International Archives of Otorhinolaryngology最新文献

Introduction: Bioabsorbable packs, which are frequently used after nasal surgery, have been recently deemed more comfortable than removable packs. If these packs cause lower levels of eustachian dysfunction than silicone nasal splint with integral airway, they would be a good alternative for nasal packing after septoplasty.

Objective: To compare the effects of chitosan-based biodegradable nasal packs and silicone nasal septal splints with integral airway on the ventilation and pressure of the middle ear after septoplasty in patients with normal otoscopic examination.

Methods: Patients who underwent septoplasty for nasal septal deviation with otoscopically-normal tympanic membranes and bilateral, normal type-A preoperative tympanograms were included. Following surgery, the patients were randomized into two groups (group P: chitosan-based biodegradable nasal packs; group S: silicone nasal septal splint).

Results: The tympanometric pressures of all patients in both groups decreased, but more so in group S in the first 24 hours following surgery. These pressure differences between the 2 groups in the first 48 hours following surgery were statistically significant.

Conclusion: The present study demonstrated that chitosan-based biodegradable nasal packs would be a good alternative for nasal packing after septoplasty.

Introduction: Cochlear nerve deficiency (CND) is characterized by a thin or absent cochlear branch of the vestibulocochlear nerve, leading to sensorineural hearing loss (SNHL). The effectiveness of cochlear implants (CIs) in patients with CND is debated, with some studies indicating poor outcomes and others showing limited speech detection and discrimination abilities. Accurate objective measures are essential for a successful CI mapping.

Objective: To investigate the use of global stimulation with live speech to measure electrically evoked stapedial reflex thresholds (eSRTs) in CI recipients with CND and compare the results with behavioral comfort levels.

Methods: This retrospective study reviewed the CI database from January 2015 to December 2023 to identify patients with CND. The eSRT measurements following CI were conducted using a standard procedure. These levels were compared with the behavioral comfort levels from their mapping data.

Results: From the CI database of 273 recipients, six children with CND were identified whose eSRT levels were documented. Among these six, two children exhibited presence of electrical stapedial reflexes that correlated well with behavioral comfort levels in response to global stimulation of electrodes. None of them presented reflexes to individual electrode stimulation.

Conclusion: Global stimulation of electrodes has the potential to elicit eSRT in patients with CND more than individual electrode stimulation. Further research is crucial to validate the effectiveness of global stimulation in eliciting eSRT in a larger cohort of patients with CND. This would be a feasible test as an outcome measure, and it would help provide better prognostic counselling.

Introduction: Concha bullosa (CB) is an anatomical variation that can affect respiratory function. Therefore, identifying it is important.

Objective: To evaluate the prevalence of CB and its association with the side of pneumatization (right/left), nasal septum deviation (NSD), and mucosal thickening of the maxillary sinuses using cone-beam computed tomography (CBCT) exams from a Brazilian subpopulation. Also, to investigate the association between CB, sex and age.

Methods: There were 297 CBCT exams assessed by two examiners who evaluated the presence of CB (> 50% pneumatization of the turbinate's height), NSD (deviation point of the nasal septum and crista galli angle >9 ^o ), and mucosal thickening of maxillary sinuses (mucosa around the sinus walls > 3 mm in height). The association between CB and side, NSD, mucosal thickening of the maxillary sinuses, sex, and age were evaluated by the chi-squared and Fisher's exact tests (α = 5%).

Results: A total of 208 CB was found, corresponding to 11.7% of the evaluated turbinates, being more prevalent in the middle one ( p  < 0.0001). Considering all exams, 132 (44.4%) had at least one CB. There was an association between the presence of middle left CB with NSD ( p  = 0.028). No other significant associations were found ( p  > 0.05).

Conclusion: Almost half of the CBCT exams had at least one CB. Its prevalence was higher in the middle turbinate. There seems to be an association between middle CB and NSD. As for the other variables, no strong association was found.

Introduction: In patients with eosinophilic chronic rhinosinusitis (ECRS), viral infection of the upper respiratory tract tends to exacerbate the symptoms.

Objective: To clarify the effect of the cytokines during viral infection in ECRS patients, we investigated the production of thymic stromal lymphopoietin (TSLP) in the sinus mucosa of ECRS patients in the presence of polyinosinic: polycytidylic acid, or poly(I:C), which mimics viral infection, with or without interleukin-4 (IL-4) or IL-13.

