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Abstract Objectives: To introduce our method managing nasal septal spurs during endoscopic septoplasty. Methods: We conducted a prospective study of cases treated with endoscopic septoplasty between March 2022 and June 2023. We innovated a surgical method to reduce the local mucosal tension at the spur by cutting the spur above and below the bony connection, and reducing the chance of mucosal tear and loss during dissection. The authors performed these cases at the First Affiliated Hospital of Fujian Medical University, where 40 surgeries were performed with regular postoperative follow-ups for 6-12 months. Results: All patients’ clinical symptoms improved significantly after surgery. After 2-4 weeks of follow-up, the mucosa could recover to the preoperative state on both sides of the nasal septum. Conclusion: This surgical method is suitable for most patients with nasal septal deviation, especially those with a spur, which can effectively reduce the chance of nasal septal mucosa tear and accelerate postoperative recovery. Level of evidence: IV.

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Abstract Objectives: Allergic diseases and Meniere’s disease found to have a possible link in observational study. However, the potential causal relationship between the two is unclear. Therefore, we aimed to explore the causal relationship between allergic diseases and Meniere’s disease using a new data analysis technique called bidirectional Mendelian randomization study. Method: Summary-level statistics for Meniere’s disease and three allergic diseases (asthma, allergic rhinitis, eczema/dermatitis) were obtained from large-scale genome-wide association studies. The inverse variance weighted method was used as the primary measure, supplemented by MR-Egger regression and the weighted median method. To ensure the reliability of the conclusions, Cochran’s Q, MR-Egger intercept, MR-PRESSO test, leave-one-out test, and MR Steiger test were used. Results: Inverse-variance weighted method showed asthma (p = 0.008, OR = 3.908, 95% CI 1.424 − 10.724, adjust p = 0.024), allergic rhinitis (p = 0.026, OR = 24.714, 95% CI 1.479 − 412.827, adjust_p = 0.026) and eczema/dermatitis (p = 0.019, OR = 3725.954, 95% CI 3.795 to 3,658,399.580, adjust_p = 0.029) all had a significant effect on Meniere’s disease. Reverse Mendelian randomization studies have shown that Meniere’s disease does not increase the risk of three allergic diseases. Sensitivity analysis showed no horizontal pleiotropy and heterogeneity for each trait. Conclusion: Our Mendelian randomization analysis supports a positive causal relationship between three allergic diseases (asthma, allergic rhinitis, eczema/dermatitis) and Meniere’s disease. This suggests that physicians should pay more attention to the Meniere’s patient’s allergy history and consider allergy avoidance as part of their treatment plan. Level of evidence: Mendelian Randomized (MR) studies are second only to randomized controlled trials in terms of the level of evidence.

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Abstract Objective: To investigate the efficacy of cluster nursing intervention based on Enhanced Recovery After Surgery (ERAS) for xerostomia in chronic rhinosinusitis after nasal endoscopic surgery. Methods: A total of 80 patients with chronic rhinosinusitis who underwent functional nasal endoscopic surgery between January 2020 and December 2021 were selected and randomly divided into a control group (n = 40) and an experimental group (n = 40). Patients in the control group were treated with general nursing, while ERAS-based cluster nursing intervention was adopted for the experimental group, in addition to general nursing. Xerostomia stage and comfort level were observed at 2h, 6h, 24h and 48h after surgery; negative emotions before and after nursing were also observed. Results: After the intervention, the xerostomia stage and comfort level at 6, 24 and 48 after surgery were higher in the experimental group (p < 0.05). Negative emotions in the experimental group were lower after nursing (p < 0.001). The self-rating depression scale and self-rating anxiety scale scores increased after nursing in both two groups (p < 0.05). Conclusion: Enhanced recovery after surgery-based cluster nursing intervention can alleviate xerostomia, improve patients’ comfort levels, reduce their negative emotions and accelerate postoperative recovery. Level of evidence: 2.

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Abstract 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 2mg/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 3min after suspension laryngoscopy (T2 and T3), at the end of the operation (T4), and at 1, 5, and 30min 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.

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Abstract 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.

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Abstract Objective: To translate and validate the Facial Feminization Surgery Outcomes Evaluation in Brazilian Portuguese. Methods: A standard back-translation method was applied to obtain the final Brazilian Portuguese language version. In total, 21 Brazilian native Portuguese speakers transgender women with surgical intent and 21 Brazilian native Portuguese speakers transgender women without surgical intent were included in the study. The FFSOE was administered to both groups and all patients underwent a test-retest two weeks later. Results: The FFSOE showed a high internal consistency with Cronbach’s alpha greater than 0.8. The test-retest reliability was high with repeated measures being highly correlated in all items, except for item 3, where the difference was significant (p = 0.027). Conclusion: The FFSOE showed reliability, internal consistency and reproducibility in the evaluations. It is easy to understand and quick to apply, making it a simple tool for pre- and post-operative assessment in facial feminization surgeries. The Oxford 2011 Levels of Evidence: Level 4.

