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Abstract Introduction The coronavirus disease 2019 (COVID-19) pandemic caused a global emergency. Screening protocols vary regarding the epidemiological situation and the dominant virus variant. Implementing these protocols can be particularly challenging in young children. Objective To evaluate the diagnostic accuracy of routine polymerase chain reaction (PCR) testing in small children. Furthermore, hidden severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) Omicron infections, missed by routine PCR testing, were intraoperatively analyzed, and multiple testing methods were compared. Methods The present prospective cohort study was performed between March and May 2022. All children aged ≤ 6 years who were admitted for adenoidectomy and/or tonsillotomy to the Department of Otorhinolaryngology – Head and Neck Surgery of the Saint Elisabeth Hospital, in Bochum, Germany, were included. Routine PCR swabs were performed ≤ 24 hours before surgery. Intraoperatively, rapid antigen tests, separate naso- and oropharyngeal PCR swabs, adenoid and/or tonsillar tissue for PCR analysis, and serological tests were collected. Results We included 55 children with negative preoperative PCR tests. Intraoperatively, SARS-CoV-2 particles were detected in 51% of the sample. Among children without a history of SARS-CoV-2 infection within 90 days before surgery, the prevalence was 43%. Compared with the PCR results regarding tissue, the preoperative PCR screening had a sensitivity of 20%, and, in the intraoperative PCR screening, the optimally performed swabs had a sensitivity of 79%. In total, 29% of the positive cases had a cycle threshold (Ct) value < 30. Nasopharyngeal PCR tests detected significantly more SARS-CoV-2 infections than oropharyngeal swabs. Conclusion Routine PCR tests in infants may present a high rate of false-negative results and a low sensitivity. These findings question preoperative screening protocols that include testing asymptomatic children who have recovered from a recent SARS-CoV-2 infection.

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Abstract Objective This study aims to evaluate the prognostic value of the Systemic Immuno-Inflammation Index (SII) for predicting the development of seroma and hematoma after thyroidectomy. Methods A retrospective analysis was conducted on 127 patients who underwent thyroidectomy between January 2017 and May 2022. Patients were categorized into two groups: those who developed seroma or hematoma (study group) and those who did not (control group). Preoperative SII scores were calculated using routine blood parameters. Results Of the 127 patients included, 29 (22.8%) developed seroma or hematoma postoperatively. The mean preoperative SII score was significantly higher in the study group compared with the control group (750 ± 86.3 versus 591.5 ± 32.8; p = 0.04). ROC analysis determined an optimal SII cutoff value of 535, with a sensitivity of 76% and specificity of 53% for predicting these complications. Conclusion The preoperative SII score may serve as a useful predictor for the development of seroma and hematoma following thyroidectomy. Further studies with larger sample sizes and prospective designs are needed to validate these findings and refine the clinical applicability of SII in predicting postoperative complications in thyroid cancer patients.

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Abstract Introduction Stapedotomy is a procedure performed for the treatment of otosclerosis in which a small hole is created in the footplate stapes and a prosthesis is inserted from the incus to the vestibule. Objective The present study aims to compare the benefits of endoscopic stapedotomy with those of microscopic stapedotomy. Methods We included 20 patients of the Outpatient Department of Ear, Nose, and Throat (ENT) of a private medical college, who were diagnosed with otosclerosis and were scheduled to undergo stapedotomy. After they provided informed consent, the patients were randomly divided into two groups: group A underwent microscopic stapedotomy, and group B, endoscopic stapedotomy. Both the groups were compared in terms of intraoperative time, surgical approach, visualization of anatomical landmarks, extent of drilling of the posterosuperior part of external auditory canal, manipulation of the facial nerve, and postoperative pain, dizziness, and hearing loss. Results A postural approach was required in 4 patients in group A. Visualization of the anatomical landmarks was better in group B. The extent of drilling of the posterosuperior part of the external auditory canal was minimal in group B, whose patients only experienced mild dizziness and low levels of pain postoperatively. Conclusion Both techniques demonstrated high efficacy in improving hearing outcomes and reducing postoperative complications. Endoscopic stapedotomy offers enhanced visualization of anatomical landmarks and requires minimal drilling and minimal manipulation of the facial nerve. Moreover, the endoscopic procedure results in lower levels of postoperative pain and dizziness, as well as better cosmetic outcomes.

