Consumers' Attitudes towards Animal Suffering: A Systematic Review on Awareness, Willingness and Dietary Change.

Planetary and human health depend on Westerners' ability to reduce meat consumption. Meat production degrades the environment while excessive meat intake is associated with cancer and cardiovascular disease, among others. Effective reasons and motivations are needed for consumers to change their diet. The fact that modern animal agriculture inflicts a great deal of pain on animals from their birth to their slaughter, animal welfare/suffering may drive consumers to curtail their meat consumption. This systematic review examined a total of 90 papers to ascertain consumers' awareness of the pain animals experience in animal agriculture, as well as consumer attitudes towards meat reduction due to animal welfare. Results show that consumers have low awareness of animal agriculture. Awareness of animal agricultural practices and animal sentience is associated with increased negative attitudes towards animal suffering. Animal suffering due to farming practices, transportation, slaughter, and animal sentience are factors that may encourage a reduction in meat consumption, and even dietary change in the short term. There is also evidence that animal suffering may be a more compelling motivation for consumers' willingness to change their diet than for health or environmental reasons. Therefore, increasing consumers' awareness of animal suffering in meat production is paramount to contributing to reduced pressure on the environment and improved human health.

Pharyngoplasty for obstructive sleep apnea: The influence of surgical technique.

INTRODUCTION AND OBJECTIVES: Obstructive sleep apnea is the most frequent sleep disorder worldwide, with rising incidence. Pharyngoplasty is an alternative treatment in patients not suitable to continuous positive airway pressure devices (CPAP). The aim of this study is to compare different surgical techniques of pharyngoplasty for treatment of obstructive sleep apnea and evaluate its influence in surgical success. MATERIAL AND METHODS: Retrospective study of 92 patients that underwent pharyngoplasty for treatment of obstructive sleep apnea from 2001 to 2020. Included patients performed classic uvulopalatopharyngoplasty (UPPP), radiofrequency assisted uvulopalatopharyngoplasty (RF-UPPP) or barbed reposition pharyngoplasty (BRP). Surgical success was defined and outcomes and complications assessed for each procedure. RESULTS: Most patients were male, with a mean age of 49.36±9.6 years and a mean apnea hypopnea index (AHI) of 29.14±2.94events/h. Thirty-six patients performed classic UPPP, thirty-one underwent RF-UPPP and the remaining twenty-five performed BRP. BRP achieved the highest success rate (66%) in comparison with UPPP (57%) and RF-UPPP (54%) (p=0.032). Mean relative AHI reduction after surgery was not statistically different between three procedures (p=0.098), although there was a tendency for greater reduction with BRP. Most symptoms improved after surgery and snoring was the most recurrent symptom. BRP had less foreign body sensation after surgery, however, it was the procedure with highest rate of post-operative tonsillar bleeding. CONCLUSIONS: In our department, the introduction of recent techniques of velopharyngeal surgery, focused in functional and lateral muscular collapse, has translated into an increase in success rate after surgery. The relative ease of the procedure and reduction of long term complications make BRP an attractive alternative option for CPAP in OSA, in carefully selected patients.

Predictive factors for repeated tympanostomy tube placement in children.

OBJECTIVES: To determine the rate and risk factors for additional tympanostomy tube (TT) placement after first set of TT extrusion in children. MATERIALS AND METHODS: Single-centre cohort study. Clinical records of children undergoing TT placement from January 2015 to December 2017 were reviewed and factors related to the need for subsequent TT were evaluated. RESULTS: A total of 183 children were included, with a mean age of 5.45±2.672 years old. All surgeries were performed simultaneously with adenoidectomy and 64.3% with tonsillectomy. The mean TT retention time was 12.13±6.033 months and the rate of second TT insertion was 21.9%. The TT retention time was significantly lower in children who needed a second TT (8.97±3.962 vs 13.05±6.229, p<.001). Other factors significantly associated with the need for a second TT in the univariate analysis were the presence of otorrhoea and snoring after TT placement (p=.042 and p=.02), RAOM (p=.016), passive smoking (p=.038) and rhinorrhoea (p=.008). However, on multivariate analysis only TT retention time (OR=.831, 95% CI: .727-.950) and RAOM as an indication for surgery (OR: 5.767; 95% CI: 1.696-19.603) were predictors of a second TT. Gender, age, asthma, prematurity, and low birth weight were not significantly associated with a second TT. CONCLUSIONS: RAOM and a short TT retention time were significantly associated with additional TT placement, enhancing the need for and importance of follow up of these children after TT extrusion.

Evaluation of the Efficacy of Paracetamol in the Control of Pain After Adenotonsillectomy in the Pediatric Population.

