Made available in DSpace on 2014-06-11T19:24:16Z (GMT). No. of bitstreams: 0 Previous issue date: 2002Bitstream added on 2014-06-13T20:51:49Z : No. of bitstreams: 1 weckwerth_ph_me_botfm.pdf: 886368 bytes, checksum: d32499aa7e3a53d555dc67c5514625a9 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A otite média crônica supurativa (OMCS) é uma condição comum em pacientes portadores de fissura palatal e lábio-palatal não reparada. Devido a uma anormalidade muscular, existe disfunção da tuba auditiva que, por sua vez, não equilibra a pressão diferencial do ar entre o ouvido médio e a nasofaringe, ocasionando acúmulo de fluidos na cavidade do ouvido médio. Amostras efusivas de OMCS de 40 pacientes portadores de fissura lábiopalatal matriculados no Hospital de Reabilitação de Anomalias Craniofaciais (HRAC) – USP – Bauru - SP, foram analisadas através de culturas bacteriológicas, e as bactérias isoladas submetidas ao padrão de susceptibilidade in vitro frente a drogas de uso clínico. Culturas positivas foram obtidas em 100% dos casos estudados. Das 57 linhagens obtidas, foram isoladas com maior freqüência as bactérias Pseudomonas aeruginosa (35%), Staphylococcus aureus (15,5%), Enterococcus faecalis (14%) e Proteus mirabilis (12%). A freqüência de bacilos Gram negativos (enterobactérias e não fermentadores da glicose) isolados foi de 67%. Frente à ciprofloxacina, a Pseudomonas aeruginosa apresentou melhor sensibilidade. Frente à gentamicina, as enterobactérias apresentaram melhor sensibilidade. As linhagens de Staphylococcus aureus e de Enterococcus faecalis mostraram melhor sensibilidade frente ao imipenem e sulfazotrim, respectivamente. Acreditamos que nossos dados possam contribuir para a escolha apropriada de antibióticos quando for considerado o tratamento não cirúrgico da OMCS em pacientes portadores de fissura lábio palatal. / Chronic suppurative otitis media (CSOM) is a common condition in patients with unrepaired cleft palate and cleft lip palate. The muscular abnormality leads to auditive tube malfunction which it will not equilibrate the differential air pressure between the middle ear and the nasopharynx. Consequently, it increases the fluid in the middle ear cavity. Effusive samples of CSOM from 40 patients with clef palate and cleft lippalate of the HRAC-USP-Bauru-SP, were studied. After bacterial cultures, the bacteria were isolated and submitted, “in vitro”, at standard susceptibility to drugs of clinical use. Positive cultures were obtained in 100% of studied cases. Pseudomonas aeruginosa (35%), Staphylococcus aureus (15,5%), Enterococcus faecalis (14%) e Proteus mirabilis (12%) were the most frequent bacteria in 57 strains. Gram negative bacilli (enteric Gram negative bacilli and nonfermentative bacilli) were observed in 67% of the samples. Pseudomonas aeruginosa shown better sensitivity to ciprofloxacin, and the enteric Gram negative baciili to gentamicin. Moreover, the S. aureus and also the E. faecalis shown hight sensitivity to imipenem and trimethoprim/sulfamethoxazole, respectively. This data will contribute to the correct choice of the antibiotic in CSOM patients with cleft palate or clef lip-palate, which the nonsurgical management is the main therapy.

