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Abstract Introduction Aural polyps are a misnomer. Any lesion can present as a mass in the external auditory canal. Aural polyps are proliferation of the granulation tissue due to long standing inflammatory process with associated otalgia and otorrhea. Objectives To document the clinicoradiological presentations, intraoperative findings, and histopathological diagnosis of aural polyp, correlating them. Methods In our study 81 patients underwent treatment for aural polyps in the department of Ear, Nose, and Throat (ENT) from April 1997 to April 2022. Results were tabulated, a simple descriptive analysis was done using the Statistical Package Social Sciences software, and the results obtained were represented as percentages and presented in tables. Results The majority (38) of the patients presenting with aural polyps were diagnosed with mucosal and squamous type of CSOM, and 22 with simple granulation polyps. There were also 5 patients with malignant otitis externa, 3 patients had glomus tumors, 2 patients with retained foreign bodies, and 3 patients with brain herniation. We also identified aberrant internal carotid artery, high jugular bulb, one patient had facial nerve neuroma, one patient had polyp from the tragus diagnosed with tuberculosis, one patient with keratosis obturans, and one with exostosis. Conclusion A thorough detailed examination and mastoid exploration with radiological and histopathological evaluation is mandatory for better defining the definitive treatment. Utmost care and meticulousness are advised for the surgeons while dealing with aural polyps to avoid any complications.

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Abstract Introduction Teachers are a high-risk group for the development of vocal dysfunction, as they use voice extensively in their profession. Objective To know the prevalence and risk factors associated with voice strain in teachers. Methods A cross-sectional study was conducted among schoolteachers in Chitwan, Nepal. The Voice Handicap Index questionnaire was used as a survey tool. Result A total of 315 teachers were enrolled in the study. The mean age of the participants was of 36.7 years. Teachers from public schools, primary grade classes, > 50 pupils in the classroom, > 24 hours of classes per week, dust in class, and recurrent tonsil problems were associated with various degrees of vocal handicap. Conclusion There is a high prevalence of voice disorder among teachers. A holistic approach, which includes teacher education regarding voice care during their work and management of their voice handicap by taking into consideration different risk factors, must be adopted.

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Abstract Introduction Myringoplasty is a common otologic procedure to restore the integrity of the tympanic membrane in cases of traumatic or pathologic perforations. Many grafting materials have been used with different techniques. Objective In the present work, we evaluate the surgical and audiological outcomes of periosteal graft overlying the mastoid cortex through a retroauricular incision in a pediatric cohort. Methods A retrospective study was carried out involving all children aged ≤ 16 years who underwent periosteal graft myringoplasty for the treatment of chronic suppurative otitis media with dry central perforation in our hospital from April 2019 to April 2021. All patients were followed up for one year to assess the anatomical success and functional outcomes by comparing the preoperative and postoperative (after six months) results of pure tone audiometry (PTA). Results The sample was composed of 36 patients; 20 of them were female (55.6%) and 16 were male (44.4%) subjects, with ages ranging from 7 to 16 (mean: 12.7) years. Four patients underwent surgery in both ears (with an interval of 6 to 9 months). Out of 40 surgeries performed, 38 ears have shown anatomical success (95%). A highly significant improvement in hearing was obtained (the mean difference between the pre- and postoperative results of the PTA was of 14.6 ± 3.45 dB (p < 0.001). Conclusion We advocate the use of periosteal graft in the pediatric population as a good alternative for other types of grafts, with comparable and even better functional and anatomical outcomes.

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Abstract Introduction One of the paths in the investigation of congenital sensorineural hearing loss (CSNHL) is to try to characterize its etiology through the inner ear evaluation using high resolution computer tomography (CT) scans. With minor malformation, it is not always possible for a simple visual inspection to recognize if the structure in the inner ear is normal or not. Objective To verify if measurements of the inner ear are predictive of sensorineural hearing loss (SNHL) and suggest cutoff points of size limits. Methods Retrospective cross-sectional study of inner ear CT scan measurements of 214 patients, 50 with congenital SNHL (CSNHL) and 164 acquired SNHL (ASNHL) (control group). Results In the CSNHL group, central bony island (CBI) were 0.48 mm smaller (p < 0.001), cochlear nerve aperture was (CNA) 0.10 mm smaller (p < 0.001), and cochlea height was (CH) 0.15 mm smaller (p < 0.001). Vestibular aqueduct (VA) and cochlea width (CW) were similar between groups (0.70 vs 0.72, p = 0.19, and 7.20 vs 7.15 p = 0.23). The predictive cutoff points for CSNHL were CBI = 3.6 mm, CAN = 1.4 mm, CH = 3.4 mm, CW = 7.0 mm, and VA = 0.9 mm. Conclusion Congenital sensorineural hearing loss determined a decrease in CBI, opening of the cochlear nerve (OCN), and CW. Thus, these measures, at the cutoff points indicated, should make us aware of the diagnosis of congenital hearing loss.

