Metástases temporais: a propósito de um caso clínico

A metastização óssea para a cabeça e pescoço é rara. Em 20-35% dos casos, pode ser a primeira manifestação de uma neoplasia oculta. No caso específico do osso temporal, as metástases são originárias, mais frequentemente, da mama, pulmão, rim, próstata e estômago. Apresenta-se o caso clínico de uma doente, do sexo feminino, 71 anos, com Diagnóstico de Carcinoma Ductal tipo Cribiforme na mama esquerda, tendo sido submetida a mastectomia total, quimioterapia e radioterapia. À observação apresentava um quadro clínico de otalgia esquerda, associada a paralisia facial da hemiface ipsilateral, sem outros sintomas otológicos. Foi-lhe diagnosticada Otite Média Crónica agudizada, tendo sido medicada e pedida Tomografia Computorizada ao Ouvido Esquerdo, que demonstrou exuberante espessamento dos tecidos moles epicranianos temporo-parieto-occipitais à esquerda com extensão ao canal auditivo externo do mesmo lado. Por agravamento da sintomatologia, foi internada no Serviço de Otorrinolaringologia deste hospital para administração de terapêutica endovenosa, tendo-se admitido a hipótese diagnóstica de Otite Externa Maligna. Por manutenção do quadro, apesar de terapêutica optimizada, foi submetida a intervenção cirúrgica onde foi efectuada biopsia temporal, tendo sido diagnosticado lesão metastática por carcinoma invasivo da mama.

Relação entre potenciais evocados auditivos de média latência e distúrbio de processamento auditivo: estudo de casos

The Auditory Evoked Middle Latency Response is one of the most promising objective tests in audiology and in revealing brain dysfunction and neuro-audiologic findings. The main advantages of its clinical use are precision and objectivity in evaluating children. This study aimed to analyze the auditory evoked middle latency response in two patients with auditory processing disorder and relate objective and behavioral measures. This case study was conducted in 2 patients (P1 = 12 years, female, P2 = 17 years old, male), both with the absence of sensory abnormalities, neurological and neuropsychiatric disorders. Both were submitted to anamnesis, inspection of the external ear canal, hearing test and evaluation of Auditory Evoked Middle latency Response. There was a significant association between behavioral test and objectives results. In the interview, there were complaints about the difficulty in listening in a noisy environment, sound localization, inattention, and phonological changes in writing and speaking, as confirmed by evaluation of auditory processing and Auditory Evoked Middle Latency Response. Changes were observed in the right decoding process hearing in both cases on the behavioral assessment of auditory processing; auditory evoked potential test middle latency shows that the right contralateral via response was deficient, confirming the difficulties of the patients in the assignment of meaning in acoustic information in a competitive sound condition at right, in both cases. In these cases it was shown the association between the results, but there is a need for further studies with larger sample population to confirm the data.

Congenital aural atresia associated with agenesis of internal carotid artery in a girl with a FOXI3 deletion.

We report on the molecular characterization of a microdeletion of approximately 2.5 Mb at 2p11.2 in a female baby with left congenital aural atresia, microtia, and ipsilateral internal carotid artery agenesis. The deletion was characterized by fluorescence in situ hybridization, array comparative genomic hybridization, and whole genome re-sequencing. Among the genes present in the deleted region, we focused our attention on the FOXI3 gene. Foxi3 is a member of the Foxi class of Forkhead transcription factors. In mouse, chicken and zebrafish Foxi3 homologues are expressed in the ectoderm and endoderm giving rise to elements of the jaw as well as external, middle and inner ear. Homozygous Foxi3-/- mice have recently been generated and show a complete absence of the inner, middle, and external ears as well as severe defects in the jaw and palate. Recently, a 7-bp duplication within exon 1 of FOXI3 that produces a frameshift and a premature stop codon was found in hairless dogs. Mild malformations of the outer auditory canal (closed ear canal) and ear lobe have also been noted in a fraction of FOXI3 heterozygote Peruvian hairless dogs. Based on the phenotypes of Foxi3 mutant animals, we propose that FOXI3 may be responsible for the phenotypic features of our patient. Further characterization of the genomic region and the analysis of similar patients may help to demonstrate this point. © 2015 Wiley Periodicals, Inc.

