Resumo em Inglês:

Abstract Objective Nasopharyngeal Carcinoma (NPC) is a tumor with ethnic and geographic distribution characteristics. HOXA Transcript at the distal Tip (HOTTIP) has been confirmed to have cancer-promoting effects in various tumors. The aim of this study was to investigate the clinical significance of HOTTIP in the development of NPC and its role in prognostic assessment. Methods Reverse transcription real-time PCR was used to analyze the expression of HOTTIP in the serum of 122 NPC patients before treatment, 35 controls and 30 NPC patients after treatment, and the relationship between HOTTIP expression and the clinicopathological features and prognosis of NPC patients was analyzed. The NPC cell lines CNE1 and HNE1 stably overexpressing HOTTIP were constructed using the retroviral method. Plate clone formation assays, MTT assays, flow cytometry, and Transwell migration and invasion assays were used to investigate the effects of HOTTIP overexpression on the colony-formation ability, cell proliferation ability, apoptosis, and migration and invasion abilities of CNE1 and HNE1 cells, respectively. Results HOTTIP was highly expressed in NPC serum and cells compared with the control group; serum HOTTIP expression in NPC patients after treatment was significantly lower than that before treatment; Kaplan-Meier survival curve revealed that the Progression-Free Survival (PFS) and Overall Survival (OS) of the HOTTIP low-expression group were both better than those of the HOTTIP high-expression group; COX proportional hazard models showed that high HOTTIP expression was an independent risk factor for PFS in NPC patients. The overexpression of HOTTIP promoted the proliferation, migration and invasion abilities of CNE1 and HNE1 NPC cells and inhibited cell apoptosis in vitro cell experiments. Conclusion Increased HOTTIP expression in serum indicates a poor prognosis and may be used as a molecular marker and therapeutic target in NPC. Level of Evidence: 4.

Resumo em Inglês:

Abstract Objective The Interleukin-1 (IL-1) family plays an important regulatory role in the development of tumors, but its function is still unclear in head and neck squamous cell carcinoma (HNSCC). Analyzing the IL-1 family can help to understand the tumor mechanism. Methods Using GEPIA2, UALCAN, cBioprotocol and HPA databases, the IL-1 family and related genes (IL-1α, IL-1β, IL1RN, IL1R1, IL1R2, IL1RL1, IL1RL2, IL1RAP, IL1RAPL1, IL1RAPL2, IL1F10, IL18, IL18BP, IL18R1, IL18RAP, IL36A, IL36B, IL36G, IL36RN, IL33, IL37, SIGIRR, CASP1, AIM2) were analyzed for their expression and prognostic relevance in HNSCC. The Kaplan-Meier, log-rank test and Spearman correlation were used to analysis. Results In tumors, IL-1α, IL-1β, IL1R1, IL1RL1, IL1F10, IL33, CASP1, and AIM2 are highly expressed, while IL1RN, IL1RAPL1, IL1RAPL2, IL18BP, IL18R1 and IL18RAP are poorly expressed. IL-1α, IL1RAP, and IL1RAPL2 were prognostic risk factors in at least two databases, while IL18RAP, IL36A, and SIGIRR were prognostic protective factors. SIGIRR was confirmed in all three databases. Compared to HPV- tumors, IL18RAP and SIGIRR are highly expressed in HPV+ tumors. In addition, IL-1α, IL-1β, IL1RL2, IL1RAP were negatively correlated with CD8A/B expression, while IL1R2, IL18R1, IL18RAP, IL33, SIGIRR, CASP1, AIM2 were positively correlated with CD8A/B expression. Conclusion The differential expression of the IL-1 family and related genes affects the microenvironment changes and survival prognosis of HNSCC patients. Among them, IL-1α, IL1RAP, IL18RAP, and SIGIRR may affect the prognosis of patients by affecting local CD8+ T cell infiltration in the tumor. Level of evidence: 3.

Resumo em Inglês:

Abstract Objectives To describe the findings of Fiberoptic Endoscopic Examination of Swallowing (FEES) in asymptomatic young and older adults, comparing results across different age groups. Additionally, this study aims to test the Eating Assessment Tool (EAT-10) as an instrument to identify dysphagia risk. Methods A prospective cross-sectional observational analysis was conducted on a sample of individuals aged 20 and above, asymptomatic for dysphagia, stratified by age groups. The EAT-10 questionnaire was completed, and the FEES was employed to assess oropharyngeal swallowing function. Various parameters, including salivary stasis, swallowing reflex trigger, swallowing sequence, residue, penetration, and aspiration were blindly analyzed by two otolaryngologists. Results A total of 184 participants were included, with a mean age of 44.7 ± 18.5 years. There was good to excellent agreement between examiners for FEES parameters. The EAT-10 score ≥3 suggested dysphagia risk in 7.6% (n = 14) of the sample, with no association with age or any FEES parameter. Individuals aged ≥80 years presented more residue (50%; n = 5/10) compared to younger individuals (11.5%; n = 20/174; p= 0.039). Salivary stasis was found exclusively in individuals aged ≥60 years (n = 5/39; 12.8%; p = 0.027). Age did not influence on the swallowing reflex trigger, swallowing sequence, penetration, and aspiration. Penetration was observed in 4.9% (n = 9) of subjects and aspiration occurred in 0.5% (n = 1) of subjects, with no statistical significance in age groups. Conclusion Age does not have a linear influence on swallowing in healthy adults and elderly people. However, individuals aged ≥80 years showed a higher prevalence of residue, and individuals aged ≥60 years showed a higher prevalence of salivary stasis, suggesting an increased risk or presence of dysphagia. Other FEES parameters were not influenced by age. These findings provide valuable insights into the nuanced dynamics of swallowing across different age groups, emphasizing the importance of age-specific considerations in dysphagia assessment. Level of evidence: 4.

Resumo em Inglês:

Abstract Objective The aim of this study was to construct a prognostic model based on the TP53 mutation to calculate prognostic risk scores of patients with HPSCC. Methods TP53 mutation and transcriptome data were downloaded from the TCGA databases. Gene expression data from GSE65858, GSE41613, GSE3292, GSE31056, GSE39366, and GSE227156 datasets were downloaded from the GEO database. GSEA, univariate, multivariate Cox analyses, and LASSO analysis were employed to identify key genes and construct the prognostic model. ROC curves were utilized to validate the OS and RFS results obtained from the model. The associations between risk scores with various clinicopathological characteristics and immune scores were analyzed via ggplot2, corrplot package, and GSVA, respectively. Single-cell sequencing data was analyzed via unbiased clustering and SingleR cell annotations. Results Initially, two key genes, POLD2 and POLR2G, were identified and utilized to construct the prognostic model. Samples were divided into different risk groups via the risk scores obtained from the model, with high-risk group samples exhibiting poorer prognosis. Furthermore, the risk score exhibited a positive correlation with lymphatic metastasis in patients and the immune scores of CD4+ T, CD8+ T, dendritic cell, macrophage, and neutrophil. The immune responses also exhibited notable disparities between the high- and low-risk groups. The results of single-cell sequencing analysis demonstrated that epithelial cells and macrophages were relatively abundant in HPSCC samples. POLD2 and POLR2G exhibited higher expressions in epithelial cells, with most of the identified pathways also enriched in epithelial cells. Conclusion The prognostic model exhibited a significant capacity for predicting the prognosis of HSPCC samples based on the TP53 mutation conditions and may also predict the cancer characteristics and immune infiltration scores of samples via different risk scores obtained from the model. Level of evidence: Level 5.

Resumo em Inglês:

Abstract Objective The aim of this study is to evaluate mastoid volume and dimensions in patients with unilateral microtia using High-Resolution Computed Tomography (HRCT) to enhance the precision of reconstructive surgical planning. Methods A retrospective analysis of HRCT mastoid scans from patients with unilateral microtia was carried out at Cipto Mangunkusumo General Hospital between May 2020 and August 2022. Parameters such as mastoid volume, height, and surface area were measured at the ear canal, Superior Semicircular Canal (SCC), and lateral SCC levels. Results The analysis revealed statistically significant decreases in median mastoid air cell volume and mastoid bone volume in the affected ears compared to contralateral ears (p= 0.0312 and p= 0.02, respectively). Additionally, decreased mastoid height and surface areas at the ear canal and superior SCC levels were identified in affected ears (p< 0.05). Conclusions Patients with unilateral microtia have diminished mastoid bone volumetric parameters and dimensions on the affected side. These findings offer critical data for surgeons in preoperative planning, enabling the selection of appropriate reconstructive techniques and providing comprehensive patient counselling. Level of evidence: Level 4.

Resumo em Inglês:

Abstract Objectives To clarify the hearing outcomes after endoscopic type I tympanoplasty for medium and large perforations due to chronic otitis media. Methods We examined the clinical records of patients who underwent endoscopic type I tympanoplasty for medium and large perforations of the eardrum resulting from chronic otitis media between January 2019 and December 2021. We analyzed the changes in hearing pre- and post-operation in patients with healed eardrums and assessed the impact of tympanosclerosis on hearing. Patients with incomplete follow-up data, middle ear cholesteatoma, stapes fixation, severe lesions in the tympanic antrum and mastoid necessitating mastoidectomy and/or ossicular chain reconstruction were excluded. Results A total of 156 patients underwent analysis for audiological outcomes. Among them, 63 had medium tympanic membrane perforations, with 18 cases showing calcification of the tympanic membrane and 20 cases with calcification in the tympanic cavity. Additionally, 93 cases had large tympanic membrane perforations, with 25 cases showing tympanic membrane calcification and 32 cases with tympanic cavity calcification. Prior to surgery, the Air Conduction threshold (AC) in the large perforation group was higher than in the medium perforation group, particularly at low frequencies, measuring (47.4 ± 13.3 dB) and (41.2 ± 14.7 dB), respectively (p-value < 0.05). Following surgery, both groups experienced an improvement in AC, measuring (33.6 ± 13.9 dB) and (32.6 ± 12.8 dB), respectively, with no significant difference noted (p-value > 0.05). There was no significant change in Bone Conduction threshold (BC) before and after surgery in either the large or medium perforation groups (all p-values > 0.05). Except for 4000 Hz an increase, bone conduction did not increase post-surgery, instead showing further improved. Pre-surgery, the Air-Bone Gap (ABG) in the large and medium perforation groups was (27.7 ± 8.5 dB) and (21.8 ± 8.3 dB), respectively, mainly affecting low frequencies, with a statistically significant difference noted (p-value < 0.05). Following surgery, ABG in both groups improved to (16.3 ± 7.6 dB) and (15.7 ± 8.4 dB), respectively, with no significant difference observed (p-value > 0.05). There was no significant difference in hearing pre-surgery among the groups with No calcification (No), Tympanic Membrane Calcification (TM), and Tympanic Cavity Calcification (TC). However, TC significantly impacted low frequency (250-500 Hz) AC and ABG. The differences in AC and ABG pre-surgery between TC and No group, and TC and TM group (at 250-500 Hz) were statistically significant (all p-values < 0.05). Preoperative ABG in TM group was better than in No group and TC group, suggesting minimal impact of tympanic membrane calcification on hearing. No interaction was observed between tympanic membrane perforation size and tympanosclerosis on hearing. Post-surgery, both large and medium tympanic membrane perforation groups, regardless of tympanosclerosis presence, showed good AC and ABG, with no statistically significant difference in △ABG (all p-values > 0.05). Conclusion Preoperative AC and ABG were increase in cases of large tympanic membrane perforations and medium tympanic membrane perforations with tympanic cavity calcification. Surgical intervention led to more significant hearing improvement in these patients. However, irrespective of tympanic membrane perforation size and the presence of tympanosclerosis, as long as the ossicular chain remains intact and functional, postoperative AC and ABG outcomes are satisfactory. Endoscopic type I tympanoplasty proves effective in achieving improved hearing outcomes for patients with medium to large tympanic membrane perforations and tympanosclerosis, provided there is no ossicle chain fixation. Level of evidence: Level 4.

Resumo em Inglês:

Abstract Objectives The present study aims to characterize immunohistochemical features of markers associated with Epithelial-Mesenchymal Transition (EMT) and proliferative activity that could lead to death in Papillary Thyroid Cancer (PTC). Methods Clinical data and tumor material were retrospectively collected. The patients were separated into death from PTC (Group 1), metastatic cases with indolent behavior (Group 2) and non-metastatic indolent PTC (Group 3). Immunohistochemical assessment of E-cadherin, β-catenin, Vimentin, ZEB-1 and Ki-67 was performed in each tumor and a semiquantitative estimation of the percentage of expression was fulfilled on the best marking area at high of the tumor invasion front. Results 31 patients were included, 15 that died from PTC (Group 1), 6 in Group 2 and 10 in Group 3. The proliferative marker Ki-67 showed a significant difference in its expression in the tumor invasion front between the groups, specifically between groups 1 and 3 (p= 0.006). On the other hand, EMT-related immunohistochemical markers did not show significant difference in their percentage of expression, since loss of E-cadherin, β-catenin and Vimentin was observed in most cases at the invasion front. Conclusion Patients that died from PTC had a significantly higher Ki-67 labelling index compared to patients with indolent disease (cutoff of 11%). Ki-67 may have a role as a prognostic marker and could be considered for routine use in PTC. Level of evidence: 4.

Resumo em Inglês:

Abstract Objective Translate, adapt, and validate the Anterior Skull Base Nasal Inventory 12 questionnaire (ASK Nasal-12) to Brazilian Portuguese. Methods A prospective longitudinal observational study was developed at the Skull Base Surgery Center clinic of the Irmandade Santa Casa de Misericórdia de São Paulo. There were five stages to translating the original ASK-12 questionnaire: two independent translations, consensus between the two, back-translation, comparison, and revision for the semi-final version. Internal consistency, reliability, and validation with a previous already validate questionnaire were all assessed. Results Over 30 months 72 patients in total were included in the study, of which six had to be excluded afterwards according to the research criteria. The internal consistency using Cronbach’s Alpha was calculated and successful. Next the reliability and agreement between the test and retest were analyzed. The Minimally Important Clinical Difference (MCID) was calculated for the 13 scores at each of the four time points. Finally, the final translated version was validated with the SNOT-22 questionnaire. Conclusion The translation, adaptation, and validation of the ASK Nasal-12 questionnaire into Brazilian Portuguese appear consistent and effective regarding its cultural equivalence for monitoring the QOL of patients undergoing transnasal access for endoscopic anterior skull base surgeries. Level of evidence: II.

Resumo em Inglês:

Abstract Objective To analyze the correlation between caloric testing response patterns with respect to cochlear impairment in individuals with unilateral Ménière's disease. Methods In this observational cross-sectional study, the factor under study was Ménière's disease and the outcome was cochleovestibular function, evaluated through caloric stimulation using videonystagmography and four-frequency averages in pure tone audiometry. Results A total of 187 patients (equal sex distribution) who met the inclusion criteria were included. In impairment analysis of the affected ear, 17 patients had only vestibular impairment, 56 had only cochlear impairment, and 114 had cochleovestibular impairment. The distribution of Ménière's disease stages according to four-frequency average was grade I: 23.53%, grade II: 16.04%, grade III: 42.25%, and grade IV: 18.18%. There was a significant association (p< 0.001) between the affected ear and labyrinthine preponderance. The Spearman correlation between four-frequency average and labyrinth preponderance (r = 0.326) indicated a moderate correlation, considering p < 0.01. Conclusion Our results show that the greater the cochlear damage due to Ménière's disease, the more impaired the vestibular function in the affected ear. Level of evidence: Level 2 - Individual cross-sectional studies with consistently applied reference standard and blinding

Resumo em Inglês:

Abstract Objective This study describes the training experience with the Versius Robotic System (CMR Surgical) for Transoral Robotic Surgery (TORS), the setup of the robot and its applicability in a human case. Methods A model mannequin with anatomical characteristics simulating the TORS working space was used for training purposes. Optimal docking, positioning of robotic arms and placement of instruments were defined using the mannequin. A human patient was selected based on the inclusion criteria, and a standardized protocol for robotic techniques was developed. The surgical procedure was conducted in accordance with ethical guidelines. Results The synthetic polymer mannequin mimicking human tissues and anatomy was used to define the robot set up for TORS. The patient was indicated for bilateral tonsillectomy due to recurrent episodes of tonsillitis. Bipolar Maryland and monopolar scissors were used. The procedure was uneventful. The patient remained hospitalized for 1 day and returned to work activities within 6-days, with no complications. Conclusion The specialized mannequin proved to be effective in the simulation, training proposal and set up standardization. Furthermore, the Versius robot was found to be safe and achieved excellent results during surgery. Despite being very promising, the Versius system is still in its developmental phase and requires larger-scale samples for a more comprehensive evaluation. Level of evidence: 4.

Resumo em Inglês:

Abstract Objective: To understand the characteristics of cervical lymph node metastasis in Oropharyngeal Squamous Cell Carcinoma (OPSCC) patients, explore the risk factors for lymph node metastasis, and its impact on prognosis. Methods: Retrospective cohort study. Statistical analysis of the relationship between various clinicopathological factors and lymph node involvement, as well as the independent risk factors affecting lymph node metastasis and their impact on prognosis. Results: The cervical lymph node metastasis rate in this group was 89.2%, with the palatine tonsils and base of the tongue more prone to cervical lymph node metastasis (p = 0.007); lower pathological differentiation of OPSCC was more likely to develop cervical lymph node metastasis (p = 0.017). The P16 protein positive rate in this group was 58.8%. P16 protein expression did not affect the incidence rate of cervical lymph node metastasis in OPSCC (p = 1.000) but influenced the risk of multiple lymph node metastases (p = 0.011) and was a risk factor affecting the prognosis of OPSCC (p = 0.003). However, the lymph node metastasis status did not affect the survival time of OPSCC patients. Conclusion: In the Shanxi region of China, HPV-related OPSCC accounts for a higher proportion; OPSCC has a high rate of cervical lymph node metastasis, but lymph node metastasis does not significantly increase the mortality risk of OPSCC patients, which may be related to the unique characteristics of HPV-related OPSCC. Level of Evidence IV: Retrospective cohort study.

Resumo em Inglês:

Abstract Objective: This study aims to evaluate the cognitive performance in adults with hearing loss and to identify associations between clinical characteristics of hearing loss and cognitive outcomes. Methods: In this cross-sectional analytical observational study, adults with hearing loss underwent the Mini-Mental State Examination (MMSE), following the collection of their clinical and audiometric data. Results: Among 134 evaluated individuals, a majority reported a progressive onset (91.04%) and bilateral nature (87.31%) of hearing loss, with moderate hearing loss being the most common (41.04%). Sensorineural hearing loss was prevalent in 76.12% of cases, with presbycusis identified as a primary etiology in 37.31%. Comorbidities were reported in 61.19% of participants, with 16.42% using benzodiazepines or antidepressants regularly. Symptoms included imbalance (33.58%), vertigo (42.54%), and tinnitus (73.88%). Notably, a sudden onset of hearing loss and imbalance complaints were linked to a higher likelihood of subnormal MMSE performance. Analysis revealed varied cognitive domain performances associated with different clinical characteristics of hearing loss. Conclusion: Various aspects of hearing loss, such as bilateral and sensorineural types, and the presence of symptoms like tinnitus and vertigo, significantly influence cognitive performance. Specifically, sudden onset hearing loss and imbalance complaints are associated with poorer overall cognitive outcomes in the MMSE. These findings underscore the importance of considering the diverse impacts of hearing loss characteristics on cognitive functions. Level of evidence: Level 4.

