Introduction:The Brazilian Unified Health System (SUS, from the Portuguese Sistema Único de Saúde) provides free hearing aids (HAs), including otological evaluation, audiological therapy, audiological exams, and ear molds through authorized centers. In addition to the complexity and high investment costs, there is no centralized government agency to manage these resources, so each authorized center works on its own. On the other hand, HAs providers are independent distributors or subsidiaries driven by profit and key-performance indicators in their best interest. Objectives:To analyze the operational efficiency of SUS in the provision of HAs and explore potential improvements through digital data governance and optimization of replacement rates through simulations. Data Synthesis:We accessed national data from 2008 to 2024 through the Ministry of Development, Industry and Foreign Trade (COMEX/MDIC) and SUS's Department of Informatics (DATASUS). We integrated these sources with operational data from Reouvir, a leading SUS-accredited center, to model cost scenarios and identify management inefficiencies. Cases from SUS accounted for an average of 49.9% of Brazil's HA imports (3.48 million units, US$437 million). However, high replacement rates-some exceeding 70%-suggest inefficiencies. Simulations indicate that reducing replacement rates by 5 to 20% could yield annual savings of US$1.23 to 5.15 million or enable an increase of 9,780 to 41,026 new fittings per year, respectively. Conclusion:Despite its robust public policy, SUS lacks performance monitoring to enable suppliers to shape market dynamics. Improved digital governance could enhance cost-efficiency and access.
Objective:Post-thyroidectomy hypocalcemia is a major complication following total thyroidectomy. This study aimed to evaluate early postoperative parathyroid hormone (PTH) measurement as a predictor of hypocalcemia after thyroidectomy and its impact on same-day discharge. Methods:This study combined a prospective IRB-approved correlation study of 60 patients who underwent total thyroidectomy with a meta-analysis of 5 observational studies. Results:Using Pearson Correlation Coefficient correlation, there was a significant positive correlation between PTH measured 1H after surgery with 4 H PTH (PCC = 0.787) and 4H Ionized Ca (PCC = 0.642). The sensitivity of early PTH measurement (cutoff < 14 pg/mL) for detecting hypocalcemia was 100%, with an AUC of 0.977 (95% CI: 0.565-1.0). Meta-analysis of previous studies confirmed a strong positive association between early PTH and late measurements. Conclusions:Early PTH measurement at 1 hour after surgery is a highly sensitive tool for detecting post-thyroidectomy hypocalcemia, which may help reduce hospital stay following thyroidectomy.
Introduction:The aditus ad antrum is a structure located on the posterior wall of the tympanic cavity, connecting the epitympanum and mastoid antrum, playing a role in ventilating the mastoid antrum and air cells. However, there is limited in-depth research on this structure. Objective:To study the anatomy and morphology of the aditus ad antrum and evaluate its correlation with mastoid pneumatization using 3D MPR-reconstructed CT scans. Methods:This cross-sectional descriptive study was conducted using 101 normal temporal bone CT scans (190 ears) from individuals aged 16 years or older in Vietnam. The aditus was examined in three planes (axial, coronal, and sagittal) using 3D MPR reconstruction. Results:The aditus ad antrum morphology was classified into four groups, with group 2 being the most prevalent (48.42%). There was no correlation between aditus morphology and gender or ear side. Additionally, no relationship was found between mastoid pneumatization and aditus morphology. With increasing mastoid pneumatization, aditus ad antrum dimensions change. In individuals with two normal ears ( N = 89), bilateral symmetry in aditus morphology was observed in 45% of cases. No significant differences were found in aditus dimensions between ears. The mean transverse diameter of the aditus in males was significantly larger than in females ( p < 0.05). The anterior-posterior diameter of the right ear was significantly greater than the left in the same individual ( p < 0.05). Conclusion:The aditus ad antrum may differ between the left and right ears in normal individuals and is not associated with mastoid pneumatization.
