International Archives of Otorhinolaryngology最新文献

Introduction: The computed tomography (CT) details of the dimensions of the larynx are not fully covered in the literature, so it is important to build up a database for the CT measurements of that area in different ethnic groups. Preoperative details provided by CT are crucial prior to any procedure or approach involving the larynx.

Objective: To measure and report the different dimensions of the larynx and vocal cords through CT.

Methods: We analyzed 100 CTs of the larynx (200 vocal cords): axial images were acquired through multiplanar reformation to obtain minute details of all subjects.

Results: The mean anteroposterior (AP) vocal fold length (VFL) was of 16.8 ± 2.6 (range: 11.8-22.9) mm, which was significantly longer in male subjects (mean = 18.4 ± 2.2 mm; range = 10.9-19.8 mm) compared to female subjects (mean = 15.3 ± 1.95 mm; range = 10.9-22.9 mm). The mean width of the subglottic area was of 14.88 ± 2.18 (range = 8.9-21.1) mm, which was significantly wider in male subjects (15.6 ± 2.13 mm; range = 9.1-21.1 mm) compared to female subjects (mean = 14.18 ± 1.99 mm; range = 8.9-17.8 mm). There was a positive correlation between the AP and transverse diameters of the subglotic area with the VFL: the longer the AP and transverse diameters of the subglottic area, the longer the VFL and vice versa.

Conclusion: The present study improves the awareness of surgeons and radiologists of the laryngeal dimensions, and it can be of help to residents in training.

Introduction: Training in Head and Neck surgery represents a complex process always in evolution. Due to the absence of specific surgical evaluation tools to assess neck dissection performance by residents during training, finding a proper way to evaluate those standards will be a matter of debate for decades, and continues to be a pending task in the field.

Objective: Validation and cross-cultural adaptation of the TSCND questionnaire to the Spanish language.

Methods: A prospective data collection, about the performance of Spanish TSCND measured with Cronbach α.

Results: Internal consistency of the task-specific checklist section measured was 0.752 (95% CI = 0.638 to 0.839) with an intraclass correlation coefficient of 0.749 (95% CI = 0.651-0.837). Internal consistency of the global rating scale section measured with Cronbach α was 0.788 (95% CI = 0.681 to 0.865) with an intraclass correlation coefficient of 0.789 (95% CI = 0.703-0.857).

Conclusion: The development of specific tools to support surgical training education makes it possible to improve surgical skills evaluation. The Spanish translation of the TSCND is a reliable option for Spanish-Speaking surgical training and trainers in the development of an up-to-date competency-based curriculum.

Introduction: Stapes surgery (SS) benefits from adequate anesthetic bleeding control due to its microscopic nature and greater difficulty in hemostasis. Adequate hypotension during intervention is considered critical to achieving this goal.

Objective: To evaluate the role of controlled hypotension (CH) on surgical outcomes in SS.

Methods: We conducted a retrospective observational study in a tertiary academic center with adults submitted to SS from January 2017 to October 2022. Hypotension was considered controlled if the mean intraoperative arterial pressure was between 50 and 65 mmHg throughout the procedure. Patients were divided into CH and non-CH groups. Demographic data, medical history, anesthetic and surgical reports, perioperative complications, and audiometry results were studied.

Results: A total of 99 SS procedures were included. Of those, 23 met the criteria for CH. The non-CH group presented a nonsignificant longer operative time (71.4 ± 21.3 versus 83 ± 27.4 minutes; p  = 0.065). No statistical difference was observed in complication rates related to the procedure (39.1 vs. 48.7%; p  = 0.421). In terms of audiometric data, both groups showed comparable pre- and postoperative pure tone average (PTA) results (preoperative: 55.4 ± 11.3 versus 53.1 ± 16.2dB; p  = 0.525; postoperative: 31.6 ± 10.2 versus 33 ± 17dB; p  = 0.722). The postoperative average air-bone gap (ABG) was 9.3 ± 8.3 versus 10.1 ± 9dB; p  = 0.709, while closure of the ABG was 24 ± 13.1 versus 19.7 ± 17dB; p  = 0.287.

Conclusion: Controlled hypotension in SS does not appear to impact the audiometric outcomes or complication rates, despite having a potential role in the surgery duration.

Introduction: Myringoplasty is a surgical procedure aimed at reconstructing the tympanic membrane, restoring acoustic protection to the round window, and improving sound conduction to enhance hearing, and prevent recurrent infections or otorrhea. This procedure can be performed either through microscopy or endoscopy.

Objective: To compare the outcomes of endoscopic myringoplasty and microscopic myringoplasty.

