Scielo RSS <![CDATA[International Archives of Otorhinolaryngology]]> vol. 19 num. 3 lang. en <![CDATA[SciELO Logo]]> <![CDATA[Angiosarcoma of the Head and Neck]]> <sec><title>Introduction</title><p>Angiosarcoma of the head and neck is a rare vascular sarcoma associated with high rates of local recurrence and distant metastasis and a poor prognosis.</p></sec><sec><title>Objective</title><p> We describe our experience treating patients with angiosarcoma of the head and neck to evaluate the outcomes, patterns of failure, and current treatments.</p></sec><sec><title>Methods</title><p> We identified six patients with angiosarcoma of the head and neck and treated at our institution between 2000 and 2013. We compared our results to the literature from 1979 to 2013.</p></sec><sec><title>Results</title><p> Mean follow-up was 42 months. Local recurrence rate was 50% with diseasespecific survival and 2-year disease-free survival rates of 33.3 and 20%, respectively. Prognostic factors included tumor size &gt; 5 cm and surgical margin status, with no correlation between histologic grade and survival. Combined-modality therapy was only used for aggressive tumors with positive surgical margins but is suggested to improve local control and overall survival.</p></sec><sec><title>Conclusions</title><p> Our data series supports that angiosarcoma of the head and neck has a high rate of recurrence and is associated with a poor prognosis, despite current combined-modality therapy. The study highlights the importance of attaining negative margins during surgical resection, the utility of adjuvant therapies, as well as the need for continued research in developing new management strategies.</p></sec> <![CDATA[Rhinosinusal Polyposis and Inverted Papilloma: A Morphometric Comparative Study]]> <sec><title>Introduction</title><p>Nasal obstruction is one of the main rhinologic complaints, and two diseases must be investigated as differential diagnosis: rhinosinusal polyposis and inverted papilloma. Using traditionalmethods, the differential diagnosis between these diseases may be difficult. The morphometric study may be a useful tool for differential diagnosis and to define prognosis.</p></sec><sec><title>Objective</title><p> Calculate the morphometric values of rhinosinusal polyposis and inverted papilloma and compare the average of variables obtained between the groups.</p></sec><sec><title>Methods</title><p> The nasal mucus of 10 patients who had surgery in the Department of Otorhinolaryngology and Surgery of Head and Neck was studied; 5 had rhinosinusal polyposis and 5 had inverted papilloma. After the capture and print of corresponding data of each slide, the largest and smallest diameters of the nuclei were measured and the morphometric variables were calculated: average diameter, perimeter, ratio between largest and smallest diameter, volume, area, ratio of volume to area, form coefficient, contour index, and eccentricity.</p></sec><sec><title>Results</title><p> We found a significant difference (p &lt; 0.05) between the two groups in the following morphometric variables: largest diameter, smallest diameter, average diameter, volume, area, perimeter, and ratio of volume to area, indicating that these parameters can be useful in diagnostic differentiation between these diseases.</p></sec><sec><title>Conclusion</title><p> We founded morphometric variables higher in patients with inverted papilloma, which can be related to the neoplastic origin of the inverted papilloma. The analysis of nuclear parameters is an instrument of great value in the differential diagnosis between rhinosinusal polyposis and inverted papilloma.</p></sec> <![CDATA[Venous Thromboembolism-Incidence of Deep Venous Thrombosis and Pulmonary Embolism in Patients with Head and Neck Cancer: A Tertiary Care Experience in Pakistan]]> <sec><title>Introduction</title><p>Although venous thromboembolism (VTE) is seen with morbidity and mortality in various surgical specialties, scarce data are available in the head and neck surgery domain.</p></sec><sec><title>Objective</title><p> We aim to determine the incidence of VTE in patients receiving surgery for head and neck cancer.</p></sec><sec><title>Methods</title><p> Four hundred thirteen patients who underwent head and neck surgery procedures between 2005 and 2013 were reviewed retrospectively. All patients with head and neck surgery had received thromboprophylaxis (i.e., compression stockings and subcutaneous heparin). Patient demographics, operating time, and length of hospital stay were analyzed. The incidence of symptomatic deep venous thrombosis (DVT) and pulmonary embolism (PE) during the initial postoperative hospitalization was assessed.</p></sec><sec><title>Results</title><p> Twelve patients were identified who developed VTE. Three patients developed DVT, and nine developed PE. The incidence of DVT and PE was 0.72 and 2.17%, respectively. Interestingly, all of these patients had undergone excision of extensive head and neck cancers accompanied by a reconstructive procedure. Patients who developed PE had a longer hospital stay compared with those who only had DVT. There were overall three mortalities in the nine patients who developed PE.