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Abstract 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.

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Abstract 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.

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Abstract 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.

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Abstract Objectives: Vestibular migraine is a neurological disorder characterized by the association of vertigo and headache, affecting up to 1% of the population. Among its differential diagnoses is endolymphatic hydrops. The aim of this study was to investigate the role of cervical vestibularevoked myogenic potential and electrocochleography in the diagnosis of vestibular migraine. Method: Thirteen women with clinical diagnosis of vestibular migraine (mean age 44 years) and 13 healthy volunteers without auditory and/or vestibular complaints matched for sex and age were evaluated by performing hydrops examinations of cervical vestibular-evoked myogenic potential and electrocochleography. Results: The presence of vertigo and headache was reported by all members of the group with vestibular migraine, associated with symptoms such as nausea, photophobia, and phonophobia. Tinnitus was the most frequent auditory complaint. A significant increase in P1 and N1 latencies was observed in the test group. There was no significant difference in the occurrence of asymmetry and decreased amplitude of the cervical vestibular-evoked myogenic potential. Electrocochleography showed an increase in amplitude of the summation potential. The altered SP/AP ratio was double in the group with vestibular migration, without statistical significance. Conclusions: Changes in latency increase of cervical vestibular-evoked myogenic potential suggests a central lesion. Patients with vestibular migraine may present electrocochleography compatible with endolymphatic hydrops. Level of evidence: Level 4.

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Abstract Objectives: Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP) is a disease characterized by chronic inflammation and tissue remodeling process. The remodeling process in nasal polyps has mainly been studied by histology analysis. However, it is limited to a polyp fragment and requires tissue removal. The present study aims to evaluate the ability of Magnetic Resonance Imaging (MRI) to depict and characterize the remodeling process in patients with CRSwNP. Methods: 30 patients that met clinical diagnostic criteria for CRSwNP, without previous history of rhinosinusitis surgery were submitted to MRI scan (conventional, diffusion-weighted and DCE MRI) and compared with polyp tissue histological findings, IL-6 concentrations in the tissue and eosinophil count in the blood. The examinations were evaluated, independently, by two radiologists blinded to other radiological and histological data. The pathologist, blinded to MRI results, also compared the tissue sample from the most central and the most peripheral portion of the polypoid tissue adjacent to the floor of the nasal fossa. Results: This study demonstrated a characteristic pattern of nasal polyps, whose peripheral portions of nasal polypoid tissue are edematous, whereas the central portions in the middle meatus and in the middle and upper ethmoid are predominantly fibrotic. ADC values found in the most anterior portion of the polyps may be a marker for radiological phenotyping the remodeling process. This non-invasive analysis presented a high degree of agreement in the fibrosis and edema rating by two radiologists and the histological analysis was concordant with the MRI findings. The polyps were characterized as eosinophilic, and no relationship was found between the severity of the eosinophilic inflammatory process or concentration of IL-6 and the remodeling process. Conclusion: MRI by using T2-weighted imaging sequence and ADCs values allows tissue characterization and is an effective tool for the differentiation of edematous and fibrotic components in CRSwNP. Level of evidence: 3.

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Abstract 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.

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Abstract 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.

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Abstract 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.

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Abstract Objectives: Upper respiratory tract infections, including COVID-19, are associated with olfactory dysfunction and there is a need for novel therapeutic approaches. The aim of study was evaluating the effectiveness of adding melatonin, multivitamin and sodium citrate to olfactory training for the treatment of olfactory loss caused by COVID-19. Methods: We evaluated olfactory function using University of Pennsylvania Smell Identification Test (UPSIT ®) scores and self-reported patient outcomes in post-infectious smell loss cases. We investigated the effectiveness involved olfactory training combined with sodium citrate, melatonin, and multivitamin supplements with zinc over a three-month period compared to an olfactory training alone. Results: A total of 66 patients were included, with 33 in each group. There was no significant difference in the proportion of participants who showed improvement in UPSIT scores between the groups (OR=1.43, 95% CI 0.43-4.8, p= 0.56). Both groups showed improvement in average test scores, but there were no significant differences in self-reported olfactory ability or discomfort with olfactory loss. Qualitative symptoms, such as parosmia and phantosmia, were reported by a similar proportion in both groups before and after the treatment (p= 0.11, p = 1, respectively). Conclusions: Olfactory training alone and olfactory training with associated with melatonin, multivitamins and topical sodium citrate did not show significant differences in improving olfactory function in post-COVID-19 patients. Level of evidence: 3.

