Changes in Coagulation Study and Risk of Developing Cholesteatoma: Is There a Link?

BACKGROUND AND OBJECTIVES: The etiopathogenesis of acquired pediatric cholesteatoma has not yet been fully clarified. Recent studies and modern technologies have led researchers to look for explanations at a molecular level. This study aims to understand if the origins of cholesteatoma could be related to dysfunctions in coagulation factors, thereby emphasizing its role in angiogenesis. Subjects and. METHODS: This was a retrospective case-control study carried out at a tertiary hospital center between January 2010 and December 2020. The study included 92 children. The variables of the summary coagulation study (partial thromboplastin time, prothrombin time, and international normalized ratio) were compared among children with and without development of chronic otitis media with cholesteatoma. RESULTS: The cases and controls were comparable in terms of age, type, and number of times that ventilation tubes were placed. Partial thromboplastin times tended to be higher in children who developed cholesteatoma, with a statistically significant difference between the two groups in terms of normal and abnormal partial thromboplastin times (p=0.029). CONCLUSIONS: The results of this case control study indicate that slight extension of partial thromboplastin times in the coagulation study may not meet the criteria for diagnosis of certain hematological pathologies or clinical significance, but at a molecular level may already have implications for activation of angiogenesis and other growth factors involved in the onset, growth, and expansion of acquired pediatric cholesteatoma.

Tailored Approach for Persistent Olfactory Dysfunction After SARS-CoV-2 Infection: A Pilot Study.

OBJECTIVE: So far, no original studies explored non-randomized, standardized protocols for COVID-19 associated olfactory dysfunction. The main objective was to determine the efficacy of a new protocol for post-COVID olfactopathy while assessing the benefit of adding adjuvant therapies to olfactory training. METHODS: Patients suffering from long-lasting post-COVID-19 olfactory dysfunction were evaluated. A non-randomized protocol based on individual nasal endoscopy findings and patient's preferences was applied. Patients were assigned for olfactory training alone or olfactory training + adjuvant therapy. Participants performed olfactory objective and subjective evaluations at first consultation and 3 months after treatment, and results were compared. RESULTS: A total of 47 patients were enrolled. All groups showed significant improvement in olfactory thresholds at 3-month follow-up suggesting protocol effectiveness (olfactory training group alone showed a mean threshold difference of 2.9, P < .001; Olfactory training + Topical Corticosteroid showed a mean threshold difference of 4, P = .006; Olfactory training + Topical Corticosteroid + Vitamin B complex showed a mean threshold difference of 4.4, P = .006; Olfactory training + Intranasal Vitamin A and E showed a mean threshold difference of 4.4, P < .001). Olfactory training alone showed lower mean olfactory threshold improvement, when compared to patients undergoing olfactory training + adjuvant therapy (olfactory training alone mean improvement 2.9 ± 2.3 vs olfactory training + adjuvants mean improvement 4.3 ± 2.458, P = .03). CONCLUSIONS: This is one of the first studies to demonstrate results in the treatment of post-COVID-19 persistent olfactory impairment. A customized approach based on endoscopy findings and patient's preferences may be a valid option for the management of persistent post-COVID-19 olfactory disorder. Adjuvant therapy could be considered in addition to olfactory training, but further studies are needed in order to confirm their effectiveness in this setting. LEVEL OF EVIDENCE: 2c (outcomes research).

Validation of the Portuguese Version of the Voice Handicap Index-10.

INTRODUCTION: The aim of this study is to validate the Voice Handicap Index 10, to be implemented on the Portuguese population. MATERIAL AND METHODS: Fourty-five subjects were included on the study with vocal complaints and 45 subjects with no vocal complaints, followed on Otorhinolaryngology external appointment at Centro Hospitalar Universitário of Porto. The Voice Handicap Index 30 (VHI-30) and The Voice Handicap Index 10 (VHI-10) questionnaires were applied to the subjects by phone call. Posteriorly, VHI-10 was again applied in the next two to seven days after the first call. These procedures helped validating VHI-10 according to its reproducibility, internal consistency and correlation between questionnaires. RESULTS: In the group with vocal complaints, we verified a significant statistical correlation and a strong linear correlation between VHI-30 and VHI-10 (r = 0.915; P< 0.001). The group without vocal complaints has shown a significant statistical correlation and a moderate linear correlation between VHI-30 and VHI-10 (r = 0.647; P< 0.001). Regarding VHI-10, It was detected a significant statistical difference between patients with and without vocal complaints. DISCUSSION: VHI-10 in Portuguese of Portugal was applied to a sample that included, not only subjects with different ages, but also subjects with and without vocal complaints. Among patients with vocal complaints, it was included subjects with different diagnosis (organic and functional pathology). Thus, the sample was representative, and VHI-10 was reliable and reproducible. CONCLUSION: VHI-10 is a valid representation of VHI-30 that helps evaluate the impact of vocal complaints on life quality, with proven psychometric properties to be implemented on the Portuguese population.

