Brazilian Journal of Otorhinolaryngology最新文献

Objective: We aimed to investigate the correlation between prevalent risk factors for high-risk neonates in neonatal intensive care unit and their hearing loss, and to examine the audiological features and genetic profiles associated with different deafness mutations in our tertiary referral center. This research seeks to deepen our understanding of the etiology behind congenital hearing loss.

Methods: We conducted initial hearing screenings, including automated auditory brainstem response, distortion product otoacoustic emission, and acoustic immittance on 443 high-risk neonates within 7 days after birth and 42 days (if necessary) after birth. Neonates who failed initial screenings underwent further diagnostic tests at 3 months. The risk factors were analyzed retrospectively by Chi-Square test and stepwise logistic regression. Genetic analysis involved a deafness sequencing panel targeting 19 pathogenic variants across four genes (GJB2, GJB3, SLC26A4, and MT-RNR), applied to both the study cohort and a larger hearing screening cohort of 14863 neonates from our center and different medical centers in the same region.

Results: Out of the 443 high-risk neonates, 222 failed their diagnostic hearing tests. Logistic regression identified preterm birth, neonatal hyperbilirubinemia and advanced maternal age (≧35 yr) as significant risk factors for hearing loss. Genetic screening of 33 neonates who failed the diagnostic tests revealed that 7 (21.21%) carried at least one pathogenic variant, with identified 1 homozygotes and 3 heterozygotes in the GJB2, 1 homozygotes and 1 heterozygotes in the SLC26A4 gene, and 1 homoplasmic variant in the MT-RNR (12SrRNA). In the larger hearing screening cohort, 497 (3.34%) were genetically positive for deafness mutations, among whom 29 had the diagnostic hearing tests and 7 eventually diagnosed with hearing loss. Of the rest 468 neonates who didn't have the diagnostic tests, 445 (95.09%) passed the hearing screening tests.

Conclusion: Preterm birth, neonatal hyperbilirubinemia and advanced maternal age are critical risk factors for hearing impairment in high-risk neonates. Mutations such as c.235delC in GJB2 and c.919-2A>G in SLC26A4 are the most common. Long-term follow-up of neonates carrying heterozygous variants, particularly in genes like GJB3, is necessary to understand their progression and hearing outcomes. This study highlights the importance of deafness gene screening in neonates to ensure accurate diagnosis and effective intervention.

Level of evidence: Level 3.

Objectives: The aim of this study was to investigate the risk factors that may cause postoperative otomycosis in patients undergoing Chronic Nonsuppurative Otitis Media (CNSOM) surgery.

Methods: In this retrospective study, 409 out of 523 patients met the inclusion criteria. 44 patients diagnosed with otomycosis CNSOM were analyzed. Perioperative factors were analyzed to determine the potential risks of otomycosis. The primary factors identified as contributing to otomycosis were firmly adherent cerumen, tympano-meatal flap positioning, and Diabetes Mellitus (DM). The study analyzed the patients' follow-up six months after the surgical procedure. Otomycosis occurring within 30-days of surgery was classified as "early otomycosis", while those occurring later were classified as "late otomycosis".

Results: Graft success at 6-months showed no significant difference between otomycosis and non-otomycosis groups. We found that the presence of DM, tympano-meatal flap positioning, and firmly adhered cerumen removal were significantly associated with the development of otomycosis. The logistic regression model was significant and explained 9.2% of the variation. Overall, individuals with the presence of advancement flap, DM, and cerumen removal status were respectively 2.0, 2.8, and 2.1 times more likely to have otomycosis. DM was the only risk factor identified in all three patients who developed late otomycosis.

Conclusion: This study found that compromised epithelial integrity in the external auditory canal, non-epithelial areas, and reduced blood circulation were independent risk factors for postoperative otomycosis.

Level of evidence: 4:

Objective: Eosinophilic Otitis Media (EOM) is an intractable disease caused by type 2 inflammation, such as Eosinophilic Chronic Rhinosinusitis (ECRS) and bronchial asthma. Biologics have recently been used to treat ECRS and bronchial asthma. Biologics are not indicated for EOM; however, because approximately 10% of ECRS cases has concomitant EOM, concomitant EOM improvement has been observed when dupilumab is administered for ECRS. Therefore, we aimed to investigate the current status of EOM treatment and clarify the effect of dupilumab on EOM.

Method: This retrospective study included 25 patients attending our hospital. The disease status of patients with EOM not treated with dupilumab (control) and those treated with dupilumab at the time of evaluation were compared. The EOM disease status was compared using the EOM severity score, temporal bone shadow on Computed Tomography (CT), and standard pure tone audiometry.

