Brazilian Journal of Otorhinolaryngology
Latest articles in this journal
Brazilian Journal of Otorhinolaryngology; doi:10.1016/j.bjorl.2021.03.002
Neurological alterations can generate swallowing disorders and fiberoptic endoscopic evaluation of swallowing is one of the tests performed for its diagnosis, as well as assistance in dysphagia management. To identify and describe a fiberoptic endoscopic evaluation of swallowing standardized protocol for the neurological adult population and its stages. Systematic review registered on the PROSPERO platform (CRD42018069428), carried out on the websites: MEDLINE, Cochrane Library and Scielo; published between 2009 and 2020. Randomized clinical trials, cross-sectional, and longitudinal studies were included. Two independent judges evaluated the study design and extracted the data from the selected studies. Doubts regarding inclusion or not of the studies were evaluated by a third judge. Scientific articles included were those with adult neurological remained patients with outcomes: (1) diagnosis of swallowing disorder (2) change in sensitivity in laryngeal region (3) penetration of food offered (4) aspiration of food offered. 3724 articles were initially selected, after personalized search for patients with neurological alterations 101 studies remained. In the end, 21 qualitative studies from 2009 to 2020 remained in the systematic review and they were described in detail and compared. Seven articles used protocols of the institutions in which the research took place and four mentioned using the same protocol. The reliable reproducibility of the protocols is feasible only in three of the articles, even presenting different protocols. There is no standard or validated protocol to assess the swallowing function of adults with neurological diseases.
Brazilian Journal of Otorhinolaryngology; doi:10.1016/j.bjorl.2021.03.007
Brazilian Journal of Otorhinolaryngology; doi:10.1016/j.bjorl.2021.03.003
Severe uncontrolled chronic rhinosinusitis with nasal polyps has a negative impact on an individual’s quality of life. Therefore, new biologics have emerged for use in specific phenotypes of chronic rhinosinusitis, changing the paradigms of its treatment. To review the current status of biologic treatment indications in chronic rhinosinusitis. The Brazilian Academy of Rhinology brought together different specialists to suggest a course of action, considering its particularities and aspects related to the national reality. Of particular interest for decision making will be the identification of subgroups of patients refractory to pre-existing treatment options and the construction of a strategy that improves their quality of life, with the best cost-benefit ratio. The use of biologics is a valid option for treatment in more severe cases. This strategy must be better understood and improved in the future, with more studies and greater clinical experience.
Brazilian Journal of Otorhinolaryngology; doi:10.1016/j.bjorl.2021.03.004
Malnutrition is a common issue in patients with head and neck squamous cell carcinoma and has a negative effect on surgical outcomes. We attempted to determine which malnutrition diagnostic variables can be used as predictors of postoperative complications in patients with head and neck squamous cell carcinoma. Forty-one patients undergoing surgery for head and neck squamous cell carcinoma were submitted to a prospective evaluation. Biochemical data, anthropometric measurements and evaluation of body composition were used in the nutritional analysis. Twenty-two patients (53.6%) developed complications. Serum albumin measured on the first postoperative day was the only variable that significantly differed between groups. A cut-off value of 2.8 g/dL distinguished between patients with a complicated and uncomplicated postoperative course. Normalization of albumin levels occurred more frequently and more rapidly in the noncomplicated group. Serum albumin measured on the first postoperative day was the only variable that was a predicter of postoperative complications after major head and neck squamous cell carcinoma surgery.
Brazilian Journal of Otorhinolaryngology; doi:10.1016/j.bjorl.2021.03.008
Brazilian Journal of Otorhinolaryngology; doi:10.1016/j.bjorl.2021.02.006
The classification of odontogenic tumors has been revised from time to time in order to provide unified terminology. This reclassification had considerable impact on their prevalence and frequency distribution. This study was aimed to emphasize impact of changing classification systems on prevalence and relative frequency of odontogenic tumors. The secondary objective was to analyze demographics of various histological types of odontogenic tumors in comparison to published literature. Review of Indian studies (1992–2020) elaborating frequency of odontogenic tumors is summarized in the end. This was a hospital-based retrospective study wherein case files of odontogenic tumors diagnosed from 1990 to 2019 period were retrieved. The classification system used originally at the time of diagnosis was retained and prevalence of odontogenic tumors in three different periods (1990–2004, 2005–2016 and 2017–2019) was compared. Further, prevalence, frequency distribution and demographics of all these tumors (1990–2019) were analyzed using latest World Health Organization 2017 classification. A total of 345 odontogenic tumors was diagnosed as per World Health Organization 2017 system of classification from 1990 to 2019. 96.81% tumors were benign and 3.81% constituted malignant odontogenic tumors. However, there was marked increase in prevalence of odontogenic tumors in 2005–2016 (6.2%) period as compared to 1990–2004 (3.87%) and 2017–2019 (3.47%). Ameloblastoma remained the most common tumor in three different periods, whereas keratocystic odontogenic tumor became second commonest tumor in 2005–2016 as compared to odontoma in 1990–2004 and adenomatoid odontogenic tumor in 2017–2019. The continuous evolving systems of classification may partly be responsible for inconsistency in odontogenic tumors, with inclusion of keratocystic odontogenic tumor,and has marked impact on prevalence and frequency distribution of odontogenic tumors. The geographical variations in demographics of odontogenic tumors might reflect genetic and environment influence; however it requires elucidation by further studies.
