Audiometric evaluation in different clinical presentations of otitis media

OBJECTIVES

To assess the hearing thresholds in acute otitis media, otitis media with effusion and chronic otitis media (non-suppurative, non-cholesteatomatous suppurative and cholesteatomatous) and to compare the hearing outcomes with non-diseased ears (in bilateral cases) or contralateral healthy ears (in unilateral cases), since hearing loss is the most frequent sequel of otitis media and there is no previous study comparing the audiometric thresholds among the different forms of otitis media.

METHODS

Cross sectional, controlled study. We performed conventional audiometry (500-8000Hz) and tympanometry in patients with otitis media and healthy individuals (control group). Hearing loss was considered when the hearing thresholds were > 25 dBHL.

RESULTS

Of the 112 patients diagnosed with otitis media (151 ears), 48 were men (42.86%) and 64 were women (57.14%). The average age was 42.72 years. Of those, 25 (22.32%) were diagnosed as AOM, 15 (13.39%) were diagnosed with OME and the remaining 72 (63.28%) were diagnosed with COM (non-suppurative COM, n=31; suppurative COM, n=18; cholesteatomatous COM, n=23). As compared with controls, all forms of otitis media had significantly higher bone-conduction thresholds (500-4000Hz). Conductive hearing loss was the most frequent type of hearing loss (58.94%). However, the number of patients with mixed hearing loss was also relevant (39.07%). We noted that the presence of sensorioneural component occurred more frequently in 1) Higher frequencies; and 2) In groups of otitis media that were more active or severe in the inflammatory/infective standpoint (AOM, suppurative COM and cholesteatomatous COM).

CONCLUSION

All types of otitis media, even those with infrequent episodes of inflammation and otorrhea, had worse bone conduction thresholds as compared with nondiseased ears (p<0.01). We observed worse hearing outcomes in ears with recurrent episodes of otorrhea and in ears with AOM, especially in high frequencies.

Cochlear implant for profound hearing loss post COVID-19 complications

•COVID-19 has been associated to Sensorineural Hearing Loss. •Cochlear implants may benefit patients with profound hearing loss post COVID-19. •Hearing rehabilitation should not be postponed in cases of deafness post COVID-19.

Bilateral Sudden Sensorineural Hearing Loss: A Distinct Phenotype Entity

OBJECTIVE

To investigate the clinical phenotype and hearing prognosis of patients with unilateral and bilateral (simultaneous and nonsimultaneous) sudden sensorineural hearing loss (SSNHL).

STUDY DESIGN

Retrospective cohort.

SETTING

Otology outpatient clinic of a tertiary university hospital.

PATIENTS

Three hundred eighty-five medical records from patients with SSNHL.

MAIN OUTCOME MEASURES

Comparison of demographic, clinical, and audiometric (pretreatment and posttreatment) data of patients with unilateral and bilateral SSNHL.

RESULTS

Our final analysis comprised of 239 medical records of patients with SSNHL. Most patients had unilateral SSNHL (186, 77.82%). We identified a potential underlying cause for the SSNHL in 105 (43.9%) of the cases, being more frequent in cases of bilateral simultaneous SSNHL (100%) as compared with unilateral (45.6%) and nonsimultaneous bilateral SSNHL (22.7%). Cases of simultaneous bilateral SSNHL presented more frequently with severe or profound hearing loss (89%; unilateral SSNHL 50.5%; nonsimultaneous bilateral SSNL, 59.1%) and had a significantly worse hearing recovery prognosis as compared with unilateral or nonsimultaneous bilateral SSNHL (p = 0.002).

CONCLUSION

We observed a high heterogeneity of clinical presentations of SSNHL, the most common being unilateral SSNHL. Our results demonstrate that the clinical and audiological prognosis of simultaneous bilateral SSNHL differed significantly from unilateral and nonsimultaneous bilateral SSNHL, suggesting that simultaneous cases of bilateral SSNHL may be a part of a different disease process. The presence of a simultaneous, bilateral SSNHL indicates the need to investigate the presence of an underlying systemic disease.

Evaluation of Oxidative-Stress Pathway and Recovery of Sudden Sensorineural Hearing Loss

Introduction  Although the pathogenesis of sudden sensorineural hearing loss (SSNHL) has been discussed in the literature, many unclear points remain. Several authors have hypothesized that oxidative stress plays a role in the pathogenesis of noise-related hearing loss, as well as in drug- and aging-related hearing loss. Reactive oxygen species (ROS) may contribute to the pathogenesis of SSNHL in a similar way as in cases of ototoxicity, noise-induced hearing loss and presbyacusis. Objective  The aim of the present study was to find potential peripheral biomarkers to show the levels of oxidative stress in samples of peripheral blood collected from SSNHL patients with and withouth metabolic disease. Methods  In total, 80 consecutive patients with SSNHL were evaluated in the otolaryngology emergency room and outpatient clinic of a tertiary hospital between May 2017 and May 2019. All patients underwent detailed anamnesis, physical examination, audiometry, magnetic resonance imaging (MRI) of the inner ears, and blood tests for serum lipids and plasma activity of thiobarbituric acid reactive species (TBARS). Results  No significant effect of malondialdehyde (MDA) activity was observed regarding the hearing recovery of patients who developed SSNHL. Conclusion  We did not observe a significant correlation between the concentration of TBARs in the peripheral blood or the presence of arterial hypertension and the severity of the initial hearing loss or the prognosis of hearing recovery in patients with SSNHL. The concentration of TBARs in the peripheral blood may not adequately represent the abnormalities that occur in the intracoclear environment.

Evaluation of vestibular symptoms and postural balance control in patients with chronic otitis media

BACKGROUND

Evidence to support potential links between chronic otitis media (COM) and vestibular impairment/postural balance control issues is lacking.

OBJECTIVE

To investigate whether COM associates with vestibular symptoms, balance problems, and abnormalities in vestibular function tests.

METHODS

We selected 126 patients with COM and excluded patients with any identifiable underlying causes for vestibular dysfunction. Fifty-two healthy volunteers were included as controls. All subjects underwent anamnesis, physical examination, posturography, and video-head impulse tests.

RESULTS

We found a high prevalence of vestibular symptoms (58.4%) among patients with COM, while only 2% of the controls had vestibular symptoms. There was a positive correlation between COM activity with the presence of tinnitus and vestibular symptoms (P < 0.05). Clinical vestibular tests were abnormal in 63% of patients with COM, and those positively associated with presence of vestibular symptoms. Posturography results shown worse postural balance control in patients with COM as compared with controls, especially in the limit of stability (LOS) (Mean LOS, COM = 157.56 cm2; controls = 228.98 cm2; p < 0.001) and worse results in the test with eyes closed while standing on a foam mattress (sway area, COM = 10.91 cm2; controls = 5.90 cm2; p < 0.001) in patients with COM as compared with controls. We did not observe differences in the average vestibuloocular reflex gains in the video-head impulse test between our COM and control groups.

