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Objectives: To evaluate symptoms related to Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) in patients with cardiovascular disease (CVD) and its relation with personal characteristics and medication use. Methods: The Pittsburgh sleep quality index (PSQI), Berlin questionnaire (BQ) and Epworth sleepiness scale (ESS) were used, including variables such as gender, body mass index, systemic arterial hypertension, cardiopathy and amount of medicines used, from January to October/2017, and performed data analysis. Results: A total of 231 patients participated, 66.23% presented poor sleep quality; 24.68% high risk of OSAHS and 31.7% excessive daytime sleepiness (EDS). The BQ showed a higher chance of a high risk for OSAHS in pre-obese and obese I-degree. The ESS showed an increase in EDS with the reduction of 1 medication for cardiopathy. The PSQI showed a higher chance of poor sleep quality in females than not male. Discussion: Other than this study, the literature shows that EDS can result from the use of drugs for heart disease and hypertension. The literature shows that overweight and obesity increase the chance of systemic arterial hypertension, moreover, this research showed that weight also had a greater influence on the high risk of OSAHS. This shows that overweight and obesity are risk factors for systemic arterial hypertension, OSAHS and CVD. This study evidenced, as well as the literature, poorer sleep quality in females.

Introduction: Auditory processing (AP) is the set of skills needed to understand auditory information. Objectives: To analyze the profile of the patients evaluated with AP during the period from 2010 to 2016 at the Phoniatrics Ambulatory. Methods: Descriptive, retrospective study by means of the survey of AP exams in the mentioned period. Casuistry divided into three age groups (WHO criteria, 2000). Evaluated among other characteristics: sex; main complaints that led to referral; and AP test results. Included: patients evaluated at the outpatient Clinic of Phoniatrics and referred for AP. Excluded: patients who did not complete the evaluation. Results: A total of 119 patients were evaluated, 50 children, 52 adolescents, and 17 adults, mostly male, in a ratio of 1:1.18. In 82% of the children, a frequent symptom was to ask to repeat what was said; 88.4% of adolescents did not seem to understand or heard poorly, 82.3% of adults had difficulty memorizing. The most altered test in all groups was the SSW (competitive left) in 52% of the children, 38.4% of the adolescents and 43.7% of the adults. In the PPS test, Nomination was altered in children and adolescents (respectively 43.7% and 30.7%) and Humming was altered in adults (31.2%). Conclusions: There was a predominance of male children and adolescents. More frequent symptoms were children asked to repeat what was said frequently, adolescents did not seem to understand or heard poorly, and adults had difficulty memorizing. Main altered tests: PPS (Appointment - children and adolescents, and Humming - adults) and SSW (competitive left). [ABSTRACT FROM AUTHOR]

INTRODUCTION: The pleomorphic adenoma is the most common benign mixed tumor of salivary glands, rarely found in the nasal cavity. Its typical clinical presentation is a unilateral nasal obstruction associated with an epistaxis and a presence of a polypoid, smooth, lobulated, and firm mass in the nasal fossa. It is diagnosed by anatomopathological examination, and the treatment of choice is surgical with tumor resection, keeping a safety margin. CASE REPORT: The case reported is a female 49-year-old patient, diagnosed with a nasal pleomorphic adenoma that was surgically treated. CONCLUSION: The importance of the case reported lies in the rarity of the pleomorphic adenoma located in this area. Therefore, this is a differential diagnosis that must be remembered for nasal tumors. [ABSTRACT FROM AUTHOR]

