As malformações do ouvido médio são eventos raros, ocorrendo em 1/15000 nados vivos1-3. Estão geralmente associadas a outras malformações da cabeça e do pescoço podendo também ser parte integrante de síndromes malformativas. As malformações isoladas do ouvido médio são, por isso, eventos ainda mais raros cujo diagnóstico é desafiante4, sendo dificultado pela normal aparência do pavilhão auricular, canal auditivo externo e membrana timpânica.
Neste artigo, iremos descrever um caso clínico de uma doente de 19 anos com história de surdez unilateral não tratada desde a infância. Ao exame objetivo ORL não apresentava alterações, tendo sido pedidos exames audiométricos que demonstraram uma surdez de condução no ouvido esquerdo com um gap aéro-ósseo de 54dB com timpanograma tipo A. O relatório da TC não descrevia alterações pelo que foi proposta uma timpanotomia exploradora que revelou uma displasia isolada da longa apófise da bigorna. Foi realizada uma ossiculoplastia do tipo II (classificação de Portmann)14 com enxerto autólogo de cortical mastoideia e cartilagem do tragus. O audiograma pós-operatório demonstrou uma redução do GAO médio para 18.75dB.
Chul Young Yoon, Tae Hoon Kong, Tae Hoon Kong
et al.
BackgroundWhile debates persist regarding the benefits and drawbacks of steroid use in treating vestibular neuritis (VN), few studies have analyzed real-world prescription patterns and clinical outcomes. This study aimed to fill this gap by leveraging South Korea’s Health Insurance Review and Assessment (HIRA) big data to explore the actual use of steroids in clinical practice and their associated patient characteristics.MethodsUsing HIRA data from 2007 to 2022, 237,673 VN patients were retrospectively analyzed and categorized into steroid (n = 23,235) and non-steroid groups (n = 214,438). Demographic, clinical, and economic variables, including age, sex, hospital type, medication use, and costs, were statistically compared using chi-square and t-tests.ResultsSteroid prescriptions accounted for 9.8% of VN cases, predominantly in females (63.2%) and younger patients (2.7% in the 20–24 age group vs. 1.6% in the non-steroid group). Prescription rates declined significantly in patients aged 55 years and older. Outpatients (87.2%) and those treated in clinics (65.1% for males, 75.3% for females) were more likely to receive steroids. Steroid prescriptions were also associated with lower hospital costs and insurance payments compared to the non-steroid group.ConclusionThis study is the first to analyze real-world steroid usage for VN through big data in Korea, offering valuable insights into clinical practices and prescription trends. Clinicians, especially in primary and outpatient clinic, are more likely to favor steroid treatment and avoid further testing or treatment when they are confident of diagnosing VN. However, the high rate of VN diagnosis in women suggests that vestibular migraine may be underdiagnosed and steroids may be misused. By identifying demographic and economic factors associated with steroid use, the findings highlight the importance of establishing evidence-based guidelines to optimize VN management in clinical settings.
Objective: We aimed to investigate the effect of bilateral sphenopalatine ganglion blockade (SPGB) on the main postoperative complications in septorhinoplasty operations. Methods: In this randomized, controlled, prospective study, 80 cases planned for Septorhinoplasty operations under general anesthesia were included in the study. The cases were divided into two groups; SPGB was performed with 2 mL of 0.25% bupivacaine bilaterally 15 min before the end of the operation in the SPGB group (Group S, n = 40). In the control group (Group C, n = 40), 2 mL of 0.9% NaCl solution was applied into both SPG areas. In the recovery unit after the operation; the pain and analgesic needs of the patients at 0, 2, 6 and 24 h were evaluated. Results: There was no statistically significant difference between the groups in terms of hemodynamic parameters (ASA, MBP, HR) (p > 0.05) All VAS values were statistically lower in Group S than in Group C (p < 0.05). In Group S, the need for analgesic medication was found in 5 cases between 0–2 h, whereas in Group C, this rate was found in 17 cases, and it was statistically significant (p < 0.05). Conclusion: Bilateral SPGB application was determined to provide better analgesia in the early postoperative period compared to the control group, it was concluded that further studies are needed to say that there are significant effects on laryngospasm and nausea-vomiting. Level of evidence: 2, degree of recommendation B.
Ahmad Mahmud, Abubakar D. Salisu, Emmanuel S. Kolo
et al.