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Abstract Introduction Functional endoscopic sinus surgery and endoscopic skull base surgery are frequently performed surgeries today. Nasal septal deviation is a common finding and can affect the surgical area. Therefore, it is important to examine the effect of this deviation on other anatomical structures. Objectıve The aim of the present study was to determine whether there is a relationship between the degree of nasal septal deviation and anterior skull base structures using computed tomography (CT). Methods A total of 312 patients (aged 18 to 65 years old) whose paranasal sinus CT images were available were included in the study. Measurements were obtained on images retrieved from Picture Archiving and Communication System (PACS) and Horos image archive systems in the bone window in the coronal and axial plane. Results The mean age of 312 patients was 33.00 years old (standard deviation [SD] 11.22 years). The presence of septal deviation was not associated with changes in olfactory fossa (OF) depths, Keros degrees, and the angle between the lateral lamella and the cribriform lamella. However, OF depths and Keros degrees on the deviated side of the septum were found to change at a significant level (p < 0.05). No significant association was observed between the degree of septal deviation and cribriform lamella-lateral lamella angle. Conclusion The study showed significantly increased OF depth and Keros degree on the deviated side of the nasal septum. Performing CT scans before endoscopic sinus surgery and endoscopic skull base surgery is important to increase the chances of a successful surgical outcome and to reduce complications.

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Abstract Introduction Eagle syndrome is a rare and an often misdiagnosed entity in otorhinolaryngology. Objective To determine the efficacy of the surgical treatment for Eagle syndrome. Methods The present prospective study included 25 patients who presented with complaints of pain in the throat, ear, and neck, as well as difficulty and/or pain while swallowing; they were assessed for Eagle syndrome. As per patient profile, we performed a clinical assessments along with orthopantomograms (OPGs), three-dimensional computed tomography (3D CT) scans, and cone beam computed tomography (CBCT). Pain was assessed pre- and postoperatively through the Numerical Rating Scale-11 (NRS-11), whose score ranges from 0 to 10. Microscopic tonsillo-styloidectomy was performed in cases in which the conservative treatment failed to relieve pain. Results The mean age of the entire study population was of 36.08 ± 7.19 years, and the male-to-female ratio was of 1.08:1. Referred otalgia was the commonest (44%) complaint. Radiologically, out of 25 patients, 20 patients presented elongated styloid processes. The longest symptomatic styloid process measured radiographically was of 64.7 mm while the shortest was of 28.2 mm. Out of 20 patients, 12 underwent surgery. The postoperative pain assessment through the NRS-11 was performed on day 0 (3.83 ± 0.83), day 7 (1.5 ± 0.52), week 4 (0.5 ± 0.52), and week 12 (0.41 ± 0.51). By 12 weeks, 7 patients were symptom-free, while 5 patients still reported mild pain. Conclusion Eagle syndrome associated with an elongated styloid process is not a rarity, but it often goes undiagnosed. Microscopic tonsillo-styloidectomy shows excellent results in the management of patients with Eagle syndrome.