Introduction Adenotonsillectomy is a common surgical procedure in otolaryngology. Over the years, several techniques have been developed and modified in order to reduce mortality and morbidity. Postoperative pain control remains controversial. The aim of this study was to evaluate the efficacy of paracetamol alone in the control of postoperative pain. Methods A prospective study was conducted between May 2018 and February 2019, including 76 pediatric patients (age < 18 years), who underwent adenotonsillectomy. The surgeries were performed by the lead author with the same surgical technique. Patients were evaluated one week and one month after surgery through the application of the visual analog pain scale and the number of days of pain was assessed by the need for medication. Results Seventy-six total adenotonsillectomy were performed, with a total of 152 tonsils removed. The majority of patients were male (n=39, 51.3%), with an average age of 6.9 years (min 5, max 15 years). The most frequent surgical indication was sleep breathing disorders, present in 86.9% of the cases. The average duration of postoperative pain was 3 days, with no significant difference between groups (p>0.05). The average intensity of postoperative pain was 3.36 and was higher in patients with infectious criteria as surgical indications (p<0.05). Postoperative bleeding occurred in 3.9% (n=3) of the children, self-limited, without the need for readmission or surgical revision. Conclusion Pain after adenotonsillectomy was more intense in patients undergoing surgery for infectious criteria. Paracetamol used in monotherapy has shown safety and efficacy in controlling postoperative pain.

Predictive factors for repeated tympanostomy tube placement in children

Objectives: To determine the rate and risk factors for additional tympanostomy tube (TT) placement after first set of TT extrusion in children.Materials and methodsSingle-centre cohort study. Clinical records of children undergoing TT placement from January 2015 to December 2017 were reviewed and factors related to the need for subsequent TT were evaluated.ResultsA total of 183 children were included, with a mean age of 5.45±2.672 years old. All surgeries were performed simultaneously with adenoidectomy and 64.3% with tonsillectomy. The mean TT retention time was 12.13±6.033 months and the rate of second TT insertion was 21.9%. The TT retention time was significantly lower in children who needed a second TT (8.97±3.962 vs 13.05±6.229, p<.001). Other factors significantly associated with the need for a second TT in the univariate analysis were the presence of otorrhoea and snoring after TT placement (p=.042 and p=.02), RAOM (p=.016), passive smoking (p=.038) and rhinorrhoea (p=.008). However, on multivariate analysis only TT retention time (OR=.831, 95% CI: .727–.950) and RAOM as an indication for surgery (OR: 5.767; 95% CI: 1.696–19.603) were predictors of a second TT. Gender, age, asthma, prematurity, and low birth weight were not significantly associated with a second TT.ConclusionsRAOM and a short TT retention time were significantly associated with additional TT placement, enhancing the need for and importance of follow up of these children after TT extrusion. (AU)

Objetivos: Determinar la tasa y los factores de riesgo para la colocación de tubos de timpanostomía (TT) adicional después de la extrusión de los primeros TT en niños.Materiales y métodosEstudio retrospectivo de los registros médicos de los niños sometidos a la colocación de TT desde enero del 2015 hasta diciembre del 2017; se evaluaron los factores relacionados con la necesidad de TT posterior.ResultadosSe incluyó a 183 niños, con una edad media de 5,45±2,672 años. Todas las cirugías se realizaron simultáneamente con adenoidectomía y el 64,3% con amigdalectomía. El tiempo medio de retención del TT fue de 12,13±6,033 meses y la tasa de segunda inserción del TT fue del 21,9%. El tiempo de retención del TT fue significativamente menor en los niños que necesitaron un segundo TT (8,97±3,962 vs. 13,05±6,229, p<0,001). Otros factores asociados significativamente a la necesidad de un segundo TT en el análisis univariable fueron la presencia de otorrea y ronquidos tras la colocación del TT (p=0,042 y p=0,02, respectivamente), la otitis media aguda de repetición (OMAr) (p=0,016), el tabaquismo pasivo (p=0,038) y la rinorrea (p=0,008). Sin embargo, en el análisis multivariado solo el tiempo de retención del TT (OR=0,831, IC del 95%: 0,727-0,950) y la OMAr como indicación de cirugía (OR: 5,767; IC del 95%: 1,696-19,603) fueron predictores de un segundo TT. El sexo, la edad, el asma, la prematuridad y el bajo peso al nacer no se asociaron significativamente con un segundo TT.ConclusionesLa OMAr y un corto tiempo de retención del TT se asociaron significativamente con la colocación de un segundo TT, lo que refuerza la necesidad e importancia del seguimiento de estos niños tras la extrusión del TT. (AU)

