International Archives of Otorhinolaryngology最新文献

Introduction: In oral carcinoma patients classified as cN0, selective neck dissection (SND) and sentinel lymph node biopsy (SLNB) may be used to stage the neck with equivalent oncological results.

Objective: Compare the costs of SLNB and SND for oral squamous cell carcinoma.

Methods: Analysis of institutional cohort and Markov chain model simulation using populational data.

Results: We included 84 patients submitted to transoral resection and SLNB or SND and patients submitted only to SND. The mean cost was R$4,943,67 for SLNB and R$ 11,005.49 for SND with significant differences in length of stay (one versus three days, p < 0.001), operative time (92 versus 177 minutes, p < 0.001) and postoperative hospital visits in 60 days (two versus eight, p < 0.001). For the simulation model, the probability of not finding the SLN ranged from 0.0% to 5.7% with 0.5% increments and the probability of occult neck metastasis ranged from 9.0% to 100.0% with 1% increments. The costs of SLNB increase progressively as the rate of occult neck metastasis increases. When this rate reaches 56%, the cost difference becomes not significant. With rates above 72%, SLNB becomes significantly more expensive than SND. Using a public database, we calculate a cost decrease ranging from 27.93% to 66.54% with SLNB adoption.

Conclusion: SLNB adoption may significantly decrease the costs associated with early-stage oral cancer treatment. It would allow more patients to be treated with the same number of resources now available.

Introduction: Bilateral fitting of bone-anchored hearing devices (BAHD) remains a contentious topic, as the use of a single device can direct sound to both cochleae. However, the interplay of interaural attenuation and time delay may result in different responses in each ear; thus, greater challenges for unilateral BAHD users.

Objective: To assess the auditory performance of BAHD users with unilateral and bilateral fitting regarding speech recognition in silence and noise and sound localization.

Methods: Cross-sectional study. Unilateral BAHD users treated at a Brazilian public hospital underwent a speech recognition test, containing a list of monosyllables at 65dBSPL in silence and noise (S/N ratio = 0dB). The sound localization test employed eight speakers arranged at 45° distance. A recorded trisyllabic word served as the stimulus. For bilateral fitting, an elastic band with a device similar to the implant was used; patients underwent the same tests under identical conditions.

Results: Sixteen patients were assessed (mean age = 24.2 years). The average monosyllable recognition in silence rate was 71.5% in unilateral fitting and 78.2% in bilateral fitting. In noise, 61% in unilateral fitting and 72.2% in bilateral fitting. The mean angular deviation for the sound localization test was 80.48° in unilateral fitting and 68.08° in bilateral fitting. The bilateral fitting outcomes were better for all tests.

Conclusion: Users with bilateral BAHD fitting had better outcomes for speech recognition and sound localization.

Introduction: Vocal fold atrophy (VFA) is the most common voice disorder, and its morbidity increases with age.

Objective: To update the epidemiological understanding of VFA by assessing prevalence and phonographic characteristics by age, sex, and occupation.

Methods: A single-center retrospective chart review examined records of patients newly diagnosed with VFA from January 2020 to December 2022, analyzing age, sex, maximum phonation time (MPT), Voice Handicap Index (VHI), occupation, and voice disease complications.

Results: Six hundred-and-ten patients (319 women, 291 men), ages 17 to 96 (median 64; mean 61.14), were included. Most were in their 70s, with a higher proportion of women overall, but a greater number of men in their 60s, and an equal sex distribution in their 70s. Among those ≥60, there were 185 women and 189 men. Some were diagnosed with atrophy at a young age. Most participants were unemployed, and functional dysphonia was the most common complication. A moderately negative correlation was found between VHI and MPT in unemployed men, while other analyses showed no or weak correlations between age, sex, occupation, and complications.

Conclusion: VFA does not exclusively impact older adults. Early diagnosis and simple tests could potentially extend healthy life expectancy in unemployed men with VFA.

Introduction: Tonsillectomy is often used to treat recurrent tonsillitis (RT), but it is less commonly performed to treat peritonsillar abscess (PTA). While most PTAs are treated with needle aspiration or incision and drainage, quinsy tonsillectomy is used in select cases.

Objective: To compare clinical characteristics and postoperative outcomes of patients undergoing quinsy tonsillectomy for PTA versus those undergoing tonsillectomy for RT.

Methods: The American College of Surgeons NSQIP database was used to identify adults who underwent tonsillectomy (CPT code 42826) with a diagnosis of either PTA or RT. Data was collected from 2018-2021. Demographics, comorbidities, risk factors, postoperative complications, and outcomes including operative time, length of stay (LOS), readmission, and reoperation were compared. Logistic regression identified predictors of readmission and reoperation.

