International Archives of Otorhinolaryngology最新文献

Introduction  Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a chronic inflammatory condition of the paranasal sinuses that is mainly associated with type-2 inflammation. Immunoglobulin E (IgE) and eosinophils in blood and nasal tissue have been suggested as biomarkers for the prognosis and severity of CRSwNP as well as indications for biological treatment. Objective  The present study aims to assess the relationships between blood IgE concentration, blood eosinophil count, and nasal polyp eosinophil count in CRSwNP patients. Methods  The present study is retrospective. Nasal polyps from CRSwNP patients (n = 73) were fixed and embedded in paraffin for hematoxylin and eosin stain. Blood was collected to measure IgE concentration and eosinophil count. Results  Weak correlations were found between blood and tissue eosinophil counts ( p  = 0.004, r = 0.367) as well as blood IgE concentration and blood eosinophil count ( p  = 0.007, r = 0.372). There was no statistically significant correlation between blood IgE concentration and tissue eosinophil count. When dividing patients based on nasal polyp eosinophil count, blood eosinophil level was higher in the severely eosinophilic group than in the mildly eosinophilic group ( p  = 0.002). Conclusion  Blood IgE and eosinophils are not reliable biomarkers to predict the inflammatory condition in CRSwNP. Further research is needed on the clinical roles of these biomarkers.

Introduction  We previously investigated the impact of video clinics on the management of closed nasal bone injuries during the coronavirus disease 2019 (COVID-19) pandemic. The aim of that study was to assess the feasibility of managing patients at their homes or workplaces, with instructions to attend outpatient clinics the next working day if they suspected any deviation or reduced nasal airflow, for further evaluation. Objective  To compare the results of our previous research with the traditional, in-person nasal injury clinics, using the same criteria as in our prior investigation. Methods  We analyzed 3 months of preexisting data from video clinics and collected 6 months of data from face-to-face clinics. We gathered information on the number of patients, categorized by age and gender, as well as records of missed appointments (DNAs) and the requirement for nasal manipulations. Data analysis was conducted using the Chi-Squared test in SciPy Python 3.0 (open source). Results  The statistical analysis revealed no significant differences between the 2 groups concerning the number of patients with closed nasal bone injuries, both under and over 18 years of age ( p -value: 0.961), the rate of missed appointments ( p -value: 0.0734), and the need for fracture reduction ( p -value: 0.0734). Conclusions  The findings suggest that video clinics are equally effective in managing suspected nasal bone injuries and should not be restricted to emergency situations. However, it is advisable to adopt a balanced approach considering the additional costs associated with appointments.

Introduction  The preoperative assessment of the computed tomography (CT) characteristics of the maxillary sinus helps to preserve its anatomical and functional integrity during and after surgery. Objective  To use CT scanning to identify maxillary sinus variations and types that were not previously published. Methods  The present study was carried out on 110 paranasal CT scans (220 sides). Axial images were obtained with multiplanar scans, to visualize details in coronal and sagittal planes for all subjects. Results  Among the 110 CTs (220 sides) of the maxillary sinus's floor, there were 53.2% type 1, 29.1% type 2, 10% type 3, and 7.7% type 4, with significant difference between genders. The most common maxillary sinus floor was type 1. The lateral maxillary sinus wall was found to be type 1 in 32.7%, type 2 in 65%, and type 3 in 2.3%, with a significant difference between genders. The most common lateral wall of the maxillary sinus type was type 2. The orbital floor was found to be type 1 in 0.9%, type 2 in 21.3%, type 3 in 50.5%, and type 4 in 27.3%, without significant difference between genders. Asymmetry was detected between the right and left sides for the maxillary sinus floor of in 22.7%, lateral maxillary wall in 16%, and orbital floor (maxillary roof) in 30%. Conclusion  This study aims to increase surgeons' awareness of maxillary sinus variations, creating new classifications for usage and communication in the otorhinolaryngology and endoscopic fields. It could also be helpful for training medical residents.