Pharyngoplasty for obstructive sleep apnea: The influence of surgical technique

Introduction and objectives: Obstructive sleep apnea is the most frequent sleep disorder worldwide, with rising incidence. Pharyngoplasty is an alternative treatment in patients not suitable to continuous positive airway pressure devices (CPAP). The aim of this study is to compare different surgical techniques of pharyngoplasty for treatment of obstructive sleep apnea and evaluate its influence in surgical success.Material and methodsRetrospective study of 92 patients that underwent pharyngoplasty for treatment of obstructive sleep apnea from 2001 to 2020. Included patients performed classic uvulopalatopharyngoplasty (UPPP), radiofrequency assisted uvulopalatopharyngoplasty (RF-UPPP) or barbed reposition pharyngoplasty (BRP). Surgical success was defined and outcomes and complications assessed for each procedure.ResultsMost patients were male, with a mean age of 49.36±9.6 years and a mean apnea hypopnea index (AHI) of 29.14±2.94events/h. Thirty-six patients performed classic UPPP, thirty-one underwent RF-UPPP and the remaining twenty-five performed BRP. BRP achieved the highest success rate (66%) in comparison with UPPP (57%) and RF-UPPP (54%) (p=0.032). Mean relative AHI reduction after surgery was not statistically different between three procedures (p=0.098), although there was a tendency for greater reduction with BRP. Most symptoms improved after surgery and snoring was the most recurrent symptom. BRP had less foreign body sensation after surgery, however, it was the procedure with highest rate of post-operative tonsillar bleeding.ConclusionsIn our department, the introduction of recent techniques of velopharyngeal surgery, focused in functional and lateral muscular collapse, has translated into an increase in success rate after surgery. The relative ease of the procedure and reduction of long term complications make BRP an attractive alternative option for CPAP in OSA, in carefully selected patients. (AU)

Introducción y objetivos: La apnea obstructiva del sueño es el trastorno del sueño más frecuente en todo el mundo, con una incidencia creciente. La faringoplastia es una alternativa de tratamiento en pacientes no aptos para dispositivos de presión positiva continua en la vía aérea (CPAP). El objetivo de este estudio es comparar diferentes técnicas quirúrgicas de faringoplastia para el tratamiento de la apnea obstructiva del sueño y evaluar su influencia en el éxito quirúrgico.Material y métodosEstudio retrospectivo de 92 pacientes que fueron sometidos a faringoplastia para el tratamiento de la apnea obstructiva del sueño desde 2001 hasta 2020. Los pacientes incluidos se sometieron a uvulopalatoplastia clásica (UPPP), uvulopalatoplastia asistida por radiofrecuencia (RF-UPPP) o faringoplastia de reposición con sutura barbada (BRP). Se definió el éxito quirúrgico y se evaluaron los resultados y las complicaciones de cada procedimiento.ResultadosLa mayoría de los pacientes fueron varones, con una edad media de 49,36±9,6 años y un índice de apnea-hipopnea (IAH) medio de 29,14±2,94 eventos/hora. Treinta y seis pacientes realizaron UPPP clásica, 31 se sometieron a RF-UPPP y los 25 restantes realizaron BRP. La BRP obtuvo la mayor tasa de éxito (66%) en comparación con la UPPP (57%) y la RF-UPPP (54%) (p=0,032). La reducción relativa media del IAH tras la cirugía no fue estadísticamente diferente entre los 3 procedimientos (p=0,098), aunque hubo una tendencia a una mayor reducción con la BRP. La mayoría de los síntomas mejoraron tras la cirugía y el ronquido fue el síntoma más recurrente. La BRP tuvo menos sensación de cuerpo extraño después de la cirugía, sin embargo, fue el procedimiento con mayor tasa de hemorragia postoperatoria. (AU)

The Influence of Abdominal Adiposity and Physical Fitness on Obesity Status of Portuguese Adolescents.

The aim of this study was to verify the relationship between abdominal adiposity and physical fitness in the obesity status of Portuguese adolescents. BMI, abdominal adiposity, and physical fitness tests from the FITescola® were evaluated in a total of 654 Portuguese adolescents, aged 10-19 years old-male: n = 334 (51%), female: n = 320 (49%). For the final model, BMI was positively related with age (ß = 0.25), abdominal adiposity (ß = 0.313), horizontal jump (ß = -0.100), 40 m maximal velocity (ß = 0.274), and aerobic fitness (ß = -0.250, R2 = 0.75, F = 382.2, and p = 0.0001). We conclude that higher age and abdominal adiposity are positively related with a higher adolescent BMI. Furthermore, lower horizontal jump distances and worse times on the 40 m maximal velocity were inversely related with a higher adolescent BMI, and lower aerobic fitness was inversely related with a higher adolescent BMI.

Primary stapedotomy: Influence of prosthesis diameter on hearing outcome.

OBJECTIVES: To evaluate the success rate of primary stapedotomy and to investigate the influence of prosthesis diameter on hearing outcome. MATERIAL AND METHODS: Retrospective medical chart review of 125 cases who underwent primary small fenestra stapedotomy, from January 2001 to December 2018. The study population was divided in two groups based on Teflon prosthesis diameter - .6mm (60%, N=75) and .4mm (40%, N=50). Pre- and postoperative (≥12 months) air-conduction (AC), bone conduction (BC) and air-bone gap (ABG) thresholds were compared. RESULTS: Postoperative ABG≤10dB and ≤20dB was achieved by 65.7% and 90% of the patients. A functional hearing (PTA-AC≤30dB) was achieved by 59.2% of patients. Sensorineural hearing loss (SNHL, worsening in BC-PTA>10dB) was identified in 7.2% of patients. Comparison of the .6mm- and .4mm-groups, revealed no differences regarding improvements in AC-PTA (22.4 vs. 20.7dB, p=.56), BC-PTA (3.4 vs. 2.3dB, p=.54) and ABG-PTA (19.1 vs. 18.4dB, p=.77). Hearing outcome evaluation identified similar postoperative success rate (.6mm, 79.7% vs. .4mm, 62%, p=.336) and comparable functional hearing (.6mm, 64% vs. .4mm, 52%; p=.197). The incidence of postoperative SNHL was similar between the two pistons (.6m, 5.3% vs. .4mm, 10%, p=.481). CONCLUSION: Primary small fenestra stapedotomy is an effective and safe procedure. A postoperative ABG within 10dB was achieved in 67.2% of patients and there was a reduced incidence of sensorineural hearing loss. Hearing outcome was not influenced by diameter of the selected prosthesis. Postoperative bone conduction hearing thresholds did not differ between the groups, which revealed no significant inner ear trauma caused by the larger piston. Although we did not find evidence to suggest one piston over the other, our results showed a trend toward better results with the larger prosthesis.

