An update on COVID-19 for the otorhinolaryngologist – a Brazilian Association of Otolaryngology and Cervicofacial Surgery (ABORL-CCF) Position Statement

IntroductionWe are facing a pandemic with a great impact worldwide, as a result of the rapid spread of the novel coronavirus (COVID-19). The medical community is still getting to know behavior of this virus and the consequences from a population point of view. All this knowledge is extremely dynamic, so some behaviors are still not well established. Otorhinolaryngologists have a central role in the management of this situation, in which they must assess the patient, avoid contamination to and by health professionals and other patients. Thus, the recommendations of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery (ABORL-CCF) have the main objective of reducing the spread of the new coronavirus during otorhinolaryngological care and assisting in the management of these patients.MethodsReview of the main recommendations of national and international scientific societies, decisions by government agencies and class councils. The topics will be related to the general aspects of COVID-19, personal protective equipment, care in patient assistance, endoscopic exam routines and the management of sinonasal, otological and pediatric evaluations related to COVID-19.ResultsThe use of personal protective equipment is considered crucial in routine ENT care. We recommend postponing appointments, exams and elective surgeries to reduce the spread of COVID-19. Similarly, we recommend changing routines in several areas of otolaryngology. Additionally, guidance is provided on the use of telemedicine resources during the pandemic period.ConclusionsWe are still at the beginning of the COVID-19 pandemic and scientific evidence is still scarce and incomplete, so these ABORL-CCF recommendations for otorhinolaryngologists may be updated based on new knowledge and the pattern of the new coronavirus spread.     

Neurotology: definitions and evidence-based therapies – Results of the I Brazilian Forum of Neurotology

IntroductionNeurotology is a rapidly expanding field of knowledge. The study of the vestibular system has advanced so much that even basic definitions, such as the meaning of vestibular symptoms, have only recently been standardized.ObjectiveTo present a review of the main subjects of neurotology, including concepts, diagnosis and treatment of Neurotology, defining current scientific evidence to facilitate decision-making and to point out the most evidence-lacking areas to stimulate further new research.MethodsThis text is the result of the I Brazilian Forum of Neurotology, which brought together the foremost Brazilian researchers in this area for a literature review. In all, there will be three review papers to be published. This first review will address definitions and therapies, the second one will address diagnostic tools, and the third will define the main diseases diagnoses. Each author performed a bibliographic search in the LILACS, SciELO, PubMed and MEDLINE databases on a given subject. The text was then submitted to the other Forum participants for a period of 30 days for analysis. A special chapter, on the definition of vestibular symptoms, was translated by an official translation service, and equally submitted to the other stages of the process. There was then a in-person meeting in which all the texts were orally presented, and there was a discussion among the participants to define a consensual text for each chapter. The consensual texts were then submitted to a final review by four professors of neurotology disciplines from three Brazilian universities and finally concluded. Based on the full text, available on the website of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery, this summary version was written as a review article.ResultThe text presents the official translation into Portuguese of the definition of vestibular symptoms proposed by the Bárány Society and brings together the main scientific evidence for each of the main existing therapies for neurotological diseases.ConclusionThis text rationally grouped the main topics of knowledge regarding the definitions and therapies of Neurotology, allowing the reader a broad view of the approach of neurotological patients based on scientific evidence and national experience, which should assist them in clinical decision-making, and show the most evidence-lacking topics to stimulate further study.     

The knowledge and beliefs regarding practical aspects of cochlear implants: A study of otorhinolaryngologists in a secondary setting in a multi-country study

Objective: The main goal of this study was to determine the knowledge and beliefs of otorhinolaryngologists in a secondary setting in selected economically advanced European countries concerning severe hearing loss, hearing aids, and cochlear implants (CIs). Secondary goals of the study looked into the information sources of the otorhinolaryngologists and into key topics of importance for these professionals. In Europe, many adults, who could benefit from a CI, do not have one despite their availability via national health care systems. This lack of coverage might be due, in part, to the knowledge and beliefs of otorhinolaryngologists.

