Preoperative Voice Characteristics in Thyroid Patients.

INTRODUCTION: Thyroid surgery outcomes have evolved from mortality control strategies to morbidity control measures. Most vocal outcomes research in thyroid surgery are focused on recurrent nerve anatomic and functional preservation. However, there are likely multiple causes of vocal dysfunction in thyroid patients. We prospectively analyzed preoperative patients with thyroid disease to define preoperative vocal characteristics of this population. OBJECTIVE: Quantify vocal and laryngeal baseline conditions in thyroid surgical patients. METHODS: Prospective study of preoperative stroboscopy findings and vocal function assessing the correlation between thyroid disease, compressive symptoms, baseline vocal conditions and laryngoscopy results. RESULTS: Vocal quantitative scores were positive for dysphonia in 36% of patients and the Vocal Handicap Index confirmed either slight or Moderate impairment in most patients. Stroboscopy results were abnormal in 60% of cases with no diagnoses of immobility. Correlation was established for diagnosis of cancer and the absence of symptoms. CONCLUSIONS: These results point to a multifactorial cause for vocal impairment in thyroid surgery patients. Research on vocal impairment in thyroid surgery should not be centered exclusively on recurrent nerve neuromonitoring and functional preservation, but also on other variables that may contribute to vocal change in thyroid disease and surgery.

Effect of Water Precautions on Otorrhea Incidence after Pediatric Tympanostomy Tube: Randomized Controlled Trial Evidence.

OBJECTIVES: Tympanostomy with ventilation tube insertion is the most common otologic surgery. Many surgeons recommend water precautions, although its utility is questioned. We aimed to investigate if water precautions reduce the rate of otorrhea after transtympanic tube insertion. STUDY DESIGN: Multicenter randomized controlled trial. SUBJECTS AND METHODS: A total of 244 children aged 2 to 10 years undergoing their first set of Shepard tubes for otitis media with effusion and concomitant adenoidectomy were randomized to 2 groups: 1 with ear protection during water exposure (ear plugs and headbands, n = 130) and 1 without (n = 114). Bathing or swimming with unprotected ears was considered the exposure event and incidence of otorrhea, the primary outcome. Outcomes were assessed during the 6-month follow-up period. RESULTS: In the water precaution group, 32% had at least 1 episode of otorrhea as compared with 22% in the unprotected group, which was not statistically significant (P = .09). Only 37% of the episodes of otorrhea in the protected group and 36% in the unprotected group had a temporal relation to water exposure (no difference, P = .81). Respectively, 56% and 52% of the episodes of otorrhea were in the context of upper respiratory tract infection. Global quality of life improved significantly, irrespective of whether water protection was prescribed. CONCLUSION: The incidence of otorrhea was not different with or without prescription of ear protection during water exposure among children with tympanostomy tubes, which supports current guideline recommendations that routine water precautions are unnecessary in this population.

Including auditory tube function on models is relevant to assess water exposure after tympanostomy tubes-Multiphase computerized fluid dynamics model.

INTRODUCTION: Myringotomy with tympanostomy tube is the most common otologic surgery and some patients are still advised to avoid water. However, there is no evidence supporting this, with published papers questioning the need for this advice. METHODS: A Multiphase Computational Fluid Dynamics (CFD) model was created using computerized tomography images of a child's healthy ear. It was then used to study the flow of fluids through the external ear, tympanic cavity, and auditory tube, with and without submersion. RESULTS: The model accurately described the behavior of the air retained in the patient's nasopharynx and tympanic cavity. A simulated elevation of pressure in the external auditory canal without submersion, without increase of pressure in the nasopharynx, demonstrated that fluids promptly crossed the tympanostomy tube into the middle ear. However, simulated elevation of pressure in the external auditory canal with concurrent elevation of air pressure in the nasopharynx during submersion did not lead to passive tube opening nor to any detectable flow through the tympanostomy tube. CONCLUSIONS: In the model, submersion increases pressure in the nasopharynx which offsets the pressure in the external auditory canal. So, in the absence of a pressure gradient, no passive tubal opening took place, and no air or fluid flow was detected through the transtympanic tube. This model now includes the exhaust function of the auditory tube in the model and shows its relevance.

[Informed Treatment Consent and Refusal in Advanced Endonasal Surgery: The Ethical Dilemma of Olfaction Sacrifice in Surgery for Chronic Rhinosinusitis with Polyposis]. / O Consentimento e a Recusa Esclarecidos na Cirurgia Endonasal Avançada: O Dilema Ãtico do Sacrifício do Olfacto na Cirurgia da Rino-Sinusite Crónica com Pólipos.

INTRODUCTION: Olfaction is frequently affected in chronic rhino-sinusitis with polyposis and has been recognised to have important impact on quality of life. Surgical resolution on cases of maximal medical therapy failure is an option to relieve symptoms, with debates as to how extensive surgery should be. A more radical approach will achieve better disease control with less relapse, but can also compromise olfaction. This decision about a more radical surgical approach should be shared with the patient. Thorough informed consent regarding disease control and hyposmia should be taken. MATERIAL AND METHODS: Literature review and consultation with a board of experts. RESULTS AND DISCUSSION: We propose some elements to be included in the informed consent discussion, in order to broadly address the surgical limitations regarding anosmia as a frequent complaint, as well as the different options and their associated consequences. CONCLUSION: Radical surgery decision making should be shared with the patient and the informed consent should be as thorough as possible regarding disease control and hyposmia resolution.

