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Abstract Introduction Mucoceles are benign expansile cystic lesions commonly seen in the frontoethmoidal region. Objective To see if the distribution of frontal air cells predisposes to mucocele formation. Methods Retrospective review of all cases of paranasal sinus mucocele from 2011 to 2021. Data on demographics, history of surgery or trauma, clinical features, radiological findings, and outcome were collected and analyzed. Results Of the 28 cases, 19 (67.9%) were male and 9 (32.1%), female, with a mean age of 40.75 years. Mucocele was unilateral in 26 (92.9%) patients. Twenty patients (71.43%) presented with primary mucocele. The distribution of mucocele was frontal and frontoethmoidal in 8 (28.6%) patients each, maxillary in 6 (21.4%), and ethmoid and sphenoid sinus in 3 (10.7%) patients each. Sixteen (57.1%) patients had frontal sinus involvement. At presentation, 13 (46.4%) patients had nasal symptoms, 17 (60.7%) had orbital symptoms, while 16 (57.1%) had headache. Pain (12; 70.59%) was the predominant orbital symptom, followed by proptosis and diplopia (8; 47.06%). The most common sites of bony erosions were along the frontal sinus floor (14; 50%), followed by lamina papyracea (13; 46.43%), and frontal sinus anterior wall (10; 35.71%). The agger nasi and suprabullar cells were the most common frontal cells encountered in mucoceles involving the frontal sinus, with no significant difference in frontal cell distribution between involved and uninvolved sides. The frontal cell distribution was similar in mucoceles with and without frontal sinus involvement too. Conclusion Though frontal and frontoethmoidal mucoceles were the most encountered, the type and distribution of frontal cells did not predispose to mucocele formation.

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Abstract Introduction The Nijmegen cochlear implant questionnaire (NCIQ) is a quantifiable self-assessment health-related quality of life (HRQoL) tool used internationally to determine quality of life (QoL) in cochlear implant (CI) users and to evaluate the implant's subjective benefits. Objective This study aimed to validate the Danish version of the questionnaire (DA-NCIQ) with a test–retest including 60 participants (30 CI users and 30 CI candidates). Methods The intraclass correlation coefficients (ICC) were calculated to evaluate the temporal stability of the participants’ answers and the internal consistency of the questionnaire domains was determined using the Cronbach alpha in order to compare these results with the NCIQ's other language versions. Results The DA-NCIQ was found to have Cronbach alpha coefficients between 0.7 and 0.91, as well as test–retest reliability with ICC values between 0.7 and 0.92. These findings were similar to the original and other language versions of this questionnaire. The Cronbach alpha coefficients varied between 0.73 and 0.89, while the ICC test–retest reliability varied between 0.64 and 0.85. Furthermore, the present study found that participants with CIs had an improved HRQoL in all subdomains, except for the advanced sound perception one, when compared to the CI candidates. Conclusion The results supported the DA-NCIQ as a reliable instrument to measure the subjective benefits of CIs in postlingually deafened/hearing-impaired adults.

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Abstract Introduction Drug-induced sleep endoscopy (DISE) is performed widely, and several studies have demonstrated its validity as it provides clinical information not available by routine clinical inspection alone. Objective This study aims to evaluate the role of transoral drug-induced sleep endoscopy (DISE) in the evaluation of tongue-palate (TP) interaction and its impact on surgical outcomes. Methods A total of 42 patients with known obstructive sleep apnea syndrome (OSAS) were classified into two groups according to TP interaction (the absence of space between tongue and palate with the visual impression that the tongue is pushing the soft palate) into +ve and –ve TP interaction. Snoring according to the visual analogue scale (VAS), the Epworth Sleepiness Scale (ESS), and sleep study data were recorded before and after the pharyngoplasty operation. Results There was a statistically significant difference between studied groups postoperative regarding minimal oxygen saturation, snoring index, apnea-hypopnea index (AHI), the ESS, and visual analogue scale of snoring (p = 0.003*, p < 0.001*, p < 0.001*, p = 0.004*, and p = 0.003*, respectively). It displayed a marked higher average improvement among cases with –ve than in those with +ve TP interaction in terms of snoring index, AHI, and ESS. Conclusion The Transoral DISE Has A Valuable Role In Evaluating And Assessing TP Interaction And Its Importance On Surgical Outcomes. Cases With Positive TP Interaction Show Poor Response To Isolated Palatopharyngeal Expansion And Need Further Analysis To Create A Better Treatment Plan And Improve Outcomes.