Introduction:Masseteric vestibular evoked myogenic potentials assess saccular-masseteric pathway function using air-conducted or bone-conducted stimuli. Objective:This study investigated whether simulated bilateral conductive hearing loss differentially affects mVEMP response characteristics under air- and bone-conducted stimulation in young adults. Methods:Fifty healthy participants were included in the study. Conductive hearing loss was simulated in 25 individuals using silicone-blocked foam ear tips to create controlled bilateral attenuation. Masseteric vestibular evoked myogenic potentials were elicited using 500 Hz tone bursts delivered to the right ear through air and bone-conducted methods. Responses were recorded using a two-channel zygomatic electrode placement and analyzed for P1 and N1 latencies and P1-N1 peak-to-peak amplitude. Results:In the simulated conductive hearing loss group, air-conducted masseteric vestibular evoked myogenic potential responses showed decreased response rate, delayed latency, and reduced amplitude compared with normal hearing participants. In contrast, bone-conducted masseteric vestibular evoked myogenic potentials were consistently recorded in both groups, demonstrating significantly higher amplitudes and earlier latencies than air-conducted responses in the simulated conductive hearing loss group. Spectral analysis revealed a consistent peak around 100 Hz for all conditions except air-conducted stimulation in the simulated conductive hearing loss group, which showed no distinct peak. Conclusion:Simulated conductive hearing loss significantly affects air-conducted masseteric vestibular evoked myogenic potential responses, often rendering them absent or diminished. However, bone-conducted responses remain robust and reliable in normal and simulated conductive hearing loss conditions, highlighting their diagnostic value when conductive pathologies compromise air-conducted responses.
Introduction:Intrinsic laryngeal muscles (ILMs) play a fundamental role in airway protection, respiration, and phonation. Objective:Knowledge of the distribution and roles of different sarcoplasmic reticulum Ca2+ ATPase (SERCA) and myosin heavy chain (MHC) isoforms in ILMs is essential for understanding their functions and associated pathophysiological changes. Methods:We immunohistochemically characterized SERCA and MHC isoform expression and co-expression patterns in five ILMs of young, aged, and denervated rats. Results:ILMs exhibited the predominant expression of fast fibers that would be important in airway protection. ILMs showed spatially different percentages of muscle fibers and SERCA2. Slow fibers were higher in medial thyroarytenoid (TA) muscles than lateral TA. Significant increases were observed in slow and hybrid fibers with aging. SERCA2 noticeably diminished after denervation, pointing to an increased vulnerability of the denervated muscle to fatigue. A compensatory increase in SERCA2 and hybrid fibers was observed in contralateral muscles likely reflecting adaptation to increased mechanical load. Conclusion:These results indicate that ILMs, like limb muscle fibers, are subject to neural regulation. These findings may significantly advance the understanding of the Ca2+ handling system in ILMs and its role in unique laryngeal muscle functions.
Introduction:Decision-making is one of the most difficult and important tasks performed by surgeons. Clinical guidelines and, more recently, Artificial Intelligence (AI) have been implemented to support these decisions. However, there is a paucity of research exploring the impact of AI on surgical decision-making strategies. Objective:To evaluate the accuracy of AI in informing clinical decision-making for the treatment of advanced oral cancer. Methods:Structured questions based on seven selected clinical recommendations were formulated and processed through multiple large language model (LLM) platforms. Claude (Sonnet 3.5) was used to identify discrepancies between established guidelines and LLM-generated responses. Subsequently, three subject matter experts assessed the identified differences to evaluate their clinical significance. Results:Analysis of the 28 generated responses revealed that 21 (75%) showed congruence between LLM outputs and established guideline recommendations. In three instances, guidelines provided significantly more comprehensive content than LLM responses. One LLM response contained additional relevant information, while three responses were contradictory to the guidelines. Conclusion:The LLMs demonstrated 75% concordance with guideline recommendations and should be considered complementary tools for established clinical guidelines.