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Abstract Introduction The optimal time for tracheostomy changes is unknown. Most surgeons opt to wait until five to seven days postoperatively, while more recent studies suggest that changes occurring as early as two to three days postoperatively are also safe. Objective To evaluate the safety of changing the tracheostomy tube later than 14 days postoperatively. Methods The charts of patients who underwent tracheostomy placement and change at a tertiary care center from 2015 to 2019 were retrospectively reviewed, and the subjects were divided into 2 cohorts (late and very late), depending on the time of the first tracheostomy change. Results The study included 198 patients, 53 of whom aged between 0 and 18 years, and 145, aged > 18 years. The time until the first tracheostomy change was on average of 131.1 days. The most common indication for tracheostomy tube placement was prolonged intubation. Adverse events were observed in 30.8% of the cases (the most common being the formation of granulation tissue), a rate that does not differ much from the incidence reported in the literature (of 34% to 77%) when tracheostomy tubes are changed as early as 3 to 7 days postoperatively. There was no significant difference in the incidence of complications between patients undergoing late and very late changes (p = 0.688), or between pediatric and adult subjects (p = 0.36). There were no significant correlations regarding the time of the first or second change and the incidence of complications (r = −0.014; p = 0.84 for the first change; and r = −0.57; p = 0.64 for the second change). Conclusion The late first tracheostomy tube change was safe and could save resources and decrease the financial burden of frequent changes. It is always crucial to provide adequate information about home tracheostomy care for patients.

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Abstract Introduction When cases of idiopathic sudden sensorineural hearing loss (SSNHL) are treated successfully, most clinicians assume the normality and symmetry of the auditory processing. This assumption is based on the recovery of the detection ability on the part of the patients, but the auditory processing involves much more than detection alone. Since certain studies have suggested a possible involvement of the central auditory system during the acute phase of sudden hearing loss, the present study hypothesized that auditory processing would be asymmetric in people who have experienced sudden hearing loss. Objective To assess the physiologic and electrophysiological conditions of the cochlea and central auditory system, as well as behavioral discrimination, of three primary aspects of sound (intensity, frequency, and time) in subjects with normal ears and ears treated successfully for SSNHL. Methods The study included 19 SSNHL patients whose normal and treated ears were assessed for otoacoustic emissions, speech auditory brainstem response, intensity and pitch discrimination, and temporal resolution in a within-subject design. Results The otoacoustic emissions were poorer in the treated ears compared to the normal ears. Ear- and sex-dependent differences were observed regarding otoacoustic emissions and pitch discrimination. Conclusion The asymmetrical processing observed in the present study was not consistent with the hearing threshold values, which might suggest that the central auditory system would be affected regardless of the status of the peripheral hearing. Further experiments with larger samples, different recovery scenarios after treatment, and other assessments are required.

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Abstract Introduction Diseases of the paranasal sinuses, nasal cavities, and those related to the skull base can be treated with nasal endoscopic surgery. Anatomical references are essential to safely perform these surgeries. Objective To measure and compare the distance from the posterior wall of the maxillary sinus to the anterior skull base in cadavers and on computed tomography (CT) scans to determine a measurement as an anatomical reference in imaging exams for sinus and anterior skull base surgery. Methods In dissections and CT scans, we took measurements from the most upper and medial point of the posterior wall of the maxillary sinus (point A) to the point where the skull base deflects and the anterior sphenoid wall is formed (Δ 90°; point B), in the right and left nasal cavities. We used 51 cadavers aged ≥ 18 years in the present research. Results The measurements obtained from CT scans and dissections were greater than 1.5 cm in all cadavers, and they were positively correlated. The 1-cm increase in the AB-tomography measurement corresponded to the 1.08-cm increase to the right and 1.07-cm to the left in the AB-dissection measurement. Conclusion The CT measurements may be considered a reliable tool to promote safe and effective access to the paranasal sinuses, matching the distance that should be dissected until the anterior base of the skull.

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Abstract Introduction Juvenile nasopharyngeal angiofibroma (JNA) is a benign vascularized tumor that affects almost exclusively male adolescents. Surgery is the treatment of choice for JNA. Objectives The present study is a 42-year retrospective review of a series of JNA cases treated surgically without previous embolization. Methods The present is a retrospective, descriptive study based on medical records of 96 patients with JNA who underwent microscopic or endoscopic excision without previous embolization from 1978 to 2020 in a single institution. The patients were categorized according to the Andrews et al. stage, and data were collected on age, gender, tumor staging, surgical approach, affected side, and outcome. Results All patients were male, with an average age of 17 years. The predominant tumor stage consisted of type II, with 52.1%. A total of 33.3% of the patients were submitted to the microscopic technique and 66.7%, to the endonasal technique. The rate of intraoperative blood transfusion was of 17.7%. Conclusion The present study reinforces that resection of JNA in various stages is viable without previous artery embolization.

