Hasil untuk "Otorhinolaryngology"

M. Gómez-Ríos, J. Sastre, X. Onrubia-Fuertes et al.

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factor, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

Elvie Zulka Kautzia Rachmawati, Mikhael Yosia

Polysomnography (PSG) remains the gold standard for evaluating sleep-disordered breathing (SDB) and related conditions, yet its clinical potential is often limited by overreliance on the apnea-hypopnea index (AHI) and similar summary metrics. This narrative review offers a structured, physiology-informed approach to PSG interpretation that integrates sleep architecture, arousal burden, respiratory event morphology, oxygenation patterns, and CO2 trends. Recognizing phenotypic patterns-such as REM-related and positional OSA-through sleep stage and positional stratification is essential for directing targeted therapy. We outline common interpretive pitfalls, including automated scoring errors, overlooked signal artifacts, and the first night effect, emphasizing the need for careful manual review and clinical correlation. In pediatric and syndromic populations, age-adjusted interpretation is critical for detecting subtle respiratory disturbances that can impact neurodevelopment or behavior. A practical stepwise framework is provided to guide interpretation, streamline clinical workflows, and reduce diagnostic error. PSG findings are also contextualized within broader systemic outcomes, such as their links to hypertension, dyslipidemia, insulin resistance, and cognitive decline. Ultimately, PSG should be viewed not as a static diagnostic report, but as a cornerstone of personalized sleep medicine-informing mechanism-based, outcome-oriented interventions tailored to individual patients.

Hannes Hefty, Danilo Esaltato, Georgios Mantokoudis et al.

ABSTRACT Mastoid cavity myiasis is a rare but important differential diagnosis. While otomyiasis mainly occurs in tropical regions, it is a diagnosis in patients with a history of radical mastoidectomy presenting with otalgia or otorrhea, particularly in those with diabetes or poor hygiene. Prompt mechanical removal of larvae combined with antiseptic irrigation and systemic antibiotics is an effective and sufficient treatment, typically preventing recurrence or complications.

Hyo Jeong Seo, Boyou Heo, Jun‐Yeong Yang et al.

Abstract The early detection of head and neck cancer (HNC) remains an important challenge owing to the lack of reliable noninvasive biomarkers. This study introduces a graphene‐assisted plasmonic nanocoral platform coupled with an artificial intelligence‐linear unmixing algorithm for diagnosing HNC from saliva and identifying associated metabolic biomarkers. The nanocoral structures, formed via a spontaneous gold growth mechanism on graphene templates, exhibit strong plasmonic enhancement and selective adsorption of volatile metabolites. Raman signals acquired from the saliva of HNC patients and healthy individuals are analyzed using a logistic regression model, achieving 98% classification accuracy. To identify potential metabolic biomarkers, candidate metabolites are initially selected based on spectral similarity using the Pearson correlation coefficient. Subsequently, the nonnegative least squares method is applied to refine this selection and extract the final set of biomarker candidates. This approach identifies 15 potential metabolic biomarkers, and their clinical relevance is corroborated through comparison with the findings of previous clinical studies. This study not only introduces a highly sensitive, noninvasive diagnostic platform for HNC but also establishes a robust framework for Raman‐based biomarker discovery, with potential applicability that warrants evaluation in other biofluid‐based disease models in future studies.

Marc Hamoir, Remco de Bree, Primoz Strojan et al.

Lena Zaubitzer, Anja Kotzur, Stefan Hegemann et al.

Study backgroundNewborn infection and sepsis remain serious problems. Guideline-compliant therapy includes, among other therapeutics, calculated intravenous antibiosis with gentamicin. One of the known side effects of gentamicin is severe vestibulotoxicity, which can be detected using the video head impulse test (VHIT), which is a sensitive examination method for the detection of vestibular hypofunction in children and adults. Previous studies on the vestibulotoxicity of gentamicin in newborns were carried out using caloric testing, rotary testing, and electronystagmography. Nevertheless, there are currently no data available on VHIT examinations in children who have been treated with neonatal gentamicin therapy.MethodsA single-center, prospective cross-sectional study, was conducted at a tertial referral center. VHIT was performed on 23 children aged 3–7 years who had received intravenous gentamicin therapy for at least five days as part of the treatment of newborn sepsis between 2012 and 2016. Main outcome was median gain and occurrence of refixational saccades as measured with VHIT. In addition, the children's parents received questionnaires to detect possible risk factors and vestibular and cochlear abnormalities.ResultsOut of 23 children with a mean age of four years and seven months (ranging from 3 to 7 years), 11 (47.8%) indicated abnormal results in VHIT. The VHIT results were unilaterally abnormal in six children (26.1%) and bilaterally abnormal in five others (21.7%). Additionally, five of the children with an abnormal HIT had abnormalities, as found in the questionnaire results.Conclusionand Relevance: Almost half of the children observed after having undergone gentamicin therapy as newborns showed abnormalities in VHIT, although they did not show any clinical signs of disbalance or vestibular hypofunction. VHIT can serve as a sensitive investigation method for the early screening of post-therapeutic vestibulotoxic side effects after gentamicin therapy in children. Additionally, VHIT can enable early intervention in these children.

