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Abstract Introduction Complaints of smell and taste disorders are present in people with coronavirus disease 2019 (COVID-19), and they particularly impact older adults in their daily activities and quality of life. Understanding these disorders in this specific population is crucial due to the heightened susceptibility to decreased general health. Objective To assess the prevalence and the factors associated with self-reported smell and taste disorders in older adults hospitalized with COVID-19. Methods The present documentary and retrospective study used a dataset from the Paraíba State Department of Health based on individual record sheets of hospitalized people with severe acute respiratory syndrome (SARS), collected through a national form routinely applied in Brazilian hospitals. The complaints of smell and taste disorders were the dependent variables. The independent variables included the clinical outcomes and comorbidities. Data analysis involved descriptive statistics, the Fisher's exact test, and binary logistic regression. The confidence interval was 95%. Results The sample comprised 5,014 older adults with a mean age of 74.50 ± 9.35 years, of both biological sexes, and most of them were admitted to the Intensive Care Unit (ICU), required non-invasive respiratory support, and experienced death. The prevalence of self-reported smell and taste disorders was 7.8% (95%CI = 7.2–8.8%) and 6.4% (95%CI = 5.6–7.1%) respectively. Smell disorders were less frequent among subjects admitted to the ICU and those who died, while taste disorders correlated with clinical outcomes such as fever, cough, sore throat, diarrhea, and comorbidities such as chronic neurological disease. Conclusion Self-reported smell and taste disorders are present in almost 10% of older adults hospitalized with COVID-19, and they are associated with clinical outcomes and commorbities.

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Abstract Introduction Nasal irrigation is a standard therapeutic option to clean the upper airways to remove abundant secretions and harmful substances. The Nasal Wash (SIIT, Milan, Italy) sinus irrigation system contains saline, bicarbonates, and polyethylene glycol. Objective The present randomized controlled trial evaluated and compared the Nasal Wash hypertonic solution (NW-HS) with physiological saline (PS) in patients with nasal symptoms common to different upper airway diseases (infectious rhinitis, allergic rhinitis, and acute and chronic rhinosinusitis). Methods The symptomatic patients were divided into two groups: those receiving NW-HS 1 to 2 times a day for 7 days and those receiving PS 1 to 2 times a day for 7 days. The primary efficacy measures included total nasal symptom score (TNSS) and the score on the verbal numeric rating scale (VNRS), assessed at baseline and during the treatment period. Results In total, 70 patients participated in the trial: 35 were allocated to the NW-HS group and 35 to the PS group. In the NW-HS group, we observed a significant reduction in the TNSS over time, at rates higher than those of the PS group (p < 0.001), as well as a significant reduction in the VNRS score at all observation times, and also at rates higher than those of the PS group (p < 0.001). The safety was good for all patients. Conclusion The present trial documented the efficacy and safety of NW-HS in the treatment of nasal symptoms common to upper respiratory tract disorders. Most of the beneficial effects appeared as early as three days after the beginning of the treatment. In addition, compared to PS, NW-HS showed impressive results; thus, it may represent a safe and valuable option in the non-pharmacological therapy for rhinitis.

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Abstract Introduction Mucormycosis, a fungal infection with severe consequences, gained prominence during the coronavirus disease 2019 (COVID-19) pandemic. While significant efforts were made to understand the systemic implications of mucormycosis, its effect on the auditory system remains unexplored. Objective This study aimed to investigate the auditory implications of mucormycosis through a comprehensive case-control study focusing on hearing loss and middle ear dysfunction. Methods A total of 30 mucormycosis patients without prior auditory issues, and 30 age and gender-matched controls, underwent comprehensive hearing assessment, including pure-tone and immittance audiometry. Statistical analyses, including descriptive statistics, Mann-Whitney U test, Pearson chi-square test, and multiple logistic regression were performed to analyze the data. Result Mucormycosis patients exhibited significantly higher auditory thresholds across all frequencies compared to controls (p < 0.05). Approximately half of these patients experienced some degree of hearing loss, predominantly mild. Immittance measurement showed a higher prevalence of abnormal tympanograms in mucormycosis patients, indicating middle ear dysfunction. Acoustic reflex was absent in half of the mucormycosis patients suggesting impaired auditory function. Conclusion The present study revealed significant auditory health impacts of mucormycosis, finding a notable prevalence of hearing loss and middle ear dysfunction, which emphasizes the need for routine audiological evaluations and increased awareness of mucormycosis-related auditory issues. Despite the study's limitations, we identified potential risk factors for hearing impairment, suggesting a need for further large-scale studies to confirm these findings and understand the mechanisms. These insights aim to improve diagnosis, treatment, and prevention strategies for better clinical outcomes.

