Transoral radical tonsillectomy and retropharyngeal lymph node dissection with a flexible next generation robotic surgical system

Abstract

Background

The purpose of this study was to describe the use of a novel flexible, single-arm robot in performing a transoral radical tonsillectomy and retropharyngeal lymph node dissection.

Methods

A 63-year-old man with a T1N2bM0 (American Joint Committee on Cancer seventh edition classification) squamous cell carcinoma (SCC) of the left tonsil underwent a transoral robotic radical tonsillectomy and retropharyngeal lymph node dissection, followed by a left selective neck dissection of levels I to IV.

Results

The tonsillar tumor was removed completely with a negative margin that was followed by a dissection and removal of a retropharyngeal lymph node, completed with primary closure of the site. A left selective neck dissection was then performed. The patient was tolerating an oral diet on postoperative day 1 and had no robotic or surgically related complications at 30-day follow-up.

Conclusion

It is feasible and safe to use this novel, flexible, single-arm robot in performing a transoral robotic radical tonsillectomy and retropharyngeal lymph node dissection.

http://ift.tt/2CCVcbk

Mixed adenoneuroendocrine carcinoma of the tongue arising within a congenital enteric cyst

Abstract

Background

Primary intestinal-type adenocarcinoma of the tongue is rare. This represents the first reported case of a primary mixed adenoneuroendocrine carcinoma (MANEC) of the tongue arising within a congenital enteric cyst.

Methods

A 52-year-old man presented with a midline tongue mass that was connected to the mucosal surface with an epithelial-lined sinus tract. Morphological examination and immunohistochemical profiling of the neoplasm were performed.

Results

Histopathological evaluation showed a primary MANEC arising within a preexisting congenital enteric cyst, comprising both adenocarcinoma and neuroendocrine components. The adenocarcinoma had a colonic-type morphology and coexpressed CK7, CK20, and CDX2. Imaging and colonoscopy excluded a distant primary colorectal neoplasm.

Conclusion

The association of primary MANEC of the tongue with a gastrointestinal heterotopic cyst supports an origin from entrapped endodermal elements as opposed to salivary duct origin. This case raises the awareness of a rare yet prognostically important complication of a gastrointestinal heterotopic cyst.

http://ift.tt/2EMzabM

Double-blind placebo-controlled multicenter phase II trial to evaluate D-methionine in preventing/reducing oral mucositis induced by radiation and chemotherapy for head and neck cancer

Abstract

Background

The purpose of this study was to test if oral D-methionine (D-met) reduced mucositis during chemoradiotherapy.

Methods

We conducted a placebo-controlled double-blind randomized phase II trial of D-met (100 mg/kg p.o. b.i.d.) testing the rate of severe (grades 3-4) mucositis.

Results

Sixty patients were randomized. Grade 2 + oral pain was higher with placebo (79% vs 45%; P = .0165), whereas grade 2 + body odor was greater with D-met (3% vs 41%; P = .0015). Mucositis was decreased with D-met by the physician (World Health Organization [WHO], P = .007; Radiation Therapy Oncology Group [RTOG], P = .009) and patient functional scales (RTOG, P = .0023). The primary end point of grades 3 to 4 mucositis on the composite scale demonstrated a decrease with D-met (48% vs 24%; P = .058), which was borderline in significance. A planned secondary analysis of a semiquantitative scoring system noted decreased oral ulceration (2.2 vs 1.5; P = .023) and erythema (1.6 vs 1.1; P = .048) with D-met.

Conclusion

Although not meeting the primary end point, results of multiple assessments suggest that D-met decreased mucositis.

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Nodule of Achilles tendon in a patient with kidney transplant revealing phaeohyphomycosis

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A subset of patients with pemphigoid (herpes) gestationis has serological evidence of celiac disease

Abstract

Background

Pemphigoid (herpes) gestationis (PG) is an uncommon, self-limited disease with other autoimmune associations; however, celiac disease (CD) is not recognized as one.

Methods

From 71 patients' sera submitted for herpes gestationis factor (HGF) testing over a 5-year period, 12 were consistent with PG demonstrating HGF and increased IgG BP180 antibody levels; these sera were tested for IgA and IgG endomysial antibodies (EMA), epithelial basement membrane zone and cell surface antibodies by indirect immunofluorescence, and for IgA and IgG tissue transglutaminase (transglutaminase 2 or TG2) antibodies, IgA epidermal transglutaminase (transglutaminase 3 or TG3) antibodies, IgG BP230, and IgG desmoglein 1 and desmoglein 3 antibodies by enzyme-linked immunosorbent assays (ELISAs).

Results

Three of 12 patients' sera with PG (25%) had CD antibodies with positive IgA EMA and increased IgA TG2 antibody levels; two of these had positive IgG EMA, and one other had an increased IgA TG3 antibody level.

Conclusions

A subset of patients with serological findings of PG also has serological evidence of CD, which may have implications in the etiopathogenesis of PG and which reveals important information about the mother's, and possibly her infant's, health.

http://ift.tt/2BIYw7I

Antioxidant action and protective and reparative effects of lentinan on oxidative damage in HaCaT cells

Summary

Background

Lentinus edodes is one of the largest edible fungi. Lentinan, extracted from its fruiting body has clinically significant anticancer, antibacterial, antiviral, and anticoagulant effects; however, its preventive effects on skin oxidative damage are unclear.

Aims

We aimed to evaluate the in vitro antioxidation capability of lentinan and its protective and reparative effects on a model of cell oxidative damage.

Methods

We evaluated the in vitro antioxidant potential of lentinan by assessing its free-radical quenching ability using DPPH and ABTS and superoxide anions. Using the HaCaT cell line as the experimental system, we tested the protective and reparative effects of lentinan on a model of H₂O₂-induced cellular oxidative damage through assessment of cell survival rate, malondialdehyde (MDA) content, and superoxide dismutase (SOD) activity.

Results

Lentinan displayed high antioxidant potential: DDPH and ABTS quenching rates were above 60%; superoxide anions, approximately 18%. Furthermore, lentinan could dose-dependently prevent the reduction of activity in HaCaT cells by H₂O₂, reduce MDA formation, and increase SOD activity. Moreover, lentinan showed not only a protective effect against oxidative damage but also reparative effects to a certain extent, in HaCaT cells.

Conclusions

Our findings demonstrated the ability of lentinan to enhance cellular tolerance to oxidative damage, stress resistance, and to have protective and reparative effects on damaged cells. Therefore, with L. edodes as a source for antiaging substances, cosmetics with homology to foods have great potential clinical applications.

http://ift.tt/2GEib8d

Cause-specific mortality in patients with head and neck cancer: Long-term follow-up of a population-based cohort from 1986 to 2012 accounting for competing risks

Publication date: April 2018
Source:Oral Oncology, Volume 79
Author(s): Janne A. Väisänen, Olli-Pekka Alho, Petri T. Koivunen, Esa Läärä
ObjectivesRecent recommendations for treating head and neck cancer (HNC) patients favor an individualized approach. Expected long-term survival – together with short-term survival – after diagnosis is the primary focus in assessing the treatment modality and follow-up scheme. "Disease-specific" survival up to five years is often used for measuring the prognosis and for assessing treatment methods. However, especially long-term survival is strongly affected by competing causes of death among HNC patients.Materials and MethodsThe long-term prognosis of patients with HNC in terms of mortality from both cancer and competing causes was analyzed according to recent methodological guidelines by examining cumulative incidence functions and models for cause-specific hazards and sub-distribution hazards in a population based cohort of 220 patients treated in a tertiary care center in Northern Finland.ResultsIn addition to well-known tumor-related factors, mortality from HNC was associated with older age. The mortality from other causes of death was strongly dependent on age and Charlson's Comorbidity Index, but less on gender. When demonstrating the importance of individualized approach in simulated patients, the mortality was highly variable across patients with similar cancer status, but with different comorbidities or age.ConclusionThe overall survival pattern of HNC patients depends not only on their cancer characteristics, but also varies greatly according to their age and comorbidities. Our findings support the need for individualized treatment and follow-up protocols, and active management of comorbid diseases. Appropriate methods for analyzing competing risks should be used when presenting survival estimates of cancer patients.



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Locoregional extension and patterns of failure for nasopharyngeal carcinoma with intracranial extension

Publication date: April 2018
Source:Oral Oncology, Volume 79
Author(s): Caineng Cao, Feng Jiang, Qifeng Jin, Ting Jin, Shuang Huang, Qiaoying Hu, Yuanyuan Chen, Yongfeng Piao, Yonghong Hua, Xinglai Feng, Xiaozhong Chen
ObjectiveTo evaluate the locoregional extension and patterns of failure for nasopharyngeal carcinoma (NPC) with intracranial extension to improve clinical target volume (CTV) delineation.Patients and methodsA total of 205 NPC patients with intracranial extension by magnetic resonance imaging (MRI) were retrospectively reviewed.ResultsAccording to the cumulative incidence rates of tumor invasion, we initially classified anatomic sites surrounding the nasopharynx into three risk grades: high risk (≥35%), medium risk (≥10–35%), and low risk (<10%). It was concluded that the anatomic sites at high risk of tumor invasion were the middle/posterior skull base and the anatomic sites adjacent to the nasopharynx. The rate of lymph node (LN) metastasis was 90.2% (185/205). Retropharyngeal region (RP) and level IIb were the most frequently involved regions. Skip metastasis occurred in only 1.6% (3/185). At their last follow-up visit, 53 patients (25.9%) had developed treatment failure. Of the 18 local failures, 12 were considered in-field failure; the other 5 were marginal; one of the patients had outside-field failure. Among the 5 patients with marginal failures, 4 occurred mainly intracranially, and 1 occurred in the floor and the left lateral wall of the nasopharynx. Of the 11 regional failures, 10 were considered in-field failures and most of them (8/10) occurred in the unilateral upper neck.ConclusionFor NPC with intracranial extension, primary disease and regional LN spread follow an orderly pattern and LN skipping was unusual. Clinical target volume reduction may be feasible for selected patients.



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The impact of HPV status on weight loss and feeding tube use in oropharyngeal carcinoma

Publication date: April 2018
Source:Oral Oncology, Volume 79
Author(s): Belinda Vangelov, Damian P. Kotevski, Janet R. Williams, Robert I. Smee
ObjectivesIt has been well established that patients with oropharyngeal carcinoma are at high nutritional risk, with significant weight loss and tube feeding common. Human papillomavirus (HPV)-associated disease has led to a change in the "typical" presentation and nutritional profile of this population. The aim of our study was to determine whether the need for a feeding tube, and weight loss during radiotherapy (RT) in patients with oropharyngeal carcinoma differed with HPV status.Materials and methodsPatients who received curative RT ± chemotherapy from January 2011 to January 2016 were included (n = 100). We retrospectively evaluated feeding tube use and timing of insertion (prophylactic vs reactive), percentage weight loss during RT and the prevalence of critical weight loss (CWL) ≥5%.ResultsHPV-positive patients had significantly higher weight loss during RT compared to the rest of the cohort (8.4% vs 6.1%, 95%CI 0.8–3.9, p = 0.003). CWL was observed in 86% and in a higher proportion with HPV-positive disease (93%, p = 0.011). Conditional probability modelling analysis revealed, with 74% accuracy, concurrent chemoradiotherapy and HPV-positive status were predictors of CWL when comparing HPV-positive patients to HPV-negative (96%, p = 0.001 and 98%, p = 0.012 respectively). More HPV-positive patients required feeding tubes (n = 43, 63%, p = 0.05), most being reactive (n = 27, 63%). All patients with reactive tubes experienced CWL.ConclusionThe high incidence of CWL in patients with HPV-positive oropharyngeal carcinoma is of concern. Tube feeding continues to be a necessary nutritional intervention in this population and predicting who will require a tube is challenging. Larger, prospective cohort studies are required.