Abstract Background Mucociliary clearance is an important defense mechanism in human upper and lower respiratory airways. Impairment of this process by certain conditions such as cigarette smoking can predispose to chronic infection and neoplasm of the nose and paranasal sinuses. Methods This was a cross‐sectional study conducted in Kano metropolis, Nigeria. Eligible adults were enrolled, a saccharine test was conducted, and the nasal mucociliary clearance time was assessed. Analysis of the result was carried out using Statistical Product and Service Solutions version 23.0. Results There were 225 participants categorized into 75 active smokers (33.3%), 74 passive smokers (32.9%), and 76 nonsmokers (33.8%, living in a smoking‐free zone). The age range of the participants was between 18 and 50 years, with a mean age of (31.2 ± 5.6) years. All participants were males. There were 139 (61.8%) of Hausa‐Fulani ethnic group, 24 (10.7%) Yoruba, 18 (8.0%) Igbo, and 44 (19.5%) other ethnic groups. Findings in this study showed that the average mucociliary clearance time among active smokers was prolonged ([15.25 ± 6.20] min) compared to passive ([11.41 ± 4.25] min) and nonsmokers ([9.17 ± 2.76] min) respectively, with a statistical significance (F = 33.59, P < 0.001). Binary logistic regression revealed that the number of cigarettes smoked per day was an independent predictor of prolonged mucociliary clearance time (P = 0.008, odds ratio = 0.44, 95% confidence interval = 0.24–0.80). Conclusion Active cigarette smoking is associated with prolonged nasal mucociliary clearance time. The number of cigarette sticks smoked per day was found to be an independent predictor of prolonged mucociliary clearance time.
Negar Moghadasi, Azadeh Andisheh-Tadbir, Amin Samiee
et al.
Statement of the Problem: Heat shock protein 27 (HSP27) plays important roles in many cellular processes and has been implicated in different types of diseases such as cancers.Purpose: This study aimed to evaluate the serum level of HSP27 in patients with salivary gland tumors and to determine its possible correlation with the prognosis of the disease.Materials and Method: This cross-sectional study was performed on 60 patients with salivary gland tumor including 16 pleomorphic adenoma, 33 adenoid cystic carcinoma, 6 mucoepidermoid carcinoma, 5 acinic cell carcinoma, and 28 healthy control subjects. The control cases were healthy blood donors who matched the study group in age and sex. Serum samples were obtained from the clotted blood and HSP27concentrations were measured with sandwich enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed by using one-way ANOVA, post Hoc test, independent sample t-test, and ROC analysis. A p value of less than 0.05 was considered as significant.Results: The mean serum level of HSP27 was 3956.1±3830.1 (pg/ml) in patients with malignant salivary gland tumor, which was significantly higher than that in benign salivary gland tumor (752.2±485.6) and healthy controls (602.3±575.8) (p< 0.001). However, there was no significant difference in the HSP27 serum levels between the patients with benign salivary gland tumors and healthy controls (p= 0.2). No association was detected between the mean serum levels of HSP27 and clinicopathologic factors such as age, sex, stage and nodal metastasis (p> 0.05), except for the tumor size (p= 0.04).Conclusion: The HSP27 concentration increased in patients with malignant salivary gland tumors. Moreover, the HSP27 level was correlated with tumor growth, invasiveness, and diagnosability. Yet, larger clinical studies are required to explore its prognostic value.
“Pediatric Swallowing and Feeding Assessment and Management” by J Arvedson, L Brodsky, and M Lefton-Greif (San Diego, CA: Plural Publishing: 2020) is about new interventions for feeding problems and swallowing disorders. Its contents inform speech and language specialists on the nature of swallowing, the etiology of relevant diseases, methods to evaluate disorders, and evidence-based therapies in the interventions for feeding problems in infants and children. In addition, the book could be useful for the pediatrician, gastroenterologist, otorhinolaryngology, occupational therapist, psychiatrist, nurses, lactation consultants, and families of children with feeding/swallowing problems. Intervention approaches are illustrated with case reports. In the third edition of this book, which was published in 2020, novel approaches and evaluation methods are discussed. In Chapters three to eight, the most important screening methods and instrumental evaluation (for example FEES, VFSS and ultrasound), as well as clinical evaluation of swallowing are presented. The advantages, disadvantages, implementation of each method is discussed in the ninth to thirteenth chapters, mainly focusing on interventions.