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Abstract Introduction Dysphagia affects a significant number of patients with Alzheimer's dementia. Neuromuscular electrical stimulation may be a promising resource for dysphagia rehabilitation in this population. Objective To investigate the immediate effects of neuromuscular electrical stimulation on hyoid bone displacement, pharyngeal transit time, and swallowing safety in elderly people with Alzheimer's dementia. Methods We evaluated 30 elderly individuals with an average age of 82.79 years, regardless of the stage of dementia and with reduced hyolaryngeal elevation, using the Northwestern Dysphagia Patient Check Sheet. Neuromuscular electrical stimulation was performed at the sensory and motor levels in the submental region during videofluoroscopy, with food being offered in solid, pudding, and liquid consistencies, and in portions of 5 mL and 10 mL. We applied Analysis of variance and the Friedman test, adopting a significance level of < 5%. Results The comparison between the sensory and motor levels of stimulation showed that there was a significant difference in hyoid bone displacement for the mushy consistency, with neuromuscular stimulation at the motor level. There was no difference in the application of stimuli for the other consistencies regarding hyoid bone displacement, pharyngeal transit time, and the penetration and aspiration scale. Conclusion In elderly people with Alzheimer's dementia, neuromuscular electrical stimulation at the motor level generated a reduction in hyoid bone displacement during swallowing of food with pudding consistency, with no effects on pharyngeal transit time or swallowing safety.

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Abstract Introduction Newborn hearing screenings must be completed within 48 hours of birth. Objective To determine the optimal timing for the first transient evoked otoacoustic emissions (TEOAEs) test by comparing the referral rates of infants tested between different time intervals. Methods The present study was a retrospective cohort analysis of 2,713 newborns who underwent TEOAE tests between February 2021 and June 2022. The infants were categorized into groups according to the age at which they were tested: 12 to 24 hours, 25 to 36 hours, 37 to 48 hours, and > 48 hours. We compared referral rates across these groups. Results The overall referral rate for infants tested within 48 hours from birth was 53%, significantly higher than the rate for those tested after 48 hours (46%, p = 0.001). Notably, the highest referral rates were observed in neonates aged 25 to 36 hours. However, no significant difference in referral rates was found for high-risk infants tested either before or after 48 hours. Conclusion Transient evoked otoacoustic emissions can be used to screen newborns' hearing within 48 hours, but the high referral rate suggests that Thailand should add automated auditory brainstem response (AABR) to its guidelines for hearing evaluation if newborns leave the hospital before 48 hours.

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Abstract Introduction Allergic rhinitis is a disease that negatively affects social and work life and sometimes does not respond to many treatments. Therefore, new treatments are needed. For the prevention and treatment of allergies, oleuropein has been emphasized, and positive results have been shown in the literature. Objective To investigate the effects of general and topical oleuropein during the allergic rhinitis period and the histopathological changes in the nasal mucosa compared with steroid nasal sprays and control group in rats. Methods We developed an experimental animal model with 44 rats divided into 6 groups. Except for the control group, the allergic rhinitis in the other five groups was created with ovalbumin. As treatment, saline was administered to group 3, steroids, to group 4, oleuropein, to group 5, and steroids and oleuropein were administered to group 6. The effects of the drugs were examined histopathologically and the levels of immunoglobulin E (IgE) in the blood were compared. Results Considering the symptomatic findings in rats, we could observe that allergic rhinitis occurred. Based on the IgE levels and histopathological findings, we have statistically shown that oleuropein may be effective in treatment of allergy rhinitis. Conclusion Oleuropein has been shown to be useful in the treatment of allergic rhinitis in an animal model, but further studies are needed before it is introduced into the medical practice.

