Mobile phones: influence on auditory and vestibular systems

SummaryTelecommunications systems emit radiofrequency, which is an invisible electromagnetic radiation. Mobile phones operate with microwaves (450900 MHz in the analog service, and 1,82,2 GHz in the digital service) very close to the user's ear. The skin, inner ear, cochlear nerve and the temporal lobe surface absorb the radiofrequency energy.Aimliterature review on the influence of cellular phones on hearing and balance.Study designsystematic review.MethodsWe reviewed papers on the influence of mobile phones on auditory and vestibular systems from Lilacs and Medline databases, published from 2000 to 2005, and also materials available in the Internet.ResultsStudies concerning mobile phone radiation and risk of developing an acoustic neuroma have controversial results. Some authors did not see evidences of a higher risk of tumor development in mobile phone users, while others report that usage of analog cellular phones for ten or more years increase the risk of developing the tumor. Acute exposure to mobile phone microwaves do not influence the cochlear outer hair cells function in vivo and in vitro, the cochlear nerve electrical properties nor the vestibular system physiology in humans. Analog hearing aids are more susceptible to the electromagnetic interference caused by digital mobile phones.Conclusionthere is no evidence of cochleo-vestibular lesion caused by cellular phone

Methods for smoking cessation and treatment of nicotine dependence

SummarySmoking is related to 30% of cancer deaths. It is a risk factor for respiratory tract, esophagus, stomach, pancreas, uterine cervix, kidney and bladder carcinomas. Nicotine induces tolerance and addiction by acting on the central dopaminergic pathways, thus leading to pleasure and reward sensations within the limbic system. It stimulates the central nervous system (CNS), enhances alertness and reduces the appetite. A 50% reduction of nicotine consumption may trigger withdrawal symptoms in addicted individuals: anxiety, anger, sleep disorders, hunger, cognitive dysfunction and cigarette craving. Medical advice is the cornerstone of smoking cessation. Pharmacotherapy of nicotine addiction comprises first-line (bupropion and nicotine replacement therapy) and second-line (clonidine and nortriptyline) drugs. Bupropion is a non-tricyclic antidepressant that inhibits dopamine uptake, whose contraindications are: epilepsy, eating disorders, uncontrolled hypertension, recent alcohol abstinence and current therapy with MAO inhibitors. Nicotine replacement therapy can be done with patches or gums. Counseling groups and behavioral interventions are efficacious. The effects of acupuncture on smoking cessation are not fully elucidated. Prompt smoking cessation or gradual reduction strategies have similar success rates

Pharyngotonsillitis in children: view from a sample of pediatricians and otorhinolaryngologists

SummaryAcute pharyngotonsillitis is a common upper airway infection in children. Aim: To analyze opinions and practices of pediatricians and otorhinolaryngologists from Sao Paulo State, Brazil, concerning diagnosis, treatment and prevention of pharyngotonsillitis and their complications in children. Methods: We randomly selected 1,370 pediatricians and 1,000 otolaryngologists from Sao Paulo State, Brazil. A questionnaire was mailed to the specialists. Study design: Cross-sectional. Results: 95.8% of the pediatricians and 91.5% of the otolaryngologists do not perform routine laboratory diagnosis for acute pharyngotonsillitis in children. The antimicrobials more commonly prescribed by pediatricians for treatment of bacterial pharyngotonsillitis were: oral penicillin for 10 days (33.6%) and s single injection of benzathine penicillin G (19.7%). The antimicrobials prescribed more often by otorhinolaryngologists for treatment were: oral penicillin for 10 days (35.4%) and oral penicillin for 7 days (25.7%). Tonsillectomy was considered the most effective measure for prevention of bacterial pharyngotonsillitis by more than half of pediatricians and otolaryngologists. Repeated pharyngotonsillitis was the main reason for otolaryngologists to indicate tonsillectomy for school-aged children and adolescents (49.3% and 53.4% respectively). Conclusions: It is necessary to standardize the practices of pediatricians and otolaryngologists regarding diagnosis and treatment of pharyngotonsillitis in children