Resumo em Inglês:

Abstract Objective: To validate and assess the reproducibility of the ISAAC Written Allergic Rhinitis Questionnaire (WARQ) for children aged between 6 and 7 years by telephone contact. Methods: Observational study through interviews with guardians of children aged 6-7 years using the ISAAC Allergic Rhinitis (AR) module questionnaire in three different phases separated by 2 weeks each: telephone interviews in the first and third contacts and face-to-face interviews, with the same guardian of telephone interviews, in the second contact. Reproducibility was estimated using the Kappa index and validation using the sensitivity and specificity coefficients. Results: Data from 94 children (48 from the allergic rhinitis Control Group - CG) were analyzed. Reproducibility showed perfect agreement (100%) for the question number 1 - Which refers to the symptoms of AR, ever: “Has your child ever had a problem with sneezing or a runny or a blocked nose when he/she did not have a cold or the flu?” and for the question number 2 - Which refers to current symptoms of AR: “In the past 12 months, has your child had a problem with sneezing or a runny or a blocked nose when he/she did not have a cold or the flu?” A strong agreement was also observed for the question number 3 (Κ = 0.871) - it defines the presence of comorbidity of allergic rhinoconjuntivitis “In the past 12 months, has this nose problem been accompanied by itchy-watery eyes?” The validation showed high specificity (≥76.7%) and sensitivity (≥98%) for all questions, except for the ones related to seasonality and intensity of symptoms. Conclusions: Our results showed that the ISAAC AR module questionnaire by telephone interviews has good reproducibility and high agreement with the clinical diagnosis of AR. It may be an appropriate alternative tool in epidemiological studies of childhood AR, especially in periods of social isolation, such as Coronavirus pandemic. Level of evidence: Cohort Study. Level IV

Resumo em Inglês:

Abstract Objectives: To evaluate vocal, swallowing and respiratory rehabilitation of patients undergoing supracricoid laryngectomy; evaluate the impact of voice changes and global quality of life. Methods: It is a prospective cohort study where voice, swallowing and respiratory rehabilitation where evaluated. Quality of life was assessed using EORTC QLQ-C30 and H&N35 questionnaires. Results: 31 patients were included in the study. 70.4% of patients were T3. In swallowing assessment, two patients (6.4%) were considered non-rehabilitated. Ten patients (32.2%) were considered partially rehabilitated and 19 (61.3%) fully rehabilitated. Sensitivity was abnormal at 74.2%. Penetration occurred in 58.1% of patients with 29% experiencing aspiration. In voice assessment, 19 (61.3%) patients were considered rehabilitated. 77.41% had a calculated voice handicap index considered abnormal. When assessing breathing, eight patients (25.8%) were considered non-rehabilitated. Disease-free survival was 87.1% in follow-up of 5.77 years. When subjected to specific exams and evaluations, only 38.7% were completely rehabilitated. When comparing results of EORTC-C30 and H&N35 questionnaires with the reference values, global score and domain scores are better on the patients of the study, as well as some of the symptoms. Conclusion: Partial supracricoid laryngectomy remains an option in patients with laryngeal tumors, especially in the most advanced ones, with a survival rate around 90%. Quality of life is impacted after surgery, but with few symptoms. Level of evidence: Level 3.1

Resumo em Inglês:

Abstract Objectives: To compare Anatomy-Based Fitting (ABF) vs. Default Fitting (DF) in terms of music perception and music enjoyment in CI users. Methods: CI users ≥ 18 years implanted with a Synchrony ST Flex28 (MEDEL) with at least 12 months of experience with either ABF or DF, with good speech tests outcomes (≥ 65% disyllables) were enrolled. Music tasks were assessed with “Discovery” level of Meludia online interactive music tool, which includes Rhythm (beat count), Spatialization (differentiating between lower and higher notes), Stable/unstable (perception of stability or instability), Melody (ascendant or descendant), and Density (presence of one or multiple simultaneous sounds). Each task consists of five levels of difficulty. Participants were allowed a maximum of 4 attempts to complete a level. The Music-Related Quality of Life (MuRQoL) and the Munich Music (MUMU) questionnaires evaluated music background. Results: Twenty CI users took part: 10 using ABF and 10 DF. There were no significant differences in age at implantation (53.2 ± 15.0 vs. 53.8 ± 14.5y), time since surgery (1.8 ± 0.5 vs. 2.4 ± 1.5y), or the percentage of disyllables in silence (68.0 ± 8.0 vs. 77.3 ± 11.5%) between groups. Regarding Meludia scores, differences were observed between both groups in Density: ABF had better mean scores when completing the level in only one attempt (8.7 ± 2.5 vs. 4.6 ± 3.1, p = 0.016) and required fewer restarts to complete the five levels (6.6 ± 1.6 vs. 9.3 ± 2.3; p = 0.009). Furthermore, the fifth level of Density was successfully completed by 60% of patients with ABF, while none of the patients with DF achieved this (p = 0.003). The scores obtained in MuRQoL were similar between ABF and DF groups. In a similar way, the MUMU showed no differences in terms of frequency and music importance. Conclusions: ABF demonstrates specific advantages in certain musical tasks, specifically in processing multiple sounds simultaneously. Further studies are necessary to explore additional benefits of ABF in musical skills in CI users. NCT05319678. Level of evidence: Level 3.

Resumo em Inglês:

Abstract Objective: To identify risk factors for Lymph Node Metastasis (LNM) in pT3-4 Laryngeal Squamous Cell Carci-noma (LSCC) patients with negative margins, and develop a nomogram to predict LNM risk. Methods: 872 patients were divided into training (2010–2014) and validation (2015–2016) cohorts. Univariate and multivariate analyses identified LNM risk factors. A nomogram incorporating significant factors was developed in the training cohort. Results: Smoking history, maximal tumor diameter ≥3.0cm, depth of tumor invasion >1.0cm, and supraglottic tumor location were significantly associated with LNM on multivariate analysis. A predictive nomogram incorporating these factors showed good discrimination (C-index >0.7) in both cohorts. Patients were stratified into low, moderate and high-risk subgroups based on total risk scores. Conclusions: A LNM risk prediction model and risk grouping system was established, which may aid treatment selection for pT3-4 LSCC patients. The model and algorithm could help optimize neck management for this high- risk patient population. Level of evidence:

Resumo em Inglês:

Abstract 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 lweeks, 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.

Resumo em Inglês:

Abstract 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.

Resumo em Inglês:

Abstract 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.

Resumo em Inglês:

Abstract Objective: This study aimed to assess the efficacy of a novel modified asymmetric chondro-perichondrial island graft in tympanoplasty. The design features a longer anterior segment compared to the posterior segment, addressing limitations of symmetrical grafts. We investigated the impact of this modified graft on hearing improvement and graft success rates in patients undergoing tympanoplasty surgery. Methods: This retrospective study evaluated 784 patients with chronic otitis media who underwent primary type I tympanoplasty with a modified asymmetric chondro-perichondrial island graft technique. Demographics and characteristics of all patients, preoperative location of the perforation, and Pure-Tone Audiometry (PTA) were assessed preoperatively, and graft success and postoperative hearing outcomes were evaluated at the 12-month follow-up. Results: This study evaluated the efficacy of a modified asymmetric chondro-perichondrial island graft in tympanoplasty. In 784 patients, the mean 12-month postoperative Air-Bone Gap (ABG) improvement was 17.3 dB with a 99% graft success rate. Preoperative ABG significantly improved from 24 dB to 6.6 dB postoperatively (p < 0.001). Perforation location did not affect ABG improvement (p = 0.193) but did influence graft success rate (p < 0.001). No sensorineural hearing loss, retraction pockets, or cholesteatoma were observed postoperatively. Conclusion: Tympanoplasty offers a well-established surgical approach for restoring hearing function and preventing recurrent otorrhea. The asymmetric cartilage-perichondrium island graft design has emerged as a promising technique to achieve optimal functional and anatomical outcomes in tympanoplasty. Level of evidence: Level 4.

Resumo em Inglês:

Abstract 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.

Resumo em Inglês:

Abstract 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.

Resumo em Inglês:

Abstract Objective: Laminin subunit Beta-1 (LAMB1), a component of the extracellular matrix, has been reported to be implicated in the development and progression of cancer. However, the role of LAMB1 in Nasopharyngeal Carcinoma (NPC) remains unknown. Methods: Three NPC datasets were utilized to identify LAMB1 as a targeted gene. The correlation between LAMB1 expression and clinical characteristics, prognosis was explored. KEGG and GO enrichment analyses were conducted to investigate LAMB1’s functions in NPC. The CIBERSORT, xCell, MCPCOUNTER, and EPIC methods were used to assess the Cancer-Associated Fibroblasts (CAFs) and immune cells infiltration. We predicted LAMB1’s effect on treatment using TIDE, CTRP, and CellMine databases. Finally, Western blot, CCK-8, Transwell, and Wound scratch were employed to validate LAMB1’s effect on NPC cells. Results: LAMB1 was highly expressed in NPC. High-expression LAMB1 was correlated with poorer progressionfree survival and impeded the infiltration of CD4+ T-cells, CD8+ T-cells and dendritic cells. It also diminished the expression of HLA and suppressed T-cells stimulation. Differential expressed cytokines and involved pathways were divergent across different level of fibroblasts infiltration. At high level of fibroblasts, LAMB1 indirectly inhibited immune cells by remolding extracellular matrix. But at low level of fibroblasts, LAMB1 directly suppressed immune response. Tumors with high LAMB1 level had weak responses to immunotherapy. In vitro experiment, LAMB1 significantly suppressed HLA-1 and enhanced the proliferation, migration, and invasion capabilities of NPC cells. Conclusion: High expression of LAMB1 is significantly associated with an immune-suppressive tumor microenvironment in NPC. LAMB1 enhances the proliferation, migration and invasion of NPC cells. These findings suggest that LAMB1 may serve as a prognostic biomarker for predicting NPC progression and a potential therapeutic target to enhance the efficacy of existing immunotherapies. Level of evidence: 3.

Resumo em Inglês:

Abstract 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.

Resumo em Inglês:

Abstract 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 clinico-pathologic 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 >1cm, 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 (95CI 0.626‒0.909) and 0.798 (95CI 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 >1cm, bilaterality, multifocality, and ETE are more likely to become LAPTC. LAPTC patients with age ≥55-years-old, tumor size >1cm, 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.

Resumo em Inglês:

Abstract 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 10of 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 dupi-lumab. 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

Resumo em Inglês:

Abstract Objective: High altitude hypobaric hypoxia can induce hearing impairment and hearing acclimatization, but few studies have been performed to decipher the potential transition between the two states. To decipher transition- related circular RNAs (circRNAs)-microRNAs (miRNAs)-messenger RNA (mRNAs) regulatory network. Methods: Wistar rats were airlifted from plain to high altitude and maintained for 30 days and 60 days. Hearing acclimatization was determined using the Auditory Brainstem Response (ABR) test. Cochlea tissues were isolated, and high-throughput circRNA analysis and mRNAs-sequencing were performed. Differentially Expressed circR-NAs (DEcircRNAs) and Differentially Expressed mRNAs (DEmRNAs) were obtained, and circRNA-miRNA and miRNA-mRNA regulation were predicted. A circRNA-miRNA-mRNA competing endogenous RNA (ceRNA) network was also constructed. The DEmRNAs in this network were functionally annotated using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses based on Metascape. Results: The ABR assay indicated that hearing impairment happened on day 30 and hearing acclimatization occurred on day 60. Hearing impairment-related circRNAs (64 upregulated and 147 downregulated) and genes (572 upregulated and 757 downregulated) were identified. Hearing acclimatization-related circRNAs (79 upregulated and 142 downregulated) and genes (690 upregulated and 751 downregulated) were also identified. Hearing impairment and hearing acclimatization ceRNA networks were also constructed after integrating the predicted miRNA regulation analyses. Anterograde trans-synaptic signaling (GO:0098916) and negative regu-lation of cellular response to growth factor stimulus (GO:0090288) were regulated by hearing impairment ceRNA networks, and embryonic organ development (GO:0048568) was regulated by hearing acclimatization ceRNA networks. Conclusion: Hearing impairment- and hearing acclimatization-associated circRNAs and ceRNA networks were identified, which contribute new knowledge to our understanding of acclimatization transition.

Resumo em Inglês:

Abstract Objectives To overcome the fear associated with conventional nomenclature related to different anatomic positions for Bonebridge. Methods Bonebridge is an active transcutaneous semi-implantable bone conduction device available for clinical use since 2012. Bonebridge is indicated in patients with conductive and mild mixed hearing loss and a bone conduction threshold above 45 dB. This situation can be mainly found in patients with aural atresia, radical cavities, chronic otitis media and selected cases of otosclerosis not suitable for stapedectomy or hearing aids. The initial proposal was to position the implant in the mastoid, adjacent to the external ear canal. This position cannot be used in patients with radical cavities and should not be used in patients with aural atresia to avoid complications of future ear reconstructive surgery. New positions were soon implemented in the retrosigmoid and the middle fossa areas. However, the terms “retrosigmoid” and “middle fossa” are clearly linked to skull base surgery and create reluctancy among a large number of potential users. Results To avoid the negative reaction of otologic surgeons to these names we propose the use of easy to remember names related to the anatomic location of the implant. These names have been presented to the scientific community in meetings over the last decade and are now published in this short paper. Conclusion The new nomenclature proposed for the different anatomic positions available for Bonebridge is designed to stop the association between Bonebridge and skull base surgery. Level of evidence Level 2.

Resumo em Inglês:

Abstract Objective To compare the results of Pure Tone Audiometry (PTA) and speech recognition, of users of Cochlear Implant (CI) between CLABOX with Direct Audio Input (DAI) and the Sound Booth (SB). Methods Fifty individuals with CIs, 33 adults and 17 children, were included. Speech recognition tests in noise fixed and adaptive were applied with the Hearing in Noise Test (HINT), Ling test, and PTA, in the SB (in free field) and in CLABOX. Results For speech recognition in noise, averages were better in the CLABOX; for PTA, they were higher in the CLABOX; and for Ling test, there was no significant change in the categories between SB and CLABOX. The fixed noise were higher in the CLABOX (88.3%) than in the SB (78.9%), p-value < 0.001. In the HINT with adaptive noise, the results were significant (p-value = 0.007); the S/N ratio was 2.14 dB in the CLABOX and 3.42 dB in the SB. For the four-tone average, the average thresholds for the CLABOX and the SB were 29.8 dB and 23 dB, respectively (p-values < 0.001). Conclusion CLABOX was an effective tool to evaluate the PTA and speech recognition tests when compared to the conventional evaluation with a SB in the CI user population.

Resumo em Inglês:

Abstract Objective Programmed Cell Death (PCD) processes have been suggested to play a role in the development of cancers. The study aimed to investigate the enrichment of different types of PCD and identify important PCD-related genes in Thyroid Carcinoma (THCA). Methods The whole study is based on transcriptomic analysis and Immunohistochemistry (IHC) experiments. For transcriptomic analysis, the transcriptomic data of THCA (n = 493) and normal thyroid samples (n = 58) was used. The enrichment score of different types of PCD in THCA samples was calculated and the most enriched PCD process was identified. Then the expression of PCD-related genes in control and THCA samples were compared and the association between cuproptosis and characteristics of Tumor Microenvironment (TME) in THCA tissues was explored. IHC experiment was performed to confirm gene expressions in THCA and para-tumor samples. Results Enrichment analysis showed that cuproptosis was the most enriched type of PCD process and associated with malignancy in THCA. The expression of a cuproptosis-related gene, CDKN2A, was found and confirmed to be higher in THCA than normal samples and associated with poor outcomes and higher clinical stages of patients with THCA. Moreover, CDKN2A expression was associated with immunosuppressive TME in THCA. Conclusion Our findings indicated the important role of cuproptosis and a cuproptosis-related gene, CDKN2A, in the development and progression of THCA, which might provide novel insights into the understanding of pathophysiology of THCA.

Resumo em Inglês:

Abstract Objective This retrospective study aimed at comparing the extent of epithelialization in mastoid obliteration after Canal Wall Down (CWD) mastoidectomy using Hydroxyapatite (HA) alone or using HA in combination with Concentrated Growth Factor (CGF) extracted from autologous blood. Methods A total of 56 patients undergoing the CWD mastoidectomy were enrolled. One group was treated by HA, while the other group received HA and CGF for mastoid obliteration (CGF/HA). A review of the medical follow-up records of all patients was conducted, with a primary focus on the otoendoscopic imaging materials. Complete epithelialization was determined by the absence of granulation, discharge, and swelling. The requisite period for complete epithelialization of the mastoid cavity was thus calculated, scored, and analyzed between treatments. Results Ear discharge, graft swelling, and poor blood supply were more frequently observed in the HA group. The proportion of patients group that achieved complete epithelialization within 60 days post operation was significantly higher in the CGF/HA group than the HA group. According to the scoring system for complete epithelialization, the median score of the CGF/HA group was 2, significantly higher than that of the HA treatment group (median score = 1, p = 0.032). Altogether, our results indicated that duration needed for complete epithelialization in the CGF/HA group was shorter than the control group. Conclusion The application of CGF to surgical cavity obliteration following a CWD mastoidectomy significantly promotes epithelialization, thereby achieving satisfactory results. Randomized controlled trials with a larger number of patients enrolled were worth launching in the future to better substantiate the value of CGF in obliteration of mastoid cavity. Level of evidence Level 2-Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.

Resumo em Inglês:

Abstract Objective Hearing loss is a widespread condition that impacts the quality of life, affecting communication, social interactions, and cognitive functions. This study aimed to evaluate the subjective benefit and satisfaction of using hearing aids among patients since the adoption rate of hearing aids remains low. Methods The study retrospectively analysed data from 133 patients with hearing aids, using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Satisfaction with Amplification in Daily Life (SADL) questionnaires. Patients were divided into two groups based on this median age and sex for comparative analysis. The Mann Whitney test was applied with references to numerical parameters (APHAB and SADL) to assess differences between male vs female subjects and adults vs elderly. The Spearman correlation test was applied to assess the possible correlation between APHAB and SADL. A p-value lower than 0.05 was considered statistically significant. Results Results indicated no significant gender differences in most APHAB and SADL subscales, except for the SADL “personal image” subscale, which showed lower scores for women (p= 0.023). Age-based comparison revealed no significant differences in APHAB scores; the SADL scores showed significant differences in the “positive effect” (p= 0.013), “negative features” (p= 0.005), and overall scores (p= 0.039), with lower satisfaction in older patients. Correlation analysis identified a positive relationship between the SADL “negative features” and APHAB “aversiveness” subscales (p= 0.042, correlation coefficient ρ = 0.176). Conclusions The study highlights the importance of addressing subjective perceptions and aesthetic concerns in hearing aid adoption, emphasizing the need for personalized rehabilitation strategies to improve patient outcomes and satisfaction. Level of evidence Level 3.

Resumo em Inglês:

Abstract Objective NLRP3 plays a key role in cellular pyroptosis and tumor progression. However, research on NLRP3-Related Genes (NRGs) in Nasopharyngeal Carcinoma (NPC) is limited. Methods We analyzed the GSE53819 dataset to identify genes positively correlated with NLRP3 mRNA and downregulated in NPC tumors, termed NRGs. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were used to characterize their biological functions. Validation was performed using the GSE64634 and GSE102349 datasets. The GSE102349 dataset was used to evaluate the impact of NRGs on the Progression-Free Survival (PFS) and their association with immune cell infiltration. A cohort of 421 NPC patients from a local hospital underwent multivariate Cox regression to assess the prognostic significance of hub NRGs. Cellular experiments further investigated the role of hub NRGs in NPC. Results In the GSE53819 dataset, 26 NRGs were identified, correlated with NLRP3 expression, and downregulated in tumor tissues. GO and KEGG analyses linked these 26 NRGs to the inflammasome complex. TMEM71, identified in the GSE64634 and GSE102349 datasets, was downregulated in tumor tissues and positively correlated with NLRP3 expression. It was the only NRG with prognostic value, with higher expression correlating with improved PFS. Immune cell infiltration analysis showed significant differences between high and low TMEM71 expression groups (e.g., naïve B cells). Local analysis confirmed that positive TMEM71 expression in tumor serves as an independent prognostic marker for NPC (HR = 0.53, 95% CI 0.366‒0.780). in vitro, TMEM71 activation of the NLRP3/caspase-1/GSDMD pathway suppressed malignant behaviors in NPC cell. Conclusion TMEM71 may serve as a prognostic biomarker for NPC and influence immune cell infiltration. Its overexpression could exert anticancer effects via the NLRP3/caspase-1/GSDMD pathway, highlight its potential as a therapeutic target in NPC.

Resumo em Inglês:

Abstract Objective The feasibility of the RS for the clinical diagnosis of thyroid tumours was explored. Methods The tumour specimens from 30 benign patients and 30 malignant patients were collected. The collected specimens were subjected to RS and histopathological analysis. The Raman peak intensities of all the specimens were calculated, and the data were analysed using discriminant analysis. Results (1) The prevalence rate of malignant tumours in females was as high as 76.7%. Central lymph node metastasis of malignant thyroid tumours accounted for 33.3% of cases, and lateral cervical lymph node metastasis accounted for only 6.7%. (2) The spectral intensity of malignant thyroid tumours was significantly greater than benign thyroid tumours at 1309 cm−1, which should be the characteristic peak of thyroid cancer. The accuracy, sensitivity, and specificity of the RS for differentiating benign from malignant thyroid tumours were 95%, 83.3% and 89.2%. Conclusion RS is feasible for the diagnosis of thyroid tumours. This study provides experimental and clinical support for the wider application of RS in the evaluation of thyroid tissue. Levels of evidence : Levels 4.

Resumo em Inglês:

Abstract Objective Hearing impairment is a common disability in elderly people. With an ageing population, it is expected that the number of people with age-related hearing loss will grow, and a proportion are likely to become Cochlear Implant (CI) candidates. The aim of this study is to investigate whether the age at which a person receives a CI has an impact on their objective speech understanding outcomes and subjective, self-reported outcomes within the first 12-months of CI use. Methods 242 CI recipients participated in this study. Participants were divided into 3 groups according to age at implantation: 72 younger adults (18-60 years); 109 older adults (60-75 years); and 65 elderly adults (>75-years). Benefit of CI use was assessed via speech understanding and patient-reported measures. Speech understanding in quiet was assessed via the Consonant-Nucleus-Consonant words test. Speech understanding in noise was assessed via the Bamford-Kowal-Bench Adaptive speech-in-noise test. Self-perceived hearing ability was assessed via the short from of the Speech, Spatial and Qualities of Hearing scale. Tinnitus reduction, if applicable, was assessed via the Tinnitus Reaction Questionnaire. All 4 assessments were completed at 4 intervals: preoperatively, 3-, 6-, and 12-months of CI use. Results For the entire cohort over time, significant improvements were found for speech understanding in quiet (p < 0.0001), and self-perceived hearing ability (p < 0.0001). Between the three groups, there were no significant differences in any postoperative (post-Op) assessment for all study outcomes. Conclusion Each age group had improved speech understanding and self-perceived hearing abilities after 12-months of CI use. No significant differences were found between groups at all post-Op test intervals. We therefore conclude that elderly people (>75-years) who are acceptable CI candidates should be offered the same opportunity to benefit from CI use as younger adult candidates. Level of evidence Level 3.