Lav Pathak, Anchal Tripathi, Supreet Singh Nayyar et al.

Nasrene Khan, Aaran T. Lewis

(1) Background: Tinnitus, often related to hearing loss, is an addressable public health concern affecting health-related quality of life (HRQoL). This study aimed to explore the influence of bone conduction hearing aid (BCHA) implantation on HRQoL and hearing disability in patients with hearing loss suffering from tinnitus. (2) Methods: Data were collected from an international hearing implant registry. Health Utilities Index Mark 3 (HUI-3), Spatial and Qualities of Hearing- 49 Questionnaire (SSQ) and self-reported tinnitus burden data for adult patients implanted with a BCHA (n = 42) who provided baseline as well as follow-up data 1-year post-implantation were extracted from the registry. Wilcoxon signed rank tests and paired samples t-tests were used to analyse outcomes data. (3) Results: Patients, with or without tinnitus, demonstrated clinically important mean improvements in HUI-3 multi-attribute utility scores, HUI-3 hearing attribute and SSQ scores. Hearing loss patients with tinnitus presented with a lower HRQoL than patients without tinnitus. (4) Conclusions: These findings demonstrate the importance of hearing rehabilitation in improving the quality of life and hearing disability of patients with or without tinnitus and in providing tinnitus relief in some patients with hearing loss and tinnitus.

Jeffrey Pradeep Raj, Miteshkumar Rajaram Maurya, Nayana Nair et al.

Introduction: Kalmegh (Andrographis paniculata) is commonly used for treating uncomplicated Upper Respiratory Tract Infection (URTI) in complementary and alternative system of medicine. AP-Bio®(KalmCold®) is a standardized extract derived from the leaves of A. paniculata. This study was proposed to evaluate its efficacy using validated scales and objective measures. Methods: Participants were randomized in a ratio of 1:1:1 to receive either AP-Bio® 200 mg/day, AP-Bio® 400 mg/day or placebo for 7 days. The primary outcome measure was Wisconsin Upper Respiratory Symptom Survey (WURSS-21) score. The secondary outcome measures were nasal mucous weight, nasal muco-ciliary clearance function and Interleukin-8 in nasal wash, as well as safety and tolerability. Results: A total of n = 331 participants were screened and N = 300 participants were enrolled. The absolute WURSS-21 global score [mean (Standard Deviation - SD)] in the AP-Bio® 400 mg group [5.70 (5.31)] was less than the AP-Bio® 200 mg group [5.81 (4.83)] on Day-3. However, it was much higher in the placebo group [9.55 (14.27)]. AP-Bio® 400 mg group (Mean Difference - MD [Standard Error - SE] = −3.85 [1.52]; 95% CI = −6.85, - 0.85; adjusted p = 0.034) and 200 mg group (MD [SE] = −3.74 [1.51]; 95% CI = −6.73, - 0.76; adjusted p = 0.038) had significantly lower score than placebo. Similarly, on Day-3, the change in global score from baseline was significantly better in the AP-Bio® 400 mg group (MD [SE] = −3.91; [1.82] 95% CI = −7.50, - 0.32; adjusted p = 0.038) and AP-Bio® 200 mg group (MD [SE] = −3.84 [1.97]; 95% CI = −7.72, - 0.04; adjusted p = 0.044) in comparison to the placebo group. Nasal mucous weight, tissue paper counts used, and interleukin-8 showed a trend towards AP-Bio® groups having a favourable outcome when compared with placebo but did not reach statistical significance due to a small sample size. None of the study participants complained of any adverse physical symptoms. However, incident eosinophilia was noted in n = 20 participants on day 3. (n = 6 in AP-Bio® 200 mg group, n = 7 in Ap-Bio® 400 mg group and n = 13 in placebo group; p = 0.181). Conclusions: Participants in both the AP-Bio® dose groups showed positive tendency towards resolution of URTI symptoms when compared with placebo on Day-3 but not on Day-5 and Day-7.

