Descending necrotising mediastinitis: a rare entity in children.

We present a case of descending necrotising mediastinitis (DNM) originating from a retropharyngeal abscess in a healthy early childhood patient. The patient had a history of fever, odynophagia and refusal to eat, followed by rapid deterioration of the clinical state. Cervicothoracic CT was performed, which revealed a right parapharyngeal abscess, extending to the mediastinum and occupying the retropharyngeal/visceral space, with gaseous content throughout this collection, associated with bilateral pleural effusion, aspects compatible with DNM. She started broad-spectrum antibiotic therapy and transoral drainage of the parapharyngeal and retropharyngeal collections was performed under general anaesthesia. She was admitted to the intensive care unit. The patient showed clinical, analytical and imaging improvement, having been transferred to the ear, nose and throat department, with favourable evolution. Early diagnosis of DNM by cervicothoracic CT and multidisciplinary approaches, including intensive care, broad-spectrum antibiotics and surgical intervention, are crucial to minimise the morbidity and mortality.

Cardiovascular risk factors among patients with acute unilateral inner ear hypofunction: A case-control study.

Objectives: To assess the prevalence of cardiovascular risk factors (CVRFs) and their impact on acute unilateral inner ear hypofunction (AUIEH), including acute unilateral peripheral vestibulopathy (AUPVP), sudden sensorineural hearing loss (SSNHL) and acute unilateral audiovestibular hypofunction (AUAVH). Methods: One hundred and twenty-five patients consecutively diagnosed with AUPVP, SSNHL or AUAVH and 250 sex- and age-matched controls were included. Cases presented a mean age of 58.6 ± 14.7 years and included 59 women and 66 men. The correlation between CVRFs (high blood pressure [HBP], diabetes mellitus [DM], dyslipidemia [DLP], cardiocerebrovascular disease [CCVD]) and AUIEH was assessed by multivariate conditional logistic regression analysis. Results: A higher prevalence of CVRFs was identified in patients than in controls (30 individuals with DM, 53 with HBP, 45 with DLP and 14 with a previous history of CCVD, p < .05). A significantly elevated risk of AUIEH was found in patients with two or more CVRFs (adjusted odds ratio [OR] 5.11; 95% CI 2.23-11.70). Previous CCVD individually predicted AUIEH (OR 8.41; 95% CI 2.36-29.88). Subgroup analysis showed the same tendency for AUPVP and SSNHL. Conclusion: Acute unilateral inner ear hypofunction patients presented significantly more CVRFs than controls, and the presence of two or more CVRFs was associated with AUIEH. Future studies evaluating vascular risk in AUIEH may include AUPVP and SSNHL patients from the same source population to better characterize risk profiles that can indicate a vascular origin. Level of Evidence: 3b.

Cardiovascular Risk and Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-Analysis.

OBJECTIVES/HYPOTHESIS: It was previously suggested that patients with idiopathic sudden sensorineural hearing loss (ISSNHL) have a higher risk of cardiovascular disease. The aim of this study is to determine if ISSNHL patients have an increased cardiovascular risk by means of a systematic review and meta-analysis. METHODS: A systematic literature review was performed using PubMed, Embase, Cochrane Libraries and Web of Science. Studies with a clear definition of ISSNHL, investigating an association between traditional vascular risk factors and ISSNHL were included. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, two reviewers extracted the data, assessed the risk of bias and performed the analysis of the collected evidence. RESULTS: Nineteen case-control studies and two cohort studies were included (102,292 patients). Individual studies argued for higher prevalence of hypercholesterolemia, diabetes mellitus (DM) and higher blood pressure (HBP) in ISSNHL patients with a range of odds ratios (ORs) from 1.03 to 19. Pooled analysis of adjusted ORs revealed a significantly increased risk of ISSNHL for patients with hypertriglyceridemia (OR 1.54; 95% confidence interval [CI] 1.18-2.02) and high levels of total cholesterol (TC) (OR 2.09; 95% CI 1.52-2.87 after sensitivity analysis), but not for HBP, DM, or high levels of low- and high-density lipoproteins. CONCLUSION: An association between higher vascular risk profile and ISSNHL seems apparent in high levels of triglycerides (TG) and TC, but more studies are needed to confirm this hypothesis due to the high levels of data heterogeneity in the literature. LEVEL OF EVIDENCE: NA Laryngoscope, 133:15-24, 2023.