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Abstract Introduction Sinonasal papilloma is the most common benign tumor of the nasal cavity, with the inverted subtype being the most frequent. Its etiology remains highly controversial, but Human Papillomavirus (HPV) is believed to be associated with its pathogenesis. In addition to being locally aggressive, this tumor is characterized by high recurrence rates and malignant transformation potential. Objective To describe the clinical and epidemiological profile of patients diagnosed with sinonasal papilloma who underwent surgery at a University Hospital. Methods A cross-sectional study was performed analyzing the profile of patients diagnosed with sinonasal papilloma who underwent surgical treatment between January 1, 2021, and December 31, 2023. Variables such as sociodemographic, symptoms, smoking history, tumor location, Krouse staging, surgical techniques, histological subtypes, recurrence, and malignant transformation were analyzed. Results A higher prevalence was observed among women (52.4%), with a mean age of 54.2 ± 12 years old, and without a history of smoking (61.9%). Nasal obstruction was the most reported symptom, with the left nasal cavity being more frequently affected. Most cases were classified as Krouse stage T3, and 85.7% of all analyzed cases were managed exclusively through endoscopic approaches. Inverted papilloma was the most common subtype (66.7%). Only 9.5% and 4.8% of patients experienced recurrence and malignant transformation, respectively. Conclusion Sinonasal papilloma was more prevalent in middle-aged women with no history of smoking. The diagnosis and treatment of sinonasal papilloma remain delayed due to nonspecific symptoms and limited access to specialized healthcare in Brazil. Long-term follow-up is crucial for monitoring potential recurrence and malignant transformation.

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Abstract Introduction Ecological momentary assessment (EMA) involves the repeated real-time or near real-time sampling of individuals' behaviors and experiences within their natural settings, offering insights into the daily challenges experienced by individuals with hearing impairment. Objective The study aims to evaluate EMA's feasibility and construct validity in the Indian context, assessing its effectiveness in analyzing hearing aid outcomes at different times. Methods Twelve participants, aged between 49 and 66 (mean: 57.83) years, with bilateral hearing loss, participated in the study. A prospective cohort study was conducted from July to November 2023. Ecological momentary assessments were administered using a questionnaire hosted on Microsoft Forms (Microsoft Corp.), with links sent via WhatsApp (Meta Platforms, Inc.) 3 times daily over 10 days. On average, participants completed 3 surveys daily, each consisting of 15 questions. Results A total of 237 entries was collected, with a 65.83% compliance rate. Most entries highlighted the evident advantages of hearing aids, especially in quiet surroundings. Utilizing Friedman's and Wilcoxon signed-rank tests for comparative analysis, significant variations were observed in EMA entries over time within identical listening environments. Conclusion The benefits of hearing aids in quiet environments were emphasized due to their capacity to restore audibility. The significant variations in individual preferences within the same environment emphasize the necessity for personalized hearing aid settings. These discrepancies in EMA entries highlight the importance of incorporating objective background noise measurements in surveys to optimize hearing aid performance. Ecological momentary assessment surveys provide valuable insights into listener preferences, facilitating optimal adjustments.

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Abstract Introduction Adenoidectomy, with or without tonsillectomy, is a common pediatric surgical procedure. It has been noted that blind curettage has many drawbacks. First of all, it cannot completely remove the adenoid tissue from the posterior choana or the margins of the Eustachian tube orifices, which leads to incomplete removal. Secondly, applying curettage blindly may damage the Eustachian tube opening. Objective To illustrate our surgical technique for a successful and safe adenoidectomy using a transoral 70° endoscope. Methods The present was a prospective study carried out from December 2022 to September 2024. All patients had adenoid hypertrophy either alone or with tonsillar hypertrophy. There were 46 female and 50 male patients, all of whom underwent transoral endoscopic adenoidectomy using a 70° scope. Results There were 96 patients included in this study. The mean age was 5 years and 8 months. Of that total, 35 cases were revisions. The primary procedure was done 12 to 26 months prior (mean: 19). All patients were compliant for the scheduled fiberoptic scope 1 year after surgery. We found that 4 patients (4.16%) had small adenoid regrowth, primarily near the Eustachian tube orifices, without causing any symptoms or airway compromise. Conclusion Transoral endoscopic adenoidectomy is a technically viable procedure that is better than the traditional curettage method. There was reduced likelihood of incomplete adenoid removal, and it is nearly impossible to damage adjacent structures, making it safer than blind curettage.