Introduction:Lactococcus lactis (L. lactis) is widely used in fermented foods and has immunomodulatory properties. However, its effects on allergic rhinitis remain unclear. Objective:This study evaluated the efficacy of L. lactis 11/19-B1 in mitigating allergic rhinitis symptoms in a mouse model. Methods:Female BALB/c mice were fed a diet supplemented with heat-killed L. lactis 11/19-B1, while allergic rhinitis was induced via intraperitoneal and intranasal administration of ovalbumin (OVA). The positive control group received a standard diet without L. lactis 11/19-B1. Sneezing frequency was recorded, and tissue samples were collected for analysis. Serum OVA-immunoglobulin E (IgE) levels were also measured, nasal mucosa histopathology assessed, and the interleukin 4 (IL-4), interferon gamma (IFN-γ), T helper (Th) 1/Th2 balance in cluster of differentiation (CD) 4+ T cells analyzed by flow cytometry (FCM). Results:Mice receiving L. lactis 11/19-B1 showed significantly reduced sneezing frequency and decreased eosinophil infiltration in the nasal mucosa. No significant changes in serum OVA-IgE levels were observed. Flow cytometry analysis showed a significant increase in the Th1/Th2 ratio in Peyer's patches in the L. lactis 11/19-B1 group compared with the positive control group. Conclusion:These findings suggest that L. lactis 11/19-B1 alleviates allergic rhinitis symptoms by modulating the Th1/Th2 balance and reducing eosinophil infiltration, independently of IgE suppression. These findings highlight its potential as a dietary supplement for allergic disease management .
Introduction:In some patients with conductive or mixed hearing loss, or single-sided deafness, bone conduction implants (BCIs) offer an effective treatment; and scar appearance is a relevant factor in the overall outcome. Objective:To compare scar appearance and alopecia between linear and curved scalp incisions in patients undergoing transcutaneous BCIs surgery. Methods:An observational, cross-sectional study was conducted at a tertiary referral center in patients who underwent transcutaneous BCI. Postoperative follow-up period was between 6m to 3y. Scar evaluation was performed using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS). Alopecia was defined as absence of hair follicles within 2 mm of the incision line. Statistical comparisons between linear and curved incisions groups were conducted, as well as multivariate analysis with logistic regression models. Results:Eighty-four cases were analyzed: 28 underwent linear incisions and 56 underwent curved incisions. Patients reported significantly better scar appearance with linear incisions in POSAS, p = 0.035. Alopecia occurred less frequently among patients who received the Bonebridge implant (OR = 0.113; 95% CI: 0.027-0.478; p = 0.003). No statistically significant differences were found in observer assessment of POSAS or VSS scores. Conclusion:Linear incisions may offer advantages in scar appearance with transcutaneous BCIs. Certain scar characteristics may also be influenced by the type of device and the surgical approach required for its placement, making it challenging to isolate this effect from that attributed solely to type of incision. These results highlight the need to consider both cosmetic factors and auditory outcomes in surgical planning.
Introduction:There is uncertainty about whether COVID-19 is a risk factor for hearing loss. Objective:To evaluate the audiometric profile of patients post-COVID-19 infection and compare it to unaffected individuals, clarifying the correlation between COVID-19 and hearing loss. Additionally, we sought correlations between reported otorhinolaryngological symptoms during COVID-19 and changes in tonal thresholds. Methods:A cross-sectional study compared the pure-tone thresholds of 120 individuals with a confirmed history of COVID-19 and 120 unexposed controls, evaluated between 2021 and 2023. Results:The median tonal thresholds of exposed individuals were predominantly higher than those of unexposed individuals in both ears. The rate of hearing threshold alteration was 28.3% in exposed individuals versus 15% in unexposed individuals, with an odds ratio (OR) of 2.24 (95% CI: 1.18-4.25). Comparison of thresholds between the right and left ears of each exposed individual demonstrated asymmetric hearing impairment. The distribution of otorhinolaryngological symptoms included: nasal symptoms 67.5%; cough 65.8%; loss of smell 60%; loss of taste 56.7%; sore throat 47.5%; dizziness 30.8%; hoarseness 21.7%; tinnitus 19.2%; earache 18.3%; hearing loss 18.3%; and facial paralysis 0.8%. The association between reported symptoms and changes in pure-tone thresholds was statistically significant only for hearing loss (p < 0.001; OR = 8.9) and tinnitus (p = 0.005; OR = 3.7). Conclusion:Individuals exposed to COVID-19 showed worse tonal thresholds and a higher rate of hearing changes compared with non-exposed individuals.
