Evaluation of post-tonsillectomy hemorrhage and assessment of risk factors.

PURPOSE: Tonsillectomy is one of the most common surgical procedures in otorhinolaryngology. Hemorrhage in the postoperative period has an incidence of up to 20% and is a potentially fatal complication. We aim to assess the incidence of hemorrhage after tonsillectomy in our institution, and to evaluate and identify the possible associated risk factors. METHODS: This retrospective study included 897 patients who underwent tonsillectomy between January 2015 and December 2018, 50.7% women and 49.3% men, aged between 2 and 83 years. No coagulopathies were identified. Comparison of age, gender, surgical indication, coagulation profile, concomitant adenoidectomy, surgical technique, surgeon's experience and hemostasis method between groups with and without post-operative bleeding was made. RESULTS: Our incidence of post-tonsillectomy hemorrhage was 6%. Most patients (83.3%) had secondary bleeding (> 24 h after surgery). In 22.2% of the bleeding cases, it was necessary to revise the hemostasis in the operating room. Adulthood (age ≥ 18 years) (p < 0.001), INR values ≥ 1.2 (p = 0.014), aPTT values ≥ 35 s (p = 0.001), as well as concomitant adenoidectomy (p < 0.001) were the predictors of post-tonsillectomy bleeding. CONCLUSION: Recognition of adult age, INR ≥ 1.2, aPTT ≥ 35 s and concomitant adenoidectomy as risk factors can be useful in identifying the patients at higher risk for bleeding complications.

Tinnitus, hearing loss and inflammatory processes in an older Portuguese population.

Objective: Tinnitus is associated with various conditions such as presbycusis, infectious, autoimmune and many other diseases. Our study aims to identify an association between inflammatory markers and the presence of tinnitus or hearing loss (HL).Design: Exploratory study including a structured interview, complete ENT observation, audiological and inflammatory markers evaluation.Study Sample: Sixty women and 54 men (55 to 75 years) from the Portuguese population, with or without sensory presbycusis and/or tinnitus.Results: IL10 levels were significantly lower in participants with tinnitus than in those without tinnitus. Moreover, TGF-ß was lower in older participants (p = 0.034), IL1α was higher in participants with tonal tinnitus (p = 0.033), and IL2 was lower in participants who reported partial or complete residual inhibition (p = 0.019). Additionally, we observed a negative correlation between tinnitus duration and IL10 levels (r= -.281), and between HSP70 levels and tinnitus loudness (r= -.377). TNF-α and HSP70 levels appears to be sensitive to the time when samples were collected (morning or afternoon).Conclusions: The results of our study showing fluctuations in inflammatory markers along the hearing loss process, reinforce the idea that inflammatory mechanisms are involved in hearing loss pathogenesis but also in tinnitus. IL10 levels appear significantly altered in tinnitus but not in hearing loss.

Audiological biomarkers of tinnitus in an older Portuguese population.

Tinnitus is a phantom sound perceived in the absence of external acoustic stimulation. It is described in a variety of ways (e.g., buzzing, ringing, and roaring) and can be a single sound or a combination of different sounds. Our study evaluated associations between audiological parameters and the presence or severity of tinnitus, to improve tinnitus diagnosis, treatment, and prognosis. Our sample included 122 older participants (63 women and 59 men), aged 55-75 years from the Portuguese population, with or without sensory presbycusis and with or without tinnitus. All participants underwent a clinical evaluation through a structured interview, Ear, Nose, and Throat observation, and audiological evaluation (standard and extended audiometry, psychoacoustic tinnitus evaluation, auditory brainstem responses, and distortion product otoacoustic emissions). The Tinnitus Handicap Inventory was used to measure tinnitus symptom severity. Our data confirmed that the odds of developing tinnitus were significantly higher in the presence of noise exposure and hearing loss. Also, participants who had abrupt tinnitus onset and moderate or severe hyperacusis featured higher odds of at least moderate tinnitus. However, it was in the ABR that we obtained the most exciting and promising results, namely, in wave I, which was the common denominator in all findings. The increase in wave I amplitude is a protective factor to the odds of having tinnitus. Concerning the severity of tinnitus, the logistic regression model showed that for each unit of increase in the mean ratio V/I of ABR, the likelihood of having at least moderate tinnitus was 10% higher. Advancing knowledge concerning potential tinnitus audiological biomarkers can be crucial for the adequate diagnosis and treatment of tinnitus.

Evidence for biological markers of tinnitus: A systematic review.

Subjective tinnitus is a phantom sound heard only by the affected person and may be a symptom of various diseases. Tinnitus diagnosis and monitoring is based on subjective audiometric and psychometric methods. This review aimed to synthesize evidence for tinnitus presence or its severity. We searched several electronic databases, citation searches of the included primary studies through Web of Science, and further hand searches. At least two authors performed all systematic review steps. Sixty-two records were included and were categorized according the biological variable. Evidence for possible tinnitus biomarkers come from oxidative stress, interleukins, steroids and neurotransmitters categories. We found conflicting evidence for full blood count, vitamins, lipid profile, neurotrophic factors, or inorganic ions. There was no evidence for an association between tinnitus and the remaining categories. The current review evidences that larger studies, with stricter exclusion criteria and powerful harmonized methodological design are needed. Protocol published on PROSPERO (CRD42017070998).

Deep neck cellulitis: a challenging diagnosis.

A 38-year-old woman with Crohn's disease, under immunosuppressive therapy, was referred to the emergency department for severe progressive neck pain and fever, with 1 week of evolution. She was unable to perform neck mobilisation due to the intense pain aroused. She referred dysphagia. Oral cavity, oropharynx, hypopharynx and larynx showed no alterations. She had an increased C reactive protein. Central nervous system infections were excluded by lumbar puncture. CT was normal. Only MRI showed T2 hyperintensity of the retropharyngeal and prevertebral soft tissues of the neck without signs of abscess. The patient was treated with broad spectrum antibiotics. Complications of deep neck infection include abscess formation, venous thrombosis and mediastinitis. In this case, no complications occurred. A high degree of clinical suspicion is essential as deep neck infections need to be promptly diagnosed and treated given their rapidly progressive character, especially in immunocompromised patients.

Angiomatous ethmoidochoanal polyp in an infant: case report.

Nasal polyps are rare in children younger than 10 years. We describe the case of an infant girl who had undergone a traumatic intubation at birth that had resulted in nasal bleeding. At the age of 5 months, she was brought to us with an obstructive left nasal mass. Imaging revealed the presence of an ethmoidochoanal polyp, as well as a fracture of the posterior cribriform plate and a small associated meningocele. Four months later, the polyp was excised, and the meningocele was corrected with endoscopic nasal surgery. Pathologic evaluation identified the lesion as an angiomatous polyp, which was probably related to the previous traumatic episode. We discuss the clinical aspects of a pathologic entity that has not been previously reported in an infant.

Sarcoma de Ewing: una rareza en la región nasosinusal / Ewing's sarcoma: A rarity in sinonasal region

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