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Tumor volume as a predictor of survival in T3 glottic carcinoma: A novel approach to patient selection

Publication date: April 2018
Source:Oral Oncology, Volume 79
Author(s): Peter T. Dziegielewski, William J. Reschly, Chris G. Morris, Reordan Danny DeJesus, Natalie Silver, Brian J. Boyce, Inocente Santiago, Robert J. Amdur, William M. Mendenhall
BackgroundThe optimal treatment for T3 glottic cancers continues to be debated. Organ preservation has become the standard of care, but not all tumors respond equally. The purpose of this was to investigate the long-term survival outcomes of organ preservation protocols based on tumor volume.MethodsA retrospective review of prospectively collected data from 1966 to 2016 was performed. Patients with T3 vocal cord cancer treated with radiation therapy (RT) at the University of Florida were included. Local control rates as well as survival rates were determined with a Kaplan Meier and Cox regression analysis. Survival was analyzed as a function of tumor volume and an optimal cut point was determined.Results107/234 patients were included. 79% received RT and 21% chemo-RT. 5-year local control was 61.5% and 5-year disease specific survival was 79.3%. Tumor volume was a significant predictor of survival (p = 0.007). An optimal cut point for tumor volume was 2.5 cc. Patients with tumor volumes ≥2.5 cc had significantly worse (p < 0.05) tumor control rates (100% vs. 70.4%).ConclusionTumor volume is a significant predictor of survival outcomes in T3 vocal cord cancers, but will need external validation. Tumors <2.5 cc have favorable outcomes. Those with higher volume tumors should be counselled appropriately and be considered for primary surgical management.



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Seven novel COL7A1 mutations identified in patients with recessive dystrophic epidermolysis bullosa from Mexico

Summary

Recessive dystrophic epidermolysis bullosa (RDEB; OMIM #226600) is one of the most devastating subtypes of epidermolysis bullosa, a group of skin and mucous membrane blistering disorders often associated with extracutaneous manifestations. RDEB is caused by mutations in COL7A1, the gene encoding type VII collagen (C7), and to date over 700 different mutations in the 8835 nucleotides constituting the open reading frame or adjacent exon–intron boundaries of COL7A1 have been described. We used targeted next-generation sequencing to identify seven previously unreported mutations in a cohort of 17 Mexican patients who were diagnosed with RDEB based on clinical presentation and immunoepitope mapping. Our study expands the spectrum of mutations identified in this cohort, including those suitable for emerging therapies reliant on precise genotyping.

http://ift.tt/2EWHdSR

Pigmented onychomatricoma: a rare mimic of subungual melanoma

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CD30-positive primary cutaneous anaplastic large cell lymphoma with coexistent pseudocarcinomatous hyperplasia

Summary

CD30-positive primary cutaneous anaplastic large cell lymphoma (C-ALCL) is an indolent type of cutaneous lymphoma with favourable clinical prognosis. Pseudocarcinomatous hyperplasia (PCH) is a rare benign epithelial condition that can resemble invasive squamous cell carcinoma both clinically and histopathologically. PCH predominantly occurs in CD30-positive lymphoproliferative disorders. We report a 75-year-old woman with PCH in a multifocal C-ALCL located on the scalp and right retroauricular area, which rapidly responded to treatment with psoralen ultraviolet A photochemotherapy. Comprehensive virological analyses for potential oncogenic viruses, including Epstein–Barr virus, human herpesvirus-8, human papillomaviruses, the recently discovered cutavirus and nine different human polyomaviruses, were negative.

http://ift.tt/2EZE4kZ

The role of tonsillectomy in the Periodic Fever, Aphthous stomatitis, Pharyngitis and cervical Adenitis syndrome; a literature review

Tonsillectomy (TE) or adenotonsillectomy (ATE) may have a beneficial effect on the clinical course in children with the Periodic Fever, Aphthous stomatitis, Pharyngitis and cervical Adenitis (PFAPA) syndrome. ...

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Treatment of post-burn and post-traumatic atrophic scars with fractional CO 2 laser: experience at a tertiary care centre

Abstract

Scars are abnormal wound responses in predisposed individuals. They occur after any kind of wound and skin inflammation in predisposed individuals. Despite their benign nature, they can be aesthetically disabling. Although several approaches have been tried in their management, most of them have produced poor results. This study aims to assess the efficacy and safety of fractional CO₂ laser treatment in the management of post-burn and post-traumatic scars. One hundred consecutive patients (77 females and 23 males) affected by post-burn scars as well as post-traumatic atrophic scars were treated with monthly sessions of fractional CO₂ laser treatment. Patient's response to treatment was assessed clinically as well as improvement of scars by comparing the photographs taken before treatment with those taken 6 months after the last treatment session. Changes in skin texture, surface irregularity and pigmentation were assessed on a quartile grading scale and scored individually from 0 to 4. A mean of the three individual scores was calculated and the response was labelled as 'excellent' if the mean score achieved was > 3. A score of 2–3 was labelled as good response while a score below 1 was labelled as 'poor' response. A mean of six treatments per scar were required and all patients, followed up for 1 year after the last treatment, had optimum results and no recurrence. Response to treatment was excellent in 53.75%, good in 16.25% patients, and poor in 30% patients. Fractional CO₂ laser gives a very good result in the management of patients with post-burn scars as well as post-traumatic scars with minimal adverse effects.

http://ift.tt/2F2fKyW

The effects of exercise training associated with low-level laser therapy on biomarkers of adipose tissue transdifferentiation in obese women

Abstract

Investigations suggest the benefits of low-level laser therapy (LLLT) to improve noninvasive body contouring treatments, inflammation, insulin resistance and to reduce body fat. However, the mechanism for such potential effects in association with exercise training (ET) and possible implications in browning adiposity processes remains unclear. Forty-nine obese women were involved, aged between 20 and 40 years with a body mass index (BMI) of 30–40 kg/m². The volunteers were divided into Phototherapy (808 nm) and SHAM groups. Interventions consisted of exercise training and phototherapy applications post exercise for 4 months, with three sessions/week. Body composition, lipid profile, insulin resistance, atrial natriuretic peptide (ANP), WNT5 signaling, interleukin-6 (IL-6), and fibroblast growth factor-21 (FGF-21) were measured. Improvements in body mass, BMI, body fat mass, lean mass, visceral fat, waist circumference, insulin, HOMA-IR, total cholesterol, LDL-cholesterol, triglycerides, and ANP in both groups were demonstrated. Only the Phototherapy group showed a reduction in interleukin-6 and an increase in WNT5 signaling. In addition, it was possible to observe a higher magnitude change for the fat mass, insulin, HOMA-IR, and FGF-21 variables in the Phototherapy group. In the present investigation, it was demonstrated that exercise training associated with LLLT promotes an improvement in body composition and inflammatory processes as previously demonstrated. The Phototherapy group especially presented positive modifications of WNT5 signaling, FGF-21, and ANP, possible biomarkers associated with browning adiposity processes. This suggests that this kind of intervention promotes results applicable in clinical practice to control obesity and related comorbidities.

http://ift.tt/2sJGjnI

Clinical significance of neutrophil gelatinase-associated lipocalin and galectin-7 in tape-stripped stratum corneum of acne vulgaris

Abstract

The usefulness of stratum corneum neutrophil gelatinase-associated lipocalin and stratum corneum galectin-7 as biomarkers of acne vulgaris was studied. A comparison of neutrophil gelatinase-associated lipocalin levels on the cheeks of patients with acne vulgaris at the start of the study and at the time of symptom improvement showed a significant decrease. On the other hand, the galectin-7 levels at the time of symptom improvement were significantly higher than those at the start of the study. Therefore, because the inflammation in the epidermis and hair follicles was reduced after therapy, as a result of the solution of the inflammatory eruptions caused by acne vulgaris, the neutrophil gelatinase-associated lipocalin level also showed a significant decrease after therapy. These results suggest that stratum corneum neutrophil gelatinase-associated lipocalin may be useful as an objective biomarker of changes in acne vulgaris symptoms.

http://ift.tt/2omUyKw

Primary cutaneous aspergillosis caused by Aspergillus tamarii in a premature infant with extremely low birthweight: A case report with short review

Abstract

Primary cutaneous aspergillosis is a rare, life-threatening fungal infection in premature infants. We report a case of primary cutaneous aspergillosis caused by Aspergillus tamarii in an extremely low birthweight infant. The infant was delivered by cesarean section with complications from an intrauterine infection, brain intraventricular hemorrhage, tension pneumothorax and cardiac tamponade. On the 12th day of life, he developed erythematous maceration with erosion on his back. Septate hyphae were detected on two occasions from specimens of the skin lesion. The manifestations of the colony and slide culture showed the characteristics of A. tamarii. The nucleotide sequences of internal transcribed spacer regions of the ribosomal RNA gene, partial sequences of β-tubulin and calmodulin gene were compatible with those of A. tamarii. Of the known Aspergillus species, Aspergillus fumigatus and Aspergillus flavus have been reported in previous studies as the major causative agents in primary cutaneous aspergillosis, whereas human infection by A. tamarii is rare. We consider that A. tamarii is important as an unusual opportunistic human pathogen among premature infants.

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Case of combined nevus showing a speckled distribution pattern

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Trousseau syndrome associated with cutaneous squamous cell carcinoma

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Microbioma and probiotics: from gut to Mars

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Preclinical evaluation of Luffa operculata Cogn. and its main active principle in the treatment of bacterial rhinosinusitis

Abstract Introduction The prevalence of rhinosinusitis is quite high. Despite the widespread use of antibiotics for rhinosinusitis, there are other forms of treatment, including phytotherapy. One of the most widely used herbal medicines for treatment of rhinosinusitis is Luffa operculata. Objective This study aimed to evaluate the efficacy of topical nasal solution of the aqueous extract of L. operculata, determining the toxicity to its use and identifying the active principles presented in the aqueous extract. The secondary objective was to evaluate the action of active principles on bacteria commonly involved in acute rhino sinusitis. Methods The study was conducted in experimental model of sinusitis. Three different concentrations of L. operculata were used as local treatment of rhino sinusitis. The results were compared with those observed in control groups that received nasal saline solution. Histological examination of the liver, kidney, spleen, myocardium, brain and lungs of all animals evaluated the toxicity of L. operculata. The aqueous extract used was subjected to chromatographic analysis and an active principle was isolated and tested for in vitro inhibition of bacterial colonies usually found in rhino sinusitis. Results Intranasal treatment of sinusitis with L. operculata showed better clinical evolution than control group. Statistically significant difference (p > 0.10) between the treated group and the control group was observed in the histologic evaluation for inflammatory pattern. The aqueous extract of L. operculata used presented a predominance of 2,3-dicafeoilglicaric acid, a substance not yet described in the literature. There was a significant difference in bacterial growth of Streptococcus pyogenes on blood-agar plates when under the influence of both the aqueous extract and the active substance. Conclusion Topical nasal solution of the aqueous extract of L. operculata is effective compared to the application of saline solution for the treatment of bacterial rhinosinusitis in an experimental model. L. operculata determined in vitro inhibition of growth of S. pyogenes.