CONCLUSIONS

Our results show that COM associates with higher prevalence of vestibular symptoms and abnormalities in clinical vestibular function tests, and worse postural control as compared with controls. Among patients with COM, the activity of the middle-ear inflammation seemed to positively associate with the severity of hearing and balance problems.

Otopathologic Abnormalities in CHARGE Syndrome

OBJECTIVE

To perform an otopathologic analysis of temporal bones (TBs) with CHARGE syndrome.

STUDY DESIGN

Otopathologic study of human TB specimens.

SETTING

Otopathology laboratories.

METHODS

From the otopathology laboratories at the University of Minnesota and Massachusetts Eye and Ear Infirmary, we selected TBs from donors with CHARGE syndrome. These TBs were serially sectioned at a thickness of 20 µm, and every 10th section was stained with hematoxylin and eosin. We performed otopathologic analyses of the external ear, middle ear (middle ear cleft, mucosal lining, ossicles, mastoid, and facial nerve), and inner ear (cochlea, vestibule, internal auditory canal, and cochlear and vestibular nerves). The gathered data were statistically analyzed.

RESULTS

Our study included 12 TBs from 6 donors. We found a high prevalence of abnormalities affecting the ears. The most frequent findings were stapes malformation (100%), aberrant course of the facial nerve (100%) with narrow facial recess (50%), sclerotic and hypodeveloped mastoids (50%), cochlear (100%) and vestibular (83.3%) hypoplasia with aplasia of the semicircular canals, hypoplasia and aplasia of the cochlear (66.6%) and vestibular (91.6%) nerves, and narrowing of the bony canal of the cochlear nerve (66.6%). The number of spiral ganglion and Scarpa's ganglion neurons were decreased in all specimens (versus normative data).

CONCLUSIONS

In our study, CHARGE syndrome was associated with multiple TB abnormalities that may severely affect audiovestibular function and rehabilitation.

Event related potentials (ERPs) to assess the tinnitus complaint during drug treatment

INTRODUCTION

Previous studies have shown that the attention given to tinnitus can be a determinant of tinnitus severity. Some of these studies have shown changes in the amplitude and/or latency parameters of the event-related auditory potentials (ERPs). One of the tools previously employed to investigate an individual's attention is the Event Related Potential (ERP), which reflects the amount of attention from the patient to the provided auditory stimuli.

OBJECTIVE

To verify if the use of central and peripheral drugs tested for the treatment of tinnitus present changes in the measurable parameters of event-related potentials when compared to Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS).

METHOD

Eighty-eight tinnitus patients were randomly sorted into two drug groups: (1) drugs with a central action mechanism and (2) drug with peripheral action mechanism. Their effects upon the negative aspects caused by tinnitus symptoms were evaluated by the ERPs during three periods: Premedication (T1), at Termination of the drug treatment (T2), and following the Washout period (T3), and then compared with the results from the THI questionnaire and VAS.

RESULTS

ERP waves in both groups did not demonstrate significant differences during the three evaluated periods (P=0.53), despite the significant improvement seen through the evaluation by the THI questionnaire and VAS for tinnitus annoyance and intensity (P<0.0001).

CONCLUSION

The use of ERPs with patients of chronic tinnitus who have been submitted to treatment using drugs having actions on both the CNS and peripheral auditory system did not present changes in either latency or amplitude of the waves throughout the treatment when compared to the THI questionnaire and VAS. The ERPs cannot be considered as criterion to evaluate the evolution of drug treatment in patients complaining of tinnitus. The statistically significant reduction in THI and VAS scores among all drugs used occurred with dopamine antagonists. Considering the possible antipsychotic effects, we can conclude that the concomitance of a variety of psychopathological conditions such as obsessive-compulsive disorder may be associated with tinnitus in some patients and may be responsible for the severity of the symptom.

Clinical Profile of Patients With Unilateral Sudden Sensorineural Hearing Loss: Correlation With Hearing Prognosis

OBJECTIVE

To characterize, with a standard systematic protocol, the clinical and audiometric profile of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) and to correlate the findings with hearing recovery prognosis.

STUDY DESIGN

Retrospective cohort of patients with ISSNHL.

SETTING

Outpatients of a tertiary referral center followed for 20 years.

METHODS

We collected clinical information, including the presence of tinnitus, vertigo, and comorbidities, as well as initial pure tone averages, degree of hearing loss, audiogram curves, and time between hearing loss onset and treatment. These variables were statistically analyzed for their impact on hearing recovery prognosis. All patients were treated with oral corticosteroids, following a standard treatment protocol. Hearing recovery was defined according to the criteria of the American Academy of Otolaryngology-Head and Neck Surgery Foundation, and hearing outcomes were reported via a standardized method (scattergrams).

RESULTS

Our final study group comprised 186 patients. Most patients were between 41 and 60 years of age. Univariate analysis revealed that vertigo; presence of severe or profound initial hearing loss; flat, U-shaped, and descending audiogram curves; and initiating treatment ≥15 days were correlated with worse hearing recovery. However, the multivariate logistic model revealed that only the presence of severe or profound hearing loss (odds ratio, 6.634; 95% CI, 2.714-16.216; P < .001) and initiating treatment ≥15 days (odds ratio, 0.250; 95% CI, 0.102-0.610; P = .008) were independent risk factors for worse hearing recovery prognosis.

CONCLUSION

This study demonstrated that the presence of severe or profound hearing loss at the first audiogram and initiating treatment after 14 days from ISSNHL onset were independent risk factors associated with a worse hearing recovery prognosis.

Sensorineural hearing loss in the acute phase of a single episode of acute otitis media

Introduction

Acute otitis media is a disease with high global prevalence, that can lead to several acute complications and auditory sequelae. Data regarding the auditory evaluation in the acute phase of acute otitis media are scarce.

Objective

To evaluate the main audiometric changes (air and bone conduction thresholds) in the initial phase of an acute otitis media episode.

Methods

A case-control study was performed. Patients diagnosed with acute otitis media with less than 7 days of evolution in relation to the complaint onset were selected, and healthy volunteers were selected as controls. The acute otitis media and control groups were submitted to pure tone and vocal audiometry.

Results

The acute otitis media group included a total of 27 patients (30 ears). Hearing loss was present in 90.0% of the ears with acute otitis media, with conductive loss in 14 (46.67%) and mixed loss in 13 (43.33%). Both the air and bone conduction thresholds obtained with the tonal audiometry in the acute otitis media group were significantly worse than the controls at all tested frequencies (p < 0.05). In patients with acute otitis media, we observed that the thresholds for frequency >1 kHz (bone conduction) and 3 kHz (air conduction) were significantly worse in patients with tinnitus compared to patients without tinnitus.

