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Abstract Introduction Nasal fractures are one of the most common diseases in the otorhinolaryngology emergency room that leads to significant complications. However, there is still no suitable method to prevent their occurrence, which may result from insufficient studies on their causes and related factors. Objectives To describe the demographic features, pattern, time of consultation, and etiological factors of patients with different types of nasal fractures. Methods We conducted a retrospective study of the records of patients with a diagnosis of nasal fracture treated between 2010 and 2021. The data included demographic characteristics, type of maxillofacial injury and associated lesions, complication rates, treatment modalities, and a description of the surgery. Results We included 599 patients, mostly male subjects (81.6%) injured in a road accident (55.3%), with a mean age of 31.64 ± 14.65 years, and mean length of hospital stay of 2.27 ± 2.21 days. Most accompanying fractures were maxillary (38.5%), multiple (24.6%), and mandibular (23.1%). The mean length of hospital stay was statistically different according to the cause of the fracture (p = 0.036) and the types of treatment performed (p = 0.041). Conclusion In general, trauma patients in the second to fourth decades of life and of the male gender are more prone to nasal fractures. Identifying the factors affecting the incidence of fractures enables the determination of the presentation patterns and the nature of the lesions to be evaluated. In addition, treatment evaluation and an analysis of the complication rate enable a more realistic interpretation of how patients are managed.

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Abstract Introduction An ideal and long-lasting adhesive and sealant is essential during endoscopic endonasal skull-base surgery to hold the reconstruction intact and prevent cerebrospinal fluid (CSF) permeation until complete healing occurs. Fibrin glue is the most common material used. Regenerated oxidized cellulose (ROC) has not been mentioned in the literature as sealant and adhesive, and, hence, we intended to study this role. Objective To evaluate the role of ROC as tissue sealant and adhesive in the reconstruction of skull-base defects in endoscopic endonasal skull-base surgery. Methods We retrospectively analyzed the medical records of patients who underwent endoscopic endonasal skull-base surgery with skull-base defect and intraoperative CSF leak, for which reconstruction was performed using fibrin glue or ROC, or both, as a sealant and adhesive. The type of sealant and adhesive used and postoperative CSF leak rates with different agents used were analyzed. Results A total of 64 patients were investigated. Fibrin glue alone was used initially in 6 patients, of which 4 (66.6%) experienced postoperative CSF leak. Both fibrin glue and ROC were used in 26 patients, among which 2 (7.6%) exhibited postoperative CSF leak. Regenerated oxidized cellulose alone was used in 24 patients, wherein 2 (8.3%) presented with postoperative CSF leak. Fibrin glue alone was once again used later in the learning curve in 8 patients, of which 2 (25%) experienced postoperative CSF leak (p = 0.002). Conclusion Fibrin glue provides intraoperative watertight seal. Regenerated oxidized cellulose has better intraoperative and long-term sealant and adhesive action in endoscopic endonasal skull-base reconstruction.

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Abstract Introduction Preauricular defect is one of the main concerns after superficial parotidectomy. Plastic surgeons have described many filling techniques to overcome the problem. Objective To discuss three reconstruction techniques after superficial parotidectomy: partial-thickness, superiorly based sternocleidomastoid muscle flap; en-bloc fat graft; and platelet-rich fibrin gel, with a comparison of aesthetic and functional outcomes. Methods The present study included 29 adult patients submitted to reconstruction after superficial parotidectomy by partial-thickness, superiorly based sternocleidomastoid muscle flap, en-bloc fat graft, and platelet-rich fibrin gel. A subjective evaluation of the facial nerve functions was conducted through a visual analog scale (VAS) with scores from 0 to 5, which was completed by the patient, a close relative, and 3 blinded staff members. Results Regarding the VAS, in the comparison of the 3 groups at the sixth and twelfth postoperative months, the fat-graft group reported the highest mean values for satisfaction (3.4 ± 1.1 and 3.83 ± 0.97 respectively). The fat-graft group also showed highly significant differences when compared with the groups submitted to the sternocleidomastoid muscle flap (p = 0.0001) and the platelet-rich fibrin gel techniques (p = 0.016). Conclusion Parotidectomy with immediate reconstruction of the surgical defect through an en-block fat graft provides better esthetic outcomes than sternocleidomastoid muscle flap and platelet-rich fibrin gel after one year. The patients submitted to the sternocleidomastoid muscle flap and fat-graft techniques reported minimal surgical site morbidity and a lower chance of developing Frey syndrome. The fat graft resulted in the best degree of cosmetic satisfaction, with minimal morbidity. Fat overcorrection is recommended.