Methods: Otorhinolaryngologists in a secondary setting in Germany, England, France, Austria, and Sweden were emailed a custom-made questionnaire on their knowledge and beliefs regarding hearing loss and its treatments. Results were presented in relative frequencies (%) according to each nation.

Results: Two-hundred and forty otorhinolaryngologists responded (50 from each nation except Sweden). Each nation regarded rehabilitation and hearing preservation as particularly important in CIs. National and international conferences and conversations with colleagues were much more popular methods of keeping abreast of medical issues than other information sources such as online media or company information.

Conclusion: The otorhinolaryngologists of the surveyed nations share many common beliefs about hearing loss, hearing aids, and CIs, although some national variation in opinion is present. The otorhinolaryngologists of each nation are knowledgeable, but could still benefit from an increased knowledge and awareness of hearing loss treatment modalities.     

Women in otolaryngology in Turkey: Insight of gender equality,career development and work-life balance

ObjectiveThe aim of this study is to collect information about the demographics, academic ambitions, job satisfactions, career development and work-life balance of female otorhinolaryngologists (FORL) in Turkey and to determine their experiences with, and attitudes towards gender discrimination throughout their academic careers.Study design and settingA prospective survey study.Subjects and methodsThe study was aimed to include all FORL who completed their residency program. An online survey was used to collect their responses.ResultsOut of 208 invitations, 156 FORL participated to the survey. The mean age of the participants was 39.7 ± 6.1 (29–75) years. 16.6% of the FORL used to occupy or still occupying administrative positions in their respective medical centers; 15.4% of them used to be assigned or still being assigned to a duty in otorhinolaryngology associations. Gender discrimination was 2.5 fold higher (p = 0.006 OR: 2.55 (95% CI 1.31, 4.99) in departments where there were no female faculty members. 53.2% of the female surgeons were both physically and psychologically harassed for their gender during their residency programs to deter from completing their program in otolaryngology. This finding is 4.1 fold higher than those who stated that they had not been exposed to any such gender discrimination (p = 0.001 OR: 4.094 (95% CI 2.22, 7.57).ConclusionHealthcare policy-makers and institutions should consider taking all the necessary actions to prevent gender discrimination in order to increase job satisfaction and achievements of female specialists in the field of otorhinolaryngology.     

Otorhinolaryngologists’ personal treatment preferences (total laryngectomy or laryngeal preservation) when faced with advanced stage laryngeal cancer

ObjectiveTo analyse the treatment options that otorhinolaryngologists would consider if faced with advanced stage laryngeal cancer amenable to total laryngectomy or an organ preservation protocol.Material and methodsProspective study conducted in a French Teaching Hospital based on questionnaires filled in by 163 otorhinolaryngologists in 2012, studying the percentage chance of cure that they would be prepared to trade-off to preserve their larynx, defining the additional information that they would like to receive and identifying any statistical associations between these parameters and various medical and socioeconomic variables.ResultsA total of 42.3% of otorhinolaryngologists would not consider the slightest trade-off to preserve their larynx and preferred to undergo total laryngectomy. In the group of otorhinolaryngologists who would consider a larynx preservation protocol (57.6%), the percentage chance of cure that they would be willing to trade-off to preserve their larynx ranged between 5 to 100% (median: 15%) and 4.2% of them were willing to trade-off all chances of cure (100%) to avoid total laryngectomy. The percentage of otorhinolaryngologists who would not consider trading off the slightest chance of survival to preserve their larynx increased from 29.3 to 49.5% (P = 0.01) when they participated in multidisciplinary consultation meetings. In the group of otorhinolaryngologists who would consider a larynx preservation protocol, the median percentage survival trade-off that they would consider in order to preserve their larynx (i) decreased from 20 to 10% (P = 0.004) when they participated in multidisciplinary consultation meetings and (ii) increased regularly with their number of years of practice (P = 0.03) and their age (P = 0.025). Finally, 25.1% of otorhinolaryngologists wanted to receive additional information, although none of the variables analysed affected this desire for more information.ConclusionTreatment options considered by otorhinolaryngologists faced with advanced stage laryngeal cancer were almost equally divided between total laryngectomy and larynx preservation. Number of years of practice and regular participation in head and neck cancer multidisciplinary consultation meetings were variables that significantly influenced this choice.     