Resumo em Inglês:

Abstract Objective To evaluate outcomes of locoregionally advanced patients with Head and Neck Squamous Cell Carcinoma (HNSCC) treated with Induction Therapy (ICT). Methods Toxicity, response rate, and Event-Free Survival (EFS) and Overall Survival (OS) were evaluated in patients treated with docetaxel, cisplatin, and 5-Fluorouracil (TPF) or docetaxel and Cisplatin (TP). Results ICT regimens did not alter response to ICT, and patients’ EFS and OS. Cox multivariate analysis identified stable or progressive disease (HR = 5.56) and interval between cycles ≥28 days (HR = 2.79) as predictors of lower EFS, and ECOG ≥ 1 (HR = 3.42), stable or progressive disease (HR = 4.67), and interval between cycles ≥28 days (HR = 2.73) as predictors of lower OS. Conclusion Our findings indicate TP as a good treatment option for locoregionally advanced HNSCC, especially in socioeconomically limited settings. Level of evidence 3.

Resumo em Inglês:

Abstract Objective The aim of this study was to retrospectively evaluate the efficacy of using the Batten septal bone graft intraoperatively to correct anterior septal deviations that covers Zone 1 and Zone 2 as proposed by Cottle using the NOSE scale. Methods To this end, 30 patients with anterior septal deviations who underwent Functional Rhinoseptoplasty surgery from February 2019 to May 2023 and used septal bone grafting to correct the deviation were collected in a clinical study at the Otorhinolaryngology Department of a tertiary hospital in São Paulo. Results There was a reduction in the Nose Scale from 75.5% to 17.3% in patients who underwent septal deviation correction using this graft (p < 0.001). Conclusion The septal bone batten trought the endonasal approach proved to be an excellent alternative for correcting anterior deviations in patients where the simple removal of osteo-cartilaginous structures is not enough to resolve them. This graft is easy to obtain, has the ideal properties for its purpose and presented no complications related to its use in the study. Level of evidence Level 2.

Resumo em Inglês:

Abstract Objective Presbycusis is a prevalent health issue among the elderly. Previous studies have shown mechanisms related to this condition, but the underlying mechanisms of presbycusis remain elusive. N6-methyladenosine (m6A) modification in regulating gene expression and cellular functions has been implicated in the development of various diseases. Nevertheless, the potential role of m6A regulators in presbycusis is still unclear. In this study, we aim to determine the expression of m6A regulators in the cochleae of young and old mice, and to investigate their potential role in aging. Methods We sequenced the transcriptome from the cochleae of six young (2-mo) and six old mice (24-mo) bioinformatics analysis. Differential expression analysis and downstream functional analysis was performed to identify m6A regulators. Association of m6A regulators with protein-protein interaction and transcription factor-miRNA networks were constructed to explore their regulatory mechanisms. Results ALKBH5 and YTHDC1 were found upregulated in the aged cochleae. They were strongly correlated with immune-related pathways, immune molecular subtypes, and immune infiltration levels in old mice, suggesting their potential involvement in immune-related mechanisms of presbycusis. Receiver Operating Characteristic (ROC) curve analysis demonstrated the high diagnostic potential molecules of AlkB Homolog 5 (ALKBH5) and YTHDC1. Conclusion This study has established a molecular foundation and introduce a novel perspective on the role of m6A regulators in presbycusis, emphasizing ALKBH5 and YTHDC1 as potential markers. Level of evidence Acknowledging methodological similarities with Level 3 (non-randomized controlled cohort or case-control studies) in clinical research, we reference Level 3 as a comparative framework, while recognizing the distinct differences between clinical and animal research settings.

Resumo em Inglês:

Abstract Objective To identify audiometric profiles of otosclerosis patients and present Computed Tomography (CT) findings with their otopathological correlates using human temporal bone specimens. Methods We analyzed sequential patients diagnosed with otosclerosis at a university hospital. Each patient underwent hearing evaluations and CT scans. We assessed the type and severity of hearing loss and the presence and location of otosclerotic foci. Audiometric results and CT images were compared. Additionally, representative otopathological specimens from the Paparella Otopathology & Pathogenesis Laboratory were examined to understand the impact of otosclerotic foci on cochlear and inner ear structures. Results The study included 40 patients (25 female, 15 male; mean age 50.9 years, range 24-72). Most patients were white (62.5%), with others being black (35%) or Asian (2.5%). Symptoms typically began at age 36.4 years, with an average disease duration of 14.3 years. Audiometric analysis of 71 ears (excluding 9 previously operated) showed mixed hearing loss in 64.78%, sensorineural loss in 23.94%, conductive loss in 2.81%, and normal hearing in 8.45%. Our data revealed a significantly higher prevalence of sensorineural hearing loss among patients with otosclerosis compared to previous reports. This disparity may be due to our higher diagnostic rate, as CT scans were used for patients with unexplained sensorineural hearing loss, and the longer disease course related to delayed specialist access caused by structural issues in the Brazilian health system. Relevant CT findings are presented and compared with similar otopathology specimens. Conclusions Our study highlights a higher prevalence of mixed and sensorineural hearing loss in patients with otosclerosis than previously reported, suggesting that otosclerosis may be associated with more significant auditory impairment than commonly recognized. However, given the limitations of our retrospective design and the potential influence of co-morbidities, these findings should be interpreted with caution. Level of evidence 2.

Resumo em Inglês:

Abstract Objective Find an association between diameter of the Thoracic Inlet (TI) and RSG to determine whether the TI would function as a natural anatomical barrier to prevent the passage of the goiters to the thoracic cavity. Methods A retrospective study was conducted with patients submitted to total thyroidectomy, with goiter greater than 50 cm3, who underwent Computed Tomography (CT) preoperatively to measure the TI volume. The values obtained from each continuous variable of parametric distribution were organized and described as mean and standard deviation. The distributions were defined as non-parametric by the Kolmogorov-Smirnov test. The Mann-Whitney test was used to compare two sample populations. Results A total of 173 patients submitted to total thyroidectomy were evaluated, and 54 patients met the inclusion criteria of the study. 85.2% were female, with a mean age of 57-years. The mean diameter of the TI was 5679 mm2. 42% of the patients presented some degree of RSG. The distance below the TI ranged from 0.2 to 5 cm. Conclusion No significant association was found between diameter of the thoracic inlet and retrosternal goiter, demonstrating that RSG can be present regardless of the TI diameter. Statistically significant association was observed between patients with larger thyroid volume and the likelihood of this tissue to extend to the thoracic cavity. Level of evidence Level IV.

Resumo em Inglês:

Abstract Objective This systematic review was performed to compare the diagnostic accuracy of FEES and VFSS in evaluating swallowing in adults with dysphagia. Methods A search for articles published between January 1991 and March 2020 was carried out in the MEDLINE EMBASE, COCHRANE, SciELO, and LILACS electronic databases. Based on the eligibility criteria, six articles were included. Results FEES demonstrated a higher ability to diagnose pharyngeal residue, penetration, and aspiration compared with VFSS, and slightly better performance in detecting premature spillage. Conclusion There were no significant differences on the diagnostic performance of both tests. The choice of test should depend on availability, team experience, and patient’s preference. Level of evidence Level III.

Resumo em Inglês:

Abstract Objective Stroboscopy can uncover significant laryngeal abnormalities in patients with Parkinson’s Disease (PD). Rigid telescope and flexible fiberscopy present differing advantages. Objective: To compare the stroboscopic findings observed using rigid telescopy to those obtained through fiberoptic examination. Methods A prospective study was conducted in order to evaluate 36 patients with PD from January 2018 to December 2019. The HY - Degree of Disability Scale was adopted in order to assess individual patients’ levels of impairment. The patients included in this study were grouped- higher than 1.5 on the scale. There were 22 men and 14 women, with ages varying from 41 to 78. Three observers analyzed the recording data, with a protocol for stroboscopic evaluation being adopted. Results Tremor, open phase closure and vocal fold bowing were the most common findings among patients. Aperiodic voice in 4 cases recommended against stroboscopic analysis. Strong gag reflex in another 3 cases, made evaluation with rigid telescope impossible. The irregularity of the edge, glottic closure, prevalence of the glottic cycle phase, amplitude; mucosal wave; vibratory behavior; phase symmetry, periodicity and movement extension were evaluated by both methods. The vibratory source was exclusively glottic in all cases. Conclusion Videolaryngostroboscopy can be performed by means of both methods - rigid and fiberoptic examination. Level of evidence Level III.

Resumo em Inglês:

Abstract Objective To describe cervical lymphnodes as an option for a donor area for the transfer of vascularized tissue in lymphedema surgeries. Methods Five microsurgical procedures were performed to transfer vascularized lymphatic tissue from cervical stages Ib, III, or IV as the donor site. Patient outcomes were evaluated from 15 to 180 days postoperatively using metric assessments and photographic documentation. Results In this study, complete improvement in the measures of certain parts of the affected limb was observed in two of the five patients (100% improvement). Two patients experienced an improvement of over 50%. One patient, lost to follow-up, showed no improvement. Conclusion Lymphatic tissue from cervical levels appears to be a viable donor site for the surgical treatment of lymphedema in the limbs. This method may yield promising future outcomes, constituting a new area of practice for head and neck surgeons. Level of evidence Level IV.

Resumo em Inglês:

Abstract Objective This study aimed to identify and analyze the difficulties experienced by head and neck (H&N) cancer patients, who are users of the Brazilian public health system (SUS), from their perspective of diagnosis to post-treatment. Methods Qualitative case series carried out using individual semi- structured interviews. Data were collected from October 2019 to March 2020 and interpreted by content analysis. Results Three categories emerged from the analysis: “difficulties in the diagnosis phase”, “conflicts experienced during treatment” and “post-treatment difficulties/sequelae”. Corroborating the literature, it was found that the difficulties faced by cancer patients are present in all stages of the disease: from access to prevention health services and diagnosis to post-treatment, influenced by late diagnosis, treatment side effects, and disease comorbidities. Conclusion It is essential to carry out studies addressing changes in the family, professional and personal scope of cancer patients, aiming to provide them with comprehensive care and health professionals with understanding about what this disease represents in the life of these individuals. Level of evidence Level IV.

Resumo em Inglês:

Abstract Objective To describe the open experience of Head and Neck Surgery division of Santa Casa in São Paulo with bedside tracheostomy. Methods A retrospective study of database tracheostomies was performed between 2013 and 2016. Then, age, gender, and main complications were analyzed. Results Analysis of 598 patients shows 9 cases (1.50%) of complications, bleeding was the cause in 6 cases (1.0%), 1 postoperative death (0.16%), 1 accidental decannulation case (0.16%) and 1 lesion in the posterior wall of the trachea (0.16%). It is possible to accomplish bedside open tracheostomy with safety. Level of evidence Level IV.

Resumo em Inglês:

Abstract Objective To evaluate our experience with the technique, functional results, and potential complications. Methods A retrospective study was conducted with a sample of 29 patients submitted to this surgical procedure between 2000 and 2015. All procedures were performed under local anesthesia with sedation, and without intercurrences. Hospitalization time was 24 h on average. Results None of the patients presented respiratory distress that required tracheostomy. Regarding vocal quality, the results were considered satisfactory or optimal, with high degree of patient satisfaction. With respect to dysphagia, all patients who needed enteral nutrition resumed exclusive peroral diet. Conclusion Arytenopexy with medialization thyroplasty and cricothyropexy are procedures with low degree of complication that can be performed under local anesthesia with excellent functional results, even in patients with marked posterior glottic gap. Level of evidence Level IV.

Resumo em Inglês:

Abstract Objective To conduct a literature review on the relationship between the ansa cervicalis (or ansa hypoglossi) and the hypoglossal nerve, discussing this disparity in terminology, and determine which of these terms is the most suitable to identify this important nerve structure. Methods This is a systematic review of the literature based on studies found through a standardized search performed at the LILACS and MEDLINE/PUBMED databases; classic anatomy textbooks were also consulted. Results Forty-five of the 3731 articles found in the scientific research databases were selected and six classic anatomy textbooks were included in the study. Controversies involving the ansa cervicalis were analyzed and the results clearly showed that most textbooks describe its relationship with the hypoglossal nerve as a temporal junction, with no exchange of nerve fibers. The ansa cervicalis contains fibers arising from the cervical cord, and not from the hypoglossal nerve. Conclusion The term ansa cervicalis should be chosen to name this loop of nerves. The term ansa hypoglossi is not structurally correct, and should be abandoned in medical practice, the teaching of anatomy, and in scientific publications. Level of evidence Level II.

Resumo em Inglês:

Abstract Objective To evaluate whether the values of Parathyroid Hormone (PTH) collected from the internal jugular veins of patients with primary hyperparathyroidism can assist in the surgical approach. Methods Prospective study of patients who underwent parathyroid adenoma excision by PHPT, collected right and left internal jugular vein blood sample for analysis of Parathyroid Hormone. Results Twenty-nine patients underwent surgery. All patients had a decrease in peripheral PTH greater than 50% with a mean of 73.47%. PTH collection from the internal jugular veins was positive regarding the confirmation of parathyroid adenoma laterality in 22 cases (75.86%) and failure in 7 cases (24.14%), (p-value = 0.001). Comparing the success rates of the Methoxyisobutylisonitrile parathyroid scintigraphy (MIBI) tests, parathyroid Ultrasonography (USG) and PTH of internal jugulars in relation to location of adenoma laterality, we observed MIBI as localizer in 89.65% of the cases followed by the Jugular PTH with 75.86% and USG with 44.82%. Conclusion PTH collection from the internal jugular veins is useful in patients with primary hyperparathyroidism who underwent surgery as a possible method of localization exams, indicating adenoma laterality. Leve of Evidence Level III.

Resumo em Inglês:

Abstract Objective The aim of this study was to analyze the peculiarities of the collection sites. Methods It is a prospective study of patients undergoing parathyroidectomy by HPTP, with PTH values in the peripheral collection and from the ipsilateral VJI at times: initial (T0) and 10-min after removal of the diseased gland (T10). Results 61 participants were evaluated. The median PTH at baseline was 147.9 in the peripheral vein and 476.58 in the central vein. The median at T10 was 36 in the peripheral vein and 33 in the central vein. The central vein values showed a greater reduction, with the peripheral values showing a median decay of 74.35%, while the central values dropped by 82.38%. In the initial collection, PTH values were higher in the central vein, while they tended towards homeostasis after the removal of the diseased gland, regardless of the collection site. Thus, the average decay values from the central vein collections were higher and more significant than those from the peripheral veins. Conclusion The use of central values thus implies greater reliability for to intraoperative monitoring, with long-term comparative studies still being necessary to determine more targeted and effective surgical approaches. Level of Evidence Level III.

Resumo em Inglês:

Abstract Objective To describe the findings of US examinations performed by Head and Neck Surgery (HNS) resident physicians in patients in the preoperative period immediately before parathyroidectomy, and to compare these results with those of examinations performed preoperatively (ultrasonography and/ or scintigraphy) and with the findings of surgical procedures. Methods Patients in the preoperative period of parathyroidectomy underwent US examinations performed by HNS resident physicians after induction of anesthesia. The findings were registered and later compared with those of preoperative and intraoperative examinations using descriptive statistical analysis and calculation of sensitivity, specificity, and accuracy. Results At least one gland was identified in 81% of the patients, most commonly the left inferior parathyroid. There was 63% agreement between the examinations performed in the operating room and the preoperative examinations. Sensitivity of 76%, specificity of 100%, and accuracy of 81.25% were evidenced in identifying parathyroids > 5 mm in patients with hyperparathyroidism associated with Chronic Kidney Disease (CKD), and sensitivity of 33% was found in patients with primary hyperparathyroidism. Conclusion US examinations performed by HNS resident physicians in patients preoperatively to parathyroidectomy are accurate (81.25%) in identifying parathyroids compared with intraoperative findings in patients with hyperparathyroidism associated with CKD. Level of evidence Level III.

Resumo em Inglês:

Abstract Objective To evaluate if patients with laryngeal SCC homolateral cN+ and contralateral cN− should be submitted to bilateral neck dissection. Methods The team reviewed medical records from 135 patients with a diagnosis of laryngeal malignancy between March/2009 and September/2017, analyzing gender, age, tobacco and alcohol comsumption, primary tumor site, neck dissection laterality, clinical and pathological contralaterality, staging, tumor recurrence or late metastasis and survival Results We observed that 40.74% were pN+ on at least one side after neck dissection, which 87.27% performed bilateral neck dissection. Of these, 66.67% did not have contralateral metastasis, 87.5% had no previously clinically evident metastasis. Conclusion Patients contralateral cN− have a risk <20% for occult metastasis and should not routinely go through bilateral neck dissection. Level of evidence Level III.

Resumo em Inglês:

Abstract Objective Patients who require surgery to treat head and neck cancer are at higher risk of perioperative complications and this scenario is not different for patients with malignant tumors of the oral cavity. Thus, the objective of the present study was to identify preoperative prognostic factors related to postoperative complications in the surgical treatment of oral cancer. Methods Prospective study with 43 consecutive squamous cell carcinomas of the oral cavity submitted to surgical treatment with curative intent. Results Seventeen patients presented postoperative complications until the thirtieth day of follow-up, of which 17.6% required surgical reoperation. The most common complications were suture dehiscence and surgical site infections. Alcohol abuse (p = 0.004), pT4a tumors (p = 0.044), tumors with thickness greater than 10 mm (p = 0.002), patients with mGPS score 1 and 2 (p = 0.027) and flap reconstruction (p < 0.001) were associated with higher rates of postoperative complications. To the multivariate analysis, patients with tumor thickness greater than 10 mm (HR = 11,240; 95% CI 1,052-120,059; p = 0.045 ‒ logistic regression) and reconstructed with myocutaneous flap (HR = 18,415; 95% CI 1,849−183,359; p = 0.013 ‒ logistic regression) had a higher risk of developing postoperative complications. Conclusion Tumor thickness greater than 10 mm or use of myocutaneous flaps in the reconstruction were the predictors of risk of postoperative complications in patients with squamous cell carcinoma of the oral cavity. Level of evidence Level III.

Resumo em Inglês:

Abstract Objective To analyze the survival rate of adult patients who underwent bronchoaspiration while hospitalized in a public university hospital with oncology care characteristics. Methods A 12-month retrospective longitudinal study was carried out using bronchoaspiration risk management and event notification analysis forms filled out in the medical records of patients admitted to this hospital. Results The 34 patients who presented the adverse event of bronchoaspiration had their survival rate reduced by 30% in the first month, and only 29.6% of them survived the second month post-event. Women were more vulnerable to clinical complications originating from the general health status decline as well as to acute pulmonary complications arising from sepsis, consequently presenting a greater reduction in survival. Conclusion Bronchoaspiration events corroborate an abrupt decrease in patient survival. Level of evidence Level III.

Resumo em Inglês:

Abstract Objective To propose a practical and accessible model that enables the training of this technique. Methods The model comprises a structure composed of a wood board resting on a PVC tube. A foam block on which the pig trachea is supported is placed on this structure. A foam sheet covered with fabric is placed over the trachea to simulate the soft parts of the neck and the skin. This is a practical training model for practice of surgeons in percutaneous tracheostomy. A questionnaire on the assessment of the proposed model to each participating surgeon was applied. Results Ten surgeons underwent training on the model: two experienced head and neck surgeons, three specialty residents, one otorhinolaryngologist, and three general surgery residents. All of them were able to perform the procedure successfully. Conclusion The proposed simulation model presented good results when applied to surgeons, and it is a possible alternative to percutaneous tracheostomy training. Level of evidence Level III.

Resumo em Inglês:

Abstract Objective To evaluate the efficacy of intraoperative Bupivacaine application in reducing postoperative pain among patients undergoing total thyroidectomy. Methods A prospective study was carried out with 153 female patients undergoing total thyroidectomy, with a randomization protocol for topical anesthetic infiltration. Postoperative pain intensity was self-reported by the patients using the Visual Analog Scale (VAS) at the 1st, 6th, and 24th postoperative hours. Results Comparative analysis revealed that patients who did not receive anesthetic infiltration experienced, on average, higher pain levels during all three observation periods (1st and 6th hours, and 24th hour; p = 0.0001 - repeated measures ANOVA multiple test) relative to those who received the anesthetic. Isolated observations showed that pain was significantly less severe at the 24th hour compared to the 6th hour (p = 0.001 - repeated measures ANOVA test). Conclusion Topical anesthetic infiltration proves to be an effective tool for managing post-thyroidectomy pain. Level of evidence Level III.

Resumo em Inglês:

Abstract Objective Evaluate the oncological and functional outcomes of patients submitted to HPL for the treatment of LSCC. Methods A retrospective descriptive study of patients submitted to HPL, performed at a cancer referral center, between January 2011 and December 2017. Results We evaluated 37 patients. The major pathological staging of the primary tumor was pT3 (35.1%), followed by pT2 (32.4%). Five patients required adjuvant radiotherapy; 62.2% of the patients were decannulated by the end of the treatment; 10.8% weren’t decannulated; 8.1% underwent a retracheostomy, and 18.9% had total laryngectomy. From the patients submitted to total laryngectomy, 3 cases were due to rehabilitation failure, 2 due to recurrence and 2 cases due to postoperative suture dehiscence. About 89% of the patients resumed oral feeding following the procedure; 86.4% didn’t present disease recurrence; 31 patients survived without disease; 3 died from disease-related causes, and 3 from unrelated causes. Conclusion HPL is an alternative procedure to total laryngectomy, presenting adequate rates of local control and overall survival while also maintaining laryngeal function. The main challenge to HPL remains achieving an ideal selection of patients. Level of evidence Level IV.