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Abstract Introduction Hearing is a complex process that involves mechanical, chemical, and neurophysiological components. Changes in hearing can be caused by congenital or acquired etiological factors. Chronic kidney disease (CKD) is one of the causes of hearing loss. Objective To compare auditory findings before and after a single session of hemodialysis in patients with chronic kidney disease. Methods A clinical cross-sectional research was conducted with a sample of 23 individuals between 24 to 57 years of age with a diagnosis of CKD undergoing hemodialysis. Distortion product otoacoustic emission (DPOAE) and transient otoacoustic emission (TOAE) tests were performed before and after a session of hemodialysis. Results The DPOAE test revealed that 26% of the participants had failure in both ears prior to dialysis and 30.4% had failure after dialysis. Comparing the DPOAE and TOAE tests before and after hemodialysis, a slight decrease was found in patients with "fail" results from the predialysis test to the postdialysis test, but the difference did not achieve statistical significance. Conclusions No significant hearing changes assessed through otoacoustic emissions occurred after a single session of hemodialysis in the sample analyzed.

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Abstract Introduction The management of recurrent thyroglossal duct cysts poses persistent challenges. The present review assesses chemical ablations and surgical re-interventions as strategies for recurrence. However, limited comparative studies exist to determine the optimal approach and follow-up outcome. Objectives The aim of the current study is to conduct a review gathering evidence from the literature to analyze and synthesize the safest and most effective approaches for treating recurrent thyroglossal duct cysts. Methods The present study aims to comprehensively search electronic databases, including the Latin American and Caribbean Literature in Health Sciences (Literatura Latino-Americana e do Caribe em Ciências da Saúde, LILACS, in Portuguese), the database of the Journal of the American Medical Association (JAMA), SciVerse Scopus, Virtual Health Library (Biblioteca Virtual em Saúde, BVS, in Portuguese), and PubMed, for articles on recurrent thyroglossal duct cysts. The selected articles include patients with recurrent cysts, cover publications from 2000 to 2022, describe clinical and/or surgical interventions, and ensure the safety and efficacy of the analyzed approach. Results The present review included 9 studies, involving a cohort of 278 patients. Out of these patients, 143 underwent surgical interventions and 135 underwent chemical ablations (82 using ethanol and 53 with OK-432). Conclusion Conservative management of recurrent thyroglossal duct cysts is a growing trend, albeit requiring further refinements. This approach presents potential advantages, including decreased recurrence rates, shorter surgical duration, cost-effectiveness, and expedited recovery. Nevertheless, surgical intervention remains the preferred therapeutic choice owing to its established efficacy and widespread familiarity. The projected therapeutic approach shifts for thyroglossal duct cysts as conservative treatment gains substantiated benefits. Systematic Review Registration: The International Prospective Register of Systematic Reviews (PROSPERO) does not accept scoping reviews, literature reviews, or mapping reviews.

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Abstract Introduction Morbidity and mortality related to tracheostomy can be reduced if complications are recognized immediately and managed effectively. Healthcare providers involved in the management of pediatric patients must be aware of tracheostomy-related emergencies, especially in life threatening situations. However, there is limited literature on this theme. Objectives To assess the knowledge of healthcare providers in managing tracheostomy-related complications in pediatric patients. Methods A descriptive, multicenter study was conducted among healthcare providers involved in the management of pediatric patients undergoing tracheostomy. Data were collected using electronic questionnaires, and participants' knowledge was evaluated using various clinical scenarios. Results A total of 520 healthcare providers from different subspecialties with varying levels of experience were included. Over 50% of participants had never dealt with tracheostomy-related complications in pediatric populations, and 30.5% were unfamiliar with the function of the introducer/obturator. Furthermore, only 17.9% understood the purpose of stay sutures. Notably, when presented with different clinical scenarios, a significant knowledge gap was observed among the participants. Conclusion There were significant gaps in knowledge among healthcare professionals regarding the management of tracheostomy-related emergencies in the pediatric population. Education on this topic is essential among healthcare professionals. This needs to be addressed to maximize patient safety. Further studies are recommended.