Conclusion

During the first 7 days of evolution after the onset of an isolated episode of acute otitis media, we observed significant increases in bone and air thresholds at all frequencies, especially >2 kHz, compared to healthy ears.

Evaluation of the vestibulo-ocular reflex in patients with chronic otitis media

Introduction

In recent years, scientific evidence has shown that chronic otitis media may cause balance and vestibular dysfunction.

Objective

To compare the results of the video head impulse test (gain and symmetry of the vestibulo-ocular reflex and presence of covert and overt saccades) in patients with chronic otitis media and controls.

Methods

Cross-sectional study of patients with chronic otitis media (study group), aged between 18 and 60 years. The patients in the study group were further divided according to the chronic otitis media type as (1) non-suppurative, (2) suppurative, and (3) cholesteatomatous. For the comparative analysis, we selected volunteers with no history of ear and vestibular diseases (control group), who met the same inclusion and exclusion criteria as the study group. Patients in both groups underwent a video head impulse test.

Results

The study group consisted of 96 volunteers, and the control group of 61 individuals. The prevalence of vestibular symptoms was 66% in the study group and 3.2% in the control group (p <  0.001). The results show a higher prevalence of changes in the vestibulo-ocular reflex gain (22.9%) and corrective saccades (12.6%) in the chronic otitis media group compared to the control group (p <  0.001). Despite the higher prevalence of changes in gain, the average vestibulo-ocular reflex gains in the chronic otitis media groups were within the pre-defined values ​​of normality; however, the mean vestibulo-ocular reflex gain in the anterior semicircular canal was statistically worse in the cholesteatomatous chronic otitis media group compared to controls (p <  0.001). Regarding the corrective saccades, the prevalence of saccades was statistically higher in the suppurative and cholesteatomatous chronic otitis media subgroups compared to the non-suppurative and control groups (p =  0.004).

Conclusion

The present study demonstrated that chronic otitis media is associated with a higher prevalence of vestibular symptoms and also a higher prevalence of changes in gain and corrective saccades when compared to controls.

Tinnitus features according to caffeine consumption

INTRODUCTION

Consumption of high amounts of caffeine has been historically associated with tinnitus worsening. However, recent studies demonstrated that this seems not to be true, and caffeine may even improve tinnitus distress.

AIM

To analyze tinnitus features according to caffeine consumption levels.

STUDY DESIGN

Case-control study.

METHOD

Tinnitus patients were compared with patients without tinnitus concerning caffeine consumption. Tinnitus characteristics were correlated to the amount of caffeine consumption among the tinnitus patients.

RESULTS

One hundred and forty two patients with and 140 patients without tinnitus were enrolled. Patients without tinnitus consumed more caffeine than patients with tinnitus (300mL/day versus 100mL/day, P=0.0001). Among the patients with tinnitus, no differences concerning age, gender, tinnitus laterality, periodicity, quality, type of onset, tinnitus matching, hearing loss, THI scores and VAS (volume) according to the amount of caffeine consumed have been found. Concerning VAS (distress), the subgroup that consumed less than 150mL of caffeine daily had greater scores (6 versus 5, P=0.048).

DISCUSSION

Data from this study are on line with more recent studies that were not able to demonstrate any kind of association between high consume of caffeine and tinnitus distress. Moreover, this study was not able to point any possible tinnitus subtype affected by high amounts of caffeine consumption. The higher VAS distress score in the low caffeine consumption subgroup may represent a protective effect of caffeine, which is also on line with other studies.

CONCLUSION

High amounts of caffeine consumption is not associated with tinnitus and with no tinnitus subgroup, according to tinnitus characteristics. An eventual protective effect of caffeine should be evaluated in further prospective studies.

Subjective Visual Vertical Testing in Patients With Chronic Suppurative Otitis Media

OBJECTIVE

To analyze the results of the subjective visual vertical test using the "bucket method" in patients with chronic suppurative otitis media (CSOM).

STUDY DESIGN

Cross-sectional, controlled study.

SETTING

Outpatient otology clinic in a tertiary care hospital.

SUBJECTS AND METHODS

Patients had CSOM, defined as the presence of chronic infection or inflammation of the middle ear cleft, associated with a perforation of the tympanic membrane, frequent or intractable middle ear suppuration, with or without cholesteatoma. Controls were selected using a nonprobability, purposive sampling method. We excluded patients with neurologic or metabolic diseases, cognitive deficits, otosclerosis, vestibular migraine, Ménière's disease, past use of ototoxic medication, or head and neck cancer. The volunteers were subjected to the subjective visual vertical test using the "bucket method." The results obtained in our study and control groups were analyzed using nonparametric tests.

RESULTS

Our study comprised 51 patients with CSOM and 50 controls. In the CSOM group, we observed that 72.5% of the patients had vestibular symptoms in the past year, and 70.5% had abnormalities identified in at least 1 vestibular function test. The subjective visual vertical test revealed that patients with CSOM (with and without cholesteatoma) had significantly higher deviations of the true vertical as compared with controls (CSOM, 3.66°; controls, 0.76°; P < .001).

CONCLUSION

Our results revealed that CSOM was associated with high rates of vestibular symptoms, abnormal vestibular function tests, and abnormal subjective vertical visual results.

Quantitative assessment of cochlear and vestibular ganglion neurons in temporal bones with chronic otitis media

PURPOSE

In this study, we aimed to determine whether or not COM leads to loss of spiral and Scarpa ganglion neurons.

METHODS

From the human temporal bone (HTB) collection at the University of Minnesota we selected human temporal bones with COM, defined as the presence of clinically intractable tissue abnormalities in the middle ear (cholesteatoma, perforation of the eardrum, granulation tissue, fibrosis, tympanosclerosis, and cholesterol granuloma). We also selected HTBs from donors with no ear diseases as controls. We quantitatively analyzed the number of spiral and Scarpa ganglion cells and compared the results obtained in the control and study groups.

RESULTS

In both COM and control groups we observed a significant negative correlation between age and number of both spiral (R = -0.632; P < 0.001; 95% CI - 0.766 to - 0.434) and Scarpa ganglion (R = - 0.404; P = 0.008; 95% CI - 0.636 to - 0.051) cells. We did not find any significant differences in the number of spiral ganglion cells (in total or per segment) or in the density of Scarpa ganglion cells (in each vestibular nerve or both) in the COM group as compared with controls (P > 0.05).

CONCLUSIONS AND RELEVANCE

Our results did not demonstrate significant loss of cochlear or vestibular peripheral ganglion neuron loss in HTBs with COM as compared with controls.