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Abstract Introduction Tonsillectomy is one of the most common operations performed by otorhinolaryngology surgeons worldwide; however, the insufficient quality of the postoperative pain management and effective posttonsillectomy pain relief remain a clinical dilemma. Objective To evaluate the efficacy of applying bismuth iodine paraffin paste (BIPP) to the dissected fossa as an adjuvant therapy for a better outcome in terms of posttonsillectomy pain management and due to its wound healing properties. Methods The present is a prospective randomized control pilot study with 44 patients aged > 7 years who underwent tonsillectomy. The patients were divided into two groups: the control group and the group that had BIPP applied to the dissected tonsillar fossa. The visual analogue scale score and the post-onsillectomy percentage of tonsillar fossa epithelization were recorded and evaluated. Results Both subjectively and objectively, there a was statistically significant pain-relieving effect in the BIPP group within the first 5 postoperative days (p < 0.05). From postoperative day 3 onward, the dissected area of the tonsillar fossa healed significantly faster in the BIPP group compared with the control group, and it became stable on day 14. Conclusion The topical application of BIPP showed a better pain-relieving effect, it was safe, and hastened wound healing after tonsillectomy.

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Abstract Introduction Despite the evidence against drain placement after thyroidectomy, there is a lack of consensus on drain use in patients with substernal goiter. Objective To assess the factors that increase the likelihood of drain placement and its impact on postoperative hematoma and other 30-day complications among adult patients undergoing thyroidectomy for substernal goiter. Methods A retrospective cohort study that used data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Adult patients (aged ≥ 18 years) who underwent elective thyroidectomy for substernal goiter from 2016 to 2020 were included. Cases with closed suction neck drains placed upon completion of surgery were included in the drain group, and the remaining cases formed the nondrain group. Results A total of 1,229 patients were included (46.5% with drain placement). The factors that increased the likelihood of drain placement included body mass index (BMI) ≥ 30 kg/m2, score between 3 and 5 on the American Society of Anesthesiologists (ASA) physical status classification, sternal split/transthoracic surgical approach, operative time ≥ 90 minutes, and surgery conducted by otolaryngologists. Patients with clean-contaminated or contaminated wound classifications were less likely to be submitted to drain placement. In addition, drain use had no impact on postoperative hematoma formation but was found to independently increase the risk of prolonged length of hospital stay. Conclusion Thyroidectomy without drain placement might be safe for substernal goiter. However, this decision should be individualized for each patient. Level Of Evidence: 3

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Abstract Introduction Permanent education in health aims to ensure that professionals are constantly learning in the workplace and in the last few years institutions resorted to the technology-mediated education modality and new teaching possibilities were explored. In Brazil, between 2017 and 2021, only six articles and five monographs were published about listening effort. Objective The objective of this study was to develop a website with scientific content on the topic listening effort for Speech -Language Therapist and Audiologist with free online access. Methods The study was carried out in five stages: Analysis, contemplating the search for scientific materials to prepare the material. Design, in which the writing and design of the website was carried out. Development, carrying out the adequacy of the online material. Implementation, a stage in which professionals in the area evaluated the quality of the material after consenting to participation through a free and informed consent term. Review, stage in which the researcher analyzed the evaluators' responses. Results The five stages of elaboration of the website were carried out, which was evaluated by professionals in the area. The average of responses to all applied questions rated the website as "superior". Conclusion The website development was validated for online availability.

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Abstract Introduction The presence of foreign bodies in the airways remain a diagnostic challenge to healthcare professionals. They can become life threatening emergencies that require immediate intervention or go unnoticed for weeks and even months. Prevention is best but early recognition remains a critical factor in treatment of foreign body inhalation in children. Objective To study the diagnostic advantages of virtual over rigid bronchoscopy in the evaluation of children with suspected foreign body in the tracheobronchial tree and plan for early management. Methods A crossectional study conducted at a tertiary care hospital & medical college in India. A total 24 patients (0-12-years-old) who presented with complaints of sudden onset of coughing, choking, and breathing difficulty were included during the 2-year duration, from January 2018 to December 2019. All patients underwent virtual and rigid bronchoscopy. Results In 8 patients, foreign bodies detected by virtual bronchoscopy were confirmed by rigid bronchoscopy. There was one case in which virtual bronchoscopy showed no foreign body, but rigid bronchoscopy detected it. In 15 cases virtual and rigid bronchoscopy did not show foreign bodies. The sensitivity, specificity, positive and negative predictive value of virtual bronchoscopy were 88.88, 100, 100, and 93.75%, respectively. Conclusions Virtual bronchoscopy is less invasive and does not require general anesthesia but cost and availability are limitations. It can be used as method of investigation in children with suspected foreign body aspiration.

