Objetivo: Caracterização dos internamentos por hemorragia tumoral de carcinoma pavimentocelular (CPC) da cabeça e pescoço num centro terciário. Desenho do Estudo: Retrospetivo. Material e Métodos: Revisão de processos clínicos com diagnóstico de hemorragia da cavidade oral (ICD 10 R04.1) associado a CPC da cabeça e pescoço, de 2018 a 2023. Resultados: Foram analisados 36 internamentos. A localização tumoral mais frequente foi a orofaringe (61%). A maioria dos tumores encontravam-se em estadio IV (89%). Tinham sido submetidos a quimioradioterapia (QRT) 50% dos doentes. No que respeita ao tratamento de hemostase, 17% receberam medidas locais; 14% necessitaram também de terapêutica anti-fibrinolítica sistémica; em 36% foi realizado tamponamento. Foi necessária hemostase cirúrgica em 17% dos episódios e 11% foram submetidos a radioterapia hemostática. 25% foi submetida a traqueostomia emergente. Conclusões: Fatores como localização tumoral orofaríngea, estadio IV e QRT prévia foram mais frequentes nos doentes com necessidade de internamento por hemorragia tumoral.

Functional rhinoseptoplasty (FRS) is a surgical procedure with both functional and aesthetic impacts, significantly affecting patients' quality of life. The influence of nonsurgical factors on FRS outcomes remains a debated topic in the literature. For instance, some authors deny the long-term impact of gender, age, inferior turbinectomy, or active smoking on the results. The rhinoplasty outcome evaluation (ROE) questionnaire is a useful tool for assessing patients' satisfaction once submitted to this surgery.To evaluate the subjective impact of nonsurgical factors on the long-term outcomes of FRS.The authors conducted a retrospective study of all patients who underwent FRS at a tertiary hospital between 2019 and 2023. Patients with less than 1 year of postoperative follow-up were excluded. The ROE questionnaire was used to quantify subjective surgical satisfaction. Various variables were analyzed, including previous nasal pyramid trauma, age, known hematologic pathology, psychiatric history, allergic rhinitis, smoking habits, and inferior turbinectomy. Statistical calculations were performed using the Kruskal-Wallis formula.The sample included 75 patients with an average age of 33.4 years, mostly female (51%; n = 38). The average ROE score in the sample was 79.6%. Thirty-eight point seven percent (n = 29) of the procedures were performed after nasal pyramid trauma, with these patients reporting higher ROE scores than others (85.78% in the trauma group; 75.6% in the nontrauma group; p-value = 0.01394). Even though no statistical correlation was demonstrated, ROE scores were also higher in patients with allergic rhinitis (82.1% vs. 78.1% on the healthy group), psychiatric disorders (85.8% vs. 75.6% on the healthy group), hematological disorders (91.7% vs. 78.9% on the healthy group), nonsmokers (81.7% vs. 74.0% on smokers), younger patients (81.7% vs. 76.8% on patients older than 33.4 years) and patients that underwent inferior turbinectomy (81.0% vs. 75.9%).This study established a correlation between the subjective degree of surgical satisfaction and previous nasal trauma in patients undergoing FRS.

This pilot study investigated the efficacy of a novel Tinnitus Retraining Therapy (TRT) device utilizing bone conduction white noise generation, in treating tinnitus in a normal hearing population. This study was designed as a prospective, single-arm, observational trial in an outpatient clinic at a tertiary referral center, with 30 consecutive normal hearing patients with tinnitus. Tinnitus-specific questionnaires, namely the Tinnitus Handicap Inventory (THI) and Tinnitus Functional Index (TFI), translated and adapted to European Portuguese were administered. Patients were categorized into Group A (tinnitus characteristics within the device’s maximum output performance) and Group B (outside the device’s maximum output performance). 69

OBJECTIVES:To determine cut-off values of the Voice Handicap Index (VHI) and the shortened version (VHI-10) for European Portuguese (EP) with voice disorders. In addition, to analyze the discriminatory power of individual items of the VHI-10 and the ability to detect differences in various Ear Nose and Throat (ENT) diagnoses. STUDY DESIGN:Cross-sectional cohort study. METHODS:All participants completed the EP VHI and a 4-point self-assessment of voice disorder severity. The case group (subjects with voice disorders) underwent assessment through strobovideolaryngoscopy examinations by ENT surgeons and perceptual analyses by speech-language pathologists (SLPs). In contrast, the control group was evaluated solely by SLPs. Data were analyzed using a receiver-operating characteristic curve to determine the accuracy and cut-off values of the VHI and VHI-10. RESULTS:The study involved a sample of 350 adults (171 cases and 179 controls), predominantly women aged 18-88 years. The area under curve (AUC) for VHI and VHI-10 was 0.997 [95% confidence interval (CI): 0.992-1] and 0.998 [95% CI: 0.995-0.999], respectively. Optimal cut-off values were identified as 13.5 for VHI (0.994 sensitivity and 0.989 specificity) and 5.5 for VHI-10 (0.977 sensitivity and 0.955 specificity). Each individual item within the VHI-10 significantly contributed to the overall assessment, exhibiting varying discriminatory power ranging from excellent (AUC = 0.937) to poor (AUC = 0.637). Significant differences were found in the case group between neurogenic disorders and healthy larynx (P = 0.014), structural and physiologic minor laryngeal abnormalities (P = 0.006), and inflammatory disorders (P = 0.043). CONCLUSIONS:The VHI and the VHI-10 exhibited accurate screening properties for predicting EP speakers with voice disorders.