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Abstract Introduction Urinary tract infections (UTIs) represent a rare postoperative complication following thyroidectomy. Objective This study aimed to assess the clinicodemographic factors associated with the development of UTIs and subsequent outcomes among patients undergoing thyroidectomy. Methods This retrospective study used the National Surgical Quality Improvement Program (NSQIP) database to analyze patients who underwent thyroidectomy from 2005 to 2019. Multivariable logistic regression models were used to identify risk factors and associations of UTIs with postoperative morbidity and mortality. Results In a cohort of 180,373 identified thyroidectomy patients, 0.28% contracted a UTI. Significant risk factors associated with UTIs included age > 60 years (adjusted odds ratio [OR] 2.187, 95% confidence interval [CI] 1.618–2.956), female gender (OR 1.767, 95% CI 1.372–2.278), American Society of Anesthesiologists (ASA) Classification 3 to 5 (OR 1.463, 95% CI 1.185–1.805), partially (OR 4.267, 95% CI 2.510–7.253) or totally dependent functional health status (OR 9.658, 95% CI 4.170–22.370), pulmonary disease (OR1.907, 95% CI 1.295–2.808), chronic steroid therapy (OR 1.649, 95% CI 1.076–2.527), inpatient procedure (OR 1.507, 95% CI 1.251–1.814), and operative time > 150 minutes (OR 1.449, 95% CI 1.027–2.044). Additionally, UTIs were independently associated with postoperative complications, including pulmonary, vascular, or cardiac complication; stroke; acute renal failure; infectious complications; sepsis; septic shock; pneumonia; prolonged length of stay; unplanned reoperation; and mortality. Conclusion While UTIs are rare after thyroidectomy, they carry a significant burden on patient outcomes. Preoperative optimization of comorbidities and reducing operative times may help mitigate the risk of UTIs. Optimized care for postoperative UTI patients is also recommended to prevent complications and improve outcomes.

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Abstract Introduction In the literature, there is divergence about the relationship between anatomical variations of the turbinates and nasal septum (NS) and alterations in the maxillary sinus (MS) mucosa. Objective To determine, through cone-beam computed tomography (CBCT) images of Brazilian individuals, the prevalence and relationship of anatomical variations of the turbinates and NS with alterations in the mucosa of the MS, as well as to analyze the relationships of these variables with demographic data. Methods The present cross-sectional study involved the analysis of 120 CBCT scans using the i-CAT Vision software, conducted by 2 calibrated examiners. The MS, lower and medium turbinates, and NS were evaluated. Data on gender, age, and the side affected by anatomical variation were also collected. The intra- and interexaminer agreements were assessed using Kappa indices. The association was analyzed using the Chi-squared or Fisher exact tests, and measured by the Phi, Cramer V, or Kendall Tau-C values. Results Most patients presented partial opacification of the MS (89.2%), inferior turbinate hypertrophy (TH) (60.8%), and NS deviation (85%). There were no cases of inferior concha bullosa (CB), while the prevalence of middle CB was of 20%. Variation in the turbinates, CB, and NS were not significantly related to changes in the MS mucosa. Conclusion We can conclude that, in the evaluated sample, there was no significant associations involving the studied variables.

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Abstract Introduction Minimally invasive Ponto surgery (MIPS) enables the installation of percutaneous bone-anchored hearing implants (BAHIs) with a drill guide through a hole punch incision. Despite being well established for adults, there is a lack of studies in the literature regarding its use in pediatric patients. Objective The aim of the present study was to investigate the hearing performance and soft-tissue outcomes of the use of MIPS under local anesthesia in children with unilateral craniofacial malformation (UCM). Methods The study used a retrospective cohort design. Nine subjects with UCM, aged between 6.5 and 17.1 (median = 12) years, who underwent the MIPS procedure under local anesthesia were included. Surgical procedure, intra, and postoperative complications were investigated. Speech recognition thresholds in quiet (SRTQ) and in noise (SRTN), daily use, satisfaction, and perceptual listening effort of the subjects were assessed after 4 months of postoperative follow-up. Results It was possible to perform MIPS under local anesthesia in 8 of 9 subjects, with no intraoperative complications. One subject (11.11%) showed adverse skin reactions during a mean follow-up period of 11.4 months with MIPS. Speech recognition thresholds in quiet, SRTN, and subjective listening effort scores significantly decreased with the use of BAHI. The subjects were overall satisfied with the device and using it 8.2 hours/day, on average. Conclusion Under local anesthesia, MIPS showed to be a viable option for BAHI installation in children with UCM. The hearing performance of the subjects improved, and they were globally satisfied with the device. Soft-tissue complications were minimal, and our results are comparable to those reported in the literature for adults.

