Endoscopic and External Dacryocystorhinostomy: Long Term Result from a Tertiary Center in Portugal.

Dacryocystorhinostomy is the gold-standard for distal lacrimal obstructions. This study aims to report the demography, clinical presentation, influence of agger nasi opening, uncinectomy and septoplasty, the use of silicone stent tubes, complications and success of endoscopic and external dacryocystorhinostomy over a period of 11 years. Retrospective review of clinical records, from January 2012 to December 2022, at a tertiary center in Portugal. A total of 249 procedures, 6 external and 243 endoscopic, were performed, including 39 revision cases. There was a female predominance (79.9%) with a mean age at diagnosis of 66.4 years. Recurrent acute dacryocystitis, reported by 33.3%, was associated with higher success (p = 0.053). Agger nasi opening, uncinectomy and septoplasty were performed in 17.7%, 6.0% and 15.3% respectively, although associated with higher success rates, no statistically significant difference was found. Minor complication rates for both external and endoscopic approach was 33.3% and 32.1% respectively. Functional and anatomical success was 100% and 83.3%, respectively, for external dacryocystorhinostomy, and 91.4% and 85.1%, respectively, for endoscopic dacryocystorhinostomy. Revision surgery was associated with a worse anatomical success (p = 0.05). Endoscopic dacryocystorhinostomy is an effective and safe alternative to the external approach. Minor procedures can increase the success rate, but multicentre studies need to be performed for a statistically significant result.

Guía de práctica clínica sobre el manejo del schwannoma vestibular / Clinical practice guideline on the management of vestibular schwannoma

Introducción: El schwannoma vestibular (SV) es el tumor más frecuente del ángulo pontocerebeloso. La mayor accesibilidad a las pruebas radiológicas ha incrementado su diagnóstico. Teniendo en cuenta las características del tumor, la clínica y la edad del paciente se han propuesto tres estrategias terapéuticas, observación, cirugía o radioterapia. La elección de la más adecuada para cada paciente es un motivo de controversia frecuente. Material y métodos: El presente trabajo incluye una revisión exhaustiva sobre cuestiones relativas al SV que pueden servir de guía clínica en el manejo de pacientes con estas lesiones. La presentación se ha orientado en forma de preguntas que el clínico se hace habitualmente y las respuestas están redactadas y/o revisadas por un panel de expertos nacionales e internacionales consultados por la Comisión de Otología de la SEORL-CCC. Resultados: Se ha elaborado un listado con los 13 bloques temáticos más controvertidos sobre el manejo del SV en forma de 50 preguntas y se han buscado las respuestas a todas ellas mediante una revisión sistemática de la literatura (artículos publicados en PubMed y Cochrane Library entre 1992 y 2023 sobre cada bloque temático). Treinta y tres expertos, liderados por la Comisión de Otología de la SEORL-CCC, han analizado y discutido todas las respuestas. En el Anexo 1 pueden encontrarse 14 preguntas adicionales divididas en cuatro bloques temáticos. Conclusiones: Esta guía de práctica clínica sobre el manejo del SV ofrece respuestas consensuadas a las preguntas más habituales que se plantean sobre este tumor. La ausencia de suficientes estudios prospectivos hace que los niveles de evidencia sobre el tema sean en general medios o bajos. Este hecho incrementa el interés de este tipo de guías de práctica clínica elaboradas por expertos.(AU)

IntroductionVestibular schwannoma (VS) is the most common tumour of the cerebellopontine angle. The greater accessibility to radiological tests has increased its diagnosis. Taking into account the characteristics of the tumour, the symptoms and the age of the patient, three therapeutic strategies have been proposed: observation, surgery or radiotherapy. Choosing the most appropriate for each patient is a frequent source of controversy. Material and methods: This paper includes an exhaustive literature review of issues related to VS that can serve as a clinical guide in the management of patients with these lesions. The presentation has been oriented in the form of questions that the clinician usually asks himself and the answers have been written and/or reviewed by a panel of national and international experts consulted by the Otology Commission of the SEORL-CCC. Results: A list has been compiled containing the 13 most controversial thematic blocks on the management of VS in the form of 50 questions, and answers to all of them have been sought through a systematic literature review (articles published on PubMed and Cochrane Library between 1992 and 2023 related to each thematic area). Thirty-three experts, led by the Otology Committee of SEORL-CCC, have analyzed and discussed all the answers. In Annex 1, 14 additional questions divided into 4 thematic areas can be found. Conclusions: This clinical practice guideline on the management of VS offers agreed answers to the most common questions that are asked about this tumour. The absence of sufficient prospective studies means that the levels of evidence on the subject are generally medium or low. This fact increases the interest of this type of clinical practice guidelines prepared by experts.(AU)

[Adaptation and Validation for European Portuguese of the Auditory Performance Categories-II and Infant-Toddler Meaningful Auditory Integration Scale for Children with Cochlear Implant]. / Adaptação e Validação para Português Europeu das Escalas Categories Auditory Performance-II e Infant-Toddler Meaningful Auditory Integration Scale em Crianças com Implante Coclear.

