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- / The present study aims to establish the level of diagnostic reliability provided by the transmission of a videolaryngoscopy by videoconference (VC), evaluating the quality of the transmitted images and its impact on diagnoses. Two DVDs with 60 laryngoscopy (30 fiberscopies and 30 telescopies) images, corresponding to 30 original and 30 transmitted by VC, were evaluated by 6 laryngologists who answered a questionnaire on the quality of the selected images (scores from 0 to 3) and on the diagnoses of the related disease. A third DVD with 26 pairs of images, an original and a VC, or two original, was also analyzed by the examiners who had to select which image presented the best quality, which corresponded to the VC image, and the possible impact of such differences on the quality of diagnoses. A high level of agreement (K = 0.911) was found among the examiners in relation to the identification of the VC (96,15% of accuracy) and to the best quality of the original image (K = 0,850). Although a partial agreement has been found among the examiners (K = 0,371), diagnoses was not jeopardized by the quality of the VC image in 75,64% of the cases. Original videotelescopy images (83,33% very good) showed the best quality and videofiberscopy VC the worst (36,66% very good and good). A high degree of correctness was found for the diagnoses by VC images (86,67% by fiberscopy and by telescopy). Consequently, the use of a VC to transmit videolaryngoscopy images has proved to be efficient for the remote diagnoses of larynx diseases

- / The present study aims to establish the level of diagnostic reliability provided by the transmission of a videolaryngoscopy by videoconference (VC), evaluating the quality of the transmitted images and its impact on diagnoses. Two DVDs with 60 laryngoscopy (30 fiberscopies and 30 telescopies) images, corresponding to 30 original and 30 transmitted by VC, were evaluated by 6 laryngologists who answered a questionnaire on the quality of the selected images (scores from 0 to 3) and on the diagnoses of the related disease. A third DVD with 26 pairs of images, an original and a VC, or two original, was also analyzed by the examiners who had to select which image presented the best quality, which corresponded to the VC image, and the possible impact of such differences on the quality of diagnoses. A high level of agreement (K = 0.911) was found among the examiners in relation to the identification of the VC (96,15% of accuracy) and to the best quality of the original image (K = 0,850). Although a partial agreement has been found among the examiners (K = 0,371), diagnoses was not jeopardized by the quality of the VC image in 75,64% of the cases. Original videotelescopy images (83,33% very good) showed the best quality and videofiberscopy VC the worst (36,66% very good and good). A high degree of correctness was found for the diagnoses by VC images (86,67% by fiberscopy and by telescopy). Consequently, the use of a VC to transmit videolaryngoscopy images has proved to be efficient for the remote diagnoses of larynx diseases

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2016-08-29T13:40:30Z No. of bitstreams: 1 TES_CAIO_MARCELO_PANITZ_SELAIMEN_PARCIAL.pdf: 164594 bytes, checksum: 018c15c8423502c0c2b2575d4a609cb2 (MD5) / Made available in DSpace on 2016-08-29T13:40:31Z (GMT). No. of bitstreams: 1 TES_CAIO_MARCELO_PANITZ_SELAIMEN_PARCIAL.pdf: 164594 bytes, checksum: 018c15c8423502c0c2b2575d4a609cb2 (MD5) Previous issue date: 2008-11-19 / Objectives: (1) To verify the prevalence of signs and symptoms of temporomandibular disorders (TMD) in patients with tinnitus and any degree of audiometric loss versus patients with tinnitus and normal audiometry versus a control group with no tinnitus; 2) To establish a possible correlation between signs and symptoms of TMD with established or presumed causes of tinnitus; 3) To verify the correlation between the worse side of tinnitus (predominant side) with the signs and symptoms of TMD according to the RDC/TMD Axis I. Methods and materials: The basic audiological evaluation, including the objective and psychoacoustic evaluation