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Resumo Introdução A prevalência de rinossinusite (RS) é bastante alta. Apesar do uso generalizado de antibióticos para RS, existem outras formas de tratamento, incluindo a fitoterapia. Uma das ervas medicinais mais utilizadas no tratamento da RS é a Luffa operculata. Objetivo Esse estudo teve como objetivo avaliar a eficácia da solução tópica nasal do extrato aquoso de Luffa operculata, determinando a toxicidade ao seu uso e identificando os princípios ativos apresentados no extrato aquoso. O objetivo secundário foi avaliar a ação dos princípios ativos sobre as bactérias comumente envolvidas na RS aguda. Método O estudo foi realizado em modelo experimental de sinusite. Utilizaram-se três concentrações diferentes de Luffa operculata como tratamento local de RS. Os resultados foram comparados com os observados em grupos de controle que receberam solução salina nasal. O exame histológico do fígado, rim, baço, miocárdio, cérebro e pulmões de todos os animais avaliou a toxicidade de Luffa operculata. O extrato aquoso utilizado foi submetido à análise cromatográfica e um princípio ativo foi isolado e testado para inibição in vitro de colônias bacterianas normalmente encontradas em RS. Resultados O tratamento intranasal da sinusite com Luffa operculata mostrou melhor evolução clínica do que o do grupo controle. Foi observada diferença estatisticamente significante (p > 0.10) entre o grupo tratado e o grupo controle na avaliação histológica do padrão inflamatório. O extrato aquoso de Luffa operculata utilizado apresentou predominância do ácido 2,3-dicafeoilglicarico, substância ainda não descrita na literatura. Houve uma diferença significativa no crescimento bacteriano de Streptococcus pyogenes em placas de ágar-sangue quando sob a influência tanto do extrato aquoso quanto da substância ativa. Conclusão A solução tópica nasal do extrato aquoso de Luffa operculata é eficaz em comparação com a aplicação de solução salina para o tratamento de RS bacteriana em um modelo experimental. Luffa operculata determinou a inibição in vitro do crescimento de Streptococcus pyogenes.

http://ift.tt/2EX2bkq

IV Brazilian Consensus on Rhinitis - an update on allergic rhinitis,

Abstract Introduction The guidelines on allergic rhinitis aim to update knowledge about the disease and care for affected patients. The initiative called "Allergic Rhinitis and its Impact on Asthma", initially published in 2001 and updated in 2008 and 2010, has been very successful in disseminating information and evidence, as well as providing a classification of severity and proposing a systemized treatment protocol. In order to include the participation of other medical professionals in the treatment of allergic rhinitis, it is important to develop algorithms that accurately indicate what should and can be done regionally. Objective To update the III Brazilian Consensus on Rhinitis - 2012, with the creation of an algorithm for allergic rhinitis management. Methods We invited 24 experts nominated by the Brazilian Association of Allergy and Immunology, Brazilian Association of Otorhinolaryngology and Head and Neck Surgery and Brazilian Society of Pediatrics to update the 2012 document. Results The update of the last Brazilian Consensus on Rhinitis incorporated and adapted the relevant information published in all "Allergic Rhinitis and its Impact on Asthma" Initiative documents to the Brazilian scenario, bringing new concepts such as local allergic rhinitis, new drugs and treatment evaluation methods. Conclusion A flowchart for allergic rhinitis treatment has been proposed.

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Resumo Introdução As diretrizes sobre rinite alergica visam atualizar os conhecimentos sobre a doença e os cuidados para com esses pacientes. A iniciativa designada "Rinite Alergica e seu Impacto na Asma", cujo relatorio inicial foi publicado em 2001 e atualizada em 2008 e 2010, tem sido muito bem sucedida na disseminaçao de informaçoes e evidencias, bem como na formulaçao da classificaçao de gravidade e proposta de sistematizaçao do tratamento. Entretanto, visando a participaçao de outros profissionais medicos no atendimento da rinite alergica, e importante o desenvolvimento de algoritmos que indiquem com precisao o que deve e pode ser feito regionalmente. Objetivo Atualizar o III Consenso Brasileiro sobre Rinites-2012, com elaboraçao de algoritmo para conduta da rinite alergica. Método Foram convidados 24 especialistas indicados pelas Associaçao Brasileira de Alergia e Imunologia, Associaçao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial e Sociedade Brasileira de Pediatria para atualizaçao do documento de 2012. Resultados A atualizaçao do ultimo Consenso Brasileiro sobre Rinites, incorporou e adaptou para a realidade brasileira as informaçoes relevantes publicadas em todos os documentos da Iniciativa "Rinite Alergica e seu Impacto na Asma", trazendo novos conceitos como a rinite alergica local, novos medicamentos e metodos de avaliaçao de tratamento. Conclusão Proposto um fluxograma de tratamento para a rinite alergica.

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Cochlear implantation in autistic children with profound sensorineural hearing loss

Abstract Introduction Cochlear implants have become the method of choice for the treatment of severe-to-profound hearing loss in both children and adults. Its benefits are well documented in the pediatric and adult population. Also deaf children with additional needs, including autism, have been covered by this treatment. Objective The aim of this study was to assess the benefits from cochlear implantation in deafened children with autism as the only additional disability. Methods This study analyzes data of six children. The follow-up time was at least 43 months. The following data were analyzed: medical history, reaction to music and sound, Ling's six sounds test, onomatopoeic word test, reaction to spoken child's name, response to requests, questionnaire given to parents, sound processor fitting sessions and data. Results After cochlear implantation each child presented other communication skills. In some children, the symptoms of speech understanding were observed. No increased hyperactivity associated with daily use cochlear implant was observed. The study showed that in autistic children the perception is very important for a child's sense of security and makes contact with parents easier. Conclusion Our study showed that oral communication is not likely to be a realistic goal in children with cochlear implants and autism. The implantation results showed benefits that varied among those children. The traditional methods of evaluating the results of cochlear implantation in children with autism are usually insufficient to fully assess the functional benefits. These benefits should be assessed in a more comprehensive manner taking into account the limitations of communication resulting from the essence of autism. It is important that we share knowledge about these complex children with cochlear implants.

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Resumo Introdução Os implantes Cocleares tornaram-se o metodo de escolha para o tratamento da perda auditiva severa a profunda em crianças e adultos. Seus beneficios estao bem documentados nas populaçoes pediatrica e adulta. Tambem as crianças surdas com necessidades adicionais, incluindo autismo, tem sido incluidas nesse tratamento. Objetivo O objetivo desse estudo foi avaliar os beneficios do implante coclear em crianças surdas com autismo como unica deficiencia adicional. Método Esse estudo analisa os dados de seis crianças. O tempo de seguimento foi de pelo menos 43 meses. Foram analisados os seguintes dados: historico medico, a reaçao a musica e ao som, teste dos seis sons de Ling, teste de palavra onomatopaica, reaçao ao nome falado da criança, resposta a pedidos, questionario aplicado aos pais, sessoes de ajustes e dados do processador de som. Resultados Apos o implante coclear, cada criança apresentou outras habilidades de comunicaçao. Em algumas crianças, foram observados sinais de compreensao da fala. Nao foi observado aumento de hiperatividade associada com o uso diario de implante coclear. O estudo mostrou que em crianças autistas a percepçao e muito importante para a sensaçao de segurança da criança e torna o contato com os pais mais facil. Conclusão Nosso estudo mostrou que a comunicaçao oral nao e uma meta realistica provavel em crianças com implantes cocleares e autismo. Os resultados do implante mostraram beneficios variaveis entre as crianças. Os metodos tradicionais de avaliaçao dos resultados do implante coclear em crianças com autismo sao geralmente insuficientes para avaliar plenamente os beneficios funcionais. Esses beneficios devem ser avaliados de forma mais abrangente, tendo em conta as limitaçoes de comunicaçao resultantes da essencia do autismo. E importante que compartilhemos conhecimentos sobre essas complexas crianças com implantes cocleares.

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Bayesian analysis of high-resolution ultrasonography and guided fine needle aspiration cytology in diagnosis of palpable thyroid nodules

Abstract Introduction To evaluate diagnostic accuracy of high-resolution ultrasonography in differentiation of benign and malignant thyroid nodules in comparison to results of guided fine needle aspiration cytology based on the Bayes rule. Objective To assess the validity of ultrasonography results of thyroid nodules in comparison to guided fine needle aspiration cytology findings. Methods This study was done on randomly chosen 80 patients presented with palpable thyroid nodules, undergone real-time sonographic evaluation of thyroid nodules to characterize features, internal consistency, margins, echotexture, calcification, peripheral lucent halo and vascularity. Ultrasonography guided fine needle aspiration cytology studies of thyroid nodules were done. Results Palpable thyroid nodules were highly prevalent in fourth and fifth decades of life with female-male ratio, 4:1. Solid internal consistency was demonstrated by 75% malignant nodules. Hypoechogenicity and intra-nodular micro-calcifications were observed in 92% malignant nodules; 83% malignant nodules had intra-nodular vascularity and absence of peripheral halo. The pre-test prevalence of malignant nodules in the targeted population was 17.5%. As type I error, 2.5% false-positive cases and as type II error, 5.0% false-negative cases were detected. Values of sensitivity and specificity of the ultrasonography test were 71.43 and 96.97%, respectively. Conclusion Malignant thyroid nodules demonstrated ultrasonography characteristics of hypoechoic texture, intra-nodular micro-calcifications, solid consistency, internal vascularity and absence of peripheral halo. The ultrasonography test has 92.5% diagnostic accuracy to differentiate malignant from benign lesions in comparison to the gold standard fine needle aspiration cytology test.

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Resumo Introdução Avaliar a precisão diagnóstica da ultrassonografia de alta resolução na diferenciação de nódulos tireoidianos benignos e malignos em comparação com os resultados da citologia de aspiração por agulha fina baseada na regra de Bayes. Objetivo Avaliar a validade dos resultados da USG de nódulos da tireoide em comparação com os resultados obtidos por citologia de aspiração por agulha fina. Método Este estudo foi feito em 80 pacientes selecionados aleatoriamente, que apresentavam nódulos palpáveis da tireoide, submetidos à avaliação ultrassonográfica em tempo real de nódulos da tireoide para estabelecer características, consistência interna, margens, ecotextura, calcificação, halo lucente periférico e vascularização. Foram feitos estudos por citologia de aspiração por agulha fina guiados pela USG dos nódulos de tireoide. Resultados Nódulos palpáveis da tireoide foram altamente prevalentes na quarta e quinta décadas de vida com uma razão sexo feminino-masculino de 4:1. A consistência interna sólida foi demonstrada em 75% de nódulos malignos. Hipoecogenicidade e microcalcificações intranodulares foram observadas em 92% de nódulos malignos; 83% dos nódulos malignos apresentaram vascularidade intranodular e ausência de halo periférico. A prevalência pré-teste de nódulos malignos na população alvo foi de 17,5%. Como erro tipo I, houve 2,5% de casos falso-positivos e como erro tipo II, foram detectados 5,0% de casos falso-negativos. Os valores de sensibilidade e especificidade do exame por USG foram de 71,43 e 96,97%, respectivamente. Conclusão Nódulos malignos da tireoide mostraram características de textura hipoecoica, microcalcificações intranodulares, consistência sólida, vascularidade interna e ausência de halo periférico na USG. O exame por USG tem 92,5% de precisão diagnóstica para diferenciar lesões malignas de benignas em comparação com o padrão ouro da citologia de aspiração por agulha fina.

