Objective To evaluate a simple psychiatric screening approach for functional otorhinolaryngologic disorders ‒ conditions that show no abnormalities on standard work-up and respond poorly to medication ‒ we analyzed Hospital Anxiety and Depression Scale (HADS) results in patients with Burning Mouth Syndrome (BMS) and persistent Globus Pharyngeus (GP) commonly seen in otorhinolaryngologic clinic, where psychiatric assessment is unfamiliar to most otorhinolaryngologists. Methods We conducted a single-center, retrospective case-control study including 185 subjects with BMS (n = 54), persistent GP (n = 69) (persisting ≥3-month despite anti-reflux medication), and controls (n = 62). Psychiatric screening used the HADS with a prespecified cut-off of ≥8 to define abnormal scores (0–7 normal, 8–10 mild, 11–14 moderate, 15–21 severe). Primary outcomes were abnormal anxiety and depression on HADS. We used logistic regression adjusted for age, sex, and prespecified predictors to estimate adjusted Odds Ratios (aOR) with 95% Confidence Intervals (95% CIs). Results Patients with moderate-to-severe HADS scores in anxiety or depression (47/185, 25.4%) all accepted psychiatric consultation (47/47, 100%). Abnormal anxiety occurred in 37.0% of BMS (20/54), 46.4% of GP (32/69), and 11.3% of controls (7/62); abnormal depression in 51.9% of BMS (28/54), 55.1% of GP (38/69), and 17.7% of controls (11/62), respectively. Compared with controls, odds of anxiety and depression were higher in both patient groups: [BMS ‒ anxiety (aOR = 4.254; 95% CI 1.606–11.269), depression (aOR = 4.512; 95% CI 1.902–10.701)] and [GP ‒ anxiety (aOR = 6.827; 95% CI 2.710–17.197), depression (aOR = 5.743; 95% CI 2.545–12.961)]. Conclusion Patients with BMS or persistent GP had higher levels of anxiety and depression than controls. A brief HADS-based screening proved clinically feasible in an otorhinolaryngology setting by identifying patients with substantial psychiatric burden and facilitating acceptance of psychiatric referral among moderate-to-severe cases. These findings may support the integration of HADS-guided psychiatric screening and referral into routine otorhinolaryngologic care. Level of evidence Level 4.
Objective To develop evidence-based Brazilian clinical practice recommendations for the evaluation and management of sudden hearing loss, with emphasis on idiopathic sudden sensorineural hearing loss. Methods A multidisciplinary Brazilian taskforce composed of otolaryngologists, otologists, and neurotologists was convened by the Brazilian Association of Otorhinolaryngology and Cervico-Facial Surgery and the Brazilian Society of Otology. Each clinical statement was supported by a focused systematic literature review addressing a predefined clinical question. Reviews were conducted according to PRISMA methodology and structured using the PICOS framework. Evidence was synthesized by the panel, and recommendations were formulated considering aggregate evidence quality, benefits and harms, patient preferences, costs, availability of diagnostic and therapeutic resources, and applicability to the Brazilian healthcare context. Results Fifteen clinical statements were developed. The guideline recommends early differentiation between conductive and sensorineural hearing loss, recognition of atypical presentations, prompt audiometric confirmation, selective use of computed tomography, magnetic resonance imaging for retrocochlear evaluation, and avoidance of routine laboratory and genetic testing in typical adult-onset idiopathic cases. Systemic corticosteroids, intratympanic corticosteroids, or a combination of both are recommended as initial treatment, while hyperbaric oxygen therapy may be considered in selected patients. Intratympanic corticosteroids are also recommended as salvage therapy. Routine use of antivirals, thrombolytics, vasodilators, vasoactive substances, immunosuppressive agents, immunobiological therapies, neurotrophic factors, stem cell therapies, and other biological agents is not recommended outside specific indications or research settings. Auditory rehabilitation counseling and structured audiometric follow-up are recommended. Conclusion This Brazilian guideline provides practical, evidence-based recommendations to standardize the diagnosis, treatment, rehabilitation, and follow-up of patients with sudden hearing loss, aiming to improve timely care and reduce unnecessary interventions.