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Abstract Introduction Music has been recognized as a therapeutic tool in auditory rehabilitation, promoting essential social and behavioral development in children with cochlear implants (CIs), as identified by the World Health Organization (WHO). Additionally, there is a lack of studies on the development of these skills in this context. Objective To investigate the effect of music training on the development of social, behavioral, and academic skills in children with CIs from the schoolteacher's perspective. Methods The present is an experimental study involving 10 children with CIs, aged between 6 and 10 years, who composed the experimental group. They had a semester of music training and were assessed through the Social Skills Rating System (SSRS) questionnaire at 4 different moments: 2 months before the beginning of the music training, at the beginning of the music training (first week of class), during the music training (3 months after the beginning), and at the end of the music training (6 months after the beginning). To compare the multiple SSRS assessments, we used the repeated measures analysis of variance (ANOVA) test and the Tukey test (p ≤ 0.05). Results The results showed a statistically significant improvement in social skills in terms of assertiveness, social resourcefulness, self-control, affectivity, cooperation, externalizing behavior problems, and academic competence. Conclusion From the schoolteacher's perspective CI-using children who had music training experienced an improvement in their social and academic skills and behavioral problems.

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Abstract Introduction Cochlear nerve deficiency (CND) is characterized by a thin or absent cochlear branch of the vestibulocochlear nerve, leading to sensorineural hearing loss (SNHL). The effectiveness of cochlear implants (CIs) in patients with CND is debated, with some studies indicating poor outcomes and others showing limited speech detection and discrimination abilities. Accurate objective measures are essential for a successful CI mapping. Objective To investigate the use of global stimulation with live speech to measure electrically evoked stapedial reflex thresholds (eSRTs) in CI recipients with CND and compare the results with behavioral comfort levels. Methods This retrospective study reviewed the CI database from January 2015 to December 2023 to identify patients with CND. The eSRT measurements following CI were conducted using a standard procedure. These levels were compared with the behavioral comfort levels from their mapping data. Results From the CI database of 273 recipients, six children with CND were identified whose eSRT levels were documented. Among these six, two children exhibited presence of electrical stapedial reflexes that correlated well with behavioral comfort levels in response to global stimulation of electrodes. None of them presented reflexes to individual electrode stimulation. Conclusion Global stimulation of electrodes has the potential to elicit eSRT in patients with CND more than individual electrode stimulation. Further research is crucial to validate the effectiveness of global stimulation in eliciting eSRT in a larger cohort of patients with CND. This would be a feasible test as an outcome measure, and it would help provide better prognostic counselling.

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Abstract Introduction In patients with eosinophilic chronic rhinosinusitis (ECRS), viral infection of the upper respiratory tract tends to exacerbate the symptoms. Objective To clarify the effect of the cytokines during viral infection in ECRS patients, we investigated the production of thymic stromal lymphopoietin (TSLP) in the sinus mucosa of ECRS patients in the presence of polyinosinic: polycytidylic acid, or poly(I:C), which mimics viral infection, with or without interleukin-4 (IL-4) or IL-13. Methods The ECRS patients were classified into mild, moderate, and severe groups based on the scoring system of the Japanese Epidemiological Study of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC). We obtained paranasal sinus mucosa from patients with ECRS through endoscopic sinus surgery, as well as nasal epithelial cells. The cells were stimulated with poly(I:C) in the presence or absence of IL-4 or IL-13. The TSLP concentrations in the culture supernatants were measured using enzyme-linked immunosorbent assay (ELISA) after 24 hours of stimulation. Results Nasal epithelial cells from patients with ECRS or healthy controls produced TSLP upon stimulation with poly(I:C) alone, and the addition of IL-4 or IL-13 increased TSLP production. Notably, the increase in poly(I:C)-induced TSLP production from nasal epithelial cells in the presence of IL-4 or IL-13 was greater among the severe group compared to the other groups. Conclusion In the sinus mucosa of patients with severe ECRS, TSLP production was enhanced more when poly(I:C) stimulation was combined with IL-4 or IL-13 stimulation. Thus, the Th2-skewed condition of the sinus mucosa during viral infection in patients with more severe ECRS may accelerate disease exacerbation.