Stratifying Presbylarynx: Characterization of its Three Types.

OBJECTIVES: To describe the clinical characteristics of each type of glottal configuration proposed in a classification that allows stratifying presbylarynx into three types: Type 0: there is no significant morphological alteration in glottal configuration. Type 1: two or more of the following endoscopic signs are present: atrophic vocal folds, vocal fold bowing, prominence of vocal processes, supraglottal hyperactivity, decreased amplitude (vocal fold edge stiffness without evidence of vocal post-traumatic scar), and tremor of laryngeal structures. Type 2: elderly patients with type 1 plus glottal insufficiency. METHODS: Prospective, observational, and cross-sectional study. Data regarding age, gender, type of glottal configuration, self-assessment regarding vocal complaints, as well as acoustic and audio-perceptive examination were collected. RESULTS: The study population included 306 subjects (180 females), and the mean age was 73.85. Type 0 was the most frequent (61%). A statistically significant association was found between type 0 and female subjects, as well as type 2 and male subjects. The mean age of the patients with type 0 was statistically lower than the mean age of the patients with type 1 or type 2. The mean score of self-assessment questionnaires of patients with type 2 was statistically higher than the mean score registered for patients with type 0 and type 1. The mean score of Jitter, Shimmer, and HNR in type 2 were statistically higher than in type 0 or type 1 (P < 0.05). The mean score of Maximum Phonation Time in type 2 was statistically lower than in type 0 or 1 (P < 0.001). Based on vocal complaints, 115 subjects (38%) had presbyphonia (46 males; 69 females), and the mean age was 75.97 years (SD = 6.98; range 65 - 97). Among subjects without presbyphonia (n = 191), type 0 was the most frequent (84%), followed by type 1 (15%) and type 2 (1%). Among subjects with presbyphonia (n = 115), type 1 was the most frequent (58%), followed by type 0 (23%) and type 2 (19%). CONCLUSIONS: This study presented the clinical characterization of a classification that allows stratifying endoscopic laryngeal signs in elderly patients with presbyphonia. We believe this classification will enrich the diagnostic protocol of the aging voice and will improve the documentation of treatment outcomes.

Anthropometry: A clue for Otorhinolaryngology surgical indications in children.

BACKGROUND: There are reports in literature concerning the relation between some maternal and neonatal factors and future risk of disease, including atopy, recurrent infections and obstructive sleep disturbances, three common pathologies eliciting surgery in children. OBJECTIVE: To evaluate if maternal and neonatal factors can relate to Otorhinolaryngology surgical indications in a cohort of children treated in a tertiary referral center. MATERIAL AND METHODS: A retrospective analysis of data from children submitted to primary Otorhinolaryngology surgery in the pediatric ambulatory unit of Centro Hospitalar Universitário do Porto between March 2016 and March 2020 was performed. Children with orofacial congenital anomalies were excluded and 1256 children met the eligibility criteria. The associations between maternal and neonatal factors and the development of atopy, recurrent infections and obstructive sleep apnea were analyzed. RESULTS: Atopic children showed higher birth weight percentile (p < 0,001) and birth weight-for-length index (p < 0,001) compared with non-atopic. Weight-at-surgery was also higher in atopic patients (p = 0,002). Maternal atopy significantly increased the risk of children atopic disease (p < 0,001; Odds Ratio 4,359). Children indicated for surgery for recurrent infections showed lower birth weight-for-length index (p = 0,038) and lower probability of atopic disease (p < 0,001). Recurrent acute otitis media related to both lower birth weight-for-length index (p = 0,002) and birth body mass index (p = 0,023). There was not a significant higher incidence of sleep apnea in preterm infants (p = 0,488). Obstructive sleep apnea patients showed lower weight-at-surgery percentile (p = 0,045). CONCLUSION: This work suggests an association between birth anthropometric measurements and atopic and infectious diseases later in life, irrespective of gestational age. There was no consistent association between perinatal parameters and obstructive sleep apnea, but the impact of disordered breathing in childhood anthropometry was significative.