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Abstract Objective: To describe pulmonary function, muscle strength and functional performance in the different qualities of sleep and the impact of this on the number of physiotherapeutic assistances. Methods: This is an observational study. In the pre and post operative period, sleep behavior was evaluated using the Pittsburgh questionnaire. Patients were divided into three groups: Good Sleep Quality (GSQ), Poor Sleep Quality (PSQ) and Sleep Disordered (SDB). At this time, other tests were also performed, such as: 6-Minute Walk Test (6MWT), Sit and Stand Test (SST), gait speed test and Timed Up to Go (TUG), Medical Research Council (MRC), maximal inspiratory pressure and maximal expiratory, vital capacity and peak expiratory flow. The functional performance and lung function of each group were compared. Results: A total of 105 people, undergoing cardiac surgery and admitted to hospital were evaluated, 33 with GSQ, 41 with PSQ and 31 with SD. Patients who were in the SDB group had a lower functional performance than the other groups. 6MWT (meters) in the GSQ was 499±87, versus 487±91 in the PSQ and 430±78 in the SD (p = 0.02). In the SST (seconds) it was 10.4±1.1 in the GQS, 11.1±2.3 in the PSQ and 15.4±2.1 in the SD (p = 0.04). Lung function and muscle strength did not differ between groups. Regarding the refusal to perform physical therapy, the SD group was more incident, the main reason being drowsiness. Conclusion: Based on the results, we found that sleep quality interferes with functional performance and physical therapy assistance during the hospital stay in patients undergoing cardiac surgery.

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Abstract Objectives: One of the most common sensory impairments in the elderly is age-related hearing loss, and individuals with this condition have a higher risk of mild cognitive impairment than the overall aged population. The purpose of this study was to conduct a systematic review of the literature in order to evaluate the evidence supporting the hypothesis that mild cognitive impairment may be developed in patients with age-related hearing loss. Methods: The PRISMA principles were followed when searching the databases of the China Knowledge Network, Wanfang, China Biomedical Literature Database, Pub Med, Cochrane Library, Embase, and Web of Science. Tw o investigators independently carried out the quality assessment, data extraction, and literature review of the eligible studies. Stata 17.0 was used to finish the statistical analysis and descriptive results. Results: A total of 13 articles containing 2,222,036 individuals who were evaluated for demographic traits, factors associated with age-related hearing loss, vascular neurologic factors, and psychological factors were included after 2166 search records were found in the database. In patients with age-related hearing loss, eleven factors were found to be risk factors for the development of mild cognitive impairment: age (OR=1.63; 95% CI 1.09 -2.43), male (OR=1.29; 95% CI 1.14 -1.47), degree of hearing loss (OR=1.35; 95% CI 1.03-1.75), not wearing hearing aids (OR=1.56; 95% CI 1.37-1.79), cerebrovascular disease (OR=1.41; 95% CI 1.17-1.69), cardiovascular disease (OR = 1.29; 95% CI 1.07-1.55), diabetes mellitus (OR = 1.28; 95% CI 1.20-1.35), head injury (OR= 1.22; 95% CI 1.13-1.33), alcohol consumption (OR=1.28; 95% CI 1.14-1.43), and tobacco use (OR= 1.19; 95% CI 1.14-1.25), and depression (OR= 1.63; 95% CI 1.47-1.81). Conclusion: Caregivers can customize care strategies to decrease the occurrence of mild cognitive impairment in elderly deaf patients by considering demographic traits, factors associated with age-related hearing loss, vascular-neurologic factors, and psychological factors.

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Abstract Objectives: This study aims to review the current role of various ultrasonographic methods in the evaluation of the upper airway in patients with obstructive sleep apnea. Methods: A literature review was performed on the medical databases: Pubmed, Web of Science, Scopus and Embase. After analyzing the available studies, six of them were selected for data extraction. Results: All selected studies demonstrated that it is possible to use ultrasonography as a method of evaluating the upper airway. Studies with gray-scale ultrasound concluded that the lateral pharyngeal wall and tongue are thicker in patients with obstructive sleep apnea compared to non-apneic patients. Moreover, studies with tissue characterization ultrasound, nowadays called quantitative ultrasound, have identified unique features in obstructive sleep apnea patients: standardized backscatter ultrasonography demonstrated that this particular sound wave analysis is associated with the severity of obstructive sleep apnea. Ultrasonography with elastography shows that the electrical stimulus generated in the hypoglossal nerve results in greater stiffness on the side of the tongue that is stimulated; whereas studies show conflicting results regarding the evaluation of baseline tongue stiffness in obstructive sleep apnea patients compared to non-apneic subjects. Conclusion: There is feasibility of different methods of ultrasonographic evaluation of the upper airway, with emphasis on ultrasonographic methods of tissue characterization, such as elastography, which proved to be a promising method of evaluating the mechanical properties of the muscles involved in the pathogenesis of obstructive sleep apnea and which require further studies for a better elucidation of its applicability.