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Abstract Introduction Adults with cochlear implants (CIs) need periodic programming of their speech processors to take advantage of alternative adjustments. However, this requires patients to attend the CI center in person. Objectives To evaluate the feasibility of speech processor (SP) self-programming with remote assistance in CI users. To establish the characteristics of those who could benefit from self-programming. Methods Adults with at least 1 year of experience with their CI, and whose SP was compatible with the use of the remote assistant fitting (RAF) were selected. Maps were created by the RAF from the neural response telemetry (NRT) results, evaluated in the same session with the audiologist. Patients were given 15-days to adjust to either the routine map or the NRT-based one. In the next session, the minimum and maximum stimulation levels (T- and C-levels) of all the maps were compared. Results No statistical difference was found when comparing the T- and C-levels of the map in use, the map adjusted by RAF, and the NRT-based map created by the RAF and adjusted by the patient. Conclusion Self-programming of the SP was safe and feasible in the studied sample of adults, since T- and C-levels were similar between the behavioral and RAF-adjusted maps. We consider it advisable to use the RAF for patients who have insertion of electrodes and at least one functioning; as well as those who do not have changes in anatomy, nor motor and cognitive conditions that prevent RAF usage.

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Abstract Introduction Bell palsy (BP) is an acquired, idiopathic facial palsy linked to lower motor neuron malfunction of the seventh cranial nerve. Several studies have identified BP as one of the many neuropathies that coronavirus disease 2019 (COVID-19) patients have developed, while other studies disagree. Objective To study if there is an association between BP in pediatric patients and COVID-19, and to examine the pattern of recovery in all pediatric cases of BP during the COVID-19 pandemic. Methods We performed a prospective cohort study on pediatric patients with acute onset unilateral facial weakness of unknown etiology (BP) during the pandemic period. All included patients were submitted to a reverse transcription-polymerase chain reaction (RT-PCR) test through nasopharyngeal and oropharyngeal swabs for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the time of the BP diagnosis. Results No significant differences were found regarding COVID-19 infection and recovery from BP at the first, third, or sixth months of follow-up. According to the results, it seems that there is no association between COVID-19 infection and facial palsy; however, the patients infected with COVID-19 in the sample experienced a rapid, early recovery from BP. The mean incidence of BP in 5 years (2017–2021) was of 1.73/100 thousand individuals, with a statistically insignificant change throughout the years. Conclusion We were not able to show any association between BP and COVID-19. The patients underwent follow-up for up to 6 months, and we studied their patterns of recovery from BP, which were like those observed before the pandemic.

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Abstract Introduction Sickle cell anemia (SCA) is a genetic disorder with clinical manifestations due to circulatory changes, leading to adverse effects on the auditory system that might impact auditory processing, such as auditory discrimination and speech perception ability. This condition is associated with the severity level of anemia. Objective The purpose of the present study was to investigate the influence of anemia severity on auditory discrimination ability and speech perception in noise among SCA patients with normal hearing sensitivity. Methods A total of 52 normal-hearing adults diagnosed with SCA in the age range of 15 to 40 were grouped into mild, moderate, and severe, based on anemia severity. Auditory discrimination tests for frequency, intensity, and duration were evaluated at 500 and 4,000 Hz along with speech perception in noise (SPIN) at 0 dB SNR using the mlp toolbox in the MATLAB software, version 2014a (MathWorks, Natick, MA, USA). The IBM Statistical Package for Social Sciences (SPSS) version 26.0 (IBM Corp., Armonk, NY, USA) was used for statistical analysis. Results The results revealed an increase in median and interquartile range among anemia groups with increasing severity. Additionally, the median scores were found to be poorer for the higher frequency in all auditory discrimination tests than for the lower one. A regression in performance with an increase in severity for the SPIN test was observed. Conclusion The severity of anemia plays an important role in functional auditory processing deterioration. Circulatory changes secondary to SCA affected auditory discrimination processing and speech perception in noise. However, all auditory discrimination abilities are not necessarily affected equally.

