International Archives of Otorhinolaryngology最新文献

Introduction  Williams syndrome (WS) is a genetic disorder caused by a microdeletion in chromosome 7, affecting ∼ 28 genes. Studies have demonstrated conductive losses seemingly related to the absence of the elastin gene and mild to profound sensorineural losses due to cochlear fragility. Objective  To characterize and compare the peripheral auditory system and auditory brainstem response (ABR) of adults with WS and neurotypical adults matched by age and gender. Methods  We conducted a cross-sectional observational study with 30 individuals of both sexes, aged 18 to 37 years - 15 of them with WS (study group) and 15 with neither the syndrome nor hearing complaints (control group), matched for sex and age. The subjects underwent pure-tone and speech audiometry, acoustic immittance, transient-evoked otoacoustic emissions (TEOAEs), and ABR. Results  Early-onset sensorineural hearing loss was found in 53.3% of the study sample, mostly mild, occurring above 3 kHz. The TEOAEs were absent in 53.3% of assessed subjects; for those in whom they were present, the signal-to-noise responses were significantly lower than in the control group. In the ABR, increased absolute latencies were observed in waves I and III. Conclusion  Individuals with WS have early and progressive cochlear impairments, mainly affecting the basal region of the cochlea. They may have low brainstem changes which seem to begin in adulthood.

Introduction  Benign vocal fold lesions (BVFLs) disrupt the superficial lamina propria, impacting vocal fold pliability. Investigating the diagnostic competency of ear, nose, and throat (ENT) residents in identifying BVFLs, we hypothesize that factors such as residency year, subspecialty focus, and training center influence diagnostic accuracy. Objectives  To assess the accuracy of diagnosis of BVFLs among ENT residents and to correlate diagnostic accuracy with the year of residency. Methods  An observational cross-sectional study included all ENT residents in Saudi Arabia. It was performed in August and September 2021 using a self-administered online questionnaire that assessed demographic variables and included three images with open-ended questions on diagnosing vocal fold lesions. Results  A total of 61 ENT residents (62.3% male) were included in this study. The images of vocal fold cyst, vocal fold polyp, and vocal fold nodule were correctly diagnosed by 60.7%, 88.5%, and 91.8% of residents, respectively. There was a correlation between the year of residency and the accuracy of diagnosing a vocal fold cyst ( p  = 0.029). Residents interested in laryngology correctly diagnosed all three lesions more frequently than other residents. Conclusion  The ability of residents to diagnose vocal fold cysts was moderate. In particular, the senior residents were able to diagnose polyps and nodules with excellent accuracy.

Introduction  One of the paths in the investigation of congenital sensorineural hearing loss (CSNHL) is to try to characterize its etiology through the inner ear evaluation using high resolution computer tomography (CT) scans. With minor malformation, it is not always possible for a simple visual inspection to recognize if the structure in the inner ear is normal or not. Objective  To verify if measurements of the inner ear are predictive of sensorineural hearing loss (SNHL) and suggest cutoff points of size limits. Methods  Retrospective cross-sectional study of inner ear CT scan measurements of 214 patients, 50 with congenital SNHL (CSNHL) and 164 acquired SNHL (ASNHL) (control group). Results  In the CSNHL group, central bony island (CBI) were 0.48 mm smaller ( p  < 0.001), cochlear nerve aperture was (CNA) 0.10 mm smaller ( p  < 0.001), and cochlea height was (CH) 0.15 mm smaller ( p  < 0.001). Vestibular aqueduct (VA) and cochlea width (CW) were similar between groups (0.70 vs 0.72, p  = 0.19, and 7.20 vs 7.15 p  = 0.23). The predictive cutoff points for CSNHL were CBI = 3.6 mm, CAN = 1.4 mm, CH = 3.4 mm, CW = 7.0 mm, and VA = 0.9 mm. Conclusion  Congenital sensorineural hearing loss determined a decrease in CBI, opening of the cochlear nerve (OCN), and CW. Thus, these measures, at the cutoff points indicated, should make us aware of the diagnosis of congenital hearing loss.