Primary stapedotomy: Influence of prosthesis diameter on hearing outcome

Objectives: To evaluate the success rate of primary stapedotomy and to investigate the influence of prosthesis diameter on hearing outcome.Material and methodsRetrospective medical chart review of 125 cases who underwent primary small fenestra stapedotomy, from January 2001 to December 2018. The study population was divided in two groups based on Teflon prosthesis diameter – .6mm (60%, N=75) and .4mm (40%, N=50). Pre- and postoperative (≥12 months) air-conduction (AC), bone conduction (BC) and air-bone gap (ABG) thresholds were compared.ResultsPostoperative ABG≤10dB and ≤20dB was achieved by 65.7% and 90% of the patients. A functional hearing (PTA-AC≤30dB) was achieved by 59.2% of patients. Sensorineural hearing loss (SNHL, worsening in BC-PTA>10dB) was identified in 7.2% of patients. Comparison of the .6mm- and .4mm-groups, revealed no differences regarding improvements in AC-PTA (22.4 vs. 20.7dB, p=.56), BC-PTA (3.4 vs. 2.3dB, p=.54) and ABG-PTA (19.1 vs. 18.4dB, p=.77). Hearing outcome evaluation identified similar postoperative success rate (.6mm, 79.7% vs. .4mm, 62%, p=.336) and comparable functional hearing (.6mm, 64% vs. .4mm, 52%; p=.197). The incidence of postoperative SNHL was similar between the two pistons (.6m, 5.3% vs. .4mm, 10%, p=.481).ConclusionPrimary small fenestra stapedotomy is an effective and safe procedure. A postoperative ABG within 10dB was achieved in 67.2% of patients and there was a reduced incidence of sensorineural hearing loss. Hearing outcome was not influenced by diameter of the selected prosthesis. Postoperative bone conduction hearing thresholds did not differ between the groups, which revealed no significant inner ear trauma caused by the larger piston. Although we did not find evidence to suggest one piston over the other, our results showed a trend toward better results with the larger prosthesis. (AU)

Objetivos: Evaluar la tasa de éxito de la estapedotomía primaria, y estudiar la influencia del diámetro de la prótesis en el resultado auditivo.Material y métodosRevisión retrospectiva de historias médicas de 125 casos sometidos a estapedotomía primaria de la ventana oval, de julio de 2001 a diciembre de 2018. La población de estudio se dividió en 2 grupos, sobre la base del diámetro de la prótesis de teflón de 0,6mm (60%, N=75) y 0,4mm (40%, N=50). Se compararon los valores preoperatorios y postoperatorios (≥12 meses) de los umbrales de conducción aérea (AC), conducción ósea (OC) y desviación aérea-ósea (ABG).ResultadosEl 65,7 y el 90% de los pacientes lograron valores postoperatorios de ABG≤10dB y ≤20dB. Se logró audición funcional (PTA-AC≤30dB) en el 59,2% de los pacientes. La hipoacusia neurosensorial (SNHL, con empeoramiento en BC-PTA>10dB) se identificó en el 7,2% de los pacientes. La comparación entre los grupos de 0,6 y 0,4mm, no reveló diferencias en cuanto a las mejoras de AC-PTA (22,4 vs. 20,7dB; p=0,56), BC-PTA (3,4 vs. 2,3dB; p=0,54) y ABG-PTA (19,1 vs. 18,4dB; p=0,77). La evaluación del resultado auditivo identificó una tasa de éxito postoperatorio similar (0,6/79,7 vs. 0,4mm/62%; p=0,336) y una audición funcional comparable (0,6/64 vs. 0,4mm/52%; p=0,197). La incidencia de SNHL postoperatorio fue similar entre los 2 pistones (0,6/5,3% vs. 0,4mm/10%; p=0,481).ConclusiónLa estapedotomía primaria de ventana oval es un procedimiento efectivo y seguro. Se logró ABG postoperatoria dentro del rango de 10dB en el 67,2% de los pacientes, y se redujo la incidencia de hipoacusia neurosensorial. El resultado auditivo no se vio influido por el diámetro de la prótesis seleccionada. Los umbrales postoperatorios de conducción ósea no difirieron entre los grupos, lo cual reveló la ausencia de daño significativo en el oído interno causado por el pistón de mayor diámetro. (AU)