The quality of life among Otorhinolaryngology residents in Distrito Federal (Brazil)

Otorhinolaryngology residents' quality of life must be investigated during medical residency. Work-related factors impacting their lives, such as depression, sleep deprivation and excessive work load may impact the well-being of these individuals.ObjectiveTo assess and discuss the quality of life of Otorhinolaryngology Resident Physicians in Distrito Federal (Reuni-ORL).Materials and MethodsCross-sectional study, the quality of life of each individual was assessed by means of a questionnaire specifically designed for this purpose - Whoqol-bref, proposed by the WHO.ResultsMales had better psychological scores when compared to females (p= 0.013). Mean scores comparison among the years in residency were statistically significant only in the psychological domain when comparing the first and second years (p=0.046), in which 2nd-year residents had the higher scores.ConclusionDespite constant changes to the ENT program (Reuni-ORL) in the Distrito Federal, aiming at improving work and training conditions for residents, there still is a psychological burden in their first year of residency.     

Translation,cross-cultural adaptation and validation of SinoNasal Outcome Test (SNOT) - 22 to Brazilian Portuguese

Quality of life questionnaires have been increasingly used in clinical trials to help establish the impact of medical intervention or to assess the outcome of health care services. Among disease-specific outcome measures, SNOT-22 was considered the most suitable tool for assessing chronic rhinosinusitis and patients with nasal polyps.AimsTo perform translation, cross-cultural adaptation and validation of the SNOT-22 to Brazilian Portuguese.MethodsProspective study involving eighty-nine patients with chronic rhinosinusitis or nasal polyps submitted to functional endoscopic sinus surgery, who answered the questionnaire before and after surgery. Furthermore, 113 volunteers without sinonasal disease also answered the questionnaire. Internal consistency, test-retest reliability, measure validity, responsiveness and clinical interpretability were assessed.ResultsMean preoperative, postoperative and no sinonasal disease scores were 62.39, 23.09 and 11.42, respectively (p<0.0001); showing validity and responsiveness. Internal consistency was high (Cronbach's alpha = 0.9276). Reliability was sufficiently good, considering inter-interviewers (r=0.81) and intra-interviewers within a 10 to 14 day-interval (r=0.72). Surgery effect size was 1.55. Minimally important difference was 14 points; and scores up to 10 points were considered normal.ConclusionThe Brazilian Portuguese SNOT-22 version is a valid instrument to assess patients with chronic rhinosinusitis and nasal polyps.     

Value of simple otoscopy in diagnosing otitis media with effusion in children

AimsTo explore the value of otoscopy in diagnosing OME when performed by otorhinolaryngology, pediatrics, and primary care physicians; to evaluate the interobserver and intraobserver agreement of interpretation of otoscopy images.Material and methodsA cross-sectional study using an anonymous mailed survey was used. We presented pre-recorded otoscopy images of pediatric patients to otorhinolaryngology, pediatrics, and primary care physicians (ten volunteer specialists and residents from each medical specialty). All participants had to answer “yes” or “no” if they considered that the image corresponded or not to an OME case, respectively. We considered that the images were positive for OME whenever the respective tympanogram was type B.ResultsThirty-one otoscopy images and 1860 responses provided by sixty physicians were analyzed. The accuracy of otoscopy in diagnosing OME was highest in the Otolaryngologists group (mean 74.8%), with the worst rate observed in the primary care residents group (mean 51.3%). Overall sensitivity, specificity, and positive predictive value of otoscopy for diagnosing OME were significantly higher when performed by otorhinolaryngologists (75.8%, 72.8%, 66.8%, respectively). Fleiss' kappa showed that interobserver agreement was globally weak within each group of specialties, with overall better interobserver agreement observed among otorhinolaryngologists (κ = 0.30; 95% CI 0.27–0.32).ConclusionAccording to our data, simple otoscopy as a single diagnostic method in pediatric OME is insufficient, even for otorhinolaryngologists. Current recommendations must be followed to improve diagnostic accuracy.     