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Abstract Introduction Bioabsorbable packs, which are frequently used after nasal surgery, have been recently deemed more comfortable than removable packs. If these packs cause lower levels of eustachian dysfunction than silicone nasal splint with integral airway, they would be a good alternative for nasal packing after septoplasty. Objective To compare the effects of chitosan-based biodegradable nasal packs and silicone nasal septal splints with integral airway on the ventilation and pressure of the middle ear after septoplasty in patients with normal otoscopic examination. Methods Patients who underwent septoplasty for nasal septal deviation with otoscopically-normal tympanic membranes and bilateral, normal type-A preoperative tympanograms were included. Following surgery, the patients were randomized into two groups (group P: chitosan-based biodegradable nasal packs; group S: silicone nasal septal splint). Results The tympanometric pressures of all patients in both groups decreased, but more so in group S in the first 24 hours following surgery. These pressure differences between the 2 groups in the first 48 hours following surgery were statistically significant. Conclusion The present study demonstrated that chitosan-based biodegradable nasal packs would be a good alternative for nasal packing after septoplasty.

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Abstract Introduction Cisplatin is an effective chemotherapeutic drug. Its side effects, ototoxicity and genotoxicity, limit widespread application. Melatonin could reduce these toxic effects due to its antioxidant activity. Objective To determine the effect of melatonin against cisplatin-induced ototoxicity and genotoxicity in rats. Methods To assess ototoxicity, 33 rats were randomly divided into: group 1 (saline), group 2 (melatonin), group 3 (cisplatin + saline), and group 4 (cisplatin + melatonin). Groups 3 and 4 received a single dose of 10 mg/kg of cisplatin. Groups 2 and 4 received daily doses of 1 mg/kg of melatonin. The number of viable neurons and their average diameter in the spiral and vestibular ganglia were analyzed. In the stria vascularis and spiral ligament, the number of viable cells was evaluated. To assess genotoxicity, 12 animals were randomly divided into: group A (saline), group B (cisplatin + saline), and group C (cisplatin + melatonin). The rats in groups B and C received a single dose of 10 mg/kg of cisplatin. Group C received a single dose of 1 mg/kg of melatonin. Results The micronucleus count and percentage of polychromatic erythrocytes in the bone marrow of rat femurs were analyzed. The animals in group 3 presented a greater loss of cells than the animals in other groups regarding all cochlear structures evaluated. Furthermore, the diameters of neurons were smaller in the animals in group 3. Melatonin-treated rats presented a lower micronucleus count and a higher number of polychromatic erythrocytes than animals treated with cisplatin alone. Conclusion Melatonin reduces cisplatin-induced cyto-histopathological damage in the bone marrow and inner ear; therefore, it could be used as a tumor adjuvant treatment.

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Abstract Introduction Concha bullosa (CB) is an anatomical variation that can affect respiratory function. Therefore, identifying it is important. Objective To evaluate the prevalence of CB and its association with the side of pneumatization (right/left), nasal septum deviation (NSD), and mucosal thickening of the maxillary sinuses using cone-beam computed tomography (CBCT) exams from a Brazilian subpopulation. Also, to investigate the association between CB, sex and age. Methods There were 297 CBCT exams assessed by two examiners who evaluated the presence of CB (> 50% pneumatization of the turbinate's height), NSD (deviation point of the nasal septum and crista galli angle >9o), and mucosal thickening of maxillary sinuses (mucosa around the sinus walls > 3 mm in height). The association between CB and side, NSD, mucosal thickening of the maxillary sinuses, sex, and age were evaluated by the chi-squared and Fisher's exact tests (α = 5%). Results A total of 208 CB was found, corresponding to 11.7% of the evaluated turbinates, being more prevalent in the middle one (p < 0.0001). Considering all exams, 132 (44.4%) had at least one CB. There was an association between the presence of middle left CB with NSD (p = 0.028). No other significant associations were found (p > 0.05). Conclusion Almost half of the CBCT exams had at least one CB. Its prevalence was higher in the middle turbinate. There seems to be an association between middle CB and NSD. As for the other variables, no strong association was found.