INTRODUCTION: The Categories of Auditory Performance II (CAP-II) scale and the Infant-Toddler Meaningful Audit Integration Scale (IT-MAIS) are simple and quick questionnaires that allow assessment of the auditory performance of children with cochlear implant (CI). The aim of this study was to translate, adapt and validate the European Portuguese version of the CAP-II and IT-MAIS scales. METHODS: A total of 85 participants completed the European Portuguese version of the CAP-II and IT-MAIS questionnaires, of which 45 were parents of children with pediatric cochlear implants (9.84 ± 4.22 years) and another 40 were parents of children with normal hearing (8.35 ± 3.56 years). Inter-rater reproducibility, test-retest reproducibility, comparison of study group versus control group results, internal consistency and correlation of the new scales were evaluated. RESULTS: The CAP-II and IT-MAIS scales showed high reliability and reproducibility, respectively, with an intraclass correlation coefficient (ICC) of 0.979 (p < 0.001) and a Spearman's correlation of 0.924 for the CAP-II scale, and an ICC of 0.932 (p < 0.001) and Spearman's correlation coefficient of 0.732 for the IT-MAIS scale. The IT-MAIS and CAP-II versions showed strong internal consistency (Cronbach's α coefficient value of 0.887 for the CAP-II scale and Spearman's positive correlation of 0.677 for the IT-MAIS scale, respectively) and allowed for the differentiation between children with normal hearing and post-implantation children (p = 0.001 and p < 0.001 respectively for each of the scales). There was no association between parental education and the results on the scales (p > 0.05). CONCLUSION: The findings demonstrated that the European Portuguese version of these scales is a valid and reliable tool for assessing auditory performance in European Portuguese-speaking children with hearing loss.

Introdução: As escalas Categories of Auditory Performance II (CAP-II) e Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) são questionários simples e de rápida aplicação que permitem avaliar o desempenho auditivo de crianças com implante coclear (IC). O objetivo deste estudo foi a tradução, adaptação e validação da versão em português europeu das escalas CAP-II e IT-MAIS. Métodos: Um total de 85 participantes completaram a versão em português europeu dos questionários CAP-II e IT-MAIS, dos quais 45 eram pais de crianças com IC pediátrico (9,84 ± 4,22 anos) e outros 40 eram pais de crianças com audição normal (8,35 ± 3,56 anos). Foi avaliada a reprodutibilidade entre avaliadores, a reprodutibilidade teste-reteste, a comparação dos resultados do grupo de estudo versus grupo de controlo, a consistência interna e a correlação das novas escalas. Resultados: As escalas CAP-II e IT-MAIS apresentaram uma elevada confiabilidade e reprodutibilidade, respetivamente com coeficiente de correlação intraclasse (ICC) de 0,979 (p < 0,001) e correlação de Spearman de 0,924 para a escala CAP-II, e ICC de 0,932 (p < 0,001) e coeficiente de correlação de Spearman de 0,732 para a escala IT-MAIS. As versões do IT-MAIS e do CAP-II apresentaram uma forte consistência interna (valor do coeficiente α de Cronbach de 0,887 para a escala CAP-II e correlação positiva de Spearman de 0,677 para a escala IT-MAIS, respetivamente) e permitem diferenciar entre crianças com audição normal e crianças pós-implantação (p = 0,001 e p < 0,001 respetivamente para cada uma das escalas). Não se verificou existir associação estatisticamente significativa entre a escolaridade e o resultado nas escalas (p > 0,05). Conclusão: A versão em português europeu destas escalas demonstrou ser uma ferramenta válida e confiável na avaliação do desempenho auditivo em crianças falantes de português europeu com deficiência auditiva.

Clinical practice guideline on the management of vestibular schwannoma.

INTRODUCTION: Vestibular schwannoma (VS) is the most common tumour of the cerebellopontine angle. The greater accessibility to radiological tests has increased its diagnosis. Taking into account the characteristics of the tumour, the symptoms and the age of the patient, three therapeutic strategies have been proposed: observation, surgery or radiotherapy. Choosing the most appropriate for each patient is a frequent source of controversy. MATERIAL AND METHODS: This paper includes an exhaustive literature review of issues related to VS that can serve as a clinical guide in the management of patients with these lesions. The presentation has been oriented in the form of questions that the clinician usually asks himself and the answers have been written and/or reviewed by a panel of national and international experts consulted by the Otology Commission of the SEORL-CCC. RESULTS: A list has been compiled containing the 13 most controversial thematic blocks on the management of VS in the form of 50 questions, and answers to all of them have been sought through a systematic literature review (articles published on PubMed and Cochrane Library between 1992 and 2023 related to each thematic area). Thirty-three experts, led by the Otology Committee of SEORL-CCC, have analyzed and discussed all the answers. In Annex 1, 14 additional questions divided into 4 thematic areas can be found. CONCLUSIONS: This clinical practice guideline on the management of VS offers agreed answers to the most common questions that are asked about this tumour. The absence of sufficient prospective studies means that the levels of evidence on the subject are generally medium or low. This fact increases the interest of this type of clinical practice guidelines prepared by experts.