Introduction: tuberculosis (TB) affects most commonly the lungs; nevertheless, extrapulmonary forms are also known. With that in mind, we intend to report a rare case of mediastinal TB located on the path of the recurrent laryngeal nerve (RLN), manifesting itself with vocal fold paralysis (VFP). Case report: male patient, 58 years old, presenting dysphonia. History of exeresis of the left testicle and anatomopathological showing chronic granulomatous orchiepididimitis, suggestive of tuberculous etiology. Former smoker, ex-alcoholic. Previous treatment for six months due to pulmonary TB, 15 years ago. Bacilli patient contactant for three years. Videolaryngoscopy identified paramedian left VFP. Computed tomography (CT) of the neck showed calcified lymph nodes in the upper mediastinum, supraclavicular fossa, and thickening on the right vocal cord. Chest CT showed calcified lymph node sequels in the mediastinal and Chronic Granulomatous TB-type sequel in pulmonary apices. Non-reactive HIV serology. Negative baciloscopy, insufficient sample. Negative sputum culture. Discussion: the finding of left VFP in videolaryngoscopy and neck CT, associated with the findings of mediastinal TB, indicated that the left RLN's involvement occurred due to the granulomatous process in its path, meaning a reactivation of mediastinal ganglionic TB. A simple treatment schedule for TB had been conducted, with subsequent resolution of the dysphonia. Even though thoracic TB is a common condition, hoarseness due to VFP is a rarely associated complication. Conclusion: we stress the importance of extending the investigation to the mediastinum in case of unilateral VFP since a dysfunction of the RLN is a possible justification of the case. [ABSTRACT FROM AUTHOR]

Thyroglossal duct cyst is a common congenital anomaly, due to failure of embryological development. Whenever diagnosed, surgical excision of the cyst is indicated due to the risk of infection and malignancy, with papillary thyroid carcinoma being the most common. This paper reports the case of a young patient who presented mass in the anterior cervical region, whose anatomopathological confirmed the diagnosis of thyroglossal duct cyst carcinoma with ectopic thyroid tissue, without evidence of carcinoma in the thyroid gland. Work carried out by reviewing the medical chart, and then analysis and discussion based on current literature. This article aimed to reinforce the importance of conducting an anatomopathological study of the thyroglossal duct cysts and the differentiation of metastatic carcinomas and primary carcinomas. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid cancer is considered the fourth most frequent malignant neoplasm in Brazilian women, and its incidence has been increased mainly by an increase in the diagnosis of papillary carcinomas, which present a low mortality rate, but sometimes may result in lymph node, lung and bone metastasis. Case report: The case reported is a 62-year-old male patient, who sought the service due to bulging in the right parietal region for 5 months; with evidence of a large heterogeneous expansive lesion in a skull cap exerting a compressive effect on the parenchyma on Cranial Computed Tomography. After excision, anatomopathological examination showed papilliform neoplasm with bone invasion, with immunohistochemistry indicating metastatic thyroid carcinoma with morphological pattern of papillary carcinoma. Thyroid ultrasonography: solid nodule (0.9 x 0.9 x 0.8 cm) in the right lobe, Class V-ATA (high degree of suspicion of malignancy by ultrasonography). After thyroidectomy, anatomopathological evidence showed papillary thyroid carcinoma, variant follicular. Conclusion: The importance of the reported case lies in the rare presentation of papillary microcarcinoma of the thyroid, in a male patient older than expected, with hematogenous metastasis distal to the skull cap without lymph node metastasis. [ABSTRACT FROM AUTHOR]

Introduction: pre-auricular appendages, together with other craniofacial malformations and temporal bone, are associated with hearing loss. Among the malformations of the auricle are the preauricular appendages, formed by skin and cartilage, and that can be present at any point between the tragus of the ear and the angle of the mouth, uni or bilateral. Objective: to evaluate the auditory response in 906 newborns without risk indicators for hearing loss and with isolated pre-auricular appendages (uni- or bilateral) for: prevalence of newborns with pre-auricular appendages; responses of cochlear-eyelid reflex; characteristics of otoacoustic emissions; characteristics of auditory brainstem evoked potential; and the incidence of this cause that presents hearing loss. Method: identification of risk indicators for hearing loss was carried out from the newborn's wallet, the medical record and the interview with the parents. The external acoustic meatus and the tympanic membrane were evaluated through otoscopy and atrial speculum. The cochlear-eyelid reflex was tested by percututing an agogot close to the newborn. Research on otoacoustic emissions was performed using the ero scan etymotic research apparatus. The auditory evoked potential of the brainstem was evaluated. Results and discussion: the prevalence of pre-auricular appendages was 1.1%. All of them presented a palpebral cochlear reflex present, passed through the OAE, and the auditory evoked potential of the brainstem presented an electrophysiological response within normality patterns in all patients studied. Conclusion: there was no correlation between hearing loss and the presence of pre-auricular appendages alone. [ABSTRACT FROM AUTHOR]

