSF leakage developed in three cases. These patients presented with very large or recurrent tumors, and the postoperative CSF fistulae were surgically closed. The cosmetic result obtained with this reconstruction was classified as excellent or good in all patients. CONCLUSION: Our results compare favorably with those reported in the literature. The surgical strategy used for cranial base reconstruction presented in this article has several advantages over the current surgical techniques used in cases of JF tumors.

Intradural jugular foramen tumors

Onze pacientes com lesões expansivas do forame jugular associadas ou não a componente extradural foram submetidos a ressecção cirúrgica no Hospital das Clínicas da Universidade Estadual de Campinas (UNICAMP) entre 1998 e 2001. Foi utilizada cirurgia combinada com dissecção do pescoço, mastoidectomia sem transposição do nervo facial e técnica de reconstrução miofascial da base do crânio desenvolvida por um dos autores. Quatro pacientes foram operados via craniectomia retrosigmoidea. Ressecção total foi feita em 9 pacientes, subtotal em um e parcial em outro. Nenhum dos 11 pacientes teve progressão da doença em 2 anos de acompanhamento. Não houve mortalidade. Cinco pacientes tiveram déficits adicionais de nervos cranianos baixos. Nove pacientes mantiveram ou melhoraram suas pontuações de acordo com a escala de Karnofsky. Para adequada abordagem do paciente com tumor de forame jugular, são necessários bom conhecimento anatômico da região, exposição cirúrgica ampla, e técnica de reconstrução eficiente para obter cura com baixas taxas de complicações pós-operatórias.