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Summary Introduction: Chronic otitis media (COM) is an inflammatory condition associated with otorrhea as well as large and persistent perforations of the tympanic membrane in some cases. COM can also lead to cholesteatoma. Surgical treatment with canal wall-down and canal wall-up tympanomastoidectomy is considered for both types of illness. The choice of technique is controversial and is dependent on several factors, including the extent of disease. Objective: We aimed to evaluate surgical outcomes in COM patients with and without cholesteatoma treated with canal wall-down and canal wall-up tympanomastoidectomy. Disease eradication and post-operative auditory thresholds were assessed. Method: Patient records from the otorhinolaryngology department of a tertiary hospital were assessed retrospectively. Results: Patients who underwent canal wall-up tympanomastoidectomy had a higher rate of revision surgery, especially those with cholesteatoma. However, there were no statistically significant differences in post-operative hearing thresholds between the two techniques. Conclusion: The canal wall-down technique is superior to the canal wall-up technique, especially for patients with cholesteatoma.

Sensori neural hearing loss (SNHL) related to chronic suppurative otitis media (CSOM) was studied to clarify the involvement of cholesteatomas in this context. Aim: to evaluate SNHL related to CSOM and its association with cholesteatomas, disease duration and patients' ages. Methods: Retrospective analysis of 115 patients with CSOM with and without cholesteatoma submitted to surgical treatment. Inclusion criteria were active unilateral disease, normal contralateral ear and age below 60 years. Results: The average age was 26.3 years, 58 males and 57 females. The duration of ear disease was, in average, 12.4 years. The average threshold of hearing was 40 dB in CSOM ear and 22 dB in the normal contralateral ear (P=0.002). CSOM with cholesteatoma occurred in 78 of 115 cases. In the abnormal ear, SNHL was seen in 15 cases, being 6 cases of profound loss, that correlated with adjusted-age (P=0.003) and absence of cholesteatoma (P=0.01), but not with disease duration (P=0.458). Conclusion: SNHL occurred in 13% of the patients with CSOM, and was correlated with older age, but not with the presence of cholesteatoma or longer duration of ear disease.

RESUMOIntrodução: Obstrução nasal crônica secundária a hipertrofia das conchas nasais inferiores é um sintoma comum, de importante morbidade em nosso meio. Várias técnicas cirúrgi-cas são descritas para os casos refratários aos tratamentos clínicos, porém, há controversas sobre qual delas é a mais efetiva e sujeita a menos complicações. Objetivo: Avaliar a eficácia, a segurança e exequibilidade do uso do ácido tricloroacético ambulatorial para o tratamento da hipertrofia dos cornetos inferiores. Método: Trabalho prospectivo com 29 pacientes que foram submetidos à técnica ambulatorial de infiltração de ácido tricloroacético a 30% submucosa dos cornetos inferiores, sob anestesia tópica. Foram avaliados os sintomas de rinorreia e obstrução nasal utilizando escala visual e analógica (EVA 010) pré cauterização e um ano pós procedimento. Resultados: Diminuição significativa da obstrução nasal e da rinorreia um ano pós procedimento. As complicações foram sinéquias leves em dois pacientes e sangramentos, de pequena monta, em quatro casos com resolução espontânea. Conclusão: O método proposto apresentou ótimos resultados quanto à obstrução nasal e rinorreia, pode ser realizado em ambiente ambulatorial, e vem nos mostrando ser de baixa complicação Palavras-chave: cauterização, obstrução nasal, ácido tricloroacético. Artigo Original SUMMARYIntroduction: Chronic secondary nasal obstruction, the hypertrophy of the inferior turbinates is a common symptom of great morbidity in our society. Several surgical techniques are described to cases refractory to medical treatments, however, there are controversy about which one of them is more effective and less subject to complications. Objective: Evaluate the efficacy, security and practicability of using ambulatory trichloroacetic acid to treat the hypertrophy of the inferior turbinates. Method: Prospective study with 29 patients submitted to the ambulatory technique of 30% trichloroacetic acid infiltration in the inferior turbinate's submucosa, under topic anesthesia. The symptoms of rhinorrhea and nasal obstruction were evaluated using the analogical and visual scale (AVS 010) precautery and one year post-procedure. Results: Significant nasal obstruction and rhinorrhea reduction one year post-procedure. The complications were light synechia in two patients and small bleedings in four spontaneous resolution cases. Conclusion: The proposed method showed excellent results concerning nasal obstruction and rhinorrhea, can be conducted in ambulatory environment, and has proved to be a lowcomplication method.

Spontaneous cerebrospinal fluid leaks of the temporal bone are uncommon conditions, but with increasing incidence in the last years. They represent the osteodural defect of the middle and posterior fossae floor with consequent communication between the subarachnoid space and the middle ear and mastoid cells, not associated with a history of trauma, chronic infections, tumors, surgery or irradiation. Physiopathogenesis is not well defined, being associated with the faulty development of the temporal bone and/or the presence of aberrant arachnoid granulations, in addition to being favored by idiopathic intracranial hypertension, obstructive sleep apnea and obesity. It has the potential for serious neurological complications, which is why surgical treatment is recommended. The main approaches involve transmastoid access and craniotomy access through the middle fossa, or a combination of both. This paper reports on a case attended at Grupo Santa Casa BH and performs a literature review and on aspects related to the clinical presentation and management of the condition.