Brazilian Journal of Otorhinolaryngology最新文献

Objectives: The aim of this study was to evaluate the anatomical dimensions and boundaries involved in Draf IIA (DIIA) and Draf IIB (DIIB) frontal sinusotomies, and to determine how complete frontal beak removal affects the frontal sinus drainage pathway. Specifically, we compared the proportional increase in drainage area between DIIA and DIIB performed with and without complete frontal beak removal.

Methods: This retrospective radiological anatomical study analyzed 296 hemifaces (from 148 patients) who underwent paranasal sinus Computed Tomography (CT). Individuals over 18-years of age without evidence of paranasal sinus disease were included. We measured the anatomical distances defining the frontal recess and estimated the differences in frontal recess area for three approaches: Draf type IIA (DIIA), Draf type IIB without complete removal of the frontal beak (DIIBwoFB), and Draf type IIB with complete removal of the frontal beak (DIIB).

Results: The measured areas of the frontal ostium were as follows: 59.00 ± 24.34 mm² (range: 0.55-160.00) for DIIA, 79.66 ± 30.29 mm² (range: 0.85-200.00) for DIIBwoFB, and 147.00 ± 35.25 mm² (range: 71.47-282.74) for DIIB. The proportional increase in drainage area was significantly higher when comparing DIIA to DIIB than to DIIBwoFB (3.64 ± 14.37 [range: 2.52-248.40] vs. 1.37 ± 0.18 [range: 1.00-2.64], respectively).

Conclusion: Among the evaluated surgical approaches, the greatest proportional increase in anatomical drainage area was achieved with Draf IIB combined with complete frontal beak removal. These findings underscore the importance of frontal beak resection when considering the Draf IIB approach.

Level of evidence: IV.

Objectives: Hearing loss significantly impacts auditory function and quality of life in children. Assessing Health-Related Quality of Life (HRQoL) using utility measures provides valuable insight into the effectiveness of interventions such as Cochlear Implants (CI) and Hearing Aids (HA). To compare HRQoL using multiple utility measures (HUI-3, EQ-5D-5 L, VAS) and functional auditory performance (PEACH, TEACH) in children with cochlear implants, hearing aids, and unaided severe to profound hearing loss.

Methods: Ninety children aged 7-10 years were divided into three groups (n = 30 each): CI users, HA users, and children with unaided severe to profound hearing loss. Utility measures and auditory performance scales were administered. Statistical analysis involved ANOVA and Pearson's correlation.

Results: CI users exhibited the highest utility scores (HUI-3 = 0.68964; EQ-5D = 0.88446) and auditory performance scores (PEACH = 37; TEACH = 25.83). Strong correlations were found between utility scores and auditory performance. HUI-3 showed greater sensitivity in detecting hearing-specific QOL improvements.

Conclusion: Cochlear implantation results in superior HRQoL and auditory performance compared to hearing aids. Use of sensitive, hearing-specific tools like HUI-3 is recommended. LEVEL 3: Non-randomized controlled cohort/follow-up study.

Objective: Epithelial barrier dysfunction is central to the pathogenesis of Allergic Rhinitis (AR), yet its molecular mechanisms remain unclear. S100A8 is implicated in epithelial barrier disruption, but its role in AR is not fully understood. This study aimed to investigate S100A8 expression in AR and its association with barrier dysfunction.

Methods: Nasal mucosal tissues were collected from 30 AR patients and 30 Healthy Controls (HCs). Expression levels of S100A8 and tight junction proteins (ZO-1, E-cadherin, occludin) were assessed by Immunofluorescence (IF), Western Blot (WB), and RT-qPCR. Correlation analysis was performed to evaluate the relationship between S100A8 and tight junction markers. Human Nasal Epithelial Cells (HNECs) from HCs were stimulated with House Dust Mite (HDM) extracts, and S100A8 expression was silenced using siRNA to assess its role in HDM-induced barrier disruption.

