Pub Date : 2025-09-06DOI: 10.1016/j.bjorl.2025.101715
Mario Augusto Ferrari de Castro , Rogerio Aparecido Dedivitis , Fatima Cristina Mendes de Matos , Marianne Yumi Nakai , Leandro Luongo de Matos , Marco Aurelio Vamondes Kulcsar , Flavio Carneiro Hojaij , Carlos Takahiro Chone , Ana Paula Souza , Giovana Meira Muller
Objectives
To standardize the necessary competencies for medical students related to Head and Neck Surgery.
Methods
The study was performed in 2025. The Delphi process was employed in its sequential phases: the selection of an expert panel; a structured questionnaire containing a preliminary list of potential competencies; the electronic distribution of the questionnaire to the experts, with options to “maintain”, “remove”, or “modify” the competencies and to suggest the inclusion of new competencies; a second round indicating “agree” or “disagree” for each reformulated or new competency; and the final consensus.
Results
Twelve competencies were established for medical students in the specialty of Head and Neck Surgery.
Conclusion
Undergraduate students should be directed toward the most prevalent conditions in the general practitioner's clinical practice.
{"title":"Competencies in Head and Neck Surgery teaching for medical internship. Position statement of Brazilian Head and Neck Surgery Society","authors":"Mario Augusto Ferrari de Castro , Rogerio Aparecido Dedivitis , Fatima Cristina Mendes de Matos , Marianne Yumi Nakai , Leandro Luongo de Matos , Marco Aurelio Vamondes Kulcsar , Flavio Carneiro Hojaij , Carlos Takahiro Chone , Ana Paula Souza , Giovana Meira Muller","doi":"10.1016/j.bjorl.2025.101715","DOIUrl":"10.1016/j.bjorl.2025.101715","url":null,"abstract":"<div><h3>Objectives</h3><div>To standardize the necessary competencies for medical students related to Head and Neck Surgery.</div></div><div><h3>Methods</h3><div>The study was performed in 2025. The Delphi process was employed in its sequential phases: the selection of an expert panel; a structured questionnaire containing a preliminary list of potential competencies; the electronic distribution of the questionnaire to the experts, with options to “maintain”, “remove”, or “modify” the competencies and to suggest the inclusion of new competencies; a second round indicating “agree” or “disagree” for each reformulated or new competency; and the final consensus.</div></div><div><h3>Results</h3><div>Twelve competencies were established for medical students in the specialty of Head and Neck Surgery.</div></div><div><h3>Conclusion</h3><div>Undergraduate students should be directed toward the most prevalent conditions in the general practitioner's clinical practice.</div></div><div><h3>Level of evidence</h3><div>4.</div></div>","PeriodicalId":49099,"journal":{"name":"Brazilian Journal of Otorhinolaryngology","volume":"91 6","pages":"Article 101715"},"PeriodicalIF":1.8,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145003758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-06DOI: 10.1016/j.bjorl.2025.101703
Li-Fang Shen, Zi-Ming Fu, Hai-Hong Chen
Objectives
Exosomes play a crucial role in intercellular communication and may contribute to the development of various diseases. Nevertheless, their role in Nasal Polyps (NPs) remains poorly understood. Herein, Nasal Polyp Fibroblasts (NPF) were used to release exosomes, and epithelial cells were cocultured with NPF-derived exosomes to analyze Epithelial-Mesenchymal Transition (EMT) in Chronic Rhinosinusitis (CRS).
Methods
We obtained exosomes from the culture media of NPFs treated with or without Fibroblast Activation Protein (FAP) inhibitor-4. Epithelial cells were coincubated with NPF-derived exosomes, and exosome internalization was analyzed by confocal microscopy. FAP and EMT markers in epithelial cells were detected by Western blotting and RT-PCR, while the migration ability of epithelial cells was detected by scratch experiments.
Results
NPF-derived FAP-containing exosomes were rapidly internalized by nasal epithelial cells. These exosomes induced epithelial cells to express reduced E-cadherin and increased N-cadherin and vimentin levels, while FAPI-4 could reverse these changes. Furthermore, the migration ability of epithelial cells was enhanced by FAP-carrying exosomes. Our results reveal that FAP-containing exosomes promote EMT in epithelial cells.
Conclusion
NPF-derived FAP-containing exosomes mediate the interaction between epithelial cells and fibroblasts and induce the EMT of epithelial cells, thereby potentially playing a crucial role in promoting remodeling in CRS. These findings suggest that FAP is a potential therapeutic target for the treatment of CRS patients.