Resumo em Inglês:

Abstract Objective Given the recent increase in diagnoses in our service, a referral center in São Paulo, this study aims to analyze the case series at this center and compare it with the existing literature. The objective is to comprehend the characteristics and prognosis of this disease and provide insights to enhance its treatment. Methods Confirmed cases of EMC were selected at the Hospital das Clínicas da FMUSP between 2011 and 2021. Fourteen cases were screened and subjected to retrospective analysis of medical records for data collection. Results The analysis covered patient and disease characteristics. Of the total, 64.3% were female, with an average age of 71.33 years. The parotid gland was the predominant primary site (92.8%). Concerning staging, there was a significant prevalence in stages III and IVa. Among the cases, 12 underwent surgery, and eight patients received adjuvant therapy. Conclusion Despite EMC being a low-grade neoplasm, our case series, while aligning with much of the existing literature, revealed a more advanced presentation. This raises questions about whether this aggressiveness is due to late diagnosis or whether the neoplasm is less indolent than presumed. Level of evidence Level IV.

Resumo em Inglês:

Abstract Objective To present a metastatic head and neck basal cell carcinoma (BCC) series treated by a university teaching service between 1993 and 2021. Methods A review of medical records of 500 patients with high-risk BCC in the head and neck was performed. Tumors with a diameter greater than or equal to 6 mm in the “H” area of the face or greater than 10 mm in other head and neck areas; recurrences; sclerodermiform, micronodular and metatypical subtypes; and perineural invasion were considered factors indicating high-risk. Results Seven cases of metastatic head and neck BCC were diagnosed. The mean age at diagnosis of the primary tumor was 49.8 years, and the median time between the diagnosis of the primary tumor and that of metastases was 3 years (ranging from 1 to 20 years). The main site of metastasis was the lymph nodes. The main modalities of metastases treatment were surgery and radiotherapy. Conclusion BCC metastasis is a rare manifestation of a frequent disease. Post-treatment follow-up should include routine clinical examination of the neck for all patients and imaging for the diagnosis of metastases in symptomatic patients. Level of evidence Level IV.

Resumo em Inglês:

Abstract Objective To evaluate the laryngeal manifestations of PD. Methods Evaluation of 18 PD patients conducted between January 2011 and December 2012. Patients were evaluated through videolaryngostroboscopy, auditory perceptual analysis of the voice using the GIRBAS scale, acoustic voice analysis, and application of the Vocal Handicap Index (VHI) questionnaire. Results Dysphonia and vocal fatigue were referred by 72.22% and 33.3% of the patients, respectively, whereas changes during laryngoscopy were verified in 94.44%. The medians of the acoustic voice analysis and the VHI self-assessment questionnaire were unchanged. The median of the VHI emotional domain was higher among patients who presented open phase closure, with statistically significant difference (p = 0.029). Conclusion Patients with PD present laryngeal and voice changes. Level of evidence Level IV.

Resumo em Inglês:

Abstract Objective To evaluate the results of OCC patients treated in low-volume regional hospitals. Methods This is a retrospective longitudinal study conducted with patients diagnosed with OCC and operated on in a low-volume hospital between January 2003 and December 2018. Results 174 patients with OCC were treated at the institution ‒ an average of 11 patients/year. The most common tumor location was the tongue (48.2%), followed by the lip (18.2%). Squamous cell carcinomas were the most frequent (94.7% of patients). Adjuvant radiotherapy and chemotherapy were performed in 46.7% and 31.9% of patients, respectively. Almost 21% of patients had some postoperative complication. Specific survival of 62.6% and global survival of 58.2% after 3-years were similar to the results reported in high-volume centers. Disease-free survival was 45.8% in the same period. Conclusion Low-volume hospitals qualified for oncological treatments can present outcomes similar to those of high-volume centers, and are thus a regional option for patients with OCC. Level of evidence Level III.

Resumo em Inglês:

Abstract Objective To evaluate the efficacy of STPX as a definitive treatment for Hyperparathyroidism after Renal Transplantation (HPT-RT) and determine whether there is a relationship between percentage intraoperative Parathyroid Hormone (ioPTH) decay levels and Parathyroid Hormone (PTH) values on the first postoperative day and surgical success. Methods This retrospective study analyzed the medical records of prospectively followed patients diagnosed with HPT-RT submitted to STPX in two tertiary hospitals (Brazilian Unified Health System ‒ SUS) for two years. Patients were allocated in two groups according to operative success (SG ‒ normalization of ionized Calcium [iCa] and PTH six months after surgery) or operative failure (FG ‒ persistence of high iCa and PTH). The percentage ioPTH decay levels and the postoperative PTH absolute values on the first postoperative day were evaluated in both groups. Results Of the total sample of 31 patients, surgical treatment was successful in 27 cases (87%). No statistically significant differences were observed between the groups for the percentage ioPTH decay levels (SG = 71.51% vs. FG = 70.4%), as well as for the PTH absolute values on the first postoperative day (SG = 52.69 pg/mL vs. FG = 54.55 pg/mL). Conclusion Subtotal parathyroidectomy is an effective and safe procedure for treating HPT-RT; however, the use of PTH levels remains subjective and cannot be considered as a predictor of surgical success.

Resumo em Inglês:

Abstract Objective This study aims to determine the impact of MTCT on local recurrence and disease-specific survival in patients with locally advanced T3-T4 OCSCC and compare it with other clinicopathological variables. Methods A retrospective database analysis of patients diagnosed with locally advanced T3-T4 OCSCC surgically treated and submitted to intraoperative frozen section guiding the margin status. Survival was analyzed using the Kaplan-Meier estimator followed by the Cox model for multivariate analysis. Results We analyzed 475 patients who met inclusion criteria: MTCT occurred in 29 patients (6.11%) and local recurrence was observed in 131 patients (27.6%). MTCT had an impact on univariate (HR = 2.205; 95% CI 1.243-3.914; p = 0.007) and multivariate (HR = 1.851; 95% CI 1.285-2.666; p = 0.001) analyses. Similar results were found for disease-specific survival: univariate (HZ = 1.669; 95% CI 1.056-2.635; p = 0.028) and multivariate (HZ = 1.307; 95% CI 0.816-2.092; p = 0.265) analyses. A total of 231 patients (48.6%) had died of cancer by the end of follow-up. The best predictor for compromised frozen sections was tumor depth of invasion. Conclusion Even after negative final margins, MTCT is an important factor associated with poorer outcome, and treatment intensification should be considered in these patients. Level of evidence Level III.

Resumo em Inglês:

Abstract Objective To assess the impact of the COVID-19 pandemic on Brazilian Head and Neck (H&N) oncology reference services. Methods This cross-sectional study evaluated data on the number of outpatient consultations, operations and infected physicians collected in 13 Brazilian Cancer Centers. Results 10% of the H&N surgeons had COVID-19 infection. Significant reduction in the average number of new treated cases (39.9%), consultations (63.1%) and surgeries (35.1%) was observed in April 2020 compared with those of the same period in 2019. Conclusion There was significant impairment in the delivery of care to H&N cancer patients during a month of pandemic. The observed reduction is expected to persist in the coming months and will require institutional efforts to adequately meet the demand imposed during the pandemic period. Level of evidence Level IV.

Resumo em Inglês:

Abstract Objective To describe the oncological results of a prospective study in the use of sentinel lymph node biopsy as part of the surgical treatment of squamous cell carcinoma T1/T2N0 of the oral cavity in comparison to the results of patients submitted to levels I, II and III SND. Methods It was a prospective study in which seventy patients were divided into two groups, 35 being submitted to SND and the other 35 to SLB. Results In the SND group, locoregional recurrence occurred in 17.1%, with a 2.9% development of distant metastasis and 8.8% evolved with a second primary tumor. In the SLB, locoregional recurrence was observed in 7 patients (20.0%), 5.7% developed distant metastasis, and 5.7% had a second primary tumor. There was no significant difference between the two groups for both overall (p= 0.521) and disease-free survival (p= 0.753). Conclusion A SLB is reliable for the management of clinically negative neck in patients with oral T1/T2N0 squamous cell carcinoma. Level of evidence Level III.

Resumo em Inglês:

Abstract Objectives This study aims to evaluate whether patients with hypopharyngeal and/or laryngeal Squamous Cell Carcinoma (SCC) who underwent Organ Preservation Therapy (OPT) present at the time of relapse some factor that determines the local recurrence of the disease. Methods Patients submitted to OPT were selected at the Cancer Institute of the State of São Paulo (ICESP), at the end of treatment, from January 2012 to December 2017. We collected retrospective data on demographics, clinical staging, location of the primary tumor, presence or absence of recurrence, weight and percentage of weight loss at different moments, alimentary pathway and symptomatology at the time of relapse. Results The absence of symptoms was associated with the absence of relapse (p< 0.001). Fully oral diet at the last visit was a significant factor for the absence of relapse (p= 0.005). The weight comparison of all the patients before the beginning of OPT and after the end of the treatment, showed an average drop of 3.4 kg. In the group-separated analysis, patients who did not recur showed an average loss of 0.7%. Patients with relapse, showed a loss of 2.0% of the weight at the time of relapse. Conclusion Weight loss and the presence of symptoms were important predictors of recurrence with statistical significance. These factors may help to better manage these patients, with earlier investigations and, therefore, the possibility of rescue treatments with a shorter duration. Level of evidence Level III.

Resumo em Inglês:

Abstract Objective To evaluate the quality of the thyroidectomy scars over a long period of time. Methods Over a period of two years the quality of the thyroidectomy scars among 283 consecutive patients was registered during their follow-up for malignancies. On a scale of 0 (excellent) to 3 (bad) thyroidectomy scars were classified according to the time after surgery. Results After 5 years or more 95% of the scars were classified as excellent or very good; 55% of them were excellent, which indicates that the scar was virtually invisible at a distance of 1.5 meters. Only 5% of the cases had a regular or bad scar after 5-years or more, and only one patient (0.5%) had a bad scar. Conclusion The scars remaining after thyroid surgery had an improved appearance with time, and the vast majority of patients had an excellent or very good scar after a period of five years or more. Level of evidence Level III.

Resumo em Inglês:

Abstract Objective Analysis of the surgical approach and postoperative outcomes of 59 pediatric patients submitted to thyroidectomy between 2003 and 2019. Methods An outpatient postoperative follow-up of 59 patients aged 3-18 years submitted to thyroidectomy for different causes was performed, and immediate and late postoperative outcomes were analyzed. The operations were performed at a University Hospital as well as at Private Tertiary Hospitals. Results The following postoperative outcomes were observed: three tracheostomies, 22 patients with transient hypoparathyroidism, eight patients with definitive hypoparathyroidism, and three patients with vocal fold paralysis. Conclusion Thyroidectomy in children is a procedure with a higher complication rate and needs to be performed by a team of high-volume surgeons. This study focuses on the adverse events, so that those interested in the subject are aware of them. Level of evidence Level III.

Resumo em Inglês:

Abstract Objective To evaluate and discuss timing possibilities for surgical treatment in thyroid cancer in pregnant women. Methods Systematic literature review based on online search at the Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and National Center for Biotechnology Information (NCBI) databases. Retrospective analysis of thyroidectomies performed in the second trimester of pregnancy by the authors between 1999 and 2019. Results The systematic review included nine articles. Their conclusions diverge with respect to the optimal timing of thyroid surgery. The medical literature considers thyroidectomy after safe delivery. The most recent studies are more flexible regarding carrying out this surgery during the second trimester of pregnancy. In the authors’ experience (n = 5), surgical treatment during the second trimester of pregnancy is a good option for more aggressive tumors. Conclusion More aggressive cases of thyroid papillary carcinoma can be treated with surgery during the second trimester of pregnancy. Performing the surgery after delivery is safer in the case of less aggressive cancer cases. The decision should consider hospital costs, surgery risks, and patient anxiety in relation to cancer. Level of evidence Level II.

Resumo em Inglês:

Abstract Objective To evaluate the initiation of oral feeding in patients following TL by a group of Brazilian head and neck surgeons. Methods Online survey - 75 responders from Brazil. Results 40.5% of the respondents introduced water and 41.9% of them introduced liquid diets between days 7 and 9 after TL without surgical complications or previous radiotherapy. Semi-solid feeds were started between days 10 and 14 in 47.3% of the patients and a free diet was begun after day 15 in 79.7% of them. There was statistically significant difference in the initiation of liquid feeds between different groups of TL patients, with earlier initiation in TL patients who had not undergone prior radio(chemo)therapy (p= 0.01419), with even greater differences when complex closure of the pharynx was needed (p= 0.00001), but not regarding the moment of a free diet introduction. Conclusion Most respondents in this Brazilian cohort prefer to wait at least 7-days before beginning oral feeding after TL without previous radiotherapy or surgical complications, with a significant number of respondents postponing feeds in patients who had undergone salvage TL and pharyngolaryngectomy. Level of evidence Level IV.

Resumo em Inglês:

Abstract Objective Suggest and validate pre-surgical tomographic evaluation criteria for OCC based on the pathological DOI criteria. Methods A retrospective cohort study was conducted with 80 patients with tongue and floor of mouth tumors, T1 and T2, followed from 2009 to 2015. Patients were initially classified according to the 7th edition of the TNM (TNM-7) using pathological samples and then reclassified based on the updated 8th edition of the TNM (TNM-8) criteria. The same was done radiologically, using extrapolation and adaptation of the pathological criteria to tomographic evaluation. The results of pathological staging were compared and correlated with the main clinical outcomes. The same was done with the radiological results. To evaluate the pre-surgical accuracy of tomographic staging, radiological and pathological results were compared. Results Regardless of the criteria (TNM-7 or TNM-8), it was observed that Computed Tomography (CT) with venous contrast may be used to guide the initial staging. Strong positive correlation was observed between tumor thickness and DOI at both CT and pathology. Considerable upstaging was observed in the sample of assessed patients for both criteria. In the comparison between tomographic and pathological T classifications, moderate correlation was observed in relation to thickness and DOI. Conclusion Computed tomography can be used to evaluate the depth of preoperative invasion in oral cavity tumors according to the criteria established in the present study. Level of evidence Level III.

Resumo em Inglês:

Abstract Objective To assess knowledge about head and neck cancer among adolescents from private schools, aged between 13 and22 years. Methods 200 questionnaires were applied among students, about the profile of adolescents and their knowledge about head and neck neoplasms, treatment, and teaching in schools on this topic. The results were analyzed both quantitatively and qualitatively. Results Only 55 students (29.9%) identified HPV as a risk factor for the disease. 137 students (74.5%) identified the brain as an organ treated by head and neck surgery. As for the therapeutic strategies used for the treatment of neoplasms in the region, only 67 students (36.4%) are aware. On the topic of teaching in schools, 153 students (83.1%) relate to some deficiency in the approach and learning. Conclusion Knowledge about head and neck cancer is insufficient. It is necessary to introduce in the curriculum basic cancer education in biology classes. The expansion of acquirements about cancer can provide better care and the ability to identify risk factors, initial signs, and symptoms of the disease, as well as the incorporation of healthy habits in families because these students can propagate valid information in their environment. Level of evidence Level IV.

Resumo em Inglês:

Abstract Objective: The aim of the present study was to evaluate the effects of different doses of broadband white noise in a group of Wistar rats. Methods: The sample consisted of 6 male Wistar rats. The animals went through sequential exposures at the intensity of 95 dB for 60 min, 100 dB for 60 min and 100 dB for 120 min. Audiological evaluation was performed by Distortion Product Otoacoustic Emissions (DPOAE) exams at frequencies from 2 to 12 KHz, after each exposure/pause protocol. Statistical analysis was performed based on the values found in the DPOAE and Signal-to-Noise Ratio (S/N) in the nine exams performed over 50 days of research. Results: The study concluded that there was a compound threshold shift induced by long-term sequential noise exposure at the intensity of 100 dB for 60 min and for 120 min, with a “plateau/’ observed in the DPOAE and S/N results that coincide with the exposure period of 6 days at the intensity of 100 dB for 120 min. Conclusion: Thus, we established the proposal of an exposure protocol for research with wistar rats exposed to noise.

Resumo em Inglês:

Abstract Objective: To evaluate toxicities, tumor control, Event-Free Survival (EFS) and Overall Survival (OS) of patients with locoregionally advanced Head and Neck Squamous Cell Carcinoma (HNSCC) treated with definitive platinum-based Chemoradiation (CTRT). Methods: A total of 233 patients underwent treatment with RT plus weekly or every three weeks Cisplatin (CDDP) or Carboplatin (Carbo). Toxicity and response to treatment were classified using conventional criteria. Kaplan-Meier, log-rank test, and Cox regression (univariate and multivariate) were used to assess patient survival. Results: Half of patients presented toxicities grade 3 or 4, with nausea/vomiting and nephrotoxicity being more common in RT and CDDP group and anemia and neutropenia in RT and Carbo group. Complete or partial response was observed in 75% of patients, and the distinct protocols did not alter the treatment response. Two-year EFS and OS probabilities were 43.3% and 66.0%, respectively. Active smoking, an ECOG score of 2 or higher, stage IV tumor, and treatment with RT and Carbo were independent prognostic factors for poorer outcomes. Patients of these groups had approximately double chance of relapse and progression to death compared to others. Conclusion: Our data indicate definitive treatment with RT and CDDP as the best treatment for locoregionally advanced HNSCC treated in Brazilian public hospitals. However, prospective randomized studies are required to establish the ideal treatment for those patients. Level of evidence: 3.

Resumo em Inglês:

Abstract Objective: Thiamine-Responsive Megaloblastic Anemia (TRMA) syndrome, caused by biallelic variants in the SLC19A2 gene, typically presents with a triad of megaloblastic anemia, diabetes mellitus, and sensorineural hearing loss. This study aims to determine the genetic etiology and clinical phenotype of a patient who presented with severe sensorineural hearing loss as the initial symptom, and to expand our understanding of the SLC19A2 variant spectrum. Methods: Proband-only whole-exome sequencing was performed to screen the candidate variants, which were subsequently validated by Sanger sequencing within the family. cDNA sequencing based on RT-PCR and TA cloning analysis was used to determine the effect of splicing variants on mRNA processing of SLC19A2 gene. Detailed clinical features were evaluated by a diagnostic hearing test, laboratory and imaging examination. Results: A 2-year-5-month-old Chinese girl was diagnosed with diabetes mellitus and severe sensorineural hearing loss, without abnormal hemoglobin. DNA sequencing revealed a novel compound heterozygous variant of c.808-1G > A and c.1228C > T (p.Gln410*) in the SLC19A2 gene. Both variants were previously unreported. The c.808-1G > A splicing variant is located in intron 2 of SLC19A2, and is predicted to cause exon 3 skipping. The cDNA experiment confirmed this biological event, further indicating that the splicing variant can cause amino acid frameshift alteration (p.Glu270Valfs*10) in SLC19A2. Conclusion: We report a patient with TRMA syndrome (without anemia) caused by a novel compound heterozygous variant in SLC19A2 gene. This study suggests that the possibility of TRMA syndrome should be considered when encountering patients with early-onset severe sensorineural hearing loss in clinical practice. Level of evidence: Level 4.

Resumo em Inglês:

Abstract Objective: Preoperative imaging is crucial for proper Cochlear Implantation (CI) planning. Currently, no universally accepted guidelines for radiological evaluation existed before CI. While High-Resolution Computed Tomography (HRCT) reveals bony structures but may miss membranous labyrinthine abnormalities, it involves substantial radiation exposure. Conversely, Magnetic Resonance Imaging (MRI) allows visualization of fluid content without radiation exposure. This study aimed to assess the accuracy of automated preoperative cochlear measurements obtained from MRI compared to those extracted manually from HRCT and MRI scans. Methods: This retrospective study included 55 cochlear implant ears. Preoperative CT and MRI were evaluated using OTOPLAN® to determine the A value, B value, and Cochlear Duct Length (CDL). These measurements were performed using manual (CT and MRI) and automatic (MRI) options. Interrater reliability, concordance, and comparative analyses of the three approaches were conducted. Results: Our findings indicated that automated MRI measurements were comparable to the manual CT and MRI assessments. No statistically significant differences were detected among the three approaches when determining the A, B, and CDL values. Automated measurements obtained from MRI showed more concordance with CT measurements than those obtained from manual MRI, suggesting that MRI-Auto assesses cochlear parameters better than manual MRI. Conclusion: Automated cochlear measurements using MRI were comparable to manual assessments using CT and MRI. Moreover, when assessing cochlear metrics, MRI-Auto outperformed the manual MRI workflow. Utilizing MRI-Auto planning for CI surgery can facilitate the process and minimize risks. Level of Evidence: Level 3.

Resumo em Inglês:

Abstract Objectives: Photobiomodulation Therapy (PBMT) is a non-invasive treatment that uses photons from the red to infrared spectrum to modulate cellular processes with anti-inflammatory and regenerative properties. This study aimed to evaluate the use of PBMT applied intranasally in patients with an impaired sense of smell after COVID-19. Methods: This proof-of-concept study was a randomized, placebo-controlled clinical trial that recruited 81 patients with olfactory disorders after SARS-CoV-2 infection (1-12 months), randomly assigned to 3 groups: controls, red light and infrared light exposure groups. PBMT was applied twice a week for five weeks, associated with prednisolone 40 mg for five days and olfactory training for 90 days from the first day of laser application. UPSIT® and subjective chemosensory scores were the outcomes collected before the first session and three months thereafter. Results: Compared to controls, patients undergoing infrared PBMT showed more improvement in UPSIT® scores (+4.6 points, 95% CI: 1.5-7.8, p = 0.004) and a tendency towards reporting a better subjective smell score at the three-month follow-up. Response rates were 26.1% (95% CI: 6.7-45.5), 43.5% (95% CI: 21.6-65.4), and 68% (95% CI: 48.3-87.7) in the control, red and infrared groups, respectively. No major adverse events were reported. Conclusion: Therapy with PBMT in the infrared frequency appears to be a safe option in treating post-COVID olfactory disorders when combined with a five-day use of systemic corticosteroid and 90 days of olfactory training. Level of evidence: 2.

