Head and Neck Diseases by Alexandros G.Sfakianakis: 08/09/18

Πέμπτη 9 Αυγούστου 2018

Coastal erosion—a “new” land-based source of labile mercury to the marine environment

Abstract

Mercury (Hg) can be introduced into the marine environment in many different ways. In the case of the Baltic Sea, rivers and atmospheric deposition are the predominant ones. However, in the face of ongoing climate change, a new potential source, coastal erosion, is starting to become more important and is currently considered to be the third largest source of Hg in the Gdansk Basin region. It is especially significant along sections of coastline where, due to the higher frequency of extreme natural phenomena such as storms, heavy rains, and floods, increased erosion processes have already been noted. Cliffs, which account for about 20% of the Polish coastline, are particularly vulnerable. The aim of the study was to estimate the annual load of labile Hg entering the Gdansk Basin as a result of coastal erosion. Samples of down-core sediments (0–65 cm) were collected in the years 2016–2017 from selected cliffs situated in the Gulf of Gdansk area. The thermodesorption method was used to distinguish between labile and stable fractions of Hg. Considering the mean total Hg concentrations in the collected sediments (9.7 ng g⁻¹) and the mean share of labile (64%), bioavailable mercury, it was estimated that the load of labile Hg originating from coastal erosion entering the Gdansk Basin is 10.0 kg per year. The load can increase by up to 50% in the case of episodic abrasion events during heavy storms and rains.

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Lower Circulating Androgens Are Associated with Overall Cancer Risk and Prostate Cancer Risk in Men Aged 25–84 Years from the Busselton Health Study

Abstract

Androgens, notably testosterone (T), have been implicated in development of several common cancers and prostate cancer; however, precise mechanisms remain unclear. This study assessed prospective associations of serum T, dihydrotestosterone (DHT) and estradiol (E2) with overall cancer (excluding skin cancer), prostate, colorectal and lung cancer risk in 1574 community-dwelling men aged 25–84 years. Sex hormones were assayed using mass spectrometry and men were followed for 20 years with outcomes ascertained using data linkage. Over 20 years, there were 289, 116, 48 and 22 men who developed any cancer, prostate cancer, colorectal cancer and lung cancer, respectively. Androgens in the lowest quartile were associated with an increased overall cancer risk (HR = 1.36, 95% CI 1.05–1.76, p = 0.020 for T; and HR = 1.30, 95% CI 1.00–1.69, p = 0.049 for DHT comparing the lowest vs other quartiles). T in the lowest quartile was associated with an increased risk of prostate cancer (HR = 1.53, 95% CI 1.02–2.29, p = 0.038 comparing the lowest vs other quartiles). The association between androgens and overall cancer risk remained similar after excluding prostate cancer outcomes; however, results were not significant. There were no associations of T, DHT or E2 with colorectal or lung cancer risk; however, LH in the highest quartile was associated with an increased risk of lung cancer (HR = 4.55, 95% CI 1.70–12.19, p = 0.003 for the highest vs other quartiles). Whether T is a biomarker of poor health in men with any cancer or prostate cancer requires further confirmation as does the nature and mechanism of the association of a high LH with future lung cancer.

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Efficacy and Safety of Topical Cantharidin Treatment for Molluscum Contagiosum and Warts: A Systematic Review

Abstract

Background and Objective

Topical cantharidin is routinely used for the treatment of molluscum contagiosum and warts. The objective of this systematic review is to assess the efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts.

Methods

We performed a systematic review of studies assessing topical cantharidin treatment of molluscum contagiosum or warts. We searched the databases of Cochrane, EMBASE, GREAT, LILACS, MEDLINE, and Scopus. Two authors performed the study selection and data extraction.

Results

Twenty studies (1958–2018) met inclusion/exclusion criteria. Twelve studies assessed warts, and eight studies assessed molluscum contagiosum. Overall, 1752 patients were included (range 0.3–62 years; specified in 15 studies). Clearance rates with topical cantharidin for molluscum contagiosum were variable (range 15.4–100%). Significant clearance of warts with maintenance of clearance was demonstrated with topical cantharidin alone. Topical cantharidin in combination with podophyllotoxin and salicylic acid demonstrated efficacy for plantar warts (pediatric and adult; clearance rate range 81–100%; four studies had 100% clearance), with the majority clearing after a single treatment. Satisfaction with cantharidin therapy was high, especially in molluscum contagiosum. Pain (7–85.7%), blistering (10–100%), and hyper-/hypopigmentation (1.8–53.3%) were the most commonly occurring adverse effects with cantharidin treatment.

Conclusion

Topical cantharidin demonstrated clearance of warts, particularly in combination with podophyllotixin and salicylic acid, and modest benefit for pediatric molluscum contagiosum with good tolerability and safety.

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Subcutaneous Mastectomy Improves Satisfaction with the Body and Psychosocial Function in Trans Men; Findings of a Cross-Sectional Study Using the BODY-Q Chest Module

Background: The effectiveness of gender confirming surgery is best evaluated on the basis of patient-reported outcomes such as appearance satisfaction and health-related quality of life. This is the first explorative study using the BODY-Q chest module, administered in trans men before and after mastectomy. Methods: Between October 2016 and May 2017, trans men were recruited to participate in a cross-sectional study. Data collection included standardized anamnesis and examination, screening questions on depression/anxiety, and seven BODY-Q scales, including new scales measuring satisfaction of the chest and nipples. Mean scores for pre- and post-operative participants were compared, and explorative regression analyses were conducted to identify factors associated with BODY-Q scores. Results: In total, 101 persons participated (89%; 50 pre-operative, 51 post-operative). Post-operative participants reported significantly higher (better) scores on the chest (M=67), nipple (M=58), body (M=58; t-tests, all p<.001 and psychological t-test p=".05)" scales compared with pre-operative patients. post-operative chest nipple mean scores did not differ significantly from a gynecomastia comparison whilst were less favorable on the psychosocial domains. pre-operatively associated objective breast size. lower planned revision surgery depressive symptoms as indicated by screening question. conclusions: present findings indicate that satisfaction differences in trans men undergoing mastectomy can be detected using body-q module. future prospective studies are needed to measure clinical change how this relates changes other aspects of health-related quality life. is an open-access article distributed under terms creative commons attribution-non commercial-no derivatives license where it permissible download share work provided properly cited. cannot changed any way or used commercially without permission journal. financial disclosure: anne klassen co-developer may receive revenues. remaining authors have no disclosures. acknowledgements: would like thank study participants developers well m marlon buncamper for their assistance data collection floyd timmermans editing final manuscript. corresponding author: tim c. van de grift vu university medical center p.o. box mb amsterdam netherlands society plastic surgeons>

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Hybrid Pre-pectoral Breast Reconstruction – A Surgical Approach that Combines the Benefits of Autologous and Implant-based Reconstruction

Background: The advantages of hybrid breast reconstruction, i.e. the combination of free tissue transfer with simultaneous implant placement, are well-known. In an attempt to further minimize morbidity and simplify the procedure, the authors have modified their approach in that a pre-pectoral approach is now routinely chosen. Methods: A retrospective analysis of patients who underwent immediate microsurgical breast reconstruction with simultaneous pre-pectoral implant placement was performed. Clinical outcomes and postoperative complications were examined. Results: A total of 23 patients with a mean age of 46.6 years (range, 26 - 72 years) and mean BMI of 25.8 kg/m2 (range, 21.4 to 32.1) underwent reconstruction with 46 free flaps with simultaneous pre-pectoral silicone gel implant placement. The most common implant volume was 210 cc (range, 150 - 255 cc). Postoperative complications included hematoma (N=1 [4.3%]), mastectomy skin necrosis (N=5 [21.7%]), fat necrosis (N=3 [13%]), and delayed wound healing at the flap donor-site (N=4 [17.4%]). No case of implant malposition, implant infection, flap loss, or "red breast" syndrome was encountered during a mean follow-up of 8.4 months (range, 2 - 17 months). Conclusion: Pre-pectoral hybrid breast reconstruction is a safe procedure that combines the benefits of autologous and implant-based reconstruction. While the transfer of well-vascularized soft tissue allows reconstruction of natural breast ptosis, the addition of an implant provides the desired projection, however, without being associated with complications such as rippling or animation deformity. Financial Disclosure: Dr. Momeni is a consultant for Allergan, AxoGen, Inc., and Stryker Corporation. Dr. Kanchwala is a consultant for AxoGen, Inc. No compensation or support was received for this study. Acknowledgement: The authors would like to thank Dr. Sarah Sorice Virk for preparing the medical illustrations. Corresponding author: Arash Momeni, MD, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, 770 Welch Road, Suite 400, Palo Alto, CA 94304, Phone: 650-723-6189, Email: amomeni@stanford.edu ©2018American Society of Plastic Surgeons

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Perioperative Ketorolac Use and Postoperative Hematoma Formation in Reduction: A Single Surgeon Experience of 500 Consecutive Cases

Background: In light of the escalating opioid crisis, surgeons are increasingly focused on minimizing opioid use. Ketorolac has well-documented opioid-sparing effects in the postoperative period; however, its use is limited due to concerns of postoperative bleeding and hematoma formation. This study explores the relationship between hematoma formation and administration of perioperative ketorolac in adolescent females and young adult women undergoing reduction mammaplasty. It also aims to determine the effect of perioperative ketorolac administration on the requirement for opioid analgesia. Methods: We reviewed the medical records of 500 consecutive female patients who underwent reduction mammaplasty for bilateral macromastia from 2007-2017. We collected data pertaining to perioperative analgesia use and postoperative hematoma formation. Results: Five-hundred patients were included in analyses. The average age was 18.1 ± 2.2 years. Three hundred and eighty-nine (77.8%) patients received intravenous ketorolac during the perioperative period. Seven (1.4%) patients developed a postoperative hematoma. Hematoma was not associated with intraoperative ketorolac use, postoperative ketorolac use, or any perioperative ketorolac use (p>0.43, all). Intraoperative ketorolac use was associated with lower total intraoperative dosing of fentanyl and morphine and lower total postoperative dosing of oxycodone and morphine (p