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Intratympanic steroid injection and hyperbaric oxygen therapy for the treatment of refractory sudden hearing loss

Abstract Introduction Controversy surrounds the use of salvage therapies to treat sudden sensorineural hearing loss (SSNHL), with no consensus on recommendations. While several studies have demonstrated the effectiveness of intratympanic administration of steroids (ITS) and hyperbaric oxygen (HBO) treatment, few have compared the efficacy of ITS and HBO therapy in patients with refractory SSNHL. Objective We evaluated the efficiency of ITS and HBO therapy in patients with refractory SSNHL. Methods Patients who did not adequately benefit from systemic treatment were evaluated retrospectively. Refractory patients were defined as those who gained less than 20 dB in hearing after initial treatment. All refractory patients were informed about salvage therapy options: ITS or HBO therapy, the advantages and disadvantages of which were explained briefly. ITS involved 4 mg/mL dexamethasone administered through a 25 gauge needle. Patients underwent HBO therapy in a hyperbaric chamber where they breathed 100% oxygen for 120 min at 2.5 atmospheric pressure. The hearing levels of both groups were evaluated before the salvage therapy and at 3 months after treatment. Improvements in hearing were evaluated according to the Furahashi criteria. We also compared the two therapies in terms of speech discrimination scores (SDSs) and the recovery of all frequencies. Results The salvage therapies generated similar results. Changes in pure tone averages and SDSs were similar for ITS and HBO therapy (p = 0.364 and p = 0.113). Comparison of SDSs and hearing thresholds at all frequencies showed similar levels of improvement. Conclusion ITS and HBO therapy produced similar improvements in SSNHL patients, but the sample size was too small to draw definitive conclusions. Further randomized controlled studies are needed to identify the best therapy for patients with refractory sudden hearing loss.

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Resumo Introdução Há muita controvérsia sobre o uso de terapias de resgate para tratar a perda auditiva neurossensorial súbita (PANSS), sem consenso sobre as recomendações. Embora vários estudos tenham demonstrado a eficácia do uso de corticoides intratimpânicos (CIT) e o tratamento com oxigenoterapia hiperbárica (HBO), poucos têm comparado a eficácia da terapia ITS e HBO em pacientes com PANSS refratária. Objetivo Avaliamos a eficiência da terapia com CIT e HBO em pacientes com PANSS refratária. Método Pacientes que não se beneficiaram adequadamente do tratamento sistêmico foram avaliados retrospectivamente. Pacientes refratários foram definidos como aqueles que ganharam menos de 20 dB na audição após o tratamento inicial. Todos os pacientes refratários foram informados sobre as opções de terapia de resgate: terapia com CIT ou HBO, cujas vantagens e desvantagens foram explicadas brevemente. O CIT envolveu 4 mg/mL de dexametasona administrada através de uma agulha de calibre 25. Os pacientes foram submetidos à terapia HBO em uma câmara hiperbárica onde respiraram 100% de oxigênio por 120 min a 2,5 pressão atmosférica. Os níveis de audição de ambos os grupos foram avaliados antes da terapia de resgate e três meses após o tratamento. As melhorias na audição foram avaliadas de acordo com os critérios de Furahashi. Também comparamos as duas terapias em termos de Escores de Discriminação de Fala (EDF) e a recuperação de todas as frequências. Resultados As terapias de resgate demonstraram resultados semelhantes. As alterações nas médias de tons puros e nas EDF foram semelhantes para a terapia com CIT e HBO (p = 0,364 e p = 0,113). A comparação dos EDF e dos limiares de audição em todas as frequências mostrou níveis de melhoria semelhantes. Conclusão CIT e HBO produziram melhorias semelhantes nos pacientes com PANSS, mas o tamanho da amostra era muito pequeno para tirarmos conclusões definitivas. Estudos randomizados e controlados adicionais são necessários para identificar a melhor terapia para pacientes com perda auditiva repentina refratária.

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The seroprevalence of hepatitis B, hepatitis C, and human immunodeficiency virus in patients undergoing septoplasty

Abstract Introduction Worldwide, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus are major health problems. Healthcare workers are at risk of transmitting blood-borne viruses, and surgeons have a higher risk of exposure to blood and higher rates of percutaneous injury than other healthcare workers. Septoplasty is among the 3 most commonly performed otolaryngological surgeries worldwide. Objective To determine the seroprevalence of Hepatitis B surface antigen, Hepatitis C virus antibody, and Human Immunodeficiency Virus antibody in patients undergoing septoplasty with and without turbinate surgery under general anesthesia, and to determine if preoperative testing should be performed in such patients. Methods This retrospective cross-sectional study included 3731 patients that underwent septoplasty with and without turbinate surgery between January 2005 and July 2015. HBsAg, anti-HCV, and anti-HIV seropositivity in the patients was evaluated retrospectively. Results Mean age of the patients was 36 years (range: 11-81 years). In all, 117 (3.6%) patients were positive for HBsAg, 12 (0.3%) were positive for anti-HCV, and 7 (0.2%) were positive for anti-HIV. Conclusions Education of healthcare workers combined with routine preoperative serological testing in patients undergoing septoplasty under general and local anesthesia are needed to increase awareness of hepatitis B and C, and HIV infection among healthcare workers and patients in order to decrease the transmission rate.

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Resumo Introdução No mundo todo, os vírus da hepatite B (VHB), da hepatite C (VHC) e da imunodeficiência humana (HIV) são problemas de saúde importantes. Os profissionais de saúde correm o risco de contrair vírus transmitidos pelo sangue e os cirurgiões têm um maior risco de exposição ao sangue e taxas mais elevadas de lesões percutâneas do que os outros profissionais de saúde. A septoplastia está entre as três cirurgias otorrinolaringológicas mais comumente feitas em todo o mundo. Objetivo Determinar a soroprevalência de anticorpos HBsAg, anti-HCV e anti-HIV em pacientes submetidos a septoplastia com e sem cirurgia de concha nasal sob anestesia geral e determinar se deve ser feito teste pré-operatório nesses pacientes. Método Este estudo transversal retrospectivo incluiu 3.731 pacientes submetidos à septoplastia com e sem cirurgia de concha nasal entre janeiro de 2005 e julho de 2015. A soropositividade para HBsAg, anti-HCV e anti-HIV nos pacientes foi avaliada retrospectivamente. Resultados A idade média dos pacientes foi de 36 anos (intervalo: 11-81); 117 (3,6%) foram positivos para HBsAg, 12 (0,3%) para anti-HCV e sete (0,2%) para anti-HIV. Conclusões A educação de profissionais de saúde combinada com testes sorológicos rotineiros pré-operatórios em pacientes submetidos a septoplastia sob anestesia geral e local é necessária para aumentar a conscientização sobre a hepatite B e C e a infecção pelo HIV entre profissionais de saúde e pacientes para diminuir a taxa de transmissão.

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Correlation between acoustic rhinometry, computed rhinomanometry and cone-beam computed tomography in mouth breathers with transverse maxillary deficiency

Abstract Introduction To provide clinical information and diagnosis in mouth breathers with transverse maxillary deficiency with posterior crossbite, numerous exams can be performed; however, the correlation among these exams remains unclear. Objective To evaluate the correlation between acoustic rhinometry, computed rhinomanometry, and cone-beam computed tomography in mouth breathers with transverse maxillary deficiency. Methods A cross-sectional study was conducted in 30 mouth breathers with transverse maxillary deficiency (7-13 y.o.) patients with posterior crossbite. The examinations assessed: (i) acoustic rhinometry: nasal volumes (0-5 cm and 2-5 cm) and minimum cross-sectional areas 1 and 2 of nasal cavity; (ii) computed rhinomanometry: flow and average inspiratory and expiratory resistance; (iii) cone-beam computed tomography: coronal section on the head of inferior turbinate (Widths 1 and 2), middle turbinate (Widths 3 and 4) and maxilla levels (Width 5). Acoustic rhinometry and computed rhinomanometry were evaluated before and after administration of vasoconstrictor. Results were compared by Spearman's correlation and Mann-Whitney tests (α = 0.05). Results Positive correlations were observed between: (i) flow evaluated before administration of vasoconstrictor and Width 4 (Rho = 0.380) and Width 5 (Rho = 0.371); (ii) Width 2 and minimum cross-sectional areas 1 evaluated before administration of vasoconstrictor (Rho = 0.380); (iii) flow evaluated before administration of vasoconstrictor and nasal volumes of 0-5 cm (Rho = 0.421), nasal volumes of 2-5 cm (Rho = 0.393) and minimum cross-sectional areas 1 (Rho = 0.375); (iv) Width 4 and nasal volumes of 0-5 cm evaluated before administration of vasoconstrictor (Rho = 0.376), nasal volumes of 2-5 cm evaluated before administration of vasoconstrictor (Rho = 0.376), minimum cross-sectional areas 1 evaluated before administration of vasoconstrictor (Rho = 0.410) and minimum cross-sectional areas 1 after administration of vasoconstrictor (Rho = 0.426); (v) Width 5 and Width 1 (Rho = 0.542), Width 2 (Rho = 0.411), and Width 4 (Rho = 0.429). Negative correlations were observed between: (i) Width 4 and average inspiratory resistance (Rho = −0.385); (ii) average inspiratory resistance evaluated before administration of vasoconstrictor and nasal volumes of 0-5 cm (Rho = −0.382), and average expiratory resistance evaluated before administration of vasoconstrictor and minimum cross-sectional areas 1 (Rho = −0.362). Conclusion There were correlations between acoustic rhinometry, computed rhinomanometry, and cone-beam computed tomography in mouth breathers with transverse maxillary deficiency.

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Resumo Introdução Numerosos exames podem ser realizados para fornecer informações clínicas e diagnósticas em respiradores bucais com atresia maxilar e mordida cruzada posterior, entretanto a correlação entre esses exames ainda é incerta. Objetivo Avaliar a correlação entre rinometria acústica, rinomanometria computadorizada e tomografia computadorizada por feixe cônico em respiradores bucais com atresia maxilar. Método Um estudo de corte transversal foi realizado em 30 respiradores bucais com atresia maxilar (7-13 anos) com mordida cruzada posterior. Os exames avaliados foram: (i) rinomanometria acústica: volumes nasais (0-5 cm e 2-5 cm) e áreas mínimas de corte transversal 1 e 2 da cavidade nasal; (ii) rinomanometria computadorizada: fluxo nasal e resistências médias inspiratórias e expiratórias; (iii) tomografia computadorizada por feixe cônico: corte coronal na cabeça da concha inferior (larguras 1 e 2), concha média (larguras 3 e 4) e na maxila (Largura 5). Rinomanometria acústica e rinomanometria computadorizada foram avaliadas antes e depois da administração de vasoconstritor. Os resultados foram comparados pelo teste de correlação de Spearman e pelo teste de Mann-Whitney (α = 0,05). Resultados Foram encontradas correlações positivas entre: (i) fluxo antes da administração de vasoconstritor e largura 4 (Rho = 0,380) e largura 5 (Rho = 0,371); (ii) largura 2 e área mínima de corte transversal 1 antes da administração de vasoconstritor (Rho = 0,380); (iii) fluxo antes da administração de vasoconstritor e volumes nasais de 0-5 cm (Rho = 0,421), 2-5 cm (Rho = 0,393) e área mínima de corte transversal 1 (Rho = 0,375); (iv) largura 4 e volume nasal de 0-5 cm antes da administração do vasoconstritor (Rho = 0,376), volume nasal de 2-5 cm antes do uso de vasoconstritor (Rho = 0,376), áreas mínimas de corte transversal 1 antes da administração de vasoconstritor (Rho = 0,410) e áreas mínimas de corte transversal 1 após o uso do vasoconstritor (Rho = 0,426); (v) largura 5 e largura 1 (Rho = 0,542), largura 2 (Rho = 0,411) e largura 4 (Rho = 0,429). Foram encontradas correlações negativas: (i) largura 4 e resistência inspiratória média (Rho = −0,385); (ii) resistência inspiratória média antes da administração de vasoconstritor e volume de 0-5 cm (Rho = −0,382) e resistência expiratória média antes da administração de vasoconstritor e área mínima de corte transversal 1 (Rho = −0,362). Conclusão Correlações foram encontradas entre a rinometria acústica, a rinomanometria computadorizada e a tomografia computadorizada de feixe cônico em respiradores bucais com atresia maxilar.