Rapid implementation of COVID-19 tracheostomy simulation training to increase surgeon safety and confidence

ObjectiveTo determine if rapid implementation of simulation training for anticipated COVID-19 tracheostomy procedures can increase physician confidence regarding procedure competency and use of enhanced personal protective equipment (PPE).MethodsA brief simulation training exercise was designed in conjunction with the development of a COVID-19 Tracheostomy Protocol. The simulation training focused primarily on provider safety, pre and post-surgical steps and the proper use of enhanced PPE. Simulation training was performed in the simulation lab at the institution over 2 days. Pre and post self-evaluations were measured using standardized clinical competency questionnaires on a 5-point Likert Scale ranging from “No knowledge, unable to perform” up to “Highly knowledgeable and confident, independent.”ResultsPhysicians self-reported a significant increase in knowledge and competency immediately after completing the training exercise. Resident physicians increased from a mean score of 3.00 to 4.67, p-value 0.0041, mean increase 1.67 (CI 95% 0.81 to 2.52). Attending physicians increased from a mean score of 2.89 to 4.67, p-value 0.0002, mean increase 1.78 (CI 95% 1.14 to 2.42). Overall, all participants increased from a mean score of 3.06 to 4.71, p-value 0.0001, mean increase 1.65 (CI 95% 1.24 to 2.05).DiscussionImplementation of this simulation training at our institution resulted in a significant increase in physician confidence regarding the safe performance of tracheostomy surgery in COVID-19 patients.Implications for practiceAdoption of standardized COVID-19 tracheostomy simulation training at centers treating COVID-19 patients may result in improved physician safety and enhanced confidence in anticipation of performing these procedures in real-life scenarios.     

Risk factors for medication-related osteonecrosis of the jaw and salivary IL-6 IN cancer patients

IntroductionMedication-related osteonecrosis of the jaws is a severe complication of the use of antiresorptive and antiangiogenic therapy, with limited treatment options and great impact on patient’s quality pf life.ObjectiveThe aim of this study was to assess the risk factors associated with medication-related osteonecrosis of the jaws in oncologic patients undergoing bisphosphonate treatment. In addition, salivary levels of interleukin-6, IL-6, were measured to investigate their association with severity and risk of medication-related osteonecrosis of the jaws.MethodsCase-control study with 74 patients with bone metastases from solid tumors and multiple myeloma was included. Patients were divided into three groups: 1) those undergoing bisphosphonate treatment with medication-related osteonecrosis of the jaws; 2) those undergoing bisphosphonate without medication-related osteonecrosis of the jaws; and 3) those with bisphosphonate pretreatment. The demographic and medical data of the patients were collected to assess risk. The clinical evaluation was performed to diagnose medication-related osteonecrosis of the jaws and unstimulated saliva was collected for quantification of IL-6.ResultsAs result, it was observed that patients diagnosed with medication-related osteonecrosis of the jaws were submitted to higher number of bisphosphonate doses (p = 0.001) and monthly infusion protocol (p = 0.044; OR = 7.75). Patients who did not have routine followup with specialized dentists during therapy with bisphosphonate and smoking were associated with medication-related osteonecrosis of the jaws (p = 0.019; OR = 8.25 and p = 0.031; OR = 9.37 respectively). Group 1 had a higher frequency of treatment with chemotherapy and corticosteroids concomitant with bisphosphonate, and surgical dental procedures (p = 0.129). Salivary IL-6 levels showed no statistically significant difference between the groups (p = 0.571) or association with medication-related osteonecrosis of the jaws severity (p = 0.923).ConclusionA higher number of bisphosphonate cycles, monthly infusion protocol, no dental follow-up for oral health maintenance and smoking were associated with medication-related osteonecrosis of the jaws. Specialized dental follow up during bisphosphonate treatment has been shown to be an important factor in preventing this complication.     