Introduction:Chronic dysfunction of the Eustachian tube is a common complaint, affecting approximately 1-5% of adults and significantly reducing quality of life. This condition may give rise to various symptoms and disorders of the middle ear. To date, the diagnostic tools for this dysfunction remain inadequate. In 2012, McCoul et al. published a questionnaire for the evaluation of Eustachian tube dysfunction, known as the ETDQ-7, and demonstrated its validity and reliability. Objectives:To prove an in Italian translated version of the ETDQ-7. Methods:The ETDQ-7 was translated into Italian and administered to two groups: 68 patients with chronic Eustachian tube dysfunction (ETD) and 50 healthy controls. Statistical analyses included test-retest reliability, item-total score correlation, receiver operating characteristic (ROC) analysis, and assessment of internal consistency. Results:Analysis of the Italian version of the ETDQ-7 confirmed the findings of McCoul et al. (2012). The Cronbach's alpha coefficient was 0.838 for the entire questionnaire. The Spearman's rho coefficient for test-retest was 0.804, indicating good temporal stability in patients' responses. Both total and item scores were significantly higher in the patient group than in the control group. Conclusion:The Italian version of the ETDQ-7 demonstrates high validity and reliability. Its use is recommended for diagnosing and monitoring patients with chronic Eustachian tube dysfunction.
Abstract Developing region-specific clinical practice guidelines (CPGs) for ear, nose, and throat (ENT) diseases is crucial in Pakistan's primary care, given their significant contribution to clinical cases, aiming to enhance healthcare standards through evidence-based practices with local adaptations. To ensure the standardization of primary healthcare and reduce unnecessary specialist referrals by creating CPGs that are appropriate to our region. We selected eight guidelines regarding epistaxis, neck masses, hearing loss, Ménière's disease, dysphonia, allergic rhinitis, acute otitis externa, and rhinosinusitis from the American Academy of Otolaryngology–Head and Neck Surgery Foundation as the source guidelines, and employed the Grading of Recommendations, Assessment, Development, and Evaluation–Adoption, Adaptation, and De Novo Development (GRADE-ADOLOPMENT) approach to contextualize guidelines by adopting, adapting, or excluding recommendations from them. Clinical-referral algorithms were created using recommendations from the CPGs created, with additional recommendations sought through a best-evidence review process. We developed local CPGs for eight ENT conditions using the GRADE-ADOLOPMENT approach. While most recommendations were adopted in the local CPGs, one recommendation for acute otitis externa, hearing loss, and epistaxis and two for allergic rhinitis were adopted with minor changes. Six recommendations were excluded due to service limitations in Pakistan. Additionally, we created 8 clinical-referral algorithms, incorporating 17 additional recommendations to address gaps in practice, distributed across various conditions. The newly-established CPGs are instrumental in delivering standardized, high-quality care at the primary care level. Simultaneously, the development of clinical referral pathways empowers general physicians to manage patients effectively and make timely, appropriate referrals to ENT specialists.
Introduction:A ringing sensation in the ear is referred to as tinnitus. It is one of the common symptoms associated with hearing loss. It can be associated even with loudness-related conditions, such as hyperacusis. Objective:To investigate the relationship between tinnitus and hyperacusis in individuals with normal hearing and up-to-mild hearing loss, focusing on the manifestation of loudness intolerance. Methods:The Tinnitus Handicap Inventory (THI) was administered among 35 adults having primary complaints of tinnitus with normal hearing and up-to-mild hearing loss. Further, the Modified Khalfa Hyperacusis Questionnaire (M-HQ) was used to evaluate the hyperacusis severity among the same individuals. Spearman's correlation coefficient was used to check the correlation between tinnitus and hyperacusis severity. Results:Of the 35 adults who reported tinnitus, 18 (51.4%) of them reported having hyperacusis. The outcome of Spearman's correlation indicated a moderate positive correlation between the THI and M-HQ scores r s = 0.401( p = 0.017). Conclusion:The results obtained suggest that tinnitus is associated with hyperacusis. With the subjective evaluation, it is clear that the change in the severity of tinnitus perception is interconnected with the perception of hyperacusis severity. But this relationship is not a completely overlapping one. Future research on the comorbid interplay of tinnitus severity and hyperacusis severity may shed further light on this link.