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Abstract Introduction The uncinate process (UP) is the most important and constant landmark in the ostiomeatal complex and the middle meatus. Objective To identify the UP variations that have not been published before and establish a categorization using computed tomography (CT). Methods The current study was carried out on 110 paranasal CT scans (220 sides). Axial images were acquired with multiplanar reformats to capture delicate details in other planes. Results Out of 120 CT scans (220 sides), the UP was found to be of type 1 in 84.5%, type 2 in 12.3%, and type 3 in 3.2%, without significant diferences between genders, and it was found to be medialized in 81.9%, vertical in 16.3%, lateralized in 0.9%, and absent in 0.9%, without significant differences between genders. A total of 8.63% of the UPs were pneumatized. Conclusion The present study improves surgeons’ and radiologists’ knowledge of the UP, while creating a standard classification and description to be used as a common language between otorhinolaryngologists and radiologists, which could also be used for training.

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Abstract Introduction Although there are several reports of endoscopic findings of the larynx and esophagus in laryngopharyngeal reflux (LPR) patients, little is known about the correlation between change in symptoms and laryngeal and esophageal mucosal findings after proton pump inhibitor (PPI) treatment. Objective The present study aimed to evaluate the changes in symptoms and mucosal findings of the larynx and esophagus using transnasal esophagoscopy (TNE) after PPI medication and to analyze their relationship in LPR patients. Methods The current prospective study included 36 patients who complained of LPR symptoms. Reflux Symptom Index (RSI), Reflux Finding Score (RFS), and modified Los Angeles classification using TNE were obtained pretreatment and 8 weeks after treatment with PPIs. Results Data from 22 patients who completed all examinations were analyzed. The mean age was 52.8 years, and 4 patients were men. The most common symptom was a globus sensation (54.6%). Both RSI (p < 0.001) and RFS (p < 0.001) were significantly improved after 8 weeks with PPI treatment. However, there was no correlation between improvement of RSI and RFS (p = 0.350). Thirteen patients showed improvement in esophageal findings. However, there was no significant association between improvement of esophageal findings and RSI (p = 0.350) or RFS (p = 0.376). Conclusion Although PPI treatment improved LPR symptoms and endoscopic findings, the change in symptoms was not related to endoscopic mucosal findings in the larynx and esophagus.

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Abstract Introduction Vestibular migraine (VM) is one of the most common vestibular disorders and its diagnosis is based entirely on clinical features. A recent case series suggested a possible link between migraines and convergence insufficiency. Objective To compare the near point of convergence (NPC) in patients with and without VM. Methods We retrospectively reviewed the data of 50 patients with and 50 without VM, comparing the NPC between both groups. The NPC was measured according to the recommendations of the American Academy of Ophthalmology. Differences in the results between groups were compared using the Mann-Whitney test. The association of the NPC with age, gender, and the use of corrective glasses or contact lenses was evaluated by the Student t or Mann-Whitney tests for parametric and nonparametric data, respectively. To determine the diagnostic accuracy and optimal cut-off point, receiver operating characteristic (ROC) curves were created. Results The mean NPC was significantly higher in patients with VM (18.50 ± 5.88 cm) compared to the control group (8.06 ± 1.46 cm; p < 0.001). The area under the curve (AUC) was 0.986 (95% CI: 0.938–0.999; p < 0.0001), suggesting that NPC was able to accurately discriminate between patients with and without VM with a sensitivity of 94% and specificity of 100%. Conclusion Our results suggest that convergence insufficiency is a common sign in patients with VM and may be considered a potential clinical biomarker. However, further studies are needed to confirm this hypothesis.