Level of evidence
Level 3 ‒ Non-randomized controlled cohort/follow-up study Recommendation B.
{"title":"Effects of fibroblasts-derived exosomal FAP in regulating EMT in epithelial cells from chronic rhinosinusitis","authors":"Li-Fang Shen, Zi-Ming Fu, Hai-Hong Chen","doi":"10.1016/j.bjorl.2025.101703","DOIUrl":"10.1016/j.bjorl.2025.101703","url":null,"abstract":"<div><h3>Objectives</h3><div>Exosomes play a crucial role in intercellular communication and may contribute to the development of various diseases. Nevertheless, their role in Nasal Polyps (NPs) remains poorly understood. Herein, Nasal Polyp Fibroblasts (NPF) were used to release exosomes, and epithelial cells were cocultured with NPF-derived exosomes to analyze Epithelial-Mesenchymal Transition (EMT) in Chronic Rhinosinusitis (CRS).</div></div><div><h3>Methods</h3><div>We obtained exosomes from the culture media of NPFs treated with or without Fibroblast Activation Protein (FAP) inhibitor-4. Epithelial cells were coincubated with NPF-derived exosomes, and exosome internalization was analyzed by confocal microscopy. FAP and EMT markers in epithelial cells were detected by Western blotting and RT-PCR, while the migration ability of epithelial cells was detected by scratch experiments.</div></div><div><h3>Results</h3><div>NPF-derived FAP-containing exosomes were rapidly internalized by nasal epithelial cells. These exosomes induced epithelial cells to express reduced E-cadherin and increased N-cadherin and vimentin levels, while FAPI-4 could reverse these changes. Furthermore, the migration ability of epithelial cells was enhanced by FAP-carrying exosomes. Our results reveal that FAP-containing exosomes promote EMT in epithelial cells.</div></div><div><h3>Conclusion</h3><div>NPF-derived FAP-containing exosomes mediate the interaction between epithelial cells and fibroblasts and induce the EMT of epithelial cells, thereby potentially playing a crucial role in promoting remodeling in CRS. These findings suggest that FAP is a potential therapeutic target for the treatment of CRS patients.</div></div><div><h3>Level of evidence</h3><div>Level 3 ‒ Non-randomized controlled cohort/follow-up study Recommendation B.</div></div>","PeriodicalId":49099,"journal":{"name":"Brazilian Journal of Otorhinolaryngology","volume":"91 6","pages":"Article 101703"},"PeriodicalIF":1.8,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145003757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Healthcare systems contribute significantly to global greenhouse gas emissions through energy consumption and waste generation. This study aims to explore strategies to make cochlear implantation processes more environmentally sustainable and aligned with the United Nations’ Sustainable Development Goals.
Methods
We examined various approaches including the use of bio-based and biodegradable materials, sustainable energy solutions, greener anesthetic practices, effective waste separation and recycling in operating rooms, and patient-centered strategies such as reducing travel and promoting early activation and fitting of cochlear implants.
Results
Establishing a ‘Green Team’ was identified as a key factor to raise awareness and motivation for sustainability initiatives. Implementing these strategies can significantly reduce the environmental footprint of cochlear implantation by decreasing surgical waste, lowering energy consumption, and minimizing patient-related emissions.
Conclusion
By adopting these sustainable practices, the cochlear implant field can reduce its environmental impact, contribute meaningfully to global sustainability efforts, and enhance patient well-being, positioning itself as a leader in healthcare sustainability.