Bacterial Pathogens Related to Chronic Suppurative Otitis Media in Individuals With Cleft Palate: Bacteriological Culture and Polymerase Chain Reaction

Objective: To characterize the microbial etiology of chronic suppurative otitis media comparing the methods of classical bacteriological culture and polymerase chain reaction.Design/Setting/Patients: Bacteriological analysis by classical culture and by molecular polymerase chain reaction of 35 effusion otitis samples from patients with cleft lip and palate attending the Hospital for Rehabilitation of Craniofacial Anomalies of the University of Sao Paulo, Bauru, Brazil.Interventions: Collection of clinical samples of otitis by effusion through the external auditory tube.Main Outcome Measure: Otolaryngologic diagnosis of chronic suppurative otitis media.Results: Positive cultures were obtained from 83% of patients. Among the 31 bacterial lineages the following were isolated. In order of decreasing frequency: Pseudomonas aeruginosa (54.9%), Staphylococcus aureus (25.9%), and Enterococcus faecalis (19.2%). No anaerobes were isolated by culture. The polymerase chain reaction was positive for one or more bacteria investigated in 97.1% of samples. Anaerobe lineages were detected by the polymerase chain reaction method, such as Fusobacterium nucleatum, Bacteroides fragilis, and Peptostreptococcus anaerobius.Conclusions: Patients with cleft lip and palate with chronic suppurative otitis media presented high frequency of bacterial infection in the middle ear. The classical bacteriological culture did not detect strict anaerobes, whose presence was identified by the polymerase chain reaction method.

Fat implant is superior to muscle implant in vestibular schwannoma surgery for the prevention of cerebrospinal fluid fistulae

OBJECTIVE: Meticulous sealing of opened air cells in the petrous bone is necessary for the prevention of cerebrospinal fluid (CSF) fistulae after vestibular schwannoma surgery. We performed a retrospective analysis to determine whether muscle or fat tissue is superior for this purpose. METHODS: Between January 2001 and December 2006, 420 patients underwent retrosigmoidal microsurgical removal by a standardized procedure. The opened air cells at the inner auditory canal and the mastoid bone were sealed with muscle in 283 patients and with fat tissue in 137 patients. Analysis was performed regarding the incidence of postoperative CSF fistulae and correlation with the patient's sex and tumor grade. RESULTS: The rate of postoperative CSF leak after application of fat tissue was lower (2.2%) than after use of muscle (5.7%). Women had less postoperative CSF leakage (3.4%) than men (5.6%). There was an inverse correlation with tumor grade. Patients with smaller tumors seemed to have a higher rate of CSF leakage than those with large tumors without hydrocephalus. Only large tumors with severe dislocation of the brainstem causing hydrocephalus showed a higher incidence of CSF leaks. CONCLUSION: Fat implantation is superior to muscle implantation for the prevention of CSF leakage after vestibular schwannoma surgery and should, therefore, be used for the sealing of opened air cells in cranial base surgery.

Radiological factors related to pre-operative hearing levels in patients with vestibular schwannomas

The pathogenetic mechanism of hearing loss in patients with vestibular schwannomas (VS) remains unclear. Our aim was to determine the radiological and clinical parameters that might be related to hearing. The radiological images and charts of 99 patients were reviewed. Image processing software was used to analyse the maximal tumor diameter in three planes; its volume; its extension cranially, caudally, anteriorly and posteriorly; the width and length of the intrameatal tumor portion, its shape and consistency; and the tumor-fundus distance. These parameters were correlated with the patient's pre-operative hearing range. The degree of hearing correlated significantly with the tumor size, volume and coronal diameter, the degree of intrameatal tumor growth, and the distance between the lateral tumor end and the fundus (p < 0.05). No correlation was found regarding tumor extension, shape and consistency, the presence of hydrocephalus, or the extent of erosion of the internal auditory canal. Loss of hearing in the VS appears to be multifactorial. Determining the radiological parameters related to the hearing level can help to clarify the pathophysiological mechanisms involved.

Prognostic clinical and radiological parameters for immediate facial nerve function following vestibular schwannoma surgery

OBJECTIVE: The paper aims to define the parameters available before surgery which could predict immediate facial nerve function after excision of a vestibular schwannoma (VS). METHODS: Ninety-nine patients with VS operated consecutively by a single surgeon using an identical surgical technique have been evaluated retrospectively. Data were collected regarding patients' sex, age at onset of symptoms and at surgery, initial symptoms, neurological status at presentation, early post-operative neurological status and complications. The main radiological parameters included in the study were tumour extension pattern, diameters, shape, and volume, as well as extent of bony changes of the internal auditory canal. RESULTS: As the tumour stage and volume increase, facial nerve function is worse after surgery (p < 0.001 and p < 0.05, respectively). Concomitantly, larger extra-meatal tumour diameters in three dimensions (sagittal, coronal and axial) led to worse function (p < 0.01). Anterior and/or caudal tumour extension (p = 0.001 and p = 0.004, respectively) had more significant correlation than posterior and/or cranial extension (p = 0.022 and p = 0.353, respectively). Polycyclic VS had the worst prognosis, followed by the tumours with oval shape. The extent of intra-meatal tumour growth does not correlate with immediate facial nerve outcome. The different angles, lengths and diameters of the internal auditory channel showed no significant correlation with facial nerve outcome. Patients with headache as an initial symptom and those with gait instability and/or pre-operative poor facial nerve function had significantly worse immediate facial nerve outcome. CONCLUSION: Our data suggests that the analysis of the radiological and neurological patient data prior to surgery could give reliable clues regarding the immediate post-operative facial nerve function.