of tinnitus as well as its etiology, were clinically established by means of basic audiologic tests performed by physicians (ENT) and speech pathologists of the Clinical Hospital of Porto Alegre (HCPA). Such methods of assessment follow the Research Diagnostic Criteria for Tinnitus created by the Tinnitus Clinic in the Ear Nose Throat Service of the HCPA. The instrument for evaluation of TMD was the official version of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Three groups were studied: a) patients with tinnitus and any degree of hearing loss confirmed by an ENT doctor; b) patients with tinnitus and normal audiometry confirmed by an ENT doctor; c) patients free of signs and symptoms of tinnitus (control group) without otolaryngological complaints confirmed by a ENT doctor. Results and conclusions: Patients from the group of tinnitus with any hearing loss had a direct association with the diagnosis of myofascial pain, with the diagnosis of disk displacement with reduction, arthralgia, osteoarthrosis and osteoarthritis of the TMJ, and also with the diagnosis of reduced vertical dimension. However, no association was detected between the diagnosis of Axis I and part of tinnitus, neither between the presence of the musculo-articular pain and the side where the tinnitus symptom was more intense, nor between the severity of tinnitus and the level of the musculo-articular pain. Patients from the tinnitus without hearing loss had a direct association with the diagnosis of disk displacement with reduction and arthralgia. A direct association between the tinnitus intensity and the pain level in the left and right posterior temporalis muscles. However, an association neither between the diagnosis and the side of tinnitus or the presence of musculo-articular pain the worst side of tinnitus. Besides that, the patient groups with tinnitus did not different between each other in relation to chronic pain grade, depression and somatization, with and without pain, despite both having superior scores than the control group. Despite not having significantly higher scores in the Axis II of the RDC, patients with tinnitus with hearing loss had worse scores than those with tinnitus with no hearing loss. / Objetivos: (1) Verificar a preval?ncia de sinais e sintomas de disfun??o temporomandibular (DTM) em pacientes com zumbido e qualquer grau de perda auditiva e em pacientes com zumbido e audiometria normal em compara??o com um grupo controle; 2) Estabelecer uma poss?vel concomit?ncia e/ou correla??o dos sinais e sintomas de DTM com as causas estabelecidas ou presum?veis do zumbido presente; 3) Verificar a exist?ncia de rela??o entre o local e o lado onde o sintoma zumbido ? mais intenso (lado predominante) e os sinais e sintomas de DTM, conforme os diagn?sticos de Eixo - I de DTM. Materiais e m?todos: A avalia??o audiol?gica b?sica, avalia??o objetiva e psicoac?stica do zumbido, bem como sua etiologia foram estabelecidas clinicamente e atrav?s de testes auditivos b?sicos executados por m?dicos otorrinolaringologistas e fonoaudi?logos do Hospital de Cl?nicas de Porto Alegre (HCPA). Os referidos m?todos de avalia??o seguiram os Crit?rios de Diagn?stico de Pesquisa para o Zumbido, estabelecidos pelo Ambulat?rio de Zumbido do Servi?o de Otorrinolaringologia do HCPA. O instrumento para avalia??o da DTM foi a vers?o oficial do question?rio e formul?rio de exame dos Crit?rios de Diagn?stico para Pesquisa das Disfun??es Temporomandibulares (RDC/TMD). Foram formados tr?s grupos de estudo: a) pacientes com zumbido e qualquer grau de perda auditiva; b) pacientes com zumbido e audiometria normal; c) pacientes do grupo controle sem queixas otorrinolaringol?gicas. As condi??es nos tr?s casos, foram comprovadas por um m?dico otorrinolaringologista. Resultados e conclus?es: Os pacientes do grupo de zumbido com qualquer grau de perda auditiva apresentaram uma associa??o direta com o diagn?stico de dor miofacial, com o diagn?stico de deslocamento de disco com redu??o, artralgia, osteoartrose, osteoartrite da ATM e tamb?m com o diagn?stico de redu??o da dimens?o vertical. Entretanto, n?o apresentaram associa??o entre o diagn?stico do Eixo I e o lado do