{"title":"The Green Cochlea","authors":"Abdulrahman Hagr , Farid Alzhrani , Fida Almuhawas , Yassin Abdelsamad , Medhat Yousef , Asma Alahmadi , Christiana Kyvelidou , Ilona Anderson","doi":"10.1016/j.bjorl.2025.101718","DOIUrl":"10.1016/j.bjorl.2025.101718","url":null,"abstract":"<div><h3>Objectives</h3><div>Healthcare systems contribute significantly to global greenhouse gas emissions through energy consumption and waste generation. This study aims to explore strategies to make cochlear implantation processes more environmentally sustainable and aligned with the United Nations’ Sustainable Development Goals.</div></div><div><h3>Methods</h3><div>We examined various approaches including the use of bio-based and biodegradable materials, sustainable energy solutions, greener anesthetic practices, effective waste separation and recycling in operating rooms, and patient-centered strategies such as reducing travel and promoting early activation and fitting of cochlear implants.</div></div><div><h3>Results</h3><div>Establishing a ‘Green Team’ was identified as a key factor to raise awareness and motivation for sustainability initiatives. Implementing these strategies can significantly reduce the environmental footprint of cochlear implantation by decreasing surgical waste, lowering energy consumption, and minimizing patient-related emissions.</div></div><div><h3>Conclusion</h3><div>By adopting these sustainable practices, the cochlear implant field can reduce its environmental impact, contribute meaningfully to global sustainability efforts, and enhance patient well-being, positioning itself as a leader in healthcare sustainability.</div></div>","PeriodicalId":49099,"journal":{"name":"Brazilian Journal of Otorhinolaryngology","volume":"91 6","pages":"Article 101718"},"PeriodicalIF":1.8,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145003759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-22DOI: 10.1016/j.bjorl.2025.101702
Sun LiNa , Tu Jianfei , Tian Zhifeng , Wang Xinbin , Wu Hui
Objectives
Malignant Peripheral Nerve Sheath Tumors (MPNST) are rapidly progressing Schwann cell neoplasms. This study aimed to develop a practical clinical nomogram that predicts prognosis in patients with Head and Neck MPNST (HN-MPNST) using the Surveillance, Epidemiology, and End Results (SEER) database.
Methods
We extracted clinical data from patients with HN MPNST between 2000 and 2020 from the SEER database. Patients were randomly divided into training cohort and validation cohorts. To estimate the chance of survival in patients with HN MPNST, we developed a nomogram. The nomogram performance was evaluated by discrimination and calibration. In addition, a decision curve analysis was conducted to evaluate the clinical usefulness of this newly developed model. Molecular data highlighting the most frequent mutations in MPNST were obtained from the Catalogue Of Somatic Mutations In Cancer (COSMIC) database.
Results
In the primary cohort, 431 patients met the inclusion criteria to be entered into this study. The median Overall Survival (OS) was 3.9-years (95% CI 2.8–6.7), and the 1-, 3-, and 5-year OS rates were 75.2%, 52.6%, and 47.1%, respectively. We included 129 consecutive patients in the validation cohort. AJCC (American Joint Committee on Cancer) staging, Collaborative Stage (CS) extension, and CS tumor size were included in the nomogram. The calibration plots showed an agreement between the predictions and observations. Based on the clinical decision curve, the model had a net clinical benefit for patients with MPNST. Analysis of COSMIC data revealed frequent mutations of MPNST in NF1 (22%), SMARCB1 (21%), TP53 (12%), SUZ12 (19%), and less commonly in BRAF and CDKN2A (each 2%).
Conclusion
Radiotherapy improves survival in patients with metastatic disease or tumors ≥ 6 cm. Using this nomogram can assist in clinical decision making, as it has satisfactory accuracy. However, an additional external validation is required.
Level of evidence
2.
目的恶性周围神经鞘肿瘤（MPNST）是一种进展迅速的雪旺细胞肿瘤。本研究旨在利用监测、流行病学和最终结果（SEER）数据库开发一种实用的临床nomogram预测头颈部MPNST （HN-MPNST）患者的预后。方法从SEER数据库中提取2000 - 2020年HN型MPNST患者的临床资料。患者随机分为训练组和验证组。为了估计HN MPNST患者的生存机会，我们开发了一个nomogram。通过判别和校准来评价nomogram性能。此外，我们还进行了决策曲线分析，以评估该新开发模型的临床实用性。强调MPNST中最常见突变的分子数据来自于癌症体细胞突变目录（COSMIC）数据库。结果在第一队列中，有431例患者符合纳入标准。中位总生存期（OS）为3.9年（95% CI 2.8-6.7）， 1年、3年和5年OS率分别为75.2%、52.6%和47.1%。我们在验证队列中纳入了129例连续患者。美国癌症联合委员会（AJCC）分期、协同分期（CS）扩展和CS肿瘤大小均纳入nomogram。校正图显示了预测和观测之间的一致性。根据临床决策曲线，该模型对MPNST患者具有净临床效益。COSMIC数据分析显示，MPNST在NF1（22%）、SMARCB1（21%）、TP53（12%）、SUZ12（19%）中频繁突变，而在BRAF和CDKN2A中较少见（各2%）。结论放疗可提高转移性疾病或肿瘤≥6cm患者的生存率。使用该图可以帮助临床决策，因为它具有令人满意的准确性。但是，需要额外的外部验证。证据水平2。