Evaluation of selective attention in patients with misophonia

IntroductionMisophonia is characterized by the aversion to very selective sounds, which evoke a strong emotional reaction. It has been inferred that misophonia, as well as tinnitus, is associated with hyperconnectivity between auditory and limbic systems. Individuals with bothersome tinnitus may have selective attention impairment, but it has not been demonstrated in case of misophonia yet.ObjectiveTo characterize a sample of misophonic subjects and compare it with two control groups, one with tinnitus individuals (without misophonia) and the other with asymptomatic individuals (without misophonia and without tinnitus), regarding the selective attention.MethodsWe evaluated 40 normal-hearing participants: 10 with misophonia, 10 with tinnitus (without misophonia) and 20 without tinnitus and without misophonia. In order to evaluate the selective attention, the dichotic sentence identification test was applied in three situations: firstly, the Brazilian Portuguese test was applied. Then, the same test was applied, combined with two competitive sounds: chewing sound (representing a sound that commonly triggers misophonia), and white noise (representing a common type of tinnitus which causes discomfort to patients).ResultsThe dichotic sentence identification test with chewing sound, showed that the average of correct responses differed between misophonia and without tinnitus and without misophonia (p = 0.027) and between misophonia and tinnitus (without misophonia) (p = 0.002), in both cases lower in misophonia. Both, the dichotic sentence identification test alone, and with white noise, failed to show differences in the average of correct responses among the three groups (p ≥ 0.452).ConclusionThe misophonia participants presented a lower percentage of correct responses in the dichotic sentence identification test with chewing sound; suggesting that individuals with misophonia may have selective attention impairment when they are exposed to sounds that trigger this condition.     

Increased neutrophil lymphocyte ratio and platelet lymphocyte ratio in malignant parotid tumors

IntroductionRecently it has been reported that a high preoperative neutrophil–lymphocyte ratio and platelet–lymphocyte ratio may be related to increased recurrence risk, tumor aggressiveness, and worsened prognosis in various malignancies.ObjectiveThe objective of this research is to explore whether neutrophil–lymphocyte ratio and platelet–lymphocyte ratio in parotid tumors may or may not be used as a cancer marker.MethodsThis retrospective research has been conducted on a total of 228 patients consisting of 83 healthy persons and 145 patients with a mass in the parotid gland, who applied to a tertiary referral center and underwent surgery. Patients have been divided into two groups by their histopathological findings as malignant or benign parotid tumor. A third group consisting of healthy people has been defined as the control group. Also the malignant parotid tumor group has been divided into two subgroups as early stage and advanced stage. The groups have been compared in terms of neutrophil–lymphocyte ratio, platelet–lymphocyte ratio and other laboratory data.ResultsThe average neutrophil–lymphocyte ratio values of malignant parotid tumor, benign parotid tumor, healthy control groups were 2.51, 2.01, 1.79 respectively and the difference was statistically significant (p < 0.001). There was no significant difference between advanced stage and early stage parotid tumor groups in terms of average neutrophil–lymphocyte ratio value (p = 0.782). In dual comparisons, the platelet–lymphocyte ratio value of patients in the malignant group was found out to be statistically significantly higher than that of benign and control groups (p < 0.001 and p = 0.001 respectively).ConclusionTo the best of our knowledge our research is the first in the medical literature comparing neutrophil–lymphocyte ratio and platelet–lymphocyte ratio in patients with parotid tumor. neutrophil–lymphocyte ratio and platelet–lymphocyte ratio can serve as cost-effective, repeatable, easily accessible, and helpful inflammatory markers in order to distinguish patients with malignant parotid tumor from healthy people.     