Current evidence of peripheral vestibular symptoms secondary to otitis media

BACKGROUND

The association between otitis media and vestibular symptoms has been hypothesized in the past. Thus, in this study, we aimed to critically analyze (based in a systematic review of the literature) whether patients who have otitis media are at greater risk of developing vestibular impairment or not.

METHODS

We performed a systematic review of the literature and identified potentially relevant articles reporting vestibular symptoms and results of vestibular function tests in patients with otitis media through searches of the PubMED, Web of Science, Scopus, and Google Scholar databases. The quality of the final set of records was assessed using the "Newcaste-Ottawa Scale".

RESULTS

Of the 2334 records searched, 43 met our inclusion and exclusion criteria, and those included 2250 patients. The records comprised 20 longitudinal studies, 21 cross-sectional studies, and 2 case reports. Regarding the type of otitis media studied, 25 examined vestibular impairment in otitis media with effusion, 6 acute otitis media, and 12 chronic otitis media. Results of anamnesis, clinical exams, and several vestibular function tests are reported and critically discussed.

CONCLUSION

Most studies evaluating the association between otitis media and vestibular symptoms have potential methodological flaws. Clinical evidence suggests that patients with otitis media have increased chances for having vestibular symptoms, delayed acquisition of developmental milestones, and abnormalities in several vestibular function tests as compared with controls. Future studies with rigorous methodology aiming to assess the clinical significance (and prognostic factors) of the association between otitis media and vestibular impairment are warranted. Key message Several studies demonstrated long-term sequelae secondary to otitis media. However, the evidence supporting those assumptions are based in low-quality evidence. Thus, better structured studies are warranted to better understand the clinical relevance of such association.

Immune response of patients with recurrent aphthous stomatitis challenged with a symbiotic

BACKGROUND

There are indications that Th1 polarization of immune response plays an important role in the pathogenesis of recurrent aphthous stomatitis (RAS), and that the use of probiotics can stimulate immune regulatory activity, influencing the course of the disease. The aim of this study was to characterize the initial immune profile of RAS patients and evaluate clinical and serological response following a challenge with symbiotic treatment containing fructooligosaccharide, Lactobacillus, and Bifidobacterium.

METHODS

The immune responses of the 45 patients with RAS, submitted to symbiotic or placebo for 120 days, in relation to 30 RAS-free controls, were evaluated over a period of 6 months. Peripheral blood was collected from all patients at 0 (T0), 120 (T4), and 180 days (T6) after the start of treatment and Th1 (IL12-p70, IFN-γ), Th2 (IL-4), Treg (IL-10), Th17 (IL-17A), inflammatory (TNF-α, IL-6)-associated cytokines, and clinical parameters were quantified.

RESULTS

At T0, significant differences were found in the serological levels of the IFN-γ, IL-4, and IL-6 cytokines of the RAS patients in comparison with the controls. It was observed that the cytokine profile of the RAS group was comprised of 2 distinct clusters: a pure Th2 and a Mixed (Th1/Th2) subtype and that symbiotic treatment induced an improvement in pain and an increase in IFN-γ levels, producing a reduction in Th2 response.

CONCLUSIONS

In RAS, symbiotic treatment based on a fructooligosaccharide, Lactobacillus, and Bifidobacterium composition produced an alteration in the Th2 serological immune profile in the direction of Th1 and improved pain symptomatology.

Prognostic and Evolutive Factors of Tinnitus Triggered by Sudden Sensorineural Hearing Loss

INTRODUCTION

The association between sudden sensorineural hearing loss (SSNHL) and tinnitus is frequent. Its correlation with the auditory prognosis remains controversial. The objective of the study is to evaluate tinnitus of which onset is concurrent with SSNHL and analyze it as a prognostic factor and its correlation with hearing recovery.

MATERIALS AND METHODS

A prospective cohort study was conducted with 30 patients with SSNHL. Serial audiometry was performed and the Tinnitus Handicap Inventory (THI) was applied at the initial consultation and after treatment.

RESULTS

Tinnitus had an incidence of 93.3%, with an initial mean THI of 63.6%. The mean decrease in THI was significant in all scale domains. However, there was no statistically significant difference between the degrees of tinnitus and hearing loss, as well as between hearing recovery percentage in relation to the degree of tinnitus. The correlation of THI gain with the hearing recovery rate was negative (the greater the decrease in the level of tinnitus discomfort, the greater the hearing recovery rate), being significant only in the emotional domain of THI, but showing a poor correlation.

DISCUSSION

There was a reduction in the level of tinnitus discomfort, as measured by THI, after treatment of SSNHL. There is a correlation between tinnitus and hearing improvement in patients with SSNHL only in the emotional domain of THI, but this correlation is considered poor. The degree of tinnitus severity as measured by THI was not proportional to the hearing loss and is not a prognostic factor for hearing improvement.

Progression of changes in the sensorial elements of the cochlear and peripheral vestibular systems: The otitis media continuum

Our study aimed to evaluate pathologic changes in the cochlear (inner and outer hair cells and stria vascularis) and vestibular (vestibular hair cells, dark, and transitional cells) sensorial elements in temporal bones from donors who had otitis media. We studied 40 temporal bones from such donors, which were categorized in serous otitis media (SOM), serous-purulent otitis media (SPOM), mucoid/mucoid-purulent otitis media (MOM/MPOM), and chronic otitis media (COM); control group comprised 10 nondiseased temporal bones. We found significant loss of inner and outer cochlear hair cells in the basal turn of the SPOM, MOM/MPOM and COM groups; significant loss of vestibular hair cells was observed in the MOM/MPOM and COM groups. All otitis media groups had smaller mean area of the stria vascularis in the basal turn of the cochlea when compared to controls. In conclusion, our study demonstrated more severe pathologic changes in the later stages of the continuum of otitis media (MOM/MPOM and COM). Those changes seem to progress from the basal turn of the cochlea (stria vascularis, then inner and outer hair cells) to the middle turn of the cochlea and to the saccule and utricle in the MOM/MPOM and COM stages.

Is the occurrence of spontaneous epistaxis related to climatic variables? A retrospective clinical, epidemiological and meteorological study

CONCLUSION

Epistaxis has a bimodal age distribution. Anterior epistaxis of mild severity is more common in children; severe epistaxis occurs more often in adults and elderly patients. The occurrence of spontaneous epistaxis was shown to be weakly-to-moderately and inversely correlated to the mean monthly temperature, relative humidity and total rainfall.

OBJECTIVES

To describe the clinical and epidemiological profiles of patients diagnosed with spontaneous epistaxis; to correlate its monthly occurrence with meteorological variables.