Nutrition. Foods and food supply, Food processing and manufacture
Bertlich, Mattis, Jakob, Mark, Bertlich, Ines
et al.
Objective: Lipedema is a relatively common yet debilitating and often misdiagnosed lipodystrophy that mainly affects females. Very little is known about the etiology and pathophysiology of the disease. However, due to its high preference for female patients, hormonal factors may contribute to the pathogenesis.Case: A 62-year-old male patient presented to the authors with painful swelling of the thighs. The patient had been treated elsewhere for lymphedema with subsequent disease progression. Lipedema stage IV was confirmed by clinical examination and ultrasound. The patient underwent three sessions of tumescence liposuction which was well tolerated. Later on, the patient reported great improvement in terms of complaints as well as disfigurement.Conclusion: The etiology and pathophysiology of lipedema remain unclear. However, the case at hand shows that lipedema may, albeit rare, also present in male patients. Moreover, we show that liposuction is efficient and safe in treating lipedema even in atypical cases.
Nikhil Rajendra Dhorje, Kshitij Dhaval Shah, Madhusudhan V
et al.
Introduction
Foreign body in the eye is one of the leading causes of temporary as well as permanent visual problems in developing world.
Case Report
We are presenting a case of 17 year old male with alleged history of traumatic insertion of foreign body acrylic glass in right orbit due to bursting of cracker in acrylic bottle and its subsequent management.
Discussion
It was removed with endoscopic guidance and floor of orbit was reconstructed to provide stability to eyeball and also to prevent secondary complications. We present this case to highlight importance of multidisciplinary approach in tertiary health care centre.
Daniella Priscila Ferracioli Batista, Maria Fernanda Bagarollo
ABSTRACT Purpose: to review, in an integrative manner, studies using surface electromyography in the orofacial and cervical musculature in mouth breathing children aged from three to 11 years and 11 months old. Methods: the survey was conducted in national and international databases, from 1998 to 2018, in Portuguese, English and Spanish. Review articles, dissertations, book chapters, case studies and editorials were excluded. Results: 86 articles were found, 14 of which met the inclusion criteria. Most of these studies used surface electromyography to assess and describe the muscle condition of the mouth breathing population. Only one study addressed the influence of myofunctional speech therapy and two studies included physical therapy treatment, using electromyographic evaluation before and after the intervention. Given the main categories of analysis, the discussion was based on the year, state of publication and journal, sample size, scientific methodology, muscles assessed, assessment protocols used and the results of the publications. Conclusions: surface electromyography has been used mainly in the initial assessment of orofacial and postural myofunctional changes caused by mouth breathing and not as a therapeutic biofeedback, thus, it is important to conduct longitudinal studies using this instrument in mouth breathers.
Objective: This study aimed to compare ultrasonography (US) features and the Korean-Thyroid Imaging Reporting and Data System (K-TIRADS) categories for diagnosing isthmic and lobar papillary thyroid carcinomas (PTC).Methods: From January 2009 to December 2012, 163 patients who underwent thyroid surgery and were confirmed with a post-operative histopathological diagnosis of isthmic PTC were retrospectively included. Fifty-nine patients were excluded because their tumor size was <0.5 cm or because of other reasons. The control group comprised of 145 patients who underwent thyroid surgery from January to April 2013 for a classic type of PTC, with the largest diameter being ≥ 0.5 cm and located in the thyroid lobe. A single radiologist retrospectively reviewed the US features and K-TIRADS categories of each nodule using a picture archiving and communication system.Results: Among 104 patients with isthmic PTC, 95 and 9 had primary and secondary cancers, respectively. On the other hand, all 145 patients with lobar PTC had primary cancers. Isthmic PTC showed a lower prevalence of non-parallel orientation than lobar PTC (23.1 and 71%). Nodule orientation was the only US feature statistically different between the two groups (p < 0.0001). However, there was no significant difference in patient age, sex, nodule size, composition, echogenicity, microcalcification, spiculated/microlobulated margin, and K-TIRADS category between the two groups (p > 0.05).Conclusions: K-TIRADS may be useful in the diagnosis of both isthmic and lobar PTC.
Diseases of the endocrine glands. Clinical endocrinology
Shiraz Syed, Himanshu Kumar Mittal, Sampan Singh Bist
et al.