Endolymphatic hydrops (EH) is universal in Ménière´s disease (MD). Given its chronic course, with variable interval before complete clinical picture is installed, it seems relevant to understand the progression of vestibular EH and hemato-perilymphatic barrier disruption in patients with MD and monosymptomatic presentations. 239 consecutive patients were referred to us with suspected hydropic ear disease. 50 individuals accepted to participate in this study—final longitudinal sample included 24 patients (7 D1, 7 D2, 10 D3). Control group included ten patients. At recruitment, a clinical and MRI re-evaluation was done (3T, intravenous technique) (MR2) and 2 years after MRI was repeated (MR3). Previous MRI (MRI1) were retrospectively evaluated. Patients were classified as definite (D1), possible (D2) and atypical (D3—monosymptomatic) MD. Control group included non-typical symptoms (C2/C3) and 6 asymptomatic (C1). Vestibular endolymphatic ratio (vER) and grading, presence/absence of cochlear EH, asymmetry of cochlear perilymphatic enhancement, and rate of progression of vER were assessed by two independent neuroradiologists and compared between patient and control groups (index ear). EH was universal and pronounced in D1 and remained stable. vER progression was more variable and higher in some D3 patients (index ear worse) and in D2 (non-index), although this observation was not statistically significant. Considering that many probable and monosymptomatic presentations progress years later into definite MD and given the bilateral tendency of the disease, these findings may indicate that there is an initial accelerated worsening of EH in initial stages of the disease. These data should be confirmed with controlled and larger sample studies.

A 23-year-old man presented with fever and cervical swelling. Contrast-enhanced CT-scan with oblique sagittal planes reconstructions with extensive collection with gaseous areas, involving multiple cervical and mediastinal spaces is shown, reflecting a cervical-mediastinal necrotizing fasciitis. Note the circumference to the laryngotracheal axis. He underwent combined surgery by ENT and thoracic surgery and was discharged without sequelae after long hospitalization. This case demonstrates the importance of working in a multidisci- plinary team to treat complex pathologies.

Background: Menière's disease (MD) is an inner ear disorder characterized by recurrent episodes of spontaneous vertigo, unilateral low-frequency sensorineural hearing loss, tinnitus, and aural fullness. Current diagnosis still often has to rely on subjective and audiometric criteria only, although endolymphatic hydrops is recognized as the pathophysiological substrate of the disease, having been demonstrated in anatomical pathological studies and by magnetic resonance (MRI). The modiolus has a close functional and anatomical relationship with the cochlear nerve and membranous labyrinth and can be evaluated with MRI but no data exist on the modiolar size in MD. Purpose: Our purpose is to examine the following hypothesis. Is cochlear modiolus smaller in symptomatic ears in MD? Methods: We used a retrospective 3 Tesla MR study (heavily T2-weighted 3D fast asymmetric spin-echo images and 0.5 mm slice thickness) comparing the mean modiolar area (MMA) in the index and best ears of eight patients with definite MD based on audiometric data. The obtained MMA values were compared against the audiometric data and the presence of vestibular endolymphatic hydrops. Results: No differences were seen in MMA between best and worst ears. Ears with a pure tone average (PTA) ≥25 dB and more pronounced endolymphatic hydrops showed lower MMA (not statistically significant). Two patients with extreme endolymphatic hydrops showed a noteworthy ipsilateral decrease in the cochlear modiolus area. Conclusion: No differences were seen in MMA between best and worst ears in definite MD. Worse hearing function (PTA ≥ 25dB) and more pronounced endolymphatic hydrops seem to be associated with lower MMA. This might be related to bone remodeling as a consequence of endolymphatic hydrops. Further research is needed to corroborate and explore these findings.

Bilateral jugular foramen stenosis with jugular bulb and vein aplasia is rare in nonsyndromic craniosynostosis and usually diagnosed during childhood. We present a case of bilateral jugular foramen stenosis with jugular bulb and vein aplasia, with subsequent persistence and enlargement of the fetal venous anastomosis in the middle and posterior cranial fossa, along with a review of the literature about this anatomical abnormality, highlighting the surgical challenges and management from the otologist/neurotologist point of view.