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Abstract Introduction In clinical practice, patients with the same degree and configuration of hearing loss, or even with normal audiometric thresholds, present substantially different performances in terms of speech perception. This probably happens because other factors, in addition to auditory sensitivity, interfere with speech perception. Thus, studies are needed to investigate the performance of listeners in unfavorable listening conditions to identify the processes that interfere in the speech perception of these subjects. Objective To verify the influence of age, temporal processing, and working memory on speech recognition in noise. Methods Thirty-eight adult and elderly individuals with normal hearing thresholds participated in the study. Participants were divided into two groups: The adult group (G1), composed of 10 individuals aged 21 to 33 years, and the elderly group (G2), with 28 participants aged 60 to 81 years. They underwent audiological assessment with the Portuguese Sentence List Test, Gaps-in-Noise test, Digit Span Memory test, Running Span Task, Corsi Block-Tapping test, and Visual Pattern test. Results The Running Span Task score proved to be a statistically significant predictor of the listening-in-noise variable. This result showed that the difference in performance between groups G1 and G2 in relation to listening in noise is due not only to aging, but also to changes in working memory. Conclusion The study showed that working memory is a predictor of listening performance in noise in individuals with normal hearing, and that this task can provide important information for investigation in individuals who have difficulty hearing in unfavorable environments.

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Abstract Introduction Unplanned hospital returns are frequent and may be preventable. Objective To comprehend the reasons for unplanned hospital readmission and return to the Outpatient Department (OPD) and Emergency Department (ED) within 60 days after discharge following head and neck surgery (HNS) at a tertiary care center in Saudi Arabia. Methods In the present retrospective study, the medical records of all patients who underwent HNS for benign and malignant conditions between January 2015 and June 2022 were reviewed in terms of demographic data, comorbidities, and reasons for hospital return. Results Out of 1,030 cases, 119 (11.55%) returned to the hospital within 60 days after discharge, 19 of which (1.84%) were readmitted. In total, 90 (8.74%) patients returned to the OPD, and 29 (2.82%), to the ED. The common reasons for readmission included infections (26.32%) and neurological symptoms (21.05%). For OPD visits, the common causes were hematoma (20%) and neurological symptoms (14.44%). For ED returns, the frequent causes were neurological symptoms (20.69%) and equipment issues (17.24%). Compared with nonreadmitted patients, readmitted patients had a higher preoperative baseline health burden when examined using the American Society of Anesthesiologists (ASA) score (p = 0.004) and the Cumulative Illness Rating Scale (CIRS; p = 0.002). Conclusion The 60-day rates of unplanned hospital return to the OPD and ED were of 8.74% and 2.82% respectively, and 1.84% of the patients were readmitted. Hematoma, infections, and neurological symptoms were common causes. Addressing the common reasons may be beneficial to decrease postoperative hospital visits.

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Abstract Introduction Adenoidectomy is one of the most common procedures performed by otolaryngologists. Traditional adenoid curettage is performed blindly, which can result in inadequate removal of the adenoid and injury to the surrounding structures. Objective To perform transnasal endoscopic examinations to assess the nasopharynx after conventional curettage adenoidectomy. Methods The present prospective study included 100 children with a mean age of 4.2 ± 3.07 years. It is composed of two steps: conventional curettage adenoidectomy by a resident trainee; and endoscopic evaluation of the nasopharynx through a 0° telescope to assess adenoidal remnants, injury to the surgical field or adjacent structures, and bleeding points. Results Adenoid remnants were observed in 42% of the cases after conventional adenoid curettage in multiple locations, such as the roof of the nasopharynx over the choana (24%), the tubal tonsil (12%), the posterior pharyngeal wall (4%), and the posterior end of the nasal septum (2%). Injury to the surgical field and adjacent structures was observed in 46% of the cases (posterior pharyngeal wall: 23%; lateral pharyngeal wall: 11%; Passavant ridge: 10%; and the Eustachian tube orifice: 2%). Endoscopic bleeding was observed in 29% of the cases; 13% of the cases were from adenoid remnants, 10%, from the mucosa, and 6%, from the pharyngeal muscles. Bleeding was mild in 19% of the cases, moderate in 9%, and severe in 1%. Conclusion Endoscopic evaluation of the nasopharynx following conventional adenoid curettage provides important data regarding adenoid remnants, injury to the surgical field or nearby structures, and bleeding points, which aids in the provision of optimal care and in the achievement of a better outcome.