</p></sec><sec><title>Conclusion</title><p> Although VTE has a low incidence, it is a known complication of extensive head and neck surgeries with life-threatening outcomes. We recommend early mobilization and physiotherapy with the possible aid from appropriate mechanical and pharmacologic thromboprophylaxis.</p></sec> <![CDATA[Ambient Noise in Emergency Rooms and Its Health Hazards]]> <sec><title>Introduction</title><p>The occupational risk due to high levels of noise in the hospital environment has been recognized, and the National Agency of Sanitary Surveillance of the Ministry of Health recommends evaluation and control of noise in hospital areas.</p></sec><sec><title>Objectives</title><p> To assess the sound environment in the emergency ward of a general trauma reference hospital in the city of Curitiba, Parana State, Brazil.</p></sec><sec><title>Methods</title><p> In this descriptive study, noise levels were assessed on mornings, afternoons, and evenings using an integrating Bruel &amp; Kjaer (Denmark) calibrated sound levelmeter, type 2230. Ten indoor points in the emergency ward were assessed; the helicopter as well as several available pieces of equipment in the ward were assessed individually.</p></sec><sec><title>Results</title><p> Noise levels in sound pressure level ambiance [dBA] ranged from 56.6 to 68.8. The afternoon period was the noisiest. The helicopter at 119 dBA and the cast saw at 90 dBA were the noisiest equipment, and the lowest noise level found was the activated oximeter at 61.0 dBA.</p></sec><sec><title>Conclusion</title><p> In all assessed points, noise levels were above the comfort levels recommended by the Brazilian Association of Technical Standards (1987), which may harm users' and professionals' health as well as influence professional performance in the emergency ward. Sound pressure levels of the helicopter and cast saw reach high hearing hazard levels, requiring professionals to use individual protection equipment, and point to the need for creation and implementation of effective control measures of noise levels in emergency wards.</p></sec> <![CDATA[Hearing Aid Use and Adherence to Treatment in a Publicly-Funded Health Service from the City of São Paulo, Brazil]]> <sec><title>Introduction</title><p> Periodic follow-up appointments are important to ensure long-term effectiveness of rehabilitation with hearing aids. However, not all users are able to maintain adherence to recommendations prescribed during the fitting process and some do not attend those appointments, which compromises the effectiveness of treatment.</p></sec><sec><title>Objective</title><p> Compare hearing aid use after 1 year between subjects who did not attend a follow-up evaluation appointment at a publicly-funded health service (nonattenders) and those who attended the appointment (attenders). Reasons for nonuse of hearing aids and unscheduled appointments were also analyzed.</p></sec><sec><title>Methods</title><p> Prospective observational cross-sectional study. Nonattenders and attenders in a follow-up evaluation appointment were interviewed by telephone about hearing aid use, reasons for nonuse, and unscheduled appointments.</p></sec><sec><title>Results</title><p> The nonattenders group consisted of 108 subjects and the attenders group had 200 subjects; in both groups, most users kept bilateral use but the nonuse rate was higher in nonattenders. The main reason for nonuse of hearing aids among nonattenders was health problems; fitting problems was the main reason for nonuse in the attenders group. Health problems and issues like unavailable companion and transportation difficulties were the reasons for unscheduled follow-up appointments.</p></sec><sec><title>Conclusion</title><p> Nonattenders had a greater nonuse rate and were more likely to abandon hearing aid use. Measures to increase hearing aid use and adherence to prescribed recommendations are also necessary to ensure long-termeffectiveness of rehabilitation with hearing aids.</p></sec> <![CDATA[Relationship between Otolaryngologic Complaints and Systemic Comorbidities Observed in a Group of Hearing Aid Users]]> <sec><title>Introduction</title><p>Optimization of the selection, adaptation, and benefit of hearing aids is necessary to characterize and manage hearing loss, user expectations, otolaryngologic symptoms, and systemic comorbidities.</p></sec><sec><title>Objective</title><p> To compare the occurrence of otologic complaints, systemic diseases, and effective use of hearing aids in men and women with deafness.</p></sec><sec><title>Methods</title><p> Patients from a Unified Health System-accredited hearing health service, who reported problems in adapting to their hearing aids, were evaluated by a physician and audiologist. An anamnesis, ENT evaluation, and audiological evaluation were performed.</p></sec><sec><title>Results</title><p> During the data collection period, 278 subjects came in for follow-up visits; of these, 61 (21%) reported otologic or operational problems with their equipment. The most prevalent type of hearing loss was basocochlear, a characteristic of presbycusis, in both men and women; the most frequently reported comorbidities were hypercholesterolemia (more significant in women) and hypertension (more significant in men). Fourteen subjects reported using their device discontinuously, with no significant difference between genders; the reasons for discontinuation of use were itching and ringing, with more complaints from women.