Audiologist's Perspective in Auditory Rehabilitation: Implications for Ethical Conduct and Decision-Making in Portugal.

Ethical standards in audiology have been continuously improved and discussed, leading to the elaboration of specific regulatory guidelines for the profession. However, in the field of auditory rehabilitation, audiologists are still faced with circumstances that question their ethical principles, usually associated with the support of the hearing aids industry. The study explores the decision-making process and ethical concerns in auditory rehabilitation as they relate to the practice of audiology in Portugal. An online questionnaire constructed by the authors was used and sent to the email addresses of a list of audiologists, registered with the Portuguese Association of Audiologists. The questionnaire was answered by 93 audiologists with clinical experience in auditory rehabilitation for more than one year. The collected data demonstrated that audiometric results and clinical experience are the most important factors for decision-making in auditory rehabilitation practice. Moreover, incentives from the employers or manufacturers were identified as the main cause of ethical dilemmas. This study highlights the ethical concerns regarding the clinical practice of auditory rehabilitation in Portugal, revealing that the decision-making process is complex and, specifically in this field, the current practice may not be adequate for effective compliance with professional ethical standards.

Asymmetric sensorineural hearing loss in children: progression and involvement of the contralateral ear.

BACKGROUND: Sensorineural hearing loss in child has a profound impact on their neurodevelopment and on language acquisition. Thus, the diagnosis and early intervention are critical, namely in unilateral or bilateral asymmetric hearing losses, which are diagnosed later than symmetric bilateral hearing losses. OBJECTIVES: This study aims to examine the progression of asymmetric SNHL in children, and the link between hearing thresholds and the technological level of the hearing aid fitted. MATERIAL AND METHODS: Eighteen children with asymmetric SNHL were submitted to a pure tone audiogram at the age of 5 years (T0) and reassessed at the age of 10 years (T1). Children were divided according to the technological level of the hearing aid fitted: basic, medium, and advanced. RESULTS: A positive correlation was established between the hearing thresholds at T0 and T1, revealing an accelerated progression of hearing thresholds in the better ear after a 5-year period. CONCLUSIONS: Hearing thresholds in the worse ear influence the progression of the SNHL. Moreover, technologically advanced hearing aids led to a slower progression of the hearing thresholds over time.

Age-related hearing loss, depression and auditory amplification: a randomized clinical trial.

PURPOSE: Our study investigates the effectiveness of aural rehabilitation to decrease depressive symptoms in older adults, and the relationship between hearing loss and depression. METHODS: A randomized controlled study was conducted at a hearing rehabilitation center with people over 65 years old. Participants were randomly allocated to the intervention group who received hearing aids, or to the control group. Data collection included pure-tone audiometry and a Portuguese version of the Geriatric Depression Scale assessed at two time points: baseline (P0) and after 4-week period (P1). RESULTS: The results show that the increase of hearing thresholds in pure-tone audiometry is associated with a significant increase in depressive symptoms (p = 0.001). The effect of aural rehabilitation for improving depressive symptoms was significant in intervention group (p = 0.000) and between groups (p = 0.003) in P1. CONCLUSION: Age-related hearing loss has adverse effects on older adults' mental health, due to reduced hearing inputs that may increase levels of effort to communicate and affect social engagement, which lead to depression. Hearing aid use improves levels of depression and can promote greater quality of life in older adults.

Sex and age biological variation of the mandible in a Portuguese population- a forensic and medico-legal approaches with three-dimensional analysis.

The medico-legal identification is based on a set of discriminatory characteristics between individuals in their biological, social, cultural, religious, legal and economic framework. The purpose of this study was to characterize the biological variation, regarding gender and age, in a Portuguese population. A three-dimensional (3D) analysis of 215 mandibles (7-20 years old) from the database of the Laboratory of Forensic Dentistry, Faculty of Medicine, University of Coimbra (CE-112/2019) was performed. A total of 13 cephalometric points defined 10 linear variables and 7 angular variables, on 3D reconstructions from ConeBeam Computed Tomography (CBCT) images. Intra and inter-observer errors were analyzed by Technical Measurement Error test. A descriptive statistics was performed. To verify the influence of gender and age on the variables and to determine its predictive value, ANOVA and Logistic Regression Analysis were performed. Gender and age influence most of the linear variables, however, the same is not true for angular variables. In the analysis of all variables, the model has a reasonable level of sensitivity (67.8%) according to gender. For the age prediction, with all variables, the model presented a reasonable level of sensitivity, classifying 79.4% of the individuals. The results supported, with a high level of statistical significance, an adequate recognition of individuals highlighting the identification and criminal imputability of Portuguese individuals.