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Breast Implant Mycobacterial Infections – An Epidemiological Review and Outcome Analysis

Background: Epidemiological evidence of periprosthetic mycobacterial infections (PMIs) is limited. The recent boom in cosmetic surgery tourism has been associated with a rise of surgical site infections (SSIs) in returning patients. This review aims to explore available data, examine trends of documented PMIs and analyze outcomes of management techniques. Methods: A search in Biosis, Embase, LILACS, Medline, and Web of Science databases from inception until December 2017 for "Breast Implants" and "Mycobacterial Infections" and equivalents was performed. Data were pooled after two screening rounds following full-text retrieval and cross-referencing. Results: Forty-one reports describing 171 female patients who had breast prosthesis-related mycobacterial infections were identified. Bibliometric case-based analysis revealed a rise of PMIs in developing countries since the start of the millennia. The mean age was 37.9 years and the majority of cases followed bilateral breast augmentation. Most patients presented with breast pain or tenderness, after an average incubation period of nine months. M. fortuitum was isolated from 90 (52.6%) of cases. Immediate explantation, with or without delayed re-implantation was most commonly employed surgical strategy, complemented by combination antimicrobial therapy for an average of 4.6 months. The mean follow-up time was 39.7 months, during which recurrences were observed in 21/171 patients (12.3%). Conclusion: The emergence of PMIs in relation to cosmetic medical tourism alerts clinicians to the importance of educating the public about the associated risks. In addition, this study identifies risk factors associated with recurrence of PMIs. Conflicts of Interest: None of the authors has a financial interest in this manuscript. Source of Funding: No funds were received in support of this study. Address correspondence and reprint requests to: Omar Fouda Neel, MBBS, MMgt, FRCSC, FAAP, FACS, Division of Plastic Surgery, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC H4A 3J1, Canada Phone Number: 5142249054 , Fax Number: 5142249054 , Email: foudaneel@gmail.com ©2018American Society of Plastic Surgeons

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High Resolution Computed Tomography of Temporal Bone: The Predictive Value in Atticoantral Disease

Abstract

To evaluate predictive value of high resolution computed tomography in atticoantral disease. We conducted a prospective observational study in 49 patients suffering from atticoantral disease at tertiary referral institute. Preoperatively, all the patients underwent unenhanced high resolution computed tomography (HRCT) of temporal bone parallel to orbitomeatal line by using multislice scanner. We evaluated presence of soft tissue attenuation, ossicular erosion, facial canal erosion, dural exposure, erosion of semicircular canal, labyrinthine fistula, erosion of scutum and tegmen tympani in CT scan. HRCT is recommended in atticoantral disease with complications. This study demonstrates the predictive value of HRCT of temporal bone as a diagnostic modality in atticoantral disease. HRCT shows 100% sensitivity (Sn) of soft tissue density detected in middle ear, aditus and attic. Specificity (Sp) was more for eustechian tube area and sinus tympani. Ossicular erosions of malleus (Sn = 90.9%, Sp = 75%), incus (Sn = 93.2%, Sp = 80%), stapes (Sn = 78.8%, Sp = 68.8%) were detected. Erosion of scutum (Sn = 94.1%, Sp = 80%), tegmen (Sn = 66.7%, Sp = 100%), sinus plate (Sn = 100%, Sp = 97.9%), facial nerve canal (Sn = 75%, Sp = 100%), semicircular canal fistula (Sn = 80%, Sp = 97.7%) and cochlear promontory fistula (Sn = 50%, Sp = 97.9%) were evaluated. HRCT temporal bone helps to evaluate disease extent and involvement of surrounding structures. Hence it helps in deciding surgical approach and also prevents impending complications.

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Maffucci Syndrome with Clival Enchondroma in Nasopharynx: A Case Report

Abstract

Maffucci syndrome is an extremely rare sporadic disease, characterized by multiple enchondromas and associated with multiple hemangiomas and/or lymphangiomas. First case was reported in 1881, and fewer than 200 case have been reported to date. Potential sarcomatous malignant transformation have been noticed in previous cases. This report describes the case of 21 years-old male complain of right sided nasal obstruction for 10 months, and right sided aural fullness. Examination revealed multiple asymptomatic nodules in both hands since childhood, that have not been investigated and a large nasopharyngeal mass. Computed tomography, showed a 36 mm in 30 mm diameter lesion extending from the inferior aspect of the clivus and basisphenoid into the nasopharynx, which did not seems to be highly vascular with angiogram. Incidental radiological findings of multiple bubbly lytic bony lesions. Endoscopic sinus surgery and clival lesion excision was performed. Pathology confirmed diagnosis of clival enchondroma with clinical and radiological features consistent with Maffucci syndrome. Clear etiology have not been established yet. Mutations in gene encoding parathyroid hormone receptor 1 found in 10% of enchondromatosis. Mutations in gene encoding isocitrate dehydrogenase 1 and 2 (IDH 1&2) occur in some enchondromas and spindle cell hemangiomas. Maffucci syndrome usually presents with asymmetrical distribution of multiple enchondromas. Malignant transformation is the most concerning potential sequel. Many studies have shown sarcomatous degeneration of enchondromas to chondrosarcomas in average of 25% of cases. Patient counselling and education are crucial in the management. Surgical excision usually for symptomatic patients and suspicious lesions. Nevertheless, all patient of Maffucci syndrome will require a long term follow up and surveillance for the lifelong risk of malignant transformation. Maffucci syndrome diagnosis based on clinical presentation, radiological and histopathological findings. Surgical excision offered for symptomatic patients and for suspicious lesions. Lifelong risk of sarcomatous malignant transformation necessitate a long term surveillance.

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High Resolution Computed Tomography of Temporal Bone: The Predictive Value in Atticoantral Disease

Abstract

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Maffucci Syndrome with Clival Enchondroma in Nasopharynx: A Case Report

Abstract

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MyD88 signaling in T regulatory cells by endogenous ligands dampens skin inflammation in filaggrin deficient mice

Publication date: Available online 9 August 2018

Source: Clinical Immunology

Author(s): Sabine Hoff, Michiko K. Oyoshi, Jason L. Hornick, Raif S. Geha, NIH/NIAID funded Atopic Dermatitis Research Network

Abstract

Mutations in filaggrin are associated with atopic dermatitis. Filaggrin-deficient flaky tail (Flg^ft/ft) mice develop spontaneous inflammatory skin lesion that wax and wane. We show that loss of MyD88 promotes the persistence of skin lesions in Flg^ft/ft mice and exaggerates their expression of the Th17-associated cytokines Il7a and Il22. The development and persistence of skin lesions in Flg^ft/ft mice was independent of the microbiota. MyD88-mediated signals are shown to be important for the accumulation of T regulatory cells (Tregs) in lesional skin of Flg^ft/ft mice. Adoptive transfer of WT Tregs dampened the severity of skin lesions in MyD88^−/−/Flg^ft/ft mice. These results suggest that MyD88 signaling in Treg cells by endogenous ligands attenuates skin inflammation in filaggrin deficiency.

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Post-traumatic thrombotic microangiopathy following pelvic fracture treated with transcatheter arterial embolization: a case report

Thrombotic microangiopathy is caused by various conditions, but few cases secondary to trauma have been reported. We present the rare case of a patient with thrombotic microangiopathy-induced high-impact traum...

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Changes of spatial and temporal characteristics of dynamic postural control in children with typical neurodevelopment with age: results of a multicenter pediatric study

Publication date: Available online 9 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Nathalie Goulème, Michel Debue, Karen Spruyt, Catherine Vanderveken, Danièle Romolo De Diati, José Ortega-Solis, Jennifer Petrossi, Sylvette Wiener-Vacher, Maria Pia Bucci, Eugen Ionescu, Hung Thai-Van, Naïma Deggouj

Abstract

Background

The aim of this multicenter study is to investigate the effect of chronological age and gender in postural control.

Methods

To approach an ecological model, we used a multicenter posturography assessment. We analyzed postural control with surface, mean velocity of center of pressure [CoP] and temporal analysis, with Postural Instability Index [PII] being a more sensitive parameter in postural evaluation. A large sample of 156 age- and gender-matched healthy children recruited in several pediatrics hospitals, participated.

Results

Our current results showed a significant decrease of all postural parameters (surface, mean velocity of CoP and PII) with age, and only on stable support condition. Our study additionally described a gender effect in conditions where all sensory inputs are most challenged with a mean velocity of CoP being significantly smaller in girls with respect to boys.

Conclusion

We concluded that postural control improves with age linked with maturation process. Moreover, this maturation process seems not yet achieved at 16.08 years and still ongoing beyond. Interestingly, our result reported specificities linked with gender effect. Indeed, girls and boys do not proceed in the same way to maintain their postural control. We could make hypothesis that more children maintain their postural control efficiently; with a low energy cost, the more they could allocate attention to learning during childhood.

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Tracing the sources of suspended sediment and particle-bound trace metal elements in an urban catchment coupling elemental and isotopic geochemistry, and fallout radionuclides

Abstract

The excessive supply of contaminants from urban areas to rivers during the last centuries has led to deleterious impacts on aquatic ecosystems. The sources, the behavior, and the dynamics of these contaminants must be better understood in order to reduce this excessive anthropogenic pollution. Accordingly, the current research investigated the particle-bound trace element (TE) contamination of the 900-km² Orge River (Seine basin, France) and the potential sources of these particles (agricultural or forest soils, channel banks, road deposited sediments), through the analysis of multiple fallout radionuclides, elemental geochemistry, and lead isotopic composition on suspended particulate matter (SPM) collected during a hydrological year at four stations following an increasing urbanization gradient (300 to 5000 inhab.km⁻²). Fallout radionuclide measurements showed an increasing contribution of recently eroded particles from urban areas to the SPM in downstream direction. However, this contribution varied depending on hydrological conditions. A greater contribution of particles originating from urban areas was observed during low stage periods. On the contrary, the contribution of agricultural soils and channel banks that are less enriched in contaminants and fallout radionuclides was higher during seasonal floods, which explained the dilution of radionuclide contents in sediment transiting the river during those events. Trace element contamination of SPM in Cu, Zn, Pb, and Sb increased from moderate to significant levels with urban pressure in downstream direction (with corresponding enrichment factors raising from 2 to 6). In addition, Pb isotopic ratios indicated that the main source of Pb corresponded to the "urban" signature found in road deposited sediments. The low variations in lead isotope ratios found in the SPM for contrasting hydrological conditions demonstrated the occurrence of a single source of Pb contamination. These results demonstrate the need to better manage urban runoff during both flood and low precipitation events to prevent the supply of diffuse particle-bound contamination to rivers draining urban areas.