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Evaluation of peripheral auditory pathways and brainstem in obstructive sleep apnea

Abstract Introduction Obstructive sleep apnea causes changes in normal sleep architecture, fragmenting it chronically with intermittent hypoxia, leading to serious health consequences in the long term. It is believed that the occurrence of respiratory events during sleep, such as apnea and hypopnea, can impair the transmission of nerve impulses along the auditory pathway that are highly dependent on the supply of oxygen. However, this association is not well established in the literature. Objective To compare the evaluation of peripheral auditory pathway and brainstem among individuals with and without obstructive sleep apnea. Methods The sample consisted of 38 adult males, mean age of 35.8 (±7.2), divided into four groups matched for age and Body Mass Index. The groups were classified based on polysomnography in: control (n = 10), mild obstructive sleep apnea (n = 11) moderate obstructive sleep apnea (n = 8) and severe obstructive sleep apnea (n = 9). All study subjects denied a history of risk for hearing loss and underwent audiometry, tympanometry, acoustic reflex and Brainstem Auditory Evoked Response. Statistical analyses were performed using three-factor ANOVA, 2-factor ANOVA, chi-square test, and Fisher's exact test. The significance level for all tests was 5%. Results There was no difference between the groups for hearing thresholds, tympanometry and evaluated Brainstem Auditory Evoked Response parameters. An association was observed between the presence of obstructive sleep apnea and changes in absolute latency of wave V (p = 0.03). There was an association between moderate obstructive sleep apnea and change of the latency of wave V (p = 0.01). Conclusion The presence of obstructive sleep apnea is associated with changes in nerve conduction of acoustic stimuli in the auditory pathway in the brainstem. The increase in obstructive sleep apnea severity does not promote worsening of responses assessed by audiometry, tympanometry and Brainstem Auditory Evoked Response.

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Resumo Introdução A Apneia Obstrutiva do Sono provoca modificações na arquitetura normal do sono, fragmentando-o de forma crônica com hipóxias intermitentes levando, a longo prazo, a sérias consequências na saúde. Acredita-se que a ocorrência de eventos respiratórios durante o sono como apneia e hipopneia pode prejudicar a transmissão de impulsos nervosos ao longo da via auditiva que são altamente dependentes do fornecimento do oxigênio. Contudo, essa associação não se encontra bem estabelecida na literatura. Objetivo Comparar os achados da avaliação da via auditiva periférica e no tronco encefálico entre indivíduos portadores e não portadores de apneia obstrutiva do sono. Método A casuística foi composta por 38 adultos do sexo masculino, média de idade de 35,8 (±7,2); divididos em quatro grupos experimentais pareados por idade e índice da massa corpórea. Os grupos foram classificados com base na polissonografia em: controle (n = 10), apneia obstrutiva do sono leve (n = 11), apneia obstrutiva do sono moderada (n = 8) e apneia obstrutiva do sono grave (n = 9). Todos os sujeitos do estudo negaram história pregressa de risco para perda auditiva e foram submetidos à audiometria, timpanometria, pesquisa dos reflexos acústicos e Potenciais Evocados Auditivos de Tronco Encefálico. As análises estatísticas foram realizadas por meio de ANOVA 3-fatores, ANOVA 2-fatores, teste de Qui-quadrado e teste exato de Fisher. O nível de significância adotado para todos os testes foi de 5%. Resultados Não houve diferença entre os grupos para os limiares auditivos, timpanometria e parâmetros avaliados do Peate. Observou-se associação entre a presença da apneia obstrutiva do sono e alteração da latência absoluta da onda V (p = 0,03). Observou-se associação entre apneia obstrutiva do sono de grau moderado e alteração da latência da onda V (p = 0,01). Conclusão A presença de apneia obstrutiva do sono está associada à presença de alteração na condução nervosa do estímulo acústico na via auditiva em tronco encefálico. O aumento do grau de severidade da apneia obstrutiva do sono não promove piora das respostas avaliadas pela audiometria, timpanometria e Potenciais Evocados Auditivos de Tronco Encefálico.

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Temporal bone paragangliomas: 15 years experience

Abstract Introduction Temporal bone paragangliomas (TBPs) are benign tumors arising from neural crest cells located along the jugular bulbus and the tympanic plexus. In general surgical excision, radiotherapy and wait-and-scan protocols are the main management modalities for TBPs. Objective In this paper we aim to present our clinical experience with TBPs and to review literature data. Methods The patients who were operated for tympanomastoid paraganglioma (TMP) or tympanojugular paraganglioma (TJP) in our clinic in the last 15 years were enrolled in the study. A detailed patient's charts review was performed retrospectively. Results There were 18 (52.9%) cases with TMPs and 16 (47.1%) cases with TJPs, a total of 34 patients operated for TBPs in this time period. The mean age was 50.3 ± 11.7 (range 25-71 years). The most common presenting symptoms were tinnitus and hearing loss for both TMPs and TJPs. Gross total tumor resection was achieved in 17 (94.4%) and 10 (62.5%) cases for TMPs and TJPs, respectively. Five patients (31.2%) with TJP experienced facial palsy following the operation. For all the patients the mean follow-up period was 25.8 months (range 4-108 months). Conclusion In conclusion, based on our findings and literature review, total surgical excision alone or with preoperative embolization is the main treatment modality for TBPs. However radiotherapy, observation protocol and subtotal resection must be considered in cases of preoperative functioning cranial nerves, large tumors and advanced age.

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Resumo Introdução Paragangliomas do osso temporal (POT) são tumores benignos derivados de células da crista neural localizados ao longo do bulbo jugular e do plexo timpânico. Em geral, a excisão cirúrgica, a radioterapia e os protocolos de acompanhamento com estudos por imagem são as principais modalidades de conduta para o POT. Objetivo Apresentar nossa experiência clínica com POT e revisar os dados da literatura. Método Os pacientes que foram submetidos a cirurgia para paraganglioma timpanomastoideo (PTM) ou paraganglioma timpanojugular (PTJ) em nossa clínica nos últimos 15 anos foram incluídos no estudo. Realizou-se retrospectivamente uma revisão detalhada dos prontuários dos pacientes. Resultados Houve 18 (52,9%) casos com PTM e 16 (47,1%) com PTJ, portanto, um total de 34 pacientes operados para POT nesse período. A idade média foi de 50,3 ± 11,7 (intervalo de 25-71 anos). Os sinais e sintomas de apresentação mais comuns foram o zumbido e perda auditiva, tanto para PTM quanto para PTJ. A ressecção tumoral completa foi obtida em 17 (94,4%) e 10 (62,5%) casos para PTM e PTJ, respectivamente. Cinco pacientes (31,2%) com PTJ apresentaram paralisia facial decorrente da cirurgia. Para todos os pacientes o tempo médio de seguimento foi de 25,8 meses (intervalo 4-108). Conclusão Com base nos nossos dados e na revisão da literatura, a excisão cirúrgica total isolada ou com embolização pré-operatória é a principal modalidade de tratamento para POT. No entanto, a radioterapia, o protocolo de observação e a ressecção subtotal devem ser considerados no caso de nervos cranianos funcionais no pré-operatório, grandes tumores e idade avançada.

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Effect of hearing aids use on speech stimulus decoding through speech-evoked ABR

Abstract Introduction The electrophysiological responses obtained with the complex auditory brainstem response (cABR) provide objective measures of subcortical processing of speech and other complex stimuli. The cABR has also been used to verify the plasticity in the auditory pathway in the subcortical regions. Objective To compare the results of cABR obtained in children using hearing aids before and after 9 months of adaptation, as well as to compare the results of these children with those obtained in children with normal hearing. Methods Fourteen children with normal hearing (Control Group - CG) and 18 children with mild to moderate bilateral sensorineural hearing loss (Study Group - SG), aged 7-12 years, were evaluated. The children were submitted to pure tone and vocal audiometry, acoustic immittance measurements and ABR with speech stimulus, being submitted to the evaluations at three different moments: initial evaluation (M0), 3 months after the initial evaluation (M3) and 9 months after the evaluation (M9); at M0, the children assessed in the study group did not use hearing aids yet. Results When comparing the CG and the SG, it was observed that the SG had a lower median for the V-A amplitude at M0 and M3, lower median for the latency of the component V at M9 and a higher median for the latency of component O at M3 and M9. A reduction in the latency of component A at M9 was observed in the SG. Conclusion Children with mild to moderate hearing loss showed speech stimulus processing deficits and the main impairment is related to the decoding of the transient portion of this stimulus spectrum. It was demonstrated that the use of hearing aids promoted neuronal plasticity of the Central Auditory Nervous System after an extended time of sensory stimulation.

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Resumo Introdução As respostas eletrofisiológicas obtidas com o Potencial Evocado Auditivo de Tronco Encefálico complexo (Peate-c) fornecem medidas objetivas do processamento subcortical dos estímulos de fala e outros estímulos complexos. O Peate-c também vem sendo utilizado para verificar a plasticidade na via auditiva nas regiões subcorticais. Objetivo Comparar os resultados do Peate-c obtidos em crianças usuárias de Aparelho de Amplificação Sonora Individual (AASI), antes e após 9 meses da adaptação, bem como comparar os resultados destas crianças com os obtidos em crianças com audição normal. Método Foram avaliadas 14 crianças com audição normal (Grupo Controle - GC) e 18 crianças com perda auditiva neurossensorial de grau leve a moderado bilateral (Grupo Estudo - GE), na faixa etária de 7 a 12 anos. As crianças foram submetidas às Audiometrias Tonal e Vocal, Medidas de Imitância Acústica e Peate com estímulo de fala, sendo submetidas às avalições em três momentos diferentes: avaliação inicial (M0), 3 meses após avaliação inicial (M3) e 9 meses após a avaliação inicial (M9), sendo que no M0 as crianças do grupo estudo ainda não faziam uso do AASI. Resultados Na comparação entre GC e GE, observou-se que o GE apresentou menor mediana para a amplitude V-A no M0 e no M3, menor mediana para a latência do componente V no M9 e, maior mediana para a latência do componente O no M3 e no M9. Observou-se no GE, redução na latência do componente A no M9. Conclusão Crianças com perda auditiva de grau leve a moderado apresentaram déficit no processamento do estímulo de fala sendo que o principal prejuízo está relacionado à decodificação da porção transitória do espectro deste estímulo. Evidenciou-se que o uso do AASI promoveu a plasticidade neuronal do Sistema Nervoso Auditivo Central após um tempo prolongado de estimulação sensorial.