Retrospective study of group A Streptococcus oropharyngeal infection diagnosis using a rapid antigenic detection test in a paediatric population from the central region of Portugal.

Group A Streptococcus (GAS) is one of the most important agents of oropharyngeal infection. To avoid unnecessary antibiotic prescription, it is recommended the confirmation of GAS infection in pharyngeal swabs using culture or rapid antigen detection test (RADT). This study aimed to retrospectively analyse the incidence of GAS oropharyngeal infection, detected by RADT, in a paediatric population in the Centre of Portugal. Data was collected from the database of the Paediatric Hospital Emergency Department (ED) regarding patients admitted with symptoms suggesting acute pharyngitis, from January 2013 to December 2018, in a total of 18,304 cases. Among these, 130 clinical files were searched for symptoms, complications and additional visits to the ED. The results showed an average GAS infection prevalence of 33%, with seasonal variation. In preschool children, especially in patients less than 3 years old, where the guidelines do not routinely encourage RADT, GAS tonsillitis assumed an unexpected importance, with 731 positive tests in a total of 3128 cases. Scarlatiniform rash and oral cavity petechiae had significant correlation with streptococcal aetiology (p < 0.05). The statistical analysis also showed that different signs and symptoms assume different weights depending on the age group of the patient. The main conclusion is that the incidence of GAS infection in the studied population is higher than generally described in preschool children, suggesting the need for a more cautious approach to children under 3 years presenting acute pharyngitis, and that RADT in this age group would contribute to a decrease in the number of unnoticed cases.

A long styloid process and Collet-Sicard syndrome / Proceso estiloides alargado y síndrome de Collet-Sicard

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Neck Pain and Acute Dysphagia.

The acute tendinitis of the longus colli muscle is an unusual diagnosis in the cases of acute dysphagia with cervical pain. Is a self-limiting condition caused by abnormal calcium hydroxyapatite deposition in the prevertebral space and can cause pharyngeal swelling with impaired swallow. It is absolutely critical to make the differential diagnosis with deep cervical infections in order to avoid invasive treatments.

Diagnóstico da qualidade da água do rio Parauapebas (Pará, Brasil) / Diagnostic of the water quality of the Parauapebas river (Pará, Brazil)

O objetivo desta pesquisa foi desenvolver um diagnóstico da qualidade da água do rio Parauapebas (Estado do Pará, Brasil), com base no monitoramento realizado nos períodos de baixa precipitação dos anos 2004, 2007 e 2009. Em 20 locais de amostragem ao longo do rio no entorno da cidade de Parauapebas, foram avaliados na água parâmetros físicos (transparência, temperatura da água e resíduo total), químicos (oxigênio dissolvido, pH, turbidez, alcalinidade, dureza, acidez, cloreto, DBO, DQO e fósforo, ferro e nitrogênio totais) e biológicos (coliformes termotolerantes). A partir dos resultados foi desenvolvido o Índice de Qualidade de Água ­ IQA para o trecho monitorado. Para interpretação dos dados realizou-se estudos complementares de análise de componentes principais, regressão múltipla e regressão linear, além de levantamentos de informações a respeito dos meios físicos, bióticos e sócio-econômicos da região. O IQA determinado para o rio Parauapebas foi de 40,01 o que o enquadra na categoria "Regular". Com as análises de componentes principais e de regressão múltipla identificaram-se quatro variáveis que influenciaram significativamente na variação do índice: oxigênio dissolvido, demanda bioquímica do oxigênio, fósforo total e coliformes termotolerantes, que explicaram 75% da variação dos resultados. A expansão urbana, especialmente nas direções N-NO e S-SO, atingiu as áreas próximas às reservas de mata ciliar, comprometendo, em parte, a qualidade das águas superficiais do rio Parauapebas.