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Development of hybrid processes for the removal of volatile organic compounds, plasticizer, and pharmaceutically active compound using sewage sludge, waste scrap tires, and wood chips as sorbents and microbial immobilization matrices

Abstract

This study evaluated the reutilization of waste materials (scrap tires, sewage sludge, and wood chips) to remove volatile organic compounds (VOCs) benzene/toluene/ethylbenzene/xylenes/trichloroethylene/cis-1,2-dichloroethylene (BTEX/TCE/cis-DCE), plasticizer di(2-ethylhexyl) phthalate (DEHP), and pharmaceutically active compound carbamazepine from artificially contaminated water. Different hybrid removal processes were developed: (1) 300 mg/L BTEX + 20 mg/L TCE + 10 mg/L cis-DCE + tires + Pseudomonas sp.; (2) 250 mg/L toluene + sewage sludge biochar + Pseudomonas sp.; (3) 100 mg/L DEHP + tires + Acinetobacter sp.; and (4) 20 mg/L carbamazepine + wood chips + Phanerochaete chrysosporium. For the hybrid process (1), the removal of xylenes, TCE, and cis-DCE was enhanced, resulted from the contribution of both physical adsorption and biological immobilization removal. The hybrid process (2) was also superior for the removal of DEHP and required a shorter time (2 days) for the bioremoval. For the process (3), the biochar promoted the microbial immobilization on its surface and substantially enhanced/speed up the bioremoval of toluene. The fungal immobilization on wood chips in the hybrid process (4) also improved the carbamazepine removal considerably (removal efficiencies of 61.3 ± 0.6%) compared to the suspended system without wood chips (removal efficiencies of 34.4 ± 1.8%). These hybrid processes would not only be promising for the bioremediation of environmentally concerned contaminants but also reutilize waste materials as sorbents without any further treatment.

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Chronic laryngopharyngeal vagal neuropathy

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Comparison of the recovery rate of otomycosis using betadine and clotrimazole topical treatment

Abstract Introduction Otomycosis is a common diseases that can be associated with many complications including involvement of the inner ear and mortality in rare cases. Management of otomycosis can be challenging, and requires a close follow-up. Treatment options for otomycosis include local debridement, local and systemic antifungal agents and utilization of topical antiseptics. Objective This study was designed to compare the recovery rate of otomycosis using two therapeutic methods; topical betadine (Povidone-iodine) and clotrimazole. Methods In this single-blind clinical trial, 204 patients with otomycosis were selected using a non-probability convenient sampling method and were randomly assigned to two treatment groups of topical betadine and clotrimazole (102 patients in each group). Response to treatment was assessed at 4, 10 and 20 days after treatment. Data were analyzed using the independent t-test, Chi-Square and Fisher exact test in SPSS v.18 software, at a significance level of p < 0.05. Results The results showed that out of 204 patients with otomycosis, fungi type isolated included Aspergillus in 151 cases (74%), and Candida albicans in 53 patients (26%). On the fourth day after treatment, 13 patients (13.1%) in the group treated with betadine and 10 patients (9.8%) in the group treated with clotrimazole showed a good clinical response to treatment (p = 0.75). A good response to treatment was reported for 44 (43.1%) and 47 patients (46.1%) on the tenth day after the treatment (p = 0.85); and 70 (68.6%) and 68 patients (67.6%) on the twentieth day after treatment (p = 0.46) in the groups treated with betadine and clotrimazole, respectively. The response to treatment was thus not significantly different in the two groups. Conclusion In the present study the efficacy of betadine and clotrimazole was the same for the treatment of otomycosis. The result of this study supports the use of betadine as an effective antifungal in otomycosis treatment, helping to avoid the emergence of resistant organisms.

Resumo Introdução A otomicose é uma das doenças comuns associadas a muitas complicações, como envolvimento da orelha interna e mortalidade em casos raros. O tratamento da otomicose pode ser realmente desafiador e requer um acompanhamento rigoroso. As opções de tratamento para otomicose podem incluir desbridamento local, agentes antifúngicos locais e sistêmicos e uso de antissépticos tópicos, os medicamentos tópicos recomendados para o tratamento da otomicose. Objetivo Comparar a taxa de recuperação de otomicose utilizando dois métodos terapêuticos de betadina tópica (povidona-iodo) e clotrimazol. Método Neste ensaio clínico simples cego, 204 pacientes com otomicose foram selecionados utilizando-se método de amostragem de não probabilidade conveniente e randomizados para dois grupos de tratamento, com betadina tópica e com clotrimazol (102 pacientes em cada grupo). A resposta ao tratamento foi avaliada aos 4, 10 e 20 dias após o tratamento. Os dados foram analisados utilizando o teste t independente, qui-quadrado e teste de Fisher no software SPSS v.18, com nível de significância de p < 0,05. Resultados Os resultados mostraram que dos 204 pacientes com otomicose, os tipos de fungos isolados incluíram Aspergillus em 151 casos (74%) e Candida albicans em 53 pacientes (26%). No quarto dia após o tratamento, 13 pacientes (13,1%) no grupo tratado com betadina e 10 pacientes (9,8%) no grupo tratado com clotrimazol apresentaram boa resposta ao tratamento (p = 0,75). Uma boa resposta ao tratamento foi relatada para 44 (43,1%) e 47 pacientes (46,1%) no décimo dia após o tratamento (p = 0,85); e 70 (68,6%) e 68 pacientes (67,6%) no vigésimo dia após o tratamento (p = 0,46) no grupo tratado com betadina e clotrimazol, respectivamente. Assim, a resposta ao tratamento não foi significativamente diferente nos dois grupos. Conclusão No presente estudo, a eficácia da betadina e do clotrimazol foi a mesma no tratamento da otomicose. O resultado deste estudo apoia o uso de betadina como um antifúngico eficaz no tratamento da otomicose que pode ajudar a evitar o surgimento de organismos resistentes.

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Body mass index and acoustic voice parameters: is there a relationship?,

Abstract Introduction Specific elements such as weight and body volume can interfere in voice production and consequently in its acoustic parameters, which is why it is important for the clinician to be aware of these relationships. Objective To investigate the relationship between body mass index and the average acoustic voice parameters. Methods Observational, cross-sectional descriptive study. The sample consisted of 84 women, aged between 18 and 40 years, an average of 26.83 (±6.88). The subjects were grouped according to body mass index: 19 underweight; 23 normal ranges, 20 overweight and 22 obese and evaluated the fundamental frequency of the sustained vowel [a] and the maximum phonation time of the vowels [a], [i], [u], using PRAAT software. The data were submitted to the Kruskal-Wallis test to verify if there were differences between the groups regarding the study variables. All variables showed statistically significant results and were subjected to non-parametric test Mann-Whitney. Results Regarding to the average of the fundamental frequency, there was statistically significant difference between groups with underweight and overweight and obese; normal range and overweight and obese. The average maximum phonation time revealed statistically significant difference between underweight and obese individuals; normal range and obese; overweight and obese. Conclusion Body mass index influenced the average fundamental frequency of overweight and obese individuals evaluated in this study. Obesity influenced in reducing maximum phonation time average.

Resumo Introdução Elementos específicos, como peso e volume corporal podem interferir na produção da voz e, consequentemente, em seus parâmetros acústicos, razão pela qual é importante que o médico esteja ciente dessas relações. Objetivo Investigar a relação entre o índice de massa corporal e os parâmetros acústicos médios da voz. Método Estudo observacional, transversal, descritivo. A amostra foi composta por 84 mulheres, com idade entre 18 e 40 anos, média de 26,83 (± 6,88). As participantes foram agrupadas de acordo com o índice de massa corporal: 19 abaixo do peso; 23 com intervalos normais, 20 com sobrepeso e 22 obesos e avaliadas quanto a frequência fundamental da vogal sustentada [a] e o tempo máximo de fonação das vogais [a], [i], [u], utilizando o software PRAAT. Os dados obtidos foram submetidos ao teste de Kruskal-Wallis para verificar se houve diferença entre os grupos com relação as variáveis do estudo. Todas as variáveis apresentaram resultados estatisticamente significativos e foram submetidas ao teste não paramétrico de Mann-Whitney. Resultados Com relação à média da frequência fundamental, houve diferença estatisticamente significativa entre os grupos com peso normal e sobrepeso e entre os grupos com peso normal e obesidade. A média do tempo máximo de fonação revelou diferença estatisticamente significativa entre indivíduos com baixo peso e obesidade; peso normal e obesidade; sobrepeso e obesidade. Conclusão O índice de massa corporal influenciou na média da frequência fundamental dos indivíduos com sobrepeso e obesos avaliados neste estudo. A obesidade mórbida influiu na redução da média do tempo máximo de fonação.