Resumo em Inglês:

Abstract Objectives: To analyze the pneumatization pattern of the frontal recess using CT scans and to determine the prevalence of frontoethmoidal cells and their possible correlation with the development of sinusopathy. Methods: By means of a retrospective, analytical and cross-sectional study, 300 CT scans of patients with clinical suspicion of chronic rhinosinusitis were examined, separately on the right and left sides, totaling a sample of 600 paranasal sinuses, with regard to the presence of frontal cells, the presence of blockage or veiling of the recess and frontal sinus. Results: Frontoethmoidal cells were present in 85.8% of cases; the most frequent cells were supra bulla cells, in 43.8%, and the least frequent were supraorbital ethmoid cells, in 11% of cases. There was a 35% prevalence of supra-Agger cells, 15.8% of supra-Agger frontal cells, 20.2% of supra bulla frontal cells and 12.3% of frontal septal cells. A significant relationship was found between the presence of supra-Agger frontal cells and supra bulla frontal cells and the development of sinusopathy. Conclusion: The supra-Agger frontal cells and supra bulla frontal cells, when present in the frontal recess, predispose to the development of frontal sinusopathy. Therefore, preoperative tomographic analysis allows a three-dimensional anatomical understanding of the recess and frontal sinus based on determining the pneumatization pattern of this region. Level of evidence: Level 3.

Resumo em Inglês:

Abstract Objective: Observational studies found that Sudden Sensorineural Hearing Loss (SSNHL) is associated with metabolic disorders, but the causal relationship remains unclear. Here we performed a two-sample Mendelian Randomization (MR) analysis to systematically assess the causation between blood metabolites and SSNHL. Methods: Summary statistics for blood metabolites were extracted from GWAS data of 7824 European participants on metabolite levels. GWAS data for SSNHL were collected from the FinnGen Consortium R10 release data, which consisted of 3128 cases and 362,353 controls in European populations. The inverse variance weighted method was the primary method for causality analysis while MR-Egger, weighted median and MR-RAPS served as complementary approaches. Cochran’sQ test, MR-Egger intercept test, MR-PRESSO, Radial MR, leave-one-out and Steiger test were used for sensitivity analyses. Additionally, we performed metabolic pathway analysis to further explore the potential pathogenesis of SSNHL. Results: We found that genetically predicted cholesterol, citrate, myristoleate (14:1n5) and tryptophan betaine may increase the risk of SSNHL, while stearate (18:0), pantothenate and glycerol 2-phosphate may act as protective factors for SSNHL. Nevertheless, these metabolites did not reach statistical significance after Bonferroni correction. Sensitivity analyses revealed no evidence of heterogeneity or horizontal pleiotropy. Metabolic pathway analysis revealed the pantothenate and CoA biosynthesis pathway and the citrate cycle pathway potentially related to the pathogenesis of SSNHL. Conclusion: The findings of our study offer new insights into the role of blood metabolites in the development and pathogenesis of SSNHL and provide potential inspiration for further advancements in clinical settings. Level of evidence: Level 3.

Resumo em Inglês:

Abstract Objective: The first aim was to develop a simple, yet effective adult hearing screening protocol, based on the existing World Health Organization recommendations. Secondary aim was to gain insight in the possibilities and potential obstacles for implementation of national adult hearing screening programs across the globe. Methods: An expert working group was formed with 14 experts from six countries. Based on their recommendations a HEARRING screening protocol was devised and shared with all HEARRING group members. A survey was sent out to 62 clinicians from 22 countries to hear their considerations and the potential challenges they expect for the introduction of national adult hearing screening programs. Results: The proposed adult hearing screening protocol is made as simple and least time consuming as possible. The tablet-based screening tool consists of two red flag questions, followed by the Hearing Handicap Inventory for the Elderly Screening (HHIE-S) questionnaire and the Digits-in-Noise test, and is developed to be implemented in the primary care setting. The results of our survey indicate that most participants deem a national adult hearing screening to be cost-effective, but the major concerns regarding costs and funding, and infrastructure have to be discussed. Conclusion: The HEARRING screening protocol is developed to assist clinicians and policy makers in their efforts to initiate effective local and national adult hearing screening programs.

Resumo em Inglês:

Abstract According to the World Health Organization, significant hearing loss in young people exposed to recreational acoustic trauma has become a public health issue. Objective: To describe the clinical and audiological profile of individuals with Sudden Sensorineural Hearing Loss (SSNHL) exposed to recreational noise. Methods. A prospective cohort study was conducted involving outpatients with SSNHL and a history of exposure to acute recreational noise. Follow-up occurred weekly in the first month, then monthly for up to six months of follow-up. All were treated with oral corticosteroids with prednisone 1 mg/kg/day, followed by a gradual dose reduction of 20 mg every 7-days until complete withdrawal of the medication. Results: Twelve individuals were included, 8 (66.7%) males, with a mean age of 24.16-years. 58.3% of the individuals had binaural involvement. Only one patient had permanent profound hearing loss, with no sign of recovery after treatment. All had associated tinnitus. Half of the participants reported having used recreational drugs, and the type of exposure varied from New Year’s Eve parties, funk and electronic music, concerts and games in stadiums. Regarding the duration of exposure and the distance from the sound source, most reported a time of 3–5 h, with a short distance from the source. Discussion: Recreational noise exposures have the potential to increase the risk of hearing loss in individuals outside of the workplace. Data such as sex, age group and the most prevalent type of noise exposure in these cases reported in this study corroborate the findings in the literature. Regarding the persistence of hearing loss after treatment, the outcome was varied, and the studies are still controversial. Conclusion: There is an association between exposure to recreational noise and SSNHL, and the epidemiological profile of patients affected by this condition is marked by adolescents and young male adults with unilateral and binaural involvement, severe degree of hearing loss at onset, and commonly associated with the use of recreational drugs, risking permanent hearing damage. Level of evidence: 3 (OCEBM Levels of Evidence Working Group*. “The Oxford 2011 Levels of Evidence”).

Resumo em Inglês:

Abstract Objective: Nasopharyngeal Carcinoma (NPC) is a highly malignant cancer with a high incidence in East and Southeast Asia, including southern China. Despite advances in treatment, the prognosis for advanced NPC remains poor due to high recurrence and metastasis rates. The molecular mechanisms driving NPC progression are not fully understood, and identifying key genes and potential therapeutic agents is critical. This study aims to uncover critical genes and screen therapeutic drugs, providing insights into NPC pathogenesis and novel treatment strategies. Methods: Three GEO datasets (GSE12452, GSE53819, and GSE61218) were analyzed to identify overlapping Differentially Expressed Genes (DEGs) in NPC. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Gene Set Enrichment Analysis (GSEA) were used to explore the biological roles of DEGs. Protein-Protein Interaction (PPI) and mRNA-miRNA-lncRNA interaction networks were constructed to identify key hub genes. Potential therapeutic drugs were predicted via a Drug-Gene Interaction network. The overexpression of hub genes was validated in NPC cells using CCK-8 assays, and the anti-proliferative effects of three drugs – valproic acid, cyclosporine, and calcitriol – were tested. Results: Eight hub genes (ASPM, BIRC5, BUB1B, CDK1, KIF23, PBK, TOP2A, and TTK) were identified, with ASPM reported for the first time in the context of NPC. Overexpression of these genes significantly promoted NPC cell proliferation. Among the tested drugs, calcitriol exhibited the most potent anti-proliferative effect, with IC50 values of 0.90 µM, 0.47 µM, and 0.31 µM at 24-, 48-, and 72-hs, respectively. Conclusion: This study identified eight key genes as potential biomarkers for NPC and validated calcitriol as a promising therapeutic agent, providing a foundation for further research into NPC treatment. Level of evidence: Level 2 (Individual cross-sectional studies or systematic review of surveys that allow matching to local circumstances).

Resumo em Inglês:

Abstract Objective: This study aims to employ Mendelian Randomization (MR) analysis to investigate causal relationships between serum metabolites and CRS, identifying key pathogenic and protective factors and analyzing their mechanisms of action. Methods: Utilizing data from the Genome-Wide Association Studies (GWAS) database, employing two-sample MR analysis to investigate the potential causal relationship between 233 circulating metabolites with the occurrence of CRS. Inverse Variance Weighted (IVW) model, MR-Egger method, Weighted Median, and Weighted model were employed. Sensitivity analyses were conducted with Bonferroni correction. This research aims to elucidate the impact of metabolites on the development and progression of CRS, providing valuable insights into the underlying mechanisms. Results: Following MR analysis, two metabolites were significantly associated with CRS: Tyrosine (OR = 1.223; 95% CI 1.115-1.341; p = 1.96E-05) and Creatinine (OR = 1.208; 95% CI 1.103–1.322; p = 4.11E-05). These two key risk factors may be further studied for their pathogenesis and could be targeted for modulation in the treatment of CRS. However, there are several protective factors also worth exploring, among which the correlation is more significant: Ratio of conjugated linoleic acid to total fatty acids (OR = 0.809; 95% CI 0.708–0.923; p = 1.73E-03), Albumin (OR = 0.787; 95% CI 0.670–0.926; p = 3.76E-03),Conjugated linoleic acid (OR = 0.664; 95% CI 0.491–0.898; p = 7.85E-03), Diacylglycerol (OR = 0.804; 95% CI 0.654–0.989; p = 3.87E-02), Apolipoprotein A–I (OR = 0.915; 95% CI 0.845–0.991; p = 2.89E-02). Conclusion: In our MR study, we discovered 28 circulating metabolites linked to CRS. Importantly, tyrosine and creatinine were identified as the most significant contributors to the pathogenesis of CRS, highlighting their potential as therapeutic targets. Additionally, several protective factors may offer new avenues for preventive strategies and therapeutic interventions. These findings underscore the clinical relevance of targeting these metabolites to modulate CRS progression and improve patient outcomes. Level of evidence: Level 2*.1

Resumo em Inglês:

Abstract Objective(s): To determine the prevalence of external auditory canal cholesteatoma in the Otolaryngology service of the Hospital Italiano de Buenos Aires, and to evaluate the therapeutic approaches and their outcomes. Methods: A retrospective review was conducted of the electronic medical records of adult patients diagnosed with external auditory canal cholesteatoma between August 2004 and April 2024. Inclusion criteria were a confirmed or presumptive diagnosis of external auditory canal cholesteatoma and a minimum follow-up of six months. Variables analyzed included age, sex, disease severity (classified using the Udayabhanu HN 2018 classification), laterality, therapeutic approach, recurrence, and follow-up duration. Results: Fifty-two patients met the inclusion criteria, with an average age of 60.3 years. Most were female (57.7%). Bilateral involvement occurred in 5.8% of cases, and 86.5% of external auditory canal cholesteatoma were primary. According to the Udayabhanu HN classification, 28.8% were grade I, 63.5% were grade II, and 7.7% were grade IIIa. Conservative treatment was administered to 53.8% of patients, while 46.2% underwent surgery. The majority of surgical patients (58.3%) received canaloplasty and reconstruction, while 33.3% underwent only canaloplasty. Canaloplasty with mastoidectomy and meatoplasty was performed in 8.3% of cases. One patient experienced recurrence 13 years post-surgery. Conclusion(s): Both surgical and conservative treatments for external auditory canal cholesteatoma can lead to successful outcomes. The therapeutic approach should be tailored to the stage of the disease and patient characteristics, with early diagnosis and appropriate management essential to preventing complications. Level of evidence: 4.

Resumo em Inglês:

Abstract Objectives: To investigate the efficacy of non-invasive correction for congenital cryptotia with auricular cartilage deformities in infants. Methods: A total of 42 cases of congenital cryptotia with auricular cartilage deformities treated with non-invasive auricular correctors in our hospital from January 2019 to December 2023 were collected. The enrolled children were divided into four groups (A: less than 28-days, B: 28–90 days, C: 90–180 days, D: more than 180-days) based on age. The effective rate, treatment time, complications, and recurrence rate of non-invasive auricular correction among the four groups were compared. Results: After treatment with non-invasive auricular correctors, all four groups of children showed 100% effectiveness. The upper part of the children’s auricles that were embedded in the temporal subcutaneous tissue improved compared to before correction, with high improvement rates in groups A and B for the correction of cartilage deformities, and the auricular shape basically returned to normal appearance after cartilage correction. In group D, the embedded part improved compared to before correction, but there was no significant change in cartilage deformities. Regarding treatment time, there was no statistical difference between groups B and C (p > 0.05), but there were statistical differences among the other groups. In terms of complications, groups A, B, C, and D showed statistical differences (p < 0.05). In terms of recurrence rate, after six months of observation, no cases of the auricular cartilage being re-embedded under the skin or cartilage deformities recurring after correction were observed in any of the four groups. Conclusion: The effect of non-invasive correction for congenital cryptotia with auricular cartilage deformities in infants is significant, with shorter correction times, higher correction rates for cartilage deformities, and fewer complications for those under three months old; older children can still consider non-invasive correction, but the correction time is relatively longer, and for those over six months old, the correction is still effective, but the rate of correction for cartilage deformities is lower, and there are more complications.

Resumo em Inglês:

Abstract Objective: Laryngeal cancer incidence is rising globally; the role of gut microbiota remains underexplored. This study aimed to establish a causal link between gut microbiota and laryngeal cancer to inform preventive and therapeutic strategies. Methods: Gut microbiota data from GWAS conducted by the MiBioGen consortium served as the exposure variable, with laryngeal cancer as the outcome variable. the exposure variable and the outcome variable were analyzed using Mendelian Randomization. The primary method was Inverse Variance Weighted analysis, with heterogeneity and pleiotropy assessed through Cochran’s Q test, MR-Egger regression, and MR-PRESSO. Results: In the study, we identified five bacterial taxa with potential causal relationships with laryngeal cancer risk: Higher levels of Clostridiaceae1 (OR = 0.9993, 95% CI 0.9986-0.9999, p = 0.0463) and Turicibacter (OR = 0.9995, 95% CI 0.9989-0.9999, p = 0.0384) were linked to reduced cancer risk, while Mollicutes RF9 (OR = 1.0010, 95% CI 1.0003-1.0016, p = 0.0027), Euryarchaeota (OR = 1.0004, 95% CI 1.0001–1.0007, p = 0.0234), and Cyanobacteria (OR = 1.0005, 95% CI 1.0000-1.0009, p = 0.0464) were associated with increased risk. Conclusion: Our findings suggest a causal relationship between gut microbiota composition and laryngeal cancer risk. Clostridiaceae1 and Turicibacter may play a protective role, while Mollicutes RF9, Euryarchaeota, and Cyanobacteria could contribute to increased cancer susceptibility. These insights highlight potential microbiome-based strategies for early detection, prevention, and therapeutic intervention in laryngeal cancer. Level of evidence: Level 5.

Resumo em Inglês:

Abstract Objective: Rosacea is a common chronic inflammatory skin disease. Observational studies reported the association between rosacea and cancer. The causal relationship between rosacea and cancer has been reported rarely. Methods: We employed a two-sample Mendelian Randomization (MR) study to assess the causality between rosacea and 17 subtypes of cancers. Rosacea and cancers’ association Genome-Wide Association Study (GWAS) data were collected. The Inverse Variance Weighted (IVW) method was utilized as the principal method in our Mendelian Randomization (MR) study, with additional using the MR-Egger, weighted median, simple mode, and weighted mode methods. The MR-Egger intercept test, Cochran’s Q test, MR-Pleiotropy RESidual Sum and Outlier (MR-PRESSO) and leave-one-out analysis were conducted to identify heterogeneity and pleiotropy. After that, Disease-related genes were also referenced from GeneCard. Results: After our MR analysis, we found rosacea has a causal relationship with pharyngeal and laryngeal cancer (PLC, Odds Ratio [OR = 1.137], 95% CI 1.010–1.283, p-value = 0.035). Rosacea may increase the risk of PLC. No causal link between rosacea and other cancer was observed. No heterogeneity or pleiotropy was observed. Reversed MR showed PLC has no causal effect on rosacea. Furthermore, disease-related genes were obtained. The intersecting genes between rosacea and PLC were identified. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed, these intersecting genes were associated with pathways related to immunity inflammation procedures or pathways. Conclusion: This study provided new evidence of the relationship between rosacea and PLC. Rosacea may play a facilitative role in PLC progression. Identification of related genes related to rosacea and PLC offers new scene for investigating the potential pathogenesis of PLC, this could provide innovative and efficient ways to address PLC treatment. Level of evidence: Level II. Mendelian Randomized (MR) studies are second only to randomized controlled trials in terms of the level of evidence.

Resumo em Inglês:

Abstract Objectives: Electrocochleography (ECOG) is a composite objective measure of the cochlea and the cochlear nerve responses. The objectives of this study were to investigate the evolution of ECOG after cochlear implantation and compare them with audiometric thresholds over a 12-month period. Methods: A prospective monocentric study was conducted in Advanced Bionics cochlear implant recipients. Audiometric thresholds were recorded preoperatively and at 1-, 3-, 6-, and 12-months post cochlear implantation; ECOGs were recorded perioperatively after the electrode array insertion and at 1-, 3-, 6-, and 12-months post cochlear implantation. Cochlear Microphonic (CM) responses were measured by an apical electrode of the cochlear implant. Postoperative behavioral and ECOG thresholds were compared using Pearson correlation analyses. Results: A total of 17 patients were included. At 1-year, residual hearing (≤90 dB HL at 500 Hz) was preserved for 4 out of 17 patients. Significant correlations were observed between perioperative ECOG and preoperative audiometric thresholds (p = 0.008), and between ECOG and audiometric thresholds at 3-months postoperative (p = 0.002). Conclusion: ECOG can reflect changes in cochlear responses during and after implantation and may help to predict deterioration of residual hearing. Level of evidence: Level 3.

Resumo em Inglês:

Abstract Objective To delve into the potential associations of blood glucose and lipid parameters with Sensorineural Hearing Loss (SHL) and Idiopathic Sudden Hearing Loss (ISHL) through a bidirectional two-sample Mendelian Randomization (MR) analysis, providing insights into the metabolic contributions to hearing loss. Methods Genome-Wide Association Studies (GWAS) database from European populations were analyzed to assess the causal effects of blood glucose and lipid risk factors on SHL and ISHL. Single Nucleotide Polymorphisms (SNPs) meeting strict p-value thresholds were used as instrumental variables. MR methods, including Inverse Variance-Weighted (IVW), MR-Egger, and weighted median, were employed. Heterogeneity and pleiotropy were evaluated using Cochran’s Q and MR-Egger intercept. Reverse MR analysis assessed the potential impact of SHL and ISHL on metabolic factors. Results Triglycerides (TG) exhibited a significant causal effect on SHL (OR = 1.162, 95% CI 1.072-1.260, p < 0.01), with findings consistent across MR methods. No other metabolic factors exhibited significant causal effects on SHL. Similarly, no associations were found between any metabolic factors and ISHL. Reverse MR analysis revealed that ISHL may causally influence fasting glucose (OR = 1.001, 95% CI 1.001-1.013, p < 0.01) and T2DM (OR = 1.039, 95% CI 1.029-1.049, p < 0.01), but SHL showed no significant reverse effects. Conclusion TG is a causal risk factor for SHL, whereas ISHL may influence glucose metabolism. These findings underscore the metabolic distinctions between SHL and ISHL and their respective etiologies. Level of evidence Level 2.

Resumo em Inglês:

Abstract It has been 10-years since the publication of Rhinosinusitis: evidence and experience, and since then a lot has changed in our understanding of the disease. Advances in pathophysiology, endotyping and new treatments such as biologics brought a new era in the management of our patients. This new guideline, developed jointly by ABR and ABORL-CCF, with the help of ASBAI presents an updated, evidence-based approach to the different forms of rhinosinusitis that aims to improve the diagnosis and treatment of this complex disease. The document covers a wide range of topics, including clear definitions of the different stages of acute sinusitis. It also introduces a new term called Prolonged Acute Viral Rhinosinusitis. Reviews phenotypes and endotypes of chronic rhinosinusitis, recommending methods for clinical and laboratory investigation, clinical and surgical treatment. We also discuss in detail fungal sinusitis and pediatric sinusitis. The objective of this updated Consensus is to clarify some already established and recent concepts, highlighting the importance of an accurate diagnosis to promote treatment approaches that reflect the best practices based on solid evidence. Therefore, we seek not only to improve the results of patients care, but also to guide thealth professionals through a clinical panorama that is in constant transformation.

Resumo em Inglês:

Abstract Objective This study aims to explore the role of Disulfidptosis-Related long Non-Coding RNAs (DRlncRNAs) in the prognosis and immune infiltration of Head and Neck Squamous Cell Carcinoma (HNSCC). Methods Using bioinformatics approaches, this study investigates the prognostic significance of DRlncRNAs in HNSCC patients and their potential association with the immune microenvironment. RNA sequencing data and clinical information for HNSCC were obtained from The Cancer Genome Atlas (TCGA) database. DRlncRNAs were identified through Pearson correlation analysis, and a prognostic model consisting of six DRlncRNAs was constructed using Least Absolute Shrinkage and Selection Operator (LASSO) regression, along with univariate and multivariate Cox analyses. Results The predictive performance of the model was assessed using Receiver Operating Characteristic (ROC) curves and Principal Component Analysis (PCA), and further validated using calibration curves, a nomogram, and univariate/multivariate Cox analyses. In addition to functional enrichment analysis, the associations between the model and Tumor Mutation Burden (TMB), immune cell infiltration, and drug sensitivity were also examined. Conclusion We developed a novel predictive model composed of six DRlncRNAs to predict the prognosis of HNSCC patients and proposed potential clinical therapeutic targets from the perspective of disulfidptosis. Level of evidence Level 5.