Introduction  Somatosensory tinnitus is a type of tinnitus that can be modified by somatosensory stimuli from the cervical spine and temporomandibular area. Temporomandibular disorders and oral behaviors are associated with a higher prevalence of somatosensory tinnitus, and this association is described in the literature as part of the diagnosis of this condition. Objective  To verify the association between somatosensory tinnitus and oral behaviors. Methods  Patients were recruited from an Orofacial Pain outpatient clinic and from Head and Neck Unit. All participants underwent anamnesis, physical examination and completed the Oral Behaviors Checklist questionnaire. Forty-six patients were divided into 2 groups, each consisting of 23 patients: somatosensory tinnitus group (STG) and a comparison group (CG), with subjective tinnitus. Data were gathered and analyzed using the Jamovi software (open source) and a significance level of 5% was adopted. Somatosensory tinnitus was associated with dizziness and neck and temporomandibular joint pain. Results  There was an association between a higher Oral Behaviors Checklist score and the presence of somatosensory tinnitus. For each point marked on Oral Behaviors Checklist, there was an 8.2% greater chance of having somatosensory tinnitus. Tinnitus modulation through somatic maneuvers and palpation of masticatory and cervical muscles was significantly associated with somatosensory tinnitus. Conclusion  Dizziness and neck and temporomandibular joint pain are associated with the presence of somatosensory tinnitus. Probable sleep and awake bruxism are not exclusive behaviors of somatosensory tinnitus patients. However, their frequency may impact its presence.

Introduction  The Otorhinolaryngology Foundation (FO), created in 1995, has played an important role in the advancement of otorhinolaryngology in Brazil, through initiatives in education, research, and service provision. Objective  To present the trajectory of FO's 30 years in public health and professional training, highlighting its contributions, historical milestones, and future challenges. Brief History  Created by the Center for Studies and Advanced Development in Otorhinolaryngology (CEDAO), the FO expanded its activities beyond academic support, becoming a national reference. Among its achievements, the commitment to the continuous improvement of teaching, research, publications, and provision of services to the community stands out. These initiatives include the promotion of courses and conferences that train thousands of professionals, the dissemination of knowledge through scientific publications, the development of innovative technologies, and the carrying out of campaigns and assistance actions aimed at the population. Final Considerations  The celebration of FO's 30th anniversary reaffirms its mission of excellence and innovation in the dissemination of knowledge in otorhinolaryngology in Brazil. The continuous commitment to improving its four fundamental pillars ensures quality in education, research, and service to society.

Introduction  Although there are several reports of endoscopic findings of the larynx and esophagus in laryngopharyngeal reflux (LPR) patients, little is known about the correlation between change in symptoms and laryngeal and esophageal mucosal findings after proton pump inhibitor (PPI) treatment. Objective  The present study aimed to evaluate the changes in symptoms and mucosal findings of the larynx and esophagus using transnasal esophagoscopy (TNE) after PPI medication and to analyze their relationship in LPR patients. Methods  The current prospective study included 36 patients who complained of LPR symptoms. Reflux Symptom Index (RSI), Reflux Finding Score (RFS), and modified Los Angeles classification using TNE were obtained pretreatment and 8 weeks after treatment with PPIs. Results  Data from 22 patients who completed all examinations were analyzed. The mean age was 52.8 years, and 4 patients were men. The most common symptom was a globus sensation (54.6%). Both RSI ( p <  0.001) and RFS ( p  < 0.001) were significantly improved after 8 weeks with PPI treatment. However, there was no correlation between improvement of RSI and RFS ( p  = 0.350). Thirteen patients showed improvement in esophageal findings. However, there was no significant association between improvement of esophageal findings and RSI ( p  = 0.350) or RFS ( p  = 0.376). Conclusion  Although PPI treatment improved LPR symptoms and endoscopic findings, the change in symptoms was not related to endoscopic mucosal findings in the larynx and esophagus.