Orientador: Carlos Alberto de Magalhães Lopes / Resumo: A otite média crônica supurativa (OMCS) é uma condição comum em pacientes portadores de fissura palatal e lábio-palatal não reparada. Devido a uma anormalidade muscular, existe disfunção da tuba auditiva que, por sua vez, não equilibra a pressão diferencial do ar entre o ouvido médio e a nasofaringe, ocasionando acúmulo de fluidos na cavidade do ouvido médio. Amostras efusivas de OMCS de 40 pacientes portadores de fissura lábiopalatal matriculados no Hospital de Reabilitação de Anomalias Craniofaciais (HRAC) - USP - Bauru - SP, foram analisadas através de culturas bacteriológicas, e as bactérias isoladas submetidas ao padrão de susceptibilidade in vitro frente a drogas de uso clínico. Culturas positivas foram obtidas em 100% dos casos estudados. Das 57 linhagens obtidas, foram isoladas com maior freqüência as bactérias Pseudomonas aeruginosa (35%), Staphylococcus aureus (15,5%), Enterococcus faecalis (14%) e Proteus mirabilis (12%). A freqüência de bacilos Gram negativos (enterobactérias e não fermentadores da glicose) isolados foi de 67%. Frente à ciprofloxacina, a Pseudomonas aeruginosa apresentou melhor sensibilidade. Frente à gentamicina, as enterobactérias apresentaram melhor sensibilidade. As linhagens de Staphylococcus aureus e de Enterococcus faecalis mostraram melhor sensibilidade frente ao imipenem e sulfazotrim, respectivamente. Acreditamos que nossos dados possam contribuir para a escolha apropriada de antibióticos quando for considerado o tratamento não cirúrgico da OMCS em pacientes portadores de fissura lábio palatal. / Abstract: Chronic suppurative otitis media (CSOM) is a common condition in patients with unrepaired cleft palate and cleft lip palate. The muscular abnormality leads to auditive tube malfunction which it will not equilibrate the differential air pressure between the middle ear and the nasopharynx. Consequently, it increases the fluid in the middle ear cavity. Effusive samples of CSOM from 40 patients with clef palate and cleft lippalate of the HRAC-USP-Bauru-SP, were studied. After bacterial cultures, the bacteria were isolated and submitted, "in vitro", at standard susceptibility to drugs of clinical use. Positive cultures were obtained in 100% of studied cases. Pseudomonas aeruginosa (35%), Staphylococcus aureus (15,5%), Enterococcus faecalis (14%) e Proteus mirabilis (12%) were the most frequent bacteria in 57 strains. Gram negative bacilli (enteric Gram negative bacilli and nonfermentative bacilli) were observed in 67% of the samples. Pseudomonas aeruginosa shown better sensitivity to ciprofloxacin, and the enteric Gram negative baciili to gentamicin. Moreover, the S. aureus and also the E. faecalis shown hight sensitivity to imipenem and trimethoprim/sulfamethoxazole, respectively. This data will contribute to the correct choice of the antibiotic in CSOM patients with cleft palate or clef lip-palate, which the nonsurgical management is the main therapy. / Mestre

Uma das condições mais comuns responsável pela perda auditiva durante a infância é a Otite Média (OM). A OM ainda é considerada “questão de saúde pública” devido à sua alta prevalência e distribuição mundial. Há poucos estudos na literatura que relatam as alterações na orelha contralateral (OCL) em pacientes com otite média crônica (OMC). Para enfatizar esses conceitos e analisar com mais profundidade a prevalência de bilateralidade na OMC, há vários anos iniciamos uma linha de pesquisa, focalizando três cenários diferentes: a histopatologia (ROSITO, COSTA, SCHARCHEN, 2007); o padrão clínico e otoscópico (COSTA et al., 2008) e a fisiologia (função auditiva) no presente estudo. Objetivo: Avaliar a função auditiva da OCL em pacientes com OMC através do gap aéreo-ósseo. Comparar os dados audiométricos da OCL levando em conta se o paciente apresenta Otite Média Crônica não Colesteatomatosa (OMCNC) ou Otite Média Crônica Colesteatomatosa (OMCC) na orelha principal (OP). Métodos: Estudo transversal, comparativo e contemporâneo, com 1000 pacientes com diagnóstico de OMC submetidos a exame otorrinolaringológico, videotoscopia e audiometria tonal liminar (ATL). Resultados: A prevalência de gap aéreo-ósseo foi de aproximadamente 40%, tanto na amostra total e na análise estratifica por tipo de OM (na amostra geral houve 392 (39,2%) pacientes, no grupo com OMCNC houve 279 (40,8%), e no grupo com OMCC foram 113 (37,17%). Conclusões: Assim como os achados de estudos clínicos e histopatológicos, a prevalência de alterações audiológicas na OCL foi elevada, evidenciando o caráter bilateral na OMC. / Otitis media (OM) is one of the leading causes of hearing loss in childhood. Due to its high prevalence and worldwide distribution, OM is still regarded as a public health issue. Nevertheless, few studies have assessed involvement of the contralateral ear (CLE) in patients with chronic otitis media (COM). To demonstrate the bilateral nature of COM, we designed three distinct studies, which focused on histopathology and anatomy, clinical findings and physiology (both previously published), and, finally, auditory function. Objective: To measure auditory function in the CLE in a sample of COM patients by means of air-conduction thresholds, bone-conduction thresholds, and the air-bone gap, and to compare CLE audiometry findings in patients with non-cholesteatomatous (NC-COM) or cholesteatomatous chronic otitis media (CCOM). Methods: This was a cross-sectional, contemporary and comparative study of 1000 patients with a diagnosis of COM. Clinical ear examination, video otoscopy, and pure-tone audiometry (PTA) were performed. Results: The overall prevalence rate of air-bone gap was approximately 40%, both in the total sample and after stratification by type of OM (393 [39.2%] patients overall, 279 [40.3%] in the NC-COM group, 113 [37.17%] in the CCOM group). Conclusions: As did clinical and histopathology findings in previous studies, audiological evaluation revealed a substantial prevalence of CLE involvement, providing evidence of the bilateral nature of COM.