Resumo em Inglês:

Abstract Objective This study presents patients with primary jugular foramen lesions who developed First Bite Syndrome (FBS) after surgery, and reviews the literature on advancements in treating FBS. Methods A retrospective review of 47 patients with primary jugular foramen lesions who underwent surgery between January 2020 and May 2022 was conducted. Results FBS were identified in 4 patients (8.5%). All 4 patients underwent Infratemporal Fossa (ITF) dissection, Internal Jugular Vein (IJV) ligation, and Internal Carotid Artery (ICA) dissection. None of the patients had the External Carotid Artery (ECA) ligated. The mean duration of FBS was 16-months (range, 6-25 months) with a mean follow-up time of 22 months (range, 20-26 months). All patients reported tolerable FBS symptoms, with an average pain intensity of 2.8 (range, 2-4). None received medical treatment. Conclusion Patients with primary jugular foramen lesion who undergo ICA dissection may be at risk for developing FBS. However, symptoms are usually mild, and a conservative, wait-and-see strategy is recommended. All patients undergoing surgery for jugular foramen lesions should be informed about the potential risk of postoperative FBS. Level of evidence 4.

Resumo em Inglês:

Abstract Objectives We evaluated the epidemiological and clinical factors related to the complications and failure of sialoendoscopy. Methods This retrospective study analyzed the medical records of patients who underwent sialoendoscopy between 2010 and 2019. Results Of the 174 sialoendoscopies analyzed, 125 (71.8%) were performed in women, and 114 (65.5%), in the parotid gland. The most prevalent complications described were false path (4.59%) and restenosis (2.30%). Complications in the submandibular gland were 3.43 times more common than those in the parotid gland and procedures in that gland were less successful (86.7% vs. 91.2%). Sialolithiasis treatment was most strongly associated with complications and failure then the other groups. Conclusion Sialoendoscopy has uncommon and limited complications. Procedures in the submandibular gland and for sialolithiasis treatment were more likely to result in complications and recurrences. Level of evidence 4.

Resumo em Inglês:

Abstract Objective Cutaneous Squamous Cell Carcinoma (cSCC) incidence has increased almost 200% in recent years. Blockade of immune checkpoint axes is an effective way to reactivate the host anti-tumor immune response across a variety of cancer types. We aimed to assess the presence of the Programmed cell Death-1 (PD-1):PD-L1/PD-L2 axis and associated CD8+ infiltration in head and neck cSCC, establish the co-localization criteria. Methods This retrospective, cross-sectional study included 46samples of patients with high-risk cSCC. Multiplex staining for PD-1, PD-L1, PD-L2, and CD8 was performed, and images were captured by an epifluorescence microscope. 1%, 20% and 50% expression cutoff values were used, as well as the COX regression method to calculate the Hazard Ratio (HR) and 95% Confidence Interval (95% CI). Results PD-1/PD-L1, PD-1/PD-L2 and PD-L1/PD-L2 co-localized in 80.4%, 45.7% and 47.8% of the patients, respectively. All patients exhibited CD8+ infiltration to some extent, with PD-1/PD-L1, PD-1/PD-L2 and PD-1/PD-L1/PD-L2 co-localized in 97.8%, 82.6% and 82.6% of the patients, respectively. There was no statistically significant relationship regarding the co-localization of immune checkpoint and the outcomes evaluated. Conclusion This study has evidenced significant expression and co-localization of immune checkpoint axes in whole tissues and tumor infiltrate, emphasizing the potential application of co-localization as a valuable tool in the clinical management of cSCC. These findings provide important insights for understanding and optimizing therapeutic strategies in head and neck cSCC. Level of evidence 4.

Resumo em Inglês:

Abstract Objective Structural changes in the brain have been identified in patients with hearing loss. However, the effect of long-term Unilateral Sensorineural Hearing Loss (USNHL) on cerebral and cerebellar morphology is not fully understood. Methods In this study, Magnetic Resonance Imaging (MRI) of 12 long-term USNHL adults was compared with their Normal-Hearing (NH) side using Voxel-Based Morphometry (VBM). The USNHL group was also compared to a control group of 12 hearing-healthy individuals. Volume and cortical thickness changes in cerebral and cerebellar structures, possibly related to hearing loss severity and duration, were assessed using VBM. Results The study found that, compared to the control group, USNHL patients had significantly higher measurements in the Frontal Operculum (FO) Gray Matter (GM) volume (cm3) (p = 0.024), Superior Temporal Gyrus (STG) thickness (p = 0.041), and cerebellum IX GM volume (cm3) (p = 0.025). No significant differences were observed between the intact and NH sides in the USNHL group (p > 0.05). Conclusion Cerebral and cerebellar structures, which are essential for perceiving and interpreting sound, integrating information, and coordinating movement, may undergo morphological changes due to neuroadaptive mechanisms in long-term USNHL patients. Larger case series are needed to explore the clinical implications of these changes for diagnosis, treatment, and prognosis. Levels of evidence Level 3.

Resumo em Inglês:

Abstract Objective This study aims to analyze how to perform a more minimally invasive and precise excision of posterior nasal neurectomy to reduce surgical time, minimize surgical trauma, and evaluate the clinical efficacy of this procedure in the treatment of moderate to severe persistent allergic rhinitis. Methods This study included a total of 110 patients, randomly divided into an experimental group and a control group based on whether preoperative CT three-dimensional positioning was used and whether middle turbinate mucosal graftcoverage was applied during surgery. In the experimental group, preoperative CT measurements were used to locate the sphenopalatine foramen, and intraoperatively, the accuracy of the positioning method was verified. Middle turbinate mucosal graftcoverage was applied to shorten the postoperative recovery time. Both groups were evaluated using Visual Analog Scales (VAS) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) to compare the differences in symptoms between baseline and six months after operation. Regular endoscopic examinations were conducted to observe the status of mucosal epithelialization at the surgical site. Results Preoperative CT measurements provided accurate intraoperative localization of the sphenopalatine foramen, allowing for a smaller surgical wound size. The average distance from the sphenopalatine foramen to the posteroinferior end of the uncinate process was 20.25 ± 2.69 mm, and from the sphenopalatine foramen to the upper edge of the inferior turbinate, it was 11.05 ± 1.71 mm. There was no statistically significant difference in preoperative symptom scores between the two groups (p> 0.05). At six months after operation, there were significant differences in VAS scores compared to baseline in both the experimental and control groups (p< 0.05). The average time for mucosal graftsurvival in the experimental group was 3.5 ± 1.0 weeks, while in the control group, the average time for exposed bone surface epithelialization was 9.0 ± 1.5 weeks. Conclusion Preoperative CT measurements for locating the sphenopalatine foramen and the use of middle turbinate mucosal grafts in the posterior nasal neurectomy are safe and effective. This new procedure reduces surgical wound size, shorten surgical time, accelerate postoperative wound recovery, and could possibly reduce complications of bleeding after surgery. Level of evidence Level 3.

Resumo em Inglês:

Abstract Objective Accurately predicting the prognosis of Submandibular Gland Carcinoma (SGC) patients remains a challenging task. The purpose of this study was to develop a columnar graph prognostic prediction model for submandibular gland cancer based on the SEER database, using feature selection with lasso regression and modeling with Cox regression. Methods This study utilized data from the SEER database, focusing on 1362 cases of SGC. Various clinical and demographic factors, including age, tumor size, histology, and lymph node metastasis, were considered as potential prognostic factors. Feature selection was performed using lasso regression, and a Cox proportional hazards model was constructed, taking into account the complex interactions between variables and their impact on survival outcomes. Results The established prognostic prediction model demonstrated good accuracy and reliability. The model effectively identified several important prognostic factors, including age, tumor size, histology, and lymph node metastasis, which strongly influenced the prognosis of SGC. The model showed good discrimination and calibration with c-indexes of 0.802 (0.784‒0.821) in the training set and 0.756 (0.725‒0.787) in the validation set. The Decision Curve Analysis (DCA) curve reflected clinical utility. Conclusion This study suggests that the prognostic prediction model based on Cox regression is a valuable tool for predicting the prognosis of patients with SGC. This approach has the potential to improve patient outcomes by facilitating personalized treatment plans and identifying high-risk patients who may benefit from more aggressive interventions. Level of Evidence Level III.

Resumo em Inglês:

Abstract Objective This study aimed to construct a ceRNA network and identify potential diagnostic biomarkers for HSCC. Methods The R software was used to identify Differentially Expressed circular RNAs (DE-circRNAs) and mRNAs (DE-mRNAs) between HSCC and Normal Control (NC) specimens. Univariate Cox analysis and survival curves were used to identify biomarkers associated with the prognosis of HSCC. In addition, the diagnostic value of the biomarkers and their relevance to the tumor microenvironment and immunotherapy were evaluated. A ceRNA network based on mRNAs, circRNAs, and miRNAs was established. Finally, qRT-PCR was used to evaluate the expression of biomarkers in HSCC and para-cancerous tissue samples. Results A network containing 90 miRNAs, 47 circRNAs, and 111 mRNAs was established via bioinformatic analysis. Three genes (NRG1, CCNG2, and CHSY1) were identified as prognostic and diagnostic biomarkers for HSCC. The low-CCNG2-expression and low-CHSY1-expression groups had higher survival rates, whereas the low-NRG1-expression group had a lower survival rate. The AUC values of the three biomarkers > 0.9, which indicated that the diagnostic value of all biomarkers was excellent. Moreover, CCNG2 and CHSY1 were associated with the severity of malignancy and the effectiveness of immunotherapy. Subsequently, a ceRNA network containing 3 mRNAs, 7 miRNAs, and 7 circRNAs was established. The results of qRT-PCR validated that the expression patterns of NRG1 and CHSY1 in clinical HSCC and para-cancerous samples were consistent with those observed in the GSE2379 dataset. Conclusion In this study, we identified three diagnostic biomarkers for HSCC (NRG1, CCNG2, and CHSY1) and established their corresponding ceRNA network via bioinformatic analysis, providing novel insights into the screening and treatment of HSCC.

Resumo em Inglês:

Abstract Objective One lower-cost alternative to either manual or APAP titration is predicting therapeutic pressure by using mathematical formulas. This study aimed to determine whether the Miljeteig and Hoffstein predictor formula was equivalent to the pressure established by manual titration in a sleep laboratory in patients using nasal or pillow masks. Methods The authors analyzed all CPAP titration polysomnography studies in adult patients for three consecutive months (May 20th to August 19th, 2018) in a sleep-disorders clinic. CPAP pressures were manually titrated over the night. Anthropometric data (age, sex, Body Mass Index [BMI], Neck [NC] and waist circumference) and polysomnographic data were documented. We tested Miljeteig and Hoffstein model formula-predicted CPAP (Hpred) accuracy in our patients, comparing formula results to our manual titration; Hpred = (0.16 BMI) + (0.13 NC) + (0.04 AHI) - 5.12. Results Nasal masks were used in 55% of our patients (n = 86) and pillow masks in 45% (n = 71). There was no difference between groups for age, body mass index, neck circumference, waist circumference, gender, baseline apnea-hypopnea index, CPAP pressure and residual AHI during titration polysomnography. The mean difference obtained between CPAP pressure and Hpred formula was 2.4 cm H2O. The CPAP pressure means during titration was 2.4 cm H2O higher than pressure obtained by a formula for pillow group and 2.3 for the nasal group. Conclusions In most patients, formula underestimated the CPAP pressure obtained during titration for both nasal and pillow masks. Even though the pressure is underestimated, this approach could help to define minimum and maximum titration pressure using APAP in patients with OSA until the optimal pressure can be determined in the sleep laboratory if necessary. Level of evidence Level 3.

Resumo em Inglês:

Abstract Objectives To establish the sociodemographic profile, identify and relate the presence of voice symptoms, risk for dysphagia, and self-perceived emotional distress, and measure the quality of life of a group of total laryngectomized patients. Method This is a descriptive, quantitative, cross-sectional study. Subjects aged 18-years and older, of both sexes, who had undergone total laryngectomy. The sample composition was non-probabilistic. A questionnaire was used to obtain sociodemographic data. The perception of voice symptoms was assessed by the Voice Symptom Scale (VoiSS) and the risk of dysphagia was screened using the Eating Assessment Tool (EAT-10). Mental health aspects were measured using the Self-Reporting Questionnaire (SRQ-20) and data on general health, treatment and illness were collected using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30). Results 12 participants were recruited; mostly male, average age of 64-years. All participants presented voice symptoms and 33% were screened with self-perceived emotional distress and 66.7% progressed with risk for dysphagia; all of them had undergone at least radiotherapy during the treatment. Conclusion All subjects in the sample had voice symptoms. Risk of dysphagia emerged as a determining factor in the quality of life and mental health of study participants, and was also related to concomitant voice symptoms. In this sample, participants with a high prevalence of voice signs and symptoms were at greater risk of emotional distress.

Resumo em Inglês:

Abstract Objective Allergic Rhinitis (AR), a prevalent allergic condition, markedly diminishes quality of life and increases public health burdens. This study investigated the mediating roles of Metabolic Biomarkers (MBs) in the associations between Circulating Inflammatory Proteins (CIPs) and AR, aiming to uncover novel therapeutic targets. Methods Utilizing Mendelian Randomization (MR), we leveraged genetic variants as instrumental variables to delineate causal relationships between CIPs and AR. Data were extracted from comprehensive Genome-Wide Association Studies (GWAS). A two-sample MR approach was employed to assess both the direct and mediated effects of CIPs on AR through MBs. Inverse-Variance Weighting (IVW) served as the main analytical method, supplemented by rigorous sensitivity analyses to confirm the robustness of the findings. Results Our analysis revealed that specific CIPs like C-C motif Chemokine-19 (CCL19), Notch-like Epidermal growth factor-related Receptor (DNER), and Interleukin-6 (IL-6) significantly elevate the risk of AR, whereas Interleukin-10 (IL-10) exhibit protective properties. Key MBs, notably Adenosine 5'-Monophosphate (AMP) to urate ratio, plasma lactate, and N-acetylputrescine, played critical roles in mediating these relationships, indicating their potential as therapeutic targets. Conclusion This investigation highlights the pivotal role of MBs in modulating the influence of CIPs on AR. The insights gained from this study not only deepen our understanding of AR pathophysiology but also open new avenues for metabolic intervention in its treatment. Level of evidence In terms of level of evidence, MR studies are second only to randomized controlled trials.

Resumo em Inglês:

Abstract Objective Seeking help for hearing loss is a complex psychological reaction. The purpose of this investigation was to cross-culturally adapt and validate the Theory of Planned Behavior-Hearing Help Seeking (TPB-HHS) to Chinese language and culture. Methods A total of 184 middle-aged and older Chinese adults completed the TPB-HHS. The study explored the factor structure and psychometric properties of the Chinese TPB-HHS, including model fit, convergent validity, discriminant validity, internal consistency and retest reliability. Results Four factors were identified, explaining 65% of the variance, with significant internal consistency and model fitting. In addition, they had satisfactory retest reliability after one week. In addition, the TPB-HHS scale showed substantial convergent and discriminant validity. Conclusion The Chinese TPB-HHS version has been shown to be a reliable and effective tool for measuring hearing test intention in initial community hearing screening. It enables healthcare providers to determine the level of intent to seek help in patients with hearing loss, laying the foundation for interventions to help these patients achieve optimal physical, psychological, and social outcomes. Level of evidence 2.

Resumo em Inglês:

Abstract Objectives Obstructive sleep apnea, a multisystem disease, affects cochlear and vestibular functions due to chronic intermittent hypoxia and recurrent oxygen desaturation. During rapid eye movement sleep, the muscle tone of the upper airway decreases more, and the cardiovascular complication risk is higher than that during non-rapid eye movement sleep. We analyzed whether tinnitus was associated with obstructive sleep apnea and rapid eye movement-related obstructive sleep apnea in patients with similar hearing thresholds. Methods We evaluated patients with obstructive sleep apnea without (24 patients; group 1) and with (27 patients; group 2) tinnitus. All participants underwent pure-tone audiometry, tinnitus tests, polysomnography, and sleep questionnaires. Results The sleep efficiency (86.23% ± 10.38% vs. 81.27% ± 8.10%) and Epworth Sleepiness Scale (8.50 ± 4.31 vs. 5.15 ± 2.82) values were higher in group 2 versus group 1. In patients with rapid eye movement-related obstructive sleep apnea, the sleep efficiency value was higher in group 2 (90.55% ± 4.61%) versus group 1 (78.13% ± 11.70%). However, in patients with obstructive sleep apnea and rapid eye movement-related obstructive sleep apnea, medication use that might affect sleep was higher in group 2 (44.4% and 54.4%, respectively) versus group 1 (16.7% and 28.6%, respectively). Conclusions We evaluated the relationship between tinnitus and obstructive sleep apnea or rapid eye movement-related obstructive sleep apnea in groups with similar hearing thresholds for the first time. The presence of tinnitus in patients with obstructive sleep apnea with similar hearing thresholds was more closely related to subjective parameters than to objective parameters. Patients with tinnitus had poorer sleep quality than those without tinnitus. Level of evidence 4.

Resumo em Inglês:

Abstract Objective Bcl2L12 plays an important role in the inflammatory response, but its role in chronic rhinitis with nasal polyps (CRSwNP) is unknown. We aimed to evaluate the relationship of Bcl2L12 with eosinophilic inflammation in CRSwNP and its value in predicting postoperative recurrence. Methods We included 80 patients with CRSwNP treated with Functional Endoscopic Sinus Surgery (FESS), and 40 Health Control (HC) subjects. The expression levels of Bcl2L12 in tissues were examined by RT-PCR, Western Blotting (WB) and Immunohistochemistry (IHC). Correlation analysis was performed to explore the relationship between the expression level of Bcl2L12 and eosinophilic inflammation of the disease. Receiver Operating Characteristics (ROC) curves were used to assess the relationship between Bcl2L12 levels and postoperative recurrence. Results RT-PCR results suggested that tissue Bcl2L12 levels were higher in the relapse CRSwNP group than in the control and primary CRSwNP group. Correlation analysis showed that elevated Bcl2L12 levels were positively correlated with disease eosinophilic inflammation (p < 0.05). In addition, tissue Bcl2L12 levels were higher by WB and IHC in the CRSwNP group than in the HC group (p < 0.05), especially in the recurrent group, and were centrally expressed in the epithelial region of the mucosa. Further regression analysis showed that blood eosinophil count and percentage, tissue eosinophil count, and tissue Bcl2L12 levels were closely associated with disease recurrence after surgery. The ROC curve suggested that tissue Bcl2L12 had a higher value in predicting postoperative recurrence. Conclusion Our study shows that Bcl2L12 is increased in patients with CRSwNP, and is associated with eosinophilic inflammation. Tissue Bcl2L12 levels may be an objective marker to predict the risk of postoperative recurrence. Level of evidence Level 3.

Resumo em Inglês:

Abstract Objectives To analyze the clinical characteristics of bilateral cholesteatoma in children and summarize the clinical treatment pathway. Methods In this retrospective cohort study, we analyzed the records of children with bilateral middle ear cholesteatoma who underwent surgery in our department between 2016 and 2023. The clinical characteristics, treatment and prognosis were analyzed. Results The records of 12-children (24-ears, 4girls and 8-boys) were reviewed. The mean age was 6.5 ± 2.6-years. Four children had Congenital Cholesteatoma (CC) in one ear and Acquired Cholesteatoma (AC) in the other ear and 8-children had AC in both ears. The onset time and lesion degree of the bilateral ears are different. Nine children had maxillary developmental deformities (75%). One child underwent simultaneous binaural surgery, and 11 underwent staged surgery, with a median interval of 3-months between surgeries. The follow-up period was 4.28 ± 2.58-years. No postoperative complications. Six children (7-ears) underwent revision surgery due to recurrence. There was no significant difference in hearing results between pure-tone average of preoperative (41.23 ± 16.50 dB) and postoperative (37.79 ± 14.42 dB) (p = 0.291, t = 1.082). There was no significant difference in postoperative hearing between CC and AC (p = 0.355, F = 4.268). There were significant differences in postoperation hearing among different surgical methods (p = 0.006, H = 12.630). There were significant differences in postoperation hearing among different ossiculoplasty methods (p = 0.001, H = 17.590). Conclusions In our cohort, the average age at diagnosis of bilateral cholesteatoma in children was notably young, with a high proportion presenting concurrent cleft palate deformities. Staged surgical intervention prioritizing the more severely affected ear was adopted for bilateral cases. Furthermore, long-term follow-up is necessary due to the observed high recurrence rate in this population. A management flowchart has been proposed based on our therapeutic experience. Level of evidence Level 4.

Resumo em Inglês:

Abstract Objectives Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is a complex inflammatory condition that significantly impairs patients’ quality of life. Despite significant efforts to develop effective treatments, a comprehensive bibliometric analysis in this field is lacking. This study aims to identify key trends, influential publications, leading authors, and collaborative networks. Methods A bibliometric analysis was conducted on October 16, 2024, examining publications in the Web of Science Core Collection (WoSCC) database from 2004 to 2024. Data visualization and interpretation were performed using VOSviewer (version 1.6.20), CiteSpace (version 6.3.R1), and R 4.3.3. Results The analysis included 1,235 publications from 5,825 authors across 4,723 institutions in 222 countries. The United States led in publication volume, followed by China and Italy. Major institutional contributors included Capital Medical University and Sanofi. The International Forum of Allergy & Rhinology published the most articles, while the Journal of Allergy and Clinical Immunology had the highest citation count. Key authors identified were Bachert Claus and Gevaert Philippe. Keyword analysis revealed “asthma”, “endoscopic sinus surgery”, and “inflammation” as dominant themes, with burst analysis indicating growing interest in “humanization”, “type 2 inflammation”, “risk”, “biologics”, and “safety”. Conclusion This bibliometric analysis underscores an increasing focus on biologic therapies, inflammation management, and endoscopic sinus surgery in CRSwNP research. Future investigations are likely to prioritize the long-term safety and cost-effectiveness of biologics, alongside advancements in precision medicine and surgical techniques. Level of evidence Level 1.