Introduction  The coronavirus disease 2019 (COVID-19) pandemic has prompted a transformation in medical practice, including the adoption of telemedicine in Brazil and globally. Otorhinolaryngology, a field at high risk of viral transmission, has witnessed an increasing use of telemedicine tools. However, the extent and challenges of telemedicine in this field in Brazil are not well understood. In the present study, we applied a questionnaire to Brazilian otorhinolaryngologists during the pandemic to assess telemedicine's advantages and challenges, shedding light on its integration and persistent issues in the field. Objective  To assess the usage profile of telemedicine in the clinical practice of otolaryngology in Brazil. Methods  The present was a cross-sectional observational study with convenience sampling. It was conducted as a web-based questionnaire distributed and advertised to Brazilian otorhinolaryngologists through social media posts on WhatsApp (Meta Platforms, Inc., Menlo Park, CA, USA), Instagram (Meta Platforms, Inc.), Facebook (Meta Platforms, Inc.), as well as direct messaging and email. Results  The sample size was 186 participants. A total of 69% of them had already provided or were currently providing telemedicine services, and 34% considered it a frequent or very frequent form of work at the time of data collection. In total, 90% of the respondents considered the lack of physical examination a problem in otolaryngological teleconsultations, while 64% reported frequently or very frequently resolving patient problems through teleconsultations. Conclusion  Telemedicine emerged in the context of the COVID-19 pandemic as a promising tool for remote patient care. More studies are needed to elucidate its role in the context of limited physical examination.

Introduction  Olfactory dysfunction (OD) has emerged as a notable symptom among coronavirus disease 2019 (COVID-19) patients, with its prevalence varying among different populations. Recognizing the need to provide therapeutic solutions for these individuals, the present study seeks to comprehensively review the current evidence on potential underlying mechanisms and treatment modalities to manage OD in COVID-19 patients. Objective  To review the recent evidence on treatments for OD in COVID-19. From the beginning of the study until August 2nd, 2023, we conducted a systematic search on four electronic databases, PubMed, Scopus, Embase, and Web of Science, to find relevant publications. Data Synthesis  In the present study, 37 articles were selected for data extraction and included in the final review. The total number of patients was of 3,560 (2,098 female and 1,462 male subjects). The predominant disorders reported were hyposmia, anosmia, and parosmia. In most of the studies, the pre and postintervention assessments were the same, except for one study, in which the pre-intervention assessment of the disorder was through the SST, Sniffin' Sticks Test (SST), and the post-intervention assessment was through the Visual Analog Scale (VAS) and the 22-item Sinonasal Outcome Test (SNOT-22). The findings suggest olfactory training (OT), ivermectin, palmitoylethanolamide, luteolin, and systemic corticosteroids, in combination with topical corticosteroids, are potential therapies for COVID-19 patients with olfactory impairment. Conclusion  Although the review suggested several medications for OD treatment, further research must delve into the specific impact of OT, a non-pharmacological modality, regarding the mitigation of OD. By continuing to investigate and refine these therapeutic approaches, we can better support COVID-19 patients and improve their quality of life while navigating the challenges posed by OD.

Introduction  The World Health Organization (WHO) estimates that ∼ 32 million children worldwide are affected by hearing loss (HL). Cochlear implant is the first-line treatment for severe to profound sensorineural HL. It is considered one of the most successful prostheses developed to date. Objective  To evaluate the oral language development of pediatric patients with prelingual deafness implanted in a reference hospital for the treatment of HL in southern Brazil. Methods  We conducted a retrospective cohort study with a review of medical records of patients undergoing cochlear implant surgery between January 2009 and December 2018. Language development was assessed by reviewing consultations with speech therapy professionals from the cochlear implant group. Results  A total of 152 children were included in the study. The mean age at cochlear implant surgery was of 41 months (standard deviation [SD]: ± 15). The patients were divided into six groups considering the type of language most used in their daily lives. We found that 36% of children use oral language as their primary form of communication. In a subanalysis, we observed that patients with developed or developing oral language had undergone cochlear implant surgery earlier than patients using Brazilian Sign Language (Língua Brasileira de Sinais, LIBRAS, in Portuguese) or those without developed language. Conclusion  The cochlear implant is a state-of-the-art technology that enables the re-establishment of the sense of hearing and the development of oral language. However, language development is a complex process known to present a critical period to properly occur. We still see many patients receiving late diagnosis and treatment, which implies a delay and, often, the impossibility of developing oral communication. Level of Evidence  Level 3 (cohort study).