Introduction: glossoptosis and retrognatia, associated with respiratory disorders, compose the Robin Sequence (RS), which may be associated with a variety of genetic syndromes. Its incidence ranges from 1/5,000 to 1/50,000 live births with varying levels of respiratory compromise. The Obstructive Sleep Apnea and Hypopnea Syndrome (OSAHS) stands out among such disorders, conferring neonatal death risk and prolonged hospitalization time. Dysphagia is a frequent symptom in patients with syndromic SR, with risk of aspiration. Among the alternatives for the treatment of respiratory disorder, mandibular bone distraction (MBD) is a rapid and definitive option, which can prevent sequelae, such as brain damage through hypoxia, and correct micrognathia permanently. Objective: to report improvement of the respiratory and swallowing pattern in a case of PRS by osteogenic mandible distraction. Result and discussion: we report a case of a patient with SPR associated with severe OSAHS: respiratory distress index (IDR) = 18 / h, neuropsychological-motor development delay, oral breathing, and severe-grade dysphagia with an exclusive gastrostomy diet. Conclusion: after DOSM, there was improvement in OSAHS and the diet was administered orally. [ABSTRACT FROM AUTHOR]

Introduction Feeding, swallowing and breathing are fundamental activities for the survival and well-being of humans; these functions are performed by themost complex neuromuscular unit of the human body, which, when altered, may raise morbidity and mortality rates. Objective To evaluate deglutition in patients with mental disability in order to determine the incidence and the severity of dysphagia. Methods A total of 189 institutionalized adult patients with mental disability were analyzed using a 3.2 mm flexible fiberscope (Machida, Japan 1995). The following food consistencies were tested: pasty, thickened liquid and liquid. Results Among the total of 189 patients, 101 (53.4%) were female aged between 14 and 55 years old. Most of them 120 (63.5%) had profound mental deficiency, 58 (30.7%) had severe mental deficiency, 9 (4.8%) had moderate mental deficiency, and 2 (1.1%) had mild mental deficiency. Gender and the degree of mental deficiency did not influence significantly the degree of dysphagia. Age, degree of disability and interaction between age groups and degrees of disability influenced significantly the degree of dysphagia. Younger patients are more likely to present more severe dysphagia. Stabilization occurs between 31 and 40 years of age, and above this age, a greater chance of less severe dysphagia, because the increase in the degree of mental deficiency decreases the probability of more severe dysphagia. Conclusion The population that mostly presented severe dysphagia was characterized by being mostly female, with profound mental deficiency, with an average age of 36.7 years. There was no relationship between gender and the degree of mental disability concerning the degree of dysphagia. [ABSTRACT FROM AUTHOR]

Introduction: cerumen impaction can cause symptoms such as tinnitus, dizziness, ear fullness and hearing loss. It is estimated that from 2% to 6% of the adult population has impacted or excess cerumen, with a higher incidence in patients with mental deficiency. Objective: this study aims to evaluate the incidence of impaction cerumen in 400 individuals with mental disabilities. Methods: longitudinal and prospective cohort study. This study included 400 patients aged 13 to 51 years, with a diagnosis of mental disability, associated or not with physical disability; considering gender, age, degree of mental deficiency, physical disability, presence of earwax and association with external auditory canal alterations such as acute external otitis. Results: the presence of impacted earwax in the left ear was found in 33.0% of the sample and in 32.75% in the right ear. In 31% of the individuals found physical disability, spastic paralysis was the one with the highest incidence (15.5%). In relation to the degree of mental deficiency, the severe one was the most incident (41.5%). Among the 165 patients with impacted earwax in the right ear, 25.5% had physical disability and 7.5% had acute external otitis; and among the 161 patients with impacted earwax in the left ear, 27.3% and acute external otitis in 8.25%. Conclusion: mentally handicapped individuals have a significantly higher impact incidence of cerumen than the population. In both ears, it was noted that the higher the degree of mental deficiency, the greater the chance of impacted earwax and acute external otitis. [ABSTRACT FROM AUTHOR]