zumbido, entre a presen?a de dor m?sculo-articular e o lado no qual o sintoma zumbido era mais intenso, nem entre a gravidade do zumbido e o n?vel de dor m?sculo-articular. Os pacientes do grupo de zumbido sem perda auditiva apresentaram uma associa??o direta com o diagn?stico de deslocamento de disco com redu??o e artralgia. Apresentaram tamb?m uma associa??o direta entre a gravidade do zumbido e o n?vel de dor nos m?sculos temporais posteriores esquerdo e direito. Entretanto, tais indiv?duos n?o apresentaram uma associa??o entre o diagn?stico do Eixo I e o lado do zumbido, nem entre a presen?a de dor m?sculo-articular e o lado no qual o zumbido era mais intenso. Al?m disso, os grupos de pacientes de zumbido n?o diferiram entre si em rela??o aos escores do grau de dor cr?nica, depress?o e somatiza??o, incluindo e excluindo dor, apesar de apresentarem escores superiores aos do grupo controle. Entretanto, embora n?o tenham apresentado escores significativamente mais elevados no Eixo II do RDC, os pacientes do grupo de zumbido com perda auditiva apresentaram valores superiores para a gravidade do zumbido em rela??o ao grupo de pacientes com zumbido sem perda auditiva.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2016-10-10T17:13:24Z No. of bitstreams: 1 DIS_RAFAELI_SAGRILO_GROSSI_PARCIAL.pdf: 731531 bytes, checksum: 2a61d4b51ae149bd92ef4ac8256b7072 (MD5) / Made available in DSpace on 2016-10-10T17:13:24Z (GMT). No. of bitstreams: 1 DIS_RAFAELI_SAGRILO_GROSSI_PARCIAL.pdf: 731531 bytes, checksum: 2a61d4b51ae149bd92ef4ac8256b7072 (MD5) Previous issue date: 2016-04-29 / Benign paroxysmal positional vertigo (BPPV) is characterized by vertigo crisis, triggered by sudden head position changes, associated with the appearance of paroxysmal positional nystagmus. The characterization of torsional nystagmus has fundamental importance while conducting a patient with BPPV, because it turns possible to identify the affected semicircular channel, as well as the physiopathological mechanism involved. However, the majority of existing videonystagmography devices are not capable of identifying these torsional movements with the required precision. This work aims to develop and test a method to model and identify torsional eye movements, when present. This new model uses a videonystagmograph prototype, comercial ophthalmic contact lens with geometric figures and a computer program, which was specially designed with this objective. Complementarily, a webapp program has also been created to support the topodiagnosis of the BPPV. Subjects with BPPV and without BPPV have been evaluated. The subjects have undergone the Dix-Hallpike maneuver, using the contact lens with geometrical figures on the left eye and the capture device. Among these evaluations, forty videos have been recorded (23 with counter-clockwise rotating movement phenomena, 10 clockwise and 7 videos with eye at rest). The extracted videos were analyzed with the developed software. The success rate in classifying the direction of the rotating movement (counter-clockwise or clockwise) and the resting position was evaluated. The accuracy of the software in correctly finding the geometric lines of the ophthalmic lens was also evaluated. Among the forty analyzed videos, the software had a success rate of 85% (70-94%) in identifying direction of movement or at rest; considering only the success rate in direction of movement, the total was 81% (64-93%). The accuracy in the measuring of the interest zone of the frames was 82,2% (81,5-82,8%) with p<0,05 significance level. Therefore, the new developed model should be able to have an important part on the topodiagnosis of the BPPV in the future, providing a more precise and effective therapeutic management to the patients with this disease. / A vertigem posicional parox?stica benigna (VPPB) ? caracterizada por crises de vertigem, desencadeadas por mudan?as bruscas de posi??o da cabe?a, associada a um nistagmo posicional parox?stico. A caracteriza??o do nistagmo rotacional ? de fundamental import?ncia na condu??o do paciente com VPPB, pois ? atrav?s das caracter?sticas do nistagmo que ? poss?vel identificar o canal semicircular acometido, bem como o