METHODS

A retrospective cross-sectional study was performed in a referral ENT service in São Paulo, Brazil. The study assessed the clinical and epidemiological features of 508 patients with spontaneous epistaxis treated between February 2010 and January 2011. The occurrence of epistaxis was associated with weather variables for the same study period.

RESULTS

Spontaneous epistaxis presented two age peaks of higher incidence (11-20 and 51-70 years). Children more frequently had localized bleeding (p = 0.003), in the anterior region of the nasal cavity (p = 0.0001), of absent-mild severity (p = 0.0082). Diffuse bleeding (p = 0.005), of moderate-severe intensity (p = 0.003), was more common in adults and elderly patients. The total number of visits because of epistaxis was inversely correlated to mean temperature (R = -0.489; p = 0.011), mean relative humidity (R = -0.364; p = 0.038), and total rainfall (R = -0.512; p = 0.009) during each month of the analyzed period.

Sudden Sensorioneural Hearing Loss and Autoimmune Systemic Diseases

Introduction  Several authors have demonstrated the relationship between sudden sensorineural hearing loss (SNHL) and systemic autoimmune diseases (SAD). Immune-mediated SNHL can rarely present as unilateral sudden SNHL and manifests itself in the contralateral ear only after years. It presents clinical relevance for being one of the few SNHL that may be reversible given that early and appropriate treatment is applied. Objective  The objective of this study is to describe the clinical presentations and audiological findings from patients with idiopathic sudden SNHL and SAD associated with a probable diagnosis of immune-mediated SNHL. Furthermore, we strive to estimate the prevalence of SAD in patients with sudden SNHL. Methods  This is an observational retrospective cohort. We have selected and studied patients with SAD. Revision of available literature on scientific repositories. Results  We evaluated 339 patients with sudden SNHL. Among them, 13 (3.83%) patients suffered from SAD. Three patients had bilateral involvement, a total of 16 ears. We evaluate and describe various clinical, epidemiological, and audiological aspects of this sample. Conclusion  In our sample of patients with sudden SNHL, the prevalence of SAD was found relevant. The majority had tinnitus and dizziness concomitant hearing loss, unilateral involvement and had experienced profound hearing loss at the time of the installation. In spite of instituted treatment, most cases showed no improvement in audiometric thresholds. Apparently, patients with sudden SNHL and SAD have a more severe initial impairment, higher percentage of bilateral, lower response to treatment, and worse prognosis than patients with sudden SNHL of unknown etiology.

Intracranial complications of otitis media: 15 years of experience in 33 patients

OBJECTIVES:

Complications in the central nervous system (CNS) from acute otitis media (AOM) and chronic otitis media (COM) are becoming fewer, although they still represent a challenge for early recognition, adequate treatment, and satisfactory results. This retrospective study analyzed clinical data and therapeutic options in 33 patients with intracranial involvement resulting from otitis media. Important clinical features of intracranial complications and the sequence of the most efficient therapeutic maneuvers are discussed.

METHODS:

Charts of six patients with AOM and 27 patients with COM associated with CNS complications were analyzed for clinical presentation, imaging, and therapeutic approach.

RESULTS:

Ages ranged from 6 months to 79 years, with no gender predilection. Persistent fever, headache, and purulent otorrhea were the main symptoms. Proteus mirabilis, Enterococcus, and Pseudomonas aeruginosa were the most common microorganisms in COM, and Pneumococus and Haemophilus were the most common microorganisms in AOM. Nineteen patients (58%) presented with more than 1 CNS complication, resulting in a total of 56 complications, including 26 cases of otogenic brain abscess, 21 cases of meningitis, 5 cases of lateral sinus thromboses, two cases of subdural empyemas, 1 case of epidural empyema, and 1 case of meningocele. Surgical interventions included craniotomy and drainage of the abscess (n = 17), open mastoidectomy with abscess drained through the mastoid (n = 10), open mastoidectomy alone (n = 8), and closed mastoidectomy (n = 2). Twelve patients who underwent craniotomy had subsequent mastoidectomy for recurrent abscess. At the 6-month, 66% of patients presented without sequelae, 24% presented with sequelae, and 9% died.

CONCLUSION:

Early identification and prompt clinical and surgical intervention with mandatory drainage of the middle ear (primary disease), was essential for better outcome.

Transcanal endoscopic myringoplasty: a case series in a university center

Introduction

Transcanal myringoplasty has the advantages of demanding lower operative time and minimal external incisions. It can be performed using the microscopic or endoscopic approach. In the last decade, the use of endoscopes in ear surgery has increased significantly. This technique may allow “around the corner” visualization of small recesses, through narrow spaces, without the aid of canalplasty in unfavorable ear canals.

Objective

To describe a case series of transcanal endoscopic myringoplasty performed in a university service. The characteristics, advantages, and disadvantages of this technique are also discussed.

Methods

A case series study, based on the chart review of patients submitted to transcanal endoscopic myringoplasty in the period from January of 2012 to October of 2014.

Results

Data from 22 patients were analyzed. Tympanic perforation closure three months after surgery was observed in 86.4% of all patients. There was statistically significant improvement in pure tone average thresholds after surgery (p < 0.001).

Conclusion

Transcanal endoscopic myringoplasty is a feasible, safe, and effective procedure; it can be an alternative to microscopic surgery.

Complications of otitis media - a potentially lethal problem still present

Introduction

It is an erroneous but commonly held belief that intracranial complications (ICCs) of chronic and acute otitis media (COM and AOM) are past diseases or from developing countries. These problems remain, despite improvements in antibiotic care.

Objective

This paper analyzes the occurrence and clinical characteristics and course of the main ICCs of otitis media (OM).

Methods

Retrospective cohort study of 51 patients with ICCs from OM, drawn from all patients presenting with OM to the emergency room of a large inner-city tertiary care hospital over a 22-year period.

Results

80% of cases were secondary to COM of which the incidence of ICC was 0.8%; 20% were due to AOM. The death occurrence was 7.8%, hearing loss in 90%, and permanent neurological sequelae in 29%. Patients were 61% male. In the majority, onset of ear disease had occurred during childhood. Delay of diagnosis of both the initial infection as well as the secondary ICC was significant. ICCs included brain abscess and meningitis in 78%, and lateral sinus thrombosis, empyema and otitic hydrocephalus in 13%, 8% and 1% of cases, respectively. Twenty-seven neurosurgical procedures and 43 otologic surgery procedures were performed. Two patients were too ill for surgical intervention.

Conclusion

ICCs of OM, although uncommon, still occur. These cases require expensive, complex and long-term inpatient treatment and frequently result in hearing loss, neurological sequelae and mortality. It is important to be aware of this potentiality in children with COM, especially, and maintain a high index of suspicion in order to refer for otologic specialty care before such complications occur.