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Abstract Introduction The pediatric cochlear implantation (PCI) outcomes, as seen through the parental perspective questionnaire (PPQ), may provide a more comprehensive and accurate view on the functional status of cochlear implant recipients in real-life situations. However, there is no Hindi language version of the PPQ. Therefore, the purpose of the present study was to translate and culturally adapt the original PPQ into Hindi to measure the outcomes in children with CI. Methods The original PPQ was translated into Hindi through a forward-backward process. The questionnaire was content- and face-validated. The harmonized Hindi questionnaire consisted of 74 items covering two domains: decision-making (26 items) and outcomes (48 items). It was piloted in 139 parents of children with CI, to determine the validity and reliability and to measure the outcome of PCI. Results The PPQ-Hindi version was easy to understand for parents. They reported that the questionnaire completion time was appropriate. The instrument had a high degree of content- and face-validity, and it matched the original. The overall Cronbach α was 0.89, and the test–retest reliability coefficient was 0.92. Conclusions The PPQ was successfully translated into Hindi and adapted to this specific culture and population, exhibiting a good validity and reliability to measure outcomes in PCI. Thus, the instrument has the potential to be an effective tool for parents to self-administer and to evaluate the effects of CI in their children.

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Abstract Introduction In May 2020, the World Health Organization declared Brazil a new epicenter of the coronavirus pandemic. Objective The present study aims to verify if the frequency of nasal bleeding and/or epistaxis in patients of a tertiary hospital was correlated with the pandemic of coronavirus disease 2019 (COVID-19) and with the use of anticoagulants. Methods The analysis performed was retrospective from the database of the otorhinolaryngology service of a Brazilian tertiary hospital, comparing 2 periods: 1 from March 2020 to July 2021 comprising the peak of pandemic setting, and another from August 2021 to May 2022. We checked data on the average number of cases/month and on the use of anticoagulants. Results In the period above mentioned, there were 61 cases of COVID-19-related epistaxis (from a total of 180 cases of nasal bleeding and/or epistaxis), with an average of 12 cases/month, demonstrating an increase in the frequency of cases at the institution, when compared to a study involving 343 cases from the same institution over a period of 42 months (October 2015–March 2019), in which the average was 8.1 cases/month. Among the patients with COVID-19 and nasal bleeding, 55 (90.17%) were using some type of anticoagulant at the time of bleeding: 41% were on subcutaneous heparin; 20% were on subcutaneous enoxaparin; 16.66% were receiving intravenous heparin on continuous infusion bomb (CIB); 6.66% were on extracorporeal membrane oxygenation (ECMO) associated with intravenous heparin on CIB; 4.99% were on oral rivaroxaban; and 1.66% are on oral apixaban. Conclusion Our study's data confirmed the increase in the number of epistaxis cases and the use of anticoagulants in COVID-19 patients.

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Abstract Introduction The preoperative assessment of the computed tomography (CT) characteristics of the maxillary sinus helps to preserve its anatomical and functional integrity during and after surgery. Objective To use CT scanning to identify maxillary sinus variations and types that were not previously published. Methods The present study was carried out on 110 paranasal CT scans (220 sides). Axial images were obtained with multiplanar scans, to visualize details in coronal and sagittal planes for all subjects. Results Among the 110 CTs (220 sides) of the maxillary sinus's floor, there were 53.2% type 1, 29.1% type 2, 10% type 3, and 7.7% type 4, with significant difference between genders. The most common maxillary sinus floor was type 1. The lateral maxillary sinus wall was found to be type 1 in 32.7%, type 2 in 65%, and type 3 in 2.3%, with a significant difference between genders. The most common lateral wall of the maxillary sinus type was type 2. The orbital floor was found to be type 1 in 0.9%, type 2 in 21.3%, type 3 in 50.5%, and type 4 in 27.3%, without significant difference between genders. Asymmetry was detected between the right and left sides for the maxillary sinus floor of in 22.7%, lateral maxillary wall in 16%, and orbital floor (maxillary roof) in 30%. Conclusion This study aims to increase surgeons' awareness of maxillary sinus variations, creating new classifications for usage and communication in the otorhinolaryngology and endoscopic fields. It could also be helpful for training medical residents.