The Portuguese version of "The Utrecht questionnaire for outcome assessment in aesthetic rhinoplasty": validation and clinical application / Versão em português do "The Utrecht questionnaire for outcome assessment in aesthetic rhinoplasty": validação e aplicação clínica

Abstract Introduction: The evaluation of surgical outcomes measured by patient satisfaction or quality of life is very important, especially in plastic surgery. There is increasing interest in self-reporting outcomes evaluation in plastic surgery. Objective: The aim of this study was to perform the translation, cross-cultural adaptation and validation of "The Utrecht questionnaire for outcome assessment in aesthetic rhinoplasty" from English to Portuguese. Methods: Retrospective study involving 50 patients undergoing to rhinoplasty comparing the preoperative period with the current postoperative situation (minimum 6 months and maximum 24 months postoperatively). Statistical analysis was performed to assess internal consistency, test-retest reliability, validity and responsiveness. Results: No patients received a negative score on the visual analogue scale comparing preoperative and postoperative appearance. The postoperative improvement on the visual analogue scale revealed a Gaussian curve of normal distribution with a mean improvement of 4.44 points. The test-retest reliability showed a positive correlation between the postoperative response and the same questionnaire repeated ninety-six hours later. The internal consistency was high (Cronbach's alpha value: Preoperative = 0.88; Postoperative = 0.86). The authors observed a significant improvement in response for all individual questions in the postoperative phase as compared with preoperative situation (t-student test - p < 0.05). Conclusion: The Portuguese version of "The Utrecht questionnaire for outcome assessment in aesthetic rhinoplasty" is a valid instrument to assess patients' outcomes following rhinoplasty surgery.

Resumo Introdução: A avaliação do resultado cirúrgico medido pela satisfação do paciente ou qualidade de vida é muito importante, especialmente na cirurgia plástica, uma especialidade na qual há um crescente interesse na avaliação de resultados por auto‐relato. Objetivo: O objetivo deste estudo foi realizar a tradução, a adaptação transcultural e a validação do questionário "The Utrecht questionnaire for outcome assessment in aesthetic rhinoplasty", do inglês para português. Método: Estudo retrospectivo envolvendo 50 pacientes submetidos a rinoplastia comparando o período pré‐operatório com a situação atual (mínimo de 6 meses e máximo de 24 meses de pós‐operatório). A análise estatística foi realizada para avaliar a consistência interna, confiabilidade teste‐reteste, validade e capacidade de resposta. Resultados: Nenhum paciente recebeu pontuação negativa na escala visual analógica ao comparar a aparência pré‐ e pós‐operatória. A melhora pós‐operatória na escala visual analógica revelou uma curva gaussiana de distribuição normal, com melhora média de 4,44 pontos. A confiabilidade teste‐reteste mostrou uma correlação positiva entre a resposta pós‐operatória e o mesmo questionário repetido noventa e seis horas depois. A consistência interna foi alta (valor do alfa de Cronbach: pré‐operatório = 0,88; pós‐operatório = 0,86). Os autores observaram uma melhora significante nas respostas para todas as questões individuais na fase pós‐operatória em comparação com a situação pré‐operatória (teste t de Student - p < 0,05). Conclusão: A versão em português do "The Utrecht questionnaire for outcome assessment in aesthetic rhinoplasty" é um instrumento válido para avaliar os resultados do paciente após a cirurgia de rinoplastia.

Spare roof technique in reduction rhinoplasty: Prospective study of the first one hundred patients.

OBJECTIVE: Assess the aesthetic and functional outcomes of the first 100 patients who underwent reduction rhinoplasty with the spare roof technique (SRT). METHODS: Prospective, interventional, and longitudinal study performed on consecutive patients undergoing primary rhinoplasty by SRT. All the surgical procedures were performed by the surgeon who first described this technique. The validated Portuguese version of the Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty was used. Patients completed the questionnaire presurgery and again 3 and 12 months postsurgery. In addition, a visual analogue scale (VAS) was used to score nasal patency for both sides. RESULTS: The study population included 100 Caucasian Mediterranean patients (33 males; 67 females). Mean age at surgery was 32.8 years. Analysis of the preoperative and postoperative mean aesthetic VAS scores showed a significant improvement from 3.67 to 8.1 (P < 0.001) and 8.44 (P < 0.001), respectively, 3 and 12 months postsurgery. Analysis of the five aesthetic Likert scale questions all showed a highly significant improvement after rhinoplasty. The mean preoperative aesthetic sum score was 13.9, which improved to 8.26 and 7.08, respectively, 3 and 12 months postsurgery (P < 0.001), indicating a significant improvement of subjective body image in relation to nasal appearance. Analysis of the preoperative and postoperative mean functional VAS score showed a significant improvement on both sides. CONCLUSION: This prospective statistical study confirms that SRT significantly improved patient quality of life regarding nose function and appearance. It is a reliable technique that can help deliver consistently good results in reduction rhinoplasty in Caucasian patients with dorsal hump seeking rhinoplasty. LEVEL OF EVIDENCE: 2 Laryngoscope, 129:2702-2706, 2019.