Diagnostic and therapeutic approaches in deep neck infections: an analysis of 74 consecutive patients

Introduct?onDeep neck infections are a group of diseases with serious complications and mortality, which can occur as a result of common diseases in the community and which have surgical and medical treatment options.ObjectivesPatients ages, genders, complaints, physical examination findings, hospitalization complaints, history of antibiotic use before the application, additional diseases, radiological tests and analysis of examinations, type of treatment method, antibiotic agents selected in treatment, bacterial culture results, duration of hospitalization, complications, mortality rates were systematically recorded. In the study, anaerobic bacterial factors, which are difficult to produce in routine, were produced by considering special transport conditions and culture media.MethodsA total of 74 patients who were hospitalized in the Department of Otorhinolaryngology, University of Mersin, between 01.07.2016 and 01.07.2017 for deep neck infection were evaluated prospectively. The study included 37 female and 37 male patients. The ages of the patients ranged from 1 to 69 and the mean age was 31 years.ResultsAccording to the analysis of the obtained data, there was a statistically significant relationship between the patients with additional diseases and the treatment modalities of the patients (p = 0.017). The surgical treatment rate was increased in this group of patients. In patients with a history of antibiotic use, it was found that patients in the pediatric group were in hospital longer in terms of length of stay compared to adults (p = 0.036). In adult patients who underwent surgery, the absorptive long axis was found to be longer in mm than in patients receiving isolated medical treatment (p = 0.008).ConclusionsDeep neck infections is a disease group that seriously concerns public health, with significant mortality and morbidity. Ensuring airway safety of patients should be the first intervention. Abscesses located lateral to the tonsil capsule may not drain adequately without concomitant tonsillectomy.     

Brazilian scientific journals in speech-language and hearing science: impact indicator

BACKGROUND: Global value of scientific papers published in national journals of the Brazilian Speech-language and Hearing Science analyzed through the Impact Factor (IF). PURPOSE: To analyze part of the Brazilian Speech-Language and Hearing Science through its scientific journals: characterization of the impact indicator--in this case the Impact Factor (IF). Seven national Speech-language and Hearing Science journals (1986/ 2001) registered in the Brazilian Institute of Information in Science and Technology (Ibict) and with a given International Standard Serial Number (ISSN) were analyzed. In order to calculate the IF of the scientific journals, the lists of bibliographic references of the published papers were consulted and the original formula of Garfield was used, adapting it to the seven journals. Bibliographic references cited in the research papers, in the case studies, in the review and update articles were considered for analyses. Researches which were cited in the summaries like letters to the editors; editorial, abstracts, commentaries and others were excluded. A total of 9,334 bibliographic references of 549 papers were analyzed, excluding self-citations of authors. It was observed that the resulting IFs revealed practically null values. The obtained results demonstrate that the Brazilian Speech-language and Hearing Science needs to develop a few aspects of its editorial and scientific processes--the researches of the Brazilian Speech-language and Hearing Science are being lost, making it necessary for the editors to raise the access and visibility of their journals and for the speech-language and hearing scientists to cite the work of their antecessors and national partners. According to the obtained data, for the Brazilian Speech-language and Hearing Science, the publication of 11.9 papers is necessary for only one of these papers to be cited in another research. It is observed that the IFs of the Brazilian Speech-language and Hearing Science, among these seven journals, have risen since 1999, suggesting a development of this Science. The follow up of this research, analyzing the years subsequent to 2001, is necessary in order to verify the real raise of the impact of these articles.     