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Abstract Introduction An association between the sensation of vertigo, and body composition has not been investigated in post-coronavirus disease 2019 (COVID-19) patients. Objective To evaluate the probable association between the sensation of vertigo and body composition—as amount of fat, bone, and muscle—in post-COVID-19 patients. Methods Cross-sectional study with a sample of post-COVID-19 patients who responded to the visual analog scale (VAS) and the Dizziness Handicap Inventory (DHI). Clinical assessment and electrical bioimpedance were used to determine body composition. Results There were 105 participants evaluated, 61% (n = 64) of whom were male, aged 49.5 ± 11.7 years, with an average height of 165.6 ± 19.9 cm, body weight of 87.6 ± 20 kg, and body mass index (BMI) of 31.1 ± 5.4 kg/m. The prevalence of self-reported vertigo was 51.4% (n = 54); of these, 11.4% (n = 12) related vertigo before the diagnosis of COVID-19, and 40% (n = 42) related vertigo during or after COVID-19. Furthermore, 37.2% (n = 39) of the sample reported that vertigo persisted after medical discharge. In the comparative analysis, the data showed a significant difference between the groups with and without vertigo for height (p = 0.001), body mass (p = 0.006), body water (p = 0.001), lean mass (p = 0.002), fat-free mass (p = 0.001), and musculoskeletal mass (p = 0.001). Conclusion There was a significant association between body composition and the complaint of vertigo in post-COVID-19 patients, suggesting that these aspects should be considered when assessing and can contribute to the construction of knowledge about long COVID.

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Abstract Introduction A meta-analysis of published articles is usually done using standard scales and checklists. Several such scales and checklists are reported in the literature. However, there is little information regarding their utility so one can select the most appropriate one, especially in the field of audiology. Objective The current study aimed to compare a quality analysis carried out using the standard quality assessment criteria (SQAC) for evaluating primary research papers from a variety of fields', and the Modified Downs and Black Checklist (MDBC) for a set of articles in the area of auditory processing deficits (APDs) in older adults. Methods Two published checklists suitable for the field of audiology (SQAC and MDBC) were compared for a quality analysis of articles on APD in older adults. The two checklists were compared after categorizing their items into five subsections. Two audiologists rated the articles according to both checklists. Results The interrater reliability was found to be good for both checklists. Significant differences between the checklists were observed for specific subsections. However, there was no significant correlation between the two checklists. Conclusion It is inferred that the selection of an appropriate quality assessment checklist depends on the objective of the study. If the aim of a quality analysis study is to differentiate articles based on their overall caliber, or primarily based on the subsections, SQAC is recommended. However, if the aim is to distinguish research articles primarily based on the control of variables, or differentiate intervention-based studies, the MDBC is recommended.

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Abstract Introduction Autism spectrum disorder is a pervasive developmental disorder characterized by deficits in communication and social interactions, as well as repetitive behavioral patterns. Understanding the relationship between auditory brainstem response and hearing is crucial, considering the importance of sensory function. Auditory brainstem response testing is a tool that evaluates the auditory system from periphery to brainstem in response to an acoustic stimulus, providing important information about the auditory pathways. Objective To compare auditory brainstem response findings in children with autism spectrum disorder versus those of a control group. Methods Cross-sectional, comparative study of 23 children (age 7–10 years) diagnosed with autism spectrum disorder and an age- and sex-matched control group of normal-hearing children with typical development. All participants underwent otoscopy, impedance audiometry, pure-tone audiometry, speech audiometry, and brainstem evoked response audiometry. Results Statistically significant between-group differences were seen on comparison of the absolute latencies of waves III (p = 0.047) and V (p = 0.034), as well as interpeak intervals III to V (p = 0.048) and I to V (p = 0.036), with increased values in the study group. The sample was composed of 8.7% females and 91.3% males. Conclusion In this sample, children with autism spectrum disorder showed increased auditory brainstem response latencies compared to the control group, suggesting auditory pathway impairment.

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Abstract Introduction We previously investigated the impact of video clinics on the management of closed nasal bone injuries during the coronavirus disease 2019 (COVID-19) pandemic. The aim of that study was to assess the feasibility of managing patients at their homes or workplaces, with instructions to attend outpatient clinics the next working day if they suspected any deviation or reduced nasal airflow, for further evaluation. Objective To compare the results of our previous research with the traditional, in-person nasal injury clinics, using the same criteria as in our prior investigation. Methods We analyzed 3 months of preexisting data from video clinics and collected 6 months of data from face-to-face clinics. We gathered information on the number of patients, categorized by age and gender, as well as records of missed appointments (DNAs) and the requirement for nasal manipulations. Data analysis was conducted using the Chi-Squared test in SciPy Python 3.0 (open source). Results The statistical analysis revealed no significant differences between the 2 groups concerning the number of patients with closed nasal bone injuries, both under and over 18 years of age (p-value: 0.961), the rate of missed appointments (p-value: 0.0734), and the need for fracture reduction (p-value: 0.0734). Conclusions The findings suggest that video clinics are equally effective in managing suspected nasal bone injuries and should not be restricted to emergency situations. However, it is advisable to adopt a balanced approach considering the additional costs associated with appointments.