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Abstract Introduction Epistaxis is a common otorhinolaryngological emergency, usually caused by digital trauma in children, and hypertension in the elderly. General practitioners in emergency rooms assist most of the cases without specific management. Objectives Describe suitable properties for efficient nasal packing in adult epistaxis. Methods Two cadaver heads, preserved by freezing process, were thawed for this research. When the room temperature was reached, the nasal cavities were evaluated by a nasal endoscope, which showed a length of 4.0 × 11.0 cm for the male and 4.0 × 8.5 cm for the female head. Through an orifice made in the left maxillary bone to access the maxillary sinus, a blue-dyed saline solution was applied using a sphygmomanometer (Premium) to control and mimic blood pressure. The nasal cavity was first packed with two foams with different thicknesses and densities evolved by a condom, then packed by the Merocel packing (Medtronicent Surgical Products Inc.). The pressure was administered and gradually increased until a saline leak was observed in the oropharynx. The best way to insert tampons was also evaluated to avoid extensive trauma. Results Despite the difficulty of the application being similar in both nasal packings made with the condom and foam, t33-densityity foam, 2.0 cm thick and 11.0 cm lon resisted to a higher pressure (250mmHg) than the commercial packing Merocel (220mmHg). Conclusion The most suitable foam for packaging wrapped with condoms is 2.0 cm thick, as it supported the blood pressure commonly found in epistaxis.

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Abstract Introduction It is important to understand the intricacies of hearing aid management early in the child's life to appreciate the full benefits of early intervention. Objective Identifying aspects of hearing aid management that carers regard as taxing will allow hearing professionals to focus and encourage these areas, potentially leading to higher hearing aid use and better outcomes. Methods 49 parents of children with hearing impairment participated in the study. Parent Hearing Aid Management Inventory (PHAMI) was used to explore parent access to information and experiences in three domains such as parent skills and confidence in hearing aid management, hearing aid use, and communication with the audiologist using a 4-point rating scale. The data was collected using direct interviews and through Microsoft forms. Results The majority of the parents desired information and support in identifying hearing aid options/accessories, obtaining financial assistance for costs, and using a listening stethoscope for determining when the hearing aid was not working. The most common challenges identified by parents as influencing their child's hearing aid use were activities (for example, playing, travelling in the car), and the fear of losing and damaging the hearing aids. Although many parents were pleased with the audiologist's assistance, they desired that the audiologist be more patient and contact them more regularly after the hearing aids were fitted. Conclusion Professionals can help with effective device management by addressing parental challenges, collaborating on specific device management goals, and helping as needed.

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Abstract Introduction Postinfectious hyposmia gained special attention in the postpandemic era, and persistent cases are particularly difficult to treat. Many unproven therapies are used in clinical practice, including corticosteroids, with insufficient evidence. Objective To establish the effectiveness of systemic corticosteroid therapy, associated with olfactory training, for persistent postinfectious hyposmia. Methods Patients with persistent postinfectious hyposmia were divided, based on comorbidities, into control group (submitted to olfactory training alone) and test group (associated 7-day course of prednisone 40 mg). Olfactory evaluations were performed (visual analogue scale, Alcohol Sniff Test, and Connecticut Olfactory Test), at baseline, and at the 3- and 6-month follow-ups. Results There was no statistically significant difference between the test (n = 10) and control (n = 7) groups (p > 0.05) for primary outcomes (visual analogue scale, Alcohol Sniff Test, and Connecticut Olfactory Test), although there was statistically significant improvement of Alcohol Sniff Test scores in both groups at 6 months (p > 0.05). The study's statistical power was reduced due to the small sample size. Even without randomization, the groups were not comparable only in terms of age (p > 0.05). Although no statistically significant association was found, there was a clear tendency for improvement in the overall olfactory function, which may be spontaneous or due to olfactory training. No side effects were reported. Conclusion There was no statistically significant benefit of systemic corticosteroid therapy for patients with persistent postinfectious hyposmia (p > 0.05). Treatment with systemic corticosteroids should be individualized, and there is no consensus in the literature.