The Portuguese version of "The Utrecht questionnaire for outcome assessment in aesthetic rhinoplasty": validation and clinical application.

INTRODUCTION: The evaluation of surgical outcomes measured by patient satisfaction or quality of life is very important, especially in plastic surgery. There is increasing interest in self-reporting outcomes evaluation in plastic surgery. OBJECTIVE: The aim of this study was to perform the translation, cross-cultural adaptation and validation of "The Utrecht questionnaire for outcome assessment in aesthetic rhinoplasty" from English to Portuguese. METHODS: Retrospective study involving 50 patients undergoing to rhinoplasty comparing the preoperative period with the current postoperative situation (minimum 6 months and maximum 24 months postoperatively). Statistical analysis was performed to assess internal consistency, test-retest reliability, validity and responsiveness. RESULTS: No patients received a negative score on the visual analogue scale comparing preoperative and postoperative appearance. The postoperative improvement on the visual analogue scale revealed a Gaussian curve of normal distribution with a mean improvement of 4.44 points. The test-retest reliability showed a positive correlation between the postoperative response and the same questionnaire repeated ninety-six hours later. The internal consistency was high (Cronbach's alpha value: Preoperative=0.88; Postoperative=0.86). The authors observed a significant improvement in response for all individual questions in the postoperative phase as compared with preoperative situation (t-student test - p<0.05). CONCLUSION: The Portuguese version of "The Utrecht questionnaire for outcome assessment in aesthetic rhinoplasty" is a valid instrument to assess patients' outcomes following rhinoplasty surgery.

Rhinoplasty-Do Patients and Surgeons See the Same? A Double-Blind Study with 100 Randomized Patients.

One of the key points of a successful rhinoplasty is communication between the patient and surgeon. The surgeon needs to get a clear understanding of the patient's motivation for surgery and expectations of the procedure. This information is mandatory in formulating an optimal surgical plan and managing realistic expectations of the procedures. Ideally, surgeons and patients see, discuss, and quantify the same nasal defects. In reality, the subjective nature of perceiving aesthetics can cause variability of inter-rating nasal appearance. Therefore, one might question how well surgeons understand their patients. Do they see what patients see? The aim of this study is to assess the level of agreement on the evaluation of nasal appearance between patients, surgeons, and nonphysicians observers, and try to find predictive factors that cause high interobserver variability. This prospective, observational, and cross-sectional study was performed on a total of 100 randomized patients undergoing rhinoplasty. All patients were photographed before surgery and asked to rate the appearance of their nose on a 10 cm visual analogue scale (VAS) with 0 indicating very ugly and 10 indicating very nice. Subsequently, the photographs of each patient were, independently, rated by two panels: one constituted by two rhinoplasty surgeons and the other by four nonmedical raters. Both panels included European raters from the north (The Netherlands) and south (Portugal). Data regarding age, gender, skin type, and major nasal deformity were also collected. The authors found that there is no statistical agreement between the aesthetical evaluation of the nose between patients and surgeons or patients and nonmedical raters. Based exclusively on the VAS for subjective evaluation of nasal appearance, the authors' findings show that surgeons and patients do not "see the same" and generally, the score attributed by the surgeon is more favorable (almost 1 point higher) than the auto-assessment's score. This is important to realize when communicating about nasal appearance before rhinoplasty.

Evaluation of aesthetic and functional outcomes in rhinoplasty surgery: a prospective study / Avaliação dos desfechos estéticos e funcionais em cirurgia de rinoplastia: um estudo prospectivo

Abstract Introduction: Evaluation of surgery outcome measured by patient satisfaction or quality of life is very important, especially in plastic surgery. There is increasing interest in self-reporting outcomes evaluation in plastic surgery. Objective: The aim of our study was to determine patient satisfaction in regard to nose appearance and function with the use of a validated questionnaire, before and after rhinoplasty surgery. Methods: A prospective study was realized at a tertiary centre. All rhinoplasty surgeries performed in adults between February 2013 and August 2014 were included. Many patients underwent additional nasal surgery such as septoplasty or turbinoplasty. The surgical procedures and patients' characteristics were also recorded. Results: Among 113 patients, 107 completed the questionnaires and the follow-up period. Analysis of pre-operative and post-operative Rhinoplasty Evaluation Outcome showed a significant improvement after 3 and 6 months in functional and aesthetic questions (p < 0.01). In the pre-operative, patients anxious and insecure had a worse score (p < 0.05). Difference in improvement of scores was not significant when groups were divided on basis of other nasal procedures, primary or revision surgery and open versus closed approach. Conclusion: We found that patients with lower literacy degree were more satisfied with the procedure. Rhinoplasty surgery significantly improved patient quality of life regarding nose function and appearance.

