International Archives of Otorhinolaryngology最新文献

Introduction  Autism spectrum disorder is a pervasive developmental disorder characterized by deficits in communication and social interactions, as well as repetitive behavioral patterns. Understanding the relationship between auditory brainstem response and hearing is crucial, considering the importance of sensory function. Auditory brainstem response testing is a tool that evaluates the auditory system from periphery to brainstem in response to an acoustic stimulus, providing important information about the auditory pathways. Objective  To compare auditory brainstem response findings in children with autism spectrum disorder versus those of a control group. Methods  Cross-sectional, comparative study of 23 children (age 7-10 years) diagnosed with autism spectrum disorder and an age- and sex-matched control group of normal-hearing children with typical development. All participants underwent otoscopy, impedance audiometry, pure-tone audiometry, speech audiometry, and brainstem evoked response audiometry. Results  Statistically significant between-group differences were seen on comparison of the absolute latencies of waves III ( p  = 0.047) and V ( p  = 0.034), as well as interpeak intervals III to V ( p  = 0.048) and I to V ( p  = 0.036), with increased values in the study group. The sample was composed of 8.7% females and 91.3% males. Conclusion  In this sample, children with autism spectrum disorder showed increased auditory brainstem response latencies compared to the control group, suggesting auditory pathway impairment.

Introduction  Many protocols carried out in animal studies use equipment developed for humans. Therefore, the equipment available on the market must be known in detail, as well as how the criteria to be evaluated are presented. Objective  To analyze the existence of an association between the amplitude and signal-to-noise ratios of distortion-product otoacoustic emissions using two methodologies (diagnostic and portable/screening equipment) in animal models. Methods  Experimental study approved by the Animal Use Ethics Committee, with a sample of 28 female Wistar rats, which were subjected to anesthesia, manual otoscopy, and distortion-product otoacoustic emission (DPOAE) examination at 4 to 8 kHz with the 2 pieces of equipment. Results  The mean amplitude values with the ILO (Otodynamics Ltd., Hatfield, United Kingdom) and OtoRead equipment (Interacoustics A/S, Middelfart, Denmark) were respectively 20.5 dB and 7.1 dB at 4 kHz; 31.8 dB and 19.37 dB at 6 kHz; and 31.4 dB and 25.1 dB at 8 kHz. The mean signal-to-noise ratios with the ILO and OtoRead equipment were respectively 20.9 dB and 25.1 dB at 4 kHz; 35.8 dB and 37.0 dB at 6 kHz; and 39.7 dB and 40.6 dB at 8 kHz. There was no statistically significant difference in signal-to-noise ratios at 6 and 8 kHz. When the data were classified as normal/abnormal, 100% agreement was found between the methodologies. Conclusion  An association was found in the analysis of the mean signal-to-noise ratio at 6 and 8 kHz between the 2 methodologies (diagnosis and portable/screening equipment).

Introduction  The management of recurrent thyroglossal duct cysts poses persistent challenges. The present review assesses chemical ablations and surgical re-interventions as strategies for recurrence. However, limited comparative studies exist to determine the optimal approach and follow-up outcome. Objectives  The aim of the current study is to conduct a review gathering evidence from the literature to analyze and synthesize the safest and most effective approaches for treating recurrent thyroglossal duct cysts. Methods  The present study aims to comprehensively search electronic databases, including the Latin American and Caribbean Literature in Health Sciences (Literatura Latino-Americana e do Caribe em Ciências da Saúde, LILACS, in Portuguese), the database of the Journal of the American Medical Association (JAMA), SciVerse Scopus, Virtual Health Library (Biblioteca Virtual em Saúde, BVS, in Portuguese), and PubMed, for articles on recurrent thyroglossal duct cysts. The selected articles include patients with recurrent cysts, cover publications from 2000 to 2022, describe clinical and/or surgical interventions, and ensure the safety and efficacy of the analyzed approach. Results  The present review included 9 studies, involving a cohort of 278 patients. Out of these patients, 143 underwent surgical interventions and 135 underwent chemical ablations (82 using ethanol and 53 with OK-432). Conclusion  Conservative management of recurrent thyroglossal duct cysts is a growing trend, albeit requiring further refinements. This approach presents potential advantages, including decreased recurrence rates, shorter surgical duration, cost-effectiveness, and expedited recovery. Nevertheless, surgical intervention remains the preferred therapeutic choice owing to its established efficacy and widespread familiarity. The projected therapeutic approach shifts for thyroglossal duct cysts as conservative treatment gains substantiated benefits. Systematic Review Registration : The International Prospective Register of Systematic Reviews (PROSPERO) does not accept scoping reviews, literature reviews, or mapping reviews.