Efficacy of myofascial trigger point deactivation for tinnitus control

Chronic pain in areas surrounding the ear may influence tinnitus.ObjectiveTo investigate the efficacy of myofascial trigger point deactivation for the relief of tinnitus.MethodA double-blind randomized clinical trial enrolled 71 patients with tinnitus and myofascial pain syndrome. The experimental group (n = 37) underwent 10 sessions of myofascial trigger point deactivation and the control group (n = 34), 10 sessions with sham deactivation.ResultsTreatment of the experimental group was effective for tinnitus relief (p < 0.001). Pain and tinnitus relieves were associated (p = 0.013), so were the ear with worst tinnitus and the side of the body with more pain (p < 0.001). The presence of temporary tinnitus modulation (increase or decrease) upon initial muscle palpation was frequent in both groups, but its temporary decrease was related to the persistent relief at the end of treatment (p = 0.002).ConclusionBesides medical and audiological investigation, patients with tinnitus should also be checked for: 1) presence of myofascial pain surrounding the ear; 2) laterality between both symptoms; 3) initial decrease of tinnitus during muscle palpation. Treating this specific subgroup of tinnitus patients with myofascial trigger point release may provide better results than others described so far.     

How obesity affects nasal function in obstructive sleep apnea: anatomic and volumetric parameters

IntroductionObstructive sleep apnea is a consequence of upper airway collapse. Any obstructive sector in the upper airway can contribute to pharyngeal collapse. Obesity and obesity-related disorders play an important role in obstructive sleep apnea and its relationship with increased upper airway resistance.ObjectiveThis study was designed to evaluate the relationship between obesity and properties of the nasal cavity in patients with obstructive sleep apnea.MethodsThe study was conducted retrospectively by review of medical records of adult patients. The nasal obstruction symptom evaluation, NOSE instrument, was used to measure nasal obstruction. Sleep breathing disorders were evaluated by polysomnography exams. Nasal volume was obtained by computed tomography scans and volumetric reconstruction of nasal airway. Nasal anatomic alterations were assessed by nasal endoscopy.ResultsAnalysis of 83 patient records, among whom 54 were male and 29 females, found the mean body mass index of 28.69 kg/m². Obese and non-obese groups were determined by using cut-off 30 kg/m². In the comparison between groups, the obese group had a positive and significant correlation with apnea/hypopnea index (p = 0.02), NOSE instrument (p = 0.033) and inferior turbinate hypertrophy (p = 0.036), with odds ratio 1.983 (95% IC 1.048 ? 3.753). nasal septum deviation (p = 0.126) and nasal airway volume evaluation (p = 0.177) showed no significant results.ConclusionObesity was significantly correlated with subjective nasal obstruction, NOSE scale, and inferior turbinate hypertrophy in patients with obstructive sleep apnea. There was no correlation with the nasal volume evaluation.Level of Evidence3b - Individual case-control study.     

The evaluation of pretreatment neutrophil–lymphocyte ratio and derived neutrophil–lymphocyte ratio in patients with laryngeal neoplasms

IntroductionSystemic inflammatory biomarkers are promising predictive and prognostic factors for solid cancers. The neutrophil–lymphocyte ratio and derived neutrophil–lymphocyte ratio are used to predict inflammation and used as biomarker in several malignancies.ObjectiveThe purpose of this study was to demonstrate the diagnostic, predictive and prognostic role of neutrophil–lymphocyte ratio and derived neutrophil–lymphocyte ratio in patients with laryngeal neoplasms.MethodsA retrospective study was conducted on medical records involving 229 patients with benign, premalignant and malignant laryngeal neoplasms between 2002 and 2015. The diagnostic, predictive and prognostic role of neutrophil–lymphocyte ratio and derived neutrophil–lymphocyte ratio were evaluated using uni– and multivariate analysis.ResultsThe neutrophil–lymphocyte ratio and derived neutrophil–lymphocyte ratio were not statistically different between patients with benign, premalignant and malignant laryngeal neoplasms. Both neutrophil–lymphocyte ratio and derived neutrophil–lymphocyte ratio were predictive factors for stage, lymph node metastasis, and distant metastasis. Patients with high neutrophil–lymphocyte ratio value (≥4) had a poor prognosis when compared with patients with low neutrophil–lymphocyte ratio value (5 year, Overall Survival: 69.0% vs. 31.1%, p < 0.001; 5 year, disease free survival: 70.0% vs. 32.7%, p ? 0.001; 5 year, locoregional recurrence free survival: 69.7% vs. 32.0%, p < 0.001). Furthermore, neutrophil–lymphocyte ratio was an independent prognostic factor for 5 year: Overall survival (HR = 2.396; 95% CI 1.408–4.077; p = 0.001), Disease free survival (HR = 2.246; 95% CI 1.322–3.816; p = 0.006) and locoregional recurrence free survival (HR = 2.210; 95% CI 1.301–3.753; p = 0.003).ConclusionPretreatment neutrophil–lymphocyte ratio is a useful and reliable predictive and prognostic biomarker for patients with laryngeal carcinoma.     

