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INTRODUCTION: Fever and pain, which are very common in ear, nose, and throat pathologies, are among the most frequent complaints recorded during emergency room pediatric patient treatment. Most of time, the pediatricians are called on to evaluate otorhinolaryngology disorders that requires specialist assessment. AIM: To determine the prevalence of otorhinolaryngologic diagnoses in a pediatric population in a reference hospital in the city of Itatiba, São Paulo. METHODS: We evaluated 2,054 pediatric patients (age range, 0-12 years, 11 months) in this descriptive, transversal observational (survey) study. Data collection was performed by a single observer during 103 night shifts (07:00 p.m. to 07:00 a.m.) between January and December 2011, and included documentation of the main diagnosis, and patient age and sex. The ethics committee and research institution approved study. Patients were divided into 2 groups based on diagnosis: Group A otorhinolaryngology disease and Group B included diagnoses not contained in Group A. RESULTS: Of the total enrolled patients, 52.2% corresponded to Group A and 47.8% to Group B; 51.9% were male and 48.1% were female. The average age was 4.5 years (Group A, 3.93 years; Group B, 5.03 years). We compared the prevalence of the diagnostic hypotheses of the 2 groups. CONCLUSION: A large number of patients sought treatment at pediatric emergency rooms for otorhinolaryngologic diagnoses.

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INTRODUCTION: Juvenile nasopharyngeal angiofibroma is a rare, highly vascular, and histologically benign tumor, generally observed in male adolescents. It shows very aggressive behavior due to local invasiveness and is associated with various symptoms. Juvenile nasopharyngeal angiofibroma originates in the sphenopalatine forame, causing epistaxes and nasal obstruction. OBJECTIVE: To retrospectively describe our experience in the diagnosis and treatment of patients with juvenile nasopharyngeal angiofibroma. SCIENTIFIC DRAWING: Retrospective, descriptive study conducted after approval from the Ethics Committee of the Federal University of Sergipe (protocol 0114.0.107.000 -11). METHODS: We analyzed findings in 20 patients who underwent surgery between 2004 and 2011. Factors analyzed include patient age and gender, symptoms, stages, treatment, length of surgery, intraoperatory bleeding, postoperative need for nasal tampons, hospitalization time, complications, and tumor recurrence. RESULTS: Patients were aged 10-29 years. All patients were treated surgically, including 17 who underwent endoscopic surgery. The mean operation time was 120 min, and the mean bleeding volume was 300 mL. Seventeen patients required clamping of the external carotids and tumor embolization. CONCLUSION: Endoscopic surgery alone or with other conventional techniques was safe for the treatment of angiofibromas of different stages.

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INTRODUCTION: Dance teachers are exposed to high sound intensities. AIM: To verify the sound intensity of music used by dance teachers during classes. METHOD: This was a transversal and prospective study. Dance teachers were evaluated with a sociodemographic questionnaire, and sound intensity level measurements were taken at the beginning, middle, and end of dance classes. RESULTS: The sample comprised 35 teachers (average age, 31.8 years). The duration of their career as dance teachers was 1-37 years; they worked daily for approximately 1-10 h. Among the classes followed, there were 15 (42.85%) classical ballet classes, 4 (11.42%) tap dancing lessons, 5 (14.28%) jazz dance classes, 2 (5.71) Arab dance lessons, 6 (17.14%) street dance classes, and 3 (8.57%) ballroom dancing lessons. The average values observed at the beginning, middle, and end of the classes were 80.91 dB (A), 83.22 dB (A), and 85.19 dB (A), respectively. The music played in the street dance classes exposed teachers to the highest sound intensity. CONCLUSION: The average level of sound intensity of the dance classes in this study was either below or equal to the limit considered harmful for hearing health. Analysis of different class types showed that the sound densities of street, ballroom, and tap dance classes were above the recommended limits.

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INTRODUCTION: The respiratory tract is one of the main points of entry of foreign substances into the body. Because of its location, the respiratory tract is heavily exposed to harmful agents, such as gases, vapors, or aerosols. AIM: Our objective was to evaluate the symptoms of occupational rhinitis in workers exposed to cotton dust. METHOD: The prospective study population consisted of workers from the "Nova Esperança" Cooperative of Nova Odessa (Sao Paulo), who were studied between September and December 2008. Data were collected through an individually and privately answered questionnaire designed by the author considering the clinical criteria for rhinitis. RESULTS: Using the questionnaire, we evaluated a total of 124 workers. Among these patients, 63.7% complained of nasal obstruction, 57.2% of nasal itching, 46.7% of rhinorrhea, and 66.1% of sneezing. Of the patients considered to have very serious symptoms, 9% had nasal obstruction; 9%, itching; 4%, rhinorrhea; and 6.4%, sneezing. DISCUSSION: Aerosol agents in the environment can clearly aggravate and even initiate rhinitis. From the standpoint of pathogenesis, the mechanisms of classical allergic airway inflammation involving mast cells, IgE, histamine, eosinophils, and lymphocytes may be responsible for the development of rhinitis after exposure to high molecular weight allergens such as proteins derived from animals and plants. This study showed a strong relationship between the occupational exposures associated with work in the cotton textile industry and the symptoms of rhinitis. CONCLUSION: Analysis of the data clearly showed the occurrence of rhinitis symptoms in these patients, demonstrating that the prevention and treatment of this condition in the workplace is extremely important.