Uma das condições mais comuns responsável pela perda auditiva durante a infância é a Otite Média (OM). A OM ainda é considerada “questão de saúde pública” devido à sua alta prevalência e distribuição mundial. Há poucos estudos na literatura que relatam as alterações na orelha contralateral (OCL) em pacientes com otite média crônica (OMC). Para enfatizar esses conceitos e analisar com mais profundidade a prevalência de bilateralidade na OMC, há vários anos iniciamos uma linha de pesquisa, focalizando três cenários diferentes: a histopatologia (ROSITO, COSTA, SCHARCHEN, 2007); o padrão clínico e otoscópico (COSTA et al., 2008) e a fisiologia (função auditiva) no presente estudo. Objetivo: Avaliar a função auditiva da OCL em pacientes com OMC através do gap aéreo-ósseo. Comparar os dados audiométricos da OCL levando em conta se o paciente apresenta Otite Média Crônica não Colesteatomatosa (OMCNC) ou Otite Média Crônica Colesteatomatosa (OMCC) na orelha principal (OP). Métodos: Estudo transversal, comparativo e contemporâneo, com 1000 pacientes com diagnóstico de OMC submetidos a exame otorrinolaringológico, videotoscopia e audiometria tonal liminar (ATL). Resultados: A prevalência de gap aéreo-ósseo foi de aproximadamente 40%, tanto na amostra total e na análise estratifica por tipo de OM (na amostra geral houve 392 (39,2%) pacientes, no grupo com OMCNC houve 279 (40,8%), e no grupo com OMCC foram 113 (37,17%). Conclusões: Assim como os achados de estudos clínicos e histopatológicos, a prevalência de alterações audiológicas na OCL foi elevada, evidenciando o caráter bilateral na OMC. / Otitis media (OM) is one of the leading causes of hearing loss in childhood. Due to its high prevalence and worldwide distribution, OM is still regarded as a public health issue. Nevertheless, few studies have assessed involvement of the contralateral ear (CLE) in patients with chronic otitis media (COM). To demonstrate the bilateral nature of COM, we designed three distinct studies, which focused on histopathology and anatomy, clinical findings and physiology (both previously published), and, finally, auditory function. Objective: To measure auditory function in the CLE in a sample of COM patients by means of air-conduction thresholds, bone-conduction thresholds, and the air-bone gap, and to compare CLE audiometry findings in patients with non-cholesteatomatous (NC-COM) or cholesteatomatous chronic otitis media (CCOM). Methods: This was a cross-sectional, contemporary and comparative study of 1000 patients with a diagnosis of COM. Clinical ear examination, video otoscopy, and pure-tone audiometry (PTA) were performed. Results: The overall prevalence rate of air-bone gap was approximately 40%, both in the total sample and after stratification by type of OM (393 [39.2%] patients overall, 279 [40.3%] in the NC-COM group, 113 [37.17%] in the CCOM group). Conclusions: As did clinical and histopathology findings in previous studies, audiological evaluation revealed a substantial prevalence of CLE involvement, providing evidence of the bilateral nature of COM.