Lysyl Oxidase Like-4 (LOXL4) as a tumor marker and prognosticator in advanced stage laryngeal cancer

IntroductionLysyl oxidase-like 4 is an amine oxidase from the lysyl oxidase family that was previously shown to be overexpressed in head and neck cancer and upregulated in response to hypoxia. The possible role of lysyl oxidase-like 4 as a tumor marker in advanced stage larynx cancer was investigated.ObjectiveTo investigate the expression of lysyl Oxidase-Like 4 protein in advanced stage laryngeal cancer and elucidate its possible role as a tumor marker, predictor of treatment response and prognosticator.MethodsDiagnostic specimens of 72 patients treated for stage III–IV laryngeal squamous cell carcinoma were evaluated for lysyl oxidase-like 4 expression by immunohistochemistry.ResultsLysyl oxidase-like 4 expression was correlated with advanced tumor stage (p = 0.041) and better differentiation (p = 0.025) but was independent of tumor diameter (p = 0.456). Response to induction chemotherapy or the need for salvage laryngectomy were not affected by lysyl oxidase-like 4 expression (p = 0.999, p = 0.070 respectively). Increased lysyl oxidase-like 4 expression was associated with better 2 year overall survival in both univariate (p = 0.036) and multivariate analyses (p = 0.014).ConclusionLysyl oxidase-like 4 expression emerges with advancing stages, is lost with worsening differentiation, and may have tumor suppressive properties in larynx cancer.     

Translation and validation of the drooling impact scale questionnaire into Brazilian Portuguese

IntroductionInadequate drooling can cause serious clinical, functional and social problems. Validated questionnaires to evaluate drooling impact on quality of life are lacking in Brazilian Portuguese.ObjectivesTo translate and validate the drooling impact scale to Brazilian Portuguese.MethodsThe drooling impact scale was translated to Brazilian Portuguese and back- translated to English to assess potential conceptual differences. Brazilian Portuguese version of drooling impact scale was applied to a 40 patients’ sample of sialorrhea presenting pediatric patients (up to 20 years of age). Chronbach’s alpha, exploratory factorial analysis and confirmatory factorial analysis were then proceeded with data collected.ResultsThe mean drooling impact scale value for the whole population was 51.77 (SD = 16.13). The internal consistency obtained with Cronbach’s alpha indicated a value of 0.72 for the entire sample. The Bartlett’s test of sphericity was significant (p < 0.0001), confirming correlation among variables tested. Kaiser-Meyer-Olkin measure of sampling adequacy revealed a value of 0.72, indicating that the correlation matrix was reasonably suitable for factor analysis. Regarding exploratory factorial analysis, parallel analysis suggested a two-factor solution that was used for confirmatory factorial analysis. The first factor was responsible for 33.78% of the variance with an Eigenvalue of 3.38. The second factor explained 16.1% of the variance with an Eigenvalue of 1.61. At confirmatory factorial analysis, the two-factor model showed consistently better adjustments parameters than the one-factor model.ConclusionThe drooling impact scale has been successfully translated to Brazilian Portuguese language, showing adequate internal validity. Validation of this instrument allows physicians and other personnel involved in the care of these patients to perform a better management of patients experiencing drooling. With this tool, we are now able to guide routines and provide guidelines both before and after the different kinds of treatments in order to improve the general well-being of the patient and his family.