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Prognostic role of margin status in open and CO2 laser cordectomy for T1a-T1b glottic cancer

Abstract Introduction Cordectomy by laringofissure and transoral laser surgery has been proposed for the treatment of early glottic cancer. Objectives The aim of this retrospective study was to evaluate the prognostic value of margin status in 162 consecutive cases of early glottic carcinoma (Tis-T1) treated with CO2 laser endoscopic surgery (Group A) or laryngofissure cordectomy (Group B), and to compare the oncologic and functional results. Methods Clinical prognostic factors, local recurrence rate according to margin status, overall survival and disease-free survival were analyzed. Results Margin status is related to recurrence rate in both groups (p < 0.05) without significant differences between open and laser cordectomy (p > 0.05). The 5 years overall survival and disease-free survival were respectively 90.48% and 85.71% in Group A; 88.14% and 86.44% in Group B (p > 0.05). Lower tracheostomy rate, earlier recovery of swallowing function and shorter hospital stay were observed in Group A (p < 0.05). Conclusions Margin status has a prognostic role in T1a-T1b glottic cancer. Transoral laser surgery showed similar oncologic results of open cordectomy, with better functional outcomes.

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Resumo Introdução Cordectomia por laringofissura e cirurgia transoral a laser têm sido propostas para o tratamento do câncer glótico inicial. Objetivos O objetivo desse estudo retrospectivo foi avaliar o valor prognóstico do estado da margem em 162 casos consecutivos de carcinoma glótico inicial (Tis-T1) tratado com cirurgia endoscópica a laser de CO2 (Grupo A) ou cordectomia por laringofissura (Grupo B) e comparar resultados oncológicos e funcionais. Método Foram analisados fatores prognósticos clínicos, taxa de recorrência local de acordo com o estado da margem, sobrevida global e sobrevida livre de doença. Resultados O estado de margem está relacionado à taxa de recorrência em ambos os grupos (p < 0,05) sem diferenças significativas entre cordectomia aberta e cirurgia a laser (p > 0,05). A sobrevida global de cinco anos e a sobrevida livre de doença foram, respectivamente, 90,48% e 85,71% no Grupo A; 88,14% e 86,44% no Grupo B (p > 0,05). Menor taxa de traqueostomia, recuperação mais rápida da função de deglutição e menor tempo de internação foram observados no Grupo A (p < 0,05). Conclusões O estado da margem tem papel prognóstico no câncer glótico T1a-T1b. A cirurgia a laser transoral mostrou resultados oncológicos semelhantes aos da cordectomia aberta, com melhores resultados funcionais.

http://ift.tt/2sKx3jj

Volumetric evaluation of pharyngeal segments in obstructive sleep apnea patients,

Abstract Introduction Obstructive sleep apnea occurs by recurrent collapse of the upper airway during sleep, resulting in total (apnea) or partial (hypopnea) reduction of the airflow and has intimate relation with changes in the upper airway. Cone Beam CT allows the analysis of the upper airway and its volume by three-dimensional reconstruction. Objective To evaluate a possible correlation between the volume of the upper airway and the severity of the obstructive sleep apnea. Methods A retrospective study was performed reviewing polysomnographic data and Cone Beam CT records of 29 patients (13 males and 16 females). The correlation between the volume of the nasopharynx, the oropharynx and the total superior pharynx with the AHI was assessed by Pearson's rank correlation coefficient. Results The obstructive sleep apnea severity division was: ten patients had severe, 7 had moderate, 6 had mild and 6 of them were healthy. The correlation between the nasopharynx, the oropharynx and the total superior pharynx volumes and the Apnea-Hypopnea-Index was respectively: −0.415 (p = 0.025), 0.186 (p = 0.334) and −0329 (p = 0.089). The Spearman's rank controlled by the Body Mass Index, the age and the gender was: −0.206 (p = 0.304), −0.155 (p = 0.439) and 0.242 (p = 0.284). Conclusion There is no correlation between the volume of the airway and the obstructive sleep apnea, assessed by Apnea-Hypopnea-Index and controlled by the Body Mass Index, the age and the gender. The volume of the upper airways as an isolated parameter did not correlate to the severity of the obstructive sleep apnea syndrome, and should be evaluated together with other factors.

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Resumo Introdução A Apneia Obstrutiva do Sono ocorre por colapso recorrente das vias aéreas superiores durante o sono, resultando em redução total (apneia) ou parcial (hipopneia) do fluxo aéreo, tendo relação estreita com alterações nas vias aéreas superiores. A TC de feixe cônico permite a análise da via aérea superior e seu volume através da reconstrução tridimensional. Objetivo Avaliar uma possível correlação entre o volume da via aérea superior e a gravidade da apneia obstrutiva do sono. Método Realizou-se um estudo retrospectivo, com revisão de dados polissonográficos e registros de TC de feixe cônico de 29 pacientes (13 do sexo masculino e 16 do sexo feminino). A correlação entre o volume total da nasofaringe, a orofaringe e a faringe superior com o IAH (Índice de Apneia-Hipopneia) foi avaliada pelo coeficiente de correlação de Pearson. Resultados A divisão por gravidade da Apneia Obstrutiva do Sono foi: dez pacientes apresentaram apneia na forma severa, 7 apresentaram apneia moderada, 6 tinham a forma leve e 6 estavam saudáveis. A correlação entre a nasofaringe, a orofaringe e os volumes da faringe superior e o Índice de Apneia-Hipopneia foram respectivamente: -0,415 (p = 0,025), 0,186 (p = 0,334) e -0329 (p = 0,089). A classificação de Spearman controlada pelo Índice de Massa Corporal, idade e sexo foi: -0,206 (p = 0,304), -0,155 (p = 0,439) e 0,242 (p = 0,284). Conclusão Não há correlação entre o volume da via aérea e a apneia obstrutiva do sono, avaliada pelo índice de apneia-hipopneia e controlada pelo índice de massa corporal, idade e sexo. O volume das vias aéreas superiores como parâmetro isolado não se correlacionou com a gravidade da síndrome da apneia obstrutiva do sono, e deve ser avaliado em conjunto com outros fatores.

http://ift.tt/2sMq1ue

Simultaneous idiopathic bilateral sudden hearing loss - characteristics and response to treatment

Abstract Introduction The aetiology of sudden hearing loss is poorly defined; however, infectious, vascular and neoplastic aetiologies are presumed to be responsible. In addition, the aetiology of bilateral sudden hearing loss is also unknown. Objective The objective of this study is identify the characteristics and treatment response of simultaneous bilateral sudden hearing loss. Methods This is a case-control study that practised in tertiary care academic centre. 132 patients with sudden hearing loss who were treated with systemic steroid and hyperbaric oxygen together were included. 26 patients had bilateral sudden hearing loss and 106 patients had unilateral sudden hearing loss. Patients were evaluated with clinical, audiological and radiological examinations and laboratory tests were done. Findings and response to treatment of the patients were compared. Results The mean ages of patients with unilateral and bilateral sudden hearing loss were 42.0 years and 24.5 years respectively with a statistically significant difference (p < 0.001). Immune response markers were more prevalent in bilateral sudden hearing loss. Pre-treatment audiologic thresholds were 69.1 dB for unilateral sudden hearing loss and 63.3 dB for the left ears and 67.6 dB for the right ears for bilateral sudden hearing loss without significant difference. Post-treatment average hearing threshold in unilateral sudden hearing loss was 47.0 dB and 55.4 dB for the left ears and 59.0 for the right ears in bilateral sudden hearing loss. Average hearing improvement in unilateral sudden hearing loss group was significant (p < 0.001) in spite of it was not significant in bilateral sudden hearing loss group for both ears. Between the groups; there was a significant difference for hearing improvement favouring unilateral sudden hearing loss (p < 0.001). Tinnitus scores decreased significantly in both groups of patients (p < 0.001) in spite of there was no significant difference between the groups of patients. Conclusion Patients with bilateral sudden hearing loss showed lower age, worse prognosis and higher rate of positive immune response markers. Cardiovascular risk factors seem to have an important role in the aetiology of unilateral cases whereas this importance was not present in bilateral ones.

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Resumo Introdução A etiologia da perda auditiva súbita ainda não está bem definida; contudo, presume-se que as etiologias infecciosas, vasculares e neoplásicas sejam as responsáveis. Além disso, a etiologia da perda auditiva súbita bilateral também é desconhecida. Objetivo O objetivo desse estudo foi identificar as características e a resposta ao tratamento de perda auditiva súbita bilateral simultânea. Método Este é um estudo de caso-controle realizado em um centro de atenção terciária. Foram incluídos 132 pacientes com Perda Auditiva Neurossensorial Súbita (PANS) que foram tratados com esteroides sistêmicos e oxigênio hiperbárico. 26 pacientes tiveram PANS bilateral e 106 pacientes tiveram PANS unilateral. Os pacientes foram avaliados com exames clínicos, audiológicos, radiológicos e exames laboratoriais. Os achados e a resposta ao tratamento dos pacientes foram comparados. Resultados As idades médias dos pacientes com PANS unilateral e bilateral foram 42,0 anos e 24,5 anos, respectivamente, com diferença estatisticamente significante (p < 0,001). Os marcadores de resposta imune foram mais prevalentes na PANS bilateral. Os limiares audiológicos pré-tratamento foram 69,1 dB para PANS unilateral e 63,3 dB para a orelha esquerda e 67,6 dB para a orelha direita para PANS bilateral, sem diferença significativa. O limiar médio de audição pós-tratamento em PANS unilateral foi de 47,0 dB e 55,4 dB para a orelha esquerda e 59,0 para a orelha direita em PANS bilateral. A melhora auditiva média no grupo com PANS unilateral foi significativa (p < 0,001), apesar de não ser significativa no grupo com PANS bilateral para ambas as orelhas. Houve diferença significativa entre os grupos na melhora auditiva favorecendo a PANS unilateral (p < 0,001). Os escores de zumbido diminuíram significativamente em ambos os grupos de pacientes (p < 0,001), apesar de não ter havido diferença significativa entre os grupos de pacientes. Conclusão Os pacientes com PANS bilateral eram mais jovens, tinham pior prognóstico e maior taxa de marcadores de resposta imunológica positiva. Os fatores de risco cardiovasculares parecem ter um papel importante na etiologia dos casos unilaterais, ao passo que essa importância não estava presente nos casos bilaterais.

http://ift.tt/2EW56dj

Osteonecrosis of the jaws: a review and update in etiology and treatment

Abstract Introduction Osteonecrosis of the jaws can result either from radiation, used in radiotherapy for treatment of malignant tumors, or medications used for bone remodeling and anti-angiogenesis such as bisphosphonates. These conditions can be associated with triggering factors such as infection, trauma and decreased vascularity. The management of patients with osteonecrosis of the jaws requires caution since there is no specific treatment that acts isolated and decidedly. However, different treatment modalities can be employed in an associated manner to control and stabilize lesions. Objective To review the current knowledge on etiology and management of osteonecrosis of the jaws, both radio-induced and medication-related, aiming to improve knowledge of professionals seeking to improve the quality of life of their patients. Methods Literature review in PubMed as well as manual search for relevant publications in reference list of selected articles. Articles in English ranging from 1983 to 2017, which assessed osteonecrosis of the jaws as main objective, were selected and analyzed. Results Infections, traumas and decreased vascularity have a triggering role for osteonecrosis of the jaws. Prophylactic and/or stabilizing measures can be employed in association with therapeutic modalities to properly manage osteonecrosis of the jaws patients. Conclusion Selecting an appropriate therapy for osteonecrosis of the jaws management based on current literature is a rational decision that can help lead to a proper treatment plan.