Type I Tympanoplasty: surgical success and prognostic factors

Objectives: To evaluate success rate of type I tympanoplasty in adults and to investigate the importance of selected prognostic factors on graft uptake.Material and methodsRetrospective medical chart review of 155 patients who underwent Type I Tympanoplasty, in our department, from January 2013 to December 2017. Graft uptake rate was evaluated and the effects of prognostic factors on surgical outcome such as sex, smoking and otological surgery history, status of the contralateral ear, size and location of the perforation, middle ear mucosa status, surgical approach and graft material. Preoperative and postoperative audiometric data were collected, and the functional success was determined.ResultsThe overall surgical anatomical success rate was 75%. Analysis of the selected variables, identified as independent prognostic factors of anatomical unsuccess (95% CI): smoking (OR=3.29, p<.01), middle ear tympanosclerosis (OR=2.96; p=.04). Perforations above 50% of the tympanic membrane area had a borderline effect on graft uptake (p=.05). There was a significative improvement in the average air conduction thresholds of 7.44dB and an ABG closure rate at 10dB and 20dB was achieved in 47% and 84.5%, respectively. Patients who received temporalis fascia graft had similar hearing gain compared to patients who underwent cartilage tympanoplasty (7.7 vs. 7.3dB, p=.79).ConclusionType I tympanoplasty is an effective and safe procedure with a high anatomical success rate in the treatment of mucosal COM. Poorer outcomes were found in patients with smoking habits, in those with tympanosclerosis of middle ear mucosa and in larger perforations. These prognostic factors should be considered in surgical planning and patients should be advised to quit smoking. Tympanoplasty with cartilage graft had a hearing outcome comparable to temporalis fascia graft and should be considered in high-risk patients. (AU)

Objetivos: Evaluar la tasa de éxito de la timpanoplastia tipo I en adultos e investigar la importancia de los factores pronósticos seleccionados en la absorción del injerto.Material y métodosRevisión retrospectiva de los registros médicos, de 155 pacientes que se sometieron a timpanoplastia tipo I en nuestro departamento, desde enero de 2013 hasta diciembre de 2017. Se evaluó la tasa de absorción del injerto y los efectos de los factores pronósticos en el resultado quirúrgico, como el sexo, el tabaquismo y la cirugía otológica. antecedentes, estado del oído contralateral, tamaño y ubicación de la perforación, estado de la mucosa del oído medio, abordaje quirúrgico y material de injerto. Se recogieron datos audiométricos preoperatorios y postoperatorios y se determinó el éxito funcional.ResultadosLa tasa general de éxito anatómico quirúrgico fue del 75%. Análisis de las variables seleccionadas, identificadas como factores pronósticos independientes de fracaso anatómico (IC 95%): tabaquismo (OR = 3,29, p < 0,01), timpanosclerosis del oído medio (OR = 2,96; p = 0,04). Las perforaciones por encima del 50% del área de la membrana timpánica tuvieron un efecto límite en la absorción del injerto (p = 0,05). Hubo una mejora significativa en los umbrales promedio de conducción de aire de 7,44 dB y se logró una tasa de cierre ABG con 10 dB y 20 dB en 47% y 84,5%, respectivamente. Los pacientes que recibieron injerto de fascia temporal tuvieron una ganancia auditiva similar en comparación con los pacientes que se sometieron a timpanoplastia de cartílago (7,7 frente a 7,3 dB, p = 0,79).ConclusiónLa timpanoplastia tipo I es un procedimiento efectivo y seguro con una alta tasa de éxito anatómico en el tratamiento de la otitis media crónica. Se encontraron resultados más pobres en pacientes con hábito de fumar, en aquellos con timpanosclerosis en la mucosa del oído medio y en perforaciones más grandes. (AU)

Adult-onset Woakes' syndrome: a rare entity.

Woakes' syndrome (WS) is a rare entity, defined as severe recalcitrant nasal polyposis with consecutive deformity of the nasal pyramid. WS occurs mainly in childhood and its aetiology remains unclear. We report a case of a 68-year old woman, with aspirin-exacerbated respiratory disease, who presented with recurrent nasal polyposis and progressive broadening of the nasal dorsum. CT scan revealed extensive bilateral nasal polyposis and diffuse osteitis, with anterior ethmoidal calcified lesions. The patient underwent revision endoscopic sinus surgery and nasal pyramid deformity was successfully managed without osteotomies.

Idiopathic sudden sensorineural hearing loss: Effectiveness of salvage treatment with low-dose intratympanic dexamethasone.