Objectives: To determine the positive predictive value (PPV) for malignancy and distribution of head and neck cancer diagnosed by biopsy in the outpatient clinic of a tertiary hospital. To identify the presence of Epstein-Barr virus (EBV) and human papilloma virus (HPV) in nasopharyngeal and oropharyngeal carcinoma, respectively. Materials and Methods: Observational, retrospective, transversal study of the pathologic anatomy results of 365 biopsies performed on the Otorhinolaryngology outpatient clinic for clinical/imagological suspected malignancy in a 2 year period (2018-2019). The PPV for malignancy was calculated for each anatomical region. Results: We identified 111 malignant results (PPV 30,4%), of which 81% were squamous cell carcinoma (SCC). Immunohistochemistry stained positive for EBV in 75% of nonkeratinizing SCC of the nasopharynx and for p16 (HPV) in 9,7% of the SCC of the oropharynx. Conclusion: The most common diagnosis in the malignant results was SCC. There was a low HPV incidence in oropharynx SCC.

Objectives: Review the main indications and intraoperative findings in patients undergoing exploratory tympanotomy. Study design: Observational, retrospective, longitudinal study Material and methods: All patients who underwent exploratory tympanotomy, in our institution, from 2015 to 2019 were included. Patients with pathologic findings at otoscopy were excluded. Results: A total of 45 patients underwent unilateral exploratory tympanotomy. Of these, 19 were excluded due to pathologic findings in otoscopy. The mean age was 38,26 years (range 5-77 years). The main indication was conductive hearing loss (88%). Intraoperatively, the ossicular chain was fixed by adhesions (23%), followed by ossicular chain discontinuity (19%), otosclerosis (15%) and cholesteatoma (15%). There were no intra or postoperative complications. Conclusions: Exploratory tympanotomy is a safe diagnostic technique, with added value, since it allows us to directly view the middle ear, obtain the correct diagnosis, and plan the surgical treatment.

Introduction:The lack of speed of information processing, balance, strength and agility are seen as determinants factors for falls in older adults.A psychomotor intervention uses the body and ovement as mediators, relying on the prevention of cognitive, sensory, perceptive, emotional and affective deterioration, exploring the neuroplasticity.Therefore, we hypothesized that a multimodal exercise program including sensorimotor and neurocognitive exercises could decrease the risk of falls. Objectives:The aim of present study is to analyse the impact of a psychomotor exercise program on determinants factors for falls in community-dwelling older adults who were fallers or were at high risk of falling.Methods: Eighteen older adults aged 74.1 AE 5.3 years attended the psychomotor exercise program.Speed of information processing was assessed by Trail Making Test (TMT) A and B (s). Balance, agility and lower body strength were assessed by Fullerton Advanced Balance (FAB) Scale (p), Timed Up and Go (TUG) (s), and 30-Second chair stand test (rep), respectively. Results:Wilcoxon or T-Test comparisons showed improvements from baseline to post-intervention on speed of information processing (TMT-A: 90.4 AE 30.0 vs. 68.1 AE 29.2, p = 0.001; TMT-B: 252.0 AE 90.1 vs. 189.8AE 104.3, p = 0.003), balance (FAB Scale: 26.0 AE 5.6 vs. 30.8AE 4.8, p < 0.001), agility (TUG: 7.2 AE 1.3 vs. 6.5 AE 1.1, p = 0.001), and lower body strength (30-Second chair stand test: 12.1 AE 3.2 vs. 17.8AE 4.0, p < 0.001). Conclusions:This preliminary results suggested that the psychomotor intervention program is effective to decreases the risk of falling by improving determinants risk factors of falling, namely speed of information processing, balance, agility and lower body strength.

Rhinoseptoplasty represents a complex surgical procedure and its primary goal is to achieve a functional and aesthetically attractive nose. The success of their results is significantly determined by performing a systematic and meticulous preoperative aesthetic and functional analysis by the surgeon, complemented with thorough and reproducible operative records. The authors present, in detail, a proposal of a protocol for preoperative analysis and surgical recording documented in paper and/or electronically in rhinoseptoplasty candidates, adapted for each individualized treatment plan.

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder that is diagnosed based solely on clinical findings. Rarely, central lesions can present with positional vertigo and nystagmus, mimicking BPPV. Recognised red flags that may help distinguish central mimics from BPPV include the presence of additional neurological symptoms and signs, atypical nystagmus patterns, and the absence of a sustained response to repositioning manoeuvres. We present seven cases that illustrate how heuristic bias may affect the detection of these features in practice. Furthermore, our cases suggest that isolated downbeat positional nystagmus (simulating anterior canal BPPV) and apogeotropic horizontal nystagmus on the supine roll test (simulating horizontal canal BPPV) should be considered additional red flags.