Introduction  Morbidity and mortality related to tracheostomy can be reduced if complications are recognized immediately and managed effectively. Healthcare providers involved in the management of pediatric patients must be aware of tracheostomy-related emergencies, especially in life threatening situations. However, there is limited literature on this theme. Objectives  To assess the knowledge of healthcare providers in managing tracheostomy-related complications in pediatric patients. Methods  A descriptive, multicenter study was conducted among healthcare providers involved in the management of pediatric patients undergoing tracheostomy. Data were collected using electronic questionnaires, and participants' knowledge was evaluated using various clinical scenarios. Results  A total of 520 healthcare providers from different subspecialties with varying levels of experience were included. Over 50% of participants had never dealt with tracheostomy-related complications in pediatric populations, and 30.5% were unfamiliar with the function of the introducer/obturator. Furthermore, only 17.9% understood the purpose of stay sutures. Notably, when presented with different clinical scenarios, a significant knowledge gap was observed among the participants. Conclusion  There were significant gaps in knowledge among healthcare professionals regarding the management of tracheostomy-related emergencies in the pediatric population. Education on this topic is essential among healthcare professionals. This needs to be addressed to maximize patient safety. Further studies are recommended.

Introduction  Pediatric dizziness is not a rare symptom, and it has a significant impact on the child's psychophysical wellbeing and quality of life. There are diverse etiologies of dizziness in children; however, it is challenging to diagnose. Vestibular and neurological assessments are crucial in the diagnosis of pediatric dizziness. Objective  To outline the most common etiologies of dizziness in children and to investigate the complementary role of the vestibular and neurological evaluations in the assessment of dizzy children. Methods  We conducted a case-control study including 40 children with a complaint of dizziness and 40 healthy children as the control group. We assessed their full medical history audiovestibular function through pure tone audiometry, videonystagmography examination, cervical vestibular evoked myogenic potentials, the results of video head impulse tests, as well as their electroencephalograms and brain magnetic resonance imaging scans. Results  The mean age of the 40 children who were presented with dizziness was of 13.65 years. Migraine was found to be the commonest cause of vertigo (27.5%), while benign paroxysmal vertigo of childhood was detected in 17.5%, and central nervous system causes, in 12.5%. The diagnosis could not be ascertained in 9 (22.5%) patients. Conclusion  The diagnosis of the etiologies of pediatric dizziness is challenging; however, detailed medical history, a comprehensive examination, a multidisciplinary approach, along with full vestibular and neurological assessments, are essential to reach an accurate diagnosis.

Introduction  Preauricular defect is one of the main concerns after superficial parotidectomy. Plastic surgeons have described many filling techniques to overcome the problem. Objective  To discuss three reconstruction techniques after superficial parotidectomy: partial-thickness, superiorly based sternocleidomastoid muscle flap; en-bloc fat graft; and platelet-rich fibrin gel, with a comparison of aesthetic and functional outcomes. Methods  The present study included 29 adult patients submitted to reconstruction after superficial parotidectomy by partial-thickness, superiorly based sternocleidomastoid muscle flap, en-bloc fat graft, and platelet-rich fibrin gel. A subjective evaluation of the facial nerve functions was conducted through a visual analog scale (VAS) with scores from 0 to 5, which was completed by the patient, a close relative, and 3 blinded staff members. Results  Regarding the VAS, in the comparison of the 3 groups at the sixth and twelfth postoperative months, the fat-graft group reported the highest mean values for satisfaction (3.4 ± 1.1 and 3.83 ± 0.97 respectively). The fat-graft group also showed highly significant differences when compared with the groups submitted to the sternocleidomastoid muscle flap ( p  = 0.0001) and the platelet-rich fibrin gel techniques ( p  = 0.016). Conclusion  Parotidectomy with immediate reconstruction of the surgical defect through an en-block fat graft provides better esthetic outcomes than sternocleidomastoid muscle flap and platelet-rich fibrin gel after one year. The patients submitted to the sternocleidomastoid muscle flap and fat-graft techniques reported minimal surgical site morbidity and a lower chance of developing Frey syndrome. The fat graft resulted in the best degree of cosmetic satisfaction, with minimal morbidity. Fat overcorrection is recommended.

Introduction  Thick-skinned patients are prevalent in the general population worldwide and represent a challenge for the rhinoplasty surgeon. The use of oral isotretinoin before and/or after surgery is a possible adjuvant treatment that can facilitate intraoperative management and improve results in the postoperative stages; however, there are still questions about its effects in the long-term. Objective  To evaluate the advantages and best practices for orally administrated isotretinoin in thick-skin rhinoplasty based on the current literature. Methods  An advanced search was conducted until August 31st, 2023, on the PubMed, Cochrane Library, ClinicalTrials.gov, Embase, and LILACS databases with the keywords rhinoplasty and isotretinoin . Sixteen articles were reviewed and 4 met the inclusion criteria, with a total of 371 patients. Meta-analysis of the data collected was not possible due to heterogeneity among papers. Conclusion  Isotretinoin can be a safe drug, and its use in rhinoplasty varies widely, although all studies reported a low-dose oral regime for up to 6 months. The medication use is well-established in thick-skin rhinoplasty. Small doses after the procedure can improve patient satisfaction and the quality and thickness of the skin in the first 6 months of postsurgery. After 6 months, studies with a control group did not show a significant difference in patient satisfaction rates. A strong framework and specific surgical maneuvers may be more important than isotretinoin for better outcomes in thick-skin rhinoplasty.