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Abstract Introduction Key performance indicators (KPIs) measure the critical functions and activities that must be performed in an organization to provide management with an assessment of quantity and quality, from which it can aid strategic decisions to achieve objectives. Objective To map the literature review on KPIs in the context of medicine. Methods In the literature review, we adopted a proposed model and made appropriate adaptations to it. The PubMed database was chosen, with filters applied to define a path. The findings of the articles were briefly discussed in comparison with others to highlight specific findings. Results Almost 100 research articles were eligible for investigation in a wide range of third- and second-degree medical specialties. In these articles, the KPIs are numbered from 1 up to 797 qualitative and quantitative measures. Conclusions The KPIs are not limited to a financial regime; instead, in the field of medicine, they play an important role in a wide range of medical specialties, from clinics, therapeutics, surgery, pharmacy, research, regulatory affairs, hospitalization, management, and product development. These indicators can be implemented and evaluated by different means, from simple resources such as home visit, telephone survey, cross-comparison with a benchmark, questionnaires, spreadsheets, to the most sophisticated technology, such as IT resources, artificial intelligence, the linear hinges model, the Research and Development/University of California, Los Angeles (RAND/UCLA) appropriateness method, and the Monte Carlo simulation.

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Abstract Introduction The main treatment of otomycosis has required the use of topical antifungal drops and/or acidifying agents. However, because of the availability issues of antifungal drops in developing countries, treatment with acidifying agents alone is necessary. Objective The objective of this study was to compare the efficacy in the treatment of otomycosis using a 10% povidone-iodine and clotrimazole solution. Methods Patients with otomycosis were assigned to 10% povidone-iodine group and Clotrimazole group. The patients were evaluated on the response of each group at 1, 2,4 and 8 weeks. Results 93 patients were assigned to the 10% povidone-iodine group and 95 patients to the Clotrimazole group. the response to treatment between groups. In the second week after treatment, 37.64% of the 10% povidone-iodine group and 40% of the Clotrimazole group had a good response to treatment (p = 0.551). In the fourth week after treatment, 52.69% of the 10% povidone-iodine group and 55.79% of the Clotrimazole group had a good response to treatment (p = 0.644). In the eighth week after treatment, 58.06% of the 10% povidone-iodine group and 64.21% of the Clotrimazole group had a good response to treatment (p = 0.642) In the 12th week after treatment, 76.34% of the 10% povidone-iodine group and 85.26% of the Clotrimazole group had a good response to treatment (p = 0.248). Conclusions There were no significant differences in the response to between 10% povidone-iodine and Clotrimazole groups in the second, fourth, eighth and twelfths after treatment.

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Abstract Introduction The University of Pennsylvania Smell Identification Test (UPSIT®) is a reliable olfactory test that is easy and quick to apply. It is a one-time use test and its reuse is not recommended by the manufacturer. Objectives Because in high-demand healthcare facilities testing all patients with UPSIT® can be costly, in this present study we sought to assess the feasibility of reusing the UPSIT. Methods Two hundred and ninety healthy volunteers aged 18 and 40 without olfactory complaints participated in the study. Two hundred and forty volunteers underwent the UPSIT® scratching the small strip of the test doing only 2 Z-shaped scratches ("2 Zs" protocol); each UPSIT® was used 20 times by same-sex participants. The remaining fifty patients performed the UPSIT® in the standard single-use fashion. Adjusted multiple regressions relating to the olfactory test score, number of times the test was applied, and demographic variables were performed. Results The mean scores using the UPSIT® repeatedly were lower than those done in the single-use standard fashion. Despite this, the scores remained stable until the tenth time the test was applied. When patients perform the UPSIT® in the "2 Zs" protocol, a correction factor of more 3 points was required in the final score. Conclusion UPSIT® reuse up to 10 times is feasible when a 3-point correction factor is added to the final score. The "2 Zs" protocol described is an alternative to reduce costs in epidemiological studies. This study, however, is limited as it was carried out only with healthy individuals.