</p></sec><sec><title>Conclusion</title><p> The incidence of systemic and audiological complaints is high in this population. These patients should be evaluated thoroughly, as resolutions of these complaints can contribute to improving the quality of life and assist in the process of hearing aid fitting.</p></sec> <![CDATA[Study of the Hearing Threshold of Dance Teachers]]> <sec><title>Introduction</title><p> High sound pressure levels can cause hearing loss, beginning at high frequencies.</p></sec><sec><title>Objective</title><p> To analyze the hearing thresholds of dance teachers.</p></sec><sec><title>Methods</title><p> This study had a cross-sectional, observational, prospective, and descriptive design. Conventional and high-frequency hearing evaluations were performed with dance teachers and subjects in the control group.</p></sec><sec><title>Results</title><p> In all, 64 individuals were assessed, 32 in the research group and 32 in the control group. Results showed that individuals in the research group had hearing loss at frequencies between 4 and 8 kHz, but no significant difference was found between groups. Frequency analysis showed that individuals in the control group had higher thresholds than individuals in the research group at the frequency of 0.25 kHz. In the control group, men showed higher thresholds than women at the frequency of 9 kHz.</p></sec><sec><title>Conclusion</title><p> A low prevalence of hearing loss was found, with no difference between teachers and subjects fromthe control group. No difference was found for hearing thresholds at high frequencies between groups. Results have been partially affected by sex.</p></sec> <![CDATA[The Effects of Unilateral Adaptation of Hearing Aids on Symptoms of Depression and Social Activity Constraints of Elderly]]> <sec><title>Introduction</title><p> Hearing loss is one of the most common problems in the elderly population. Besides compromising oral communication, it directly affects social relations and prevents elderly patients from living actively in society, possibly leading to the onset of depression or other conditions. Objective To analyze the effects of unilateral adaptation of hearing aids on symptoms of depression and the social activity constraints of elderly subjects with hearing impairment.</p></sec><sec><title>Methods</title><p> The sample consisted of elderly subjects with hearing loss who did not use hearing aids. Data were collected in two phases. Initially, all participants underwent an audiological assessment and answered the Hearing Handicap Inventory for Elderly (summarized version) and the Geriatric Depression Scale. All subjects participated in the selection and hearing aid adaptation processes and became monaural hearing aid users. After 30 days of hearing aid use, they were assessed with the same instruments. The results of the questionnaires before and after hearing aid adaptation were compared.</p></sec><sec><title>Results</title><p> The sample consisted of 13 individuals, between 60 and 90 years old (mean 72.85 ± 11.05 years). Data analysis showed that there was significant improvement in social activity constraints (p &lt; 0.001) and in symptoms of depression (p = 0.031). Conclusion Results show that, in the sample studied, unilateral hearing aid adaptation reduced social activity constraints and depression symptoms.</p></sec> <![CDATA[Reflux Laryngitis: Correlation between the Symptoms Findings and Indirect Laryngoscopy]]> <sec><title>Introduction</title><p>The indirect laryngoscopy has an important role in the characterization of reflux laryngitis. Although many findings are nonspecific, some strongly suggest that the inflammation is the cause of reflux.</p></sec><sec><title>Objective</title><p>The aim of this study was to evaluate the correlation between reflux symptoms and the findings of indirect laryngoscopy.</p></sec><sec><title>Methods</title><p>We evaluated 27 patients with symptoms of pharyngolaryngeal reflux disease.</p></sec><sec><title>Results</title><p>Laryngoscopy demonstrated in all patients the presence of hypertrophy of the posterior commissure and laryngeal edema. The most frequent symptoms were the presence of dry cough and foreign body sensation.</p></sec><sec><title>Conclusion</title><p>There was a correlation between the findings at laryngoscopy and symptoms of reflux.</p></sec> <![CDATA[Effectiveness of a Vestibular Rehabilitation Protocol to Improve the Health-Related Quality of Life and Postural Balance in Patients with Vertigo]]> <sec><title>Introduction</title><p>Dizziness can be characterized as a balance disorder that causes discomfort, leading to several functional limitations. Currently, vestibular rehabilitation has been highlighted as a possible treatment.</p></sec><sec><title>Objective</title><p>Analyze the effects of completing a vestibular rehabilitation treatment protocol on quality of life and postural balance in patients with vestibular complaints, as well as to compare these effects between the patients taking or not taking antivertigo drugs.