Introduction The present study aimed to evaluate the adherence of Brazilian otolaryngologists to key recommendations from contemporary international tonsillectomy guidelines, particularly the 2019 Clinical Practice Guideline by Mitchell et al. Objective To evaluate how Brazilian otorhinolaryngologists perform tonsillectomies and manage potential postoperative complications. Methods An online questionnaire was developed and completed by otorhinolaryngologists affiliated with relevant medical associations. Results Revealed that 40.4% of surgeons had over 20 years of experience, indicating substantial expertise. Primary indications for tonsillectomy included snoring, hypertrophy, and recurrent tonsillitis. Diagnostic criteria for acute bacterial tonsillitis and obstructive sleep apnea were analyzed, with 35% of respondents considering episode frequency a key criterion. Polysomnography was requested in specific cases, reflecting concerns about respiratory severity. Conclusion The present study provides the first comprehensive analysis of the adoption of international guidelines for tonsillectomy in Brazil. We conclude that, although the Brazilian otolaryngology community has adopted key recommendations regarding diagnosis and postoperative care, deeply entrenched deviations persist in technical aspects and intraoperative medication. These latter aspects represent opportunities for educational interventions, resource mobilization, and the development of adapted national guidelines that take local realities into account, with the ultimate goal of standardizing and improving the quality of care for all children undergoing tonsillectomy in the country.
Introduction:Virtual reality is a tool used in the rehabilitation of neurodegenerative diseases and vestibular disorders, enabling immersion in a playful and illusory world. Objective:To determine the effects of vestibular rehabilitation with virtual reality in adults with vestibular disorders. Data Synthesis:Appropriate word combinations were selected and tailored specifically to seven electronic databases. Studies that investigated vestibular rehabilitation with virtual reality in individuals > 18-years-old and diagnosed with vestibular dysfunction were included. The risk of bias and the certainty of the evidence was assessed. A random-effects meta-analysis was performed, with a total of 18 articles included. There was an improvement in the level of confidence in balance scores between baseline and postintervention of 11.22 (95% CI = 8.55-13.88; I 2 = 18%). An improvement in the disabling effects caused by dizziness was also observed, with a difference between means in relation to the two periods of -22.76 (95% CI = -28.70 to -16.82; I 2 = 88%). The certainty of evidence assessment was very low. Conclusion:Virtual reality therapy in vestibular disorders has shown efficient results, being a useful, low-cost, and motivating tool in the treatment of these disorders.
Introduction:Prevalence of elongated styloid process (SP) is 4% and only 4-10% of these patients are symptomatic. In this study morphology was assessed among the patients unlike the dry skulls. Comparison of elongation and angulation of SP between the case and control groups, as well as symptomatic correlation was done. This study also imparts information regarding symptomatic outcomes following medical and surgical management. Objective:To compare the anatomical variations in SP morphology and symptomatology in patients with and without stylalgia. Methods:A prospective study was done over a period of 1.5 years on 84 participants. The required details were recorded. Radio-imaging was done through Towne's and lateral view of skull X-rays to measure length, as well as medial and anterior angulations. Pain assessment was done with the visual analogue scale before and after conservative or surgical managements. Results:Mean age of participants was 37.2 ± 8.8 years, with a female preponderance. The most common symptom was recurrent oropharyngeal pain (67.8%). Elongated SP was observed in the case group with a mean length of 4.07 cm, compared with 2.36 cm in controls. The mean medial angulation of the SP was of 21.28° in the case group and of 16.77° in the controls. Anterior angulation in the case group was of 32.19°, compared with 21.74° in the controls. A statistically significant difference was noted in in length, medial and anterior angulations in the case group when compared with controls. Conclusion:Symptomatic elongated SP is a complex condition for many patients. Its precise identification will aid in early recovery from symptoms. Surgical management showed better symptomatic outcomes. Level of Evidence:Level 3.