{"title":"Clinical predictors of survival in malignant peripheral nerve sheath tumors of the head and neck: A cox regression and nomogram study","authors":"Sun LiNa , Tu Jianfei , Tian Zhifeng , Wang Xinbin , Wu Hui","doi":"10.1016/j.bjorl.2025.101702","DOIUrl":"10.1016/j.bjorl.2025.101702","url":null,"abstract":"<div><h3>Objectives</h3><div>Malignant Peripheral Nerve Sheath Tumors (MPNST) are rapidly progressing Schwann cell neoplasms. This study aimed to develop a practical clinical nomogram that predicts prognosis in patients with Head and Neck MPNST (HN-MPNST) using the Surveillance, Epidemiology, and End Results (SEER) database.</div></div><div><h3>Methods</h3><div>We extracted clinical data from patients with HN MPNST between 2000 and 2020 from the SEER database. Patients were randomly divided into training cohort and validation cohorts. To estimate the chance of survival in patients with HN MPNST, we developed a nomogram. The nomogram performance was evaluated by discrimination and calibration. In addition, a decision curve analysis was conducted to evaluate the clinical usefulness of this newly developed model. Molecular data highlighting the most frequent mutations in MPNST were obtained from the Catalogue Of Somatic Mutations In Cancer (COSMIC) database.</div></div><div><h3>Results</h3><div>In the primary cohort, 431 patients met the inclusion criteria to be entered into this study. The median Overall Survival (OS) was 3.9-years (95% CI 2.8–6.7), and the 1-, 3-, and 5-year OS rates were 75.2%, 52.6%, and 47.1%, respectively. We included 129 consecutive patients in the validation cohort. AJCC (American Joint Committee on Cancer) staging, Collaborative Stage (CS) extension, and CS tumor size were included in the nomogram. The calibration plots showed an agreement between the predictions and observations. Based on the clinical decision curve, the model had a net clinical benefit for patients with MPNST. Analysis of COSMIC data revealed frequent mutations of MPNST in NF1 (22%), SMARCB1 (21%), TP53 (12%), SUZ12 (19%), and less commonly in BRAF and CDKN2A (each 2%).</div></div><div><h3>Conclusion</h3><div>Radiotherapy improves survival in patients with metastatic disease or tumors ≥ 6 cm. Using this nomogram can assist in clinical decision making, as it has satisfactory accuracy. However, an additional external validation is required.</div></div><div><h3>Level of evidence</h3><div>2.</div></div>","PeriodicalId":49099,"journal":{"name":"Brazilian Journal of Otorhinolaryngology","volume":"91 6","pages":"Article 101702"},"PeriodicalIF":1.8,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-22DOI: 10.1016/j.bjorl.2025.101700
Reginaldo Raimundo Fujita , Shirley Shizue Nagata Pignatari , Vitor Guo Chen , Paula Angelica Lorenzon , Luciano Rodrigues Neves , Gabriela Ricci Lima Luz Matsumoto , Manoel de Nobrega , Ektor Tsuneo Onishi , Silvana Bommarito , Jaquelina Ota Araki
{"title":"What can be done to reduce surgical waiting time for pediatric ent in public health care in Brazil?","authors":"Reginaldo Raimundo Fujita , Shirley Shizue Nagata Pignatari , Vitor Guo Chen , Paula Angelica Lorenzon , Luciano Rodrigues Neves , Gabriela Ricci Lima Luz Matsumoto , Manoel de Nobrega , Ektor Tsuneo Onishi , Silvana Bommarito , Jaquelina Ota Araki","doi":"10.1016/j.bjorl.2025.101700","DOIUrl":"10.1016/j.bjorl.2025.101700","url":null,"abstract":"","PeriodicalId":49099,"journal":{"name":"Brazilian Journal of Otorhinolaryngology","volume":"91 5","pages":"Article 101700"},"PeriodicalIF":1.8,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-21DOI: 10.1016/j.bjorl.2025.101699
Yao Zhou , Shouju Huang , Lijuan Zhao , Chengzhen Pan , Jianguo Wang , Shuxia Qian
Objective
Transient Receptor Potential Vanilloid 5 (TRPV5) is an essential Ca2+ transporter mediated by estrogen in osteoclast differentiation and bone resorption. However, the mechanism of how estrogen mediates TRPV5 expression in Benign Paroxysmal Positional Vertigo (BPPV) remains unclear.