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Abstract Introduction Many protocols carried out in animal studies use equipment developed for humans. Therefore, the equipment available on the market must be known in detail, as well as how the criteria to be evaluated are presented. Objective To analyze the existence of an association between the amplitude and signal-to-noise ratios of distortion-product otoacoustic emissions using two methodologies (diagnostic and portable/screening equipment) in animal models. Methods Experimental study approved by the Animal Use Ethics Committee, with a sample of 28 female Wistar rats, which were subjected to anesthesia, manual otoscopy, and distortion-product otoacoustic emission (DPOAE) examination at 4 to 8 kHz with the 2 pieces of equipment. Results The mean amplitude values with the ILO (Otodynamics Ltd., Hatfield, United Kingdom) and OtoRead equipment (Interacoustics A/S, Middelfart, Denmark) were respectively 20.5 dB and 7.1 dB at 4 kHz; 31.8 dB and 19.37 dB at 6 kHz; and 31.4 dB and 25.1 dB at 8 kHz. The mean signal-to-noise ratios with the ILO and OtoRead equipment were respectively 20.9 dB and 25.1 dB at 4 kHz; 35.8 dB and 37.0 dB at 6 kHz; and 39.7 dB and 40.6 dB at 8 kHz. There was no statistically significant difference in signal-to-noise ratios at 6 and 8 kHz. When the data were classified as normal/abnormal, 100% agreement was found between the methodologies. Conclusion An association was found in the analysis of the mean signal-to-noise ratio at 6 and 8 kHz between the 2 methodologies (diagnosis and portable/screening equipment).

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Abstract Introduction Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a chronic inflammatory condition of the paranasal sinuses that is mainly associated with type-2 inflammation. Immunoglobulin E (IgE) and eosinophils in blood and nasal tissue have been suggested as biomarkers for the prognosis and severity of CRSwNP as well as indications for biological treatment. Objective The present study aims to assess the relationships between blood IgE concentration, blood eosinophil count, and nasal polyp eosinophil count in CRSwNP patients. Methods The present study is retrospective. Nasal polyps from CRSwNP patients (n = 73) were fixed and embedded in paraffin for hematoxylin and eosin stain. Blood was collected to measure IgE concentration and eosinophil count. Results Weak correlations were found between blood and tissue eosinophil counts (p = 0.004, r = 0.367) as well as blood IgE concentration and blood eosinophil count (p = 0.007, r = 0.372). There was no statistically significant correlation between blood IgE concentration and tissue eosinophil count. When dividing patients based on nasal polyp eosinophil count, blood eosinophil level was higher in the severely eosinophilic group than in the mildly eosinophilic group (p = 0.002). Conclusion Blood IgE and eosinophils are not reliable biomarkers to predict the inflammatory condition in CRSwNP. Further research is needed on the clinical roles of these biomarkers.

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Abstract Introduction The classification and management of laryngomalacia are challenging topics that are continuously updated and modified by pediatric airway surgeons. However, a numerical stratification of the patients to decide on the conservative management or intervention has not yet been established. Objective To provide an easy approach to cases of laryngomalacia by adopting an updated scoring system with a stepwise management algorithm. Methods We conducted a prospective study that included patients diagnosed with laryngomalacia over three years. The proposed symptom and history score was used to categorize patients into mild, moderate, and severe grades. Then, the examination and investigation scores designed were applied to the selected cases according to the management algorithm. Basic data from the patients and their flow throughout the study were assessed. Results The study included 112 patients with a mean age of 4.3 ± 2.2 months. In total, 44 (39.3%) cases were considered mild, 48 (42.86%), moderate, and 20 (17.85%), severe. The examination score was used to assess 68 out of 112 patients, including all moderate and severe cases of laryngomalacia. All of the mild cases were followed up, and none required surgery. The investigation score was applied to 55 cases, including all the severe cases, as preoperative evaluation, and 35 out of 48 moderate cases. Conclusion This newly proposed scoring system with the associated algorithm is an easily applicable way to deal with, classify, and properly manage laryngomalacia cases.