Bone cement in ossicular chain reconstruction: systematic review and meta-analysis.

OBJECTIVES: To compare the hearing outcomes of ossicular chain reconstruction using bone cement versus other materials such as prostheses and autografts. METHODS: This study included articles that compared hearing outcomes in patients with conductive hearing loss who underwent stapes revision surgery or chronic otitis media surgery. A systematic search for articles from January 2000 to February 2022 was conducted in Medline, Embase, and Cochrane Library databases. Only articles in English were included. An effective postoperative air-bone gap (ABG) was defined as ≤20 dB. A bias assessment tool was developed according to Cochrane guidelines, and the chi-square test was used to evaluate the mean age of the samples. RESULTS: Of the 418 studies that met the selection criteria, only seven were eligible for this study, consisting of 187 patients in the bone cement group and 173 in the non-bone cement group. Ossiculoplasty using bone cement yielded significantly better results, with a combined odds ratio (OR) of 2.03 (95% CI: 1.16-3.55, p = 0.01). CONCLUSIONS: The results of this study suggest that the effectiveness of bone cement in ossiculoplasty was greater than that of other materials in chronic otitis media surgery or stapes revision surgery, with a higher number of patients achieving ABG ≤20 dB.

Relationship between the Presence of Nystagmus in the Fourth Position of the Epley Maneuver and Treatment Efficacy for PSC BPPV: A Prospective Study.

OBJECTIVE: To investigate whether a specific nystagmus observed during the Epley maneuver can enable immediate reassessment of patients, eliminating the need for deferred diagnosis. STUDY DESIGN: Prospective cohort. SETTING: Tertiary center. PATIENTS: Patients with posterior semicircular canal (PSC) benign paroxysmal positional vertigo (BPPV) diagnosed by the Dix-Hallpike test between March 2022 and March 2023. INTERVENTIONS: All patients were treated with the Epley maneuver. The presence and the characteristics of the nystagmus were recorded in each of the four intermediate positions of the maneuver. Fifteen minutes later, all patients were reevaluated with the Dix-Hallpike test to determine the therapeutic success. MAIN OUTCOME MEASURES: Outcome of the Epley maneuver and its relationship with nystagmus characteristics during the four positions of the maneuver. RESULTS: Sixty-six patients (77.3% female) were included in the study, of which 66.7% exhibited right PSC BPPV. Therapeutic success of the first Epley maneuver was 74.2%. Almost one third (30.3%) of patients presented with nystagmus in the second and third positions of the Epley maneuver. All patients with down-beating and torsional nystagmus toward the opposite direction of the diagnostic nystagmus in the fourth position of the Epley maneuver needed a second rehabilitative maneuver. None of the patients without nystagmus in this fourth position remained with active BPPV after the first Epley maneuver. CONCLUSIONS: The presence of nystagmus in the fourth position of the Epley maneuver appears to have a high predictive value, reducing waiting time for a second diagnostic maneuver. Its absence may exempt subsequent reevaluation.

[Translation, Cultural Adaptation and Contributions to the Validation of the Nijmegen Cochlear Implant Questionnaire (NCIQ) for European Portuguese]. / Tradução, Adaptação Cultural e Contributos para a Validação da Escala Nijmegen Cochlear Implant Questionnaire (NCIQ) para o Português Europeu.

INTRODUCTION: The Nijmegen Cochlear Implant Questionnaire (NCIQ) scale uses a simple and easily administered questionnaire to evaluate the adaptation of individuals to their cochlear implants. The aim of this study was to validate the NCIQ for European Portuguese, through its translation and cultural adaptation. It also presents the evaluation of reproducibility and the description of the results of this questionnaire in patients using IC. MATERIAL AND METHODS: Fifty postlingually deaf adult multichannel cochlear implant users (uni- or bilateral) participated in the study. Participants used the cochlear implant for at least 12 months and were patients of the Department of Otolaryngology at the Egas Moniz Hospital in Lisbon. Permission, as well the guidelines for translation, were obtained from the authors of the scale. Translation and cultural adaptation were carried out, in addition to the evaluation of reproducibility and internal consistency. RESULTS: The participants were 44.0% male and 56.0% female, aged between 20 and 79 years (55.50 ± 15.69). The results of the study showed an overall level of satisfaction of 65.07 among cochlear implants users. The level of satisfaction of the subdomains was 64.40 in basic sound perception, 71.35 in advanced sound perception, 57.91 in speech production, 59.05 in self-esteem, 69.75 in activity and 68.50 in social functioning. Internal consistency (Cronbach α score = 0.96) and test-retest reliability coefficients proved to be strong. Furthermore, the questionnaire's overall and subdomains average scores did not differ significantly from the results obtained with the original scale. CONCLUSION: This adaptation of the NCIQ questionnaire for European Portuguese should be considered a good tool to evaluate the level of satisfaction of cochlear implant users and, so far, it is the only scale in this field validated for application in the Portuguese population.