Brazilian Journal of Otorhinolaryngology; doi:10.1016/j.bjorl.2021.01.008
Children with developmental language disorder have been reported to have poor temporal auditory processing. This study aimed to examine the frequency following response. This work aimed to investigate speech processing in quiet and in noise. Two groups of children were included in this work: the control group (15 children with normal language development) and the study group (25 children diagnosed with developmental language disorder). All children were submitted to intelligence scale, language assessment, full audiological evaluation, and frequency following response in quiet and noise (+5QNR and +10QNR). Results showed no statically significant difference between both groups as regards IQ or PTA. In the study group, the advanced analysis of frequency following response showed reduced F0 and F2 amplitudes. Results also showed that noise has an impact on both the transient and sustained components of the frequency following response in the same group. Children with developmental language disorder have difficulty in speech processing especially in the presence of background noise. Frequency following response is an efficient procedure that can be used to address speech processing problems in children with developmental language disorder.
Brazilian Journal of Otorhinolaryngology; doi:10.1016/j.bjorl.2021.02.014
In surgical training, large animal models are more suitable as their anatomy is more similar to humans. In otology, there have been relatively few studies about large animal models for surgical training. In this study, we aimed to do a neuroradiologic evaluation and surgical insertion of a cochlear implant electrode array on a sheep head model. Twenty cadaveric sheep heads were studied. A computed tomography scan and neuroradiologic evaluation was performed on each head, obtaining measurements of the inner ear for each sheep. Sheep measurements were compared to those from temporal bone computed tomography scans from 20 female humans. Surgical procedures were first trained with 13 of the sheep temporal bones, after which cochlear implantation was performed on the remaining 7 temporal bones. The position of the inserted electrode array insertion was confirmed by computed tomography scan after the procedure. Neuroradiologic evaluation showed that, relative to the 20 female humans, the mean ratio for sheep was 0.60 for volume of cochlea, 0.70 for height of cochlea, 0.73 for length of cochlea; ratios for other metrics were >0.80. For the surgical training, the round window was found in all 20 sheep temporal bones. Computed tomography scans confirmed that electrode insertions were fully complete; the mean value of electrode array insertion was 18.3 mm. The neuroradiologic and surgical training data suggest that the sheep is a realistic animal model to train cochlear implant surgery and collection of perilymph samples, but less so for surgical training of mastoidectomy due to pneumatization of the mastoid.
Brazilian Journal of Otorhinolaryngology; doi:10.1016/j.bjorl.2021.02.004
The diagnosis of vestibular neuritis is based on clinical and laboratory findings after exclusion of other disease. There are occasional discrepancies between clinical impressions and laboratory results. It could be the first vertigo episode caused by other recurrent vestibular disease, other than vestibular neuritis. This study aimed to analyze the clinical features and identify the diagnostic evolution of patients with clinically suspected vestibular neuritis. A total of 201 patients clinically diagnosed with vestibular neuritis were included in this study. Clinical data on the symptoms and signs of vertigo along with the results of vestibular function test were analyzed retrospectively. Patients were categorized in terms of the results of caloric testing (CP - canal paresis) group; canal paresis ≥25%; (MCP -minimal canal paresis) group; canal paresis <25%). Clinical features were compared between the two groups and the final diagnosis was reviewed after long-term follow up of both groups. Out of 201 patients, 57 showed minimal canal paresis (CP < 25%) and 144 showed definite canal paresis (CP ≥ 25%). A total of 48 patients (23.8%) experienced another vertigo episode and were re-diagnosed. Recurring vestibular symptoms were seen more frequently in patients with minimal canal paresis (p = 0.027). Repeated symptoms were observed on the same affected side more frequently in the CP group. The proportion of final diagnosis were not different between two groups. Patients with minimal CP are more likely to have recurrent vertigo than patients with definite CP. There was no significant difference in the distribution of the final diagnoses between two groups when the vertigo recurs.
Brazilian Journal of Otorhinolaryngology; doi:10.1016/j.bjorl.2021.02.009
Lysyl oxidase-like 4 is an amine oxidase from the lysyl oxidase family that was previously shown to be overexpressed in head and neck cancer and upregulated in response to hypoxia. The possible role of lysyl oxidase-like 4 as a tumor marker in advanced stage larynx cancer was investigated. To investigate the expression of lysyl Oxidase-Like 4 protein in advanced stage laryngeal cancer and elucidate its possible role as a tumor marker, predictor of treatment response and prognosticator. Diagnostic specimens of 72 patients treated for stage III–IV laryngeal squamous cell carcinoma were evaluated for lysyl oxidase-like 4 expression by immunohistochemistry. Lysyl oxidase-like 4 expression was correlated with advanced tumor stage (p = 0.041) and better differentiation (p = 0.025) but was independent of tumor diameter (p = 0.456). Response to induction chemotherapy or the need for salvage laryngectomy were not affected by lysyl oxidase-like 4 expression (p = 0.999, p = 0.070 respectively). Increased lysyl oxidase-like 4 expression was associated with better 2 year overall survival in both univariate (p = 0.036) and multivariate analyses (p = 0.014). Lysyl oxidase-like 4 expression emerges with advancing stages, is lost with worsening differentiation, and may have tumor suppressive properties in larynx cancer.