Methods: The ECRS patients were classified into mild, moderate, and severe groups based on the scoring system of the Japanese Epidemiological Study of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC). We obtained paranasal sinus mucosa from patients with ECRS through endoscopic sinus surgery, as well as nasal epithelial cells. The cells were stimulated with poly(I:C) in the presence or absence of IL-4 or IL-13. The TSLP concentrations in the culture supernatants were measured using enzyme-linked immunosorbent assay (ELISA) after 24 hours of stimulation.

Results: Nasal epithelial cells from patients with ECRS or healthy controls produced TSLP upon stimulation with poly(I:C) alone, and the addition of IL-4 or IL-13 increased TSLP production. Notably, the increase in poly(I:C)-induced TSLP production from nasal epithelial cells in the presence of IL-4 or IL-13 was greater among the severe group compared to the other groups.

Conclusion: In the sinus mucosa of patients with severe ECRS, TSLP production was enhanced more when poly(I:C) stimulation was combined with IL-4 or IL-13 stimulation. Thus, the Th2-skewed condition of the sinus mucosa during viral infection in patients with more severe ECRS may accelerate disease exacerbation.

Introduction: Epistaxis is a common otorhinolaryngological emergency, usually caused by digital trauma in children, and hypertension in the elderly. General practitioners in emergency rooms assist most of the cases without specific management.

Objectives: Describe suitable properties for efficient nasal packing in adult epistaxis.

Methods: Two cadaver heads, preserved by freezing process, were thawed for this research. When the room temperature was reached, the nasal cavities were evaluated by a nasal endoscope, which showed a length of 4.0 × 11.0 cm for the male and 4.0 × 8.5 cm for the female head. Through an orifice made in the left maxillary bone to access the maxillary sinus, a blue-dyed saline solution was applied using a sphygmomanometer (Premium) to control and mimic blood pressure. The nasal cavity was first packed with two foams with different thicknesses and densities evolved by a condom, then packed by the Merocel packing (Medtronicent Surgical Products Inc.). The pressure was administered and gradually increased until a saline leak was observed in the oropharynx. The best way to insert tampons was also evaluated to avoid extensive trauma.

Results: Despite the difficulty of the application being similar in both nasal packings made with the condom and foam, t33-densityity foam, 2.0 cm thick and 11.0 cm lon resisted to a higher pressure (250mmHg) than the commercial packing Merocel (220mmHg).

Conclusion: The most suitable foam for packaging wrapped with condoms is 2.0 cm thick, as it supported the blood pressure commonly found in epistaxis.

Introduction: Cisplatin is an effective chemotherapeutic drug. Its side effects, ototoxicity and genotoxicity, limit widespread application. Melatonin could reduce these toxic effects due to its antioxidant activity.

Objective: To determine the effect of melatonin against cisplatin-induced ototoxicity and genotoxicity in rats.

Methods: To assess ototoxicity, 33 rats were randomly divided into: group 1 (saline), group 2 (melatonin), group 3 (cisplatin + saline), and group 4 (cisplatin + melatonin). Groups 3 and 4 received a single dose of 10 mg/kg of cisplatin. Groups 2 and 4 received daily doses of 1 mg/kg of melatonin. The number of viable neurons and their average diameter in the spiral and vestibular ganglia were analyzed. In the stria vascularis and spiral ligament, the number of viable cells was evaluated. To assess genotoxicity, 12 animals were randomly divided into: group A (saline), group B (cisplatin + saline), and group C (cisplatin + melatonin). The rats in groups B and C received a single dose of 10 mg/kg of cisplatin. Group C received a single dose of 1 mg/kg of melatonin.

Results: The micronucleus count and percentage of polychromatic erythrocytes in the bone marrow of rat femurs were analyzed. The animals in group 3 presented a greater loss of cells than the animals in other groups regarding all cochlear structures evaluated. Furthermore, the diameters of neurons were smaller in the animals in group 3. Melatonin-treated rats presented a lower micronucleus count and a higher number of polychromatic erythrocytes than animals treated with cisplatin alone.

Conclusion: Melatonin reduces cisplatin-induced cyto-histopathological damage in the bone marrow and inner ear; therefore, it could be used as a tumor adjuvant treatment.

Introduction: It is important to understand the intricacies of hearing aid management early in the child's life to appreciate the full benefits of early intervention.

