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We present the case of a cerebrospinal fluid leak and a meningoencephalocele as a late complication of ear surgery, manifested with cerebrospinal fluid otorrhea. The objective is to alert to this rare condition, its clinical manifestations, diagnosis and treatment, as well as the potential complications of its early non-recognition. We describe the case of an 81-year-old man, with a past history of ear surgery (20 years ago), with one month history of otorrhea, refractory to medical treatment. Objectively, he had colorless, medium-output otorrhea, which increased with valsalva maneuver, and a polypoid lesion in auditory canal. The otorrhea test strip was positive for glucose. Ear CT and cranial MRI revealed the presence of a meningoencephalocele in the tympanic cavity. The patient was successfully treated with surgery using a combined multidisciplinary approach that the authors describe. Apresentamos o caso de uma fístula de líquido cefalorraquidiano e meningoencefalocelo como sequelas tardias de cirurgia otológica. Este artigo tem como objetivo alertar para esta condição clínica rara, as suas manifestações, diagnóstico e tratamento, assim como para as potenciais complicações do seu não reconhecimento precoce. Descrevemos o caso de um homem de 81 anos, com antecedentes de cirurgia otológica há 20 anos, que recorreu ao serviço de urgência por otorreia com um mês de evolução e refratária ao tratamento médico. Objetivamente, apresentava uma otorreia incolor e que aumentava com manobra de valsava, associada e uma lesão polipoide a ocupar o canal auditivo externo. Foi realizada uma tira-teste que foi positiva para glicose. A TC dos ouvidos e a RMN craniana revelaram a presença de meningoencefalocelo na cavidade timpânica associado a um defeito osteo-dural ao nível do tégmen timpani. O doente foi tratado cirurgicamente, com sucesso, através de uma abordagem combinada envolvendo uma equipa multidisciplinar.

Objective:To describe the results obtained with endolymphatic sac drainage in patients with Ménière's disease.Method:A retrospective case review study was conducted of 95 Ménière's disease patients who underwent endolymphatic sac drainage in a tertiary care referral centre, after failing a long course of medical management. The main outcome measures were vertigo control and hearing preservation.Results:In patients with unilateral disease, vertigo control was obtained in 94.3 per cent of patients. A significant improvement in cochlear function was seen in 14 per cent of patients, and hearing was preserved or improved in 88 per cent. For the bilateral group, vertigo control was obtained in 85.7 per cent of patients and cochlear function improved in 28 per cent. Hearing preservation was attained in 71 per cent of these patients.Conclusion:Endolymphatic sac drainage is a good surgical option for patients with incapacitating endolymphatic hydrops, providing a high percentage of vertigo control and hearing preservation.

Hypothesis. This study aimed to evaluate whether there is a difference in the degree of intracochlear trauma when the cochlear implant electrode arrays is inserted through different quadrants of the round window membrane.Background. The benefits of residual hearing preservation in cochlear implant recipients have promoted the development of atraumatic surgeries. Minimal trauma during electrode insertion is crucial for residual hearing preservation.Methods. In total, 25 fresh human temporal bones were subjected to mastoidectomy and posterior tympanotomy. The cochlear implant electrode array was inserted through the anterosuperior quadrant of the round window membrane in 50% of the bones and through the anteroinferior quadrant in the remaining 50%. The temporal bones were dehydrated, embedded in epoxy, serially polished, stained, viewed through a stereomicroscope, and photographed with the electrode arraysin situ. The resulting images were analyzed for signs of intracochlear trauma.Results. Histological examinations revealed varying degrees of damage to the intracochlear structures, although the incidence and severity of intracochlear trauma were not influenced by the quadrant of insertion.Conclusions. The incidence and severity of intracochlear trauma were similar in all samples, irrespective of electrode array insertion through the anterosuperior or anteroinferior quadrant of the round window membrane.

Lateral and sigmoid sinus malformations are uncommon and dangerous anatomical variations that surgeons may encounter when performing a retroauricular approach. We report three cases of rare temporal bone venous sinus anomalies seen in patients who underwent cochlear implant surgery. The first patient had a diagnosis of CHARGE syndrome and presented a bilateral persistent petrosquamosal sinus with sigmoid sinus agenesis, which made mastoidectomy for cochlear implantation difficult. The second patient presented an anomalous venous lake in the occipital region, which communicated the left dural venous sinuses with a conglomerate of pericranial vessels in the left nuchal region, also consistent with left sinus pericranii. The third patient presented with an extracranial sigmoid sinus that produced a troublesome bleeding immediately after the muscular-periosteal flap incision was performed.

In mammals, damage to sensory receptor cells (hair cells) of the inner ear results in permanent sensorineural hearing loss. Here, we investigated whether postnatal mouse inner ear progenitor/stem cells (mIESCs) are viable after transplantation into the basal turns of neomycin-injured guinea pig cochleas. We also examined the effects of mIESC transplantation on auditory functions. Eight adult female Cavia porcellus guinea pigs (250-350 g) were deafened by intratympanic neomycin delivery. After 7 days, the animals were randomly divided in two groups. The study group (n=4) received transplantation of LacZ-positive mIESCs in culture medium into the scala tympani. The control group (n=4) received culture medium only. At 2 weeks after transplantation, functional analyses were performed by auditory brainstem response measurement, and the animals were sacrificed. The presence of mIESCs was evaluated by immunohistochemistry of sections of the cochlea from the study group. Non-parametric tests were used for statistical analysis of the data. Intratympanic neomycin delivery damaged hair cells and increased auditory thresholds prior to cell transplantation. There were no significant differences between auditory brainstem thresholds before and after transplantation in individual guinea pigs. Some mIESCs were observed in all scalae of the basal turns of the injured cochleas, and a proportion of these cells expressed the hair cell marker myosin VIIa. Some transplanted mIESCs engrafted in the cochlear basilar membrane. Our study demonstrates that transplanted cells survived and engrafted in the organ of Corti after cochleostomy.

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016 Submitted by Biblioteca da Faculdade de Medicina da Universidade de Lisboa (repositorio@medicina.ulisboa.pt) on 2017-02-24T15:33:00Z No. of bitstreams: 1 GISELADLEIRAS.pdf: 559013 bytes, checksum: 69411a38ca681ce3711d0db8d582d330 (MD5) Made available in DSpace on 2017-03-03T16:30:30Z (GMT). No. of bitstreams: 1 GISELADLEIRAS.pdf: 559013 bytes, checksum: 69411a38ca681ce3711d0db8d582d330 (MD5) Previous issue date: 2016