Introduction: rhinoid cerebrospinal fluid fistula is a communication of the subarachnoid space with the nasal fossa or paranasal sinuses, due to an anatomical defect of the dura mater, bone and mucosa. Spontaneous nasal fluid fistulas are rare events, about 3%, with possible deleterious complications and a definite cause. Case report: the case reported is a 47-year-old patient complaining of severe headache, diagnosed with spontaneous sphenoidal cerebrospinal fluidfistula. Conclusion: has an important role in the diagnosis and assistance of cases with rhinoid cerebrospinal fluid fistula. [ABSTRACT FROM AUTHOR]

Introduction: Kleine-Levin Syndrome (KLS) is a rare neurological condition characterized by episodes of hypersomnia associated with hyperphagia and hypersexuality; although these were initially considered the central symptoms of the syndrome, KLS so does not necessarily include the triad. It predominantly affects male adolescents and the duration of episodes vary according to clinical presentation, which usually extend from one week to one or two months and end in complete resolution. Among the episodes, the patient remains asymptomatic, but multiple relapses tend to occur. Patients can usually identify a triggering event, such as an infection in most cases, but also sleep deprivation, alcohol intake, mental stress, or head trauma. Objective: Report the clinical case of a patient with Kleine-Levin syndrome. Resumed report: Male gender, 29 years old, with episodes of hypersomnia lasting 24 hours every 40 days, beginning in adolescence, without other symptoms of the syndrome, such as hyperphagia and hypersexuality. First episode occurred after first plane trip, with no other commemorative. Polysomnography with reduced sleep efficiency by increased sleep latency and sleep apnea and hypopnea index within normal range. Test of multiple latencies for sleep was normal. Nuclear magnetic ressonasse of brain without alterations. Treatment with lithium, L. carnitine and modafilin without results. Conclusion: KLS is a rare disease and is a difficult and essentially clinical diagnosis. No medication was consistently effective and, with the exception of episodes of a more serious character, the best treatment is only supportive. [ABSTRACT FROM AUTHOR]

Choristoma is a tumor consisting of normal cells that evolve in an ectopic location. The osseus choristoma of the tongue is rare, with less than a hundred cases described in the literature. In the oral cavity, it's most common presentations are osteocartilaginous, gastric mucosa or sebaceous cyst. The reported case is of a 38-year-old patient, with a complaint of glossalgia and a nodular lesion of the dorsum of the tongue. Biopsy was performed with histopathological diagnosis of osteocartilaginous choristoma. Choristoma's etiology is still debatable, with two main theories: malformation and local trauma. The main differential diagnosis is lingual thyroid. This is a rare pathology, with few cases described in literature. The most frequent treatment is surgical excision and it has a low rate of recurrence. [ABSTRACT FROM AUTHOR]

Introduction: Foreign bodies (FB) are frequent reasons for consultation in otolaryngology, especially in the pediatric age group. They present highly symptomatic cases with a favorable outcome if diagnosed and treated promptly. Result: The reported case is of an oligosymptomatic patient with a challenging diagnosis who underwent surgical treatment. Discussion: FBs are common reasons for consultations in otolaryngology, accounting for 11% of emergency cases. They can progress to complications in 22% of cases. The most frequent age group affected was 1-4 years old, with no gender prevalence. The most commonly affected sites are the ear, followed by the nasal cavity and oropharynx. FBs in the oropharynx are highly symptomatic, with odynophagia being the main symptom. When oligosymptomatic, they become one of the most silent, making diagnosis difficult, as in the reported case. Generally, complications are uncommon, and surgical treatment is rarely required. Conclusions: Early diagnosis, combined with management by a qualified professional, can prevent major complications during FB removal. Therefore, this becomes extremely necessary when dealing with patients with FBs located in unusual locations with atypical symptoms. The significance of this article lies in its uncommon clinical presentation, which complements the existing literature on the subject. [ABSTRACT FROM AUTHOR]