Result: Twenty-four of the 25 patients with EOM had concomitant ECRS, and 12 were administered with dupilumab. The severity score of EOM, temporal bone CT score, and air conductance hearing were significantly improved after dupilumab administration in 12 patients with EOM. Comparison of EOM patients without dupilumab (control) and those treated with dupilumab at the time of evaluation revealed that the severity score of EOM, temporal bone CT score, and air conduction hearing were significantly better in patients treated with dupilumab.

Conclusion: Our study demonstrated that dupilumab was administered to approximately half of the patients with EOM, suggesting that the treatment of EOM has undergone significant changes due to dupilumab administered to ECRS. Our study also suggests that dupilumab is highly effective in patients with EOMs.

Level of evidence: 4:

Objective: This review aims to analyse the implications of the World Health Organization's 2021 world report on hearing, with a particular focus on the cochlear implant field. The objective is to understand the challenges and opportunities highlighted in the report and propose viable solutions for effective implementation within the cochlear implant community.

Methods: Following the release of the World Health Organization's world report on hearing, cochlear implant professionals explored and discussed the implications of the report with examples from various countries to understand the disparities in access, reimbursement policies, and social stigma associated with hearing loss.

Results: The world hearing report identifies hearing loss as a major global health issue, with an estimate of 1.5 billion people currently affected and a projected increase to 2.5 billion by 2050. Key challenges in the cochlear implantation field include disparities in access to services, particularly in low- and middle-income countries, lack of reimbursement policies in many regions, and the social stigma surrounding hearing loss.

Conclusion: A multi-faced approach is needed to address the rising prevalence of hearing loss and policy makers must prioritize ear and hearing care as a public health concern. Organizations like the HEARRING group can promote education, awareness, and training, and act as advocates for changes in healthcare systems to expand access to hearing care services.

Objective: Differentiated thyroid cancers tend to excellent long-term survival after surgery. However, Locally Advanced Papillary Thyroid Cancers (LAPTCs) have poor prognosis. This study was to investigate the clinicopathologic features of LAPTC and the risk factors that affect its postoperative recurrence. We aimed to construct a nomogram to predict Recurrence-Free Survival (RFS) in LAPTC.

Methods: We retrospectively reviewed the data of patients who underwent surgery from 2011 to 2020 at a single institution. Univariate and multivariate analyses were used to investigate the clinicopathologic features of LAPTC. The risk factors that affecting recurrence of LAPTC were screened. The risk factors were subsequently integrated to establish a predictive model. C-index, receiver operating characteristic curve and calibration curve were used to validate the accuracy. A Decision Analysis Curve (DCA) was used to evaluate the clinical value.

Results: A total of 2530 Early Papillary Thyroid Cancer (EPTC) and 764 LAPTC were enrolled. Compared to EPTC, the proportion of male, bilaterality, multifocality, tumor size > 1 cm, ETE, central lymph node metastasis, and lateral lymph node metastasis was higher in LAPTC (all p < 0.05). Univariate and multivariate analyses found that age ≥ 55-years-old, male, and ETE were independent risk factors for the LAPTC patients' RFS (all p < 0.05). C-index of the nomogram was 0.79. The AUC values of nomogram were 0.767 (95% CI 0.626‒0.909) and 0.798 (95% CI 0.669‒0.926) for 3- and 5-year RFS, respectively. The calibration curves of the nomogram showed good accuracy and consistency, and the DCA curves exhibited that the model had good clinical utility.

Conclusion: Male patients who with tumors tumor > 1 cm, bilaterality, multifocality, and ETE are more likely to become LAPTC. LAPTC patients with age ≥ 55-years-old, tumor size > 1 cm, and ETE are more likely to have postoperative recurrence. The model can help surgeons to predict 3- and 5-year RFS in LAPTC.

Evidence level: This article's evidence level is four. Level 4 evidence, the case series, comes in the form of a group of patients subjected to surgical procedure. Authors may detect a statistically significant and clinically relevant outcome.

Objectives: Lingual Thyroglossal Duct Cysts (LTDCs) are a rare variant of thyroglossal duct Cyst (LDC). This study aimed to explore the efficacy of transoral excision of LTDC and evaluate the added benefit of concomitant management of laryngomalacia during the surgical intervention.

Methods: Infants with LTDCs were retrospectively collected from our department from January 2009 to January 2022. The baseline characteristics, clinical symptoms, the features of transnasal flexible fiberoptic laryngoscopy, CT and MRI, surgical treatments, and follow-up results were described and analyzed.

