Avaliação microbiológica pré e pós operatória da orofaringe de crianças submetidas à adenotonsilectomia

Orientador: Prof. Dr. Jorge E.F. MatiasCo-orientador: Prof. Dr. Eduardo BaptistellaDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Clínica Cirúrgica. Defesa: Curitiba, 22/05/2015Inclui referências f. 38-40Área de concentração : Clinica cirurgiaResumo: Adenotonsilectomia é um dos procedimentos cirúrgicos pediátricos mais comuns realizados visando à resolução de problemas obstrutivos e infecciosos das vias aéreas superiores nesta população. O objetivo do estudo foi determinar, através dos índices de cultura positiva de secreção da orofaringe, as alterações da flora local ocorridas após adenotonsilectomia em crianças. Estudo controlado prospectivo, com 100 crianças entre 2 e 12 anos que foram selecionadas para a cirurgia por infecções recorrentes das tonsilas, e/ou queixas obstrutivas. Amostras de secreção da orofaringe foram colhidas durante e novamente após sete dias da mesma, semeadas e cultivadas em meios de cultura próprias para a observação do crescimento de fungos, bactérias anaeróbias e bactérias aeróbias (Staphylococcus ssp, Streptococcus ssp, Streptococcus alfa hemolítico e Streptococcus beta hemolítico). Os resultados obtidos das culturas antes e depois da adenotonsilectomia foram analisadas comparativamente segundo os critérios: faixa etária (2-6 anos e 7-12 anos) e indicação da operação (infecciosa e/ou obstrutiva). Para as comparações estatísticas usou-se o teste Exato de Fisher e o Teste Binomial com significância definida para valores de p?0,05. As crianças menores (2- 6 anos) tinham índice de culturas positivas para Streptococcus beta hemolítico estatisticamente superior às crianças maiores (7-12 anos) no pré-operatório (p=0,025). Na presença de ambas etiologias, houve erradicação completa do Streptococcus beta hemolítico no grupo etário geral (p<0,001) e na faixa etária menor (p<0,001). Houve negativação do Streptococcus beta hemolítico em todas as culturas realizadas após a operação em ambas as faixas etárias (p<0,001 e p=0,016). A adenotonsilectomia determinou erradicação do Streptococcus beta hemolítico da orofaringe de crianças colonizadas, submetidas a operação em ambas as faixas etárias, porém apenas na indicação infecciosa e obstrutiva na faixa etária menor. Palavras-chave: Microbiologia. Amigdalectomia. Tonsila palatina. Tonsila faríngea.Abstract: Adenotonsillectomy is the most common pediatric surgical aimed resolution of problems obstructive and infectious of upper airway in this population. The aim of the study was to determine, through the positive culture rates of oropharyngeal secretion, changes in local flora occurred after adenotonsillectomy in children. Prospective study, controlled, with 100 children between 2 and 12 years who were selected for surgery for recurrent tonsillitis and/or obstructive symptoms. Samples of oropharyngeal secretion were collected during surgery and again seven days after of the same, seeded and grown in culture medium for observation of the presence of following microorganisms: fungi, anaerobic bacteria and aerobic bacteria (Staphylococcus spp, Streptococcus spp, Streptococcus alpha hemolytic and Streptococcus beta hemolytic). The results of the cultures before and after adenotonsillectomy were analyzed according to the criteria: age (2-6 years and 7-12 years) and indication for surgery (infectious and/or obstructive). Statistical comparisons based the Fisher's exact test and the Binomial test with significance when p ? 0.05 values. Younger children (2-6 years) had rate of positive cultures for Streptococcus beta hemolytic statistically bigger than older children (7-12 years) prior to surgery (p = 0.025). Regarding child with of both etiologies (infectious and obstructive), there was complete eradication of Streptococcus beta hemolytic (p <0.001), when considering all ages (p <0.001). There was negative beta hemolytic streptococci of all cultures performed after the operation in both age groups (p <0.001 and p = 0.016). The adenotonsillectomy determined eradication of Streptococcus beta hemolytic oropharynx colonized children who made this surgery in both age groups, although only those children who had indication for surgery as both (infectious and obstructive) e belonging to the youngest group presented statistical relevance. Keywords: Microbiology. Tonsillectomy. Palatine tonsil. Adenoids

Avaliação microbiológica pré e pós operatória da orofaringe de crianças submetidas à adenotonsilectomia