Methods
In this study, the Ovariectomized (OVX) rats were established to explore whether TRPV5 was regulated by estrogen.
Results
Lower protein expression level of TRPV5 showed in OVX rats were found to be restored by injection of Estradiol (E2). The same result was observed when TRPV5 expression was disturbed by si-TRPV5 fragment transfection. In addition, overexpression of TRPV5 up-regulated the expression of pho-Akt (Ser473) and promoted proliferation and apoptosis of cochlear hair cells.
Conclusion
Estrogen may contribute to BPPV by stimulating TRPV5 overexpression to further up-regulate the expression of pho-Akt (Ser473) and promote cell proliferation and apoptosis. Our study provides preliminary insights into the pathogenesis of BPPV.
{"title":"Estrogen-mediated TRPV5 modulates proliferation and apoptosis of rat cochlear hair cells via the PI3K/Akt pathway","authors":"Yao Zhou , Shouju Huang , Lijuan Zhao , Chengzhen Pan , Jianguo Wang , Shuxia Qian","doi":"10.1016/j.bjorl.2025.101699","DOIUrl":"10.1016/j.bjorl.2025.101699","url":null,"abstract":"<div><h3>Objective</h3><div>Transient Receptor Potential Vanilloid 5 (TRPV5) is an essential Ca<sup>2+</sup> transporter mediated by estrogen in osteoclast differentiation and bone resorption. However, the mechanism of how estrogen mediates TRPV5 expression in Benign Paroxysmal Positional Vertigo (BPPV) remains unclear.</div></div><div><h3>Methods</h3><div>In this study, the Ovariectomized (OVX) rats were established to explore whether TRPV5 was regulated by estrogen.</div></div><div><h3>Results</h3><div>Lower protein expression level of TRPV5 showed in OVX rats were found to be restored by injection of Estradiol (E2). The same result was observed when TRPV5 expression was disturbed by si-TRPV5 fragment transfection. In addition, overexpression of TRPV5 up-regulated the expression of pho-Akt (Ser473) and promoted proliferation and apoptosis of cochlear hair cells.</div></div><div><h3>Conclusion</h3><div>Estrogen may contribute to BPPV by stimulating TRPV5 overexpression to further up-regulate the expression of pho-Akt (Ser473) and promote cell proliferation and apoptosis. Our study provides preliminary insights into the pathogenesis of BPPV.</div></div>","PeriodicalId":49099,"journal":{"name":"Brazilian Journal of Otorhinolaryngology","volume":"91 6","pages":"Article 101699"},"PeriodicalIF":1.8,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-21DOI: 10.1016/j.bjorl.2025.101659
Rafael Filipe Dal Ben Martins , Bruna Andressa Quirino , Leandro Luongo Matos , Marcelo Passos Teivelis , Nelson Wolosker , Ana Kober Nogueira Leite
Objective
Analyze the trends and outcomes of total laryngectomy in Brazil, focusing on the influence of surgical volume on mortality.
Methods
A retrospective, population-based study was conducted using data from the Brazilian Unified Health System (SUS) between 2008 and 2023. Total laryngectomies were identified through specific procedure codes, and hospitals were categorized into quartiles based on surgical volume. The number of procedures over time, mortality rates, and hospital characteristics were analyzed.
Results
A total of 8884 total laryngectomies were performed, decreasing from 1142 in 2008 to 289 in 2023, a 75% reduction (APC = −9.06% per year, p < 0.001). The overall in-hospital mortality rate was 2.7% with no significant change over time Hospitals performing less than two procedures per year had significantly higher mortality rates (3.14%). However, after excluding very low-volume hospitals, mortality rates were similar among the remaining groups.
Conclusion
There was a significant reduction in total laryngectomies in Brazil over the years, suggesting a shift to nonoperative treatment. Moreover, increased mortality in very low-volume hospitals underscores the need for regionalization policies to centralize complex procedures in experienced centers.