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Free tissue flaps in head and neck reconstruction: clinical application and analysis of 93 patients of a single institution

Abstract Introduction Reconstruction with a free flap is routine in head and neck surgery because of better functional outcomes, improved esthetics, and generally higher success rates. Objective To evaluate the clinical outcomes in patients undergoing different microvascular free flap reconstructions. Methods This was a retrospective study of 93 patients undergoing reconstructions with free flaps from 2007 to 2015. Four types of free flap were performed: anterolateral thigh (76.3%), radial forearm (16.1%), fibula (4.3%) and jejunum (3.3%). Patients' demographic data were collected, and the outcomes measured included flap survival and complications. Postoperative functional and oncological outcome were also analyzed. Results The patients included 73 men and 20 women, with a mean age of 56.1 years. The most common tumor location was the tongue. Squamous cell carcinoma represented the vast majority of the diagnosed tumors (89.2%). The most common recipient vessels were the superior thyroid artery (77.4%) and the internal jugular vein (91.4%). Nine patients required emergency surgical re-exploration and the overall flap success rate was 90.3%. Venous thrombosis was the most common cause for re-exploration. Other complications included wound infection (5.4%), wound dehiscence (1.1%), partial flap necrosis (9.7%), fistula formation (10.8%), and 1 bleeding (1.1%). The majority of patients had satisfactory cosmetic and functional results of both donor site and recipient site after 46.7 months of mean follow-up. Conclusion Microsurgical free flap is shown to be a valuable and reliable method in head and neck surgery. It can be used safely and effectively with minimal morbidity in selected patients. The reconstruction can be performed by appropriately skilled surgeons with acceptable outcomes. Success rate appears to increase as clinical experience is gained.

Resumo Introdução Reconstrução com retalhos livres é um procedimento de rotina nas cirurgias de cabeça e pescoço devido aos melhores resultados funcionais e estéticos e às taxas de sucesso geralmente maiores. Objetivo Avaliar os desfechos clínicos de pacientes submetidos a diferentes reconstruções microvasculares com retalhos livres. Método Estudo retrospectivo de 93 pacientes submetidos à reconstruções com retalhos livres, de 2007 a 2015. Foram utilizados quatro tipos de retalho livre: coxa anterolateral (76,3%), antebraço radial (16,1%), fíbula (4,3%) e jejuno (3,3%). Os dados demográficos dos pacientes foram coletados e os parâmetros avaliados incluíram sobrevida e complicações. Os resultados funcionais e oncológicos pós-operatórios também foram analisados. Resultados Os pacientes incluíram 73 homens e 20 mulheres, com idade média de 56,1 anos. O local mais comum para o tumor foi a língua. O carcinoma de células escamosas representou a maioria dos tumores diagnosticados (89,2%). As artérias receptoras mais comuns foram a artéria tireóidea superior (77,4%) e a veia jugular interna (91,4%). Nove pacientes necessitaram de reexploração cirúrgica de emergência e a taxa de sucesso global do retalho foi de 90,3%. A trombose venosa foi a causa mais comum da reexploração. Outras complicações incluíram infecção da ferida cirúrgica (5,4%), deiscência da ferida (1,1%), necrose parcial do retalho (9,7%), formação de fístula (10,8%) e sangramento (1,1%). A maioria dos pacientes apresentou resultados estéticos e funcionais satisfatórios, tanto no local doador quanto no receptor, após 46,7 meses de seguimento médio. Conclusão O retalho livre microcirúrgico mostrou ser um método valioso e confiável na cirurgia de cabeça e pescoço. Pode ser usado de forma segura e eficaz, com morbidade mínima em pacientes selecionados. A reconstrução pode ser feita por cirurgiões adequadamente qualificados com resultados aceitáveis. A taxa de sucesso parece aumentar à medida que a experiência clínica é adquirida.

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Outcomes of external septorhinoplasty in a Turkish male population

Abstract Introduction The first and one of the most important steps in facial plastic surgery is accurate preoperative facial analysis and recording of data that may help the surgeon to check the outcomes of his/her techniques, promoting a surgeon's professional development. Objective To evaluate the esthetic outcomes of external septorhinoplasty relevant to ethnic facial harmony and to investigate the relationship of the columellar incision scar with the type of skin and columellar incision type in a Turkish population. Methods In total, 28 consecutive adult male patients with a mean age of 32.14 ± 10.66 years (range: 18-61 years) were included the study. Primary outcomes were preoperative and postoperative photogrammetric facial analyses of the patients including measurement of nasofrontal angle, nasolabial angle and nasal projection ratios (Gode) assessed according to the data derived from the Rhinobase program. Results were compared to facial proportions of the Turkish population. Columellar incision scar scores related to the Fitzpatrick skin type classification of the patients and columellar incision types used for the external approach were secondary outcomes of the study. Results Mean preoperative and postoperative nasofrontal angles were 148.04° ± 8.18° and 144.50° ± 7.15°, respectively, while mean preoperative and postoperative nasolabial angles were 87.59° ± 14.01° and 98.50° ± 9.71°, respectively. Mean preoperative and postoperative nasal tip projection ratios were 0.56 ± 0.05 and 0.60 ± 0.06, respectively. The differences between pre- and postoperative measurements were all significantly different and were in accordance with Turkish nasal harmony. Columellar inverted "V" incisions were performed in 15 (53.6%) patients while "V" incisions were used in 13 (46.4%) patients. Fitzpatrick skin Type 4 was seen in 46.42% of the patients, Fitzpatrick Type 3 in 46.42% and Fitzpatrick Type 2 in 7.14% of the patients. No significant difference was seen between columellar scar scores according to skin type and columellar incision type used for external septorhinoplasty. Conclusions This study demonstrated that outcomes for nasofrontal angle, nasolabial angle and nasal tip projection ratios analyzed using the Rhinobase program in patients who underwent external septorhinoplasty were similar to reference values for the Turkish population.

Resumo Introdução O primeiro e um dos mais importantes passos na cirurgia plástica facial é a análise pré-operatória facial precisa e o registro de dados que podem ajudar o cirurgião a verificar os resultados de suas técnicas, promovendo seu desenvolvimento profissional. Objetivo Avaliar os resultados estéticos da rinosseptoplastia externa relevantes para a harmonia étnica facial e investigar a associação da cicatriz de incisão columelar com o tipo de pele e o tipo de incisão columelar em uma população turca. Método No total, 28 pacientes adultos consecutivos com média de idade de 32,14 ± 10,66 anos (intervalo: 18-61 anos) foram incluídos no estudo. Os desfechos primários foram as análises faciais fotogramétricas pré-operatórias e pós-operatórias dos pacientes, incluindo a medida do ângulo nasofrontal, ângulo nasolabial e razões da projeção nasal (Gode), avaliados de acordo com os dados derivados do programa Rhinobase. Os resultados foram comparados às proporções faciais da população turca. Os escores de cicatriz de incisão columelar relacionados com a classificação de Fitzpatrick do tipo de pele dos pacientes e os tipos de incisão columelar usados para a abordagem externa foram os desfechos secundários do estudo. Resultados Os ângulos nasofrontais pré- e pós-operatórios médios foram 148,04 ± 8,18° e 144,50 ± 7,15°, respectivamente, enquanto os ângulos nasolabiais pré- e pós-operatórios médios foram 87,59 ± 14,01° e 98,50 ± 9,71°, respectivamente. As razões médias da projeção nasal pré- e pós-operatória foram de 0,56 ± 0,05 e 0,60 ± 0,06, respectivamente. As diferenças entre as medidas pré- e pós-operatórias foram todas significativamente diferentes e estavam de acordo com a harmonia nasal turca. A incisão columelar em "V" invertido foi utilizada em 15 (53,6%) pacientes e a incisão em "V" foi utilizada em 13 (46,4%) pacientes. Pele Fitzpatrick tipo 4 foi observada em 46,42% dos pacientes, Fitzpatrick tipo 3 em 46,42% e Fitzpatrick tipo 2 em 7,14% dos pacientes. Não foi observada diferença significativa entre os escores de cicatriz columelar de acordo com o tipo de pele e o tipo de incisão columelar utilizados na rinosseptoplastia externa. Conclusões Este estudo demonstrou que os desfechos para ângulo nasofrontal, ângulo nasolabial e razões de projeção nasal analisados pelo programa Rhinobase em pacientes submetidos à rinosseptoplastia externa foram semelhantes aos valores de referência para a população turca.

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Turkish validity and reliability of Eustachian tube dysfunction questionnaire-7

Abstract Introduction During clinical evaluations, in order to interpret patients' complaints caused by Eustachian tube dysfunction and to monitor the success of the treatment, standardized and disease-related scales are necessary. Objective The aim of this study was to investigate the validity and reliability of the Turkish version of Eustachian tube dysfunction questionnaire-7. Methods Forty patients diagnosed with Eustachian tube dysfunction and 40 healthy individuals were enrolled for the study. After language validation of the Eustachian tube dysfunction questionnaire-7 for Turkish, a scale was completed by the both Eustachian tube dysfunction and control groups. Two weeks after the first evaluation, 15 of the cases filled out the scale again without any treatment intervention. Known-groups method was used in validity analysis. Floor-ceiling effect, test-retest method, item-total score correlation and internal consistency analysis were used in reliability analyses. Results Cronbach's alpha coefficient was 0.714 for the entire questionnaire. The test-retest reliability coefficient for the total scale was determined as 0.792, indicating correlation between the two questionnaires completed by the same patient over time. In the Eustachian tube dysfunction group, total and each item scores were found significantly higher than the control group (p < 0.001). Conclusion The Turkish version of Eustachian tube dysfunction questionnaire-7 was found to be highly valid and reliable. This scale is recommended to use for screening of Eustachian tube dysfunction and evaluating treatment outcome.

Resumo Introdução No intuito de interpretar as queixas dos pacientes causadas por disfunções na tuba auditiva durante uma avaliação clínica, e para monitorar o sucesso do tratamento, há necessidade de escalas padronizadas relacionadas à doença. Objetivo Investigar a validade e a confiabilidade da versão turca do Eustachian tube dysfunction questionnaire-7. Método Quarenta pacientes diagnosticados com disfunção da tuba auditiva e 40 indivíduos saudáveis foram incluídos no estudo. Após a validação do Eustachian tube dysfunction questionnaire-7 para o idioma turco, o questionário foi aplicada aos grupos disfunção da tuba auditiva e controle. Duas semanas após a primeira avaliação, 15 pacientes preencheram o questionário novamente sem qualquer tratamento. O método de grupos conhecidos foi utilizado na análise de validade. Os efeitos teto e chão, o método teste-reteste, a correlação se escore de item-total e a análise de consistência interna foram utilizados nas análises de confiabilidade. Resultados O coeficiente alfa de Cronbach foi de 0,714 para todo o questionário. O coeficiente de confiabilidade teste-reteste para a escala total foi determinado como 0,792, indicando correlação entre os dois questionários preenchidos pelo mesmo paciente ao longo do tempo. No grupo disfunções da tuba auditiva, foi observado que os escores total e de cada item foram significativamente maiores do que no grupo controle (p < 0,001). Conclusão A versão no idioma turco do Eustachian tube dysfunction questionnaire-7 foi considerada altamente válida e confiável. Recomenda-se a utilização dessa escala para a triagem de disfunções da tuba auditiva e avaliação do resultado do tratamento.