Introdução: O questionário Nijmegen Cochlear Implant Questionnaire (NCIQ) consiste numa escala simples e de rápida aplicação para avaliar a satisfação dos indivíduos que utilizam implantes cocleares. O objetivo deste estudo foi a validação do NCIQ para o Português Europeu e avaliação da qualidade de vida em adultos utilizadores de implantes cocleares. Material e Métodos: Participaram no estudo 50 adultos utilizadores de implante coclear multicanal (uni ou bilateral), com surdez pós-lingual, no mínimo com 12 meses de uso, implantados e seguidos no serviço de Otorrinolaringologia do Hospital Egas Moniz em Lisboa. Foram pedidas a autorização e as normas para a tradução do questionário aos autores da escala e realizada a tradução e retroversão do questionário, a adaptação cultural, e a avaliação da reprodutibilidade e da consistência interna. Resultados: Os participantes eram 44,0% do género masculino e 56,0% do feminino, com idades compreendidas entre os 20 e os 79 anos (55,50 ± 15,69). Os resultados obtidos neste estudo demonstraram um nível de satisfação global de 65,07 nos utilizadores de implantes cocleares. O nível de satisfação dos subdomínios foi de 64,40 na perceção básica do som, 71,35 na perceção avançada do som, 57,91 na produção da fala, 59,05 na autoestima, 69,75 na atividade e 68,50 nas interações sociais. A versão traduzida do questionário NCIQ apresentou uma boa consistência interna para todos os domínios existentes no questionário (α de Cronbach = 0,96). Verificou-se também uma boa reprodutibilidade inter-pesquisadores. Para a pontuação global e das subescalas do questionário, os resultados médios obtidos demonstraram não haver diferenças significativas com a escala original. Conclusão: A adaptação do Nijmegen Cochlear Implant Questionnaire para Português Europeu deve ser considerada um bom instrumento para a avaliação da satisfação dos utilizadores de implantes cocleares e é, até ao momento, a única escala neste domínio validada para aplicação na população portuguesa.

Lateral semicircular canal-BPPV: Prospective randomized study on the efficacy of four repositioning maneuvers.

INTRODUCTION: Multiple repositioning maneuvers have been described to treat lateral semi-circular canal Benign Paroxysmal Positional Vertigo (LC-BPPV) patients. In this study, we compare efficacy of four therapeutic repositioning maneuvers for LC-BPPV patients and aim to identify clinical variables associated with persistent disease. MATERIAL AND METHODS: A prospective study was conducted at a tertiary center, between January 2017 and September 2019. Patients diagnosed with LC-BPPV were randomly treated with Gufoni or barbecue-roll maneuvers (for the geotropic variant) and Gufoni-Appiani, barbecue-roll or Zuma-e-Maia maneuvers (for the apogeotropic form). Efficacy was compared and statistical analysis was performed to find clinical factors associated with no response. RESULTS: Forty-eight patients and 82 maneuvers were included. Female patients and right side were more commonly affected. The mean age was 67 years. Seven cases (14.6%) resulted from a canal-switch. One single maneuver resolved 23 cases (47.9%) and the success rate rose to 75% at the end of the first visit (after up to 4 maneuvers) and to 93.8% after a-week of follow-up. Success rates were significantly better with Gufoni (68%) than with barbecue roll (34.8%; p=0.021) in geotropic LC-BPPV and better with Gufoni-Appiani (71.4%) than barbecue roll and Zuma-e-Maia maneuvers (33.3%; p=0.239) in apogeotropic LC-BPPV. Higher rates of persistent disease after first visit were found with older patients, left side and apogeotropic LC-BPPV and with longer latency and duration diagnostic nystagmus. CONCLUSION: Our study suggests that Gufoni and Gufoni-Appiani maneuvers may be the most efficacious treatment for geotropic and apogeotropic LC-BPPV, respectively, compared to barbecue-roll and Zuma-e-Maia maneuvers.