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Abstract Introduction Perioperative management of antithrombotic agents may affect bleeding and lead to thromboembolic complications, but there is no consensus on optimal protocol in head and neck surgery. Objective To explore the effect of antithrombotic agents on postoperative bleeding. Methods We compared clinical characteristics, type of surgery, antithrombotic agents, continued use of medication or not, and frequency of postoperative bleeding among patients who were receiving antithrombotic therapy at the time of their decision to undergo surgery for head and neck malignancies, from 2008 to 2022. Results A total of 168 patients were included. There was no significant difference in the incidence of intraoperative blood loss or postoperative bleeding between the group that underwent surgery while on antithrombotic therapy and those that underwent surgery after antithrombotic therapy was discontinued. In particular, there was no increase in bleeding complications with antiplatelet agents, regardless of the type or number of agents used. Conclusion Surgery for head and neck malignancies with continued antiplatelet therapy may not increase bleeding complications, regardless of the type of antiplatelet therapy and even when multiple agents are taken.

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Abstract Introduction Mucormycosis is an aggressive, lethal fungal infection affecting the nasal and paranasal territory in immunocompromised patients. Orbital involvement is not uncommon and may require orbital exenteration. Objectives The management of orbital involvement in invasive fungal sinusitis is challenging, ranging from conservative retrobulbar amphotericin B injection in the early stages to orbital exenteration in late stages. Endoscopic endonasal debridement is a minimally invasive technique used to manage orbital fungal involvement in the late stages. Methods Endoscopic endonasal orbital clearance was performed to manage late-stage orbital invasive fungal infection (≥ stage 3c) or after failure of retrobulbar amphotericin B injection with no light perception. Removal of the lamina papyracea (LP) and incision of the periorbita were done to expose all the necrotic intraorbital content in the extra and intraconal spaces. A microdebrider was utilized to debride necrotic fungal infected tissue until a healthy vascularized plane was reached. Gelfoam (Pfizer Inc., New York, NY, United States) soaked in amphotericin B was applied as an adjunctive step to deliver antifungal medication to the orbital content. Results Fourteen patients were included in the study, 9 of whom were male and 5 female, with a mean age of 58.5 years. Eleven patients showed no evidence of disease progression (complete recovery and cessation of medical treatment). Two patients died 15 days after the surgery. The last patient developed frontal lobe abscess but has been treated with double antifungal medication. Conclusion Endoscopic endonasal orbital debridement could be an effective method to treat late-stage orbital fungal infection without jeopardizing the patient's life. Level of Evidence: 4.

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Abstract Introduction Platelet-rich plasma (PRP) contains high platelet concentration and growth factors that help in rapid wound healing, hemostasis, and decreased scarring. It has been used in various conditions to aid in healing, but its use in ear, nose, and throat (ENT) is not yet common. Objective To compare the outcome of using PRP with myringoplasty with that of myringoplasty alone in the repair of tympanic membrane perforations. Methods Sixty-eight patients in the 16-to-50 years age group with tympanic membrane perforation of 3 months duration, with dry ear for 6 weeks, and mild to-moderate conductive hearing loss were selected and divided by simple randomization into 2 equal groups. A thorough preoperative evaluation was done. In group A, patients underwent myringoplasty, and in group B, patients underwent myringoplasty with PRP. Patients were followed up for 3 months postsurgery. Results At 6 weeks, 67.6 and 94.1% had graft uptake in groups A and B, respectively (p-value 0.011). At 3 months, 85.3 and 97.1% had graft uptake in groups A and B, respectively (p-value 0.197). The mean pure tone audiometry difference in group A was 8.35 ± 2.05, and 11.00 ± 2.28 in group B (p < 0.001). The mean air-bone gap difference for group A was 8.29 ± 2.14, and 10.76 ± 2.36 for group B (p < 0.001). Graft uptake rate at 6 weeks, pure tone audiometry, and air-bone gap difference were statistically significant. Conclusion The present study results showed that the use of PRP during myringoplasty aids healing of the tympanic membrane with better hearing improvement in the postoperative period when compared to myringoplasty alone.