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Abstract Introduction The limited access to temporal fine structure (TFS) cues is a reason for reduced speech-in-noise recognition in cochlear implant (CI) users. The CI signal processing schemes like electroacoustic stimulation (EAS) and fine structure processing (FSP) encode TFS in the low frequency whereas theoretical strategies such as frequency amplitude modulation encoder (FAME) encode TFS in all the bands. Objective The present study compared the effect of simulated CI signal processing schemes that either encode no TFS, TFS information in all bands, or TFS only in low-frequency bands on concurrent vowel identification (CVI) and Zebra speech perception (ZSP). Methods Temporal fine structure information was systematically manipulated using a 30-band sine-wave (SV) vocoder. The TFS was either absent (SV) or presented in all the bands as frequency modulations simulating the FAME algorithm or only in bands below 525 Hz to simulate EAS. Concurrent vowel identification and ZSP were measured under each condition in 15 adults with normal hearing. Results The CVI scores did not differ between the 3 schemes (F (2, 28) = 0.62, p = 0.55, η2p = 0.04). The effect of encoding TFS was observed for ZSP (F (2, 28) = 5.73, p = 0.008, η2p = 0.29). Perception of Zebra speech was significantly better with EAS and FAME than with SV. There was no significant difference in ZSP scores obtained with EAS and FAME (p = 1.00) Conclusion For ZSP, the TFS cues from FAME and EAS resulted in equivalent improvements in performance compared to the SV scheme. The presence or absence of TFS did not affect the CVI scores.

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Abstract Introduction Williams syndrome (WS) is a genetic disorder caused by a microdeletion in chromosome 7, affecting ~ 28 genes. Studies have demonstrated conductive losses seemingly related to the absence of the elastin gene and mild to profound sensorineural losses due to cochlear fragility. Objective To characterize and compare the peripheral auditory system and auditory brainstem response (ABR) of adults with WS and neurotypical adults matched by age and gender. Methods We conducted a cross-sectional observational study with 30 individuals of both sexes, aged 18 to 37 years – 15 of them with WS (study group) and 15 with neither the syndrome nor hearing complaints (control group), matched for sex and age. The subjects underwent pure-tone and speech audiometry, acoustic immittance, transient-evoked otoacoustic emissions (TEOAEs), and ABR. Results Early-onset sensorineural hearing loss was found in 53.3% of the study sample, mostly mild, occurring above 3 kHz. The TEOAEs were absent in 53.3% of assessed subjects; for those in whom they were present, the signal-to-noise responses were significantly lower than in the control group. In the ABR, increased absolute latencies were observed in waves I and III. Conclusion Individuals with WS have early and progressive cochlear impairments, mainly affecting the basal region of the cochlea. They may have low brainstem changes which seem to begin in adulthood.

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Abstract Introduction Facial trauma can cause damage to the facial nerve, which can have negative effects on function, aesthetics, and quality of life if left untreated. Objective To evaluate the effectiveness of peripheral facial nerve direct end-to-end anastomosis and/or nerve grafting surgery for patients with facial nerve injury after facial trauma. Methods Fifty-nine patients with peripheral facial nerve paralysis after facial injuries underwent facial nerve rehabilitation surgery from November 2017 to December 2021 at Ho Chi Minh City National Hospital of Odontology. Results All 59 cases of facial trauma with damage to the peripheral facial nerve underwent facial nerve reconstruction surgery within 8 weeks of the injury. Of these cases, 25/59 (42.3%) had end-to-end anastomosis, 22/59 (37.3%) had nerve grafting, and 12/59 (20.4%) had a combination of nerve grafting and end-to-end anastomosis. After surgery, the rates of moderate and good recovery were 78.4% and 11.8%, respectively. All facial paralysis measurements showed statistically significant improvement after surgery, including the Facial Nerve Grading Scale 2.0 (FNGS 2.0) score, the Facial Clinimetric Evaluation (FaCE) scale, and electroneurography. The rate of synkinesis after surgery was 34%. Patient follow-up postoperatively ranged from 6 to > 36 months; 51 out of 59 patients (86.4%) were followed-up for at least 12 months or longer. Conclusion Nerve rehabilitation surgery including direct end-to-end anastomosis and nerve grafting is effective in cases of peripheral facial nerve injury following facial trauma. The surgery helps restore nerve conduction and improve facial paralysis.