Introduction: peripheral nerve tumors are a heterogeneous group, predominantly benign and rare in the general population. Schwannoma is the most common, having its origin in Schwann cells. They occur frequently in the head and neck region, but only 1% are intraoral. The treatment of choice is surgical excision. Objective: to report the case of a patient with benign schwannoma in the jugal mucosa. Case report: a 59-year-old female patient with a cystic mass on the right lower lip for one year, painless and progressively growing. Outpatient surgery performed to excise the lesion. The anatomopathological study revealed the presence of low histological grade spindle cell proliferation, and the immunohistochemical revealed the presence of Benign Schwannoma (Neurilemoma grade I). After removal of the nodule, the patient did not present recurrences. Conclusion: The diagnosis of this pathology is a great challenge. Therefore, to evaluate its impact and forms of presentation in the population is crucial. This involves identifying neurological complications associated with the tumor and supportive and rehabilitative measures to improve the well-being of those affected. It is relevant for early diagnosis, the appropriate choice of treatment, scientific advancement in the understanding of the tumor, and the improvement of the quality of life of affected patients. [ABSTRACT FROM AUTHOR]

Introduction: Cysts of temporal bones are rare benign tumors of the head and neck region. The ones that affect the Eustachian tube (ET) are even more uncommon. They can be identified by computed tomography (CT) and magnetic resonance imaging (MRI). They can be a lesion with intensity of adipose tissue, homogeneous, circumscribed, occupying, and expanding the ET region. Objective: To present a clinical case of a patient with a Eustachian tube cyst. Summary case: An 83-year-old male patient complained of dysphagia and snoring with breathing pauses. Nasal endoscopy revealed a pulsatile mass in the rhinopharynx on the left. MRI showed a lesion suggestive of a non-serous cyst of ET on the left. Expectant management was chosen due to the surgical risk and little symptomatic condition of the patient. Conclusion: Primary tumors of ED manifest in several ways, by benign or malignant conditions, even asymptomatically, and may present as incidental findings of examinations. It is always necessary to be attentive to their differential diagnoses, promoting their correct investigation and aiming at their treatment, with the best definition of the surgical approach if necessary. [ABSTRACT FROM AUTHOR]

Osteoma is a benign, usually asymptomatic bone tumor, which often occurs in paranasal sinuses. Surgical treatment is required whenever the patient becomes symptomatic or presents ophthalmological or neurological complications. An endoscopic approach is increasingly used. Depending on the size and site of the osteoma, open surgery may be preferable and remains the standard treatment, though. This article describes a case of osteoma of the frontal sinus that required a bicoronal approach with reconstruction using surgical cement. [ABSTRACT FROM AUTHOR]

Osteomyelitis of the facial and cranial base bones is a rare and aggressive osseous inflammatory process that demands an immediate treatment because of its potential fatality, representing a clinical and diagnostic challenge. The general risk factors for osteomyelitis include systemic conditions that diminish osseous vascularization and immunosuppressive conditions. Fungi are rarely implicated in the disease's etiology, accounting for approximately 10% of infection cases opportunistically. Mucorales and Aspergillus are the two most commonly associated agents of invasive fungal osteomyelitis. This study reports a case of chronic rhinosinusitis complicated by cranial base osteomyelitis in a diabetic patient. Invasive craniofacial fungal infections with primary maxillary involvement are a rare phenomenon and constitute an aggressive and potentially fatal condition in this population. Diabetes mellitus (DM) is a globally prevalent disease and a primary predisposing factor for mucormycosis. Definitive diagnosis poses a medical dilemma because of its fulminant progression, technical challenges in conducting specific diagnostic tests, and scarcity of occurrences and reports. Early diagnosis, following clinical suspicion based on history and clinical examination, aided by radiographic study, and histopathological confirmation are imperative to determine the immediate initiation of a treatment, which is essential for reducing mortality rates. [ABSTRACT FROM AUTHOR]