</p></sec><sec><title>Methods</title><p>A nonrandomized controlled trial was performed with 20 patients previously diagnosed with vestibular diseases. Information regarding vertigo symptoms, quality of life as assessed through the Dizziness Handicap Inventory, visual analog scale of dizziness, and stabilometry using force platform was collected. Patients were treated for 12 weeks by a customprotocol. The sample was divided into two groups according to the use (medicated group, n = 9) or not (control group, n = 11) of antivertigo drugs.</p></sec><sec><title>Results</title><p>There was improvement in quality of life (p &lt; 0.001) and intensity of dizziness (p = 0.003) with the intervention. An improvement of postural balance was observed through functional tests. However, no statistically significant difference was noted in stabilometry. When both groups were compared, no statistically significant differences between the variations of the variables analyzed were found in the re-evaluation session.</p></sec><sec><title>Conclusion</title><p>Quality of life and postural balance are improved with intervention. However, this improvement is not associated with pharmacologic treatment.</p></sec> <![CDATA[Voice Outcome after Gore-Tex Medialization Thyroplasty]]> <sec><title>Introduction</title><p>Although medialization thyroplasty utilizing Gore-Tex (Gore and Associates, Newark, Delaware, United States) has been discussed in the literature, few reports have assessed voice quality afterward, and they did not use a full assessment protocol.</p></sec><sec><title>Objective</title><p> To assess the improvement in voice quality after medialization thyroplasty utilizing Gore-Tex in patients with glottic insufficiency of variable etiology.</p></sec><sec><title>Methods</title><p>Eleven patients with glottic insufficiency of different etiologies that failed compensation were operated by type 1 thyroplasty utilizing Gore-Tex. Pre- and postoperative (1 week, 3 months, and 6 months) voice assessment was done and statistical analysis was performed on the results.</p></sec><sec><title>Results</title><p>In all postoperative assessments, there was significant improvement in the grade of dysphonia (p &lt; 0.004) and highly significant reduction in the size of glottic gap and prolongation of maximum phonation time (p &lt; 0.0001). The difference in voice parameters in the early (1 week) and the late (3 and 6months) postoperative period was not significant. None of the patients developed stridor or shortness of breath necessitating tracheotomy, and there was no implant extrusion in any patient during the study period.</p></sec><sec><title>Conclusion</title><p>Gore-Tex medialization provides reliable results for both subjective and objective voice parameters. It leads to a satisfactory restoration of voice whatever the etiology of glottic incompetence is. This technique is relatively easy and does not lead to major complications. Further studies with larger number of patients andmore extended periods of follow-up are still required to assess the long-term results of the technique regarding voice quality and implant extrusion.</p></sec> <![CDATA[Transient Evoked and Distortion Product Otoacoustic Emissions in a Group of Neonates]]> <sec><title>Introduction</title><p>The most commonly used method in neonatal hearing screening programs is transient evoked otoacoustic emissions in the first stage of the process. There are few studies comparing transient evoked otoacoustic emissions with distortion product, but some authors have investigated the issue.</p></sec><sec><title>Objective</title><p> To correlate the results of transient evoked and distortion product otoacoustic emissions in a Brazilian maternity hospital.</p></sec><sec><title>Methods</title><p> This is a cross-sectional, comparative, and prospective study. The study included 579 newborns, ranging from 6 to 54 days of age, born in a low-risk maternity hospital and assessed for hearing loss. All neonates underwent hearing screening by transient evoked and distortion product otoacoustic emissions. The results were analyzed using the Spearman correlation test to relate the two procedures.</p></sec><sec><title>Results</title><p> The pass index on transient evoked otoacoustic emissions was 95% and on distortion product otoacoustic emissions was 91%. The comparison of the two procedures showed that 91% of neonates passed on both procedures, 4.5% passed only on transient evoked otoacoustic emissions, 0.5% passed only on distortion product otoacoustic emissions, and 4% failed on both procedures. The inferential analysis showed a significant strong positive relationship between the two procedures.</p></sec><sec><title>Conclusion</title><p> The failure rate was higher in distortion product otoacoustic emissions when compared with transient evoked; however, there was correlation between the results of the procedures.