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Abstract Introduction The World Health Organization (WHO) estimates that ~ 32 million children worldwide are affected by hearing loss (HL). Cochlear implant is the first-line treatment for severe to profound sensorineural HL. It is considered one of the most successful prostheses developed to date. Objective To evaluate the oral language development of pediatric patients with prelingual deafness implanted in a reference hospital for the treatment of HL in southern Brazil. Methods We conducted a retrospective cohort study with a review of medical records of patients undergoing cochlear implant surgery between January 2009 and December 2018. Language development was assessed by reviewing consultations with speech therapy professionals from the cochlear implant group. Results A total of 152 children were included in the study. The mean age at cochlear implant surgery was of 41 months (standard deviation [SD]: ± 15). The patients were divided into six groups considering the type of language most used in their daily lives. We found that 36% of children use oral language as their primary form of communication. In a subanalysis, we observed that patients with developed or developing oral language had undergone cochlear implant surgery earlier than patients using Brazilian Sign Language (Língua Brasileira de Sinais, LIBRAS, in Portuguese) or those without developed language. Conclusion The cochlear implant is a state-of-the-art technology that enables the re-establishment of the sense of hearing and the development of oral language. However, language development is a complex process known to present a critical period to properly occur. We still see many patients receiving late diagnosis and treatment, which implies a delay and, often, the impossibility of developing oral communication. Level of Evidence Level 3 (cohort study).

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Abstract Introduction Spinocerebellar ataxias (SCAs) are a heterogeneous group of neurodegenerative diseases. Objective To evaluate the living standard of patients with SCA, by applying the Vestibular Disorders Activities of Daily Living Scale (VADL) and Activitiesspecific Balance Confidence Scale (ABC) questionnaires. Methods An uncontrolled clinical trial study was conducted with 28 patients who underwent anamnesis, ENT evaluation, and vestibular assessment and the application of questionnaires VADL and ABC before and after rehabilitation with virtual reality. Results The vestibular exam was altered in 64.3% of the cases. The result between the correlation of the VADL and ABC questionnaires showed significant results in all cases (p < 0.005). The correlation between the ages and disease length with the VADL and ABC questionnaires was significant in the T3 assessment (p = 0.015). The correlation between the disease length and the VADL questionnaire was significant in all cases (p < 0.005). The comparison of the vestibular rehabilitation result (T1 to T2) showed a significant difference for all the applied games, except for the ski slalom. The comparison of the vestibular rehabilitation result (T1 to T3) showed significant difference for all the applied games (p < 0.005) (1st assessment before the start of rehabilitation designated T1, after 10 rehabilitation sessions, considered T2 and, at the end of 20 rehabilitation sessions, called T3). Conclusion We can point out a direct improvement in the living standard, reflected by the reduction of falls, better balance, and march, contributing to a higher self-confidence in patients in daily activities.

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Abstract Introduction Benign paroxysmal positional vertigo (BPPV) is the peripheral vestibular dysfunction that most affects people worldwide, but its etiopathogenesis is still not fully understood. Considering the etiological diversity, some studies highlight the association between BPPV and thyroid diseases. Objective To investigate the association between thyroid diseases and BPPV. Data Synthesis Systematic review and meta-analysis of epidemiological studies searched in the PubMed, Web of Science, Embase, Cochrane Library, and Scopus databases. Studies that were fully available and investigated the association between BPPV and thyroid diseases were selected. The articles that composed the meta-analysis were analyzed using the dichotomous model, the Mantel-Haenszel statistical test, odds ratio (OR), and a 95% confidence interval (CI). Of the 67 articles retrieved from the databases, 7 met the eligibility criteria of the systematic review, and 4 had data necessary to perform the meta-analysis. Qualitative analysis revealed that the studies were conducted in the European and Asian continents. The predominant methodological design was the case-control type, and thyroid dysfunctions, hypothyroidism, and Hashimoto thyroiditis occurred more frequently. The meta-analysis showed no association between hypothyroidism and BPPV; however, there was a statistically significant relationship between Hashimoto thyroiditis and BPPV. Conclusion The meta-analysis results suggest a possible association between BPPV and Hashimoto thyroiditis. Nevertheless, we emphasize the need for further studies to elucidate the evidence obtained.