Introduction: Stenosis of the major salivary ducts most commonly affects the parotid ducts, and it is typically found in women between the fourth and sixth decades of life. The traditional approach, in most cases, involves controlling obstructive symptoms. Whenever unsuccessful, the excision of the affected major salivary gland is conducted. Advances in technology have led to the emergence of more conservative techniques, such as sialoendoscopy. However, these innovative technologies are not available in all contexts, demanding the exploration of alternative approaches to the problem. Objectives: To report the case of a patient who underwent marsupialization of the parotid duct due to bilateral stenosis. Case summary: A 49-year-old female presented complaints of postprandial edema and pain in the parotid area, experienced daily for the past four years, associated with xerostomia. Physical examination revealed palpable enlargement of both parotid glands with slight salivary discharge from the parotid duct orifices upon manual expression. Sialography showed diffuse ectasia of bilateral parotid ducts with a distal stenosis area. The patient then underwent marsupialization with the removal of the stenotic area in both parotid ducts. The histopathological findings were consistent with chronic inflammatory process. Symptoms improved significantly in the postoperative period, and there were no recurrences one year after the surgery. Conclusions: The traditional management of obstructive symptoms poses a challenging problem that often leads to surgical removal of the salivary gland. Minimally invasive techniques have been developed; however, they are not widely available, demanding the exploration of more conservative techniques. Marsupialization of the salivary ducts proved a viable option for this case. [ABSTRACT FROM AUTHOR]

Sleep disorders significantly interfere with the health and quality of life of individuals. Therefore, this study documented the profile and clinical picture of patients submitted to polysomnography in a private clinic. The medical records of 4611 patients between 2007 and 2016 were analyzed. In agreement with the literature, more than 50% of the patients were male and older than 40 years of age. The main finding was snoring, followed by the report of apnea. The main risk factors were obesity and systemic arterial hypertension. [ABSTRACT FROM AUTHOR]

To analyze and correlate auditory signs and symptoms, emphasising tinnitus, audiological findings, and their incidence in individuals with vascular loop (AV) of VII/VIII pair demonstrated by MRI images of the cerebellopontine angle, classifying them according to Chavda. A retrospective and cross-sectional study by analyzing clinical data from the medical records of 15 patients, correlating hearing and otological complaints with results found in the complementary tests of Audiometry and MRI. Patients who presented alterations in the path of the vessels that penetrate the IAC, forming a vascular loop of the VII and/or VIII cranial nerve, were classified according to Chavda. All patients had an MRI with a vascular loop of the VIII pair diagnosed. Eleven of them (73.33%) were bilateral. In 5 patients, there was an agreement between the complaint and the MRI findings: bilateral symptoms and bilateral vascular loop. Tinnitus generated by vascular para-auditory structures is also called pulsatile tinnitus. These conditions lead to turbulent flow that causes tinnitus, synchronous with the patient's pulse. There are studies demonstrating there is no correlation between tinnitus and vascular contact with the VIII pair. We found the presence of tinnitus in approximately 80% of patients with vascular loop, but the complaint did not always coincide with the pathology, making it hard to correlate complaints and pathology. The presence of a vascular loop on MRI is not pathological but an examination finding. The neurovascular conflict of the VII/VIII cranial nerve present in the MRI images did not alone justify the otoneurological signs and symptoms and the audiovestibular alterations found in the individuals evaluated in this study. [ABSTRACT FROM AUTHOR]

Introduction: Universal Newborn Hearing Screening (UNHS) Test was instituted to detect cases with higher probability of hearing loss. Children may pass the test and have late or progressive deafness or even mild and moderate losses that are not observed. Objective: To discuss, through this report of case, the pertinent auditory exams in each situation and the orientation of the health professionals who first receive these patients. Case Description: The case shows the importance of hearing evaluation for diagnostic assistance. Case 1 was referred for language delay and hypothesis of hearing loss. He presented difficulties in social interaction and behavioral changes. Audiological evaluation was normal, being diagnosed as Autistic Spectrum Disorder (ASD). Comments: Patients with delayed communication may be difficult to assess, since many of the auditory exams are subjective and depend on the interaction of the examiner with the child. The reported case presents one of the several situations that professionals may face and reveals what examinations are appropriate for an adequate auditory assessment. [ABSTRACT FROM AUTHOR]