Objectives To describe the real-world clinical application of a single-use flexible rhinolaryngoscope in routine otolaryngology practice. Methods This retrospective cohort study included consecutive patients who underwent flexible rhinolaryngoscopy at a tertiary medical center between August 1 and December 1, 2024. Patients were examined using either a Single-use Flexible Rhinolaryngoscope (SFR) or a Reusable Flexible Rhinolaryngoscope (RFR) as part of standard clinical care. All procedures followed institutional protocols. Outcome measures included examination time, treatment time, operator-rated procedural performance (insertion, rotation, withdrawal, and instrument compatibility), subjective image quality, and procedure-related adverse events. Results A total of 426 patients were analyzed, including 219 in the SFR group and 207 in the RFR group. Baseline demographic and clinical characteristics were comparable between groups. Mean examination time (SFR: 2.20 ± 1.22 min vs. RFR: 2.18 ± 1.02 min, p = 0.431) and treatment time (SFR: 5.80 ± 3.96 min vs. RFR: 5.35 ± 5.18 min, p = 0.639) did not differ significantly. There was no difference in operator ratings between the two devices regarding insertion, rotation, withdrawal, and compatibility with accessory instruments. Image quality scores were lower for SFR compared with RFR (4.26 ± 0.76 vs. 4.82 ± 0.39, p = 0.001). The SFR was successfully used across a wide range of diagnostic and therapeutic indications, with no device-related adverse events observed. Conclusion This single-center retrospective study describes the use of a single-use flexible rhinolaryngoscope in routine otolaryngology practice, with procedures completed without device-related interruptions or adverse events. Level of Evidence Level 3.
Objectives To determine the correlation between hearing thresholds obtained using free-field Cortical Auditory Evoked Potentials (CAEPs) and behavioral audiometry in children with sensorineural hearing loss after hearing-aids or cochlear-implant intervention, and to determine whether P1 latency and N1-P1 inter-peak amplitude can be used to assess hearing device outcome in young children. Methods Thirty-three children (2–14 years) with mild-to-profound sensorineural hearing loss were divided into a cochlear-implant group (22-ears) and a hearing-aid group (27-ears). Tone burst stimuli at 0.5-, 1-, 2-, and 4-kHz were used to evoke CAEPs and behavioral audiometry thresholds in a free field. The CAEP P1 latency and N1-P1 inter-peak amplitude were recorded. Results Free-field tone-burst CAEP P1 response thresholds were positively correlated with free-field behavioral audiometry thresholds at 0.5-, 1-, 2-, and 4-kHz in both the hearing-aid group (Pearson correlation coefficients: 0.567, 0.670, 0.637, and 0.762, respectively, p < 0.01) and the cochlear-implant group (0.825, 0.662, 0.538, and 0.567 respectively). At the tested frequencies, the mean differences between the 2 testing methods were 5–8 dB in the cochlear-implants group and 1–6 dB in the hearing-aid group. In both groups, the CAEP P1 latencies were 130–150 ms, and the N1-P1 inter-peak amplitudes were 6 μV. Conclusions When evaluating the efficiency of hearing interventions in clinical settings, free-field CAEP testing using tone-burst stimuli may serve as a clinically useful supplementary tool for pediatric patients who have difficulty cooperating with behavioral audiometry, provided its limitations are taken into account. Level of evidence This study is a diagnostic study providing Level 2b evidence. The results demonstrate a significant correlation between CAEP and behavioral hearing thresholds in children using hearing devices, supporting its potential applicable value as an objective clinical assessment tool.
Objective This study aimed to describe the global and regional trends in the Disease Burden (DB) of complete hearing loss among individuals aged ≥70-years from 1990 to 2023, and to project prevalence and Years Lived with Disability (YLD) rates through 2040, so as to inform prevention and control strategies for complete hearing loss in this aging population. Methods Using data from the Global Burden of Disease (GBD) 2023 study, we used Prevalence (PR) and YLD rates to describe the burden of complete hearing loss in individuals aged ≥70 years from 1990 to 2023, stratified by Socio‑Demographic Index (SDI) region, GBD region, and sex. Analytical methods included join point regression, smoothing regression, frontier analysis, slope index of inequality, concentration index, and Autoregressive Integrated Moving Average (ARIMA) models. Results The DB of complete hearing loss was highest in Sub‑Saharan Africa, High‑income North America, and High‑income Asia Pacific. From 1990 to 2023, both PR and YLD declined globally, with larger decreases in low‑to‑middle SDI regions than in high‑SDI regions. A positive DB‑SDI correlation was observed only in high‑SDI settings. Regional inequality in DB lessened over the study period. Except for high‑SDI regions, future DB trends through 2040 remain uncertain globally and across the other four SDI strata. Conclusion Although the global burden of complete hearing loss has improved, regional disparities persist, indicating substantial room for further gains. More targeted interventions to improve access to diagnosis and treatment are urgently needed across regions.