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Evaluating the ototoxicity of an anti-MRSA peptide KR-12-a2

Abstract Introduction Methicillin-resistant staphylococcus aureus is an emerging problem for the treatment of chronic suppurative otitis media, and also for pediatric tympanostomy tube otorrhea. To date, there are no effective topical antibiotic drugs to treat methicillin-resistant staphylococcus aureus otorrhea. Objective In this study, we evaluated the ototoxicity of topical KR-12-a2 solution on the cochlea when it is applied topically in the middle ear of guinea pigs. Methods The antimicrobial activity of KR-12-a2 against methicillin-resistant staphylococcus aureus strains was examined by using the inhibition zone test. Topical application of KR-12-a2 solution, gentamicin and phosphate buffered saline were applied in the middle ear of the guinea pigs after inserting ventilation tubes. Ototoxicity was assessed by auditory brainstem evoked response and scanning electron microscope examination. Results KR-12-a2 produced an inhibition zone against methicillin-resistant staphylococcus aureus from 6.25 µg. Hearing threshold in the KR-12-a2 and PBS groups were similar to that before ventilation tube insertion. However, the gentamicin group showed elevation of the hearing threshold and there were statistically significant differences compared to the phosphate buffered saline or the KR-12-a2 group. In the scanning electron microscope findings, the KR-12-a2 group showed intact outer hair cells. However, the gentamicin group showed total loss of outer hair cells. In our experiment, topically applied KR-12-a2 solution did not cause hearing loss or cochlear damage in guinea pigs. Conclusion In our experiment, topically applied KR-12-a2 solution did not cause hearing loss or cochlear damage in guinea pigs. The KR-12-a2 solution can be used as ototopical drops for treating methicillin-resistant staphylococcus aureus otorrhea; however, further evaluations, such as the definition of optimal concentration and combination, are necessary.

Resumo Introdução O staphylococcus aureus resistente à meticilina é um problema emergente não só para a otite média supurativa crônica, mas também para casos de otorreia crônica em crianças com tubo de ventilação. Até o momento, não há antibióticos tópicos efetivos para a otorreia causada por staphylococcus aureus resistente à meticilina. Objetivo Nesse estudo, avaliamos a ototoxicidade da solução tópica de KR-12-a2 na cóclea quando aplicada topicamente na orelha média de cobaias. Método A atividade antimicrobiana de KR-12-a2 contra cepas de staphylococcus aureus resistente à meticilina foi avaliada utilizando-se o teste de zona de inibição de crescimento. Foram aplicados na orelhas médias de 3 grupos de cobaias, ou solução tópica de KR-12-a2, ou gentamicina ou solução salina tamponada com fosfato após timpanostomia. A ototoxicidade foi avaliada através do exame auditivo de potencial evocado auditivo de tronco encefálico e por microscopia eletrônica de varredura. Resultados O KR-12-a2 produziu uma zona de inibição contra o staphylococcus aureus resistente à meticilina a partir de 6,25 µg. Alterações do limiar de audição no grupo KR-12-a2 e no grupo com solução salina foram semelhantes aos observados antes da inserção do tubo de ventilação. No entanto, o grupo gentamicina apresentou um limiar auditivo mais elevado, estatisticamente significativo em comparação ao grupo solução salina ou ao grupo KR-12-a2. Nos achados da microscopia eletrônica, o grupo KR-12-a2 apresentou células ciliadas externas intactas. No entanto, o grupo gentamicina apresentou perda total das células ciliadas externas. Em nosso experimento, a solução de KR-12-a2 aplicada topicamente não causou perda auditiva ou dano coclear em cobaias. Conclusão Em nosso experimento, a solução de KR-12-a2 aplicada topicamente não causou perda auditiva ou dano coclear em cobaias. A solução de KR-12-a2 pode ser utilizada como gotas otológicas para o tratamento da otorreia causada por staphylococcus aureus resistente à meticilina; no entanto, são necessárias outras avaliações, para a definição da concentração e das associações ideais.

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Influence of chronic lymphocytic thyroiditis on the risk of persistent and recurrent disease in patients with papillary thyroid carcinoma and elevated antithyroglobulin antibodies after initial therapy

Abstract Introduction In patients with papillary thyroid carcinoma who have negative serum thyroglobulin after initial therapy, the risk of structural disease is higher among those with elevated antithyroglobulin antibodies compared to patients without antithyroglobulin antibodies. Other studies suggest that the presence of chronic lymphocytic thyroiditis is associated with a lower risk of persistence/recurrence of papillary thyroid carcinoma. Objective This prospective study evaluated the influence of chronic lymphocytic thyroiditis on the risk of persistence and recurrence of papillary thyroid carcinoma in patients with negative thyroglobulin but elevated antithyroglobulin antibodies after initial therapy. Methods This was a prospective study. Patients with clinical examination showing no anomalies, basal Tg < 1 ng/mL, and elevated antithyroglobulin antibodies 8-12 months after ablation were selected. The patients were divided into two groups: Group A, with chronic lymphocytic thyroiditis on histology; Group B, without histological chronic lymphocytic thyroiditis. Results The time of follow-up ranged from 60 to 140 months. Persistent disease was detected in 3 patients of Group A (6.6%) and in 6 of Group B (8.8%) (p = 1.0). During follow-up, recurrences were diagnosed in 2 patients of Group A (4.7%) and in 5 of Group B (8%) (p = 0.7). Considering both persistent and recurrent disease, structural disease was detected in 5 patients of Group A (11.1%) and in 11 of Group B (16.1%) (p = 0.58). There was no case of death related to the disease. Conclusion Our results do not support the hypothesis that chronic lymphocytic thyroiditis is associated with a lower risk of persistent or recurrent disease, at least in patients with persistently elevated antithyroglobulin antibodies after initial therapy for papillary thyroid carcinoma.

Resumo Introdução Em pacientes com carcinoma papilífero de tireoide e com tireoglobulina sérica negativa após a terapia inicial, o risco de doença estrutural é maior entre aqueles com anticorpos antitireoglobulina elevados em comparação com pacientes sem anticorpos antitireoglobulina. Outros estudos sugerem que a presença de tireoidite linfocítica crônica está associada a um menor risco de persistência/recorrência do carcinoma papilífero de teireoide. Objetivo Este estudo prospectivo avaliou a influência da tireoidite linfocítica crônica sobre o risco de persistência e recorrência do carcinoma papilífero de tireoide em pacientes com tireoglobulina negativa, mas com anticorpos antitireoglobulinas elevados após a terapia inicial. Método Esse foi um estudo prospectivo, no qual foram selecionados pacientes com exame clínico sem anomalias; tireoglobulina basal < 1 ng/mL e anticorpos antitireoglobulina elevados 8-12 meses após ablação. Os pacientes foram divididos em dois grupos: Grupo A, com tireoidite linfocítica crônica no exame histológico; Grupo B, histologicamente sem tireoidite linfocítica crônica. Resultados O tempo de seguimento variou de 60 a 140 meses. Doença persistente foi detectada em 3 pacientes do Grupo A (6,6%) e em 6 do Grupo B (8,8%) (p = 1,0). Durante o seguimento, as recidivas foram diagnosticadas em 2 pacientes do Grupo A (4,7%) e em 5 do Grupo B (8%) (p = 0,7). Considerando tanto a doença persistente quanto a recorrente, doença estrutural foi detectada em 5 pacientes do Grupo A (11,1%) e em 11 do Grupo B (16,1%) (p = 0,58). Não houve nenhum caso de óbito relacionado à doença. Conclusão Nossos resultados não apoiam a hipótese de que a tireoidite linfocítica crônica esteja associada a um menor risco de doença persistente ou recorrente, pelo menos em pacientes com anticorpos antitireoglobulina persistentemente elevados após a terapia inicial do carcinoma papilífero de tireoide.

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25 (OH) D3 levels, incidence and recurrence of different clinical forms of benig paroxysmal positional vertigo

Abstract Introduction Benign paroxysmal positional vertigo is the most common cause of dizziness in the general population. It is a condition with potential impact of reduced levels of vitamin D on its recurrent attacks. Objectives The aim of this study was to measure the serum levels of 25-hydroxyvitamin D3 (25-OH D3) in patients with benign paroxysmal positional vertigo and determine whether there is a difference in the serum levels of vitamin D3 between patients with and without recurrence, as well as between the different clinical forms of benign paroxysmal positional vertigo. Methods The study included 40 patients who came to the regular medical examination, diagnosed with posterior canal-benign paroxysmal positional vertigo based on the positive Dix-Hallpike's test. All patients underwent Epley manoeuvre after the diagnosis. Patients were classified according to current guidelines for levels of vitamin D3 in the serum in three groups: the deficiency, insufficiency and adequate level. Results The average serum level of 25-OH D3 among respondents was 20.78 ng/mL, indicating a lack or insufficiency of the aforementioned 25-OH D3. According to the levels of 25-OH D3, most patients suffer from deficiency (47.5%). 7 (17.5%) respondents had adequate blood level of 25-OH D3, and 14 (35%) respondents suffer from insufficiency. A significant difference was not found in the serum level of 25-OH D3 between patients with and without benign paroxysmal positional vertigo recurrence. There was a significant difference in the serum levels of 25-OH D3 in comparison to the clinical form of the disease. Lower 25-OH D3 values were found in patients with canalithiasis compared to those with cupulolithiasis. Conclusions There were no significant differences in the vitamin D3 serum level in patients with and without recurrence. The study showed a low level of serum vitamin D3 in most patients, indicating the need for supplemental therapy.