Introduction  An association between the sensation of vertigo, and body composition has not been investigated in post-coronavirus disease 2019 (COVID-19) patients. Objective  To evaluate the probable association between the sensation of vertigo and body composition-as amount of fat, bone, and muscle-in post-COVID-19 patients. Methods  Cross-sectional study with a sample of post-COVID-19 patients who responded to the visual analog scale (VAS) and the Dizziness Handicap Inventory (DHI). Clinical assessment and electrical bioimpedance were used to determine body composition. Results  There were 105 participants evaluated, 61% (n = 64) of whom were male, aged 49.5 ± 11.7 years, with an average height of 165.6 ± 19.9 cm, body weight of 87.6 ± 20 kg, and body mass index (BMI) of 31.1 ± 5.4 kg/m. The prevalence of self-reported vertigo was 51.4% (n = 54); of these, 11.4% (n = 12) related vertigo before the diagnosis of COVID-19, and 40% (n = 42) related vertigo during or after COVID-19. Furthermore, 37.2% (n = 39) of the sample reported that vertigo persisted after medical discharge. In the comparative analysis, the data showed a significant difference between the groups with and without vertigo for height ( p  = 0.001), body mass ( p  = 0.006), body water ( p  = 0.001), lean mass ( p  = 0.002), fat-free mass ( p  = 0.001), and musculoskeletal mass ( p  = 0.001). Conclusion  There was a significant association between body composition and the complaint of vertigo in post-COVID-19 patients, suggesting that these aspects should be considered when assessing and can contribute to the construction of knowledge about long COVID.

Introduction  Hemithyroidectomy is performed for the treatment of symptomatic unilateral benign nodules, cytologically indeterminate nodules, and some cases of well-differentiated thyroid cancer. Objective  To evaluate the frequency of postlobectomy thyroid hormone replacement (THR), and to analyze the clinical-pathological factors predicting L-thyroxine (T4) use in patients undergoing hemithyroidectomy. Methods  We conducted an observational, retrospective study in which clinical, biochemical, and anatomopathological parameters were analyzed and correlated with the need for THR after thyroid lobectomy. Results  The frequency of postoperative THR was 63%. The preoperative thyroid-stimulating hormone (TSH) level was an important predictor of postoperative THR. When stratifying preoperative TSH levels, the frequencies of T4 replacement in each TSH quartile varied, being more frequent with increasing presurgical TSH levels ( p  = 0.029). The preoperative cutoff that maximized sensitivity and specificity for the development of hypothyroidism was 1.21 μIU/mL. Conclusion  Our results demonstrated a significant frequency of postlobectomy THR. Higher preoperative TSH is a strong risk factor for postsurgical hypothyroidism, and even lower preoperative levels within the normal references do not exclude the risk of thyroid hormone use after thyroid lobectomy.

Introduction  An ideal and long-lasting adhesive and sealant is essential during endoscopic endonasal skull-base surgery to hold the reconstruction intact and prevent cerebrospinal fluid (CSF) permeation until complete healing occurs. Fibrin glue is the most common material used. Regenerated oxidized cellulose (ROC) has not been mentioned in the literature as sealant and adhesive, and, hence, we intended to study this role. Objective  To evaluate the role of ROC as tissue sealant and adhesive in the reconstruction of skull-base defects in endoscopic endonasal skull-base surgery. Methods  We retrospectively analyzed the medical records of patients who underwent endoscopic endonasal skull-base surgery with skull-base defect and intraoperative CSF leak, for which reconstruction was performed using fibrin glue or ROC, or both, as a sealant and adhesive. The type of sealant and adhesive used and postoperative CSF leak rates with different agents used were analyzed. Results  A total of 64 patients were investigated. Fibrin glue alone was used initially in 6 patients, of which 4 (66.6%) experienced postoperative CSF leak. Both fibrin glue and ROC were used in 26 patients, among which 2 (7.6%) exhibited postoperative CSF leak. Regenerated oxidized cellulose alone was used in 24 patients, wherein 2 (8.3%) presented with postoperative CSF leak. Fibrin glue alone was once again used later in the learning curve in 8 patients, of which 2 (25%) experienced postoperative CSF leak ( p  = 0.002). Conclusion  Fibrin glue provides intraoperative watertight seal. Regenerated oxidized cellulose has better intraoperative and long-term sealant and adhesive action in endoscopic endonasal skull-base reconstruction.