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Abstract Introduction Various factors have been reported to affect the rates of success after tympanoplasty, among them, myringosclerosis. However, there are few studies focusing only on the effect of myringosclerotic plaque removal on tympanoplasty outcomes. Objective To compare the outcome of tympanoplasty in perforated eardrums with and without myringosclerosis. Methods The study included patients aged between 21 and 53 years diagnosed at the outpatient department with inactive mucosal chronic otitis media. The sample was divided into the case group, which included subjects with tympanic membrane perforation and myringosclerosis, and the control group, which included subjects with tympanic membrane perforation only, without myringosclerosis. We assessed the audiological findings of the patients before and after surgery, as well as hearing gain, graft uptake, and residual perforation/reperforation. Results No significant relationships were observed involving the age or sex of the patient and the closure rate or hearing gain, neither between the location of the perforation and graft uptake. Graft uptake was higher in patients with perforation size < 50%. The graft uptake and hearing gain were higher in the case group. Conclusion The removal of sclerotic plaques increases the surface of the raw area created by subepithelial excision of the myringosclerotic plaques, leading to a high rate of surgical success for the closure of tympanic membrane defects with coexisting myringosclerosis.

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Abstract Introduction Few studies have investigated the relationship between cytokines and dizziness in elderly individuals. Objective To assess the levels of inflammatory biomarkers and their relationship with quality of life (QoL) among elderly individuals with dizziness. Methods We conducted a cross-sectional study with 103 participants (90 women and 13 men) who were assessed through the Visual Analogue Scale (VAS) and the Dizziness Handicap Inventory (DHI). The plasma levels of cytokines were measured through the cytometric bead array (CBA) method. Cross-tabulations with the Chi-squared test were used to verify sample homogeneity, and parametric tests were used to analyze the data. Results Out of the total sample of 103 individuals, dizziness was reported by 40 women and 5 men. A difference between the groups with and without dizziness was observed regarding the levels of interleukin 4 (IL-4; p = 0.011): the group without dizziness presented a higher mean level (2.1 ± 2.8 pg/mL) when compared to the group that presented dizziness (1.0 ± 1.7 pg/mL). Another difference was found between the DHI classifications and the plasma levels of tumor necrosis factor alpha (TNF-α;) p = 0.015): the groups without any losses in QoL presented lower TNF-α levels (1.4 pg/mL) compared to the group that presented moderate QoL loss (6.3 pg/mL). Conclusion Dizziness affects the functional, physical and emotional dimensions of QoL and plays a role in the decrease in the levels of IL-4 and in the presence of fullness and tinnitus. Higher VAS scores are related to dizziness in the elderly. Moreover, the increased levels of TNF-α were associated to light-to-moderate losses in QoL among elderly patients with dizziness.

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Abstract Introduction Microtia and aural atresia present congenital ear anomalies that affect external ear and are associated with conductive hearing loss. Both anomalies result from exposure to various prenatal risk factors, most common during the first trimester of pregnancy. Objective This study was aimed at epidemiological analysis of microtia/atresia and associated risk factors in the Kazakhstani population. Methods A retrospective study in two stages. First, a cross-sectional analysis of microtia/ atresia frequencies from 2015 to 2019 on the basis of official statistics obtained from the Republican Centre for E-Health. Then, a case-control study was carried out to elucidate maternal risk factors associated with occurrence of microtia/atresia. We recruited patients presented in Almaty, Kazakhstan, between September 2021 and February 2022. Results There was a substantial regional variation in the rates of both aural atresia and microtia/anotia. Mothers of children with microtia disclosed toxoplasmosis, other agents (including HIV, syphilis, varicella), rubella, cytomegalovirus, herpes simplex (TORCH) infections during pregnancy more often than those of healthy children (45.8 versus 7.3%; p < 0.001). Exposure to different chemicals during pregnancy was mentioned more frequently by mothers of children with microtia when compared with the healthy controls (18.1 versus 8.1%; p = 0.035). Self-reporting of alcohol consumption and intake of antibiotics was also significantly higher in mothers of children with microtia (31.9 and 36.1% respectively). Conclusion Elucidation of microtia/atresia epidemiology is important due to their imposed social and economic burden, associated with treatment and rehabilitation costs.