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INTRODUCTION: Stroke is considered one of the most frequent neurological causes of oropharyngeal dysphagia. AIM: To determine the effect of cryostimulation on oropharyngeal sensitivity and, subsequently, on the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke. METHODS: Clinical and experimental study. The study enrolled 7 adult subjects, 6 men and 1 woman ranging from 28 to 64 years of age, with a diagnosis of stroke and current oropharyngeal dysphagia without any other underlying disease. The selected subjects underwent speech-language pathology evaluation and videofluoroscopic assessment of the dysphagia. The subjects were then treated with cryostimulation consisting of 10 applications to each structure (anterior faucial pillar, posterior oropharyngeal wall, soft palate, and back tongue) 3 times a day (for a total of 30 daily applications per structure) for 4 consecutive days. The patients were then re-evaluated based on the same criteria. The pre- and post-cryostimulation results of the clinical and videofluoroscopic evaluations were analyzed descriptively and statistically using Student's t-test and Fisher's exact test. RESULTS: Cryostimulation had beneficial effects on oropharyngeal sensitivity in 6 of the 7 subjects. There was also a significant improvement in swallowing and in the premature escape in six subjects. CONCLUSION: Cryostimulation increased sensitivity and subsequently improved the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke. These effects were evident by both speech-language pathology and videofluoroscopic evaluation.

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Introduction: The effects of lead on children's health have been widely studied. AIM: To analyze the correlation between the long latency auditory evoked potential N2 and cognitive P3 with the level of lead poisoning in Brazilian children. METHODS: This retrospective study evaluated 20 children ranging in age from 7 to 14 years at the time of audiological and electrophysiological evaluations. We performed periodic surveys of the lead concentration in the blood and basic audiological evaluations. Furthermore, we studied the auditory evoked potential long latency N2 and cognitive P3 by analyzing the absolute latency of the N2 and P3 potentials and the P3 amplitude recorded at Cz. At the time of audiological and electrophysiological evaluations, the average concentration of lead in the blood was less than 10 ug/dL. RESULTS: In conventional audiologic evaluations, all children had hearing thresholds below 20 dBHL for the frequencies tested and normal tympanometry findings; the auditory evoked potential long latency N2 and cognitive P3 were present in 95% of children. No significant correlations were found between the blood lead concentration and latency (p = 0.821) or amplitude (p = 0.411) of the P3 potential. However, the latency of the N2 potential increased with the concentration of lead in the blood, with a significant correlation (p = 0.030). CONCLUSION: Among Brazilian children with low lead exposure, a significant correlation was found between blood lead levels and the average latency of the auditory evoked potential long latency N2; however, a significant correlation was not observed for the amplitude and latency of the cognitive potential P3.

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INTRODUCTION: Experts on nasal cosmetics and nasal surgery agree that aesthetic rhinoplasty leads to overall facial beautification and the perception of youth in patients. This "assumed truth" has never been proven in the international literature. AIM: To examine increases in facial attractiveness ratings after rhinoplasty surgery. METHODS: We conducted a study series by choosing 30 female patients on whom we had operated and 25 evaluators in a single blind trial. The evaluators graded the patients' attractiveness before and after surgery. RESULTS: Beauty indices were significantly improved after the operation. CONCLUSION: According to the third-party evaluation, the patients appeared prettier after undergoing aesthetic rhinoplasty.