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Abstract Introduction Myringoplasty is a surgical procedure aimed at reconstructing the tympanic membrane, restoring acoustic protection to the round window, and improving sound conduction to enhance hearing, and prevent recurrent infections or otorrhea. This procedure can be performed either through microscopy or endoscopy. Objective To compare the outcomes of endoscopic myringoplasty and microscopic myringoplasty. Methods Data were retrospectively collected from the electronic medical records of patients who underwent myringoplasty either through microscopy or videoendoscopy at Hospital do Servidor Público Estadual de São Paulo (HSPE) between December 2015 and December 2020. We evaluated the therapeutic success rate, defined as tympanic membrane closure, the variation in the pre- and postoperative speech recognition threshold (SRT), and the incidence of immediate and late complications in each group. Results We included 118 patients: 64 underwent microscopic myringoplasty (group 1) and 54, videoendoscopic myringoplasty (group 2). The groups were comparable in terms of mean age, sex, and body mass index (BMI). The surgical success rates were similar between the 2 groups: group 1: 70.3%; and group 2: 75.9% (p = 0.494). Group 1 presented a significant improvement in the mean postoperative hearing thresholds (30.0 ± 14.9) compared to the mean preoperative levels (41.0 ± 16.3) (p < 0.001), while group 2 did not present a statistically significant improvement (from 37.8 ± 14.7 preoperatively to 32.0 ± 20.7 postoperatively; p = 0.284). Conclusion Microscopic and endoscopic myringoplasty yielded similar tympanic membrane closure rates. However, the videoendoscopic procedures resulted in lower SRT reduction, while the microscopic procedures resulted in a higher rate of immediate postoperative complications. Level Of Evidence 3

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Abstract Introduction The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has brought up reports of an increase in new cases of tinnitus and changes in chronic and/or preexisting episodes. Nevertheless, there is no established data on the characteristics of tinnitus and its correlation with coronavirus disease 2019 (COVID-19). Objective To analyze the characteristics of tinnitus in subjects affected by COVID-19 while detailing the correlation between these two factors. Data Synthesis We found 327 articles, 37 of which were selected: 11 cross-sectional studies, 4 case-control studies, 3 cohort studies, and 19 observational studies. The sum of the samples totaled 399,524 patients included in the present review. The prevalence of new tinnitus varied from 0.2% to 96.2%. Most articles provided incomplete information or were missing information. Systemic arterial hypertension was the most common underlying disease. Finally, we found a predominance of hearing loss and olfactory and taste disorders, followed by fever and cough. Conclusion The prevalence of new tinnitus ranged from 0.2 to 96.2%, whereas the prevalence of preexisting tinnitus varied from 8 to 76.2%. It was not possible to satisfactorily assess the characteristics of tinnitus. Therefore, a direct correlation between tinnitus and COVID-19 could not be determined, as this symptom may be influenced by other factors.

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Abstract Introduction Necrotizing otitis externa (NOE), also known as malignant otitis externa (MOE), is a severe infection that begins in the external auditory canal and can extend to adjacent tissues and bone. It primarily affects elderly, diabetic, and immuno-compromised patients. Despite the advancements in antibiotics and surgical interventions, NOE remains a condition with significant morbidity and mortality. Objective To evaluate the efficacy of hyperbaric oxygen therapy (HBOT) as an adjunctive treatment for NOE, focusing on clinical outcomes and the potential benefits in refractory or advanced cases. Methods We conducted a comprehensive literature search on the PubMed/MEDLINE and Cochrane Library databases for articles published from January 1980 to December 2023. The search terms included hyperbaric oxygen therapy, necrotizing otitis externa, and refractory otitis. A total of 8 studies met the inclusion criteria, comprising case reports, observational studies, and case series. Study quality was assessed through the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale. Results The results indicate that HBOT shows promise in the treatment of NOE, with several studies reporting complete resolution of infection and prevention of recurrence, especially in refractory cases. Conclusion The current evidence is insufficient to establish HBOT as a standard treatment for NOE; however, its potential benefits in improving clinical outcomes and reducing morbidity are significant. High-quality research, including randomized controlled trials, is necessary to validate the role of HBOT in NOE treatment. Where hyperbaric facilities are accessible, HBOT should be considered for refractory NOE cases.