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Abstract Introduction Pediatric dizziness is not a rare symptom, and it has a significant impact on the child's psychophysical wellbeing and quality of life. There are diverse etiologies of dizziness in children; however, it is challenging to diagnose. Vestibular and neurological assessments are crucial in the diagnosis of pediatric dizziness. Objective To outline the most common etiologies of dizziness in children and to investigate the complementary role of the vestibular and neurological evaluations in the assessment of dizzy children. Methods We conducted a case-control study including 40 children with a complaint of dizziness and 40 healthy children as the control group. We assessed their full medical history audiovestibular function through pure tone audiometry, videonystagmography examination, cervical vestibular evoked myogenic potentials, the results of video head impulse tests, as well as their electroencephalograms and brain magnetic resonance imaging scans. Results The mean age of the 40 children who were presented with dizziness was of 13.65 years. Migraine was found to be the commonest cause of vertigo (27.5%), while benign paroxysmal vertigo of childhood was detected in 17.5%, and central nervous system causes, in 12.5%. The diagnosis could not be ascertained in 9 (22.5%) patients. Conclusion The diagnosis of the etiologies of pediatric dizziness is challenging; however, detailed medical history, a comprehensive examination, a multidisciplinary approach, along with full vestibular and neurological assessments, are essential to reach an accurate diagnosis.

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Abstract Introduction Antrochoanal polyp, which is a kind of smooth-surfaced single nasal polyp, is commonly present in cases of nasal obstruction. The pathogenesis of polyp formation is still unclear, but allergy is supposed to be a cause. Objectives To investigate the expression levels of antioxidant enzymes in antrochoanal polyp tissue. Methods The antrochoanal polyp group was composed of 23 patients who were diagnosed microscopically, and the control group was composed of 38 healthy patients. The sample of the control group was taken from the inferior turbinate mucosa by punch biopsy under general anesthesia, and the antrochoanal polyp sample was collected from sinus surgery. The cytochrome P450 (CYP) and glutathione S-transferase (GST) expressions of the groups were investigated under microscopy and scored by senior pathologists. Results The antrochoanal polyp group had statistically less expression of CYP family 1 subfamily A member 1 (CYP1A1) than the control group (p < 0.05). Moreover, GST Pi 1 (GSTP1), GST Mu 1 (GSTM1), and GST Alpha 1 (GSTA1) expressions were not different between the groups (p > 0.05). Conclusion Allergy and chronic inflammation are postulated reasons for antrochoanal polyp formation, but, according to our results, we could not detect any relation between antrochoanal polyp formation and GST expression in tissue. However, the decreased level of CYP1A1 expression in the antrochoanal polyp group may be related with the pathogenesis of the antrochoanal polyp formation.

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Abstract Introduction Hemithyroidectomy is performed for the treatment of symptomatic unilateral benign nodules, cytologically indeterminate nodules, and some cases of well-differentiated thyroid cancer. Objective To evaluate the frequency of postlobectomy thyroid hormone replacement (THR), and to analyze the clinical-pathological factors predicting L-thyroxine (T4) use in patients undergoing hemithyroidectomy. Methods We conducted an observational, retrospective study in which clinical, biochemical, and anatomopathological parameters were analyzed and correlated with the need for THR after thyroid lobectomy. Results The frequency of postoperative THR was 63%. The preoperative thyroid-stimulating hormone (TSH) level was an important predictor of postoperative THR. When stratifying preoperative TSH levels, the frequencies of T4 replacement in each TSH quartile varied, being more frequent with increasing presurgical TSH levels (p = 0.029). The preoperative cutoff that maximized sensitivity and specificity for the development of hypothyroidism was 1.21 μIU/mL. Conclusion Our results demonstrated a significant frequency of postlobectomy THR. Higher preoperative TSH is a strong risk factor for postsurgical hypothyroidism, and even lower preoperative levels within the normal references do not exclude the risk of thyroid hormone use after thyroid lobectomy.

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Abstract Introduction Somatosensory tinnitus is a type of tinnitus that can be modified by somatosensory stimuli from the cervical spine and temporomandibular area. Temporomandibular disorders and oral behaviors are associated with a higher prevalence of somatosensory tinnitus, and this association is described in the literature as part of the diagnosis of this condition. Objective To verify the association between somatosensory tinnitus and oral behaviors. Methods Patients were recruited from an Orofacial Pain outpatient clinic and from Head and Neck Unit. All participants underwent anamnesis, physical examination and completed the Oral Behaviors Checklist questionnaire. Forty-six patients were divided into 2 groups, each consisting of 23 patients: somatosensory tinnitus group (STG) and a comparison group (CG), with subjective tinnitus. Data were gathered and analyzed using the Jamovi software (open source) and a significance level of 5% was adopted. Somatosensory tinnitus was associated with dizziness and neck and temporomandibular joint pain. Results There was an association between a higher Oral Behaviors Checklist score and the presence of somatosensory tinnitus. For each point marked on Oral Behaviors Checklist, there was an 8.2% greater chance of having somatosensory tinnitus. Tinnitus modulation through somatic maneuvers and palpation of masticatory and cervical muscles was significantly associated with somatosensory tinnitus. Conclusion Dizziness and neck and temporomandibular joint pain are associated with the presence of somatosensory tinnitus. Probable sleep and awake bruxism are not exclusive behaviors of somatosensory tinnitus patients. However, their frequency may impact its presence.