VPPB del canal semicircular lateral: estudio prospectivo aleatorizado de la eficacia de 4 maniobras de reposicionamiento / Lateral semicircular canal-BPPV: Prospective randomized study on the efficacy of four repositioning maneuvers

Introduction: Multiple repositioning maneuvers have been described to treat lateral semi-circular canal Benign Paroxysmal Positional Vertigo (LC-BPPV) patients. In this study, we compare efficacy of four therapeutic repositioning maneuvers for LC-BPPV patients and aim to identify clinical variables associated with persistent disease. Material and methods: A prospective study was conducted at a tertiary center, between January 2017 and September 2019. Patients diagnosed with LC-BPPV were randomly treated with Gufoni or barbecue-roll maneuvers (for the geotropic variant) and Gufoni-Appiani, barbecue-roll or Zuma-e-Maia maneuvers (for the apogeotropic form). Efficacy was compared and statistical analysis was performed to find clinical factors associated with no response. Results: Forty-eight patients and 82 maneuvers were included. Female patients and right side were more commonly affected. The mean age was 67 years. Seven cases (14.6%) resulted from a canal-switch. One single maneuver resolved 23 cases (47.9%) and the success rate rose to 75% at the end of the first visit (after up to 4 maneuvers) and to 93.8% after a-week of follow-up. Success rates were significantly better with Gufoni (68%) than with barbecue roll (34.8%; p=0.021) in geotropic LC-BPPV and better with Gufoni-Appiani (71.4%) than barbecue roll and Zuma-e-Maia maneuvers (33.3%; p=0.239) in apogeotropic LC-BPPV. Higher rates of persistent disease after first visit were found with older patients, left side and apogeotropic LC-BPPV and with longer latency and duration diagnostic nystagmus. Conclusion: Our study suggests that Gufoni and Gufoni-Appiani maneuvers may be the most efficacious treatment for geotropic and apogeotropic LC-BPPV, respectively, compared to barbecue-roll and Zuma-e-Maia maneuvers. (AU)

Introducción: Se han descrito múltiples maniobras de reposicionamiento para tratar a los pacientes con vértigo postural paroxístico benigno del canal semicircular lateral (VPPB-CSL). En este estudio comparamos la eficacia de 4 maniobras de reposicionamiento terapéutico para pacientes de BPPV-CSL, con el objetivo de identificar las variables clínicas asociadas a la persistencia de la enfermedad. Material y métodos: Se realizó un estudio prospectivo en un centro terciario, entre enero de 2017 y septiembre de 2019. Se trató aleatoriamente a los pacientes diagnosticados de VPPB-CSL con las maniobras de Gufoni o Barbecue-Roll (para la variante geotrópica) y las maniobras de Gufoni-Appiani, Barbecue-Roll o Zuma-e-Maia (para la forma apogeotrópica), comparándose su eficacia y realizándose un análisis estadístico para encontrar los factores clínicos asociados a la falta de respuesta. Resultados: El estudio incluyó 48 pacientes y 82 maniobras. Las mujeres y el lado derecho fueron los más comúnmente afectados. La edad media fue de 67 años. Siete casos (14,6%) fueron resultado de un fenómeno de reentrada. Una única maniobra resolvió 23 casos (47,9%), elevándose la tasa de éxito al 75% al finalizar la primera visita (tras un máximo de 4 maniobras) y al 93,8% tras una semana de seguimiento. Las tasas de éxito fueron significativamente más altas con la maniobra de Gufoni (68%) en comparación con la de Barbecue-Roll (34,8%; p=0,021) en VPPB-CSL geotrópico, y también fueron más altas con las maniobras de Gufoni-Appiani (71,4%) en comparación con las de Barbecue-Roll y Zuma-e-Maia (33,3%; p=0,239) en VPPB-CSL apogeotrópico. Las tasas más altas de persistencia de la enfermedad tras la primera visita se encontraron en pacientes mayores, lado izquierdo y VPPB-CSL apogeotrópica, con mayor latencia y duración del nistagmo diagnóstico. (AU)

Tracheostomy in COVID-19 Patients: Experience at a Tertiary Center in the First 11 Months of the Pandemic.

This study aimed to evaluate the experience of tracheostomy in COVID-19 patients in a Southern Europe tertiary hospital. Retrospective observational study in tracheostomized patients from April 1, 2020 to February 28, 2021. Data related to tracheostomy were evaluated in patients with and without COVID-19, including infections in healthcare professionals involved in patient care. Forty-two tracheostomies were performed in COVID-19 patients aged 68.4 ± 11.1 years, predominantly men (71%) and caucasians (81%). They had at least 1 comorbidity (93%), on average 3. The most frequent were heart disease (71%), age > 65 years (67%) diabetes (40%) and obesity (33%). The greater number of comorbidities was associated with the lesser probability of the patient's recovery (p = .001). Age (p = .047) and renal failure (p = .013) were associated with higher mortality. Patients were tracheostomized by prolonged endo-tracheal intubation (50%), pneumonia (33%) and extubation failure (10%). Ventilation time before the tracheostomy (22.9 ± 6.5 days) was higher than ventilation time after the tracheostomy (7.1 ± 15.1 days) (p < 0.001). No differences were found in ventilation time (p = 0.094) and tracheostomy time (p = 0.514) in the different indications. There were 3 minor complications (7.1%), 25 discharges (60%) and 11 deaths (26%). During the same period 49 tracheostomies were performed in patients without COVID-19, with a homogeneous gender and age distribution, 31% without comorbidities, with an average of 1 comorbidity per patient and higher mortality (43%). Tracheostomy in COVID-19 patients proved to be a safe procedure for both patients and healthcare professionals and improves the clinical outcome of patients with severe infection. The 21-day procedure timing seems adequate. Comorbidities played an essential role in patient´s recovery. Age and renal failure are associated with a worse vital prognosis.