Resumo Introdução Vertigem posicional paroxística benigna é a causa mais comum de tonturas na população em geral. É uma condição no qual níveis reduzidos de vitamina D podem ter um potencial impacto para o desenvolvimento de crises recorrentes. Objetivos O objetivo desse estudo foi medir os níveis séricos de 25-hidroxivitamina D3 (25-OH D3) em pacientes com vertigem posicional paroxística benigna e determinar se há diferença nos níveis séricos de vitamina D3 entre pacientes com e sem recorrência, bem como entre as diferentes formas clínicas de vertigem posicional paroxística benigna. Método O estudo incluiu 40 pacientes submetidos a exame médico regular, diagnosticados com vertigem posicional paroxística benigna de canal posterior baseado no resultado positivo do teste de Dix-Hallpike. Todos os pacientes foram submetidos à manobra de Epley após o diagnóstico. Os pacientes foram classificados de acordo com as diretrizes atuais para os níveis de vitamina D3 sérica em três grupos: deficiência, insuficiência e nível adequado. Resultados O nível sérico médio de 25-OH D3 entre os indivíduos avaliados foi de 20,78 ng/mL, indicando falta ou insuficiência desta vitamina. De acordo com os níveis de 25-OH D3, a maioria dos pacientes apresentou deficiência (47,5%). Sete indivíduos (17,5%) entrevistados tinham nível sanguíneo adequado de 25-OH D3 e 14 (35%) apresentavam insuficiência. Não foi encontrada diferença significativa no nível sérico de 25-OH D3 entre pacientes com e sem recidiva de vertigem posicional paroxística benigna. Houve uma diferença significativa nos níveis séricos de 25-OH D3 de acordo com a forma clínica da doença. Baixos níveis de 25-OH D3 foram mais encontrados em pacientes com canalitíase em comparação com aqueles com cupulolitíase. Conclusões Não houve diferenças significativas no nível sérico de vitamina D3 em pacientes com e sem recorrência. O estudo mostrou um baixo nível de vitamina D3 sérica na maioria dos pacientes, indicando a necessidade de terapia suplementar.

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Performance of the phonatory deviation diagram in the evaluation of rough and breathy synthesized voices,

Abstract Introduction Voice disorders alter the sound signal in several ways, combining several types of vocal emission disturbances and noise. The phonatory deviation diagram is a two-dimensional chart that allows the evaluation of the vocal signal based on the combination of periodicity (jitter, shimmer, and correlation coefficient) and noise (Glottal to Noise Excitation) measurements. The use of synthesized signals, where one has a greater control and knowledge of the production conditions, may allow a better understanding of the physiological and acoustic mechanisms underlying the vocal emission and its main perceptual-auditory correlates regarding the intensity of the deviation and types of vocal quality. Objective To analyze the performance of the phonatory deviation diagram in the discrimination of the presence and degree of roughness and breathiness in synthesized voices. Methods 871 synthesized vocal signals were used corresponding to the vowel /ɛ/. The perceptual-auditory analysis of the degree of roughness and breathiness of the synthesized signals was performed using visual analogue scale. Subsequently, the signals were categorized regarding the presence/absence of these parameters based on the visual analogue scale cutoff values. Acoustic analysis was performed by assessing the distribution of vocal signals according to the phonatory deviation diagram area, quadrant, shape, and density. The equality of proportions and the chi-square tests were performed to compare the variables. Results Rough and breathy vocal signals were located predominantly outside the normal range and in the lower right quadrant of the phonatory deviation diagram. Voices with higher degrees of roughness and breathiness were located outside the area of normality in the lower right quadrant and had concentrated density. Conclusion The normality area and the phonatory deviation diagram quadrant can discriminate healthy voices from rough and breathy ones. Voices with higher degrees of roughness and breathiness are proportionally located outside the area of normality, in the lower right quadrant and with concentrated density.

Resumo Introdução Os distúrbios de voz alteram o sinal sonoro de diversas formas, combinam variados tipos de perturbações e ruídos na emissão vocal. O diagrama de desvio fonatório é um gráfico bidimensional que possibilita a avaliação do sinal vocal a partir da combinação de medidas de periodicidade (jitter, shimmer e coeficiente de correlação) e de ruído (Glottal to Noise Excitation). O uso de sinais sintetizados, no qual se tem um maior controle e conhecimento das condições de produção, pode possibilitar uma maior compreensão dos mecanismos fisiológicos e acústicos subjacentes à emissão vocal e seus principais correlatos perceptivo-auditivos quanto à intensidade do desvio e aos tipos de qualidade vocal. Objetivo Analisar o desempenho do diagrama de desvio fonatório na discriminação da presença e do grau de rugosidade e soprosidade em vozes sintetizadas. Método Foram utilizados 871 sinais vocais sintetizados correspondentes à vogal/ɛ/. Realizou-se a análise perceptivo-auditiva do grau de rugosidade e soprosidade dos sinais sintetizados, com uma escala visual analógica. Posteriormente, os sinais foram categorizados quanto à presença/ausência desses parâmetros a partir dos valores de corte da escala visual analógica. A análise acústica foi realizada por meio da avaliação da distribuição dos sinais vocais de acordo com a área, quadrante, forma e densidade do diagrama de desvio fonatório. Executou-se o teste de igualdade de proporções e o teste qui-quadrado para comparar as variáveis. Resultados Sinais vocais rugosos e soprosos localizaram-se predominantemente fora da área de normalidade e no quadrante inferior direito do diagrama de desvio fonatório. Vozes com maiores graus de rugosidade e soprosidade localizaram-se fora da área de normalidade, no quadrante inferior direito e apresentaram densidade concentrada. Conclusão A área de normalidade e o quadrante do diagrama de desvio fonatório são capazes de discriminar vozes saudáveis de rugosas e soprosas. Vozes com maior grau de rugosidade e soprosidade localizam-se proporcionalmente fora da área de normalidade, no quadrante inferior-direito e com densidade concentrada.

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IRF6 rs2235375 single nucleotide polymorphism is associated with isolated non-syndromic cleft palate but not with cleft lip with or without palate in South Indian population

Abstract Introduction Transcription factors are very diverse family of proteins involved in activating or repressing the transcription of a gene at a given time. Several studies using animal models demonstrated the role of transcription factor genes in craniofacial development. Objective We aimed to investigate the association of IRF6 intron-6 polymorphism in the non-syndromic cleft lip with or without palate in a South Indian population. Methods 173 unrelated nonsyndromic cleft lip with or without cleft palate patients and 176 controls without clefts patients were genotyped for IRF6 rs2235375 variant by allele-specific amplification using the KASPar single nucleotide polymorphism genotyping system. The association between interferon regulatory factor-6 gene intron-6 dbSNP208032210:g.G>C (rs2235375) single nucleotide polymorphism and non-syndromic cleft lip with or without palate risk was investigated by chi-square test. Results There were significant differences in genotype or allele frequencies of rs2235375 single nucleotide polymorphism between controls and cases with non-syndromic cleft lip with or without palate. IRF6 rs2235375 variant was significantly associated with increased risk of non-syndromic cleft lip with or without palate in co-dominant, dominant (OR: 1.19; 95% CI 1.03-2.51; p = 0.034) and allelic models (OR: 1.40; 95% CI 1.04-1.90; p = 0.028). When subset analysis was applied significantly increased risk was observed in cleft palate only group (OR dominant: 4.33; 95% CI 1.44-12.97; p = 0.005). Conclusion These results suggest that IRF6 rs2235375 SNP play a major role in the pathogenesis and risk of developing non-syndromic cleft lip with or without palate.

Resumo Introdução Fatores de transcrição constituem uma família de proteínas muito diversa envolvida na ativação ou repressão da transcrição de um gene, em um determinado momento. Vários estudos usando modelos animais demonstraram o papel dos genes do fator de transcrição no desenvolvimento craniofacial. Objetivo Nosso objetivo foi investigar a associação do polimorfismo IRF6 intron-6 na fenda labial não sindrômica com ou sem fenda palatina em uma população do sul da Índia. Método Um total de 173 pacientes com fenda labial não sindrômica com ou sem fenda palatina e 176 controles sem fendas foram genotipados para a variante IRF6 rs2235375 por amplificação alelo-específica utilizando o sistema KASPar de genotipagem de polimorfismo de nucleotídeo único. A associação entre o polimorfismo de nucleotídeo único Fator 6 Regulatório do Interferon (IRF6) intron-6 dbSNP208032210:g.G>C (rs2235375) e o risco de fenda labial não sindrômica com ou sem fenda palatina foi investigado pelo teste qui-quadrado. Resultados Houve diferenças significativas nas frequências de genótipos ou alelos do rs2235375 SNP entre controles e casos com fenda labial não sindrômica com ou sem fenda palatina. A variante IRF6 rs2235375 foi significativamente associada ao aumento do risco de fenda labial não sindrômica com ou sem fenda palatina em modelos codominantes, dominantes (OR: 1,19; IC 95%: 1,03-2,51; p = 0,034) e alélicos (OR: 1,40; IC 95%: 1,04-1,90; p = 0,028). Quando a análise do subgrupo foi realizada, um risco significativamente aumentado foi observado no grupo Fenda Palatina Isolada (OR dominante: 4,33; IC 95%: 1,44-12,97; p = 0,005). Conclusões Esses resultados sugerem que o polimorfismo de nucleotídeo único IRF6 rs2235375 desempenha um papel importante na patogênese e no risco de desenvolvimento de fenda labial não sindrômica com ou sem fenda palatina.