OBJECTIVES: To evaluate hearing outcome of salvage treatment with intratympanic steroids (ITS) in idiopathic sudden sensorineural hearing loss (ISSNHL) refractory to initial systemic steroid (SS) therapy. MATERIAL AND METHODS: A retrospective medical chart review was conducted on 54 consecutive patients with ISSNHL refractory to SS. Salvage treatment with a low dose intratympanic dexamethasone (4 mg/ml) was offered after one week of primary treatment. Patients were divided into two groups: 25 patients accepted ITS (treatment group) and 29 patients did not undergo additional treatment (control group). A pure tone average (PTA) gain of at least 10 dB was considered hearing improvement. RESULTS: Hearing improvement rate was higher in ITS group compared to control group (40% vs. 13.8%, p = 0.035). A mean PTA improvement of 8.6 ± 9.8 dB was observed in the ITS group and, whereas the control group had an average hearing gain of 0.7 ± 2 dB (p < 0.001). Audiometric analysis revealed a significant hearing gain in ITS group at all tested frequencies compared to control group (p < 0.05). Analysis of the selected variables, identified intratympanic steroid treatment as the only independent prognostic factor for hearing improvement (OR = 4.2, 95% CI: 1.1-15.7; p = 0.04). CONCLUSION: Intratympanic low dose dexamethasone is effective in patients with incomplete hearing recovery after primary systemic steroid treatment.

Type I Tympanoplasty: surgical success and prognostic factors.

OBJECTIVES: To evaluate success rate of type I tympanoplasty in adults and to investigate the importance of selected prognostic factors on graft uptake. MATERIAL AND METHODS: Retrospective medical chart review of 155 patients who underwent Type I Tympanoplasty, in our department, from January 2013 to December 2017. Graft uptake rate was evaluated and the effects of prognostic factors on surgical outcome such as sex, smoking and otological surgery history, status of the contralateral ear, size and location of the perforation, middle ear mucosa status, surgical approach and graft material. Preoperative and postoperative audiometric data were collected, and the functional success was determined. RESULTS: The overall surgical anatomical success rate was 75%. Analysis of the selected variables, identified as independent prognostic factors of anatomical unsuccess (95% CI): smoking (OR=3.29, p<.01), middle ear tympanosclerosis (OR=2.96; p=.04). Perforations above 50% of the tympanic membrane area had a borderline effect on graft uptake (p=.05). There was a significative improvement in the average air conduction thresholds of 7.44dB and an ABG closure rate at 10dB and 20dB was achieved in 47% and 84.5%, respectively. Patients who received temporalis fascia graft had similar hearing gain compared to patients who underwent cartilage tympanoplasty (7.7 vs. 7.3dB, p=.79). CONCLUSION: Type I tympanoplasty is an effective and safe procedure with a high anatomical success rate in the treatment of mucosal COM. Poorer outcomes were found in patients with smoking habits, in those with tympanosclerosis of middle ear mucosa and in larger perforations. These prognostic factors should be considered in surgical planning and patients should be advised to quit smoking. Tympanoplasty with cartilage graft had a hearing outcome comparable to temporalis fascia graft and should be considered in high-risk patients.

Laryngeal oncocytic cystadenoma mimicking a combined laryngomucocele.

Laryngeal oncocytic cystadenomas are rare benign tumours lined by oncocytic epithelium and arising from the salivary glands; they usually present as a supraglottic mass. Oncocytic changes are very uncommon in the larynx and occur mainly in ventricles and false vocal cords, where seromucinous glands predominate. The authors present the case of a 62-year-old woman who reported a 6-month history of hoarseness associated with a soft and non-compressible upper left side neck swelling. Transnasal fiberoptic laryngoscopy revealed a left submucosal supraglottic mass involving the false vocal fold and the vallecula, partially obstructing the airway. CT scan showed a homogeneous isodense cystic lesion centred at the left laryngeal ventricle, with extension through the thyrohyoid membrane. The patient was successfully managed by a lateral thyrotomy approach. Histopathological examination of the specimen revealed a papillary oncocytic cystadenoma and excluded malignancy. There was no evidence of recurrence after 9 months of follow-up.

Role of age and anticoagulants in recurrent idiopathic epistaxis / El papel de la edad y los anticoagulantes en la epistaxis idiopática recurrente

OBJECTIVE: Epistaxis is one of the commonest causes of attendance of Otolaryngology emergency rooms. Given its incidence, potential severity and high recurrence rate, a systematic and careful management is mandatory. This work aims to define prognostic factors of epistaxis recurrence. MATERIAL AND METHODS: Retrospective review of medical records of patients with epistaxis admitted to our emergency department from January 2012 to December 2016. Data of 1005 patients with idiopathic epistaxis were analysed and independent risk factors for recurrence were determined by multiple logistic regression analysis. RESULTS: Recurrence of epistaxis was found in 303 (30.1%) patients. Patients with recurrent epistaxis were older (p < .001) and more commonly had a history of hypertension (p = .001) and antiplatelet (p = .048) and anticoagulant (p = .001) use than those with episodic epistaxis. Age (adjusted OR 1.21, 95%CI 1.08-1.32, p = .003) and anticoagulant use (adjusted OR 2.68, 95%CI 1.94-3.70, p = .009) were predictors of increased risk of recurrent epistaxis. Gender, alcohol abuse, medical history, active bleeding at admission, unidentified bleeding point or treatment modalities were not associated with recurrence. CONCLUSION: Age and use of anticoagulation drugs were risk factors for recurrence of epistaxis. None of the previously described risk factors for episodic epistaxis were found to increase the risk of recurrence. Knowledge of factors involved in recurrence might provide important information for assessment and management of increased risk patients