mecanismo fisiopatol?gico envolvido. Por?m, a maioria dos dispositivos de videonistagmoscopia existentes n?o s?o capazes de identificar com precis?o esses movimentos rotat?rios. A proposta deste trabalho foi desenvolver e testar um novo modelo de quantifica??o de movimentos oculares rotat?rios quando presentes. Este novo modelo utiliza prot?tipo de videonistagmosc?pio, lente de contato oft?lmica comercial com figuras geom?tricas e o desenvolvimento de um software especificamente para esta finalidade. De forma complementar, uma WebApp tamb?m foi criada para auxiliar no topodiagn?stico da VPPB. Participaram do estudo 4 indiv?duos com VPPB e 4 sem VPPB. Os sujeitos foram submetidos ? manobra de Dix-Hallpike, utilizando a lente de contato com formas geom?tricas no olho esquerdo e o dispositivo de captura. Dessas manobras, foram gravados 40 v?deos (23 com fen?menos de movimento rotat?rio anti-hor?rio, 10 no sentido hor?rio e 7 v?deos com olho em repouso). Os v?deos extra?dos foram analisados com o software criado. Foi analisada a taxa de acertos na classifica??o da dire??o do fen?meno de movimento rotat?rio (anti-hor?rio ou hor?rio) quando presente ou v?deo repouso. Tamb?m foi avaliada acur?cia do software em encontrar corretamente as marcas geom?tricas da lente oft?lmica. Dos 40 v?deos analisados, o software obteve como taxa de acerto da dire??o ou repouso valor de 85% (70-94%); considerando-se apenas a taxa de acerto da dire??o, o valor foi de 81% (64-93%). A acur?cia na medida da zona de interesse dos frames foi de 82,2% (81,5-82,8%) com n?vel de signific?ncia de p<0,05. Assim, o novo modelo desenvolvido poder? no futuro ter um papel importante no aux?lio do topodiagn?stico da VPPB, proporcionando aos doentes com esta enfermidade um manejo terap?utico mais preciso e eficaz.

Made available in DSpace on 2015-12-06T23:45:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2012 / Introdução: Apesar de estudos ja terem sido realizados na tentativa de encontrar variaveis antropometricas, polissonograficas, parametros cefalometricos e analise de modelos dentais que pudessem predizer o sucesso no tratamento da Sindrome da Apneia Obstrutiva do Sono (SAOS) com Aparelhos Reposiicionadores Mandibulares (ARM), o seu uso na pratica clinica ainda permanece incerto pela inexistencia de estudos prospectivos e que associem essas variaveis ou que correlacionem a analise de alteracoes otorrinolaringologicas ao sucesso do tratamento da SAOS com ARM. Objetivo: Avaliar se parametros polissonograficos, demograficos, antropometricos, cefalometricos e otorrinolaringologicos, predizem o sucesso no tratamento da SAOS com ARM. Metodos: Foram selecionados homens com indice de apneia e hipopneia por hora de sono (IAH) entre 5 e 30 eventos por hora de sono. Todos realizaram avaliacoes pre e pos dois meses de tratamento com ARM. Analizaram-se parametros polissonograficos incluindo pressao de titulacao de CPAP, demograficos, antropometricos, otorrinolaringologicos, cefalometricos, modelos dentais, escala de sonolencia de Epworth, qualidade de vida (SF-36) e estado e humor (POMS). Boa resposta ao tratamento foi considerada IAH final &#8804; a 5 eventos/hora de sono associado a reducao de pelo menos 50% no IAH pretratamento. Resultados: Foram selecionados 40 portadores de SAOS leve e moderada apresentando indice de apneia e hipopneia (IAH) (11,99 - 18,14) / hora, idade (34,98 - 49,31) anos, indice de massa corporea (IMC) (24,04 - 27,76) kg/m2 e circunferencia cervical (38,21 - 41,69) cm. Individuos com SAOS leve respondem mais ao ARM do que os com SAOS moderada (p=0,005). Respondedores apresentaram ausencia de alteracoes faringeas (p=0,050), espaco faringeo superior aumentado (p=0,032), espaco aereo inferior diminuido (p=0,042), distancia intercaninos mandibulares aumentada (p=0,029) e reducao na escala de Epworth no pos-tratamento (p=0,000). Conclusoes: Homens com SAOS mais leve, apresentando uma via aerea mais pervea, maior distancia inter-dentaria apresentam maior sucesso ao tratamento com ARM. Entretanto uma combinacao entre avaliacao funcional e estrutural e necessaria para predizer com precisao a eficacia no tratamento com ARM / BV UNIFESP: Teses e dissertações