Personality and psychopathology in Ménière's disease.

INTRODUCTION AND OBJECTIVES: Psychological factors in vertigo patients have been extensively studied but the role of anxiety and personality traits in the clinical course of Ménière's disease (MD) is unknown. The objectives of this study are to identify and characterize psychopathology in MD and to find risk factors for an increased rate and intensity of crisis and chronic symptoms. MATERIALS AND METHODS: We performed a transversal study in all patients diagnosed with definite MD in our department during a 5-year period. Sample subjects were interviewed in 3 steps: first, an otorhinolaryngologist collected information about clinical and pharmacological background of MD; second, a psychiatrist screened for mood, anxiety and personality disorders; in a third stage, the patient completed the DHI (Dizziness Handicap Inventory), STAI-Y (State Trait Anxiety Inventory), NEO-PI-R (Neo Personality Inventory Reviewed) and VAS (Visual Analogue Scale) for vertigo and dizziness. Statistical analysis was performed to search for risk factors for multiple and intense crisis and chronic symptoms. RESULTS: Thirty-four patients completed all 3 phases of the study. A predominant dysfunctional personality trait was identified in 80% of patients (predominantly cluster C type), 35% were being treated with psychiatric medication and 34.4% had a considerable mood or anxiety disorder. All patients scored high (>7) in VAS during crisis. There was a statistically significant positive correlation between crisis rate and STAI, anxiety-subscale (N1) in NEO-PI-R, VAS and DHI scores (p<.044). Crises were more common in bilateral MD (p=.041). DHI scores were higher with higher STAI and N1 (p=.001). Disease duration and pure tone average were found to have a positive moderate correlation (p=.017). CONCLUSIONS: The positive correlations between crisis rate, chronic dizziness and anxiety-related personality traits reveal a bidirectional and intimate relationship between personality, anxiety and MD, affecting these patients' quality of life. These results support the relevance of prospecting adjuvant psychological and psychiatric approaches to these patients.

Personality and psychopathology in Ménière's disease

Introduction and Objectives: Psychological factors in vertigo patients have been extensively studied but the role of anxiety and personality traits in the clinical course of Ménière's disease (MD) is unknown. The objectives of this study are to identify and characterize psychopathology in MD and to find risk factors for an increased rate and intensity of crisis and chronic symptoms.Materials and MethodsWe performed a transversal study in all patients diagnosed with definite MD in our department during a 5-year period. Sample subjects were interviewed in 3 steps: first, an otorhinolaryngologist collected information about clinical and pharmacological background of MD; second, a psychiatrist screened for mood, anxiety and personality disorders; in a third stage, the patient completed the DHI (Dizziness Handicap Inventory), STAI-Y (State Trait Anxiety Inventory), NEO-PI-R (Neo Personality Inventory Reviewed) and VAS (Visual Analogue Scale) for vertigo and dizziness. Statistical analysis was performed to search for risk factors for multiple and intense crisis and chronic symptoms.ResultsThirty-four patients completed all 3 phases of the study. A predominant dysfunctional personality trait was identified in 80% of patients (predominantly cluster C type), 35% were being treated with psychiatric medication and 34.4% had a considerable mood or anxiety disorder. All patients scored high (>7) in VAS during crisis. There was a statistically significant positive correlation between crisis rate and STAI, anxiety-subscale (N1) in NEO-PI-R, VAS and DHI scores (p<.044). Crises were more common in bilateral MD (p=.041). DHI scores were higher with higher STAI and N1 (p=.001). Disease duration and pure tone average were found to have a positive moderate correlation (p=.017). (AU)