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Abstract Objective To assess the readability and quality of various websites providing information on cochlear implantation (CI) in children in Arabic. Methods The present is a cross-sectional online search. We conducted searches in the Arab language using the three most popular search engines, Yahoo, Google, and Bing, to search the topics of "cochlear implant" and "cochlear implant in children." The information quality was evaluated through the DISCERN tool, while readability was examined using the OSMAN readability tool, which incorporated two readability metrics: the automated readability index (ARI) and the Läsbarhetsindex (LIX, reliability index). Results In a study of 50 websites, the median Discerning the Quality of Information on Treatment Choices (DISCERN) quality score was 38, with an interquartile range (IQR) of 29 to 46, suggesting poor quality. Out of the 50 websites evaluated, only 10 were deemed to be of good quality. The median readability ARI was 8th grade (IQR: 6–9), which considered above the level of general population. Certain websites were found to be at or below the suggested 6th grade reading proficiency level. The median LIX was of 69 (IQR: 64–71), indicating that the text is very difficult. There was no correlation between readability and the DISCERN score. Conclusions Our results suggest that many websites offering information on CIs for children in Arabic exhibit varying levels of quality and are composed in language surpassing the general population's reading ability. Developers should focus on improving the readability of their online content to ensure that the average reader can understand and benefit from the information.

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Abstract Introduction Stuttering is a human communication disorder characterized by involuntary interruptions to speech flow. Electrophysiological tests and behavioral evaluations allow the neuroaudiological processes involved in stuttering to be investigated. Objective To investigate group differences in the central auditory system using long-latency auditory evoked potentials, cognitive potentials, and behavioral assessments in children who stutter and compare them with fluent children. Methods We assessed 18 children with stuttering and compared them with a control group of 18 children without speech or language impairment. All children were evaluated with pure tone and speech audiometry, acoustic immittance measures, brainstem auditory evoked potentials, long latency auditory evoked potentials, cognitive potentials, and behavioral tests of auditory processing – Random Gap Detection Test (RGDT), Dichotic Digit Test (DDT); Duration Pattern Test (DPT); Pediatric Speech Intelligibility (PSI); and Masking Level Difference (MLD). The Scale of Auditory Behaviors (SAB) questionnaire was also applied. Results Children who stuttered had longer latencies of the P2 and P3 waves compared with the fluent group. There was no difference in P2 amplitudes, but there was a smaller P3 amplitude in children who stuttered, and they also showed significant alterations in the DDT and DPT. Furthermore, an association was found between increased P2 and P3 latency and SAB scores. Conclusion The present study indicates that children who stutter tend to have decreased auditory ability in terms of central auditory processing, and this shows up psychophysically and on the SAB questionnaire.

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Abstract Introduction Radiotherapy is the primary treatment for nasopharyngeal carcinoma. Radiation exposure to the cochlea and middle ear can cause hearing loss. Objective To develop a multivariable normal tissue complication probability (NTCP) model to predict the risk of hearing impairment in nasopharyngeal cancer patients based on clinical and radiation dosimetry features and to identify the key factors associated with hearing loss. Methods A retrospective review of 229 patients was conducted. We recorded the audiometry and presence of middle ear effusion (MEE) and compared findings before and after therapy. The factors included age, gender, signs and symptoms at presentation, tumor staging, prescribed dose at the tumor and high-risk nodal region, cochlea, and concurrent chemotherapy treatment. The model was formulated using multivariate logistic regression. Results Age of more than 50 years, high primary staging, and dose at the cochlea > 43 Gy were major risk factors for sensorineural hearing loss. The final NTCP model for hearing loss comprised age and cochlea dose with an area under the curve (AUC) of 0.644; the predicted risk ranged from 15.84 to 44.52%. Locally advanced disease and cochlea dose greater than 44 Gy were risk factors for MEE; the predicted risk ranged from 20.42 to 51.99%. Conclusion Age over 50, T stages 3 and 4, and > 43 Gy dose to the cochlea were significantly associated with an increased risk of sensorineural hearing loss and MEE. The developed NTCP model provides information to predict these risks, aiding in treatment planning and decision-making to avoid complications.