Results: WB and RT-qPCR results showed that the expression of S100A8 was significantly enhanced in nasal mucosal samples of AR patients compared to the HC group. S100A8 mRNA level was significantly elevated, and its level was positively correlated with the Visual Analog Scores (VAS) and total nasal symptom scores (TNSS) of the patients. Moreover, IF further confirmed that S100A8 was enhanced in the AR group, and mainly localised in the nasal epithelium. The expression of ZO-1, E-cadherin, and occludin was markedly reduced in AR patients and showed a negative correlation with S100A8 levels. In vitro, HDM stimulation of HNECs led to a dose- and time-dependent increase in S100A8 expression, along with reduced levels of tight junction proteins. Silencing S100A8 via siRNA significantly restored tight junction protein expression, indicating that S100A8 inhibition may help preserve nasal epithelial barrier integrity.

Conclusion: S100A8 is upregulated in AR and associated with disease severity and epithelial barrier dysfunction. Targeting S100A8 may offer a therapeutic strategy to preserve nasal barrier integrity in AR.

Level of evidence: Level 3.

Objective: To describe and analyze the microscopic morphometry of the mastoid segment of the human facial nerve in the region of the stylomastoid foramen, in different age groups of elderly individuals.

Methods: Eighteen blocks of temporal bones from cadavers aged between 63 and 94 years old were used and divided into 3 age groups: 60-70, 71-80 and over 80-years-old. The nerve was collected, fixed in a glutaraldehyde and paraformaldehyde solution and then subjected to dehydration and resin embedding processes. Semi-thin cross-sectional sections (1 μm) were obtained using an ultramicrotome and stained with toluidine blue. Histological images were captured and analyzed using Zen 2.6 software. The variables were described by mean and standard deviation and compared between age groups (SPSS; p < 0.05).

Results: The Cross-Sectional Area (CSA) of the nerve, diameter of the myelinated fiber, CSA of the myelinated fiber, thickness of the myelin sheath and percentage of total area occupied by myelinated fibers were lower in the groups with older ages, with significant differences among all age groups (p < 0.001). The total number of myelinated fibers and density remained constant and did not present significant differences between age groups. CSA and axon diameter decreased at older ages, with significant differences only between the second and third groups (p < 0.001). The degree of myelination (g ratio) and the percentage of area occupied by the endoneurium, unmyelinated fibers and degenerating tissue were higher in the older age groups (p < 0.001). In the older age groups, there was an increase in the percentage of myelinated fibers with lower CSA and a reduction in the percentage of myelinated fibers with higher CSA.

Conclusion: The results indicate that the facial nerve presents morphometric variations suggestive of neurodegeneration, associated with aging.

Level of evidence: Level V.

Objectives: Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is a common and severe subtype of Chronic Rhinosinusitis (CRS), characterized by persistent inflammation and tissue remodeling in the nasal cavity. Hypoxia, resulting from chronic inflammation, is believed to play a pivotal role in CRSwNP pathogenesis. This study aims to identify Hypoxia-Related Genes (HRGs) involved in CRSwNP and explore their potential as diagnostic biomarkers and therapeutic targets.

Methods: We retrieved transcriptomic datasets (GSE136825 and GSE179265) from the Gene Expression Omnibus (GEO) database. Differential expression analysis was conducted to identify Hypoxia-Related Differentially Expressed Genes (HRG-DEGs) in CRSwNP. Machine learning techniques, including Least Absolute Shrinkage and Selection Operator (LASSO) regression and random forest, were employed to identify key HRGs. Validation of these genes was performed using qRT-PCR on clinical CRSwNP and control tissue samples. Additionally, consensus clustering analysis was applied to categorize CRSwNP patients into different molecular subtypes based on HRG expression, followed by gene ontology (GO) enrichment and immune infiltration analysis.

Results: A total of 19 hypoxia-related Differentially Expressed Genes (DEGs) were identified. Through LASSO regression and Random Forest analysis, followed by validation using an external dataset and qRT-PCR of clinical samples, four hypoxia-related hub genes ‒ CXCR4, HMOX1, DTNA, and FBP1 ‒ were identified. Receiver Operating Characteristic (ROC) curve analysis demonstrated that all four genes had Area Under the Curve (AUC) values exceeding 0.8. Additionally, consensus clustering revealed two distinct clusters with different hypoxia characteristics.

Conclusion: This study identifies four key hypoxia-related genes (CXCR4, HMOX1, DTNA, and FBP1) that may serve as novel diagnostic biomarkers for CRSwNP. The molecular subtypes identified through clustering provide further insights into CRSwNP heterogeneity, suggesting the need for personalized treatment approaches targeting hypoxia-related pathways.