Brazilian Journal of Otorhinolaryngology最新文献

Objective

Continuous research on the structure and function of intestinal microecology has confirmed the association between gut microbiota and the occurrence, development, and outcome of allergic diseases. Here, we explored the genetic causality between gut microbiota and rhinitis.

Methods

We conducted a two-sample Mendelian Randomization (MR) study to investigate the genetic causal relationship between gut microbiota and allergic rhinitis and vasomotor rhinitis. Genetic variations in the human gut microbiota were obtained from the summary statistics of the MiBioGen study. Genome-wide summary statistics of rhinitis were obtained from the FinnGen consortium. The causal effect between gut microbiota and rhinitis was assessed using the inverse variance weighted, MR-Egger regression, and weighted median methods. In addition, sensitivity analyses were conducted using different methods, including maximum likelihood, simple mode, and weighted model methods.

Results

The IVW approach revealed a causal association of the genus Ruminococcus gauvreauii group with an increased risk of allergic rhinitis (IVW Odds Ratio [OR = 1.26] [1.04, 1.53], p-value = 0.01645). In addition, the genus Fusicatenibacter (IVW OR = 1.20 [1.02, 1.41], p-value = 0.02868) was causally associated with an increased risk of vasomotor rhinitis.

Conclusion

Gut microbiota belonging to different genera exert different effects on allergic rhinitis and vasomotor rhinitis, including reducing the risk of rhinitis, and increasing the risk of rhinitis. New insights into the mechanisms of underlying gut microbiota-associated rhinitis are provided.

Level of evidence

Level 5.

Objectives

To determine whether routinary walking activity and the derived neutrophil-to-lymphocyte ratio are associated with outcomes in patients with recurrent and/or metastatic squamous cell carcinoma of head and neck.

Methods

This multicenter retrospective cohort study included 64 patients diagnosed with recurrent and/or metastatic squamous cell carcinoma of head and neck and treated with immunotherapy (Programmed Death-1 and Programmed Death-ligand-1 proteins inhibitors) at two tertiary centers. We compared a group that performed uninterrupted physical activity for 1 h per day and controls who performed no activity. The derived neutrophil-to-lymphocyte ratio was calculated as follows: [neutrophils / (leukocytes – neutrophils)]. Progression-free survival and overall survival were evaluated.

Results

We included 28 (44%) and 36 (56%) patients in the activity and non-activity groups, respectively. Patient characteristics, treatment details, and tumor Programmed Death-ligand-1 expression were not associated with either progression-free survival or overall survival. Physical activity was an independent beneficial factor for progression-free survival (p < 0.001) and overall survival (p < 0.001). By contrast, a derived neutrophil-to-lymphocyte ratio <3.5 was an independent beneficial factor for overall survival (p = 0.013), but not for progression-free survival (p = 0.328).

Conclusions

Walking one hour per day and having a high proportion of lymphocytes to neutrophiles (expressed as a low derived neutrophil-to-lymphocyte ratio) independently predict a better prognosis in patients with recurrent and/or metastatic squamous cell carcinoma of head and neck treated with immunotherapy.

Level of evidence

III.

Objectives

This study aims to assess the impact of the Neutrophil/Lymphocyte Ratio (NLR) and C-Reactive Protein (CRP), both markers of systemic inflammation, on the duration of hospitalization for Deep Neck Infections (DNIs).

Methods

The research encompassed patients of all age groups admitted between January 2016 and January 2021 due to DNIs. Patient data, including demographic details, etiology, comorbidities, radiological findings, treatment specifics, laboratory results (CRP values, leukocyte counts, neutrophil counts, lymphocyte counts, NLR), culture outcomes, length of stay, complications, mortalities were retrospectively evaluated. Patients were categorized into two groups based on their hospitalization duration: less than 7-days and 7-days or more. Univariate and multivariate analyses were conducted to examine the association between age, NLR, CRP, and hospital stay length.

Results

The study encompassed 275 patients, with a mean age of 36 ± 20.2 years. The mean hospital stay was 9.6 ± 6.6 days. Tonsillopharyngeal infections were the most common etiology (34%). Notably, in both univariate and multivariate analyses, age, NLR, and CRP values demonstrated significant (p < 0.05) predictive influence on hospitalization duration.