{"title":"National trends in laryngectomy and the influence of hospital volume on short-term outcomes in Brazil: A 16-year cross-sectional analysis","authors":"Rafael Filipe Dal Ben Martins , Bruna Andressa Quirino , Leandro Luongo Matos , Marcelo Passos Teivelis , Nelson Wolosker , Ana Kober Nogueira Leite","doi":"10.1016/j.bjorl.2025.101659","DOIUrl":"10.1016/j.bjorl.2025.101659","url":null,"abstract":"<div><h3>Objective</h3><div>Analyze the trends and outcomes of total laryngectomy in Brazil, focusing on the influence of surgical volume on mortality.</div></div><div><h3>Methods</h3><div>A retrospective, population-based study was conducted using data from the Brazilian Unified Health System (SUS) between 2008 and 2023. Total laryngectomies were identified through specific procedure codes, and hospitals were categorized into quartiles based on surgical volume. The number of procedures over time, mortality rates, and hospital characteristics were analyzed.</div></div><div><h3>Results</h3><div>A total of 8884 total laryngectomies were performed, decreasing from 1142 in 2008 to 289 in 2023, a 75% reduction (APC = −9.06% per year, p < 0.001). The overall in-hospital mortality rate was 2.7% with no significant change over time Hospitals performing less than two procedures per year had significantly higher mortality rates (3.14%). However, after excluding very low-volume hospitals, mortality rates were similar among the remaining groups.</div></div><div><h3>Conclusion</h3><div>There was a significant reduction in total laryngectomies in Brazil over the years, suggesting a shift to nonoperative treatment. Moreover, increased mortality in very low-volume hospitals underscores the need for regionalization policies to centralize complex procedures in experienced centers.</div></div>","PeriodicalId":49099,"journal":{"name":"Brazilian Journal of Otorhinolaryngology","volume":"91 6","pages":"Article 101659"},"PeriodicalIF":1.8,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-20DOI: 10.1016/j.bjorl.2025.101697
Marianna Momoe Nanakuma Matsumoto, Bruna Fernanda Alves da Silva, Maria Luiza Paulo de Oliveira Costa, Amanda Aparecida Carneiro, Daniela Regina Molini-Avejonas
Objective
To verify the accuracy of a protocol for the Brazilian population of the ABFW ‒ Adapted Child Language Test, named ABFW Triagem.
Methods
This was a diagnostic accuracy study carried out at the speech therapy outpatient clinic of one of Brazil's leading public universities. Through the database, protocols were selected for patients aged between 0 and 5 years and 11-months who visited the outpatient clinic between 2016 and 2019 with any speech and hearing complaint. A follow up was carried out in 2024 to find out whether the speech therapy hypothesis was assertive or not.
Results
188 protocols were selected and only 43 caregivers answered the researcher's call. The ABFW Screening protocol showed 72.1% accuracy and 64.3% balanced accuracy. Of all the hypotheses, the main one was language alteration characteristic of autism spectrum disorder (88.89%) with a sensitivity of 94.12% and specificity of 92.31%.
Conclusion
The ABFW protocol adapted for speech and hearing screening proved to be a tool with the potential to make significant contributions to Brazilian public policies of interest to Primary Health Care. We suggest a greater volume of other speech therapy diagnostic hypotheses so that it can be validated and used by specialists, thus fulfilling the methodological rigor and development essential for its quality.
Level of evidence
Is this diagnostic or monitoring test accurate? (Diagnosis) ‒ Level 2 (Individual cross-sectional studies with consistently applied reference standard and blinding).
{"title":"Accuracy of the ABFW ‒ Screening for speech disorders in early childhood","authors":"Marianna Momoe Nanakuma Matsumoto, Bruna Fernanda Alves da Silva, Maria Luiza Paulo de Oliveira Costa, Amanda Aparecida Carneiro, Daniela Regina Molini-Avejonas","doi":"10.1016/j.bjorl.2025.101697","DOIUrl":"10.1016/j.bjorl.2025.101697","url":null,"abstract":"<div><h3>Objective</h3><div>To verify the accuracy of a protocol for the Brazilian population of the ABFW ‒ Adapted Child Language Test, named ABFW Triagem.</div></div><div><h3>Methods</h3><div>This was a diagnostic accuracy study carried out at the speech therapy outpatient clinic of one of Brazil's leading public universities. Through the database, protocols were selected for patients aged between 0 and 5 years and 11-months who visited the outpatient clinic between 2016 and 2019 with any speech and hearing complaint. A follow up was carried out in 2024 to find out whether the speech therapy hypothesis was assertive or not.</div></div><div><h3>Results</h3><div>188 protocols were selected and only 43 caregivers answered the researcher's call. The ABFW Screening protocol showed 72.1% accuracy and 64.3% balanced accuracy. Of all the hypotheses, the main one was language alteration characteristic of autism spectrum disorder (88.89%) with a sensitivity of 94.12% and specificity of 92.31%.</div></div><div><h3>Conclusion</h3><div>The ABFW protocol adapted for speech and hearing screening proved to be a tool with the potential to make significant contributions to Brazilian public policies of interest to Primary Health Care. We suggest a greater volume of other speech therapy diagnostic hypotheses so that it can be validated and used by specialists, thus fulfilling the methodological rigor and development essential for its quality.</div></div><div><h3>Level of evidence</h3><div>Is this diagnostic or monitoring test accurate? (Diagnosis) ‒ Level 2 (Individual cross-sectional studies with consistently applied reference standard and blinding).</div></div>","PeriodicalId":49099,"journal":{"name":"Brazilian Journal of Otorhinolaryngology","volume":"91 6","pages":"Article 101697"},"PeriodicalIF":1.8,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-05DOI: 10.1016/j.bjorl.2025.101694