Introdução: Na rino-sinusite crónica com pólipos, ou polipose naso-sinusal, o olfacto está frequentemente afectado de forma significativa, e é reconhecido o impacto importante deste sintoma na qualidade vida. A resolução por cirurgia endonasal nos casos de resistência à terapêutica médica máxima é uma opção para minorar os sintomas, mas a sua extensão é alvo de controvérsia, sendo que uma cirurgia mais radical, como a nasalização, controla melhor a doença com menos recidivas, mas pode comprometer mais o olfacto. A decisão da extensão da cirurgia deve ser partilhada com o doente, devendo o esclarecimento informado ser tão completo quanto possível quanto às expectativas de controlo da doença como à resolução da hipósmia. Material e Métodos: Revisão bibliográfica e discussão por quadro de peritos. Resultados e Discussão: Baseando-nos em revisão de literatura, apresentamos uma proposta de elementos a incluir no esclarecimento cirúrgico, de modo a contemplar de forma abrangente as limitações da cirurgia no que diz respeito ao sintoma anósmia, bem como das diferentes opções e suas consequências quanto à sua radicalidade, focando a atenção no ponto de vista da ética médica. Conclusão: A decisão da extensão da cirurgia deve ser partilhada com o doente, devendo o esclarecimento informado ser tão completo quanto possível quanto às expectativas de controlo da doença como à resolução da hipósmia.

Structure of the rat nasal mucosa after acute and chronic hyperbaric oxygen therapy.

OBJECTIVE: We aimed at the identification of putative morphologic changes induced in the rat nasal mucosa by acute or chronic hyperbaric oxygen (HBO2) treatment. STUDY DESIGN: Nasal samples were obtained from three groups of eight adult Wistar rats. The first group was submitted to 30 daily sessions of 100-minute-long HBO2 treatments at 2.5 ATA, the second group to a single 485-minute-long HBO2 session following the U.S. Navy Table 6 extended twice at 2.8 and 1.9 ATA, and the third group was composed of rats not submitted to any HBO2 therapy. METHODS: Samples of anterior portion of the lower nasal turbinates (concha nasalis ventralis) were collected after sacrifice and head dissection of the animals. The samples were processed for light and electron microscopy and for morphometric analysis. Inflammatory leukocyte infiltration was evaluated by a semiquantitative method. Non-parametric ANOVA was applied to evaluate statistical differences between leukocyte infiltration, and ANOVA one-way was used to evaluate the thickness of epithelium and basement membrane from samples of HBO2-treated rats and untreated rats. RESULTS: Samples of the turbinate mucosa of the rats submitted to chronic HBO2 treatment showed a significant increase in the thickness of the epithelium and a mild enhancement in the number of infiltrating leukocytes when compared with data from samples from untreated rats or from rats submitted to a single HBO2 treatment. CONCLUSIONS: Chronic HBO2 treatment causes only minor changes in the architecture of the nasal mucosa of the rat; they reflect a mild inflammatory response of the respiratory tract to the increase in pressure and in oxygen content induced by HBO2. No significant morphological changes were observed after a single HBO2 treatment.

Chronic hyperbaric oxygen therapy and the human nasal mucosa: increased thickness of epithelium basement membrane and moderate neutrophilic infiltration.

OBJECTIVE: We aimed to identify potential morphologic changes induced in the nasal mucosa by hyperbaric oxygen (HBO) treatment. STUDY DESIGN: Biopsies were obtained from two groups of 9 individuals: the first group had a diagnosis of tinnitus and was submitted to 15 sessions of 100 min-long HBO treatments, and the latter group consisted of healthy volunteers not submitted to HBO therapy. METHODS: Small biopsies of the anterior portion of the lower nasal turbinate were collected with the help of a Hartmann forceps under direct visual inspection. The samples were processed for light microscopy and morphometric analysis. Inflammatory infiltration (neutrophils and lymphocytes) was evaluated by a semiquantitative method. Unpaired t test and Bernoulli distribution were applied to evaluate statistical differences between data from the two groups of samples. RESULTS: Samples of the turbinate mucosa of the HBO-treated group showed a significant increase in the thickness of the epithelial basement membrane and a moderate enhancement in infiltrating neutrophils when compared with the samples from the control group. CONCLUSIONS: Chronic HBO treatment causes only minor changes in the architecture of the nasal mucosa that may represent the response of the respiratory tract to the increase in pressure and in oxygen content induced by this type of therapy.

Thyroid paraganglioma: case report

Los paragangliomas de la glándula tiroides son tumores poco frecuentes. Se presenta un caso clínico de una mujer de 32 años de edad, con una masa en el lóbulo derecho de la glándula tiroides, sin otros síntomas. El diagnóstico inicial, al que se llegó por citopunción, fue de carcinoma medular de tiroides. La opción terapéutica fue de hemitiroidectomía. Los estudios anatomopatológicos de la pieza operatoria y la histoquímica fueron compatibles con un paraganglioma. Se pone de manifiesto las dificultades del diagnóstico y la importancia de la