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Short-term evaluation of tegumentary changes of the nose in oral breathers undergoing rapid maxillary expansion

Abstract Introduction Rapid maxillary expansion is an orthodontic and orthopedic procedure that can change the form and function of the nose. The soft tissue of the nose and its changes can influence the esthetics and the stability of the results obtained by this procedure. Objective The objective of this study was to assess the changes in nose dimensions after rapid maxillary expansion in oral breathers with maxillary atresia, using a reliable and reproducible methodology through computed tomography. Methods A total of 30 mouth-breathing patients with maxillary atresia were analyzed and divided into a treatment group who underwent rapid maxillary expansion (20 patients, 10 of which were male and 10 female, with a MA of 8.9 years and a SD of 2.16, ranging from 6.5 to 12.5 years) and a Control Group (10 patients, 5 of which were male and 5 female, with a MA of 9.2 years, SD of 2.17, ranging from 6.11 to 13.7 years). In the treatment group, multislice computed tomography scans were obtained at the start of the treatment (T1) and 3 months after expansion (T2). The patients of the control group were submitted to the same exams at the same intervals of time. Four variables related to soft tissue structures of the nose were analyzed (alar base width, alar width, height of soft tissue of the nose and length of soft tissue of the nose), and the outcomes between T1 and T2 were compared using Osirix MD software. Results In the TG, the soft tissues of the nose exhibited significant increases in all variables studied (p < 0.05), whereas, changes did not occur in the control group (p > 0.05). In the treatment group, mean alar base width increased by 4.87% (p = 0.004), mean alar width increased by 4.04% (p = 0.004), mean height of the soft tissues of the nose increased by 4.84% (p = 0.003) and mean length of the soft tissues of the nose increased by 4.29% (p = 0.012). Conclusion In short-term, rapid maxillary expansion provided a statistically significant increase in the dimensions of the soft tissues of the nose.

Resumo Introdução A expansão rápida da maxila é um procedimento ortodôntico e ortopédico que pode alterar a forma e a função do nariz. Os tecidos moles do nariz e suas alterações podem influenciar na estética e na estabilidade dos resultados obtidos por esse procedimento. Objetivo O objetivo desse estudo foi avaliar as alterações nas dimensões do nariz após expansão rápida da maxila em respiradores orais com atresia maxilar, usando uma metodologia confiável e reprodutível com o auxílio de tomografia computadorizada. Método Um total de 30 pacientes respiradores orais com atresia maxilar foram avaliados e divididos em um grupo de tratamento, submetidos à expansão rápida da maxila (20 pacientes, 10 dos quais do sexo masculino e 10 do sexo feminino, com média de idade de 8,9 anos e DP de 2,16, variando de 6,5 a 12,5 anos) e um grupo controle (10 pacientes, sendo 5 do sexo masculino e 5 do sexo feminino, com média de idade de 9,2 anos, DP de 2,17, variando de 6,11 a 13,7 anos). No grupo tratado, foram realizados exames de tomografia computadorizada multislice no início do tratamento (T1) e 3 meses após a expansão (T2). Os pacientes do grupo controle foram submetidos aos mesmos exames nos mesmos intervalos de tempo. Foram analisadas quatro variáveis relacionadas às estruturas dos tecidos moles do nariz (largura da base alar, largura alar, altura do tecido mole do nariz e comprimento do tecido mole do nariz) e os resultados entre T1 e T2 foram comparados, utilizando-se o software Osirix MD. Resultados No grupo tratado (GT), os tecidos moles do nariz apresentaram aumentos significativos em todas as variáveis estudadas (p < 0,05), enquanto isso não ocorreu no GC (p > 0,05). No GT, a largura média da base alar aumentou 4,87% (p = 0,004), a largura média alar aumentou 4,04% (p = 0,004), a altura média dos tecidos moles do nariz aumentou 4,84% (p = 0,003) e o comprimento médio dos tecidos moles do nariz aumentou 4,29% (p = 0,012). Conclusão A curto prazo, a expansão rápida da maxila proporcionou um aumento estatisticamente significativo nas dimensões dos tecidos moles do nariz.

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Anthropometric study of the caucasian nose in the city of Curitiba: relevance of population evaluation,

Abstract Introduction Norms and patterns of nasal esthetics are essential for an adequate preoperative evaluation and surgical programming. The esthetic nasal patterns used are a blend of artistic beauty ideals and tracings in models and celebrities. Because they do not consider population measures, they vary according to the period, and allow a discrepancy between the surgeon's preference and the patient's real desire for rhinoplasty. Not all populations wish to obtain an esthetic result according to these values, but prefer a natural result, that is, one with some of the nasal characteristics of the population to which they belong to. The Brazilian population lacks population studies to evaluate its nose measurements. Objective (1) To evaluate the anthropometric measures of Caucasian noses of people living in the city of Curitiba (state of Paraná), and to compare them to the ideal esthetic pattern of the literature; (2) To compare them between genders. Methods This is a prospective cohort study involving 100 Caucasian volunteers at a tertiary hospital in Southern Brazil. Through the frontal and lateral view photos, intercanthal distance, alar distance, nasal dorsum length, nasofrontal angle, nasolabial angle, and nasal tip projection (Goode's method) were obtained. A statistical analysis was performed to compare the measures obtained between genders and with the ideal patterns. Results Comparing the results obtained with those predicted by the esthetic ideals, the sample presented: similar nasolabial angle (p = 0.07), alar width greater than intercanthal distance (p < 0.001), higher nasal tip projection (p < 0.001), larger width-length ratio (p < 0.001), and more obtuse nasofrontal angle (p < 0.001). The nasofrontal angle (p = 0.0008) and the tip projection (p = 0.032) were statistically different between the genders. Men had a smaller nasofrontal angle, and a larger Goode's ratio. Conclusion Except for the nasolabial angle, the measures obtained in the population sample differed from the published esthetic ideals. Comparing the genders, men had a sharper nasofrontal angle, and higher tip projection than women.

Resumo Introdução Normas e padrões de estética nasal são essenciais para uma adequada avaliação pré-operatória e programação cirúrgica. Os padrões estéticos nasais usados são uma mistura dos ideais artísticos de beleza e traçados em modelos e celebridades. Por não considerar medidas populacionais, variam conforme o período e permitem uma discrepância entre o desejo do cirurgião e o real desejo do paciente com a rinoplastia. Nem todas as populações desejam obter um resultado estético conforme esses valores, mas um resultado natural, ou seja, com algumas das características nasais da população a que pertencem. A população brasileira carece de estudos populacionais que avaliam as suas medidas nasais. Objetivo 1) Avaliar as médidas antropométricas de narizes caucasianos da cidade de Curitiba (Paraná) e compará-los com o padrão estético ideal da literatura; 2) Compará-los entre os sexos. Método Estudo prospectivo, coorte, envolveu 100 voluntários caucasianos em um hospital terciário no Sul do Brasil. Através de fotografias na vista frontal e lateral, foram obtidas: distância intercantal, distância alar, comprimento do dorso nasal, ângulo nasofrontal, ângulo nasolabial e projeção da ponta nasal (método do Goode). Análise estatística foi realizada para comparar as medidas obtidas: entre os gêneros e com os padrões ideais. Resultados Comparando os resultados obtidos com o apregoado pelos ideais estéticos, a amostra apresentou: ângulo nasolabial similar (p = 0,07), largura alar maior do que distância intercantal (p < 0,001), maior projeção da ponta nasal (p < 0,001), relação largura-comprimento maior (p < 0,001) e ângulo nasofrontal mais obtuso (p < 0,001). Diferiram estatisticamente entre os sexos o ângulo nasofrontal (p = 0,0008) e a projeção da ponta (p = 0,032). Homens apresentaram o ângulo nasofrontal menor e a razão de Goode maior. Conclusão Com exceção do ângulo nasolabial, as medidas obtidas na amostra populacional diferiram dos ideais estéticos publicados. Na comparação dos sexos, homens apresentaram um ângulo nasofrontal mais agudo e uma projeção da ponta maior do que as mulheres.

https://ift.tt/2KFKW60

Quality of life and cochlear implant: results in adults with postlingual hearing loss

Abstract Introduction Considering the variability of results found in the clinical population using a cochlear implant, researchers in the area have been interested in the inclusion of quality of life measures to subjectively assess the benefits of the implantation. Objective To assess the quality of life of adult users of cochlear implant. Methods A cross-sectional and clinical study in a group of 26 adults of both genders, with mean duration of cochlear implant use of 6.6 years. The Nijmegen Cochlear Implantation Questionnaire and the generic World Health Organization Quality of Life questionnaire were sent electronically. Results The best assessed domain in the quality of life assessment for the cochlear implantation questionnaire was the social domain, whereas for the quality of life questionnaire it was the psychological domain. The variables, gender, time of cochlear implant use and auditory modality did not influence the results of both questionnaires. Only the variable level of education was correlated with the environment domain of the quality of life questionnaire. The variable telephone speech comprehension was associated with a better perception of quality of life for all the domains of the specific questionnaire and for the self-assessment of quality of life in general. Conclusion From the users' perspective, both questionnaires showed that cochlear implant brought benefits to different aspects related to quality of life.

Resumo Introdução Diante da variabilidade de resultados clínicos encontrada na população usuária de implante coclear, pesquisadores da área têm se interessado pela inclusão de medidas de qualidade de vida para avaliar os benefícios do implante coclear de maneira subjetiva. Objetivo Avaliar a qualidade de vida de adultos usuários de implante coclear. Método Estudo transversal e clínico em um grupo de 26 adultos, de ambos os gêneros, com tempo de uso médio do implante coclear de 6,6 anos. Foram usados o questionário específico Nijmegen de Implantes Cocleares e o questionário genérico World Health Organization Quality of Life, enviados via mídia eletrônica. Resultados O domínio mais bem pontuado na avaliação da qualidade de vida para o questionário Nijmegen foi o social e para o questionário World Health Organization Quality of Life foi o psicológico. As variáveis gênero, tempo de uso do implante coclear e modalidade auditiva não influenciaram os resultados dos questionários. Apenas a variável nível de instrução correlacionou-se com o domínio meio ambiente do questionário sobre qualidade de vida. A variável compreensão de fala ao telefone associou-se a uma melhor percepção da qualidade de vida para todos os domínios do questionário específico e para a autoavaliação da qualidade de vida em geral. Conclusão Na perspectiva dos usuários, o implante coclear trouxe benefícios para os diversos aspectos relacionados à qualidade de vida em ambos os questionários.