Introduction: Nearly 5-10 percent of patients seen in general
OPD, and between 10-20 percent of patients seen by ENT
specialists and neurologists are those with complaints pertaining
to vertigo and dis-equilibrium. The standard definition of vertigo
states it to be an illusion of motion particularly rotatory sensation.
Overlapping symptoms and terms such as dizziness, light
headedness, giddiness and pre-syncope make it challenging to
achieve a proper diagnosis.
Aim: To study the clinical profile and revisit the various aetiological
factors for vertigo in patients with actual sensation of rotatory
motion seen in contemporary Otolaryngology practice.
Materials and Methods: The present study was a crosssectional observational study carried out over a period of
12 months in the Department of Otorhinolaryngology at a
tertiary care centre. One-hundred and ten cases complaining
of the sense of rotation of either head or their surroundings
with at least a single episode in preceding one month were
included. Comprehensive otological and vestibular evaluation
was done. Each patient was subjected to thorough clinical
vestibular and laboratory tests. Subjects with known cervical
spine disease, neurological disorders and cardiac ailments
were excluded. Statistical analysis was done and Chi-square
test was applied.
Results: The mean age of patients in the study was 49.75 years
with a male to female ratio of 1:1. Majority of the patients (90%)
presented with acute onset of vertigo. The total duration of
symptoms most commonly observed ranged between one week
to one month. Nearly, all patients had intermittent character of
vertigo. The duration of each episode in most of the patients
ranged between 1 minute to 10 minutes. Maximum patients
(90.9%) were observed with intensity of vertigo as mild and
moderate type (Level II and III SVVSLCRE). Positional variation
was observed in 64.5% of the patients. The most common
aetiological diagnosis deduced from the study was benign
paroxysmal positional vertigo (30.4%) followed by orthostatic
hypotension (17.9%) and Meniere’s disease (13.4%).
Conclusion: The most common aetiological factor of vertigo
was found to be benign paroxysmal positional vertigo, which
can be effectively treated by performing Epley’s maneuver.
Orthostatic hypotension has been observed as an important
cause liable to be missed by otologists. The management of
vertigo must be directed by a meticulous work up of aetiologies
and should not be treated under a blanket regimen.
Yifei Ma,1,2,* Zili Chen,3,* Guodong Yu2 1School of Clinical Medicine, Guizhou Medical University, Guiyang 550004, Guizhou, People’s Republic of China; 2Department of Otorhinolaryngology, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, People’s Republic of China; 3Department of Hepatobiliary Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Guodong Yu Tel/Fax +86-851-86855119Email GuodongYU453@163.comBackground: Laryngeal cancer (LCA) is a common head and neck cancer. Lysine demethylase 5B (KDM5B) knockdown is expected as a new target for cancer prevention. We investigated the molecular mechanism of KDM5B in LCA.Materials and Methods: The levels of KDM5B, microRNA (miR)-139-3p and high-mobility-group box 2 (SOX2) in LCA tissues and cells, normal tissues and cells were detected. The effect of KDM5B on LCA was evaluated. The upstream miR of KDM5B and the downstream gene and pathway of KDM5B were predicted and their effects on LCA were analyzed. The Wnt/β-catenin pathway-specific activator agonist was delivered into LCA cells expressing miR-139-3p mimic to evaluate the role of the Wnt/β-catenin pathway.Results: KDM5B was highly expressed in LCA, and inhibition of KDM5B suppressed LCA progression. miR-139-3p, downregulated in LCA tissues, was a regulatory miR of KDM5B. Overexpression of miR-139-3p significantly inhibited the malignant biological behaviors of LCA cells. KDM5B promoted SOX2 expression via histone demethylation. SOX2 was highly expressed in LCA, and overexpression of SOX2 promoted LCA progression by inducing the Wnt/β-catenin pathway. Activated Wnt/β-catenin pathway attenuated the inhibitory effect of miR-139-3p mimic on the malignant biological behaviors of LCA cells.Conclusion: miR-139-3p overexpression inhibited LCA development via regulating the KDM5B/SOX2 axis and inhibiting the Wnt/β-catenin pathway.Keywords: laryngeal cancer, microRNA-139-3p, lysine demethylase 5B, high-mobility-group box 2, Wnt/β-catenin pathway
Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Justin A. Edward, Alkis J. Psaltis, Ryan A. Williams
et al.