Glass ionomer cement in otological microsurgery: experience over 16 years

A retrospective evaluation of glass ionomer cement (GIC) in middle ear surgery with emphasis on short- and long-term safety was conducted at the tertiary referral center. GIC was applied between 1995 and 2006 in 444 patients in otologic surgery. Technical aspects, safety, benefits and complications due to GIC were analysed until 2011 (follow-up 5-16 years; mean 10 years). GIC was applied in stapes surgery (228 primary, 92 revisions), cochlear implants (108) and implantable hearing aids (7), ossiculoplasty (7), for coverage of opened mastoid air cells towards the external ear canal (1) and inner ear fistula closure (1). GIC turned out to be very handy in stapes surgery for optimal prosthesis fixation at the incus (260) and on the malleus handle (60) without complications. Results suggest that GIC may diminish the danger of incus necrosis in primary stapedotomy. In cochlear implants and implantable hearing aids, GIC was used for casing alone (74), casing and electrode fixation (27) and electrode alone fixation (14). Inflammatory reactions were observed in five cases (4.3 %), mostly after trauma. Broken cement fragments appeared to promote foreign body rejection. In seven cases an incudo-stapedial gap was repaired with GIC with excellent hearing gain; in three cases (43 %) revision surgery was needed due to cement breakage. In one case, GIC was applied for a watertight coverage of opened mastoid cells, and in the other for fistula closure of the lateral semi-circular canal over cartilage, covered with bone pathé; follow-up was uneventful. Targeted use of GIC in middle ear surgery rarely poses problems. GIC cannot be used in neuro-otosurgery in contact with cerebrospinal fluid because of possible aluminium encephalopathy.

Propionibacterium acnes:infection beyond the skin

Propionibacterium acnes is a Gram-positive bacterium that forms part of the normal flora of the skin, oral cavity, large intestine, the conjunctiva and the external ear canal. Although primarily recognized for its role in acne, P. acnes is an opportunistic pathogen, causing a range of postoperative and device-related infections. These include infections of the bones and joints, mouth, eye and brain. Device-related infections include those of joint prostheses, shunts and prosthetic heart valves. P. acnes may play a role in other conditions, including inflammation of the prostate leading to cancer, SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome, sarcoidosis and sciatica. If an active role in these conditions is established there are major implications for diagnosis, treatment and protection. Genome sequencing of the organism has provided an insight into the pathogenic potential and virulence of P. acnes. © 2011 Expert Reviews Ltd.

Assessment of external root temperature during root canal irradiation by Nd:YAG and Er:YAG lasers

Different types of laser have been widely studied for applicability in the oral health area. In the endodontic area, investigations with some types of laser have been conducted to establish safe parameters for clinical application in root canals. However, it has not been duly explained whether the temperature increase caused by laser irradiation could cause alteration in the temperature on the external surface of the root and, consequently, alterations in the cells of the periodontal ligament, causing resorption and even loss of the dental element. The proposal in this paper was to gauge the external root temperature in the apical and cervical regions of the roots of human teeth during root canal irradiation with Nd:yttrium aluminum garnet (YAG) and Er:YAG lasers using different parameters. The novel approach of this paper is the use of the technique of laser applications along the total length of the root canal with series of repetitive irradiation, however, using time of 1 s of irradiation associated with 1 s off to avoid cumulative thermal effects. Experimental results confirm the accuracy of the parameters and exposure regimen obtained. All the parameters used in this paper are acceptable from a clinical as well as a biological point of view. (C) 2009 Laser Institute of America.