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Abstract Introduction In recent years, transcanal endoscopic ear surgery (TEES) has gained widespread recognition as an excellent surgical field for blind spots such as the sinus tympani (ST) when compared to microscopic ear surgery (MES). Objective To investigate the postoperative hearing results for pars tensa cholesteatoma and the indications for utilizing endoscopy. Methods The medical records of 16 patients (10 men and 6 women) with pars tensa cholesteatoma, who received initial surgical treatment between 2018 and 2022, were reviewed. We performed MES, TEES, or endoscopy-assisted MES (dual approach) depending on the pathological involvement in the mastoid cavity and ST. Results The mean age of the patients was 45 years, and the surgical techniques utilized were MES in 2 cases, TEES in 7 cases, and dual approach in 7 cases. The preoperative pathological classification was stage I in 3 patients and stage II in 13 patients. The overall surgical success rates of postoperative hearing outcomes were 69% and 50% (1/2 patients) in the TEES group, 71% (5/7 patients) in the MES group, and 71% (5/7 patients) in the dual approach group. The successful cases (n = 11) were significantly younger and demonstrated better mastoid pneumatization than unsuccessful cases (n = 5). Conclusion Endoscopy-assisted MES is appropriate for treating pars tensa cholesteatoma when pathological involvement is present at the deep bottom of the ST. Early surgical intervention and good eustachian tube function are crucial for improving hearing prognosis. Transcanal endoscopic ear surgery can be particularly useful in identifying and removing residual cholesteatoma within the ST.

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Abstract Introduction Otosclerosis leads to stapes fixation and consequent conductive hearing loss. Surgery is the mainstay of treatment, and it can be achieved through small fenestra stapedotomy or stapedectomy. Despite the first being favored by most, evidence supporting its superiority over the latter remains inconclusive. Objective To assess the hearing outcomes and complications of stapes surgery performed in a series of patients with otosclerosis and compare the results of stapedotomy with stapedectomy. Methods A retrospective study of 134 ears in 125 otosclerosis patients undergoing primary stapes surgery was conducted. Patients underwent either stapedotomy or stapedectomy, and outcomes were compared using pre- and postoperative audiometric data and complication rates. Results Most cases (81%) underwent stapedotomy. Both techniques resulted in significant improvement in air-bone gap (ABG) and speech recognition threshold (SRT) postoperatively, with no significant difference between them. Complication rates were comparable between techniques, with no statistical difference in postoperative complications. Conclusion Both stapedotomy and stapedectomy offer favorable hearing outcomes with low complication rates in otosclerosis patients. While stapedotomy remains the preferred technique, if the initial plan shifts to a stapedectomy, surgeons should remain composed and confident in a good hearing outcome.

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Abstract Introduction Stapedotomy is the standard of care in the surgical management of clinical otosclerosis. It is a precise and technically demanding craft requiring impeccable surgical skills. Both conventional and laser-assisted procedures aim to achieve closure of the air-bone gap (ABG) with minimum collateral damage. Objective To compare the postoperative outcomes of conventional stapes surgery and CO2 laser-assisted surgery. Methods We conducted a retrospective analysis of the medical records of 74 adult patients who underwent stapedotomy at our center. The patients were divided into two groups for comparison: the "cold steel method" (CSM) group, which was composed of patients who had undergone conventional stapedotomy (manual microperforators/hand-held microdrill); and the "CO2 laser-assisted" (LA) group. The postoperative outcomes assessed at 3 and 6 months in both groups were analyzed and compared. The average operative time and complications of both groups were also compared. Results The hearing outcomes presented statistically significant postoperative improvement in both groups. The LA group presented statistically significant better air conduction thresholds at 3 and 6 months (p < 0.05). The ABG and its degree of closure were statistically better at 3 months in the LA group; however, the difference became insignificant at 6 months. Transient vertigo was more common in the LA group (p < 0.01). There was no new sensorineural hearing loss in either group. The operative time was longer in the LA group. Conclusion In experienced hands, both conventional and laser techniques can be used with equal ease and expectation of better outcomes. The CO2 laser is not an indispensable tool to achieve good surgical results on a routine basis.