Results: 10241 patients had RT and 366 had PTA. PTA patients had significantly higher rates of smoking (27.0% versus 12.3%), diabetes (6.6% versus 2.5%), hypertension (11.5% versus 5.8%), and preoperative sepsis (14.5% versus 0.3%; p  < .001 for all). Operative time and LOS were longer in the PTA group (33.5 minutes versus 25.8 minutes; 2.5 days versus 0.2 days, respectively; p  < .001 for both). Despite higher rates of rare complications like ventilator use (0.8% versus 0.0%) and sepsis (2.2% versus 0.0%; p  < .001 for both), no significant differences were observed in postoperative hemorrhage, readmission, or reoperation.

Conclusion: Adults undergoing quinsy tonsillectomy for PTA have more comorbidities and rare complications compared with RT patients, likely due to active infection. However, the procedure is not linked to increased hemorrhage risk and remains safe treatment.

Introduction: Telerehabilitation has been used in several areas of physical therapy, including for respiratory, neurological, and musculoskeletal functions of patients with coronavirus disease 2019 (COVID-19), after stroke, and after hospital discharge (respectively). However, a few studies investigated protocols for assessing vestibular dysfunctions using teleconsultation.

Objective: To propose a protocol for remote physical therapy assessment of vestibular dysfunctions.

Methods: A literature review on telerehabilitation in physical therapy was conducted in the PubMed and SciELO databases using the search terms telehealth , telerehabilitation , vestibular disease , dizziness , vertigo , and postural balance . Four physical therapists with experience in the vestibular rehabilitation field discussed the collected data and suggested adaptations for remote clinical and functional tests to assess patients with vestibular dysfunctions.

Results: The proposed protocol for remote assessment of vestibular dysfunctions comprised anamnesis, adaptations of nine oculomotors, two static balance, and one dynamic gait balance tests, a questionnaire assessing the impact of dizziness on quality of life, and observation of cervical mobility.

Conclusion: The protocol may be a valuable tool to assess and monitor the care of patients with vestibular dysfunction, reducing healthcare costs for the therapist and patient and enabling the attendance of those with difficulties in traveling to the rehabilitation center or needing isolation.

Objective: To investigate and relate the risk of dysphonia, voice handicap, and laryngological findings in COVID-19 critical illness survivors, stratified by sex and the need for orotracheal intubation (OTI) during hospitalization in the intensive care unit. Additionally, identify predictors of voice symptoms after COVID-19 critical illness.

Methods: A cross-sectional study included 50 patients (mean age 51.70 ± 11.90 years; 26 women and 24 men) from a post-COVID-19 Rehabilitation Outpatient Clinic. Evaluations for voice symptoms and dysphonia risk were conducted using the Screening Index for Voice Disorder, vocal handicap using the Voice Handicap Index, and laryngeal health via laryngoscopic examination.

Results: Dysphonia risk and voice handicap were significantly more frequent in women. There was no significant association between voice self-assessment instruments and OTI. However, voice symptoms were significantly higher in intubated women. Commonly reported voice symptoms included dry throat, throat clearing, hoarseness, and vocal fatigue. Intubation was associated with laryngeal disorders, particularly in women, with the hypopharyngeal and supraglottic regions more affected by erythema and edema. Female gender, dyspnea, and cough accounted for 51% of the variance in voice symptoms.

Conclusions: COVID-19 critical illness survivors reported dry throat, throat clearing, hoarseness, and vocal fatigue even four months post-discharge. Women were at greater risk of dysphonia and voice handicaps. More than a quarter of patients presented laryngeal disorders related to OTI. Female gender and persistent symptoms of cough and dyspnea were predictors of voice symptoms. These findings enhance understanding of COVID-19's impact on the voice, highlighting the need for multidisciplinary approaches.

Introduction: Over the past decade, a mechanistic hypothesis emerged linking limited water diffusivity (often reflecting densely packed, actively dividing tumor cells) to elevated glucose uptake in head and neck cancer.

Objective: A systematic search of MEDLINE via PubMed identified eligible studies assessing the correlation between apparent diffusion coefficients from diffusion-weighted MRI and standardized uptake values from 18F-fluorodeoxyglucose PET/CT in head and neck cancer. Weighted correlation coefficients (ρ) were computed using Fisher Z transformations, and 95% confidence intervals (CIs) were calculated. Heterogeneity was evaluated with Higgins's inconsistency index, and potential publication bias was evaluated by visually inspecting funnel plots.