Methods: Data were retrospectively collected from the electronic medical records of patients who underwent myringoplasty either through microscopy or videoendoscopy at Hospital do Servidor Público Estadual de São Paulo (HSPE) between December 2015 and December 2020. We evaluated the therapeutic success rate, defined as tympanic membrane closure, the variation in the pre- and postoperative speech recognition threshold (SRT), and the incidence of immediate and late complications in each group.

Results: We included 118 patients: 64 underwent microscopic myringoplasty (group 1) and 54, videoendoscopic myringoplasty (group 2). The groups were comparable in terms of mean age, sex, and body mass index (BMI). The surgical success rates were similar between the 2 groups: group 1: 70.3%; and group 2: 75.9% ( p  = 0.494). Group 1 presented a significant improvement in the mean postoperative hearing thresholds (30.0 ± 14.9) compared to the mean preoperative levels (41.0 ± 16.3) ( p  < 0.001), while group 2 did not present a statistically significant improvement (from 37.8 ± 14.7 preoperatively to 32.0 ± 20.7 postoperatively; p  = 0.284).

Conclusion: Microscopic and endoscopic myringoplasty yielded similar tympanic membrane closure rates. However, the videoendoscopic procedures resulted in lower SRT reduction, while the microscopic procedures resulted in a higher rate of immediate postoperative complications.

Level of evidence: 3.

Introduction: The University of Pennsylvania Smell Identification Test (UPSIT ^® ) is a reliable olfactory test that is easy and quick to apply. It is a one-time use test and its reuse is not recommended by the manufacturer.

Objectives: Because in high-demand healthcare facilities testing all patients with UPSIT ^® can be costly, in this present study we sought to assess the feasibility of reusing the UPSIT.

Methods: Two hundred and ninety healthy volunteers aged 18 and 40 without olfactory complaints participated in the study. Two hundred and forty volunteers underwent the UPSIT ^® scratching the small strip of the test doing only 2 Z-shaped scratches ("2 Zs" protocol); each UPSIT ^® was used 20 times by same-sex participants. The remaining fifty patients performed the UPSIT ^® in the standard single-use fashion. Adjusted multiple regressions relating to the olfactory test score, number of times the test was applied, and demographic variables were performed.

Results: The mean scores using the UPSIT ^® repeatedly were lower than those done in the single-use standard fashion. Despite this, the scores remained stable until the tenth time the test was applied. When patients perform the UPSIT ^® in the "2 Zs" protocol, a correction factor of more 3 points was required in the final score.

Conclusion: UPSIT ^® reuse up to 10 times is feasible when a 3-point correction factor is added to the final score. The "2 Zs" protocol described is an alternative to reduce costs in epidemiological studies. This study, however, is limited as it was carried out only with healthy individuals.

Introduction: Key performance indicators (KPIs) measure the critical functions and activities that must be performed in an organization to provide management with an assessment of quantity and quality, from which it can aid strategic decisions to achieve objectives.

Objective: To map the literature review on KPIs in the context of medicine.

Methods: In the literature review, we adopted a proposed model and made appropriate adaptations to it. The PubMed database was chosen, with filters applied to define a path. The findings of the articles were briefly discussed in comparison with others to highlight specific findings.

Results: Almost 100 research articles were eligible for investigation in a wide range of third- and second-degree medical specialties. In these articles, the KPIs are numbered from 1 up to 797 qualitative and quantitative measures.

Conclusions: The KPIs are not limited to a financial regime; instead, in the field of medicine, they play an important role in a wide range of medical specialties, from clinics, therapeutics, surgery, pharmacy, research, regulatory affairs, hospitalization, management, and product development. These indicators can be implemented and evaluated by different means, from simple resources such as home visit, telephone survey, cross-comparison with a benchmark, questionnaires, spreadsheets, to the most sophisticated technology, such as IT resources, artificial intelligence, the linear hinges model, the Research and Development/University of California, Los Angeles (RAND/UCLA) appropriateness method, and the Monte Carlo simulation.

Introduction: The main treatment of otomycosis has required the use of topical antifungal drops and/or acidifying agents. However, because of the availability issues of antifungal drops in developing countries, treatment with acidifying agents alone is necessary.

Objective: The objective of this study was to compare the efficacy in the treatment of otomycosis using a 10% povidone-iodine and clotrimazole solution.

Methods: Patients with otomycosis were assigned to 10% povidone-iodine group and Clotrimazole group. The patients were evaluated on the response of each group at 1, 2,4 and 8 weeks.

Results: 93 patients were assigned to the 10% povidone-iodine group and 95 patients to the Clotrimazole group. the response to treatment between groups. In the second week after treatment, 37.64% of the 10% povidone-iodine group and 40% of the Clotrimazole group had a good response to treatment (p = 0.551). In the fourth week after treatment, 52.69% of the 10% povidone-iodine group and 55.79% of the Clotrimazole group had a good response to treatment (p = 0.644). In the eighth week after treatment, 58.06% of the 10% povidone-iodine group and 64.21% of the Clotrimazole group had a good response to treatment (p = 0.642) In the 12th week after treatment, 76.34% of the 10% povidone-iodine group and 85.26% of the Clotrimazole group had a good response to treatment (p = 0.248).