Surgery of frontal sinus fractures. Epidemiologic study and evaluation of techniques

SummaryThe frontal sinus trauma is not rare and it is 8% of the facial fractures. It can affect the anterior and/or posterior plates, with or without hitting the nasofrontal duct. It has a large potential of complications and its management still being a controversy. Objective: To present the casuistic of fractures frontal sinus, the epidemiology and clinical and surgical management of frontal sinus fractures. Materials and Methods: Not randomized retrospective study of 24 patients with frontal sinus fractures Hospital of Clinics, School of Medicine Botucatu, São Paulo, Brazil. Results: From the 24 patients, we had 16 (66,6%) fractures of the extern plate and 8 (33,4%) of both. In 2 patients the nasofrontal duct was involved. Others facial fractures were associated in 20 (83,4%) cases and major lesions of the cerebral segment were found in 13 (54,2%). Subpalpebral incision was performed in the majority with satisfactory aesthetic results. The basis of the surgical treatment was reduction and fixation with different materials (steel wire, mononylon, titanium miniplates) and if necessary we used alogen implants or parietal bone to reconstruct the anterior plate. Conclusion: The principal cause of frontal sinus fractures is crashed car. The management depends of the complexity, because commonly there are cranioencephalic lesions associated. The surgical thecniques used are the incisions, bicoronal flap or browglabella, infra-orbital rim (“butterfly”), associated a endoscopy sinus surgery in cases of infection, cerobrospinal fluid leak and orbital complications

Hyperactivity and attention deficit syndrome in obstructive sleep apnea syndrome: is there improvement with surgical management?

SummaryNeuropsychological disorders are frequently associated with obstructive ventilatory disorders (OVD).AimTo analyze the incidence of neuropsychological disorders in Brazilian children with OVD, using a screening questionnaire and to compare the answers given before and after surgery.Patients and MethodsWe studied 30 children with clinical diagnosis of OVD. The children were divided into 3 groups: group I, children aged 4 to 7; group II, from 8 to 10; and group III, children over 11. The applied questionnaires were answered by the parents or tutors, and comprised 30 questions, 10 for each disorder: attention deficit, hyperactivity and impulsivity. The children were diagnosed with one of the disorders when presented 3 or more positive answers. The follow up interview occurred 6 months after adenotonsillectomy.ResultsThere was a predominance of male gender (60.6%) over female gender (39.4%). Group II presented the highest number of significant changes, with reductions raging from 87.5% to 33.3% of patients with attention deficit, 75% to 50% of the hyperactive patients, and 50% to 33% of the impulsive patients.ConclusionThere was neuropsychological improvement after the surgery, which occurred mainly in the children from group II. More interaction among health professionals is necessary when diagnosing and following up similar cases

Etiology and incidence facial fractures in children and adults

SummaryFacial trauma has presented an increasing occurrence in the last four decades, due especially to the growth of accidents with automobiles as well as to the urban violence. Both of which continue being the main cause of such traumas. Aim: To evaluate the features of the population victim of facial trauma as to gender, age, occupation, origin, type of fracture and its cause. Design study: retrospective clinical with transversal cohort. Material and Method: Retrospective study consulting hospital registers of 513 patients victms of the facial trauma. Results: There was a higher incidence of facial trauma on men (84,9%), white (82,7) and with an average age of 29. Regarding occupation, the trauma was mostly occurred to students (16,6%) and Masons (11,2%). The jaw was the most affected place (35%), followed by zygoma (24%) and by the nose (23%), though most patients presented a single facial fracture (82,5%). Among the causes, accidents with automobiles (28,3%), aggressions (21%) and accidental fall s (19,5%) were the most common. Conclusions: Accidents with automobiles continue being the main cause of facial trauma, especially of multiple factures due to the great transmission of kinetic energy