Objective: Identifying aspects of hearing aid management that carers regard as taxing will allow hearing professionals to focus and encourage these areas, potentially leading to higher hearing aid use and better outcomes.

Methods: 49 parents of children with hearing impairment participated in the study. Parent Hearing Aid Management Inventory (PHAMI) was used to explore parent access to information and experiences in three domains such as parent skills and confidence in hearing aid management, hearing aid use, and communication with the audiologist using a 4-point rating scale. The data was collected using direct interviews and through Microsoft forms.

Results: The majority of the parents desired information and support in identifying hearing aid options/accessories, obtaining financial assistance for costs, and using a listening stethoscope for determining when the hearing aid was not working. The most common challenges identified by parents as influencing their child's hearing aid use were activities (for example, playing, travelling in the car), and the fear of losing and damaging the hearing aids. Although many parents were pleased with the audiologist's assistance, they desired that the audiologist be more patient and contact them more regularly after the hearing aids were fitted.

Conclusion: Professionals can help with effective device management by addressing parental challenges, collaborating on specific device management goals, and helping as needed.

Introduction: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has brought up reports of an increase in new cases of tinnitus and changes in chronic and/or preexisting episodes. Nevertheless, there is no established data on the characteristics of tinnitus and its correlation with coronavirus disease 2019 (COVID-19).

Objective: To analyze the characteristics of tinnitus in subjects affected by COVID-19 while detailing the correlation between these two factors.

Data synthesis: We found 327 articles, 37 of which were selected: 11 cross-sectional studies, 4 case-control studies, 3 cohort studies, and 19 observational studies. The sum of the samples totaled 399,524 patients included in the present review. The prevalence of new tinnitus varied from 0.2% to 96.2%. Most articles provided incomplete information or were missing information. Systemic arterial hypertension was the most common underlying disease. Finally, we found a predominance of hearing loss and olfactory and taste disorders, followed by fever and cough.

Conclusion: The prevalence of new tinnitus ranged from 0.2 to 96.2%, whereas the prevalence of preexisting tinnitus varied from 8 to 76.2%. It was not possible to satisfactorily assess the characteristics of tinnitus. Therefore, a direct correlation between tinnitus and COVID-19 could not be determined, as this symptom may be influenced by other factors.

Introduction: Head and neck cancer are rare and require complex medical and surgical management. Regionalization or centralization of care, defined as the concentration of patients with complex diseases from a specific area in institutions with more experienced and highly functional multidisciplinary teams, may be an alternative to achieve better oncologic outcomes.

Objective: To systematize the current knowledge regarding the centralization of care in head and neck oncology and its consequences in the practice of related surgeries.

Data synthesis: Currently, there is evidence that this strategy shows better oncologic outcomes in centers with greater volumes, greater adherence to evidence-based clinical guidelines and quality indicators, and a multidisciplinary team in charge of decision-making. The center in Ontario, Canada, is framed as an example of this strategy, achieving improved outcomes while maintaining a high level of quality.

Conclusion: Although more high-quality studies are needed to support this strategy, we believe that the evidence already available is sufficient to consider it a valid option to improve the oncologic outcomes of patients.

Introduction: Music has been recognized as a therapeutic tool in auditory rehabilitation, promoting essential social and behavioral development in children with cochlear implants (CIs), as identified by the World Health Organization (WHO). Additionally, there is a lack of studies on the development of these skills in this context.

Objective: To investigate the effect of music training on the development of social, behavioral, and academic skills in children with CIs from the schoolteacher's perspective.

Methods: The present is an experimental study involving 10 children with CIs, aged between 6 and 10 years, who composed the experimental group. They had a semester of music training and were assessed through the Social Skills Rating System (SSRS) questionnaire at 4 different moments: 2 months before the beginning of the music training, at the beginning of the music training (first week of class), during the music training (3 months after the beginning), and at the end of the music training (6 months after the beginning). To compare the multiple SSRS assessments, we used the repeated measures analysis of variance (ANOVA) test and the Tukey test ( p ≤ 0.05).

Results: The results showed a statistically significant improvement in social skills in terms of assertiveness, social resourcefulness, self-control, affectivity, cooperation, externalizing behavior problems, and academic competence.

Conclusion: From the schoolteacher's perspective CI-using children who had music training experienced an improvement in their social and academic skills and behavioral problems.