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Abstract Introduction Submandibular gland fistula (SGF) is a rare subset of salivary gland fistulas. It is seldom tough to diagnose them prior to surgical exploration, and it is often clinically confused with close differentials. An early diagnosis based on pertinent clinical features and focused radiological findings can be pivotal in optimal management and help prevent recurrence and avoid unnecessary investigations/interventions. Objective To review articles that discuss SGF and provide vital etiological, clinical, and imaging features of this rare entity that can aid in early clinical diagnosis. Data Synthesis An extensive review involving PubMed and Google Scholar and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Conclusion Submandibular gland fistula is a rare entity. It can be confused with close differentials, including branchial fistulas, if not thoroughly examined. Discharge from fistulae along with submandibular pain/tenderness and/or swelling are important diagnostic clues. A history of trauma, nodule at the site of discharge, prior submandibular disease/calculi, or discharge aggravated with food further increases a clinical suspicion. Optimal radiological investigation looking for calculi/foreign body and delineating the fistula tract is vital to affirm a diagnosis. Gland with fistula excision is a commonly advocated treatment of choice with no reports of recurrence, although conservative management and gland preserving surgery have also reported a favorable prognosis.

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Abstract Introduction CyberKnife (CK) radiosurgery is a treatment strategy for vestibular schwannoma (VS). Objectives To evaluate hearing preservation (HP) after CK for VS. Data Synthesis The study was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, and it was registered at the International Prospective Register of Systematic Reviews (PROSPERO, under number CRD42021250300). The inclusion criteria were based on the population, intervention, comparison, outcome, timing and study design (PICOTS) strategy: population – patients with VS; intervention – CK; Comparison – none; Outcome – serviceable HP defined by Gardner and Robertson as grades I or II, or by the American Academy of Otolaryngology and Head and Neck Surgery as classes A or B; timing – mean follow-up longer than 1 year; and study design – retrospective or prospective studies. The exclusion criteria were: studies not published in English; studies published before January 2000 and after October 2021; and studies only including patients with neurofibromatosis type 2 or submitted to a previous treatment. The PubMed/MEDLINE, EMBASE, Web of Science, Cochrane Library, LILACS, and IBECS databases were used and last searched on October 27th, 2021. Statistical heterogeneity was assessed using I2 statistics. The appraisal checklist was used to assess the risk of bias in the included studies. A total of 222 studies were analyzed, and 13 were included in the synthesis, which represents 493 participants with serviceable hearing before intervention. The mean HP rate after CK using a random effects model was of 68% (95% confidence interval [95%CI]: 59–76%) at a mean follow-up of 42.96 months. Conclusion The longer follow-up period was associated with a lower HP rate after CK radiosurgery for VS in the qualitative synthesis.

Resumo em Inglês:

Abstract Introduction The prevalence of otitis media (OM) is substantial all over the world. Epidemiological data related to the economic burden of OM globally is minimal. The present systematic review was undertaken to estimate the economic burden of this disease in various parts of the world. Objectives An extensive literature search was done using PRISMA guidelines to identify relevant studies that estimated the economic burden of OM in monetary terms. The databases searched were PubMed Central, Ovid, and Embase. The cost estimation was done for one specific year and then compared considering the inflation rate. Data Synthesis The literature search led to the inclusion of 10 studies. The studies evaluated direct and indirect costs in monetary terms. Direct costs (health system and patient perspective) ranged from USD (United States Dollar) 122.64 (Netherlands) to USD 633.6 (USA) per episode of OM. Looking at only the patient perspective, the costs ranged from USD 19.32 (Oman) to USD 80.5 (Saudi Arabia). The total costs (direct and indirect) ranged from USD 232.7 to USD 977 (UK) per episode of OM. The economic burden per year was highest in the USA (USD 5 billion). The incidence of OM episodes was found more in children < 5 years old. Introduction of pneumococcal conjugate vaccines decreased the incidence in children and now the prevalence in adults is of concern. Conclusion The economic burden of OM is relatively high globally and addressing this public health burden is important. Approaches for the prevention, diagnosis, and treatment should be undertaken by the health system to alleviate this disease burden.