Conclusion

Age emerges as a determinant that affects hospital stay duration in DNIs. Moreover, NLR is proven to be comparable to CRP in predicting hospitalization length for these patients. NLR's feasibility as a cost-effective predictive marker, being conveniently derived from routine complete blood count assessments, adds to its clinical significance. This study underscores the potential value of NLR and CRP in informing patient management and care strategies for DNIs.

Objective

Inferior turbinate (IT) hypertrophy-induced chronic nasal obstruction is one of the most common problems in rhinology. However, the histopathological analysis of the hypertrophic IT is unclear. Therefore, this study aimed to identify the histological changes and the most functional areas of the IT to assist otolaryngologists with improving and modifying surgical techniques and minimizing potential complications.

Methods

This prospective, cross-sectional study was conducted to evaluate the contribution of hypertrophic IT to nasal obstruction. For the analysis, a total of 38 adult patients (IT hypertrophy group and non-IT hypertrophy [control] group) were enrolled, and 131 specimens were obtained during the surgical procedures (IT hypertrophy group, endoscopic submucosal turbinoplasty and septoplasty; non-IT hypertrophy group, septoplasty). Intraoperative samples were collected from four sites of the IT to determine the dimensions, composition, and possible pathological changes in each individual site. The samples were analyzed using light microscopy.

Results

A comparison of the four sites of the IT in the IT hypertrophy group showed that the posterior end had the highest normal epithelium percentage, and cilia count. This suggests that preserving the functional part of the IT during surgery is crucial. Furthermore, a comparison of both groups in terms of basement membrane thickness and vessel wall thickness (p = 0.005 and p = 0.03, respectively) showed significant differences.

Conclusion

Our findings can assist otolaryngologists select the most appropriate surgical procedures for IT hypertrophy. In addition, they advocate the importance of preserving the functional part of the IT during surgical intervention to achieve an efficiently working IT and avoid undesirable complications while improving the nasal airway passage.

Level of evidence

Level 3.

Objective

Methods

Results

Conclusion

Objective

Observational studies have shown that Helicobacter pylori is related to some otolaryngological diseases. However, it is unclear if H. pylori infection causally affects these diseases. To elucidate H. pylori role in 12 common otolaryngological diseases, we conducted two-sample Mendelian randomization analysis.

Methods

Single-nucleotide polymorphisms associated with 7 H. pylori antibodies (IgG, CagA, Catalase, GroEL, OMP, UREA and Vac A) served as instrumental variables. We primarily employed random-effects inverse variance weighting for causal estimation, supplemented by MR Egger, weighted median, simple mode, and weighted mode. Sensitivity analyses, including heterogeneity, pleiotropy, and leave-one-out tests, validated robustness.

Results

MR analysis using inverse variance weighting (random effects) revealed genetically predicted H. pylori CagA antibodies correlated with increased risk of nonsuppurative otitis media (OR = 1.0778, 95% CI 1.0114–1.1487, p-value = 0.021). No causal relationship was observed between H. pylori antibodies and other common otolaryngological diseases. Sensitivity analyses found no pleiotropy or heterogeneity, affirming result reliability.

Conclusion

This study suggests that the levels of H. pylori CagA antibodies may contribute to the development of nonsuppurative otitis media. Further studies are needed in the future to elucidate the specific mechanism of H. pylori in this disease.

Level of evidence

Level III.

Objective

To analyze the Benefit of Modulated Masking (BMM) on hearing in young, adult and elderly normal-hearing individuals.

Methods

The sample included 60 normal-hearing individuals aged 18–75 years who underwent behavioral assessment (sentence recognition test in the presence of steady and modulated noise) and electrophysiological assessment (cortical Auditory Evoked Potential) to investigate BMM. The results were analyzed comparatively using the paired t-test and ANOVA for repeated measures, followed by the Bonferroni post-hoc test (p-value < 0.05).