Introducción y objetivos: Se han estudiado ampliamente los factores psicológicos en los pacientes con vértigo, pero se desconoce el rol de los rasgos de ansiedad y personalidad en el curso clínico de la enfermedad de Ménière (EM). El objetivo de este estudio es identificar y caracterizar la psicopatología en la EM, y encontrar los factores de riesgo del incremento de la tasa de crisis, intensidad de la crisis y síntomas crónicos.Materiales y métodosRealizamos un estudio transversal en todos los pacientes diagnosticados de EM definida en nuestro departamento durante un periodo de 5 años. Se entrevistó a los sujetos de la muestra en 3 pasos: en primer lugar un otorrinolaringólogo recabó información sobre los antecedentes clínicos y farmacológicos de EM; en segundo lugar, un psiquiatra determinó los trastornos emocionales, de ansiedad y personalidad y, en tercer lugar, el paciente completó las escalas Dizziness Handicap Inventory (DHI), State Trait Anxiety Inventory (STAI-Y), Neo Personality Inventory Reviewed (NEO-PI-R) y Escala analógica visual (EVA) en cuanto a vértigo y mareo. Se realizó un análisis estadístico para identificar los factores de riesgo de crisis múltiples e intensas y síntomas crónicos.ResultadosTreinta y cuatro pacientes completaron las 3 fases del estudio. Se identificó un rasgo predominante de personalidad disfuncional en el 80% de los pacientes (predominantemente el clúster tipo C), el 35% fue tratado con fármacos psiquiátricos, y el 34,4% tenía trastornos emocionales o de ansiedad notorios. Todos los pacientes tuvieron puntuaciones EVA altas (>7) durante la crisis. Existió una correlación positiva estadísticamente significativa entre la tasa de crisis y la subescala de ansiedad STAI (N1) en las escalas NEO-PI-R, EVA y DHI (p<0,044). (AU)

Migrating fish bone presenting as a neck fistula.

The case report describes an extremely rare finding of fish bone migration from the aerodigestive tract causing a neck fistula 2 years after its ingestion. Detailed case study and surgical treatment is presented. This case highlights the need for further assessment in presence of a high clinical suspicion of foreign body ingestion with a normal physical examination of the upper aerodigestive tract, to avoid serious and potential life-threatening complications later on.

How Can We Develop an Efficient eHealth Service for Provision of Care for Elderly People with Balance Disorders and Risk of Falling? A Mixed Methods Study.

This study aimed to identify relevant topics for the development of an efficient eHealth service for elderly people with balance disorders and risk of falling, based on input from physicians providing healthcare to this patient group. In the quantitative part of the study, an open multiple-choice questionnaire was made available on the website of the Portuguese General Medical Council to assess the satisfaction with electronic medical records regarding clinical data available, the time needed to retrieve data and the usefulness of the data. Of the 118 participants, 55% were dissatisfied/very dissatisfied with data availability and 61% with the time spent to access and update data related to the focused patient group. Despite this negative experience, 76% considered future e-Health solutions as pertinent/very pertinent. Subsequently, these findings were further explored with eight semi-structured interviews. The physicians confirmed the reported dissatisfactions and pointed out the lack of comprehensive data and system interoperability as serious problems, causing inefficient health services with an overlap of emergency visits and uncoordinated diagnostics and treatment. In addition, they discussed the importance of camera and audio monitoring to add significant value. Our results indicate considerable potential for e-Health solutions, but substantial improvements are crucial to achieving such future solutions.

Single-sided deafness: Bone conduction devices or cochlear implantation? A systematic review with meta-analysis / Hipoacusia unilateral: ¿dispositivos de conducción de vía ósea o implantes cocleares? Una revisión sistemática con metaanálisis

OBJECTIVES: To perform a systematic review with meta-analysis of the studies published on the efficacy of bone conduction devices and cochlear implantation in single-sided deafness, through the evaluation of speech discrimination in noise, sound localization and tinnitus suppression. As a secondary outcome, patient satisfaction is also assessed. DESIGN: A systematic search in PubMed, Embase and CENTRAL was conducted, including all articles written in English and published in the last 10 years. The outcomes selected were speech perception in noise, sound localization, tinnitus intensity and, secondarily, quality of life assessment. Studies that met prospectively defined criteria were subjected to random effects meta-analyses. The review protocol is registered on PROSPERO with number CRD42019121444. RESULTS: Nineteen articles reporting a total of 210 patients (95 patients with bone conduction devices and 115 in the cochlear implantation group) were included. The meta-analysis identifies statistically significant benefits in cochlear implantation for sound localization, tinnitus suppression, in global quality of life assessment and in 2 of the 3 subscales of quality of life assessment (ease of communication and reverberation). Bone conduction devices are better regarding speech discrimination in noise and background noise quality of life assessment. CONCLUSION: Cochlear implants effectively offer better results in 2 of the 3 evaluated parameters, being a very valid option. Bone conduction devices should continue to be considered in the treatment of these patients because, in addition to allowing better discrimination in noise, patient satisfaction is greater in environments with background noise