Orientador: Prof. Dr. Jorge E.F. MatiasCo-orientador: Prof. Dr. Eduardo BaptistellaDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Clínica Cirúrgica. Defesa: Curitiba, 22/05/2015Inclui referências f. 38-40Área de concentração : Clinica cirurgiaResumo: Adenotonsilectomia é um dos procedimentos cirúrgicos pediátricos mais comuns realizados visando à resolução de problemas obstrutivos e infecciosos das vias aéreas superiores nesta população. O objetivo do estudo foi determinar, através dos índices de cultura positiva de secreção da orofaringe, as alterações da flora local ocorridas após adenotonsilectomia em crianças. Estudo controlado prospectivo, com 100 crianças entre 2 e 12 anos que foram selecionadas para a cirurgia por infecções recorrentes das tonsilas, e/ou queixas obstrutivas. Amostras de secreção da orofaringe foram colhidas durante e novamente após sete dias da mesma, semeadas e cultivadas em meios de cultura próprias para a observação do crescimento de fungos, bactérias anaeróbias e bactérias aeróbias (Staphylococcus ssp, Streptococcus ssp, Streptococcus alfa hemolítico e Streptococcus beta hemolítico). Os resultados obtidos das culturas antes e depois da adenotonsilectomia foram analisadas comparativamente segundo os critérios: faixa etária (2-6 anos e 7-12 anos) e indicação da operação (infecciosa e/ou obstrutiva). Para as comparações estatísticas usou-se o teste Exato de Fisher e o Teste Binomial com significância definida para valores de p?0,05. As crianças menores (2- 6 anos) tinham índice de culturas positivas para Streptococcus beta hemolítico estatisticamente superior às crianças maiores (7-12 anos) no pré-operatório (p=0,025). Na presença de ambas etiologias, houve erradicação completa do Streptococcus beta hemolítico no grupo etário geral (p<0,001) e na faixa etária menor (p<0,001). Houve negativação do Streptococcus beta hemolítico em todas as culturas realizadas após a operação em ambas as faixas etárias (p<0,001 e p=0,016). A adenotonsilectomia determinou erradicação do Streptococcus beta hemolítico da orofaringe de crianças colonizadas, submetidas a operação em ambas as faixas etárias, porém apenas na indicação infecciosa e obstrutiva na faixa etária menor. Palavras-chave: Microbiologia. Amigdalectomia. Tonsila palatina. Tonsila faríngea.Abstract: Adenotonsillectomy is the most common pediatric surgical aimed resolution of problems obstructive and infectious of upper airway in this population. The aim of the study was to determine, through the positive culture rates of oropharyngeal secretion, changes in local flora occurred after adenotonsillectomy in children. Prospective study, controlled, with 100 children between 2 and 12 years who were selected for surgery for recurrent tonsillitis and/or obstructive symptoms. Samples of oropharyngeal secretion were collected during surgery and again seven days after of the same, seeded and grown in culture medium for observation of the presence of following microorganisms: fungi, anaerobic bacteria and aerobic bacteria (Staphylococcus spp, Streptococcus spp, Streptococcus alpha hemolytic and Streptococcus beta hemolytic). The results of the cultures before and after adenotonsillectomy were analyzed according to the criteria: age (2-6 years and 7-12 years) and indication for surgery (infectious and/or obstructive). Statistical comparisons based the Fisher's exact test and the Binomial test with significance when p ? 0.05 values. Younger children (2-6 years) had rate of positive cultures for Streptococcus beta hemolytic statistically bigger than older children (7-12 years) prior to surgery (p = 0.025). Regarding child with of both etiologies (infectious and obstructive), there was complete eradication of Streptococcus beta hemolytic (p <0.001), when considering all ages (p <0.001). There was negative beta hemolytic streptococci of all cultures performed after the operation in both age groups (p <0.001 and p = 0.016). The adenotonsillectomy determined eradication of Streptococcus beta hemolytic oropharynx colonized children who made this surgery in both age groups, although only those children who had indication for surgery as both (infectious and obstructive) e belonging to the youngest group presented statistical relevance. Keywords: Microbiology. Tonsillectomy. Palatine tonsil. Adenoids

Estudo da prevalência de hipoacusia em indivíduos com diabetes mellitus tipo 1 Hearing loss prevalence in patients with diabetes mellitus type 1

Diabetes mellitus (DM) é uma doença crônica causada pela não produção e uso inadequado de insulina. Enfermidade crônico-degenerativa. Complicações crônicas do DM, no sistema auditivo, podem causar atrofia do gânglio espiral, degeneração da bainha de mielina do VIII par craniano, diminuição de fibras nervosas na lâmina espiral ou espessamento das paredes capilares da estria vascular e das pequenas artérias. OBJETIVO: Verificar os limiares auditivos em indivíduos portadores de DM tipo 1. MATERIAL E MÉTODOS: Estudo clínico envolvendo 60 indivíduos, divididos em Grupo Estudo (GE) e Grupo Controle (GC), indivíduos diabéticos e não diabéticos. Realizada anamnese, exame físico, otorrinolaringológico e exame audiométrico. RESULTADOS:Quanto aos limiares de audibilidade, no GE, houve diferença estatisticamente significante nas frequências 250, 500, 10.000, 11.200, 12.500, 14.000 e 16.000 Hz em ambas as orelhas e médias das orelhas. Na comparação dos GE e GC, houve diferença estatisticamente significativa com maior probabilidade de ocorrência de hipoacusia em alguma frequência independente da orelha testada no GE. CONCLUSÕES: Houve diferenças estatisticamente significativas nos achados audiológicos no GE quando comparado com GC, justificando avaliação audiológica completa em pacientes diabéticos tipo 1, incluindo audiometria de altas frequências.<br>Diabetes mellitus (DM) is a chronic degenerative disease that impairs normal insulin production and use. DM chronic auditory complications may include spiral ganglion atrophy, degeneration of the vestibulocochlear nerve myelin sheath, reduction of the number of spiral lamina nerve fibers, and thickening of the capillary walls of the stria vascularis and small arteries. OBJECTIVE: This paper aims to verify the hearing thresholds of individuals with type 1 DM. MATERIALS AND METHODS: Sixty patients were enrolled in this trial and divided into case and control groups featuring diabetic and non-diabetic subjects respectively. All individuals were interviewed and underwent physical examination, ENT examination, and audiometric tests. RESULTS: Statistically significant difference was observed in hearing thresholds of case group subjects at 250, 500, 10,000, 11,200, 12,500, 14,000 and 16,000 Hz for both ears and ear average. Case group subjects had higher likelihood of having hypacusis at any frequency regardless of ear than controls. CONCLUSION: Statistically significant differences were seen in the audiological findings of case group subjects when compared to controls. Thorough audiological examination including high frequency audiometry is required for subjects with diabetes mellitus type 1