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Abstract Introduction Head and neck cancer are rare and require complex medical and surgical management. Regionalization or centralization of care, defined as the concentration of patients with complex diseases from a specific area in institutions with more experienced and highly functional multidisciplinary teams, may be an alternative to achieve better oncologic outcomes. Objective To systematize the current knowledge regarding the centralization of care in head and neck oncology and its consequences in the practice of related surgeries. Data Synthesis Currently, there is evidence that this strategy shows better oncologic outcomes in centers with greater volumes, greater adherence to evidence-based clinical guidelines and quality indicators, and a multidisciplinary team in charge of decision-making. The center in Ontario, Canada, is framed as an example of this strategy, achieving improved outcomes while maintaining a high level of quality. Conclusion Although more high-quality studies are needed to support this strategy, we believe that the evidence already available is sufficient to consider it a valid option to improve the oncologic outcomes of patients.

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Abstract Introduction The quality of life of head and neck cancer patients is significantly impacted. Bibliometric analysis is crucial to get the scholarly landscape, figuring out the research area related to quality of life among head and neck cancer patients. Objective To use network visualization mapping to perform a bibliometric analysis of the quality of life among head and neck cancer patients. Methods A literature search was done using the Scopus database. The searched keywords among papers included the amalgamation of quality of life, and head and neck cancer. The data were extracted, and bibliometric analysis was performed based on the bibliometric indicators: the trend of article publishing, citations, leading countries, and institutions contributing to a publication, potential authors, journals, and frequently occurring keywords. Network visualization mapping was performed using the VOSviewer software (Leiden University). Results A total of 366 articles met the predefined eligibility criteria and were selected for analysis. The selected papers were published in 57 journals between 1983 and 2024. The results provide insightful information on there being a maximum of 25 articles in 2022 and the highest citation count of 1,683 in 2001. Among 52 countries, the United States was the leading contributor, having published 75 articles. The top contributing institution was Liverpool University Hospital, Aintree, United Kingdom, with four articles. Roger Simon was the author with the most potential, and Head and Neck was an impactful journal. The most frequently occurring keywords were quality of life, head and neck, and oral cancer. Conclusion The current bibliometric analysis identified the scholarly impact and characteristics of articles, which provide researchers and policymakers with baseline data to frame research strategies for improving quality of life among head and neck cancer patients.

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Abstract Introduction Obstructive sleep apnea (OSA) is a prevalent condition often managed with continuous positive airway pressure (CPAP) treatment. There is an ongoing debate about the link between OSA and cardiovascular disease (CVD), but the existing evidence points toward an association. Objective The present study aims to investigate whether CPAP is an effective strategy to reduce the risk of developing CVD risk among OSA patients. Methods The literature search was conducted in collaboration with Weill Cornell Medical College librarians, and we identified the five most recent papers highlighting the correlation between CPAP treatment for OSA and CVD risk reduction. Results Recent studies highlight the link between OSA and CVD, emphasizing the potential of the CPAP therapy to reduce the risks of developing CVD and the mortality associated with the condition. The analyses by Guo et al., Peker et al., Khan et al., and Wickwire et al., collectively involving thousands of patients across various study designs, including randomized clinical trials and retrospective cohort studies, consistently demonstrate that the CPAP treatment improves cardiovascular outcomes by lowering blood pressure, reducing sleepiness scores, and significantly decreasing the risk of serious CVD events, especially with consistent adherence to therapy. Conclusion Although further studies are needed to confirm these findings among patients with consistent high compliance to the CPAP treatment, it remains reasonable to continue to prescribe CPAP as the first-line therapy for OSA due to its potential cardiovascular benefits and low associated risks.