The objective of this research was to develop a diagnostic of the water quality of the Parauapebas River (Pará, Brazil), in the dry periods of 2004, 2007 and 2009. In 20 sampling sites in Parauapebas River, around of the Parauapebas City, physical (transparency, water temperature and total solid residues), chemical (dissolved oxygen, pH, turbidity, alkalinity, hardness, acidity, chloride, Biochemical Oxygen Demand, Chemical Oxygen Demand, total phosphorus, total iron and total nitrogen), and biological parameters (thermotolerant coliforms) were measured. The results were used for the determination of Water Quality Index (WQI). As support to the interpretation of these parameters, a Principal Components Analysis (PCA), multiple regression and linear regression analyses and, a general survey of physical, biotical and social-economic of the region were performed. WQI for the Parauapebas River, in the monitored area, was 40.01, which classifies it in the category "Regular". The PCA and multiple regression analysis identified four parameters that have been employed in the WQI determination and that influenced significantly the variation of the Index: dissolved oxygen, BOD, total phosphorus and thermotolerant coliforms, which explained 75% of the variation of the results. The results indicate that the urban expansion, in especial in the directions N-NW and S-SW, has reached the areas surrounding the Riparian Forest, and affected partially the surface water quality of the Parauapebas River.

[Hearing aids rehabilitation: state of the art]. / Réhabilitation auditive par prothèse acoustique état actuel.

OBJECTIVES: The three-dimensional characteristic of heari ng as a neurosensory loss can be associated with distortions in the axes of intensity, frequency and also temporal. This type of distortions can be isolated or combined, with many functional characteristics which complicate the fixing of the hearing aid and makes its result extremely variable. The ENT specialist in charge of the prescription of the hearing aid must know the various types of available devices, its indications and limitations. The different current hearing aids by acoustic stimulation are described, behind the ear, intra-auricular, intra-canal, micro-behind the ear with receiver in the canal (RIC). Some clinical and audiometric elements make it possible to envisage the difficulty of such equipment as the air bone gap, the dynamic, the frequential shift, the hearing discrimination. Concerning the hearing aid itself, the amplifier represents the fundamental part allowing the compensation of the quatitative loss; it presents however many possibilities of adaptation (multifrequential compression, the adaptive directionnality coming from the directional microphones, the suppression of the acoustic feedback, the increase of the bandwidth and software of statistical analysis of environmental acoustics as well as procedures of decision). Finally software of treatment of the signal like the software of suppression of acoustic feedback, identification of the speech and noise, of adaptive directionality, of measurement of the hearing thresholds (which is possible on certain prosthesis for each channel) refine the adjustment of the hearing aid. CONCLUSION: The knowledge of these technological possibilities currently available, like their indications and limitations, allows the ENT specialist to get an active role in the process of acceptation of the hearing aid.

[New potentialities of the hearing aids: the frequential transposition in high frequencies sensorineural hearing losses]. / Nouvelles potentialités des appareils auditifs: transposition en fréquence dans la surdité de perception avec amputation des aiguës.

OBJECTIVES: Hearing aids are becoming very complex instruments with amplification combining numerous signal processing. Digital equipment allows a transposition of acute frequencies towards lower frequencies. The goal of this study is to extend the possibilities of this transposition based on results obtained on 8 patients. MATERIAL AND METHODS: With these new systems, the frequential transposition involves tiny artifacts but the relation of frequency between the various components of the original signal is preserved. The transposition must be done only in the frequencies which are necessary and must as selective as possible. The structure of the original sound must be preserved which implies a certain flexibility and specificity to guarantee the individual needs of the patient. These complex adjustments are assisted by a linear transposition algorithm; Audibility Extender (Widex). This system was used to fit 8 patients presenting a significant acute frequency loss. RESULTS: The improvement is evident on the level of perception of sounds of the environment and consonant recognition. The improvement is significant as well on the tonal sensitivity as on the threshold of vocal intelligibility with a conservation of the percentage of speech discrimination for monosyllabic words. CONCLUSION: The frequential transposition is an alternative to cochlear implants in certain indications and has its place alongside hybrid implants. The indications are reserved to patients presenting dead cochlear zones in the acute frequencies. The algorithm with its various adjustments allows an adaptation preserving the characteristics of the transposed sounds. The adaptation to such a system of hearing amplification requires an adaptation, and rehabilitation is essential in all the cases.