Variables with prognostic value in the onset of idiopathic sudden sensorineural hearing loss

Introduction

The establishment of an individualized prognostic evaluation in patients with a diagnosis of idiopathic sudden sensorineural hearing loss (ISSHL) remains a difficult and imprecise task, due mostly to the variety of etiologies. Determining which variables have prognostic value in the initial assessment of the patient would be extremely useful in clinical practice.

Objective

To establish which variables identifiable at the onset of idiopathic sudden sensorineural hearing loss have prognostic value in the final hearing recovery.

Methods

Prospective, longitudinal cohort study. Patients with ISSHL followed by the Department of Otology-Neurotology of a quaternary hospital were included. The following variables were evaluated and correlated with final hearing recovery: age, gender, vertigo, tinnitus, initial degree of hearing loss, contralateral ear hearing, and elapsed time to treatment.

Results

127 patients with ISSHL were evaluated. Rates of absolute and relative recovery were 23.6 dB and 37.2% respectively. Complete hearing improvement was observed in 15.7% patients; 27.6% demonstrated significant improvement and improvement was noted in 57.5%.

Conclusion

During the onset of ISSHL, the following variables were correlated with a worse prognosis: dizziness, profound hearing loss, impaired hearing in the contralateral ear, and delay to start treatment. Tinnitus at the onset of ISSHL correlated with a better prognosis.

Micro-endoscopic ear anatomy of guinea pig applied to experimental surgery

PURPOSE

To describe topographic and endoscopic anatomy of guinea pig ear for development of surgical approaches in experimental studies.

METHODS

Experimental study. Eight adult guinea pigs (Cavia porcellus) were used in this study. Four animals were described through endoscopic view and four animals were used to describe topographic anatomy.

RESULTS

The main structures of middle ear were well identified through endoscopy view: oval and round window, ossicles and vascular structures. Temporal bone position, landmarks and its relations to skull are perceived with topographic description.

CONCLUSION

Topographic anatomic description allowed exposition of temporal bone relations for external surgical approaches. Alternatively, grooves and middle ear structures were identified and may be used to transcanal accesses.

ENT foreign bodies: profile of the cases seen at a tertiary hospital emergency care unit

Individuals often seek help with foreign bodies (FB) in their ears, noses, and throats. Proper recognition, study, and management of foreign bodies is required to prevent complications.

Objective

To analyze the profile of the patients seen for FB at a reference otorhinolaryngology emergency care unit between February of 2010 and January of 2011.

Method

Cross-sectional retrospective historical cohort study based on digitized patient charts.

Results

FB accounted for 827 cases and 5.3% of all patients seen in the ENT emergency unit. Children were affected more frequently, particularly when aged 8 and under. No statistically significant differences were seen between genders. Foreign bodies were mostly located in the ears (64.4%), followed by the nasal fossae (19.5%), and the oropharynx (8.9%). Complications were seen in 4.5% of the cases, and 4.4% required general anesthesia to have the FB removed.

Conclusion

In our ENT practice, foreign bodies were more commonly seen in children; the ears were the preferential site of occurrence. Complication rates and use of general anesthesia were low in our practice. It should be stressed that ENT foreign bodies need to be properly managed so as to avoid complications.

Systematic review of evidence on the association between personality and tinnitus

Introduction

Objective

Methods

Results

Conclusion

Effects of the reduction of caffeine consumption on tinnitus perception

Introduction

For many years, excessive caffeine consumption has been touted as an aggravating factor for tinnitus. The pathophysiology behind this effect is probably related to the blockage of adenosine receptors by the action of caffeine on the central nervous system.

Objective

To evaluate the effects of reduction of coffee consumption on tinnitus sensation and to identify subgroups more prone to benefit from this therapeutic strategy.

Study design

Prospective.

Methods

Twenty-six tinnitus patients who consumed at least 150 mL of coffee per day were selected. All were asked to reduce their coffee consumption. The Tinnitus Handicap Inventory (THI) questionnaire was completed by the patients before and after the reduction of coffee consumption, as well as a visual-analog scale (VAS) graduated from 1 to 10.

Results

THI and VAS scores were significantly reduced (p < 0.05). In the subgroups less than 60 years old, bilateral tinnitus and daily coffee consumption between 150 and 300 mL showed a significantly greater reduction of THI and VAS scores.

Conclusion

Patients under 60 years of age with bilateral tinnitus and daily coffee consumption between 150 and 300 mL are more prone to benefit from consumption reduction. Thirty-day observation periods may be helpful for a better therapeutical decision.

Glucocorticoid influence on prognosis of idiopathic sudden sensorineural hearing loss

Introduction

Idiopathic Sudden Sensorineural Hearing Loss (ISSHL) is defined when a loss of at least 30 dB occurs in over 3 continuous frequencies, in up to 72 hours, of which etiology is not established, despite adequate investigation. Different types of treatment regimens have been proposed, but only glucocorticoids have shown some evidence of benefit in the literature.

Objective

To analyze whether the type of treatment or time of treatment with glucocorticoids have any influence on hearing recovery in ISSHL.

Methods

Observational retrospective cohort study. One hundred twenty-seven patients with ISSHL, treated at outpatient clinics between the years 2000 and 2010, were studied. We evaluated the prognostic correlation of the type of treatment and time to treatment with glucocorticoids and ISSHL.

Results

The absolute hearing gain and the relative hearing gain was as follows: 23.6 dB and 37.2%. Complete recovery was observed in 15.7% of patients, significant recovery in 27.6% and recovery in 57.5%.

Conclusion

In this study, there was no difference between the use and nonuse of glucocorticoids in hearing improvement. However, when started within seven days after onset, the use of glucocorticoids was a factor of better prognosis.

Profile of otorhinolaryngology emergency unit care in a high complexity public hospital

Urgent and emergency care are common happenings in ENT practice and most carry low morbidity and mortality. There are but few studies that address the epidemiology of these situations.

Objective

To evaluate the epidemiological characteristics of care in the emergency department of otorhinolaryngology at a high complexity hospital.

Method

Epidemiological, cross-sectional study, retrospective with data collection carried out from medical records from the emergency department of otorhinolaryngology of a high complexity hospital in São Paulo, for a period of 12 months. Data collected: age, gender, clinical diagnosis and management. The cases were divided by subspecialty: otology, rhinology, pharyngolaryngealstomatology and head and neck surgery. We evaluated the level of urgency/emergency, etiology and monthly distribution of visits.

Results

17,503 medical records were obtained; 1,863 were excluded. Of the 15,640 cases included, the average age was 36.3 years. 9,818 (62.77%) corresponded to cases considered as emergency/ urgency. Among the urgency/emergency cases, 6,422 (65.41%) were diagnosed in the ear and among the 10 most prevalent diagnostics, 7 were in the subspecialty of otology.