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Water protection after tympanostomy (Shepard) tubes does not decrease otorrhea incidence - retrospective cohort study

Abstract Introduction Myringotomy for tube insertion is the most common otologic surgery. Otorrhea is a frequent complication of this procedure and, to prevent it, most surgeons strongly recommend avoiding contact with water as this is thought to adversely impact on post-operative quality of life. Objective To understand the benefit of this recommendation. Methods Observational study - retrospective cohort study comparing the incidence of post-operative otorrhea and its impact on patients' quality of life, in two groups of patients comprising children under 10 years of age who underwent bilateral myringotomy and tube placement for chronic otitis media with effusion between May 2011 and May 2012. One group received water protection care after surgery, the other did not. Data was collected through telephonic interview, after one year of follow up (one year after the procedure). Water exposure without protection was considered the exposure event. Incidence of otorrhea and perceived impact on quality of life were the outcome measures. Results were compared after logistic regression. Results We included 143 children: 116 were not exposed to water without protection and 27 were exposed. In the not exposed group 36.2% had at least one episode of otorrhea, compared to 40.0% of the exposed group. Odds ratio for otorrhea on exposed was 1.21 (95% CI 0.51-2.85, p = 0.6). Negative impact on quality of life was reported by parents of 48.2% on the not exposed children, compared to 40.7% on the exposed group. This difference was not significant (p = 0.5). Conclusion We found that recommending water protection did not have beneficial effect on the incidence of otorrhea after myringotomy with tubes on chronic otitis media with effusion. However, such measures did not appear to have a negative impact on quality of life. This is a populational observational study with few cases (143 cases); these final statements would be better stated by a very large populational study with another large control group.

Resumo Introdução A miringotomia para inserção de tubo de ventilação é a cirurgia otológica mais comum. Otorreia é uma complicação frequente deste procedimento e, para evita-la, a maioria dos cirurgiões recomenda evitar o contato com a água, pois acredita-se que isso possa afetar negativamente a qualidade de vida pós-operatória. Objetivo Verificar o benefício dessa recomendação. Método Estudo observacional - estudo de coorte retrospectivo, comparando a incidência de otorreia pós-operatória e seu impacto na qualidade de vida dos pacientes, em dois grupos de pacientes com crianças menores de 10 anos submetidas à miringotomia bilateral e colocação de tubo de ventilação para o tratamento de otite média crônica com efusão, entre maio de 2011 e maio de 2012. Um grupo recebeu cuidados de proteção contra a água após a cirurgia, o outro não. Os dados foram coletados através de entrevista telefônica, após um ano de seguimento (um ano após o procedimento). A exposição à água sem proteção foi considerada o evento de exposição. A incidência de otorreia e o impacto percebido na qualidade de vida foram as medidas de resultado. Os resultados foram comparados após a regressão logística. Resultados Incluímos 143 crianças: 116 não foram expostas à água sem proteção e 27 foram expostas. No grupo não exposto, 36,2% apresentaram pelo menos um episódio de otorreia, em comparação com 40,0% do grupo exposto. A razão de chances (odds ratio) para otorreia no grupo exposto foi de 1,21 (IC 95%: 0,51-2,85, p = 0,6). O impacto negativo na qualidade de vida foi relatado pelos pais de 48,2% nas crianças não expostas, em comparação com 40,7% no grupo exposto. Essa diferença não foi significante (p = 0,5). Conclusão Não verificamos um efeito benéfico sobre a incidência de otorreia ao recomendar a proteção contra a água após colocação de tubos de ventilação para otite média com efusão. Entretanto, tais medidas não parecem ter tido um impacto negativo na qualidade de vida.

https://ift.tt/2MhBNFI

Factors associated with voice disorders among the elderly: a systematic review

Abstract Introduction During the aging process, natural modifications occur in the larynx and the structures involved in phonation which explain the specific characteristics found in the voices of elderly persons. When, at any moment, a voice fails and there is interference with communication, a voice disorder has occurred. This can generate disadvantages in communicative efficiency and have a negative impact on quality of life, compromising mechanisms of socialization, the maintenance of autonomy, and the sense of well-being. Nevertheless, there appears to be little clarity about which factors are associated with voice disorders in this population, especially from an epidemiological perspective. Objective The present study is a literature review to identify factors associated with voice disorders among the elderly described in population-based studies. Methods A systematic review of electronic databases was carried out. The methodological quality of the studies was analyzed with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. The research was conducted independently by two researchers. Results Although two articles met the eligibility criteria, none fulfilled all the criteria for the evaluation of methodological quality. According to the two studies selected for this review, factors associated with voice disorders among the elderly included both physical and psychosocial aspects. However, the methodological discrepancies between the studies, particularly in relation to sample selection and the instruments used indicate great variability and compromise the reliability of the results. Conclusion Further prevalence studies and investigations of factors associated with voice disorders in the elderly from an epidemiological perspective, and which involve different cultures, should be carried out.

Resumo Introdução Durante o processo de envelhecimento, modificações naturais ocorrem na laringe e nas estruturas envolvidas na fonação que explicam as características específicas encontradas nas vozes de pessoas idosas. Quando, a qualquer momento, a voz falha e há interferência com a comunicação, ocorre um distúrbio de voz. Isso pode gerar desvantagens na eficiência de comunicação e um impacto negativo sobre a qualidade de vida, comprometendo os mecanismos de socialização, a manutenção da autonomia e o sentido de bem-estar. Entretanto, ainda não estão claros quais os fatores associados aos distúrbios de voz nessa população, especialmente considerando-se uma perspectiva epidemiológica. Objetivo O presente estudo é uma revisão da literatura para identificar fatores associados a distúrbios de voz em idosos descritos em estudos de base populacional. Método Foi realizada uma revisão sistemática das bases de dados eletrônicas. A qualidade metodológica dos estudos foi analisada utilizando-se as diretrizes Strengthening the Reporting of Observational Studies in Epidemiology. A pesquisa foi realizada de forma independente por dois pesquisadores. Resultados Embora dois artigos tenham preenchido os critérios de elegibilidade, nenhum deles preencheu todos os critérios para a avaliação da qualidade metodológica. De acordo com os dois estudos selecionados para esta revisão, os fatores associados aos distúrbios de voz em idosos incluíram aspectos físicos e psicossociais. Entretanto, as discrepâncias metodológicas entre os estudos, particularmente em relação à seleção da amostra e aos instrumentos utilizados, indicam grande variabilidade e comprometem a confiabilidade dos resultados. Conclusão Devem ser realizados estudos de prevalência e investigações de fatores associados a distúrbios de voz em idosos a partir de uma perspectiva epidemiológica e que levem em consideração diferentes culturas.

https://ift.tt/2MCwkq0

Degree of tinnitus improvement with stapes surgery - a review

Abstract Introduction Otospongiosis is temporal bone osteodystrophy, characterized by disordered bone resorption and neoformation in genetically predisposed individuals. Clinically, otospongiosis is characterized by progressive conductive and/or mixed hearing loss and by tinnitus. Objective A review of the last two decades of publications that report the degree of tinnitus improvement with stapes surgery. Methods 125 articles published in the last 20 years mentioning the relationship between otosclerosis and tinnitus. Literature has always shown that the hearing improvement after stapes surgery was the main result sought and found. However, recent articles has reinforced the need for surgery for the tinnitus improvement. The ideal time to assess tinnitus through different scales is in the sixth month post-operative. The estimated average hearing improvement is 93% and tinnitus is 85.52%. Results Summaries of 12 articles were reviewed which fulfilled the search criteria of the survey, and 8 studies were included in the study according the selection criteria. This studies investigating the degree of tinnitus improvement with stapes surgery, using different scales as: tinnitus functional index, visual analog scale, tinnitus functional index and visual analog scale, visual analog scale and "questionnaire asking about tinnitus", Newman's method and Tinnitus Score Advocated by the Japan Audiological Society. The total of the samples of the evaluated articles was of 254 participants. Conclusion We conclude that stapes surgery is effective for the treatment of tinnitus (average improvement is 85.52%), and hearing loss (average improvement is 93%). When deciding about the surgical indication in patients with otosclerosis, the presence and level tinnitus should be considered as well as the level of hearing.

Resumo Introdução A otosclerose é uma osteodistrofia do osso temporal, caracterizada pela reabsorção e neoformação óssea desordenadas em indivíduos geneticamente predispostos. Clinicamente, a otosclerose é caracterizada por perda auditiva progressiva condutiva e/ou mista e por zumbido. Objetivo Uma revisão das últimas duas décadas de publicações que relatam o grau de melhora do zumbido com a estapedectomia. Método Foram analisados 125 artigos publicados nos últimos 20 anos que mencionavam a relação entre otosclerose e zumbido. A literatura sempre mostrou a melhoria auditiva como principal objetivo e resultado da estapedectomia. No entanto, artigos recentes reforçaram a necessidade de cirurgia para a melhoria do zumbido. O momento ideal para avaliar o zumbido através de diferentes escalas é no sexto mês pós-operatório. A melhoria auditiva média estimada é de 93% e a do zumbido, de 85,52%. Resultados Foram revisados resumos de 12 artigos que preencheram os critérios de pesquisa, foram incluídos no estudo 8 artigos de acordo com os critérios de seleção. Este estudo investiga o grau de melhora do zumbido com a estapedectomia, utilizando diferentes escalas: tinnitus functional index, escala visual analógica, tinnitus functional index e escala visual analógica, escala visual analógica e "questionário sobre o zumbido", método de Newman e o Tinnitus Score Advocated, da Sociedade Audiológica do Japão (Japan Audiological Society). O total das amostras dos artigos avaliados foi de 254 participantes. Conclusão Concluímos que a estapedectomia é bastante eficaz no tratamento do zumbido (melhoria média de 85,52%) e perda auditiva (melhoria média de 93%). Ao decidir sobre a indicação cirúrgica em pacientes com otosclerose, a presença e o nível de zumbido devem ser considerados, assim como o nível de audição.

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Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Πέμπτη 9 Αυγούστου 2018

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