Victor Hugo da Costa Ferreira , Carolina Sponchiado Miura , Bruna de Alencar Custodio Lupoli , Denny Marcos Garcia , Bruno Carvalho Portes Lopes , Fernando Gustavo Stelzer , Fábio Lourenço Romano , Tabata Luna Garavazzo Tavares , Alan Luiz Eckeli , Fabiana Cardoso Pereira Valera
Objective
This study aimed to evaluate which physical findings, observed during both awake and DISE examinations, correlate best with polysomnographic severity in obese children with Obstructive Sleep Apnea (OSA).
Methods
Children diagnosed with pediatric OSA and obesity (BMI > 95th percentile) were evaluated. All underwent polysomnography to confirm the OSA diagnosis. Demographic data, physical exams, and ENT clinical evaluations were also collected. DISE (drug induced sleep endoscopy) was performed just before adenotonsillectomy, following Boudewyns' protocol to assess pharyngeal collapse.
Results
Nineteen obese children with OSA were evaluated, with 37% showing adenoid hypertrophy (>75%) on nasal endoscopy, and 53% presented tonsillar hypertrophy on physical examination. The median AHI (apnea / hypopnea index) was 7 (range: 3; 17): 9 had mild, 2 moderate, and 8 severe OSA. Children with adenoid hypertrophy had higher arousal indices, AHI, REM (rapid eye movement) AHI, OAHI (obstructive AHI) and lower minimum saturation compared to those without obstruction, in both awake and DISE evaluations. The presence of other factors, such as tonsillar hypertrophy, tongue base obstruction, palatal and epiglottic collapses, or hypotonia, was not associated with OSA severity or polysomnographic findings in either awake or DISE exams.
Conclusion
In our cohort, adenoid hypertrophy was the factor most strongly correlated with OSA severity in obese children. This correlation was consistent between awake physical examination and DISE findings.
{"title":"Adenoid hypertrophy is directly associated with the severity of OSA in obese children: A pilot study","authors":"Victor Hugo da Costa Ferreira , Carolina Sponchiado Miura , Bruna de Alencar Custodio Lupoli , Denny Marcos Garcia , Bruno Carvalho Portes Lopes , Fernando Gustavo Stelzer , Fábio Lourenço Romano , Tabata Luna Garavazzo Tavares , Alan Luiz Eckeli , Fabiana Cardoso Pereira Valera","doi":"10.1016/j.bjorl.2025.101694","DOIUrl":"10.1016/j.bjorl.2025.101694","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate which physical findings, observed during both awake and DISE examinations, correlate best with polysomnographic severity in obese children with Obstructive Sleep Apnea (OSA).</div></div><div><h3>Methods</h3><div>Children diagnosed with pediatric OSA and obesity (BMI > 95th percentile) were evaluated. All underwent polysomnography to confirm the OSA diagnosis. Demographic data, physical exams, and ENT clinical evaluations were also collected. DISE (drug induced sleep endoscopy) was performed just before adenotonsillectomy, following Boudewyns' protocol to assess pharyngeal collapse.</div></div><div><h3>Results</h3><div>Nineteen obese children with OSA were evaluated, with 37% showing adenoid hypertrophy (>75%) on nasal endoscopy, and 53% presented tonsillar hypertrophy on physical examination. The median AHI (apnea / hypopnea index) was 7 (range: 3; 17): 9 had mild, 2 moderate, and 8 severe OSA. Children with adenoid hypertrophy had higher arousal indices, AHI, REM (rapid eye movement) AHI, OAHI (obstructive AHI) and lower minimum saturation compared to those without obstruction, in both awake and DISE evaluations. The presence of other factors, such as tonsillar hypertrophy, tongue base obstruction, palatal and epiglottic collapses, or hypotonia, was not associated with OSA severity or polysomnographic findings in either awake or DISE exams.</div></div><div><h3>Conclusion</h3><div>In our cohort, adenoid hypertrophy was the factor most strongly correlated with OSA severity in obese children. This correlation was consistent between awake physical examination and DISE findings.</div></div><div><h3>Level of evidence</h3><div>3.</div></div>","PeriodicalId":49099,"journal":{"name":"Brazilian Journal of Otorhinolaryngology","volume":"91 6","pages":"Article 101694"},"PeriodicalIF":1.8,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-05DOI: 10.1016/j.bjorl.2025.101677
Kelen Fernanda Catarochi, Vaneli Colombo Rossi, Carlos Takahiro Chone
Objective
Of this study was to evaluate the presence and severity of depressive symptoms in total laryngectomy patients and identify variations in results of each item on the depression scale.
