Sudden sensorineural hearing loss and vertigo (SSNHLV) has multifactorial causes, of which viral, autoimmune and vascular insufficiency are the most common. The therapeutic management for SSNHLV includes antiviral drugs, corticosteroids, vasodilators, normovolemic hemodilution therapy and hyperbaric oxygen therapy. Vertebrobasilar occlusive disease and carotid occlusive disease are seldom related to SSNHLV. Discussions concerning SSNHLV caused by occlusive vascular disease are important and necessary for both neurologists and otolaryngologists, since their therapeutic management and prognosis are very different from other causes of hearing loss and vertigo. Here, we present our experience with three cases managed with interventional treatment and conduct a review and discussion on the relevant literature. We conclude that investigation of vertebrobasilar and carotid occlusive diseases is necessary in patients over 50 years of age who present SSNHLV, mild neurological symptoms and a history of arteriosclerosis, high blood pressure or thrombosis.
Os potenciais de média latência são potenciais auditivos que ocorrem entre 10ms a 80ms, formados por ondas polifásicas positivas e negativas denominadas de N0, P0, Na, Pa, Nb e Pb. O logon é um estímulo acústico que permite eliciar respostas de média latência ativando regiões específicas da cóclea. Sua vantagem sobre o clique é a possibilidade avaliar as áreas de baixa freqüência (abaixo de 1kHz). OBJETIVO: O objetivo deste trabalho foi verificar a resposta eletrofisiológica das MLR estimulados por logon nas freqüências de 500, 1000 e 2000 Hz. CASUÍSTICA E MÉTODO: Forma de estudo prospectivo e descritivo de uma amostra de 14 voluntárias do sexo feminino, normais dos pontos de vista otológico e audiológico convencional. O estímulo foi monoaural e ipsilateral à derivação de captação dos potenciais (Cz/A1-2). RESULTADOS: O complexo NaPa foi o mais facilmente identificado e esteve presente em 100% dos exames realizados a 2000 Hz e em 96,4% a 500 e 1000 Hz. CONCLUSÕES: As MLR podem se eliciadas pelo logon nas freqüências de 500, 1000 e 2000 Hz; o complexo NaPa foi o evento prevalente das MLR e o estímulo logon a 2000 Hz eliciou maior número de respostas do que as outras freqüências.
OBJECTIVES: 1. Describe two cases of rare laryngeal sarcomas: leiomyosarcoma (LMS) and liposarcoma. 2. Investigate management options, recurrence, prognosis, and the role of adjunctive diagnostic studies in the diagnosis of liposarcoma and LMS of the larynx. METHODS: Review of two cases and a study of all relevant cases and reviews in the English literature in PubMed from 1941 to 2005. RESULTS: Diagnosis of certain laryngeal sarcomas is challeging and may depend more on adjunctive studies, such as immunohistochemistry, electron microscopy, and genetic analysis. While surgical resection is the mainstay of treatment, certain cases of laryngeal sarcomas may benefit from radiotherapy and even chemotherapy. CONCLUSIONS: Laryngeal sarcomas are uncommon, accounting for less than 1% of all laryngeal cancers. Osteosarcoma, liposarcoma, and LMS are among the rarest laryngeal sarcomas with approximately 24, 30, and 45 cases reported in the literature, respectively. Liposarcoma and LMS of the larynx have relatively high rates of recurrence and low rates of metastasis, and their presenting symptoms are similar to those of laryngeal carcinomas. Two cases are presented: a 62-yearold man with a compromised airway secondary to dedifferentiated liposarcoma of the supraglottic larynx, and a 53-year-old man with hoarseness secondary to an intermediately differentiated LMS involving the subglottic larynx, right vocal cord, and anterior commissure. In a review of reported cases, management options and the prognosis of liposarcoma and LMS of the larynx are discussed. The report also reviews the role of immunohistochemistry and electron microscopy in the diagnosis of rare laryngeal sarcomas.
agement implications of P4P including data collection and utilization, reimbursement and socioeconomic impact, etc., and (3) discuss physicians' concerns regarding appropriateness of measures used by CMS and other third-party carriers. It is critical that otolaryngologists and the AAO-HNS are an integral part of the development and implementation of the P4P system, which will ultimately allow for quality patient care and fairness for both the patient and physician.
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