Resumo em Inglês:

Abstract 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.

Resumo em Inglês:

Abstract Objective Screen for differential proteins in the cochlea of mice associated with Age-Related Hearing Loss (ARHL), analyze and validate the expression of specific differential proteins and genes in the cochlea and auditory cortex of ARHL mice, and preliminarily explore their potential mechanisms of action. Methods ABR (Auditory Brainstem Response) hearing tests were conducted to select 15-month-old C57BL/6 mice with significantly decreased hearing as the experimental group and 2-month-old mice with normal hearing as the control group. Cochleae were dissected, and unlabeled quantitative proteomics was employed to identify and analyze differentially expressed proteins in the inner ear of the two groups of mice. Key node proteins were selected via the STRING database and Cytoscape analysis. The expression of two selected proteins, ApoE and Spp1, in the cochlea was detected using qRT-PCR, Western blot, and immunofluorescence techniques, and their expression in the auditory cortex of the brain was further explored. Results Label-free quantitative proteomics identified 115 differentially expressed proteins in the cochlea of 15-month-old ARHL mice compared to 2-month-old hearing-normal mice, including 42 upregulated and 73 downregulated proteins. GO and KEGG enrichment analyses revealed significant enrichment of differentially expressed proteins in functions and signaling pathways associated with neurodegenerative diseases and neurotransmission. Protein-Protein Interaction (PPI) analysis using the STRING database and Cytoscape selection identified ApoE and Spp1 as key hub proteins. Validation via qRT-PCR, Western blot, and immunofluorescence demonstrated that both ApoE and Spp1 were highly expressed in the cochlea and auditory cortex of the ARHL mice compare to 2-month-old hearing-normal mice. Conclusion ApoE and Spp1 are upregulated in the cochlea of ARHL mice, particularly in spiral ganglion neurons, and in the auditory cortex, suggesting their potential involvement in the pathogenesis and progression of ARHL through the modulation of auditory neural conduction systems. Level of evidence: Level 2.

Resumo em Inglês:

Abstract Objective To describe a novel endoscopic approach to the Uncinate Process (UP) via the agger nasi region and evaluate its anatomical basis and clinical outcomes. Methods This study comprised two components. In the imaging study, 51 paranasal sinus CT scans were analyzed to measure the distance between the UP and the medial orbital wall at the agger nasi and ethmoid infundibulum regions, using standardized coronal and axial planes. In the clinical study, 53 patients with chronic rhinosinusitis underwent uncinectomy through the agger nasi approach. Pre- and postoperative SNOT-22 scores were compared after 6-months of follow-up, and complications were recorded. Results The distance from the UP to the orbit was significantly greater at the agger nasi region compared to the ethmoid infundibulum on both sides (p < 0.001). Clinically, the agger nasi approach allowed consistent identification of the maxillary sinus ostium and preservation of key anatomical structures. There was a significant improvement in SNOT-22 scores postoperatively (p < 0.001), with no major complications observed. Conclusion The agger nasi approach to the UP is a safe, reproducible, and effective technique. The greater distance from the UP to the orbit in this region may reduce the risk of orbital injury and facilitate complete identification of the natural drainage pathway of the maxillary sinus. Level of evidence: 3.

Resumo em Inglês:

Abstract Objective To study clinicopathological features and differential diagnosis of hyalinizing clear cell carcinoma in the head and neck. Methods A retrospective analysis was performed patients with hyalinizing clear cell carcinoma in the head and neck, who underwent surgical resection in Beijing Tongren Hospital affiliated to Capital Medical University from January 2014 to May 2024. The clinical features of HCCC were analyzed by computed tomography and magnetic resonance imaging. Tumor sections were further characterized using hematoxylin and eosin staining, immunohistochemistry, and fluorescence in situ hybridization. Results There were 4 male and 5 female cases in 9 patients. The age range was 28–84 years-old, the middle age was 60 years-old. 9 patients, 5 in the nasopharynx, 2 in the base of the tongue, and 2 in the oropharynx. At the cellular level, the HCCC tumors were composed of transparent and eosinophilic cells (in various ratios), which were typically arranged into nests, cords, and trabeculae, and embedded in a glassy hyaline substance. Immunohistochemical evaluation showed positivity for CK7, P63, P40, CK5/6, and negativity for S100, SMA, GFAP, and calponin. Fluorescence in situ hybridization revealed EWSR1 rearrangement in all the nine patients evaluated. Conclusions Hyalinizing clear cell carcinoma is a rare low-grade salivary gland carcinoma that mostly occurs in the minor salivary glands. They had an indolent disease course, with few metastases. Our study shows that the above combination of analytical techniques can be used to accurately characterize and diagnose HCCC. Level of evidence: Level 1.

Resumo em Inglês:

Abstract 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. Level of evidence: Level 3.

Resumo em Inglês:

Abstract Objective Nasal Septal Perforation (NSP) is a challenging condition with limited treatment options, often resulting in symptoms like nasal obstruction and epistaxis. Nigella Sativa Oil (NSO), known for its anti-inflammatory and regenerative properties, has shown promise in promoting wound healing. This study aims to investigate the effects of NSO on the wound healing process in an experimental NSP model using rats, exploring its potential as a therapeutic agent for NSP treatment. Methods Twenty-two male Sprague Dawley rats were randomly assigned to two groups. Each subject had a Nasal Septal Perforation (NSP) approximately 2 mm in diameter created. NSO (study group) and saline (control group) were applied topically once a day for 14 days. At the end of the 14th day, the rats were sacrificed, and their nasal septa were excised for macroscopic and histopathological examination. Immunohistochemically Vascular Endothelial Growth Factor (VEGF) and Proliferating Nuclear Cell Antigen (PCNA) parameters examined. Tissue morphology was evaluated, collagen density was measured. The macroscopic closure rate of the NSPs and the histopathological parameters were analyzed statistically. Results NSO group showed significantly higher collagen density, surface morphology score, International Cartilage Repair Society (ICRS) matrix examination score, PCNA immunoreactivity and macroscopic closure rate of NSPs compared to the saline group (p < 0.05). In terms of VEGF immunoreactivity, no difference was detected between both groups (p > 0.05). Conclusion Locally administered NSO may enhance wound healing in the nasal septum within an experimental NSP model, suggesting that NSO could be an effective alternative or adjunctive treatment for NSP, promoting better clinical outcomes. Level of evidence: Level 3.

Resumo em Inglês:

Abstract Objectives The objectives of this work were to evaluate the results of otosclerosis surgery and to study the predictors of its functional success. Methods Our study was retrospective on 322 patients, equivalent to 418 ears operated in the otolaryngology and head and neck surgery department, from January 2000 to December 2020. Results Hearing success was noted in 89.5% of patients considering the Postoperative Residual Air Bone Gap (PRABG) ≤10 dB criterion; in 94.3% of patients according to the conductive gain ≥20 dB criterion; in 96.4% of patients based on the improvement of cochlear reserve criterion; in 88.8% according to the Air Bone Gap improvement (ABGi) ≥70% criterion and in 81.8% considering all these criteria. The short, medium and long-term postoperative tonal audiometries could be superimposed, reflecting the stability of the hearing results. A regression of tinnitus has been reported in 79.2% of cases. The independent predictors of hearing success were the Aubry's audiometric stages I and II, mean preoperative air curve >40 dB and platinotomy. The independent predictors of tinnitus regression retained were male sex, no exposure to loud noise and Veillon radiological stages I and II. Conclusion The identification of factors influencing the functional results of surgery allows a better selection of candidates for the intervention and more relevant information for patients. Level of evidence: Level 3: Non-randomized controlled cohort or follow-up study.

Resumo em Inglês:

Abstract Objectives This study aimed to explore the impact of prosthesis position on hearing outcomes in otosclerosis patients based on Ultra-High-Resolution CT (U-HRCT). Methods We retrospectively reviewed medical records of 142 patients (182 ears) who underwent stapedotomy. We compared preoperative with postoperative hearing results. An experienced radiologist extracted data about stapes prostheses from U-HRCT images, including absolute insertion depth, relative insertion depth, angle between the prosthesis and incus, angle between the prosthesis and footplate, and the relative position of the hook clamped onto the long process of incus. We analyzed potential relationships between the imaging data and postoperative hearing outcomes. Results We obtained satisfactory hearing results from 129 ears postoperatively. 119 ears (92.2%) presented Air-Bone Gaps (ABG) in the 0–20 dB range. We observed statistically significant differences between mean pre- and post-operative ABG at different frequencies (0.5, 1, 2, and 4 kHz). The best results occurred at 2 kHz (98.5%). We found that the observed values for prosthesis insertion depth (mean 0.6 mm, relative depth: mean 23%) and mean angle between the prosthesis and incus (mean 91.2 °) were safe and effective. We also found that the mean angle between prosthesis and footplate was related to postoperative ABG (p = 0.049). The hook position on the long process of incus (relative distance of 10.5%) is also a crucial factor in determining postoperative hearing results (p = 0.726). Conclusion Prosthesis position and postoperative hearing outcomes are related. Postoperative imaging evaluation is especially important for patients who did not benefit substantially from stapes surgery. Level of evidence: Level 3.

Resumo em Inglês:

Abstract Objectives To analyze the presence of cancer stem cells markers in consecutive patients with locally advanced Head and Neck Squamous Cell Carcinoma (HNSCC) and establish their suitability as a prognostic biomarker in samples from routine practice. Methods Retrospective study of 104 consecutive patients with locally advanced HNSCC treated with definitive surgery and adjuvant chemoradiotherapy. Immunohistochemical expression of CD44, HLA-I, pan-cytokeratin, and phosphorylated Epidermal Growth Factor Receptor (p-EGFR) were evaluated in surgical specimens. Overall Survival (OS) and Disease-Free Survival (DFS) rates were calculated based on clinical characteristics and the total positive score (for tumor marker expression). Hazard ratios were calculated by Cox multivariate analysis. Results After a median follow-up of 50-months, higher OS rates were observed for patients without cervical node pathological involvement (p < 0.001), patients with HLA-I overexpression and a total positive score ≥ 15% (p = 0.017), and patients with low CD44 expression and a total positive score ≤ 60% (p = 0.022). Grouping by p-EGFR (p = 0.648) or pan-cytokeratin (p = 0.477) expression did not show statistical differences in OS. None of the biomarkers were associated with different DFS rates. Cox multivariate analysis revealed that positive cervical nodes (HR = 1.294; 95% CI 1.025–1.634; p = 0.030) and the expressions of HLA (HR = 0.373; 95% CI 0.168‒0.829; p = 0.015) and CD44 (HR = 2.170; 95% CI 1.031–4.569; p = 0.041) were independently associated with OS. Conclusion Nodal involvement, HLA-I overexpression, and decreased CD44 expression are independent prognostic factors of survival in patients with locally advanced HNSCC. Level of evidence: III.

Resumo em Inglês:

Abstract Objective To evaluate the clinical efficacy of high-frequency electrocautery under electronic laryngoscopy combined with acid-suppressing drugs (Proton Pump Inhibitor, PPI) in the treatment of Refractory Laryngeal Contact Granuloma (RLCG). Methods A total of 42 patients with RLCG, treated at our hospital from January 2019 to January 2024 were included in this study. The patients underwent high-frequency electrocautery to excise laryngeal granulomas under local anesthesia using electronic laryngoscopy, followed by PPI therapy. Follow-up started one-month post-surgery and lasted for 6–12 months (average of 8.5 months), to assess the cure rate and overall efficacy. Results The cure rate was 76.19%, and the overall efficacy rate was 92.86%. On average, each patient underwent 1.79 procedures. The combined treatment of high-frequency electrocautery under local anesthesia with electronic laryngoscopy and PPI therapy demonstrated significant therapeutic effects for RLCG. The treatment was simple, well-tolerated by patients, cost-effective, and resulted in rapid symptom improvement, all without the need for general anesthesia or intubation. Conclusion The combined approach of high-frequency electrocautery under local anesthesia with electronic laryngoscopy and PPI therapy is effective in treating refractory laryngeal contact granuloma. This method offers the advantages of a straightforward surgical procedures, high patient tolerance, low cost, quick symptom relief, and no requirement for general anesthesia or intubation. Level of evidence: Level 4-Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.

Resumo em Inglês:

Abstract 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. Level of evidence: 3.

Resumo em Inglês:

Abstract Objective To investigate the prevalence of undiagnosed olfactory changes in individuals over 40 and the associated factors. Methods A cross-sectional study enrolled a group of adult and elderly patients who did not report any nasal issues or olfactory changes with a clear or highly probable causal connection. They were subjected to the University of Pennsylvania Smell Identification Test (UPSIT) and the Visual Analog Scale to evaluate olfactory capacity. Results Two hundred eighty-four volunteers participated. Among the elderly, 96.9% experienced olfactory changes, while 80.4% of the younger group did. There was a significant correlation between age and UPSIT results (Rho = 0.33, p < 0.001) in the elderly. A higher prevalence of olfactory impairment was found in the elderly (p < 0.001). The age predictor showed an OR of 1.081 (p < 0.01, 95% CI 1.03–1.12). Both elderly and adults reported similar rates of altered olfaction, at 14.5% and 14.3%, respectively. Conclusion There was a higher prevalence and risk of developing decreased olfaction in the elderly, with an 8% greater risk of olfactory dysfunction for each passing year. Level of evidence: 5.

Resumo em Inglês:

Abstract 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).

Resumo em Inglês:

Abstract 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.

Resumo em Inglês:

Abstract 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.

Resumo em Inglês:

Abstract 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.

Resumo em Inglês:

Abstract Objective To present the outcomes of dupilumab in olfactory function, Nasal Polyp Score (NPS) and quality of life in Brazilian patients with severe CRSwNP. Methods We selected severe type 2 CRSwNP patients from different Brazilian centers. Dupilumab was indicated after failure of optimized medical and surgical treatment. Patients were evaluated with endoscopic Nasal Polyps Score (NPS), Connecticut smell test (CCCRC) and quality of life questionnaire (SNOT-22), at baseline (T0) and at one year (T1) after dupilumab was initiated. The clinical response was classified as good or non-responsive, according to the degree of improvement at T1. Regarding disease control, patients were classified as controlled, partially controlled or uncontrolled. Results 53 patients completed one year of treatment (19–76 years-old); 51 individuals (96.2%) had asthma and 33 had Aspirin-Exacerbated Respiratory Disease (AERD) (62.3%). Dupilumab decreased mean SNOT-22 scores from 61.9 to 16.7 points (paired t-test, t = 13.4, p < 0.0001). The median CCCRC scores improved from anosmia (0-points) to mild hyposmia (5.5-points) (Wilcoxon signed rank test, p < 0.0001). Regarding NPS, we observed a decrease from a median of 6 in T0 to 1 at T1. AERD patients showed similar responses to those with only asthma as comorbid disease. Overall, most of the patients (86.8%) showed improvement in the disease control (Bowker's Test, p < 0.0001). Conclusions Real-world data show that dupilumab improved NPS, smell function, and SNOT-22 scores in the Brazilian CRSwNP population. These results support the benefits of dupilumab in treating severe cases of CRSwNP. Level of evidence: Level 3.

Resumo em Inglês:

Abstract 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. Level of evidence: 4.

Resumo em Inglês:

Abstract Objective To investigate, through a systematic review of the literature, whether there are differences in the results of otoacoustic emissions suppression tests in individuals with and without central auditory processing disorder. Methods Searches were carried out in the scientific databases Latin American and Caribbean Health Sciences Literature, PubMed, Scientific Electronic Library Online, Web of Science, Scopus, Science Direct and Cochrane, as well as the databases of gray literature British Library, OpenGrey.eu and Object View and Interaction Design. A systematic review of the literature was carried out, with the descriptors otoacoustic emissions and auditory perceptual disorders and their synonyms, combined by the Boolean operators AND and OR. The reading of the studies was done by peers independently and in case of disagreement in the inclusion of studies, a third researcher was consulted. Original cross-sectional articles with a comparison group that suppressed transient evoked otoacoustic emissions in individuals with and without central auditory processing disorder were included. Results Seven studies that evaluated children aged between 7 and 14 years old were included, with methodological variability in the performance and analysis of the exam, the contralateral noise was the most used to elicit suppression. In only three studies did the group with central auditory processing disorder show lower suppression values, however the meta-analysis shows significant differences between the groups, with lower suppression values in the study groups. Conclusion This study points the need for a protocol that standardizes the measurement of OAE suppression and its findings, aiming to reduce the inclusion of results unrelated to the olivocochlear system.

Resumo em Inglês:

Abstract Objective To comprehensively analyze the benefits and harms associated with the use of isotretinoin as a skin preparation agent for rhinoplasty. Method A systematic review of the literature was carried out, conducted through a comprehensive search in scientific databases: LILACS and PUBMED. Results Although isotretinoin has beneficial effects on skin preparation, some studies indicate that its continuous use before rhinoplasty may interfere with healing, suggesting the need for a period of suspension prior to the procedure. Other concerns include the impact on blood levels, increasing the risk of hematological changes, highlighting the importance of regular hematological monitoring during treatment. The decision to use isotretinoin as preparation for rhinoplasty must take into account the surgeon's experience and the specific characteristics of the patient, seeking to balance the aesthetic benefits with the potential risks. Conclusion The decision to use isotretinoin as part of skin preparation for rhinoplasty must be individualized, taking into account the specific characteristics of the patient, their aesthetic objectives and the assessment of risks and benefits. A collaborative approach between the plastic surgeon, dermatologist and patient is essential to ensure safe and effective use of isotretinoin, maximizing its benefits while minimizing the potential harm associated with this therapy.

Resumo em Inglês:

Abstract Since we published the “IV Brazilian Consensus on Rhinitis”, in 2017, several advances have been achieved and have enabled a further understanding of the different aspects of “Rhinitis”. This new guideline, developed jointly by ASBAI, SBP and SBORL, represents a relevant milestone in the updated and integrated management of the different forms of the disease, and it aims to unify evidence-based approaches to improve the diagnosis and treatment of this common and often underestimated condition. The document covers a wide range of topics, including clear definitions of the different phenotypes and endotypes of rhinitis, risk factors, updated diagnostic criteria, and recommended methods for clinical and laboratory investigation. We stress the importance of detailed clinical history and objective assessment, as well as tools for control and assessing severity tools an accurate diagnostic approach to the disease. Regarding treatment, it emphasizes the treatment customization, considering the severity of symptoms, the presence of comorbidities and the impact on the patient's quality of life. We discuss different drug treatment, in addition to non-pharmacological measures, such as environmental control and specific immunotherapy; and the possible role of immunobiological agents. Furthermore, the consensus addresses issues related to patient education, prevention and management of special situations, such as rhinitis in children, in pregnant women and in the elderly. In short, the “V Brazilian Consensus on Rhinitis” represents a comprehensive and updated guide for healthcare professionals involved in the diagnosis and management of rhinitis, aiming to improve patients' quality of life through an integrated and evidence-based approach.

Resumo em Inglês:

Abstract Objective To make evidence-based recommendations for the indications and complications of Cochlear Implant (CI) surgery in adults and children. Methods Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on cochlear implantation were eligible for inclusion. The American College of Physicians’ guideline grading system and the American Thyroid Association’s guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results The topics were divided into 2 parts: (1) Evaluation of candidate patients and indications for CI surgery; (2) CI surgery - techniques and complications. Conclusions CI is a safe device for auditory rehabilitation of patients with severe-to-profound hearing loss. In recent years, indications for unilateral hearing loss and vestibular schwannoma have been expanded, with encouraging results. However, for a successful surgery, commitment of family members and patients in the hearing rehabilitation process is essential.

Resumo em Inglês:

Abstract Objective To make evidence-based recommendations for the treatment of Single-Sided Deafness (SSD) in children and adults. Methods Task force members were instructed on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on SSD were eligible for inclusion. The American College of Physicians’ guideline grading system and the American Thyroid Association’s guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results The topics were divided into 3 parts: (1) Impact of SSD in children; (2) Impact of SSD in adults; and (3) SSD in patients with temporal bone tumors. Conclusions Decision-making for patients with SSD is complex and multifactorial. The lack of consensus on the quality of outcomes and on which measurement tools to use hinders a proper comparison of different treatment options. Contralateral routing of signal hearing aids and bone conduction devices can alleviate the head shadow effect and improve sound awareness and signal-to-noise ratio in the affected ear. However, they cannot restore binaural hearing. Cochlear implants can restore binaural hearing, producing significant improvements in speech perception, spatial localization of sound, tinnitus control, and overall quality of life. However, cochlear implantation is not recommended in cases of cochlear nerve deficiency, a relatively common cause of congenital SSD.