OBJETIVO: La epistaxis es una causa frecuente de asistencia a los servicios de urgencias de otorrinolaringología. Dada su incidencia, posible gravedad y alta tasa de recurrencia, es obligatorio un manejo sistemático y cuidadoso. Este trabajo tiene como objetivo definir los factores pronósticos de recurrencia de la epistaxis. MATERIAL Y MÉTODOS: Revisión retrospectiva de los registros médicos de pacientes con epistaxis admitidos en nuestro servicio de urgencias desde enero de 2012 a diciembre de 2016. Se analizaron los datos de 1.005 pacientes con epistaxis idiopática, y se determinaron los factores de riesgo independientes de recurrencia mediante análisis de regresión logística múltiple. RESULTADOS: La recurrencia de la epistaxis se encontró en 303 (30,1%) pacientes. Los pacientes con epistaxis recurrente eran mayores (p < 0,001), tenían con más frecuencia antecedentes de hipertensión (p = 0,001) y de tratamiento con antiplaquetarios (p = 0,048) y anticoagulantes (p = 0,001) que aquellos con epistaxis episódica. La edad (OR ajustada: 1,21; IC 95%: 1,08-1,32; p = 0,003) y el uso de anticoagulantes (OR ajustada: 2,68; IC 95%: 1,94-3,7; p = 0,009) fueron factores predictivos de mayor riesgo de epistaxis recurrente. El sexo, el abuso del alcohol, el historial médico, el sangrado activo al ingreso, el punto de sangrado no identificado o las modalidades de tratamiento, no se asociaron a la recurrencia. CONCLUSIÓN: La edad y el uso de medicamentos anticoagulantes fueron factores de riesgo para la recurrencia de la epistaxis. Ninguno de los factores de riesgo descritos anteriormente para la epistaxis episódica aumentó el riesgo de recurrencia. El conocimiento de los factores involucrados en la recurrencia podría proporcionar información importante para la evaluación y el manejo de los pacientes de mayor riesgo

Clinical assessment, diagnosis and management of patients with unilateral sinonasal disease / Evaluación clínica, diagnóstico y manejo de pacientes con patología nasosinusal unilateral

OBJECTIVES: Unilateral sinonasal disease is commonly encountered in practice and represents an issue of major concern since neoplasms may mimic inflammatory conditions. This paper aims to describe the demographic, clinical and radiological patterns of unilateral pathologies and, accordingly, to establish a guiding algorithm for diagnosis and management. MATERIAL AND METHODS: We conducted a retrospective review of medical records of patients with unilateral sinus opacification on CT scan who underwent endoscopic nasal surgery in our department from January 2011 to December 2017. RESULTS: Of the 150 patients included, 97(64.7%) and 53(35.3%) had inflammatory and neoplastic pathology, respectively. In the neoplastic group, malignancy was present in 35% of patients. Neoplastic conditions were more common in males (p = 0.02) and older patients (56 ± 18 years vs. 38 ± 18, p < .01). Nasal mass or polyp was observed in 56.7% patients. Chronic sinusitis was the most prevalent inflammatory condition, whereas inverted papilloma and osteoma were the most frequent neoplasms. Facial neuralgia, paraesthesia, epistaxis and, on CT scan, superior Lund-Mackay scores, bone remodelling and erosion were significantly more common in neoplastic conditions. Excellent agreement between punch biopsy and postoperative histological results was obtained (k = .883, p < .001). CONCLUSION: A sequential and careful management of unilateral lesions is mandatory. Based on our experience, we propose that, as routine, physical examination should be complemented with nasal endoscopy, CT scan and punch biopsy, in case of visible mass. Although clinical and radiological information might raise suspicion of some conditions, final diagnosis can only be established with histological examination of the surgical specimen