Investigation of the Effect of Sealer Use on the Heat Generated at the External Root Surface during Root Canal Obturation Using Warm Vertical Compaction Technique with System B Heat Source

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

3-D Audio in Mobile Communication Devices: Effects of Self-Created and External Sounds on Presence in Auditory Virtual Environments

This article describes a series of experiments which were carried out to measure the sense of presence in auditory virtual environments. Within the study a comparison of self-created signals to signals created by the surrounding environment is drawn. Furthermore, it is investigated if the room characteristics of the simulated environment have consequences on the perception of presence during vocalization or when listening to speech. Finally the experiments give information about the influence of background signals on the sense of presence. In the experiments subjects rated the degree of perceived presence in an auditory virtual environment on a perceptual scale. It is described which parameters have the most influence on the perception of presence and which ones are of minor influence. The results show that on the one hand an external speaker has more influence on the sense of presence than an adequate presentation of one’s own voice. On the other hand both room reflections and adequately presented background signals significantly increase the perceived presence in the virtual environment.

Auditory hallucinations in dissociative identity disorder and schizophrenia with and without a childhood trauma history: Similarities and differences.

Little is known about similarities and differences in voice hearing in schizophrenia and dissociative identity disorder (DID) and the role of child maltreatment and dissociation. This study examined various aspects of voice hearing, along with childhood maltreatment and pathological dissociation in 3 samples: schizophrenia without child maltreatment (n = 18), schizophrenia with child maltreatment (n = 16), and DID (n = 29). Compared with the schizophrenia groups, the DID sample was more likely to have voices starting before 18, hear more than 2 voices, have both child and adult voices and experience tactile and visual hallucinations. The 3 groups were similar in that voice content was incongruent with mood and the location was more likely internal than external. Pathological dissociation predicted several aspects of voice hearing and appears an important variable in voice hearing, at least where maltreatment is present.

Plastic brain mechanisms for attaining auditory temporal order judgment proficiency.

Accurate perception of the order of occurrence of sensory information is critical for the building up of coherent representations of the external world from ongoing flows of sensory inputs. While some psychophysical evidence reports that performance on temporal perception can improve, the underlying neural mechanisms remain unresolved. Using electrical neuroimaging analyses of auditory evoked potentials (AEPs), we identified the brain dynamics and mechanism supporting improvements in auditory temporal order judgment (TOJ) during the course of the first vs. latter half of the experiment. Training-induced changes in brain activity were first evident 43-76 ms post stimulus onset and followed from topographic, rather than pure strength, AEP modulations. Improvements in auditory TOJ accuracy thus followed from changes in the configuration of the underlying brain networks during the initial stages of sensory processing. Source estimations revealed an increase in the lateralization of initially bilateral posterior sylvian region (PSR) responses at the beginning of the experiment to left-hemisphere dominance at its end. Further supporting the critical role of left and right PSR in auditory TOJ proficiency, as the experiment progressed, responses in the left and right PSR went from being correlated to un-correlated. These collective findings provide insights on the neurophysiologic mechanism and plasticity of temporal processing of sounds and are consistent with models based on spike timing dependent plasticity.

Comprovação da real comunicação entre o endodonto e o periodonto através do canal cavo inter-radicular e sua prevalência em molares inferiores humanos

The neurovascular system of the pulp and of the periodontium is interconnected and among the possible intercommunications between these two tissues, there is the cavo inter-radicular canal. It is a small canal that goes through any inter-radicular dentine and arises in the furca region of the multi-radicular teeth. Its predominance has been studied in the literature, by several methodologies, with divergent results. The objective of this work was to establish, in vitro, the predominance of the cavo inter-radicular canal, in human lower molars, through the diaphanization technique and dye leakage. For this research, 140 teeth (100 first and second 40 lower molars) were selected, extracted due to different reasons, belonging to a teeth bank of the Endodontics discipline of the Dentistry College at Federal University of Rio Grande do Norte. The teeth were preserved in formol until the moment of use and immersed in physiological solution. Had the endodontic access fulfilled and the whole external surface, except for the furcation, sealed with two layers of nail enamel. The cleaning of the pulpar chamber floor was carried out with sodium hypochlorite solution 5%, being this solution renewed every 5 minutes, during 1 hour. The teeth were immersed in Indian dye and, after drying of the dye, they had their crowns split up in the amelo-cemental junction. Then, they were examined in a stereomicroscope, where marks of the coloring were observed in the furcation and on the pulpar floor. After this recording, the sample was diaphanized and with the transparent teeth, it was possible to observe in the stereomicroscope, the true inter-radicular canals. As a result of this experiment, the presence of these canals was observed in 13 % of the first and 7, 5 % of the second evaluated molars. The study showed that both the presence of the cavo inter-radicular canal is real and the diaphanization and dye leakage is an efficient method for this type of research