</p></sec> <![CDATA[Tinnitus Neural Mechanisms and Structural Changes in the Brain: The Contribution of Neuroimaging Research]]> <sec><title>Introduction</title><p>Tinnitus is an abnormal perception of sound in the absence of an external stimulus. Chronic tinnitus usually has a high impact in many aspects of patients' lives, such as emotional stress, sleep disturbance, concentration difficulties, and so on. These strong reactions are usually attributed to central nervous system involvement. Neuroimaging has revealed the implication of brain structures in the auditory system.</p></sec><sec><title>Objective</title><p> This systematic review points out neuroimaging studies that contribute to identifying the structures involved in the pathophysiological mechanism of generation and persistence of various forms of tinnitus.</p></sec><sec><title>Data Synthesis</title><p> Functional imaging research reveals that tinnitus perception is associated with the involvement of the nonauditory brain areas, including the front parietal area; the limbic system, which consists of the anterior cingulate cortex, anterior insula, and amygdala; and the hippocampal and parahippocampal area.</p></sec><sec><title>Conclusion</title><p> The neuroimaging research confirms the involvement of the mechanisms of memory and cognition in the persistence of perception, anxiety, distress, and suffering associated with tinnitus.</p></sec> <![CDATA[Wegener Granulomatosis: Otologic Manifestation as First Symptom]]> <sec><title>Introduction</title><p>Wegener granulomatosis is a systemic vasculitis affecting small and medium-sized vessels of the upper and lower respiratory tract and kidneys.</p></sec><sec><title>Objective</title><p> To describe a case of Wegener disease with atypical manifestation.</p></sec><sec><title>Resumed Report</title><p> We describe the case of a 50-year-old woman with chronic otitis media and sensorineural hearing loss as the primary symptoms, without other manifestations.</p></sec><sec><title>Conclusion</title><p> In cases of acute ear manifestations with or without hearing loss and with poor response to usual treatments,Wegener granulomatosis should be included among the possible etiologies. After adequate diagnoses and treatment of this rare disease, there was favorable evolution.</p></sec> <![CDATA[Telephone Usage and Cochlear Implant: Auditory Training Benefits]]> <sec><title>Introduction</title><p>Difficulties with telephone use by adult users of cochlear implants (CIs) are reported as a limitation in daily life. Studies to improve the speech understanding of CI users on the telephone are scarce in the Brazilian scientific literature.</p></sec><sec><title>Objective</title><p>To develop and evaluate the effectiveness of a training program of auditory abilities on the telephone for an adult CI user.</p></sec><sec><title>Resumed Report</title><p>The subject was a 55-year-old woman with a degree in accounting who used a CI for 24 months. The program consisted of three stages: pretraining evaluation, eight sessions of advanced auditory abilities training, and post-training evaluation. Auditory abilities with CI were evaluated before and after training in three conditions: sound field, telephone with the speech processor in the microphone function, and telephone with the speech processor in the telecoil function. Speech recognition was assessed by three different lists: one with monosyllabic and dissyllabic words, another with nonsense syllables, and another one with sentences. The Client Oriented Scale of Improvement (COSI) was used to assess whether the needs established by the CI user in everyday telephone use situations improved after training. The auditory abilities training resulted in a relevant improvement in the percentage of correct answers in speech tests both in the telephone use conditions and in the sound field condition. Conclusion The results obtained with the COSI inventory indicated a performance improvement in all situations presented at the beginning of the program.</p></sec> <![CDATA[Thickened Pituitary Stalk Associated with a Mass in the Sphenoidal Sinus: An Alarm to Suspect Hypophysitis by Immunoglobulin G4?]]> <sec><title>Introduction</title><p>Hypophysitis is a chronic inflammation of the pituitary gland of complex and still incompletely defined pathogenesis. It belongs to the group of non-hormonesecreting sellar masses, sharing with them comparable clinical presentation and radiographic appearance.</p></sec><sec><title>Objectives</title><p> Describe the case of immunoglobulin G4 (IgG4)-related hypophysitis presenting as a mass in the sphenoid sinus.</p></sec><sec><title>Resumed Report</title><p>A 40-year-old Brazilian man had a diagnosis of central diabetes insipidus since 2001 associated with pituitary insufficiency. Pituitary magnetic resonance imaging revealed a centered pituitary stalk with focal nodular thickening and the presence of heterogeneous materials inside the sphenoid sinus. The patient was treated with testosterone replacement therapy. Laboratory results revealed increased IgG4 serum.</p></sec><sec><title>Conclusion</title><p>IgG4-related hypophysitis should be considered in patients with pituitary insufficiency associated with sellar mass and/or thickened pituitary stalk. IgG4 serum measurement for early diagnosis of IgG4-related hypophysitis should be performed.</p></sec>