Resumo Introdução: A avaliação do desfecho de cirurgia medido pela satisfação ou qualidade de vida do paciente é muito importante, especialmente em cirurgia plástica. Existe um interesse crescente na autoavaliação de desfechos nesta especialidade cirúrgica. Objetivo: O objetivo deste estudo foi determinar a satisfação do paciente em relação à aparência e função do nariz com o uso de um questionário validado, antes e depois da cirurgia de rinoplastia. Método: Estudo prospectivo realizado em um centro terciário. Todas as cirurgias de rinoplastia feitas em adultos entre fevereiro de 2013 e agosto de 2014 foram incluídas. Muitos pacientes foram submetidos à cirurgia nasal adicional, como septoplastia ou turbinoplastia. Os procedimentos cirúrgicos e as características dos pacientes também foram registrados. Resultados: Entre 113 pacientes, 107 completaram os questionários e o período de acompanhamento. A análise da avaliação do desfecho de rinoplastia (ADR) no pré-operatório e pós-operatório mostrou uma melhoria significativa após 3 e 6 meses em questões funcionais e estéticas (p < 0,01). No pré-operatório, os pacientes ansiosos e inseguros apresentaram um escore pior (p < 0,05). A diferença na melhoria dos escores não foi significativa quando os grupos foram divididos com base em outros procedimentos nasais, cirurgia primária ou revisão e abordagem aberta versus fechada. Conclusão: Verificou-se que pacientes com menor grau de alfabetização estavam mais satisfeitos com o procedimento. A cirurgia de rinoplastia melhorou significativamente a qualidade de vida do paciente quanto à função e ao aspecto do nariz.

Congenital defects of the middle ear - uncommon cause of pediatric hearing loss / Malformações congênitas da orelha média - causa rara de hipoacusia pediátrica

INTRODUCTION: In children, hypoacusis, or conductive hearing loss, is usually acquired; otitis media with effusion is the most common etiology. However, in some cases this condition is congenital, ranging from deformities of the external and middle ear to isolated ossicular chain malformations. The non-ossicular anomalies of the middle ear, for instance, persistent stapedial artery and anomaly of the facial nerve, are uncommon but may accompany the ossicular defects. OBJECTIVE: This study aimed to describe the clinical presentation, diagnostic tests, and therapeutic options of congenital malformations of the middle ear. METHODS: This was a retrospective study of cases followed in otolaryngologic consultations since 2007 with the diagnosis of congenital malformation of the middle ear according to the Teunissen and Cremers classification. A review of the literature regarding the congenital malformation of the middle ear and its treatment is presented. CONCLUSION: Middle ear malformations are rarely responsible for conductive hearing loss in children. As a result, there is often a late diagnosis and treatment of these anomalies, which can lead to delays in the development of language and learning. .

INTRODUÇÃO: Na criança, a hipoacusia de condução é geralmente adquirida, sendo a otite média com efusão a etiologia mais comum. No entanto, em alguns casos é congênita, decorrente desde de deformidades das orelhas média e externa até malformações isoladas da cadeia ossicular. As anomalias não ossiculares da orelha média, como a persistência da artéria estapédica e a alteração do percurso do nervo facial, são incomuns, podendo acompanhar as malformações ossiculares. OBJETIVO: Este estudo tem como objetivo descrever a apresentação clínica, os meios auxiliares de diagnóstico e opções terapêuticas das malformações congênitas da orelha média. MÉTODOS: Os autores apresentam um estudo retrospectivo de casos de malformação congênita da orelha média diagnosticados de acordo com a classificação de Teunissen e Cremers, acompanhados em consultas otorrinolaringológicas desde 2007. É também apresentada uma revisão da literatura sobre malformações congênitas da orelha média e seu tratamento. CONCLUSÃO: As malformações da orelha média são raramente responsáveis pela hipoacusia de condução nas crianças. A demora no diagnóstico e tratamento pode levar a atrasos na linguagem e na aprendizagem. .