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Resumo Introdução A osteonecrose da mandíbula pode resultar da radiação usada na radioterapia para tratamento de tumores malignos ou de medicamentos usados para remodelação óssea e antiangiogênese, como os bifosfonatos. Essas condições podem ser associadas a fatores desencadeantes, como infecção, trauma e diminuição da vascularização. O tratamento de pacientes com osteonecrose da mandíbula requer cautela, pois não existe um tratamento específico que atue de maneira isolada e decisiva. No entanto, diferentes modalidades de tratamento podem ser empregadas de forma associada para controlar e estabilizar lesões. Objetivo Revisar os conhecimentos atuais sobre a etiologia e o tratamento da osteonecrose da mandíbula, tanto induzidos por radiação quanto relacionados à medicação, para melhorar o conhecimento dos profissionais que busquem a qualidade de vida de seus pacientes. Método Revisão de literatura na base de dados PubMed, bem como pesquisa manual de publicações relevantes na lista de referência de artigos selecionados. Foram selecionados e analisados artigos em inglês publicados de 1983 a 2017, que avaliaram osteonecrose da mandíbula como seu principal objetivo. Resultados Infecções, traumas e diminuição da vascularização são fatores desencadeantes da osteonecrose da mandíbula. Medidas profiláticas e/ou estabilizadoras podem ser usadas em associação com modalidades terapêuticas para o tratamento adequado de pacientes com osteonecrose da mandíbula. Conclusão Selecionar uma terapia apropriada para o tratamento de osteonecrose da mandíbula com base na literatura atual é uma decisão racional que pode ajudar a estabelecer a um plano de tratamento adequado.

http://ift.tt/2sJwndU

Effectiveness of Otolith Repositioning Maneuvers and Vestibular Rehabilitation exercises in elderly people with Benign Paroxysmal Positional Vertigo: a systematic review

Abstract Introduction Benign Paroxysmal Positional Vertigo is highly prevalent in elderly people. This condition is related to vertigo, hearing loss, tinnitus, poor balance, gait disturbance, and an increase in risk of falls, leading to postural changes and quality of life decreasing. Objective To evaluate the outcomes obtained by clinical trials on the effectiveness of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises in the treatment of Benign Paroxysmal Positional Vertigo in elderly. Methods The literature research was performed using PubMed, Scopus, Web of Science and PEDro databases, and included randomized controlled clinical trials in English, Spanish and Portuguese, published during January 2000 to August 2016. The methodological quality of the studies was assessed by PEDro score and the outcomes analysis was done by critical revision of content. Results Six studies were fully reviewed. The average age of participants ranged between 67.2 and 74.5 years. The articles were classified from 2 to 7/10 through the PEDro score. The main outcome measures analyzed were vertigo, positional nystagmus and postural balance. Additionally, the number of maneuvers necessary for remission of the symptoms, the quality of life, and the functionality were also assessed. The majority of the clinical trials used Otolith Repositioning Maneuver (n = 5) and 3 articles performed Vestibular Rehabilitation exercises in addition to Otolith Repositioning Maneuver or pharmacotherapy. One study showed that the addition of movement restrictions after maneuver did not influence the outcomes. Conclusion There was a trend of improvement in Benign Paroxysmal Positional Vertigo symptomatology in elderly patients who underwent Otolith Repositioning Maneuver. There is sparse evidence from methodologically robust clinical trials that examined the effects of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises for treating Benign Paroxysmal Positional Vertigo in the elderly. Randomized controlled clinical trials with comprehensive assessment of symptoms, quality of life, function and long-term follow up are warranted.

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Resumo Introdução A vertigem posicional paroxística benigna é altamente prevalente em idosos. Essa condição está relacionada a vertigem, perda auditiva, zumbido, equilíbrio precário, distúrbios da marcha e aumento do risco de quedas, levando a mudanças posturais e redução da qualidade de vida. Objetivo Avaliar os desfechos obtidos por ensaios clínicos sobre a eficácia da manobra de reposicionamento de otólitos e de exercícios de reabilitação vestibular no tratamento de vertigem posicional paroxística benigna em idosos. Método A pesquisa da literatura foi feita nos bancos de dados do PubMed, Scopus, Web of Science e PEDro e incluiu ensaios clínicos controlados randomizados em inglês, espanhol e português, publicados de janeiro de 2000 a agosto de 2016. A qualidade metodológica dos estudos foi avaliada pelo escore PEDro e a análise dos desfechos foi feita por revisão crítica do conteúdo. Resultados Seis estudos foram totalmente revisados. A idade média dos participantes variou entre 67,2-74,5 anos. Os artigos foram classificados de 2 a 7/10 pelo escore PEDro. As principais medidas de desfecho analisadas foram vertigem, nistagmo posicional e equilíbrio postural. Além disso, o número de manobras necessárias para a remissão dos sintomas, a qualidade de vida e a funcionalidade também foram avaliados. A maioria dos ensaios clínicos usou manobra de reposicionamento de otólitos (n = 5) e três artigos fizeram exercícios de RV, além de manobra de reposicionamento de otólitos ou farmacoterapia. Um estudo mostrou que a adição de restrições de movimento após a manobra não influenciou os resultados. Conclusão Houve uma tendência de melhoria na sintomatologia da vertigem posicional paroxística benigna em pacientes idosos submetidos à manobra de reposicionamento de otólitos. Existem evidências escassas de ensaios clínicos metodologicamente robustos que examinaram os efeitos dos exercícios de manobra de reposicionamento de otólitos e reabilitação vestibular para o tratamento da vertigem posicional paroxística benigna nos idosos. Ensaios clínicos controlados randomizados com avaliação abrangente de sintomas, qualidade de vida, função e acompanhamento de longo prazo são necessários.

http://ift.tt/2EXnYbD

Aggressive osteoblastoma of the temporal bone: an unusual cause of facial palsy

Abstract Introduction Benign Paroxysmal Positional Vertigo is highly prevalent in elderly people. This condition is related to vertigo, hearing loss, tinnitus, poor balance, gait disturbance, and an increase in risk of falls, leading to postural changes and quality of life decreasing. Objective To evaluate the outcomes obtained by clinical trials on the effectiveness of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises in the treatment of Benign Paroxysmal Positional Vertigo in elderly. Methods The literature research was performed using PubMed, Scopus, Web of Science and PEDro databases, and included randomized controlled clinical trials in English, Spanish and Portuguese, published during January 2000 to August 2016. The methodological quality of the studies was assessed by PEDro score and the outcomes analysis was done by critical revision of content. Results Six studies were fully reviewed. The average age of participants ranged between 67.2 and 74.5 years. The articles were classified from 2 to 7/10 through the PEDro score. The main outcome measures analyzed were vertigo, positional nystagmus and postural balance. Additionally, the number of maneuvers necessary for remission of the symptoms, the quality of life, and the functionality were also assessed. The majority of the clinical trials used Otolith Repositioning Maneuver (n = 5) and 3 articles performed Vestibular Rehabilitation exercises in addition to Otolith Repositioning Maneuver or pharmacotherapy. One study showed that the addition of movement restrictions after maneuver did not influence the outcomes. Conclusion There was a trend of improvement in Benign Paroxysmal Positional Vertigo symptomatology in elderly patients who underwent Otolith Repositioning Maneuver. There is sparse evidence from methodologically robust clinical trials that examined the effects of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises for treating Benign Paroxysmal Positional Vertigo in the elderly. Randomized controlled clinical trials with comprehensive assessment of symptoms, quality of life, function and long-term follow up are warranted.

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Resumo Introdução A vertigem posicional paroxística benigna é altamente prevalente em idosos. Essa condição está relacionada a vertigem, perda auditiva, zumbido, equilíbrio precário, distúrbios da marcha e aumento do risco de quedas, levando a mudanças posturais e redução da qualidade de vida. Objetivo Avaliar os desfechos obtidos por ensaios clínicos sobre a eficácia da manobra de reposicionamento de otólitos e de exercícios de reabilitação vestibular no tratamento de vertigem posicional paroxística benigna em idosos. Método A pesquisa da literatura foi feita nos bancos de dados do PubMed, Scopus, Web of Science e PEDro e incluiu ensaios clínicos controlados randomizados em inglês, espanhol e português, publicados de janeiro de 2000 a agosto de 2016. A qualidade metodológica dos estudos foi avaliada pelo escore PEDro e a análise dos desfechos foi feita por revisão crítica do conteúdo. Resultados Seis estudos foram totalmente revisados. A idade média dos participantes variou entre 67,2-74,5 anos. Os artigos foram classificados de 2 a 7/10 pelo escore PEDro. As principais medidas de desfecho analisadas foram vertigem, nistagmo posicional e equilíbrio postural. Além disso, o número de manobras necessárias para a remissão dos sintomas, a qualidade de vida e a funcionalidade também foram avaliados. A maioria dos ensaios clínicos usou manobra de reposicionamento de otólitos (n = 5) e três artigos fizeram exercícios de RV, além de manobra de reposicionamento de otólitos ou farmacoterapia. Um estudo mostrou que a adição de restrições de movimento após a manobra não influenciou os resultados. Conclusão Houve uma tendência de melhoria na sintomatologia da vertigem posicional paroxística benigna em pacientes idosos submetidos à manobra de reposicionamento de otólitos. Existem evidências escassas de ensaios clínicos metodologicamente robustos que examinaram os efeitos dos exercícios de manobra de reposicionamento de otólitos e reabilitação vestibular para o tratamento da vertigem posicional paroxística benigna nos idosos. Ensaios clínicos controlados randomizados com avaliação abrangente de sintomas, qualidade de vida, função e acompanhamento de longo prazo são necessários.

http://ift.tt/2sNtjh4

Middle turbinate angiofibroma: an unusual location for juvenile angiofibroma

Abstract Introduction Benign Paroxysmal Positional Vertigo is highly prevalent in elderly people. This condition is related to vertigo, hearing loss, tinnitus, poor balance, gait disturbance, and an increase in risk of falls, leading to postural changes and quality of life decreasing. Objective To evaluate the outcomes obtained by clinical trials on the effectiveness of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises in the treatment of Benign Paroxysmal Positional Vertigo in elderly. Methods The literature research was performed using PubMed, Scopus, Web of Science and PEDro databases, and included randomized controlled clinical trials in English, Spanish and Portuguese, published during January 2000 to August 2016. The methodological quality of the studies was assessed by PEDro score and the outcomes analysis was done by critical revision of content. Results Six studies were fully reviewed. The average age of participants ranged between 67.2 and 74.5 years. The articles were classified from 2 to 7/10 through the PEDro score. The main outcome measures analyzed were vertigo, positional nystagmus and postural balance. Additionally, the number of maneuvers necessary for remission of the symptoms, the quality of life, and the functionality were also assessed. The majority of the clinical trials used Otolith Repositioning Maneuver (n = 5) and 3 articles performed Vestibular Rehabilitation exercises in addition to Otolith Repositioning Maneuver or pharmacotherapy. One study showed that the addition of movement restrictions after maneuver did not influence the outcomes. Conclusion There was a trend of improvement in Benign Paroxysmal Positional Vertigo symptomatology in elderly patients who underwent Otolith Repositioning Maneuver. There is sparse evidence from methodologically robust clinical trials that examined the effects of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises for treating Benign Paroxysmal Positional Vertigo in the elderly. Randomized controlled clinical trials with comprehensive assessment of symptoms, quality of life, function and long-term follow up are warranted.