Results

A decrease in latencies and an increase in amplitudes of cortical components (P1-N1-P2) was observed due to noise modulation in all age groups. Modulated noise generated better auditory threshold responses (electrophysiological and behavioral), compared to steady noise. The elderly presented a higher threshold in both hearing domains, compared to the other participants, as well as a lower BMM magnitude.

Conclusion

It was possible to conclude that the modulated noise generated less interference in the magnitude of the neural response (smaller latencies) and in the neural processing time (larger amplitudes) for the speech stimulus in all participants. The higher auditory thresholds (electrophysiological and behavioral) and the lower BMM magnitude observed in the elderly group, even in the face of noise modulation, suggest a lower temporal auditory performance in this population, and may indicate a deficit in the temporal resolution capacity, associated with the process of aging.

Level of evidence

3.

Objective

To evaluate the ability of the variables Muscle Mass percentage (%MM), Body Fat percentage (%BF), Phase Angle (PhA), and Standardized Phase Angle (SPhA) to predict overall survival rates in individuals with surgically treated HNC.

Methods

A prospective cohort study of surgically treated HNC patients was carried out between 2017 and 2022 at a cancer referral center in Feira de Santana, Bahia. All subjects were seen by an experienced dietitian the week before surgery. During this visit, patients had their sociodemographic and clinical data collected, as well as anthropometric measurements (weight and height) and BIA variables. In this study, postoperative overall 5-year survival was defined as the time in months between the date of surgery and the date of death, regardless of the cause of death. Patients were followed up after surgery until death.

Results

Seventy-eight older adult patients were consecutively included. Patients had a median age of 65.5-years, were mostly men (83.3%), and most had low education levels (62.3%) and low household income, ranging from zero (19.2%) to the minimum wage (60.2%). They were mostly alcohol drinkers (91%) and tobacco smokers (87.2%). Glottic cancer was diagnosed in 48.7% of patients, with 44.8% of cases with stage-IV disease. Forty (51.2%) deaths were recorded in the follow-up period, with a median survival time of 39 months. Variables %MM, %BF, and SPhA were not significantly different between groups (alive vs. dead patients). PhA was considered an independent predictor of overall survival, with an accuracy of 69% (95% CI 0.57‒0.80). When comparing survival curves, patients with a preoperative PhA < 6.8° were more than twice as likely to die during follow-up (HR = 2.38; p =  0.02; 95% CI 1.14‒4.97).

Conclusion

Out of the assessed BIA variables, preoperative PhA was considered a good predictor of overall survival after HNC surgery.

Level of evidence

3.

Objective

This study aimed to investigate the potential reduction of cardiovascular stress response caused by suspension laryngoscopic surgery through the application of lidocaine spray on the larynx and trachea.

Methods

A total of 68 patients scheduled for elective suspension laryngoscopic surgery were randomly assigned to either the lidocaine group (Group L, n = 34) or the control group (Group C, n = 33). In Group L, patients received a sprayed lidocaine dose of 2 mg/kg on the larynx and trachea after anesthesia induction, prior to intubation. In Group C, equal volumes of saline solution were administered. MAP and HR were recorded at various time points: before anesthesia (T0), 1-minute after intubation (T1), 1 and 3 min after suspension laryngoscopy (T2 and T3), at the end of the operation (T4), and at 1, 5, and 30 min after extubation (T5, T6, and T7). Arterial blood glucose, epinephrine, and norepinephrine levels were measured at T0, T2, T5, and T7. The occurrence of severe cough and sore throat at T6 and T7 after extubation was compared between the two groups.

Results

At T0 and T1, there were no statistically significant differences in mean arterial pressures, heart rate, and blood catecholamine levels between the two groups. However, from T2 to T7, the blood pressure and heart rate in Group L were lower compared to Group C, with significant differences observed at T2‒T6 (p < 0.05). Group L also showed less elevation in blood glucose at T2, T5, and T7 (p < 0.05). The changes in epinephrine and norepinephrine levels between the two groups were statistically significant at T2 and T5 (p < 0.05).

Conclusions

Administering lidocaine spray on the larynx and trachea during intubation for suspension laryngoscopic surgery can effectively alleviate the stress response.

Level 1 evidence

Patients in this study are randomly assigned to the treatment or control group and are followed prospectively.