Bokhyun Song, Yong Gi Jung, Sang Duk Hong et al.

Objectives. Our previous study found that multilevel obstructive sleep apnea (OSA) surgery mitigated laryngopharyngeal reflux (LPR) symptoms in terms of the reflux symptom index (RSI), but no studies have investigated the impact of OSA surgery on laryngoscopic parameters. The aim of this study was to examine the clinical outcome of LPR improvement following OSA surgery, with a focus on both the RSI and the reflux finding score (RFS). Methods. Prospectively collected data from 28 patients who underwent multilevel OSA surgery from 2017 to 2021 were retrospectively analyzed. Patients were asked to complete the RSI questionnaire and underwent a laryngoscopic examination to evaluate the RFS before and after surgery. Age, height, weight, body mass index (BMI), and polysomnography data before and after surgery were also reviewed. Results. After surgery, the total RSI and RFS decreased significantly from 11.96±8.40 to 7.68±6.82 (P=0.003) and from 6.57±3.49 to 3.21±1.87 (P<0.001). The positive rates of RSI and RFS decreased from 28.6% to 17.9% and 32.1% to 0%, respectively. Significant improvements were found in the RSI subdomains of throat clearing, throat mucus, breathing difficulty, troublesome cough, and heartburn sensation, while all RFS subdomains except granuloma improved significantly. In subgroup analyses, no significant differences were found between subgroups based on age, OSA severity, or BMI. Conclusion. OSA surgery has the potential to alleviate both LPR symptoms and laryngoscopic results. Additional research integrating more objective techniques and novel treatment strategies is required to better comprehend the clinical impact of OSA surgery on LPR.

Akira Nakazono, Yuji Nakamaru, Mahnaz Ramezanpour et al.

BackgroundFrom the first detection in 2019, SARS-CoV-2 infections have spread rapidly worldwide and have been proven to cause an urgent and important health problem. SARS-CoV-2 cell entry depends on two proteins present on the surface of host cells, angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2). The nasal cavity is thought to be one of the initial sites of infection and a possible reservoir for dissemination within and between individuals. However, it is not known how the expression of these genes is regulated in the nasal mucosa.ObjectiveIn this study, we examined whether the expression of ACE2 and TMPRSS2 is affected by innate immune signals in the nasal mucosa. We also investigated how fluticasone propionate (FP), a corticosteroid used as an intranasal steroid spray, affects the gene expression.MethodsPrimary human nasal epithelial cells (HNECs) were collected from the nasal mucosa and incubated with Toll-like receptor (TLR) agonists and/or fluticasone propionate (FP), followed by quantitative PCR, immunofluorescence, and immunoblot analyses.ResultsAmong the TLR agonists, the TLR3 agonist Poly(I:C) significantly increased ACE2 and TMPRSS2 mRNA expression in HNECs (ACE2 36.212±11.600-fold change, p&lt;0.0001; TMPRSS2 5.598±2.434-fold change, p=0.031). The ACE2 protein level was also increased with Poly(I:C) stimulation (2.884±0.505-fold change, p=0.003). The Poly(I:C)-induced ACE2 expression was suppressed by co-incubation with FP (0.405±0.312-fold change, p=0.044).ConclusionThe activation of innate immune signals via TLR3 promotes the expression of genes related to SARS-CoV2 cell entry in the nasal mucosa, although this expression is suppressed in the presence of FP. Further studies are required to evaluate whether FP suppresses SARS-CoV-2 viral cell entry.

Surova V, Slavik P, Calkovsky V et al.

Malignancies in the ENT (Ear, Nose, and Throat) area are mostly manifested by dysphagia, dysphonia, dyspnea, throat swelling, and other “traditional” head and neck symptoms. Sporadically, a primary tumor or metastasis can reach such a size and it can be localized in such an area in which it can cause the pathology of the brachial plexus. If this appears first, differential diagnosis may be more difficult.