Introduction  Sinonasal inverted papilloma (SNIP) is a rare benign epithelial tumor of the nasal cavity and paranasal sinuses that accounts for 0.4% and 4.7% respectively, of all tumors of this anatomical region. Objective  To analyze the outcomes after surgical resection of SNIP and identify the risk factors for recurrence in a Swiss tertiary center. Methods  We conducted a retrospective review of all cases of SNIP treated at the Lausanne university hospital between 2005 and 2018. All data available on the patients and tumors were collected for analysis. We studied the recurrence rate and looked for risk factors. Results  We included 57 patients with a mean age of 55.5 years. There were 46 primary cases (80.7%) and 11 recurrences (19.3%). Maxillary sinus was the most frequent location (33.3%). Approximately half of the patients (52.6%) presented with a T3 tumor according to the Krouse classification. The mean recurrence rate after surgery was of 17.5% and it was more frequent among the patients in the recurrence group (45.5%) than among the primary cases (10.9%), reaching statistical significance (odds ratio [OR] = 6.8; 95% confidence interval [95%CI]: 1.5-30.8; p  = 0.0165). Most patients were treated endoscopically (94.7%). Frontal sinus location, higher Krouse stage, and combined approach seemed to increase the risk of recurrence, but without statistical significance. Conclusion  Difficult surgical access, as in the case of tumors located in the frontal sinus, higher stage of the disease, and previously operated cases carry the higher risk of incomplete resection and recurrence.

Introduction  Mismatch negativity (MMN) represents a negative component of event-related potentials, which is mentioned by guidelines as an important tool to provide measurable data regarding the functionality of the auditory system in acoustic processing. However, the literature still lacks reliable data that can support the clinical use of this potential in the complementary diagnosis of central auditory processing (CAP) disorder (CAPD). Objectives  To analyze whether MMN assessment might be associated with the CAP behavioral test battery, as well as to assess the effects of auditory ability deficits on MMN responses in the pediatric population. Methods  In total, 45 age-matched children participated in the study. They were submitted to the CAP behavior assessment and to MMN. The children were tested with a combination of speech contrast consisting of acoustic syllables [da] versus [ta], governed by the oddball paradigm. Results  Mismatch negativity did not show a direct association with a single test but with the combination of the four tests used as a behavioral test battery to identify CAPD. The results also indicated that the auditory ability deficits influenced the measurement of MMN latency ( p  = 0.003*), but not the amplitude ( p  = 0.857) or the area ( p  = 0.577). Conclusion  Mismatch negativity was shown to be statistically associated with the battery of tests used to identify deficits in auditory abilities in the studied sample rather than with a single behavioral test. The deficits in auditory abilities were observed in the MMN latency. Mismatch negativity can be used to assess children with CAPD.

Introduction  Myringoplasty is a common otologic procedure to restore the integrity of the tympanic membrane in cases of traumatic or pathologic perforations. Many grafting materials have been used with different techniques. Objective  In the present work, we evaluate the surgical and audiological outcomes of periosteal graft overlying the mastoid cortex through a retroauricular incision in a pediatric cohort. Methods  A retrospective study was carried out involving all children aged ≤ 16 years who underwent periosteal graft myringoplasty for the treatment of chronic suppurative otitis media with dry central perforation in our hospital from April 2019 to April 2021. All patients were followed up for one year to assess the anatomical success and functional outcomes by comparing the preoperative and postoperative (after six months) results of pure tone audiometry (PTA). Results  The sample was composed of 36 patients; 20 of them were female (55.6%) and 16 were male (44.4%) subjects, with ages ranging from 7 to 16 (mean: 12.7) years. Four patients underwent surgery in both ears (with an interval of 6 to 9 months). Out of 40 surgeries performed, 38 ears have shown anatomical success (95%). A highly significant improvement in hearing was obtained (the mean difference between the pre- and postoperative results of the PTA was of 14.6 ± 3.45 dB ( p  < 0.001). Conclusion  We advocate the use of periosteal graft in the pediatric population as a good alternative for other types of grafts, with comparable and even better functional and anatomical outcomes.

Introduction  The advent of the video head impulse test (vHIT) enables the study of each one of the six semicircular canals. In the present study, certain patients present disorders related only to the vertical semicircular canals, and they were carefully evaluated. Objective  To investigate vestibular disorders limited to the vertical semicircular canals. Methods  In total, 9,891 patients were submitted to the vHIT in our clinic; 26 (2.63%) of them, 11 men and 15 women, showed reduced vestibulo-ocular reflex (VOR) limited to the vertical canals. All of these patients had vestibular symptoms. Results  These patients presented different disorders of the vestibular system, and ten of them presented vestibular neuritis. Conclusion  Now, vestibular disorders limited the vertical canals can be evaluated through the vHIT. These disorders, however, may relate do different labyrinthine diseases.