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Abstract Introduction Supracricoid partial laryngectomy is a surgical treatment for advanced laryngeal cancer which is implemented to preserve organ function, but it may cause obstructive sleep apnea syndrome (OSAS) due to anatomical changes after surgery that may be neglected by clinicians. Although the gold standard for the diagnosis of OSAS is polysomnography, respiratory polygraphy is an alternative valid method with a high level of diagnostic sensitivity and specificity; since the equipment is portable, it can be used at home, with no need for hospitalization. Objective To describe the polygraphy result of patients submitted to supracricoid partial laryngectomy. Methods The present study included 13 patients, and we collected data on age, date of the surgery, body mass index, cardiovascular risk factors, Epworth score, and apnea-hypopnea index (AHI). Results The 13 patients were all male, with a mean age of 62 years. As for the AHI, one patient was classified as severe, six, as moderate, and three patients, as mild; moreover, 3 patients were simple snorers. While 77% of the sample presented OSAS, only 23% presented symptoms of drowsiness. Conclusion The study group, who underwent supracricoid partial laryngectomy, did not present self-reported symptoms of OSAS. Nevertheless, polygraphy was a useful tool in this group, and we recommend its systematic use after decannulation to avoid leaving OSAS undiagnosed. Level of evidence 4; case series study

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Abstract Introduction Given the severity with which obstructive sleep apnea (OSA) syndrome can affect the patient's health, many therapies have been presented to minimize the occurrence of episodes of airway obstruction during sleep. Regarding non-invasive and effective methods, orofacial myofunctional therapy (OMT) is an important adjuvant in the clinical treatment. Objective To verify the effectiveness of OMT in the treatment of adult patients affected by OSA. Data Synthesis A search strategy was developed with terms adapted to the requirements of the main databases in the health field (PubMed, Cochrane, Embase and secondary databases) to designate the adult OSA population and the OMT intervention. The analysis of the records found was performed by two independent examiners and, at the end, we included five randomized clinical trials that presented the outcome of effectiveness of the OMT verified through the apnea-hypopnea index (AHI). Conclusion The effectiveness of the OMT in the treatment of adult OSA patients was verified, both alone and in association with other interventions, through the reduction in the AHI and the Epworth Sleepiness Scale.

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Abstract Introduction The Otorhinolaryngology Foundation (FO), created in 1995, has played an important role in the advancement of otorhinolaryngology in Brazil, through initiatives in education, research, and service provision. Objective To present the trajectory of FO's 30 years in public health and professional training, highlighting its contributions, historical milestones, and future challenges. Brief History Created by the Center for Studies and Advanced Development in Otorhinolaryngology (CEDAO), the FO expanded its activities beyond academic support, becoming a national reference. Among its achievements, the commitment to the continuous improvement of teaching, research, publications, and provision of services to the community stands out. These initiatives include the promotion of courses and conferences that train thousands of professionals, the dissemination of knowledge through scientific publications, the development of innovative technologies, and the carrying out of campaigns and assistance actions aimed at the population. Final Considerations The celebration of FO's 30th anniversary reaffirms its mission of excellence and innovation in the dissemination of knowledge in otorhinolaryngology in Brazil. The continuous commitment to improving its four fundamental pillars ensures quality in education, research, and service to society.

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Abstract Introduction There are no clear guidelines for deciding between endoscopic sinus surgery and tooth extraction for the treatment of odontogenic sinusitis. Furthermore, tooth extraction does not necessarily improve sinusitis and eventually results in additional endoscopic sinus surgery. Objective The present study aimed to retrospectively investigate negative predictive factors of tooth extraction for odontogenic sinusitis. Methods In total, 22 patients with odontogenic sinusitis, who underwent tooth extraction between April 2017 and March 2021, were included. The patients were divided into the improved (n = 15) and non-improved (n = 7) groups. Subsequently, the two groups were compared. Results A higher percentage of patients in the non-improved group had polyps in the middle nasal meatus (p = 0.0008), higher Lund-Mackay score (LMS) (p = 0.0008), and apical lesions penetrating the maxillary sinus (p = 0.113). Patients with middle nasal meatus polyps, with LMS ≥ 7, or with a combination of apical lesions penetrating the maxillary sinus and LMS ≥ 5, were less likely to see improvement in sinusitis with tooth extraction. Conclusion Tooth extraction as the initial intervention for odontogenic sinusitis presents a higher risk of failure, particularly in cases in which polyps are present in the middle nasal meatus, with LMS ≥ 7, or with a combination of apical lesions penetrating the maxillary sinus and LMS ≥ 5.