Degree of the patient satisfaction and post-operative complications for septoplasty surgery with and without the use of nasal buffer

Objective: To assess the degree of satisfaction of pacients submitted the septoplasty with and without the use of nasal buffer and assess the most common complications pursuant to the use of tampons or not after nasal septoplasty. Method: Randomized prospective clinical method compared between patients with and without nasal buffer. The authors observed 152 patients operated on septoplasty in Hospital Angelina Caron. They were assessed for degree of satisfaction in the first 72 hours and after 7 days; and the major complications in intervals of 72 hours and after 7 days. Results: The group without nasal buffer assessed the post-operative as offering good quality, only 2 patients evaluated it as a bad recovery. For the group using nasal buffer the recovery was not well tolerated by more than a half of the patients and the reason for not undergoing a new surgery was the nose buffer, followed by the fear of undergoing anesthesia. Patients who did not use buffer also had fewer cases of complications such as bleeding, abscesses, infection, pain/respiratory complaints and synechia/crusts in the immediate postoperative period, after 72 hours and after 7 days. Conclusion: Although septoplasty with nasal buffer is very widespread in the surgical middle, It does not provide the patient satisfaction. As most surgeons now propose holding of surgery with general or local anesthesia, they should also assess the technique to be employed and inform the patient about the possibility of conducting the surgery with and without nasal buffer

Vestibular Findings in Military Band Musicians

Introduction Exposure to music is the subject of many studies because it is related to an individual's professional and social activities. Objectives Evaluate the vestibular behavior in military band musicians. Methods A retrospective cross-sectional study was performed. Nineteen musicians with ages ranging from 21 to 46 years were evaluated (average&#8201;=&#8201;33.7 years and standard deviation&#8201;=&#8201;7.2 years). They underwent anamnesis and vestibular and otolaryngologic evaluation through vectoelectronystagmography. Results The most evident otoneurologic symptoms in the anamnesis were tinnitus (84.2%), hearing difficulties (47.3%), dizziness (36.8%), headache (26.3%), intolerance to intense sounds (21.0%), and earache (15.7%). Seven musicians (37.0%) showed vestibular abnormality, which occurred in the caloric test. The abnormality was more prevalent in the peripheral vestibular system, and there was a predominance of irritative peripheral vestibular disorders. Conclusion The alteration in vestibular exam occurred in the caloric test (37.0%). There were changes in the prevalence of peripheral vestibular system with a predominance of irritative vestibular dysfunction. Dizziness was the most significant symptom for the vestibular test in correlation with neurotologic symptoms. The present study made it possible to verify the importance of the labyrinthine test, which demonstrates that this population should be better studied because the systematic exposure to high sound pressure levels may cause major vestibular alterations

Otoneurologic Findings in a Fishermen Population of the State of Santa Catarina: Preliminary Study

Introduction&#8195; Fishing, one of the oldest productive activities, is an important sector of the national and world economy. Aim&#8195; To evaluate the vestibular behavior in a population of fishermen. Methods&#8195; In a retrospective and cross-sectional study, 13 fishermen (mean 45.0), between 33 and 62 years of age, were submitted to anamnesis, otorhinolaryngological evaluation, and vestibular exam through the vector electronystagmography. Results&#8195; The most evident otoneurologic symptoms were hearing loss (76.9%), tinnitus (61.7%), dizziness (46.1%), and headache (46.1%). The most evident clinical symptoms were fatigue (46.1%), depression (23.0%), anxiety (15.3%), insomnia (7.7%), and agitation during sleep (7.7%). There were alterations in the vestibular exam in 5 fishermen (38.5%) discovered in the caloric test. There was a prevalence of alteration in the peripheral vestibular system. There was a major frequency of the peripheral vestibular irritative syndrome. Conclusion&#8195; The otoneurologic complaints were frequent in the population studied to verify the importance of allowing labyrinth exams and the need for adopting preventive measures relating to noise exposure as well as carbon monoxide exposure, because they can cause and/or enhance various manifestations of labyrinthine vestibular impairment that can affect the quality of life of these workers