Introduction  Vestibular migraine (VM) is one of the most common vestibular disorders and its diagnosis is based entirely on clinical features. A recent case series suggested a possible link between migraines and convergence insufficiency. Objective  To compare the near point of convergence (NPC) in patients with and without VM. Methods  We retrospectively reviewed the data of 50 patients with and 50 without VM, comparing the NPC between both groups. The NPC was measured according to the recommendations of the American Academy of Ophthalmology. Differences in the results between groups were compared using the Mann-Whitney test. The association of the NPC with age, gender, and the use of corrective glasses or contact lenses was evaluated by the Student t or Mann-Whitney tests for parametric and nonparametric data, respectively. To determine the diagnostic accuracy and optimal cut-off point, receiver operating characteristic (ROC) curves were created. Results  The mean NPC was significantly higher in patients with VM (18.50 ± 5.88 cm) compared to the control group (8.06 ± 1.46 cm; p  < 0.001). The area under the curve (AUC) was 0.986 (95% CI: 0.938-0.999; p  < 0.0001), suggesting that NPC was able to accurately discriminate between patients with and without VM with a sensitivity of 94% and specificity of 100%. Conclusion  Our results suggest that convergence insufficiency is a common sign in patients with VM and may be considered a potential clinical biomarker. However, further studies are needed to confirm this hypothesis.

Introduction  Given the severity with which obstructive sleep apnea (OSA) syndrome can affect the patient's health, many therapies have been presented to minimize the occurrence of episodes of airway obstruction during sleep. Regarding non-invasive and effective methods, orofacial myofunctional therapy (OMT) is an important adjuvant in the clinical treatment. Objective  To verify the effectiveness of OMT in the treatment of adult patients affected by OSA. Data Synthesis  A search strategy was developed with terms adapted to the requirements of the main databases in the health field (PubMed, Cochrane, Embase and secondary databases) to designate the adult OSA population and the OMT intervention. The analysis of the records found was performed by two independent examiners and, at the end, we included five randomized clinical trials that presented the outcome of effectiveness of the OMT verified through the apnea-hypopnea index (AHI). Conclusion  The effectiveness of the OMT in the treatment of adult OSA patients was verified, both alone and in association with other interventions, through the reduction in the AHI and the Epworth Sleepiness Scale.

Introduction  Various factors have been reported to affect the rates of success after tympanoplasty, among them, myringosclerosis. However, there are few studies focusing only on the effect of myringosclerotic plaque removal on tympanoplasty outcomes. Objective  To compare the outcome of tympanoplasty in perforated eardrums with and without myringosclerosis. Methods  The study included patients aged between 21 and 53 years diagnosed at the outpatient department with inactive mucosal chronic otitis media. The sample was divided into the case group, which included subjects with tympanic membrane perforation and myringosclerosis, and the control group, which included subjects with tympanic membrane perforation only, without myringosclerosis. We assessed the audiological findings of the patients before and after surgery, as well as hearing gain, graft uptake, and residual perforation/reperforation. Results  No significant relationships were observed involving the age or sex of the patient and the closure rate or hearing gain, neither between the location of the perforation and graft uptake. Graft uptake was higher in patients with perforation size < 50%. The graft uptake and hearing gain were higher in the case group. Conclusion  The removal of sclerotic plaques increases the surface of the raw area created by subepithelial excision of the myringosclerotic plaques, leading to a high rate of surgical success for the closure of tympanic membrane defects with coexisting myringosclerosis.

Introduction  Perioperative management of antithrombotic agents may affect bleeding and lead to thromboembolic complications, but there is no consensus on optimal protocol in head and neck surgery. Objective  To explore the effect of antithrombotic agents on postoperative bleeding. Methods  We compared clinical characteristics, type of surgery, antithrombotic agents, continued use of medication or not, and frequency of postoperative bleeding among patients who were receiving antithrombotic therapy at the time of their decision to undergo surgery for head and neck malignancies, from 2008 to 2022. Results  A total of 168 patients were included. There was no significant difference in the incidence of intraoperative blood loss or postoperative bleeding between the group that underwent surgery while on antithrombotic therapy and those that underwent surgery after antithrombotic therapy was discontinued. In particular, there was no increase in bleeding complications with antiplatelet agents, regardless of the type or number of agents used. Conclusion  Surgery for head and neck malignancies with continued antiplatelet therapy may not increase bleeding complications, regardless of the type of antiplatelet therapy and even when multiple agents are taken.