When is surgical therapy for head and neck malignant epithelial tumors not indicated?

European Archives of Oto-Rhino-Laryngology -     

Intranasal fungi and chronic rhinosinusitis: what is the relationship?

OBJECTIVES: The aim of this study was to investigate the effects of intranasal fungi on chronic rhinosinusitis (CRS). METHODS: Forty-one patients with CRS were included in the study. The patients were put into 2 groups, with and without intranasal fungi as detected by polymerase chain reaction, and were compared in terms of different laboratory and clinical parameters of CRS. A chi2 test was used to analyze statistical differences between the 2 groups. RESULTS: Serum eosinophilia, eosinophilia in the nasal mucus, prick and intradermal test positivity for fungi, elevated total IgE, fungal-specific IgE, prevalence of symptoms, frequency of bronchial asthma, aspirin sensitivity, and nasal polyposis did not differ significantly between the 2 groups of patients (p > .05). CONCLUSIONS: The findings of this study failed to reveal a clear correlation between the presence of fungi in the nasal passage and various factors that are assumed to be involved in the pathogenesis or clinical course of CRS. If fungi have a role in the pathogenesis of CRS, it may be via other mediators and reactions rather than IgE and type I hypersensitivity. However, the sample size was relatively small, and further studies with more cases are needed on the same topic.     

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.     

Candidacy and the Children's Implant Profile: is our selection appropriate?

This study has two aims: first, to determine whether our paediatric Cochlear Implant Programme uses a modified version of the Children's Implant Profile (ChIP) in a consistent manner to inform candidacy decisions; and second, to establish whether our ratings of concern on the ChIP are predictive of speech discrimination, speech production and language outcomes. Retrospective data were collated over a 6-year period. For each ChIP category, ratings of 'no concern', 'mild moderate concern' or 'great concern' were agreed for each child, and scores of 0, 1 or 2 were assigned respectively. During the period of study, of 147 children assessed, 63% were considered to be suitable for cochlear implantation. A forward stepwise logistic regression showed that degree of concern on five of the ChIP factors significantly predicted the decision to implant. At 1 year and 3 years after switch-on, the total ChIP score significantly predicted some speech perception outcomes, as did the degree of concern pre-implant regarding speech and language abilities and functional hearing. These concerns were also significantly predictive of receptive language ability and speech intelligibility ratings 3 years after implantation.     

How reliable is the measurement of tracheal stenosis by means of computed tomography?

BACKGROUND: A reliable preoperative appraisal of laryngotracheal stenoses is necessary for airway surgery as well as stent implantation. Through progress of modern radiological modalities, particularly the computer tomography (CT), sectional image data and three dimensional airway reconstruction gain increasingly in meaning in Otorhinolaryngology. METHODS: The aim of this study was to evaluate the reliability of this modern CT data in comparison to laser scan data. For this purpose deep frozen pig tracheal segments were prepared and examined by means of helical CT at different CT sets. Subsequently the measurement of the tracheal lumen employing a highly precise laser scanner was performed. RESULTS: As a result we found that a CT slice thickness of 3 mm, a maximal pitch of 1.5 as well as the application of the so-called: edge enhancing modus seems to be the best compromise between the precision of CT airway measurement on one hand and breath-hold time for patient and total X-ray dose on the other hand. CONCLUSIONS: The ENT specialist requires a good cooperation with the radiologist for the measurement of laryngotracheal stenoses using CT scans. We recommend the working out of standard parameters for respiratory tract-CTs.     

Hearing loss induced by occupational and impulse noise: Results on threshold shifts by frequencies,age and gender from the Nord-Trøndelag Hearing Loss Study

The aim of the study was to compare the frequency-specific effects of noise on hearing acuity across the range 250–8000 Hz and the extent to which the patterns of frequency-specific threshold shifts differ between occupational noise and impulse noise. Pure-tone audiometry was administered to an adult general population sample with 51?975 subjects who also provided questionnaire information about noise exposure and other risk factors. Threshold shifts induced by life-long occupational noise and impulse noise (mostly shooting) were estimated separately in six age and sex groups for eight frequencies. Reported noise exposure, as well as observed threshold shifts, were moderate among women. Threshold shifts averaged over both ears among subjects in the higher 2% of exposure to occupational noise, reached 13 dB (3000 Hz, age 65 years?+?) among men and were generally largest at 3000–4000 Hz. The shifts induced by impulse noise reached approximately 8 dB among men 45–64 years and men 65 years+. The effects of impulse noise were strongest at 3000–8000 Hz and varied little within this frequency range.     

Hearing loss induced by occupational and impulse noise: results on threshold shifts by frequencies, age and gender from the Nord-Trøndelag Hearing Loss Study

The aim of the study was to compare the frequency-specific effects of noise on hearing acuity across the range 250-8000 Hz and the extent to which the patterns of frequency-specific threshold shifts differ between occupational noise and impulse noise. Pure-tone audiometry was administered to an adult general population sample with 51 975 subjects who also provided questionnaire information about noise exposure and other risk factors. Threshold shifts induced by life-long occupational noise and impulse noise (mostly shooting) were estimated separately in six age and sex groups for eight frequencies. Reported noise exposure, as well as observed threshold shifts, were moderate among women. Threshold shifts averaged over both ears among subjects in the higher 2% of exposure to occupational noise, reached 13 dB (3000 Hz, age 65 years + ) among men and were generally largest at 3000-4000 Hz. The shifts induced by impulse noise reached approximately 8 dB among men 45-64 years and men 65 years+. The effects of impulse noise were strongest at 3000-8000 Hz and varied little within this frequency range.     

What is the Relationship between the Localization of Maxillary Fungal Balls and Intranasal Anatomic Variations?

Objectives

Although the mechanisms underlying the initiation and maintenance of inflammation in unilateral maxillary fungal balls (FBs) are poorly understood, the relationship between intranasal anatomy and maxillary FB is thought to play an important role. The aim of this study was to investigate the relationship between anatomic variations and FB.

Methods

We enrolled 140 patients who were composed of 56 patients with FB, 56 patients with unilateral chronic rhinosinusitis (CRS), and 28 patients with no sinus disease. Computed tomography scans were retrospectively analyzed to identify and compare the associated nasal anatomic abnormalities. To measure the volume of the nasal cavity and middle meatus, computed tomography scans were reconstructed into three-dimensional images.

Results

The relatively larger volume of the middle meatus was associated with the localization of the FB in contrast with the CRS. However, the nasal-cavity volume, nasal valve area, and nasal septal deviation were not significantly associated with localization of FB. The mean volumetric and areal measurements such as nasal cavity, middle meatus, and nasal valve in FB-ipsilateral sides were not significantly different from those in contralateral sides as well as other groups.

Conclusion

The middle meatus bears the major part of the inspiratory nasal airflow, and its volume may influence the occurrence of FB.