Resumo em Inglês:

Abstract Objectives Postoperative chemoradiotherapy has arisen as an adjuvant option for head and neck cancers, but its superiority to radiotherapy alone in patients with adverse pathologic factors is not yet well defined. We aimed to perform an updated meta-analysis comparing outcomes in head and neck cancer patients with adverse pathologic factors who underwent postoperative chemoradiotherapy and radiotherapy alone. Methods We systematically searched PubMed, Scopus and the Cochrane Central Register of Controlled Trials for Randomised Controlled Trials (RCTs) in patients submitted to postoperative adjuvant therapy with radiotherapy alone or chemoradiotherapy. Results We included 8 studies with a total of 2376 patients, of whom 1183 (49.8%) underwent postoperative chemoradiotherapy. In pooled analysis, overall survival (HR = 0.86; 95% CI 0.76‒0.98; p = 0.64; I2 = 0%) and disease-free survival (HR = 0.85; 95% CI 0.75‒0.96; p = 0.64; I2 = 0%) were shown to be superior in patients undergoing combined therapy. Chemoradiotherapy was also associated with significantly lower locoregional recurrence. However, there was no significant difference in distant metastasis occurrence between both groups. In an analysis of the extracapsular extension subgroup, the overall survival (OR = 3.12; 95% CI 1.76-5.51; p = 0.78; I2 = 0%), disease-free survival (OR = 3.44; 95% CI 2.00‒5.91; p = 0.68; I2 = 0%), and locoregional control (OR = 1.86; 95% CI 1.16‒2.99; p = 0.98; I2 = 0%) were better in the postoperative adjuvant chemoradiotherapy branch over radiotherapy alone. Conclusion The results of our meta-analysis suggest that postoperative adjuvant chemoradiotherapy in patients with head and neck cancer with adverse pathologic factors favors a superior survival and a better locoregional control compared to postoperative radiotherapy alone, despite not affecting the ocurrence of distant metastasis.

Resumo em Inglês:

Abstract Objectives This study aimed to clarify the impact of hypertonic solutions on various outcomes, including persistence or reduction of nasal crusts, polypoid edema, and postoperative inflammatory symptoms. Methods We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials for studies comparing hypertonic with isotonic saline irrigation after FESS in adult patients with Chronic Rhinosinusitis (CRS). Outcomes were polypoid mucosa, nasal crusts, and variation from the baseline of Sino-Nasal Outcome Test (SNOT) 20/22 and Visual Analog Scale (VAS). For statistical analysis, we used RevMan 5.4.1, and assessed heterogeneity with I2 statistics. Results We included a total of 479 patients from 7 studies. In the hypertonic saline group, there was a reduction in the nasal crust Risk Ratio (RR) (RR = 0.65; 95% CI 0.49 to 0.87; p= 0.004; I2 = 0%) after 30-45 days and severe crusts at 14-21 days (RR = 0.59; 95% CI 0.38 to 0.91; p= 0.02; I2 = 0%). Additionally, the persistence of polypoid mucosa was lower in the intervention arm (RR = 0.53; 95% CI 0.43 to 0.65; p< 0.00001; I2 = 0%) after 14-21 days. In the symptomatic evaluation hypertonic saline group showed an improvement in postoperative symptoms by a VAS Mean Difference (MD) (MD = −5; 95% CI −5.77 to −4.24; p< 0.00001; I2 = 0%) and a SNOT 20/22 Standard Mean Difference (SMD) (SMD = −1.65; 95% CI −2.7 to −0.61; p= 0.002; I2 = 93%) reduction from baseline in 30-45 days after the surgery. Conclusion Hypertonic saline showed a superior improvement in postoperative evaluation by means of nasal crusting, mucosal healing aspect, and nasal inflammatory symptoms compared with isotonic saline irrigation.

Resumo em Inglês:

Abstract Objectives Several studies have evaluated the prognostic significance of Perineural Invasion (IPN) in laryngeal cancer; however, the results are non-conclusive. Therefore, we conducted a meta-analysis aiming to identify the prognostic value of IPN in laryngeal cancer. Methods A literature review was performed, searching MedLine via PubMed, Scielo, Lilacs, Cochrane and Websco. RevMan 5.4 was used for the statistical analysis. Results A total of 19 laryngeal cancer studies were included. The results indicate that IPN in laryngeal cancer shows 2-year survival with RR 0.71 (0.59‒0.86); disease-free survival RR 0.51 (0.14-1.95); and locoregional recurrence RR 1.71 (1.25-2.35). Conclusion IPN is a negative prognostic factor in laryngeal cancer.

Resumo em Inglês:

Abstract Objective: This study aimed to examine the correlation between smoking, alcohol drinking, and the prognosis of Nasopharyngeal Carcinoma (NPC). Methods: Clinical data from 721 NPC cases treated at our hospital between January 2005 and December 2010 were collected. Information on smoking and drinking, including duration, daily quantity, and cumulative amount, was recorded and graded according to WHO standards. Statistical analysis was performed to assess the influence of smoking and alcohol drinking on NPC patient prognosis. After controlling for confounding factors, survival analysis compared the 5-year Progression-Free Survival rate (PFS) and Overall Survival rate (OS) among patients with varying degrees of smoking and drinking. The association between smoking, drinking, cumulative amount, and NPC patient prognosis was evaluated. Multivariate Cox regression analysis was then employed, considering patient demographic characteristics and clinical features, to comprehensively analyze prognostic influencing factors in NPC patients. Additionally, the multivariate Cox regression analysis was utilized to comprehensively examine the influencing factors of prognosis, taking into account the patients’ basic demographic characteristics and clinical features. The findings revealed significant differences in the aforementioned rates. Results: (1) Analysis of PFS and OS differences in NPC patients considered smoking status, smoking duration, daily smoking quantity, and cumulative smoking amount. No significant influence of smoking on NPC patient PFS and OS within 5-years was observed (p > 0.05). (2) Non-drinkers with NPC exhibited higher 5-year PFS and OS rates compared to drinkers (p = 0.047, p = 0.026). Furthermore, non-drinkers and those with a drinking duration of less than 120 months or between 120-240 months showed higher 5-year PFS and OS rates than individuals with a drinking duration exceeding 240 months (p < 0.05). Similarly, non-drinkers and individuals consuming less than 50 g/day had higher 5-year PFS and OS rates compared to those consuming 50-100 g/day or more than 100 g/day (p < 0.05). Additionally, the 5-year PFS and OS rates were higher in the non-drinking and light drinking groups compared to the moderate and heavy drinking groups (p < 0.05). (3) A partial synergistic effect between smoking and alcohol drinking was observed in NPC. (4) Alcohol drinking emerged as an independent prognostic factor for NPC. Conclusion: Alcohol drinking is a significant factor influencing the prognosis of nasopharyngeal carcinoma, with the adverse effects further amplified when combined with smoking. Level of evidence: Level 2.

Resumo em Inglês:

Abstract 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.

Resumo em Inglês:

Abstract Objectives Hearing loss is associated with increased cognitive decline and incident dementia in older adults. Given the rapidly rising incidence of dementia, management of modifiable risk factors such as hearing loss, is essential to mitigate the impact on the individual and society in general. In this narrative review, we discuss the current state-of-art with respect to studying cognitive function before and after cochlear implantation in the elderly population. Future perspectives are considered to shed light into the pathophysiology of cognitive decline due to hearing loss and how objective measures may contribute to this field. Methods The existing literature on cochlear implantation and cognition is reviewed. The potential limitations and objective measures for cognitive functioning are discussed. Relevant studies were identified through a broad search of academic databases, including Pubmed and Web of Science. Given the narrative nature of this review, no strict inclusion or exclusion criteria were applied, allowing for a broad overview of the current state-of-the-art literature on the effects of cochlear implantation on cognitive functioning, the challenges of studying cognition in this population and future research directions. Results Multiple studies have been able to demonstrate an improvement of cognitive functioning in older adults with severe-to-profound hearing loss after cochlear implantation. However, it is important to consider the challenges of studying cognition in this population. Evoked response potentials might have potential as an objective marker for cognition in this study population. Conclusion Although there is no standardized study protocol to investigate cognition after cochlear implantation, a significant improvement in cognition is observed in the majority of studies one year after cochlear implantation. The identification of an objective marker of cognitive functioning will help unravel how cochlear implantation affects cognition.

Resumo em Inglês:

Abstract Objective This study aimed to characterize audiological porfile in inviduals with Brown-Vialetto-Van Laere syndrome (BVVLS). Methods This is a scoping review following the methodological structure developed by the Joana Briggs Institute (JBI). The PCC mnemonic was used to elaborate the research question, which resulted in the research question: “What are the audiological findings in individuals with BVVLS?”. Results All of the studies included in this review were case reports. The main audiological findings are sensorineural hearing loss and Auditory Neuropathy Spectrum Disorder (ANSD). Conclusion All individuals presented a severe to profound bilateral hearing loss, related to ANSD.

Resumo em Inglês:

Abstract Objective To evaluate hearing outcomes and postoperative complications among patients with middle and external ear malformations undergoing active middle ear implantation with Vibrant Soundbridge® (VSB). Methods Review of the literature. Studies published in English, Portuguese, or Spanish at the following databases: PubMed, MEDLINE, Scopus, Web of Science, EMBASE, and Cochrane Library were searched. The search strategy yielded a total of 141 potentially relevant studies. Of these, ten were included in this analysis. Results The mean preoperative air conduction threshold was 66.7 ± 6.2 dB. The mean air-bone gap was 46 ± 7.7 dB. VSB implantation resulted in mean hearing gain of 40.5 ± 7.1 dB in the air-conduction thresholds among the evaluated frequencies. The speech recognition index if the Floating Mass Transducer (FMT) was placed in the short process was 86.0% ± 9.6%, with significant difference when compared to long process coupling (p= 0.035) and the round window coupling (p= 0.048). Conclusion Bone conduction thresholds did not worsen in any of the studies included in the present review. VSB implantation resulted in a mean hearing gain of 40 dB at air conduction thresholds.

Resumo em Inglês:

Abstract Objectives In recent years, indications for Cochlear Implants (CIs) have been on the rise, with Vestibular Schwannoma (VS) patients among these emerging indications. On the other hand, there is growing evidence in favor of the 'wait and see' approach as opposed to surgery or irradiation for most small VS. The aim of this paper is to discuss the current role of CIs in patients with VS, addressing the most controversial topics such as the variability of outcomes, the emerging clinical scenarios, the lack of consistent prognostic factors, and the need for an intraoperative tool to aid decision-making in challenging cases. Methods A Pubmed search was performed, with a selection of relevant citations, and critical appraisal of selected studies. Articles written in English on VS and cochlear implantation were eligible for inclusion. Pictures of illustrative cases from a tertiary center were included. Results The discussed topics were the following: (1) Variability in audiological outcomes; (2) Prognostic factors including tumor size, preoperative hearing, previous irradiation, extent of resection, and Neurofibromatosis type II (NF2) status; (3) Postoperative imaging; (4) The role of intraoperative testing; and (5) The current indication of CIs in different clinical scenarios. Conclusions CIs have become a useful solution for certain patients with VS. Audiological outcomes are variable, but worse than those of conventional CI candidates. Small and medium-sized tumors and those with a better preoperative hearing are more likely to benefit from a CI. The effect of irradiation is uncertain. Outcomes in NF2 patients may decrease in the long term. The auditory nerve test system is a useful intraoperative tool in most scenarios. The variability of the outcomes still precludes routine CI in VS with normal contralateral hearing. In addition to VS undergoing surgical resection and CI placement, some observed and irradiated VS cases also benefit from a CI. Level of evidence 5.

Resumo em Inglês:

Abstract Objective The European Association of Neuro-Oncology (EANO) indicated that different study designs and methodologies led to inconsistent conclusions about treatment methods and QoL in patients with Vestibular Schwannoma (VS). This study systematically reviews recent findings about QoL assessment instruments for patients with VS and provides recommendations for the measurement of QoL with standardized psychometric tools. Methods This study was conducted based on the PRISMA 2020 guideline for reporting systematic reviews. The key words used were as follows: quality of life, health-related quality of life, vestibular schwannomas, acoustic neuroma. Studies were included when the following eligibility criteria were met. Results Our search finally yielded 48 articles published in years 2014-2024 that measured QoL in patients with VS using standardized psychometric tools. The studies examined various dimensions of QoL. The most frequently used disease-specific questionnaire was the Penn Acoustic Neuroma Quality of Life (PANQOL). As a generic tool, authors preferred to use the Short-Form 36-Item Health Survey (SF-36). Conclusion Recent findings and data on Quality of Life (QoL) tools for patients with VS emphasize the importance of using standardized and disease specific tool like PANQOL, due to their frequent use and large amount of patient data. Although the SF-36 is commonly used for general assessments, it may not be sensitive enough for a complete QoL evaluation and should not be the only tool used. The GBI is effective for assessing changes after specific medical treatments. Using methods similar to those in past studies helps medical professionals make reliable conclusions about QoL and evaluate the effects of different treatments in VS patients.

Resumo em Inglês:

Abstract Objective To gather the technical definitions, diagnostic accuracy and scientific evidence of otoneurological exams in a succinct, easily accessible document, so that decision-making is as effective as possible. Method This paper was the results of the II Forum of Otoneurology, held on May 27, 2018, in Sao Paulo, during the III Combined Meeting + Four Otology, as part of the Otoneurology Forums project, undertaken by the Department of Otoneurology of the Brazilian Association of Otorhinolaryngology (ABORL-CCF) since 2017. Each paper gathered here was a literature review written by specialists from all over Brazil, based on the latest practices and scientific evidence related to diagnostic tests in Otoneurology. Each author presented their paper and a debate about it took place among the participants, generating an accepted-by-all interpretation paper after each presentation. Subsequently, the papers were reviewed by representatives of the country’s Otoneurology training department for final adjustments and standardization. For each paper presented, ABORL-CCF prepared a recommendation, taking into account existing scientific evidence and the best practices, according to the experts’ opinion. Using the full paper, that was published on the website of the Brazilian Association of Otorhinolaryngology and Maxillofacial Surgery, this summarized version was written as a scientific review article. Outcome The paper is presented as a practical, objective and complete guide on the main tests used to evaluate patients with otoneurological complaints, from bedside physical examinations to the most modern complementary tests done with sophisticated equipment. Conclusion With this scientific review, the authors hope to aid the organization of the professional’s behavior, from the bedside assessment to the choice of assessment methods, including requisitions, accomplishments, and understanding tests and diagnostic procedures.

Resumo em Inglês:

Abstract Objective: Presenting evidence available on perioperative isotretinoin application in, and benefits for, thick-skinned patients subjected to rhinoplasty. Methods: Analysis was applied to articles available in the following databases: Cochrane, PubMed, ScienceDirect and Scielo. The analyzed corpus comprised studies published from 2004 to 2023 focused on investigating thick-skinned patients subjected to rhinoplasty and treated with isotretinoin. Inappropriate and unrelated methodologies were excluded from the analysis. Results: Initially, 1,214 articles were collected, but this number dropped to 617 after duplicates’ removal. Twenty (20) articles remained in the corpus after inclusion criteria application, but 10 of them were excluded from the analysis based on exclusion criteria. Finally, 10 articles were selected for review purposes: 1 experience report, 2 case studies, 3 narrative reviews and 4 clinical trials. Conclusions: The current findings suggested aesthetic improvements in patients treated with isotretinoin, although its long-term benefits remain uncertain. Thus, further research on this topic should be conducted.

Resumo em Inglês:

Abstract Objectives: Direct comparison of the long-term effectiveness and safety of biologics for Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is lacking. The study aimed to compare the long-term efficacy and safety of various biologics in the management of CRSwNP. Methods: The PubMed, Embase, Cochrane Library, and Web of Science databases were searched from database inception to March 2024, to identify all relevant literature on the use of biologics for CRSwNP. The research protocol was registered on PROSPERO.Two independent reviewers screened the studies, extracted the data, and performed a quality assessment using the Cochrane Risk of Bias tool. Network meta-analysis was conducted using STATA 17.0 and Review Manager (Version 5.3). Results: Six studies with a minimum follow-up period of 52-weeks were analyzed, demonstrating the superior long-term efficacy of dupilumab compared to the other three biologics. The surface under the cumulative ranking curve were 100% for Nasal Polyp Score (NPS), 72.7% for Sino-Nasal Outcome Test-22 (SNOT-22), 94.6% for Visual Analogue Scale (VAS), and 100% for Nasal Congestion Score (NCS). In the comparison of NPS, dupilumab showed improvements of 1.84 (95% Confidence Interval [95% CI 0.78, 2.91]) over mepolizumab and 2.31 (95% CI 0.99, 3.63) over benralizumab. Among the symptom scores evaluated, only dupilumab achieved a significant improvement in NCS compared to benralizumab, with an improvement of 0.74 (95% CI 0.86, 1.19). No significant differences in adverse events was observed between biologics treatment or versus placebo. Conclusion: Treatment with dupilumab in patients with CRSwNP has shown superior long-term efficacy in reducing NPS and various symptom scores compared to other biologics. However, the results should be interpreted with caution due to the heterogeneity of patient characteristics across the included studies (e.g., disease severity, history of surgery, use of oral corticosteroids).

Resumo em Inglês:

Abstract Objectives To estimate patients’ overall and disease-free survival with squamous cell carcinoma of the oral cavity, oropharynx, and larynx, and assess the influence of primary local staging and histopathological features on these outcomes. Methods Retrospective data analysis of 102 patients with head and neck squamous cell carcinoma who underwent exclusive surgery as the initial treatment modality. p16 analysis was not evaluated. Exclusion criteria included patients with synchronous or metachronous tumors, those undergoing adjuvant or neoadjuvant chemotherapy or radiotherapy, and those with prior surgery at the exact site. Univariate and multivariate Cox Regression analyses were performed to evaluate outcome-related factors. Survival curves were estimated using the Kaplan-Meier method. Results The majority presented early stage I and II (83.4%), T1/T2 tumors (86.2%), N0 (95.1%), and all M0. The primary sites were mainly the larynx (46.1%) and oral cavity (41.2%). The mean overall survival was 71.76 months, with survival rates at 1-, 2-, 3-, 4-, and 5-years of 95.9%, 88.2%, 85.5%, 80.4%, and 74.7%, respectively. The mean disease-free survival was 68.2 months, with rates at 1-, 2-, 3-, 4-, and 5-years of 87.5%, 85.1%, 82.2%, 76.6%, and 69.3%, respectively. Active smoking was associated with a higher risk of death (HR = 9.4, p< 0.001) and recurrence (HR = 9.7, p< 0.001). Active smoking patients with perineural invasion presented worse overall and disease-free survival. Positive margins were associated with reduced disease-free survival. Conclusion Exclusive surgery in the early stages (I and II) emerges as a practical approach. Stage, primary site, margins, perineural invasion, lymphovascular invasion, and smoking cessation were the significant prognostic factors that affected patient outcomes. Level of evidence 2C.

Resumo em Inglês:

Abstract Objectives Children with Single-Sided Deafness (SSD) may experience a range of developmental challenges. While cochlear implantation has demonstrated significant improvements in hearing, its impact on Quality of Life (QoL) remains underreported. This review evaluates how cochlear implantation for SSD influences the quality of life in children. Methods A systematic review was conducted following the PRISMA guidelines across nine different databases, without language restrictions, including articles indexed up to December 15, 2023. Eligible studies included patients up to 18-years-old; severe to profound unilateral hearing loss, and normal contralateral hearing; cochlear implantation with more than 3 months of follow-up; QoL assessed by structured questionnaires. Meta-analysis compared QoL scores obtained between pre- and post-operative periods for time of onset or hearing loss (congenital vs. post-lingual), evaluated by parents and children, and the effective cochlear implant usage time. Results A total of 296 articles were identified, with 6 eligible for qualitative analysis and 3 for meta-analysis, involving 187 patients. The mean age at implantation was 5.8 years, with an average auditory deprivation time of 3.8 years. Both the congenital and post-lingual groups demonstrated improvement in QoL, with a mean increase of 1.51 points in children's evaluations (p-value < 0.001) and 2.70 points in parental perspectives (p-value < 0.001), assessed on a 10-point scale. The estimated effective device use time was 8.8 h per day, with 8.55 h per day for the congenital group and 10.37 h per day for the post-lingual group. There was no statistically significant difference in usage time between the two groups (p-value = 0.140). Conclusion The results indicated a significant improvement in QoL, as reported by both parents and through self-assessment. The treatment also demonstrated high levels of adherence. Both congenital and post-lingual groups yielded similar outcomes in terms of QoL and device usage time.

Resumo em Inglês:

Abstract Objectives For patients with Head and Neck Cancer (HNC), flap reconstruction is one of the treatment modalities for large head and neck defects. While most patients achieve satisfactory outcomes with a single flap, some may require a second or additional flaps due to various reasons. The aim of our study was to systematically review the relevant articles and investigate the application of sequential flaps in reconstruction of patients with HNC. Methods Two authors independently screened articles from PubMed, EBSCO, and Web of Science. Studies were included if they reported at least one of the following outcomes: duration of operation or hospitalization, flap-related postoperative complications, flap success rate, and follow-up outcomes. Results A total of 17 articles were included, comprising 832 patients and 1037 flaps (excluding the number of flaps used in initial reconstructions). The overall flap failure rate was 5.4%. Among the 314 flap-related postoperative complications, the most common were revision (5.8%), complete flap necrosis (5.2%), and arterial or venous thrombosis (3.3%). Conclusion Sequential flaps are an optional and effective reconstructive modality for HNC patients. However, prospective studies are needed to explore prognostic-related risk factors and better determine the suitability of sequential flaps for individual patients. Additionally, since reconstruction impacts both aesthetics and function, it is crucial to emphasize during preoperative discussions that postoperative outcomes may not fully align with patient expectations.

Resumo em Inglês:

Abstract Objectives 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.