Conclusion

Among the patients seen in the emergency department of otolaryngology evaluated in this study, 62.77% corresponded to cases of urgency/emergency, predominantly in the otology subspecialty.

Systematic review on the evidences of an association between tinnitus and depression

Tinnitus has been associated with several psychiatric disorders, however there are still several questions regarding such association.

Objective

To assess the scientific evidence on the associations between symptoms of depression, depression, and tinnitus.

Method

A systematic review was performed using PubMed, Lilacs, and SciELO scientific databases. This review included studies published in Portuguese, Spanish, or English correlating tinnitus with depression; letters to the editor and case reports were excluded.

Results

A total of 64 studies were identified, of which only 20 met the inclusion criteria and only 2 were case-control clinical trials. The majority of the studies (n = 18) found that depression is associated with tinnitus, either as a predisposition - resulting in poor adaptation to tinnitus or as a consequence of severe disease.

Conclusion

An overall assessment of all of the selected studies suggests at least 3 possible associations between depression and tinnitus: depression affecting tinnitus, tinnitus predisposing individuals to depression, and tinnitus appearing as a comorbidity in patients with depression. There is a high prevalence of depressive symptoms in individuals with tinnitus, but the mechanisms by which depression and tinnitus mutually interact, are not fully understood.

Comparação entre critérios de recuperação auditiva na perda neurossensorial súbita

The countless methods available to analyze hearing recovery in idiopathic sudden sensorineural hearing loss (ISSHL) cases hinder the comparison of the various treatments found in the literature.

Objective

This paper aims to compare the different criteria for hearing recovery in ISSHL found in the literature.

Materials and Methods

This is an observational clinical cohort study from a prospective protocol in patients with ISSHL, treated between 2000 and 2010. Five criteria were considered for significant hearing recovery and four for complete recovery by pure tone audiometry, using non-parametric tests and multiple comparisons at a significance level of 5%. After determining the stricter criteria for hearing recovery, vocal audiometry parameters were added.

Results

There was a significant difference between the criteria (p < 0.001) as they were analyzed together. Mild auditory recovery occurred in only 35 (27.6%) patients. When speech audiometry was added, only 34 patients (26.8%) showed significant improvement.

Conclusions

There is a lack of consistency among the criteria used for hearing recovery. The criterion of change of functional category by one degree into at least mild hearing recovery was the stricter. Speech audiometry did not prove essential to define significant hearing recovery.

Mastoidite e paralisia facial como manifestações iniciais de Granulomatose de Wegener

Wegener's Granulomatosis (WG) is characterized by necrotizing granulomas and vasculitis. If left untreated, the prognosis is poor – a 90% mortality rate within 2 years. Several authors have described the otologic manifestations of WG; these authors, however, have not mentioned the stage of the disease in which these findings present – whether as initial manifestations or subsequent to other findings.

Aim

To describe three confirmed cases of WG with mastoiditis as the first manifestation, progressing to peripheral facial paralysis (PFP).

Material and Method

A clinical series study. Patients diagnosed with WG that initially presented with otologic findings are described.

Results

The three cases presented with unilateral otalgia, otorrhea, and hearing loss associated with ipsilateral PFP. None recovered in spite of the treatment; an investigation of associated diseases was therefore undertaken. Positive ANCA-C titers where detected in all patients, confirming the diagnosis of WG. Clinical improvement was seen after treatment of WG; the PFP regressed and hearing thresholds improved partially.

Conclusion

Complications of otitis media (mastoiditis and PFP) that do not respond to the usual treatment require an investigation of associated diseases; WG should be included for an early diagnosis to change the prognosis in these patients.

Eficácia da avaliação audiométrica no tratamento medicamentoso da otospongiose

Otospongiosis is a primary osteodystrophy of the otic capsule that affects genetically predisposed individuals and leads to a progressive hearing loss.

Aim

To evaluate the applicability of audiometric evaluation during drug treatment for otospongiosis.

Materials and Methods

A prospective, randomized, controlled, double-blind study involving 26 patients with clinical, audiometric and CT scan image of otosclerosis. Patients eligible for the study were divided into three groups (A, B and C) and received treatment with alendronate sodium (B), sodium fluoride (C) and placebo (A) for 6 months. After this period they were submitted to new tests.

Results

There were not statistically significant differences between air and bone conduction (gap). We also found no differences in the speech recognition threshold (SRT) and speech discrimination (IRF) between before and after treatment.

Conclusion

After six months of drug treatment the audiometric evaluation kept the same hearing thresholds, suggesting stabilization of the otospongiotic lesions.

Retrograde Guided Balloon Dilatation Eustachian Tuboplasty

Objective: Evaluate a new option for treatment of patients with Eustachian tube stenosis.

Method: Prospective surgical study. Three patients with unilateral intractable Eustachian tube stenosis (after surgical procedures) underwent retrograde illumination with Relieva Luma Sentry from middle ear to nasopharyngeal area and with endoscopic nasal approach to balloon dilatation to that area under general anesthesia. The procedures were done between 2010 and 2011.

Results: By following the light that was dissected through the stenosis tissue until we could have the Relieva Luma Sentry, we then inserted it retrograde inside a sphenoid balloon catheter and inserted the balloon inside a tubal lumen. After that, the balloon was inflated for 2 minutes with 10 atm to tubal dilatation. The approach to the middle ear was done transtympanically. Balloon catheters had success in dilatation in all cartilaginous Eustachian tubes. Balloon dilatation was not difficult to perform. Patients reported a very good improvement of hearing levels and a good dilatation comparing the tomography before and two months after the procedure.

Conclusion: Retrograde guided balloon dilatation of the nasopharyngeal Eustachian tube ostia showed good results. Larger studies are now needed to show the real role of this surgery.

Perda auditiva neurossensorial súbita idiopática: evolução na presença de hipertensão arterial sistêmica, diabetes melito e dislipidemias

Retrospective study aiming at evaluating the interference of associate diseases in the evolution and prognosis of idiopathic sudden sensorineural hearing loss.

Presentation, treatment, and clinical course of otogenic lateral sinus thrombosis

CONCLUSIONS

Otogenic lateral sinus thrombosis (OLST) is almost always associated with other complications of chronic otitis media (COM) and did not present a distinct clinical expression. In our experience, OLST exhibits a benign course if the underlying disease is controlled. Mastoidectomy in combination with broad-spectrum antibiotics provided effective treatment. Anticoagulation therapy is no longer used routinely. Recanalization is rare and is independent of the use of anticoagulants.

OBJECTIVES

This study aimed to contribute to the understanding of the clinical aspects and evolution of OLST.