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INTRODUCTION: Hearing loss (HL) is defined as the complete or partial loss of hearing ability. AIMS: To characterize (1) the degree of satisfaction among adult and elderly hearing aid (HA) users who were treated by a public hearing health service and (2) the relationship between satisfaction and the variables of gender, age, degree of HL, and type of HA. METHOD: The clinical and experimental study included the administration of the Satisfaction with Amplification in Daily Life (SADL) questionnaire to 110 patients who had used HAs for more than 3 months and were 18 years of age or older. RESULTS: Test patients were sex-balanced (48% were women) and had a mean age of 67 years. A relatively high incidence of sensorineural moderate HL was detected in the study patients (66%) and device B was the most commonly used HA type (48%). No significant differences were evident between HA satisfaction and sex. The importance placed on services/costs and personal image varied between age groups. Correlation was evident at all levels between user satisfaction and amplification. Decreased satisfaction was observed in individuals with severe and/or profound HL. The type of HA used yielded statistically significant differences in the positive effects referring. CONCLUSION: No correlations were evident between the different factors proposed. HA users exhibited high levels of satisfaction in all SADL areas.

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INTRODUCTION: Cochlear implants may guarantee sound perception and the ability to detect speech at a close-to-normal hearing intensity; however, differences have been observed among implantees in terms of performance on discrimination tests and speech recognition. OBJECTIVE: To identify whether patients with post-meningitis deafness perform similarly to patients with hearing loss due to other causes. METHOD: A retrospective clinical study involving post-lingual patients who had been using Nucleus-22 or Nucleus-24 cochlear implants for at least 1 year. These patients were matched with respect to age (± 2 years), time since the onset of deafness (± 1 year), and the duration of implant use with implant users who had hearing loss due to other causes. Speech perception was assessed using the Portuguese version of the Latin-American Protocol for the Evaluation of Cochlear Implants. RESULTS: The sample consisted of 52 individuals (26 in each of the 2 groups). The post-meningitic group had a median of 18.5 active electrodes. The group with hearing loss due to other causes had a median of 21, but no significant statistical difference was observed (p = 0.07). The results of closed- and open-set speech recognition tests showed great variability in speech recognition between the studied groups. These differences were more pronounced for the most difficult listening tasks, such as the medial consonant task (in the vowel-consonant-vowel format). CONCLUSION: Cochlear implant recipients with hearing loss due to bacterial meningitis, who had been using the device for 1 year performed more poorly on closed- and open-set speech recognition tests than did implant recipients with hearing loss due to other causes.

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INTRODUCTION: Fibrin tissue adhesive, which has applications in several areas of medicine, can be prepared by different methods. Aim: To compare fibrin tissue adhesives prepared by 3 different methods. METHOD: In this prospective experimental laboratory study, fibrin tissue adhesives prepared by the use of plasma fibrinogen (group 1), cryoprecipitation (group 2), and precipitation by ammonium sulfate (group 3) were tested on 15 rabbits and 10 fragments of dura mater. The quality of the clots was assessed in terms of the success of the healing process, local toxicity, graft adhesion capacity, and degree of adhesion of 2 fragments of dura mater produced. RESULTS: All methods produced a clot with high adhesion and no toxicity, but tensile strength testing revealed that the glue produced from the ammonium sulfate-precipitated clot (group 3) was the strongest, requiring 39 g/cm ² to separate the fragments as opposed to 23 g/cm ² for group 2 and 13 g/cm ² for group 1. CONCLUSION: All methods produced good results as far as clot formation and non-toxicity, but ammonium sulfate precipitation produced the best tensile strength and was thus the most effective method of preparing fibrin tissue adhesive.

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INTRODUCTION: Spinocerebellar ataxia (SCA) is a degenerative disease that can cause loss of coordination of voluntary muscle movement such as that required for swallowing. AIMS: The purposes of this cross-sectional and comparative case study were: (1) to assess the severity of dysphagia through a videofluoroscopic swallow study, and (2) to compare differences in frequency, intensity, and duration of sound waves produced during swallowing in normal and SCA patients by using sonar Doppler. METHOD: During swallow evaluation using videofluoroscopy, a sonar Doppler transducer was placed on the right side of the neck, at the lateral edge of the trachea, just below the cricoid cartilage to capture the sounds of swallowing in 30 SCA patients and 30 controls. RESULT: The prevalence in the dynamic evaluation of swallowing videofluoroscopy was by changes in the oral phase of swallowing. The analysis of variance of the averages found in each variable - frequency, intensity and duration of swallowing - shows there was a significant correlation when compared to the healthy individual curve. CONCLUSION: The study demonstrates the prevalence of oral dysphagia observed in dynamic videofluoroscopic swallow evaluation. In patients with SCA, the mean initial frequency (IF), initial intensity (II), and final intensity (FI) were higher and the time (T) and peak frequency (PF) were lower, demonstrating a pattern of cricopharyngeal opening very close to that found in normal populations.