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Abstract Introduction After the pandemic caused by the coronavirus, many patients have presented remaining otorhinolaryngological symptoms, but most of them are unknown to health professionals. Objectives To characterize otorhinolaryngological symptoms and sequelae in hospitalized patients for Covid-19. Methods We made a recall to patients hospitalized between April 2020 and April 2022 due to Covid-19. Demographic data, initial and remaining symptoms, days of hospitalization, intubation and/or tracheostomy, and vaccination data were collected. Results 845 patients were hospitalized, 441 died, 404 patients were contacted by telephone, but only 109 responded to the questionnaire about initial and remaining otorhinolaryngological symptoms after 1.5 to 2 years of illness, 59 men and 50 women, with an average age of 58.61 years (20 to 94). Two study groups were composed: G 1 (n- 44; with remaining symptoms) and G 2 (n- 65; without remaining symptoms). 81% of patients in G1 and 67% of patients in G2 had been hospitalized for up to 20 days. Intubation occurred in 17 patients (G1–7; G2–10). Seven patients underwent tracheostomy. The most prevalent initial and remaining otorhinolaryngological symptoms, respectively, were dyspnea (68.8%; 14.6%), cough (65.1%; 11.92%), nasal obstruction (47.7%; 5.58%), smell dysfunction (44%; 11%), taste dysfunction (42%; 4.58%). Vaccination was reported by 54 patients (G1–21; G2–34). Conclusions Otorhinolaryngological symptoms were common in patients hospitalized for Covid-19, especially dyspnea, cough, nasal obstruction, smell, and taste dysfunction. Although there was a favorable long-term evolution, 40% of patients maintained permanent symptoms, such as smell and taste dysfunction and dizziness, unrelated to the vaccine doses.

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Abstract Introduction Thick-skinned patients are prevalent in the general population worldwide and represent a challenge for the rhinoplasty surgeon. The use of oral isotretinoin before and/or after surgery is a possible adjuvant treatment that can facilitate intraoperative management and improve results in the postoperative stages; however, there are still questions about its effects in the long-term. Objective To evaluate the advantages and best practices for orally administrated isotretinoin in thick-skin rhinoplasty based on the current literature. Methods An advanced search was conducted until August 31st, 2023, on the PubMed, Cochrane Library, ClinicalTrials.gov, Embase, and LILACS databases with the keywords rhinoplasty and isotretinoin. Sixteen articles were reviewed and 4 met the inclusion criteria, with a total of 371 patients. Meta-analysis of the data collected was not possible due to heterogeneity among papers. Conclusion Isotretinoin can be a safe drug, and its use in rhinoplasty varies widely, although all studies reported a low-dose oral regime for up to 6 months. The medication use is well-established in thick-skin rhinoplasty. Small doses after the procedure can improve patient satisfaction and the quality and thickness of the skin in the first 6 months of postsurgery. After 6 months, studies with a control group did not show a significant difference in patient satisfaction rates. A strong framework and specific surgical maneuvers may be more important than isotretinoin for better outcomes in thick-skin rhinoplasty.

Resumo em Inglês:

Abstract Introduction Vocal cord paralysis (VCP) is a deprivation of motility and the dysfunction of the vocal cords due to a defect in the vagal nerve or recurrent laryngeal nerve (RLN). It also occurs due to mutilation in the cricoarytenoid joint or posterior commissure scarring after prolonged tracheal intubation. It is a disorder with an extensive range of etiologies reliant on its laterality pattern. Objective To discuss the laterality pattern of VCP due to endotracheal intubation and its respective treatments, the associated etiologies, and the risk factors, to provide a new direction to physicians for its treatment and to avoid its occurrence. Data Synthesis We conducted a peer review of many of the articles published to date on VCP. An analysis of 967 patients from 5 studies determined that unilateral VCP (UVCP) is three times more frequent than bilateral VCP (BVCP). Furthermore, we analyzed 2,232 patients from 6 different studies that concluded surgery was the most common cause, followed by neoplastic diseases or malignancies. Another important though highly uncommon etiology of VCP is endotracheal intubation; however, it is disturbing for doctors as endotracheal intubation is a common procedure for general anesthesia. Conclusion A variety of factors may cause VCP, including age, comorbidities, body mass index BMI, the duration of the intubation, the handling of the apparatus, operative time, and tracheal tube sizes. Preventive measures should be prioritized to avoid severe consequences, and intubation must be performed carefully in elderly people and in subjects with lower BMIs. Knowledge of the risk factors will help physicians customize intubation procedures in the future.