Klippel-Feil syndrome (KFS) is associated with numerous craniofacial abnormalities but rarely with skull base tumor formation. We report an unusual and dramatic case of a symptomatic, mature skull base teratoma in an adult patient with KFS, with extension through the basisphenoid to obstruct the nasopharynx. This benign lesion was associated with midline palatal and cerebral defects, most notably pituitary and vertebrobasilar arteriolar duplications. A multidisciplinary workup and a complete endoscopic, transnasal surgical approach between otolaryngology and neurosurgery were undertaken. Out of concern for vascular control of the fibrofatty dense tumor stalk at the skull base and need for complete teratoma resection, we successfully employed a tissue resection tool with combined ultrasonic and bipolar diathermy to the tumor pedicle at the sphenoid/clivus junction. No CSF leak or major hemorrhage was noted using this endonasal approach, and no concerning postoperative sequelae were encountered. The patient continues to do well now 3 years after tumor extirpation, with resolution of all preoperative symptoms and absence of teratoma recurrence. KFS, teratoma biology, endocrine gland duplication, and the complex considerations required for successfully addressing this type of advanced skull base pathology are all reviewed herein.
Introduction
Inverted papillomas are notorious for recurrence. The surgical cause attributed to recurrence is failure to achieve good surgical exposure and inadequate clearance of disease. Pre-operative prediction about the site of origin by CT Scan may contribute to a better surgical outcome. This study was undertaken to assess if focal hyperostosis on pre-operative CT scan can be considered to be a predictor of the site of tumour origin and correlate with endoscopic finding of the site of origin.
Materials and Method
A prospective descriptive study was carried out between Jan 2014 and May 2016. Fifteen patients of histopathologically proven inverted papilloma that reported during this time period were evaluated using contrast enhanced CT Scan and subsequently underwent endoscopic excision of tumour identifying the tumour origin. Assessment of age, gender, symptoms, pre-operative staging, location of the tumour origin on CT Scan and surgical correlation of origin was done. Post-operative follow-up was done at 1 month, 3 months and 6 monthly thereafter.
Results
Six (40%) were classified as Krouse II and nine (60%) were classified as Krouse III. 12 (80%) arising from maxillary sinus, 02 (13.3%) arising from maxillary sinus and anterior ethmoids and 01 (6.7%) from sphenoid. Thirteen (86.7%) cases CT scan could predict the tumour origin which was confirmed during surgery. All cases managed by endoscopic technique with no recurrence or co-existence of malignancy.
Discussion
Focal hyperostosis in the walls of paranasal sinus is seen to be associated with IP tumour origin, the cause of which is not fully understood. It is hypothesized that tumour induced inflammation at the site of origin leads to bone remodeling and increased bone deposition with vascularity at the site of attachment.
Conclusion
CT scan is a good predictor of tumour origin and a conservative endoscopic approach can be planned accordingly for complete clearance of disease.
Papilomatose respiratória recorrente ou papilomatose laríngea recorrente é uma doença da laringe, causada pelo papiloma vírus humano, caracterizada por lesões epiteliais verrucosas e, geralmente, recorrentes. Na literatura são descritos diversos tipos de tratamento, como cirurgia a frio, a laser e/ou uso de microdebridador, além das terapias adjuvantes; todas no sentindo de diminuir possíveis sequelas permanentes da doença. OBJETIVO: Realizar uma revisão de literatura a respeito desta doença com ênfase nas técnicas cirúrgicas e terapias adjuvantes mais utilizadas atualmente. MÉTODO: Utilizou-se a metodologia de revisão bibliográfica, por meio de levantamentos em base de dados eletrônicos de domínio público, entre 1992-2012, utilizando-se as palavras-chave: papiloma, infecções por papillomavírus, laringe, terapêutica, vacinas contra papillomavírus. RESULTADOS: Foram levantados 357 artigos, dos quais 49 foram usados como base para esta revisão. Os trabalhos científicos apontam para a redução de recidiva na maioria das terapêuticas adjuvantes. Entretanto, o levantamento demonstrou metodologias e amostras diferentes, o que não permitiu comparar os tipos de tratamento e de terapias adjuvantes. CONCLUSÃO: A escolha da técnica cirúrgica varia entre os autores, porém, há uma tendência atual ao uso do microdebridador. As terapias adjuvantes recentes, como cidofovir, vacina tetravalente contra o papiloma vírus humano e bevacizumab, necessitam de estudos mais amplos.