Introduction The etiology of Ménière disease (MD), a difficult-to-treat condition with great morbidity, remains controversial in the literature. The possible clinical and diagnostic impact of anatomical variations of the temporal bone among patients with MD has been recently studied. Objective To identify anatomical variations of the temporal bone associated with the diagnosis of MD. Methods Thirty-seven patients were included, although each ear was considered separately ( n = 74). A case group ( n A = 33) was composed of the affected ears of patients with definite MD and a control group ( n B = 41) was used consisting of the ears of individuals who did not meet the criteria for MD and of the contralateral ears from patients with unilateral disease. Tomographic images from the individuals included in the study were submitted to a blinded and systematic evaluation regarding a broad variety of anatomical variations of the temporal bone. Obtained data were compared statistically between the groups and after stratifying the study sample. Significance level was set at 0.05. Results Among the affected ears, it was observed an increased number of tomographic scans in which the vestibular aqueduct could not be identified ( p = 0.01, Fisher exact test). No statistically significant differences were observed when comparing the affected and contralateral ears from patients with unilateral MD, between affected ears from patients with unilateral and bilateral disease or between contralateral ears of patients with unilateral affection and patients without the disease. Conclusion Some anatomical variations might be more frequent in the affected ears of patients with MD, such as the lower rates of individualization of the vestibular aqueduct.
Imaging data provided by computed tomography scans of the temporal bone are fundamental for both the diagnosis and treatment of diseases affecting this complex structure. Despite its importance, the expertise required to analyze this exam is seldom properly acquired as it is time-consuming and often neglected among young doctors and even otolaryngologists. Physicians may not even have a look at the scans but rely only on radiology reports. Radiologists, on the other hand, may not describe the individual scans the same way as clinicians. Lack of a standardized and didactic protocol for scrolling through the images obtained might also contribute to the difficulties reported by residents and physicians in daily practice. We present here a sequential checklist which could be employed in a systematic and organized manner, aiming to both develop and practice the know-how of this indispensable and challenging method of evaluation of the temporal bone.
Abstract. Paracoccidioidomycosis is a systemic mycosis caused by Paracoccidioides brasiliensis. It occurs more frequently in its chronic form, which particularly affects male adults from rural areas. These patients present with pulmonary involvement and systemic symptoms. Skin and mucosal lesions are rather typical and might suggest the diagnosis. The involvement of the upper airway mucosa is common and the patients usually complain of dysphagia and dysphonia. Nonetheless, in endemic areas, physicians should maintain a high level of suspicion even when faced with some atypical symptoms. We present the case of an adult diagnosed with nasopharyngeal paracoccidioidomycosis after presenting with an unusual otolaryngologic syndrome including unilateral soft palate paralysis with velopharyngeal insufficiency and hearing loss secondary to middle ear effusion. CASE REPORTA 31-year-old man attended the department of otorhinolaryngology at Federal University of Paraná, in Curitiba, Brazil, in January 2015, complaining of nasal obstruction, purulent rhinorrhea, and odynophagia. Fever or any other systemic symptoms were not reported. He had been treating in our Otoloaryngology clinic for chronic sialadenitis, although at that moment he denied oral discharge and parotid or submandibular enlargement.The patient had also been diagnosed with both selective IgM deficiency and Netherton syndrome, an autosomal recessive genodermatosis and primary immunodeficiency characterized by congenital erythroderma, a specific hairshaft abnormality known as trichorrhexis invaginata, high susceptibility to infection, and atopic manifestations.After this first assessment, he was treated with analgesics, nasal saline irrigations, rest, and hydration. Nonetheless, 2 months later, he presented to consultation for right aural fullness, hypernasal speech, and nasal regurgitation of fluids during swallowing. He reported having been already prescribed antibiotics and oral glucocorticoids, which did not improve his condition. Physical examination revealed apathy, weakness, persistent postnasal purulent discharge, halitosis, paralysis of the right soft palate, and a retracted right tympanic membrane with the presence of air/fluid level and bubbles. Laboratory data showed only mild normochromic, normocytic anemia (hemoglobin = 13.4; mean cell volume = 90.8; mean cell hemoglobin = 30
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