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Resumo Introdução A vertigem posicional paroxística benigna é altamente prevalente em idosos. Essa condição está relacionada a vertigem, perda auditiva, zumbido, equilíbrio precário, distúrbios da marcha e aumento do risco de quedas, levando a mudanças posturais e redução da qualidade de vida. Objetivo Avaliar os desfechos obtidos por ensaios clínicos sobre a eficácia da manobra de reposicionamento de otólitos e de exercícios de reabilitação vestibular no tratamento de vertigem posicional paroxística benigna em idosos. Método A pesquisa da literatura foi feita nos bancos de dados do PubMed, Scopus, Web of Science e PEDro e incluiu ensaios clínicos controlados randomizados em inglês, espanhol e português, publicados de janeiro de 2000 a agosto de 2016. A qualidade metodológica dos estudos foi avaliada pelo escore PEDro e a análise dos desfechos foi feita por revisão crítica do conteúdo. Resultados Seis estudos foram totalmente revisados. A idade média dos participantes variou entre 67,2-74,5 anos. Os artigos foram classificados de 2 a 7/10 pelo escore PEDro. As principais medidas de desfecho analisadas foram vertigem, nistagmo posicional e equilíbrio postural. Além disso, o número de manobras necessárias para a remissão dos sintomas, a qualidade de vida e a funcionalidade também foram avaliados. A maioria dos ensaios clínicos usou manobra de reposicionamento de otólitos (n = 5) e três artigos fizeram exercícios de RV, além de manobra de reposicionamento de otólitos ou farmacoterapia. Um estudo mostrou que a adição de restrições de movimento após a manobra não influenciou os resultados. Conclusão Houve uma tendência de melhoria na sintomatologia da vertigem posicional paroxística benigna em pacientes idosos submetidos à manobra de reposicionamento de otólitos. Existem evidências escassas de ensaios clínicos metodologicamente robustos que examinaram os efeitos dos exercícios de manobra de reposicionamento de otólitos e reabilitação vestibular para o tratamento da vertigem posicional paroxística benigna nos idosos. Ensaios clínicos controlados randomizados com avaliação abrangente de sintomas, qualidade de vida, função e acompanhamento de longo prazo são necessários.

http://ift.tt/2EVzch5

Iatrogenic nasal vestibular stenosis after maxillofacial reconstructive surgery

Abstract Introduction Benign Paroxysmal Positional Vertigo is highly prevalent in elderly people. This condition is related to vertigo, hearing loss, tinnitus, poor balance, gait disturbance, and an increase in risk of falls, leading to postural changes and quality of life decreasing. Objective To evaluate the outcomes obtained by clinical trials on the effectiveness of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises in the treatment of Benign Paroxysmal Positional Vertigo in elderly. Methods The literature research was performed using PubMed, Scopus, Web of Science and PEDro databases, and included randomized controlled clinical trials in English, Spanish and Portuguese, published during January 2000 to August 2016. The methodological quality of the studies was assessed by PEDro score and the outcomes analysis was done by critical revision of content. Results Six studies were fully reviewed. The average age of participants ranged between 67.2 and 74.5 years. The articles were classified from 2 to 7/10 through the PEDro score. The main outcome measures analyzed were vertigo, positional nystagmus and postural balance. Additionally, the number of maneuvers necessary for remission of the symptoms, the quality of life, and the functionality were also assessed. The majority of the clinical trials used Otolith Repositioning Maneuver (n = 5) and 3 articles performed Vestibular Rehabilitation exercises in addition to Otolith Repositioning Maneuver or pharmacotherapy. One study showed that the addition of movement restrictions after maneuver did not influence the outcomes. Conclusion There was a trend of improvement in Benign Paroxysmal Positional Vertigo symptomatology in elderly patients who underwent Otolith Repositioning Maneuver. There is sparse evidence from methodologically robust clinical trials that examined the effects of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises for treating Benign Paroxysmal Positional Vertigo in the elderly. Randomized controlled clinical trials with comprehensive assessment of symptoms, quality of life, function and long-term follow up are warranted.

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Resumo Introdução A vertigem posicional paroxística benigna é altamente prevalente em idosos. Essa condição está relacionada a vertigem, perda auditiva, zumbido, equilíbrio precário, distúrbios da marcha e aumento do risco de quedas, levando a mudanças posturais e redução da qualidade de vida. Objetivo Avaliar os desfechos obtidos por ensaios clínicos sobre a eficácia da manobra de reposicionamento de otólitos e de exercícios de reabilitação vestibular no tratamento de vertigem posicional paroxística benigna em idosos. Método A pesquisa da literatura foi feita nos bancos de dados do PubMed, Scopus, Web of Science e PEDro e incluiu ensaios clínicos controlados randomizados em inglês, espanhol e português, publicados de janeiro de 2000 a agosto de 2016. A qualidade metodológica dos estudos foi avaliada pelo escore PEDro e a análise dos desfechos foi feita por revisão crítica do conteúdo. Resultados Seis estudos foram totalmente revisados. A idade média dos participantes variou entre 67,2-74,5 anos. Os artigos foram classificados de 2 a 7/10 pelo escore PEDro. As principais medidas de desfecho analisadas foram vertigem, nistagmo posicional e equilíbrio postural. Além disso, o número de manobras necessárias para a remissão dos sintomas, a qualidade de vida e a funcionalidade também foram avaliados. A maioria dos ensaios clínicos usou manobra de reposicionamento de otólitos (n = 5) e três artigos fizeram exercícios de RV, além de manobra de reposicionamento de otólitos ou farmacoterapia. Um estudo mostrou que a adição de restrições de movimento após a manobra não influenciou os resultados. Conclusão Houve uma tendência de melhoria na sintomatologia da vertigem posicional paroxística benigna em pacientes idosos submetidos à manobra de reposicionamento de otólitos. Existem evidências escassas de ensaios clínicos metodologicamente robustos que examinaram os efeitos dos exercícios de manobra de reposicionamento de otólitos e reabilitação vestibular para o tratamento da vertigem posicional paroxística benigna nos idosos. Ensaios clínicos controlados randomizados com avaliação abrangente de sintomas, qualidade de vida, função e acompanhamento de longo prazo são necessários.

http://ift.tt/2sOvQr7

Effects of exposure to 2100 MHz GSM-like radiofrequency electromagnetic field on auditory system of rats

Abstract Introduction Benign Paroxysmal Positional Vertigo is highly prevalent in elderly people. This condition is related to vertigo, hearing loss, tinnitus, poor balance, gait disturbance, and an increase in risk of falls, leading to postural changes and quality of life decreasing. Objective To evaluate the outcomes obtained by clinical trials on the effectiveness of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises in the treatment of Benign Paroxysmal Positional Vertigo in elderly. Methods The literature research was performed using PubMed, Scopus, Web of Science and PEDro databases, and included randomized controlled clinical trials in English, Spanish and Portuguese, published during January 2000 to August 2016. The methodological quality of the studies was assessed by PEDro score and the outcomes analysis was done by critical revision of content. Results Six studies were fully reviewed. The average age of participants ranged between 67.2 and 74.5 years. The articles were classified from 2 to 7/10 through the PEDro score. The main outcome measures analyzed were vertigo, positional nystagmus and postural balance. Additionally, the number of maneuvers necessary for remission of the symptoms, the quality of life, and the functionality were also assessed. The majority of the clinical trials used Otolith Repositioning Maneuver (n = 5) and 3 articles performed Vestibular Rehabilitation exercises in addition to Otolith Repositioning Maneuver or pharmacotherapy. One study showed that the addition of movement restrictions after maneuver did not influence the outcomes. Conclusion There was a trend of improvement in Benign Paroxysmal Positional Vertigo symptomatology in elderly patients who underwent Otolith Repositioning Maneuver. There is sparse evidence from methodologically robust clinical trials that examined the effects of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises for treating Benign Paroxysmal Positional Vertigo in the elderly. Randomized controlled clinical trials with comprehensive assessment of symptoms, quality of life, function and long-term follow up are warranted.

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Resumo Introdução A vertigem posicional paroxística benigna é altamente prevalente em idosos. Essa condição está relacionada a vertigem, perda auditiva, zumbido, equilíbrio precário, distúrbios da marcha e aumento do risco de quedas, levando a mudanças posturais e redução da qualidade de vida. Objetivo Avaliar os desfechos obtidos por ensaios clínicos sobre a eficácia da manobra de reposicionamento de otólitos e de exercícios de reabilitação vestibular no tratamento de vertigem posicional paroxística benigna em idosos. Método A pesquisa da literatura foi feita nos bancos de dados do PubMed, Scopus, Web of Science e PEDro e incluiu ensaios clínicos controlados randomizados em inglês, espanhol e português, publicados de janeiro de 2000 a agosto de 2016. A qualidade metodológica dos estudos foi avaliada pelo escore PEDro e a análise dos desfechos foi feita por revisão crítica do conteúdo. Resultados Seis estudos foram totalmente revisados. A idade média dos participantes variou entre 67,2-74,5 anos. Os artigos foram classificados de 2 a 7/10 pelo escore PEDro. As principais medidas de desfecho analisadas foram vertigem, nistagmo posicional e equilíbrio postural. Além disso, o número de manobras necessárias para a remissão dos sintomas, a qualidade de vida e a funcionalidade também foram avaliados. A maioria dos ensaios clínicos usou manobra de reposicionamento de otólitos (n = 5) e três artigos fizeram exercícios de RV, além de manobra de reposicionamento de otólitos ou farmacoterapia. Um estudo mostrou que a adição de restrições de movimento após a manobra não influenciou os resultados. Conclusão Houve uma tendência de melhoria na sintomatologia da vertigem posicional paroxística benigna em pacientes idosos submetidos à manobra de reposicionamento de otólitos. Existem evidências escassas de ensaios clínicos metodologicamente robustos que examinaram os efeitos dos exercícios de manobra de reposicionamento de otólitos e reabilitação vestibular para o tratamento da vertigem posicional paroxística benigna nos idosos. Ensaios clínicos controlados randomizados com avaliação abrangente de sintomas, qualidade de vida, função e acompanhamento de longo prazo são necessários.

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Body Mass Index, Vitamin D Status, and Asthma Control Among Inner-City Children: A Feasibility Study

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.


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Vitamin D deficiency in patients with chronic and acute urticaria: A systematic review and meta-analysis

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Pregnancy Outcomes in Patients with Vitiligo: A Nationwide Population-based Cohort Study from Korea

Vitiligo is a chronic autoimmune skin disorder affecting 1% of populations worldwide. Few large-scale studies have explored adverse pregnancy outcomes in patients with vitiligo.

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The "Dermatologist Recommended" Label: is it meaningful?

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Simple mixing technique of triamcinolone acetonide solution by air bubble movement

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Isotretinoin Therapy: A Retrospective Cohort Analysis of Completion Rates and Factors Associated with Non-Adherence

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Atopic Dermatitis is Not a Risk Factor for Keratoconus: A Population-based Cohort Study

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Interleukin-17, Inflammation, and Cardiovascular Risk in Patients With Psoriasis

In addition to being recognized as a chronic inflammatory disease that manifests in the skin, psoriasis is increasingly understood to be a systemic disease that causes immune dysregulation throughout the body. The systemic nature of psoriasis is evidenced by the higher burden of comorbidities and shorter life expectancies of patients with psoriasis, particularly those with early onset and severe disease. Notably, psoriasis is associated with an increased risk for cardiovascular disease, which is the most common cause of morbidity and mortality in patients with psoriasis.

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A Spectrum Including Features of Psoriasis and Pityriasis Rubra Pilaris

Heterozygous mutations in CARD14 have been shown to be associated with psoriasis and familial pityriasis rubra pilaris (PRP). Many patients with CARD14 mutations display features of both disorders, which can result in diagnostic uncertainty. In addition, these eruptions are often recalcitrant to conventional psoriasis therapies such as methotrexate, oral retinoids and TNF-α inhibitors.

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