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INTRODUCTION: The effects of voiced vibration technique can be assessed by laryngeal imaging. Kymographic images derived from high-speed videoendoscopy allow actual visualization of vocal folds vibration. PURPOSE: The aim of this study is to identify the immediate effects of the voiced vibration technique in healthy vocal folds using high-speed digital laryngeal imaging. METHODS: Samples were obtained from 15 healthy subjects with no history of voice disorders (6 men and 9 women aged 21 to 43 years). High-speed videoendoscopy recordings were performed before and after the voiced vibration technique. Kymographic images were obtained using high-speed videoendoscopy. The vocal folds were examined in their open and closed positions and the characteristics of the opening and closing phases were determined. A customize computational routine was used quantify these parameters. The closing, opening, and speed quotients were also calculated. RESULTS: In this study, women displayed statistically significant differences in opened phase (P= 0.05*), closed phase (P= 0.046*), and closing phase (P= 0.026*) phase characteristics. Men displayed the highest difference rate in opening time characteristics (P= 0.06). The closing and opening quotients for the female group showed significant differences (P= 0.029* and P= 0.049*, respectively). The speed quotient exhibited statistically significant differences in the male group (P= 0.048*). CONCLUSION: The kymographic images indicated that the immediate effect of the voiced vibration technique was smooth contact in healthy vocal fold vibration.

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AIM: To review the literature about the effects of environmental noise on the hearing ability of firefighters. METHOD: The PubMed and Scielo databases were searched and studies from 2002 to 2012 that included the keywords firefighters, noise, and hearing loss were identified. Initially, 24 studies were selected, but only 10 met the inclusion criteria of investigating the effects of occupational noise on firefighters. RESULTS: Only 2 (20%) studies quantified levels of sound pressure and performed audiological tests to identify associations with noise intensity and 3 (30%) questionnaire-based studies reported that these professionals are more susceptible to hearing loss. Four (50%) studies found that noise exposure damages the auditory system in this population. DISCUSSION: These findings indicate that there is a necessity for preventive measures to be adopted by this population since it is considered to be at risk. CONCLUSION: In recent years, there have been few studies of firefighters' exposure to occupational noise, but our findings show the importance of new studies that include proper means of quantifying their exposure to noise in different work environments, in order to identify possible adverse conditions as well as to aid in the diagnosis of hearing loss.

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AIM: Antibiotic prophylaxis aims to prevent infection of surgical sites before contamination or infection occurs. Prolonged antibiotic prophylaxis does not enhance the prevention of surgical infection and is associated with higher rates of antibiotic-resistant microorganisms. This review of the literature concerning antibiotic prophylaxis, with an emphasis on otolaryngologic surgery, aims to develop a guide for the use of antibiotic prophylaxis in otolaryngologic surgery in order to reduce the numbers of complications stemming from the indiscriminate use of antibiotics.

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INTRODUCTION: Paragangliomas are neuroendocrine tumors that most commonly originate in the adrenal gland, a type that is called pheochromocytoma; however, 5-10% of paragangliomas are extra-adrenal and may arise in any area between the neck and pelvic region along the sympathetic nervous system. Those located in the head and neck comprise 3% of extra-adrenal tumors, with the majority originating in the tympanic-jugular region and carotid body. OBJECTIVE: To present a rare case of nasal paraganglioma and review the literature. CASE REPORT: The patient was submitted to medial subtotal maxillectomy, and her clinical findings, diagnostic data, and treatment outcome were recorded. CONCLUSION: Paragangliomas are considered benign tumors, but they occasionally display a malignant character. The most important finding in this case was the need for total resection of the tumor to avoid recurrence.

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INTRODUCTION: Description for using stethoscopes adapted to hearing aids. AIM: To describe the adaptation of HAs to stethoscopes used by 2 students in the health field with bilateral hearing impairment. CASE REPORTS: Two subjects with hearing loss had their stethoscopes coupled to HAs because of the individual requirements of their professions (healthcare) to perform auscultation. CONCLUSION: The improvement was measured in situ, and satisfaction was evaluated using a subjective questionnaire. The use of a stethoscope coupled to an HA allowed students with hearing loss to perform auscultation.

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INTRODUCTION: Cystadenoma is an uncommon epithelial neoplasia that arises from the salivary glands. The malignancy can affect structures such as the larynx, nasopharynx, buccal mucosa, and palate. OBJECTIVE: To describe a case of a giant cystadenoma of the floor of the mouth treated at a public hospital in midwestern Brazil. CASE REPORT: The patient was a 46-year-old woman with complaints of difficulties in articulating words and swallowing solid food and vocal fatigue. The progression of the disease since the initial consultation, the results of clinical examinations, and the outcome of surgery are described. FINALS COMMENTS: Cystadenoma must be considered in the differential diagnosis of cystic injuries in the floor of the mouth if the patient's symptoms are suggestive of this malignancy.