Surdez após meningite em idade pediátrica

Trabalho final de mestrado integrado em Medicina área científica de Otorrinolaringologia, apresentado á Faculdade de Medicina da universidade de CoimbraA meningite é uma das principais causas de surdez neurossensorial adquirida na infância e esta, por sua vez, é a principal sequela a longo prazo nos sobreviventes. Foi nosso propósito, com este estudo, avaliar a repercussão auditiva da meningite bacteriana em crianças. Assim, foram feitas avaliações otológica, neurológica e auditiva (impedancimetria, otoemissões acústicas, potenciais evocados auditivos e audiometria tonal, consoante a idade) de crianças com o diagnóstico de meningite bacteriana, admitidas no Departamento Pediátrico do Centro Hospitalar de Coimbra, entre 2000 e 2008. Foi identificada de surdez neurossensorial em 26% dos casos (em 13% bilateral). A Neisseria meningitidis foi o agente etiológico de meningite em 40% destes casos; em 20% não houve identificação de gérmen. Os outros agentes etiológicos identificados foram Streptococcus pneumoniae, Streptococcus do grupo B, Escherichia coli e Haemophilus influenzae, cada um deles identificado em 10% dos casos. As crianças com surdez apresentavam uma elevada incidência de sequelas neurológicas (40%). Em conclusão, a avaliação auditiva precoce após meningite é de extrema importância de forma a identificar lesões comprometedoras da função auditiva que possam interferir com a aquisição da linguagem. Um diagnóstico tardio pode comprometer o prognóstico e as opções terapêuticasBacterial meningitis is an important and prevalent aetiology of acquired sensorineural hearing loss in paediatric population, and deafness is the main long term consequence in the survivors. Our main goal was to study audiological consequences in children victim of meningitis. This way, otologic, neurologic and auditory complete assessment of children admitted in Paediatric Department of Centro Hospitalar de Coimbra, with the diagnosis of meningitis, between 2000 e 2008, was conducted. Clinical otological and neurological examination, impedancimetry, otoacoustic emissions, auditory brainstem evoked potentials and tonal audiometry were performed, depending on age. The incidence of sensorineural hearing loss was twenty-six percent (13% bilateral). Neisseria meningitidis was the etiological agent responsible for 40% of these cases, and in 20% the agent was not identified. The other aetiological agents identified were Streptococcus pneumoniae, Streptococcus B, Escherichia coli and Haemophilus influenzae, each one responsible for 10% of the cases. Children with hearing impairment had a high incidence of neurological sequelae (40%). In conclusion, early auditory assessment after meningitis is of great importance in order to identify any ear damage that could determine restricted access to sound and lack of progress in development of auditory skills and speech. Later diagnosis could compromise outcomes and treatment options

Laryngeal chondrosarcoma – Ten years of experience

AbstractIntroductionLaryngeal involvement by cartilaginous tumors is rare. However, although accounting for only 1% of laryngeal tumor pathology, they are the most frequently occurring non-epithelial neoplasms. The most probable location is the endolaryngeal surface of the cricoid cartilage. Their symptoms are variable, depending on the size and location, and may include hoarseness, stridor, and dyspnea. Treatment is based on surgical excision. Some centers take into account the degree of differentiation and whether it is a case of relapse when deciding to perform a radical resection.AimTo evaluate this disease in a sample of the Portuguese population.MethodsA review of the medical records from 2002 to 2012 by assessment of clinical processes was performed. Data on demographics, clinical treatments, and outcomes were collected.ResultsSix patients were included in the study. Five of them underwent total laryngectomy, and in one case, partial excision of the thyroid cartilage was performed. None of the patients had either metastases or tumor-related death.ConclusionLaryngeal chondrosarcomas remain a rare disease of unknown etiology, with slow and insidious symptoms. The treatment is surgical, with favorable prognosis, and metastases rarely occur. The main concern regards their propensity to relapse