Results: A total of 25 articles, encompassing 790 patients, were systematically appraised to summarize the available evidence regarding the relationship between functional parameters in head and neck cancer. Thirteen studies, involving 367 patients and reporting a statistically significant inverse correlation between functional parameters, were summarized in the forest plot; the pooled correlation coefficient estimate was ρ = -0.55 (95% CI: -0.624 to -0.473; P < 0.05), with low heterogeneity. A further 12 studies were systematically reviewed for qualitative analysis due to the absence of significant relationships.

Conclusion: The correlations observed in some studies between apparent diffusion coefficients and standardized uptake values may provide insights to develop metrics for evaluating treatment efficacy and predicting clinical outcomes in head and neck cancer. However, not all studies confirmed this result, possibly due to factors such as molecular characteristics or clinical settings.

Introduction: Thyroid cancer extending to trachea has a poor prognosis. Deep tracheal invasion necessitates circumferential tracheal resection and anastomosis with thyroidectomy to achieve radical resection. Thyroid gland invasion by advanced tracheal tumors is rare. Similarly, tracheal resection with thyroidectomy is the treatment of choice for these cancers.Neck trauma that results in simultaneous damage of a tracheal segment and thyroid gland, may necessitate tracheal resection with thyroidectomy.

Objectives: The aim of this study was to evaluate the oncologic and functional outcomes in patients who had undergone thyroidectomy with tracheal/cricotracheal resection anastomosis for pathologies involving both a thyroid gland and airway.

Methods: This is a study that was conducted over 5 years on 11 patients who underwent thyroidectomy with tracheal/cricotracheal resection for pathologies involving both the thyroid gland and the airway (thyroid gland tumors, primary tracheal tumors, and traumatic impaction of the thyroid gland in the trachea).

Results: Successful outcomes were achieved in all patients. No intraoperative complications were reported. Minor postoperative complications were reported in 1 patient, in the form of limited surgical emphysema and air leak through the drains.

Conclusion: Tracheal/cricotracheal resection anastomosis represents the best compromise between oncologic radicality and postoperative quality of life. Highly skilled teams familiar with these types of airway surgery are required to achieve optimum results.

Introduction: There is a lack of community-dwelling population-based examinations of geriatric dysphagia and laryngopharyngeal reflux (LPR).

Objective: To assess the prevalence of geriatric dysphagia and laryngopharyngeal reflux (LPR) in a community-dwelling population from a rural area.

Methods: Volunteers from Velestino, a 4,000-person community, were given the Eating Assessment Tool (EAT-10) and Reflux Symptom Index (RSI) questionnaires at the health center. Demographic, medical, and pharmaceutical histories were recorded.

Results: 160 participants (92 females, 68 males) self-presented. Ages were between 65-95 years (Mean 76.04). 27 (16.88%) scored an abnormal EAT-10 and 13 (8.13%) RSI over 13. RSI was statistically correlated with total and positive only EAT-10 scores. Age and gender did not affect EAT-10 or RSI scores. The EAT-10 score decreased with age progression.

Conclusion: This is one of the few studies to investigate the relationship between geriatric dysphagia and LPR in a rural population. A 23.0% prevalence of dysphagia was observed in elderly adults as well as an increase in both EAT-10 and RSI scores with age progression. More studies are needed to explore this field.

Introduction: Children with auditory processing disorder (APD) exhibit various auditory processing deficits, including temporal processing deficits. Temporal processing abilities are assessed by estimating the gap detection threshold (GDT) as the lowest perceivable gap duration identified by the subject.

Objective: The present study attempted to examine the performance of normal-hearing children and children with APD using adaptive within-channel and across-channel gap detection tests.

Methods: Two groups of children aged between 10 and 12 years participated in the study. Group 1 included children diagnosed with APD, and group 2 included normal hearing, typically developing children (TD), with 12 participants in each group. For each subject, the lowest detectable gap duration was obtained monoaurally, using broadband noise (BBN), within-channel (narrow bands of noise centered spectrally at 2 kHz on either side of the gap), and across-channel (narrow bands of noise leading marker spectrally centered at 2 kHz and trailer marker spectrally centered at 1 kHz) gap detection tests through the Psycon platform (free).

Results: The results of the statistical analysis revealed significant group differences only in across-channel GDT measures between the two groups. In contrast, there were no statistically significant differences between the groups in terms of either within-channel GDT or BBN GDT.

Conclusion: The results indicate that, compared to other stimuli, an across-channel gap detection test would be a better diagnostic test of temporal resolution to identify and assess children with APD.