Faculty Bibliography

OBJECTIVE:To assess changes in the prevalence of otitis media, associated with the use of highly active antiretroviral therapy, in Brazilian human immunodeficiency virus (HIV) infected children. SETTING/METHODS:Division of otorhinolaryngology, Hospital das Clínicas, Sao Paulo University Medical School, Brazil. PATIENTS/METHODS:A cohort of 459 HIV-infected children aged below 13 years. MAIN OUTCOME MEASURES/METHODS:The prevalence of otitis media and the serum cluster of differentiation four glycoprotein T lymphocyte count were compared for children receiving highly active antiretroviral therapy (with protease inhibitors) and those receiving standard antiretroviral therapy (without protease inhibitors). RESULTS:Otitis media was present in 33.1 per cent of the children. Children aged from zero years to five years 11 months receiving highly active antiretroviral therapy had a higher prevalence of acute otitis media (p=0.02) and a lower prevalence of chronic otitis media (p=0.02). Children who were receiving highly active antiretroviral therapy had a mean serum cluster of differentiation four glycoprotein T lymphocyte count greater than that of those who were receiving standard antiretroviral therapy (p<0.001). CONCLUSIONS:The use of highly active antiretroviral therapy in Brazilian HIV-infected children was associated with a lower prevalence of chronic otitis media.

BACKGROUND:Reconstruction of the skull base after an expanded endonasal approach (EEA) is critical to achieve a good outcome. A novel technique based on the use of a pedicled nasoseptal flap has proven to be a reliable and versatile reconstructive option for extensive defects of the skull base. Data regarding the potential dimensions of a nasoseptal flap are lacking in the literature. This pilot study was developed to help optimize the design of the nasoseptal flap and to ensure that when harvesting the flap, its width and length are adequate to reconstruct the defects that are created by various EEAs. METHODS:We analyzed the computed tomographic (CT) scans of four patients who underwent EEAs for skull base lesions. Sagittal and coronal CT reconstructions were generated from axial images. The measurements were divided into skull base measurements, flap dimensions required to cover skull base defects resulting from various EEAs, and potential maximal dimensions of the nasoseptal flap. Measurements were studied for three different EEAs: sellar/transplanar, transclival, and transcribiform/anterior skull base. We measured the potential defects for each of these EEAs and the nasoseptal flap dimensions that would be required to reconstruct them. We estimated all dimensions based on the most extensive defect that could result with each EEA. We then compared these with various modifications of the nasoseptal flap. RESULTS:Two male and two female patients were studied. Twenty-seven measurements were taken to compare the different skull base defects and nasoseptal flaps. CONCLUSIONS:The length of the nasal septum comprises sufficient mucoperichondrium and mucoperiosteum to allow the harvesting of a nasoseptal flap that could cover any defect resulting from an anterior skull base, a transsellar/transplanar, or a transclival EEA. Similarly, the height of the nasal septum has the potential to yield a nasoseptal flap with a width that is adequate to cover the laterolateral aspect of any defect of the anterior skull base and clivus. Skull base defects resulting from combined EEAs, such as those that would create a defect that comprises the skull base from sella turcica to frontal sinus, are beyond the potential dimensions of a single nasoseptal flap. This and other defects resulting from a combination of EEAs require other strategies, such as the use of bilateral nasoseptal flaps, or the use of other reconstructive options.

UNLABELLED:The advent of new antiretroviral drugs such as protease inhibitors has generated sensible changes in morbity and mortality in HIV-infected patients. OBJECTIVES/OBJECTIVE:To evaluate the impact of Highly Active Antiretroviral Therapy (HAART) on the prevalence of chronic otitis media in HIV-infected pediatric population. METHODS:We analyzed medical charts of 471 children aged zero to 12 years and 11 months with HIV infection from an Ambulatory of ENT and AIDS. Children were divided according to the age: 0 to 5 years and 11 months and 6 to 12 years and 11 months and classified as having chronic otitis media based on history, physical examination, audiologic and tympanometric data. Prevalence of chronic otitis media, as well as CD4+ lymphocyte count were compared between groups in use of HAART and the group without HAART. RESULTS:Out of 459 children, 65 (14.2%) had chronic otitis media. We observed that in children aged 0 to 5 years and 11 months who were taking HAART there was significant lower prevalence of chronic otitis media (p=0.02). The use of HAART was associated to higher mean CD4+ lymphocyte count (p<0.001). CONCLUSION/CONCLUSIONS:The use of HAART was associated to reduction in prevalence of chronic otitis media in HIV infected children, probably due to increase in mean CD4+ lymphocyte count.

INTRODUCTION/BACKGROUND:The anterior ethmoidal artery (AEA) is an important point of anatomical reference in order to locate the frontal sinus and the skull base. Notwithstanding, despite numerous endoscopic studies in cadavers, we still lack an anatomical study on the AEA in the western population. AIM/OBJECTIVE:to determine reference points used to locate the artery, study its relationship with the skull base and its degree of dehiscence, as well as to study intra and inter individual variations. MATERIALS AND METHODS/METHODS:we dissected the nasal fossae belonging to 25 cadavers. RESULTS:the average intranasal length of the anterior ethmoidal artery was 5.2 mm. The anterior ethmoidal canal presented some degree of dehiscence in 66.7%. The average distance between the artery middle point to the anterior nasal spine was of 61.72 mm (sd=4.18 mm); to the lateral nasal wall (nasal axilla) was of 64.04 mm (sd=4.69 mm); and from the anterior axilla to the middle turbinate was of 21.14 mm (sd=3.25 mm). For all the measures there was no statistically significant measures when both sides were compared (p>0.05). CONCLUSIONS:We concluded that the middle conchae axilla is the most reliable point of reference to locate the AEA.

UNLABELLED:Endonasal endoscopic dacryocystorhinostomy (EN-DCR) is now a well-established procedure to relieve nasolacrimal duct obstruction, becoming its domain for the ENT surgeons indispensable. AIM/OBJECTIVE:The aim of the present study is to report the experience of the Otorhinolaryngology Department of the University of São Paulo Medical School in the management of the obstruction of the drainage of the nasolacrimal system by EN-DCR, comparing with the results in literature. STUDY DESIGN/METHODS:clinical retrospective. MATERIAL AND METHOD/METHODS:We reviewed the medical records of 17 patients (17 eyes) that were submitted to EN-DCR between april 2001 and july 2004. We analysed: sex, age at the time of diagnosis, etiology, clinical findings, surgical technique, use of silicone tubes, follow-up and complications. RESULTS:Eight men and nine women, the age range was from 29 to 79 years (mean 42.6413.1 years), mean follow-up time: 15 months, presented a lacrimal clinic with epiphora. Powered DCR was performed in 06 cases and YAG LASER in 01 patient. Silicone tubes were used in all cases and left in place mean 7.9 weeks. The surgical success rate was 82,3%. CONCLUSION/CONCLUSIONS:EN-DCR showed one safe technique, with advantages in relation to the external technique. So ophthalmologists and ENT physicians must work in harmony to offer more benefits to its patients.