OBJETIVOS: La patología nasal unilateral es común en la práctica clínica y causa preocupación ya que las neoplasias pueden mimetizar las condiciones inflamatorias. Este trabajo pretende describir los patrones demográficos, clínicos y radiológicos de las patologías unilaterales y establecer un algoritmo para el diagnóstico y manejo. MATERIAL Y MÉTODOS: Revisión retrospectiva de los registros médicos de pacientes con opacificación sinusal unilateral en la TC sometidos a cirugía nasal endoscópica en nuestro servicio desde enero de 2011 hasta diciembre de 2017. RESULTADOS: De los 150 pacientes incluidos, 97(64,7%) y 53(35,3%) presentaban patología inflamatoria y neoplásica, respectivamente. En el grupo neoplásico, la malignidad estaba presente en el 35% de los pacientes. Las condiciones neoplásicas fueron más comunes en hombres (p = 0,02) y pacientes mayores (56 ± 18 años vs. 38 ± 18, p < 0,01). Se observó masa nasal en el 56,7% de los pacientes. La sinusitis crónica fue la afección inflamatoria más prevalente, mientras que el papiloma invertido y el osteoma fueron las neoplasias más frecuentes. La neuralgia facial, la parestesia, la epistaxis y, en la TC, las puntuaciones superiores de Lund-Mackay, remodelación y erosión ósea fueron significativamente más comunes en los trastornos neoplásicos. Se encontró una excelente concordancia entre la biopsia por punción y los resultados histológicos postoperatorios (k = 0,88, p < 0,01). CONCLUSIÓN: Con base en nuestra experiencia, proponemos que, el examen físico se complemente con endoscopia nasal, TC y biopsia, en caso de una masa visible. A pesar de que la información clínica y radiológica puede generar sospechas de algunas afecciones, el diagnóstico final solo se puede establecer con el examen histológico postoperatorio

Clinical assessment, diagnosis and management of patients with unilateral sinonasal disease.

OBJECTIVES: Unilateral sinonasal disease is commonly encountered in practice and represents an issue of major concern since neoplasms may mimic inflammatory conditions. This paper aims to describe the demographic, clinical and radiological patterns of unilateral pathologies and, accordingly, to establish a guiding algorithm for diagnosis and management. MATERIAL AND METHODS: We conducted a retrospective review of medical records of patients with unilateral sinus opacification on CT scan who underwent endoscopic nasal surgery in our department from January 2011 to December 2017. RESULTS: Of the 150 patients included, 97(64.7%) and 53(35.3%) had inflammatory and neoplastic pathology, respectively. In the neoplastic group, malignancy was present in 35% of patients. Neoplastic conditions were more common in males (p=0.02) and older patients (56±18 years vs. 38±18, p<.01). Nasal mass or polyp was observed in 56.7% patients. Chronic sinusitis was the most prevalent inflammatory condition, whereas inverted papilloma and osteoma were the most frequent neoplasms. Facial neuralgia, paraesthesia, epistaxis and, on CT scan, superior Lund-Mackay scores, bone remodelling and erosion were significantly more common in neoplastic conditions. Excellent agreement between punch biopsy and postoperative histological results was obtained (k=.883, p<.001). CONCLUSION: A sequential and careful management of unilateral lesions is mandatory. Based on our experience, we propose that, as routine, physical examination should be complemented with nasal endoscopy, CT scan and punch biopsy, in case of visible mass. Although clinical and radiological information might raise suspicion of some conditions, final diagnosis can only be established with histological examination of the surgical specimen.

Role of age and anticoagulants in recurrent idiopathic epistaxis.

OBJECTIVE: Epistaxis is one of the commonest causes of attendance of Otolaryngology emergency rooms. Given its incidence, potential severity and high recurrence rate, a systematic and careful management is mandatory. This work aims to define prognostic factors of epistaxis recurrence. MATERIAL AND METHODS: Retrospective review of medical records of patients with epistaxis admitted to our emergency department from January 2012 to December 2016. Data of 1005 patients with idiopathic epistaxis were analysed and independent risk factors for recurrence were determined by multiple logistic regression analysis. RESULTS: Recurrence of epistaxis was found in 303 (30.1%) patients. Patients with recurrent epistaxis were older (p<.001) and more commonly had a history of hypertension (p=.001) and antiplatelet (p=.048) and anticoagulant (p=.001) use than those with episodic epistaxis. Age (adjusted OR 1.21, 95%CI 1.08-1.32, p=.003) and anticoagulant use (adjusted OR 2.68, 95%CI 1.94-3.70, p=.009) were predictors of increased risk of recurrent epistaxis. Gender, alcohol abuse, medical history, active bleeding at admission, unidentified bleeding point or treatment modalities were not associated with recurrence. CONCLUSION: Age and use of anticoagulation drugs were risk factors for recurrence of epistaxis. None of the previously described risk factors for episodic epistaxis were found to increase the risk of recurrence. Knowledge of factors involved in recurrence might provide important information for assessment and management of increased risk patients.

Extranodal natural killer/T cell lymphoma, nasal type: a diagnostic challenge.

Extranodal natural killer/T cell lymphoma, nasal type (ENKL) is a rare and aggressive tumour that can, clinically and histologically, mimic infectious and inflammatory conditions, presenting a diagnostic challenge. The authors report the case of a 69-year-old Portuguese woman previously misdiagnosed with chronic recurrent sinusitis. Despite maximal medical and surgical treatments, the disease was refractory and progressed. The patient had undergone multiple biopsies when the histopathological diagnosis of ENKL was made, 5 months after the initial complaints. Multiagent chemotherapy was offered, but during the first cycle, the patient developed severe infection and pancytopenia, which culminated in her death. This case highlights the need to consider a neoplastic cause when faced with aggressive sinonasal disease not responsive to maximal treatment and the difficulties in establishing the diagnosis of ENKL, with multiples biopsies of deep-tissue usually being required.