Conclusions: There were no significant differences in the response to between 10% povidone-iodine and Clotrimazole groups in the second, fourth, eighth and twelfths after treatment.

Introduction: Postinfectious hyposmia gained special attention in the postpandemic era, and persistent cases are particularly difficult to treat. Many unproven therapies are used in clinical practice, including corticosteroids, with insufficient evidence.

Objective: To establish the effectiveness of systemic corticosteroid therapy, associated with olfactory training, for persistent postinfectious hyposmia.

Methods: Patients with persistent postinfectious hyposmia were divided, based on comorbidities, into control group (submitted to olfactory training alone) and test group (associated 7-day course of prednisone 40 mg). Olfactory evaluations were performed (visual analogue scale, Alcohol Sniff Test, and Connecticut Olfactory Test), at baseline, and at the 3- and 6-month follow-ups.

Results: There was no statistically significant difference between the test (n = 10) and control (n = 7) groups ( p  > 0.05) for primary outcomes (visual analogue scale, Alcohol Sniff Test, and Connecticut Olfactory Test), although there was statistically significant improvement of Alcohol Sniff Test scores in both groups at 6 months ( p  > 0.05). The study's statistical power was reduced due to the small sample size. Even without randomization, the groups were not comparable only in terms of age ( p  > 0.05). Although no statistically significant association was found, there was a clear tendency for improvement in the overall olfactory function, which may be spontaneous or due to olfactory training. No side effects were reported.

Conclusion: There was no statistically significant benefit of systemic corticosteroid therapy for patients with persistent postinfectious hyposmia ( p  > 0.05). Treatment with systemic corticosteroids should be individualized, and there is no consensus in the literature.

Introduction: The quality of life of head and neck cancer patients is significantly impacted. Bibliometric analysis is crucial to get the scholarly landscape, figuring out the research area related to quality of life among head and neck cancer patients.

Objective: To use network visualization mapping to perform a bibliometric analysis of the quality of life among head and neck cancer patients.

Methods: A literature search was done using the Scopus database. The searched keywords among papers included the amalgamation of quality of life , and head and neck cancer . The data were extracted, and bibliometric analysis was performed based on the bibliometric indicators: the trend of article publishing, citations, leading countries, and institutions contributing to a publication, potential authors, journals, and frequently occurring keywords. Network visualization mapping was performed using the VOSviewer software (Leiden University).

Results: A total of 366 articles met the predefined eligibility criteria and were selected for analysis. The selected papers were published in 57 journals between 1983 and 2024. The results provide insightful information on there being a maximum of 25 articles in 2022 and the highest citation count of 1,683 in 2001. Among 52 countries, the United States was the leading contributor, having published 75 articles. The top contributing institution was Liverpool University Hospital, Aintree, United Kingdom, with four articles. Roger Simon was the author with the most potential, and Head and Neck was an impactful journal. The most frequently occurring keywords were quality of life , head and neck , and oral cancer .

Conclusion: The current bibliometric analysis identified the scholarly impact and characteristics of articles, which provide researchers and policymakers with baseline data to frame research strategies for improving quality of life among head and neck cancer patients.

Introduction: Necrotizing otitis externa (NOE), also known as malignant otitis externa (MOE), is a severe infection that begins in the external auditory canal and can extend to adjacent tissues and bone. It primarily affects elderly, diabetic, and immuno-compromised patients. Despite the advancements in antibiotics and surgical interventions, NOE remains a condition with significant morbidity and mortality.

Objective: To evaluate the efficacy of hyperbaric oxygen therapy (HBOT) as an adjunctive treatment for NOE, focusing on clinical outcomes and the potential benefits in refractory or advanced cases.

Methods: We conducted a comprehensive literature search on the PubMed/MEDLINE and Cochrane Library databases for articles published from January 1980 to December 2023. The search terms included hyperbaric oxygen therapy , necrotizing otitis externa , and refractory otitis . A total of 8 studies met the inclusion criteria, comprising case reports, observational studies, and case series. Study quality was assessed through the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale.

Results: The results indicate that HBOT shows promise in the treatment of NOE, with several studies reporting complete resolution of infection and prevention of recurrence, especially in refractory cases.

Conclusion: The current evidence is insufficient to establish HBOT as a standard treatment for NOE; however, its potential benefits in improving clinical outcomes and reducing morbidity are significant. High-quality research, including randomized controlled trials, is necessary to validate the role of HBOT in NOE treatment. Where hyperbaric facilities are accessible, HBOT should be considered for refractory NOE cases.