Uma das condições mais comuns responsável pela perda auditiva durante a infância é a Otite Média (OM). A OM ainda é considerada “questão de saúde pública” devido à sua alta prevalência e distribuição mundial. Há poucos estudos na literatura que relatam as alterações na orelha contralateral (OCL) em pacientes com otite média crônica (OMC). Para enfatizar esses conceitos e analisar com mais profundidade a prevalência de bilateralidade na OMC, há vários anos iniciamos uma linha de pesquisa, focalizando três cenários diferentes: a histopatologia (ROSITO, COSTA, SCHARCHEN, 2007); o padrão clínico e otoscópico (COSTA et al., 2008) e a fisiologia (função auditiva) no presente estudo. Objetivo: Avaliar a função auditiva da OCL em pacientes com OMC através do gap aéreo-ósseo. Comparar os dados audiométricos da OCL levando em conta se o paciente apresenta Otite Média Crônica não Colesteatomatosa (OMCNC) ou Otite Média Crônica Colesteatomatosa (OMCC) na orelha principal (OP). Métodos: Estudo transversal, comparativo e contemporâneo, com 1000 pacientes com diagnóstico de OMC submetidos a exame otorrinolaringológico, videotoscopia e audiometria tonal liminar (ATL). Resultados: A prevalência de gap aéreo-ósseo foi de aproximadamente 40%, tanto na amostra total e na análise estratifica por tipo de OM (na amostra geral houve 392 (39,2%) pacientes, no grupo com OMCNC houve 279 (40,8%), e no grupo com OMCC foram 113 (37,17%). Conclusões: Assim como os achados de estudos clínicos e histopatológicos, a prevalência de alterações audiológicas na OCL foi elevada, evidenciando o caráter bilateral na OMC. / Otitis media (OM) is one of the leading causes of hearing loss in childhood. Due to its high prevalence and worldwide distribution, OM is still regarded as a public health issue. Nevertheless, few studies have assessed involvement of the contralateral ear (CLE) in patients with chronic otitis media (COM). To demonstrate the bilateral nature of COM, we designed three distinct studies, which focused on histopathology and anatomy, clinical findings and physiology (both previously published), and, finally, auditory function. Objective: To measure auditory function in the CLE in a sample of COM patients by means of air-conduction thresholds, bone-conduction thresholds, and the air-bone gap, and to compare CLE audiometry findings in patients with non-cholesteatomatous (NC-COM) or cholesteatomatous chronic otitis media (CCOM). Methods: This was a cross-sectional, contemporary and comparative study of 1000 patients with a diagnosis of COM. Clinical ear examination, video otoscopy, and pure-tone audiometry (PTA) were performed. Results: The overall prevalence rate of air-bone gap was approximately 40%, both in the total sample and after stratification by type of OM (393 [39.2%] patients overall, 279 [40.3%] in the NC-COM group, 113 [37.17%] in the CCOM group). Conclusions: As did clinical and histopathology findings in previous studies, audiological evaluation revealed a substantial prevalence of CLE involvement, providing evidence of the bilateral nature of COM.

The chorda tympani nerve, also known as the taste nerve, runs uncovered through the middle ear cavity, a localization that exposes the nerve to pathological processes and surgical trauma in the middle ear. People operated on for otosclerosis tend to complain more about postoperative taste disturbances than those operated on for chronic otitis media. It has been suggested that this difference may be explained by gradual deterioration of chorda tympani nerve function caused by chronic otitis media infection and that further impairment caused by surgery is less noticeable in these patients. This thesis aimed to evaluate the function of the chorda tympani nerve, the effects of middle ear disease on taste and complications resulting from ear surgery for chronic otitis media or otosclerosis. This information will help to improve the ear surgeon’s ability to predict the prognosis of iatrogenic taste disturbances in patients with middle ear disease and after ear surgery. Taste was assessed using electrogustometry and the filter paper disc method before and after surgery for chronic otitis media or otosclerosis. Patients also completed questionnaires about symptoms and quality of life. The status of the chorda tympani nerve upon surgical opening of the ear and grading of the trauma to the nerve during the surgery were recorded. The ultrastructure of the chorda tympani nerve from healthy ears and from ears with chronic otitis media was examined. Electrogustometry and the filter paper disc method were evaluated. The results of electrogustometry and the filter paper disc method were highly reproducible, although their correlation was moderate. Patients with chronic otitis media, patients with a more traumatized nerve, female patients and younger patients were more likely to report postoperative taste disturbances. Most of the patients recovered their taste after 1 year. The quality of life study showed only minor changes after surgery. Electron microscopic observations of nerves from ears with chronic otitis media showed signs of structural degeneration, although signs of regeneration, such as sprouting were also observed. This results may explain the recovery of taste postoperatively and indicate that the nerve should be carefully handled during surgery.