PATIENTS AND METHODS

The study investigated a retrospective case series in a tertiary teaching hospital. From 1993 to 2007, eight cases of OLST were treated. The clinical and imaging data, treatments, and outcomes were analyzed. The follow-up period ranged from a minimum of 6 months to 5 years.

RESULTS

In all eight patients, the lateral sinus thrombosis was detected by imaging studies performed to evaluate complications and symptoms related to COM. Fever, headache, and cranial nerve paralysis were the main clinical manifestations associated with coexisting mastoiditis, meningitis, and cerebellar and epidural abscess. We could not identify features specific to lateral sinus thrombosis in any case. All patients underwent mastoidectomy and were given broad-spectrum antibiotics for 2 months. Four cases were anticoagulated and all eight cases experienced complete clinical recovery without sequelae.

Effect of trans-retinoic acid in the inhibition of cholesteatoma in guinea pigs

Middle ear cholesteatoma affected more than 5 million people until the 80;s. Many animal models were used, unsuccessfully, to study an alternative therapy to cholesteatoma.

AIM

observe the effect of the trans-retinoic acid in the inhibition of middle ear cholesteatomas induced by propylene glycol.

STUDY DESIGN

Clinical and Experimental.

METHODS

25 guinea pigs were submitted to the application of a 100% propylene glycol solution in their bulla bilaterally and a solution of trans-retinoic acid was applied locally in the external right ear, while in the left ear saline solution was applied (control ear). The guinea pigs were slaughtered and their temporal bones were prepared for macroscopic and histological analysis.

RESULTS

The macroscopic findings had evidenced the presence of cholesteatoma in 25% of the right ears and 85% of the left ears (P=0.0003 *). The histological study had evidenced the presence of cholesteatoma in 30% of right ears and 75% of the left ears (P=0.0104*).

CONCLUSION

The local use of the trans-retinoic acid is effective in inhibiting the induced formation of cholesteatomas in guinea pigs.

Vestibular Schwannoma: spontaneous tumor involution

The natural history of Vestibular Schwannomas (VS) is yet not totally known, but most of them have the tendency to slow growth, sometimes without any kind of symptoms during the individual's entire time. About 69% of diagnosed VS do not grow at all and 16% of these can even regress. Considering tumors that grow, about 70% have grown less than 2mm an year. Advanced radiological diagnosis, especially magnetic resonance imaging with gadolinium helps us diagnose small and less symptomatic tumors. Treatment of choice still is complete tumor resection. Surgical approaches have improved considerably and have helped preserve facial nerve function and hearing. Considering VS's natural history, there is a possibility for conservative treatment for these tumors, because their growth in the first year after diagnosis predicts tumor growth behavior in the next years. Surgery should be done in cases of tumor growth, patient's desire or symptoms worsening. Moreover, in terms of postoperative sequelae, there is no difference between patients who underwent surgery immediately after diagnosis and those who underwent initial conservative treatment for these tumors.

Efeito do ácido trans-retinóico na inibição de colesteatoma em cobaias

O colesteatoma de orelha média atingia mais de 5 milhões de pessoas até a década de 80. Vários modelos animais já foram utilizados para alternativas de tratamento do colesteatoma sem sucesso. OBJETIVO: Estudar os efeitos do ácido trans-retinóico, uso tópico na orelha externa em cobaias, na inibição da formação do colesteatoma de orelha média induzido pelo propilenoglicol. Estudo experimental prospectivo. MATERIAL E MÉTODOS: 25 cobaias foram submetidas à aplicação de propilenoglicol a 100% na bula timpânica bilateralmente e uma solução de ácido trans-retinóico foi aplicada topicamente (total de 5 aplicações) na orelha externa, região justa-timpânica, na orelha direita, enquanto na orelha esquerda aplicou-se solução fisiológica (orelha controle). As cobaias foram sacrificadas após 6 semanas do procedimento inicial e os ossos temporais foram separados, fixados e descalcificados, para análise macroscópica e histológica. RESULTADOS: Os achados macroscópicos evidenciaram a presença e suspeita de colesteatoma em 25% das orelhas direitas e 85% das orelhas esquerdas (P=0,0003*). Os achados histológicos dos 40 ossos temporais evidenciaram a presença de colesteatoma em 30% das orelhas direitas e 75% das orelhas esquerdas (P=0,0104*). CONCLUSÃO: O uso tópico do ácido trans-retinóico é efetivo na inibição da formação de colesteatoma induzido pelo propilenoglicol em cobaias.

Matrix metalloproteinase 2: an important genetic marker for cholesteatomas

AIM

This study is to determine the MMP2s presence in cholesteatomas and whether complicating cholesteatomas show a higher immunohistochemical expression of matrix metalloproteinase 2. Cholesteatoma produces enzymes that cause bone erosion like matrix metalloproteinase 2 (MMP2).

MATERIAL AND METHODS

We analyzed the expression of MMP2 in invasive (causing complications) compared to latent cholesteatomas (not causing complications). A cross-sectional study with nineteen slides and paraffin blocks of cholesteatomas derived from mastoidectomies were located and processed, including 8 invasive and 11 latent cholesteatomas. Immunohistochemical technique was empregated to MMP2.

RESULTS

The results are expressed as 0, + (to low), ++ and +++(high) according to the quantity and color of the immunohistochemical staining of MMP2. Higher expression of MMP2 was observed in 7 (87.5%) of the 8 invasive cholesteatomas. With respect to latent cholesteatomas, higher expression of MMP2 was observed in 27.3% (3 cases), with Fishers exact test indicating a significant difference (p=0.015).

CONCLUSIONS

Cholesteatoamas express MMP2 and Invasive cholesteatomas had high MMP2 compared to latent cholesteatomas.

Sigmoid sinus thrombosis associated to chronic otitis media

Otogenous lateral sinus thrombosis (OLST) is a rare disease and presents a controversial treatment.

AIM

Clinical aspects and treatment were reported based on our experience.

METHODS

Retrospective study. Six cases of OLST were treated in our institution in the last ten years. Clinical and imaging data were analyzed.

RESULTS

All six patients had the lateral sinus thrombosis detected during image evaluation for other symptoms related to chronic otitis media (COM) complications. Fever, headache and facial paralysis were the main clinical manifestation related to mastoiditis, meningitis and cerebellar abscess. We could not identify, in any case, specific features of lateral sinus thrombosis. In all cases a mastoidectomy was associated with large spectrum antibiotics maintained for 3 months. In three cases anticoagulation therapy was introduced and in three cases anticoagulation was not indicated. All cases presented a good clinical evolution, without sequelae.

CONCLUSIONS

OLST is almost always associated with other complications of COM. It is diagnosed almost by accident during the investigative image study. We believe such disease is underestimated. In our experience, OLST presents a benign course, and mastoidectomy with antibiotics is the treatment of choice.