Berke Özücer, Osman Halit Çam

Objective: Distal masseter-to-facial neurorrhaphy is an option to improve smile excursion in facial paralysis patients in the early period without truncating the facial nerve truncus and by ensuring the continuity of the facial nerve. This study aimed to study the effect of distal masseter-to-facial neurorrhaphy on smile excursion.Methods: Charts of eight patients were retrospectively examined. Screenshots showing the best possible smiles were taken from preoperative videos. Screenshots were taken from postoperative videos showing the best combination of a natural smile on the healthy side and a smile with clenched teeth on the paralytic side. Emotrics and Photoshop software were used for computing vertical, horizontal, and overall excursion from facial landmarks. Scaled measurements of improvement in lip excursion and lip angle was evaluated. Symmetry was evaluated by accepting the healthy side as 100 percent, and the paralytic side was calculated as a percentage of the healthy side.Results: Five patients had total facial paralysis and three had facial paresis. Mean postoperative follow-up period was 15.0±10.2 months. The average interval between facial denervation and nerve repair was 14.0±4.1 months (range, 11-23). All neurorrhaphies were coapted end-to-end to either the zygomatic or the buccal branch without an interposition graft. Mean postoperative initial movement occurred at 95.5±20.5 days (range, 72-138). Paralytic side to healthy side horizontal excursion changed from preoperative 72.5±17.4% to postoperative 93.4±6.9%. Vertical excursion changed from preoperative 38.4±24.6% to postoperative 89.3±11.8%. Overall excursion changed from preoperative 68.4±19.6% to postoperative 92.9±10.4%. Paralytic side to healthy side mean lip angle changed from 64.7% preoperative to 95.2% postoperatively. All changes were statistically significant (p<0.05).Conclusion: Facial paralysis patients with an asymmetric smile benefit from distal masseter-to-facial nerve transfer and it improves smile excursion dramatically. This effect was especially prominent in the vertical component of the smiling vector.

Luciane Mazzini Steffen, Luise Sgarabotto Pezzin, Natassia Sulis et al.

Introduction Cystic fibrosis (CF) is a genetic disease that limits the quality of life mainly due to respiratory symptoms. The relationship between findings of the upper airways and CF lung disease is not yet completely understood. Objective The aim of the present study is to describe the most frequent nasal findings and pathogens in patients with CF and investigate the association between the findings of the upper respiratory tract and markers of lung disease progression. Methods Retrospective study in patients with CF from the Pediatric Pulmonology Department who underwent otorhinolaryngological evaluation between 2015 and 2017. Nasal endoscopy and nasal swab collection were part of the evaluation. The severity markers used were: percentage of predicted forced expiratory volume in the first second (FEV1%), body mass index (BMI) and the Shwachman-Kulczycki (SK) clinical score. Results A total of 48 patients with CF were included. The mean of the predicted percentage of FEV1% was 83.36 ± 30.04. The average 14 and SK score 89.11 ± 10.50. The bacteriology of the nasal swab was positive in 27 (54.1%) patients. Staphylococcus aureus was positive in 18 patients, Pseudomonas aeruginosa in 5, Pseudomonas cepacea in 3 and Stenotrophomonas maltophila in 1 patient. Nasal polyps were found in nine participants. Nasal polyps were found in nine participants and were associated with lower SK score. Conclusion The pathogens found in the upper airway were, in order: S. aureus, P. aeruginosa, P. cepacea e S. maltophila. The presence of polyps in the nasal cavity showed statistical significance and appears to have association with the prognostic factor measured by the SK score.

Taner Kemal Erdağ

Isadora Diniz dos Santos, Jaqueline Carvalho dos Santos, Aline Cabral de Oliveira et al.

ABSTRACT Purpose: to describe the results obtained in the stomatognathic system screening applied in preschoolers of the public and private school systems. Methods: a cross-sectional, observational study randomly which selected four preschools linked to the Diretoria Regional de Educação. Two municipalities were drawn, and the educational institutions located in the city Center were selected. After submission of the proposal to the secretaries, managers and family members, the consent was granted for the screening involving face structures, muscle tonus, teeth, occlusion, mobility, speech, breathing, chewing and swallowing, by means of a tested and standardized protocol for evaluation of the stomatognathic system in a synthesized way. The results were submitted to descriptive statistical analysis and the chi-square test, with a significance level of 5%. Results: a total of 218 preschoolers, aged between two and six years old, participated in the study. Most of the participants, regardless of the institution attended, presented normality of the aspects surveyed. However, when comparing preschool children results among the institutions, there were significant differences for facial symmetry, speech, swallowing (for students in public schools), structural aspects and muscle tonus (private schools). Conclusion: the results obtained allowed the differentiated planning of health promotion and preventive actions of orofacial myofunctional disorders for preschoolers of distinct institutional systems, determining the importance of epidemiological surveys in health promotion spaces.