Abstract: Introduction:There are concerns about addiction to opioids due to excessive prescription after surgery. Objective:We compared the impact of dexmedetomidine as an additive to ropivacaine for bilateral cervical plexus block to that of ropivacaine alone for postoperative analgesia in patients undergoing thyroidectomy. Methods:A total of 60 patients were randomized in 2 groups: those submitted to bilateral superficial cervical plexus block (BSCPB) using 0.375% ropivacaine (group BSCPB-R, the control group) and those submitted to BSCPB using 0.375% ropivacaine with 1mcg/kg of dexmedetomidine (group BSCPB-RD, the study group). The resultant postoperative analgesia was compared by the morphine milligram equivalents (MMEs) required by each patient. Results:Only 3 (10%) patients in the BSCPB-R group and 2 (6.6%) patients in the BSCPB-RD group required opioid analgesia. The mean total rescue opioid required in the first 24 hours was significantly higher in group BSCPB-R compared to group BSCPB-RD (20 ± 8.14 versus 8 ± 2.85 MME respectively; p = 0.0001). Similarly, the mean total MMEs required during the first 5 days after surgery was of 38 ± 16.4 for group BSCPB-R and 18 ± 8 for group BSCPB-RD ( p = 0.0001). Conclusion:The combination of dexmedetomidine and ropivacaine in the BSCPB protocol results in a lower requirement of opioids for pain in the postoperative period, and very few (if any) patients undergoing thyroid surgery require postoperative opioids with this strategy.
Introduction:Understanding the relationship between blood groups (A, B, AB, and O) and auditory functioning can provide valuable insights into individual differences in hearing ability and potential risks for hearing loss. Objective:To assess the impact of blood group on auditory functions. It examined contralateral suppression of transient evoked otoacoustic emissions (TEOAEs), speech perception in noise (SPIN), and binaural integration using the dichotic consonant-vowel (DCV) test. Methods:There were 60 female participants, from the blood groups A, B, AB, and O, aged 18 to 30 years with normal hearing were included. This study's preliminary assessments included pure-tone audiometry, immittance audiometry, and otoscopy to exclude hearing loss and middle ear dysfunction. Suppression of TEOAE was measured with and without contralateral broadband noise, while SPIN was tested at signal-to-noise ratios (SNRs) of -10, 0, and +10 dB. The DCV test assessed binaural integration with the presentation of prerecorded consonant-vowel stimuli simultaneously. Results:The Kruskal-Wallis H test showed no significant differences in TEOAE suppression amplitudes, SPIN scores across SNRs, or DCV scores across the four blood groups. Conclusion:These findings suggest that blood type has no discernible effect on central auditory functions, such as binaural integration, speech perception in noisy environments, or efferent auditory system functioning. This research, thus, highlights the need for further investigation with diverse methodologies and larger cohorts, to better understand the role of blood groups in auditory processing.
Introduction:Allergic rhinitis (AR) is an IgE-mediated inflammatory reaction of the nasal mucosa triggered by various allergens, leading to nasal congestion, rhinorrhoea, sneezing, nasal itching, ocular redness, lacrimation, and postnasal dripping. This condition can also cause sleep disturbances and fatigue, which can affect productivity at work and academic performance, therefore posing substantial economic burden. Positive outcomes rely on efficacy of medications, potential adverse effects of medication, treatment response, and overall prognosis. Objective:To investigate the utility of the Rhinitis Control Assessment Test (RCAT) as a clinical tool in Urdu for evaluating and monitoring allergic rhinitis. Methods:The RCAT is a self-administered questionnaire consisting of six questions addressing specific rhinitis symptoms. Results:The study included 60 (35 male and 25 female) patients with ages ranging from 18 to 55 (mean: 35) years. The RCAT demonstrated acceptable internal consistency with a Cronbach's alpha of 0.759. Interitem correlations supported that the questionnaire items reflected related constructs. Paired sample t-tests showed statistically significant improvements in all RCAT items posttreatment ( p < 0.001), except for the compliance-related item (q5; p = 0.166). The overall score increased significantly (mean difference = 9.28; p < 0.001), indicating improved rhinitis control. Conclusion:The RCAT has proven to be a valuable tool for assessing allergic rhinitis control. Its ease of use and adaptability across languages make it an excellent choice for routine monitoring and management of AR. The successful application of RCAT in Urdu further enhances its accessibility and effectiveness for native speakers.