Methods
This study is a quantitative, analytical and cross-sectional study, with 30 total laryngectomized participants, using the Instrument (BDI-II) Beck Depression Inventory-II, from April to July 2024, all total laryngectomized participants who attended the Head and Neck surgery Otorhinolaryngology Outpatient Clinic and were invited to participate in the research, the assessment was carried out by the same reserarcher and the estimated response time was 22 min.
Results
Show tha depression was identified in 20% of patients with mild symptoms, 13% moderate and 20% severe. The sleep pattern was altered in 63% of respondents and difficulty concentrating was reported by 57%. Altered appetit was identified in 53%. The feeling of sadness was identified in 60% of patients, also crying, pessimism and loss of interest in 40%. Regarding irritability, agitation and feelings of punishment, 47% of participants showed changes. The self-criticism and self-esteem were preserved in 70% and 63% respectively. Suicidal thoughts or desires were identified in 17% and any percentage for this resuts needs attention. The group was 80% male, the average age of participants is 65±7-years. Married patientes are 67%, divorced 20%, singles 3% and widower are 10%. The time after surgery ranged fron 1 to 10 years; 50% had undergone chemotherapy and 73% denied post-surgical complications.
Conclusion
This this study points to is that 53% of patients showed signs of depression on some scale.
{"title":"Assessment of depression in total laryngectomy patients","authors":"Kelen Fernanda Catarochi, Vaneli Colombo Rossi, Carlos Takahiro Chone","doi":"10.1016/j.bjorl.2025.101677","DOIUrl":"10.1016/j.bjorl.2025.101677","url":null,"abstract":"<div><h3>Objective</h3><div>Of this study was to evaluate the presence and severity of depressive symptoms in total laryngectomy patients and identify variations in results of each item on the depression scale.</div></div><div><h3>Methods</h3><div>This study is a quantitative, analytical and cross-sectional study, with 30 total laryngectomized participants, using the Instrument (BDI-II) Beck Depression Inventory-II, from April to July 2024, all total laryngectomized participants who attended the Head and Neck surgery Otorhinolaryngology Outpatient Clinic and were invited to participate in the research, the assessment was carried out by the same reserarcher and the estimated response time was 22 min.</div></div><div><h3>Results</h3><div>Show tha depression was identified in 20% of patients with mild symptoms, 13% moderate and 20% severe. The sleep pattern was altered in 63% of respondents and difficulty concentrating was reported by 57%. Altered appetit was identified in 53%. The feeling of sadness was identified in 60% of patients, also crying, pessimism and loss of interest in 40%. Regarding irritability, agitation and feelings of punishment, 47% of participants showed changes. The self-criticism and self-esteem were preserved in 70% and 63% respectively. Suicidal thoughts or desires were identified in 17% and any percentage for this resuts needs attention. The group was 80% male, the average age of participants is 65±7-years. Married patientes are 67%, divorced 20%, singles 3% and widower are 10%. The time after surgery ranged fron 1 to 10 years; 50% had undergone chemotherapy and 73% denied post-surgical complications.</div></div><div><h3>Conclusion</h3><div>This this study points to is that 53% of patients showed signs of depression on some scale.</div></div><div><h3>Level of evidence</h3><div>Level 3.</div></div>","PeriodicalId":49099,"journal":{"name":"Brazilian Journal of Otorhinolaryngology","volume":"91 6","pages":"Article 101677"},"PeriodicalIF":1.8,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号