OBJETIVOS: Realizar una revisión sistemática con metaanálisis de los estudios publicados sobre la eficacia de los dispositivos de conducción de vía ósea y los implantes cocleares en la hipoacusia unilateral, a través de la evaluación de la discriminación del habla en el ruido, la localización del sonido y la supresión del tinnitus. Como resultado secundario, también se evalúa la satisfacción del paciente. DISEÑO: Se realizó una búsqueda sistemática en PubMed, Embase y CENTRAL, incluidos todos los artículos escritos en inglés y publicados en los últimos 10 años. Los resultados seleccionados fueron la percepción del habla en el ruido, la localización del sonido, la intensidad del tinnitus y, en segundo lugar, la evaluación de la calidad de vida. Los estudios que cumplieron los criterios definidos prospectivamente fueron sometidos a metaanálisis de efectos aleatorios. El protocolo de revisión está registrado en PROSPERO con el número CRD42019121444. RESULTADOS: Se incluyeron 19 artículos que informaban un total de 210 pacientes (95 pacientes con dispositivos de conducción de vía ósea y 115 en el grupo de implante coclear). El metaanálisis identifica beneficios estadísticamente significativos en la implantación coclear para la localización del sonido, la supresión del tinnitus, en la evaluación de la calidad de vida global y en 2 de las 3 subescalas de la evaluación de la calidad de vida (facilidad de comunicación y reverberación). Los dispositivos de conducción de vía ósea son mejores con respecto a la discriminación del habla en el ruido y la evaluación de la calidad de vida relacionada con el ruido de fondo. CONCLUSIÓN: Los implantes cocleares ofrecen efectivamente mejores resultados en 2 de los 3 parámetros evaluados, siendo una opción muy válida. Los dispositivos de conducción de vía ósea deben seguir considerándose en el tratamiento de estos pacientes porque, además de permitir una mejor discriminación del ruido, la satisfacción del paciente es mayor en entornos con ruido de fondo

Lateral semicircular canal-BPPV: Prospective randomized study on the efficacy of four repositioning maneuvers.

INTRODUCTION: Multiple repositioning maneuvers have been described to treat lateral semi-circular canal Benign Paroxysmal Positional Vertigo (LC-BPPV) patients. In this study, we compare efficacy of four therapeutic repositioning maneuvers for LC-BPPV patients and aim to identify clinical variables associated with persistent disease. MATERIAL AND METHODS: A prospective study was conducted at a tertiary center, between January 2017 and September 2019. Patients diagnosed with LC-BPPV were randomly treated with Gufoni or barbecue-roll maneuvers (for the geotropic variant) and Gufoni-Appiani, barbecue-roll or Zuma-e-Maia maneuvers (for the apogeotropic form). Efficacy was compared and statistical analysis was performed to find clinical factors associated with no response. RESULTS: Forty-eight patients and 82 maneuvers were included. Female patients and right side were more commonly affected. The mean age was 67 years. Seven cases (14.6%) resulted from a canal-switch. One single maneuver resolved 23 cases (47.9%) and the success rate rose to 75% at the end of the first visit (after up to 4 maneuvers) and to 93.8% after a-week of follow-up. Success rates were significantly better with Gufoni (68%) than with barbecue roll (34.8%; p=0.021) in geotropic LC-BPPV and better with Gufoni-Appiani (71.4%) than barbecue roll and Zuma-e-Maia maneuvers (33.3%; p=0.239) in apogeotropic LC-BPPV. Higher rates of persistent disease after first visit were found with older patients, left side and apogeotropic LC-BPPV and with longer latency and duration diagnostic nystagmus. CONCLUSION: Our study suggests that Gufoni and Gufoni-Appiani maneuvers may be the most efficacious treatment for geotropic and apogeotropic LC-BPPV, respectively, compared to barbecue-roll and Zuma-e-Maia maneuvers.

Single-sided deafness: Bone conduction devices or cochlear implantation? A systematic review with meta-analysis.

OBJECTIVES: To perform a systematic review with meta-analysis of the studies published on the efficacy of bone conduction devices and cochlear implantation in single-sided deafness, through the evaluation of speech discrimination in noise, sound localization and tinnitus suppression. As a secondary outcome, patient satisfaction is also assessed. DESIGN: A systematic search in PubMed, Embase and CENTRAL was conducted, including all articles written in English and published in the last 10 years. The outcomes selected were speech perception in noise, sound localization, tinnitus intensity and, secondarily, quality of life assessment. Studies that met prospectively defined criteria were subjected to random effects meta-analyses. The review protocol is registered on PROSPERO with number CRD42019121444. RESULTS: Nineteen articles reporting a total of 210 patients (95 patients with bone conduction devices and 115 in the cochlear implantation group) were included. The meta-analysis identifies statistically significant benefits in cochlear implantation for sound localization, tinnitus suppression, in global quality of life assessment and in 2 of the 3 subscales of quality of life assessment (ease of communication and reverberation). Bone conduction devices are better regarding speech discrimination in noise and background noise quality of life assessment. CONCLUSION: Cochlear implants effectively offer better results in 2 of the 3 evaluated parameters, being a very valid option. Bone conduction devices should continue to be considered in the treatment of these patients because, in addition to allowing better discrimination in noise, patient satisfaction is greater in environments with background noise.