Results: 50 babies with LTDCs were included. Five infants had urgent bedside cyst aspiration prior to surgery for respiratory distress. All patients underwent cyst resection. Concurrent LTDC and laryngomalacia were found in 10 patients on preoperative laryngoscopy. Due to breathing and swallowing issues, these infants underwent transoral cyst removal and supraglottoplasty in the same surgical setting. 3 large cyst cases, laryngomalacia were undetectable pre-cystectomy. When extubation failed after 1weeks, repeat laryngoscopy revealed severe laryngomalacia necessitating successful supraglottoplasty. All patients were discharged from the hospital once oral intake is safe and adequate.

Conclusion: Transoral surgery for LTDC is an effective and safe surgical treatment. Additionally, identifying and promptly addressing other laryngeal conditions, such as laryngomalacia, significantly enhances the success rate of the surgery.

Level of evidence: 4:

Objective: Pharyngocutaneous Fistula (PCF) is one of the most common and challenging postoperative complications after Total Laryngectomy (TLE). This study aimed to evaluate the impact of the modified Vertical Pressure Bandage (VPB) on the occurrence of Pharyngocutaneous Fistula (PCF) after Total Laryngectomy (TLE) for Head and Neck (H&N) cancer.

Methods: This retrospective study included patients with H&N cancer who underwent TLE at our hospital between January 2010 and January 2021. The patients were grouped according to whether modified VPB was used or not after surgery. The primary outcome was the occurrence of PCF. The secondary outcomes were the interval from operation to PCF, the healing time of PCF, and the length of hospital stay.

Results: This study included 133 patients: 82 (aged 57.93 ± 10.18 years, 80 males) in the VPB group and 51 (aged 54.98 ± 9.22 years, 51 males) in the conventional group. Patients who received the modified VPB had a significantly lower occurrence of PCF compared with those did not (9.8% vs. 33.3%, p = 0.001). In addition, the patients in the VPB group had similar interval from the operation to the PCF (p = 0.374) and healing time of PCF (p = 0.256) but a significantly shorter length of hospital stay (p < 0.001) compared with those in conventional group. Moreover, multivariable logistic regression analysis showed that, after adjusting for age, preoperative radiotherapy, postoperative hematocrit < 35%, VPB (RR = 0.165, 95% CI 0.057‒0.474, p = 0.001) was an independent protective factor for PCF.

Conclusion: The modified VPB might reduce the occurrence of PCF after TLE for H&N cancers.

Level of evidence: Level 4.

Objective: This study aimed to evaluate and compare the outcomes of patients undergoing video-assisted thyroidectomy versus those undergoing traditional open surgery.

Methods: In this retrospective study, we reviewed the clinical records of 449 patients who underwent thyroid surgery at our institution between April 2017 and March 2022. Of these, 209 underwent video-assisted thyroidectomy, while 248 underwent traditional open surgery. After excluding those who received total thyroidectomy, central node dissection, or lateral node dissection, we focused our analysis on 136 patients with video-assisted lobectomy and 92 patients with traditional open surgery. We compared patient outcomes, including surgical results and adverse events, between these groups.

Results: Significant differences were observed in the maximum tumor diameter between the video-assisted lobectomy and traditional open surgery groups. However, no significant differences were noted in surgical time, bleeding, or adverse events.

Conclusion: Video-Assisted Neck Surgery (VANS) offers great cosmetic benefits and is comparable to traditional open surgery in terms of adverse events.

Level of evidence: IV.

Objective: To assess the impact of the somatosensory influence on annoyance and quality of life of individuals with tinnitus.

Methods: This cross-sectional study included individuals with tinnitus of both sexes, aged ≥18 years, recruited from a specialized otolaryngology outpatient, and evaluated by a multidisciplinary team (otorhinolaryngologists, physical therapists, and audiologists). An evaluation adapted from the Diagnostic Criteria of Somatosensory Tinnitus (ST) was performed to verify the influence of the somatosensory system on the cause of tinnitus. The intensity of discomfort from tinnitus was assessed by the Numerical Rating Scale, the impact on quality of life by the Tinnitus Handicap Inventory (THI), and factors of exacerbation of tinnitus were self-reported. Individuals were divided into ST and non-ST groups. Unpaired t-test and Chi-Square were used for group comparisons; Cohen's d and Phi measured effect sizes.

Results: A total of 100 individuals were evaluated: 46 from the ST group and 54 from the non-ST group. The ST group demonstrated greater discomfort from tinnitus (p <  0.01); stress was identified as a factor of exacerbation 82.6 (p <  0.01), and sleep disturbance as a consequence of tinnitus 63% (p =  0.04). Additionally, the ST group presented a greater impact on quality of life in the functional domain (p = 0.03) and total THI score (p =  0.05) than the non-ST group.

Conclusion: Individuals with ST reported greater discomfort from tinnitus and a more significant impact on the quality of life.