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Abstract Objective To evaluate the risk factors for the development of laryngotracheal injuries in patients with coronavirus disease 2019 (COVID-19) undergoing orotracheal intubation (OTI). Methods A cohort study was performed with intubated patients diagnosed with COVID-19, hospitalized from March 1st to October 31st, 2020. They were called for outpatient follow-up after being discharged from the hospital. Results There were 421 patients with COVID-19 (31%) who required OTI, of which the outcome was: hospital discharge for 172 (40.9%) and death for 249 (59.1%). Outpatient videoendoscopy was performed in 95 patients (55.2%). Conclusion We observed a greater risk for the development of laryngotracheal injury in patients who presented an increase in leukocyte count at hospital admission with lymphopenia, hypoalbuminemia, increased arterial lactate, troponin, and total bilirubin, as well as endotracheal tube with larger caliber and pronation. Furthermore, patients who at the time of OTI showed greater inflammatory reactivity or developed coagulation disorders were also at greater risk.

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Abstract Objective To estimate the prevalence of hearing impairment and significant risk factors for congenital loss in a tertiary hospital in South India. Methods Over 3 years, a prospective analytical study was conducted in the Department of Otorhinolaryngology in a tertiary hospital in South India. All newborns born in the hospital or those referred were initially screened using the Transient Evoked Otoacoustic Emissions (TEOAE) in a soundproof room by a trained audiologist at 24 to 48 hours of birth. Results were either "PASS" or "REFER." Those who did not pass the initial screening were retested with TEOAE at their 6-week vaccination appointment. If the second result was "REFER," the neonate underwent Brain Evoked Response Auditory (BERA) for confirmation. Results A total of 3,679 neonates (1,931 males, 1,748 females) underwent TEOAE testing. Of those, 2,426 (65.9%) passed the first test, and 1,253 (34.1%) were referred. The second TEOAE test was done for 1,174 patients, with results of 1,013 (86.29%) as "PASS" and 161 (13.71%) as "REFER." The BERA results of 95 neonates showed normal in 84 (88.42%), and 11 (11.58%) had profound hearing loss. The prevalence of hearing impairment in the present study was 0.29% (95% CI: 0.2–0.6%). Major risk factors such as maternal infections, like toxoplasmosis, others (syphilis, hepatitis B), rubella, cytomegalovirus, and herpes simplex (TORCH), craniofacial anomalies, low birth weight < 1,500 g, low Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores (0–4 at 1 minute and 0–6 at 5 minutes), and mechanical ventilation lasting for 5 days or longer, were significantly associated with hearing impairment at p < 0.05. Conclusion Newborn hearing screenings must be made mandatory, irrespective of risk factors. This way, early diagnosis and necessary interventions can be implemented.

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Abstract Introduction Recurrent laryngeal nerve (RLN) paralysis is a distressing complication of thyroidectomy, and many methods have been investigated for prevention. Objective The aim of our study is to investigate to what extent intraoperative neuromonitoring (IONM) predicts postoperative RLN paralysis and what factors may be causing it. Methods Patients who underwent thyroidectomy in our clinic between January 2014 and December 2020 were included. Patient diagnoses, demographic characteristics, laboratory and imaging results, surgical information, and IONM results were evaluated. Results Data from 287 patients and 523 RLNs were evaluated. Twenty-two (4.2%) of the RLNs were paralytic. The rate of paralysis was significantly higher in total thyroidectomies than in lobectomies (p = 0.046), permanent paralysis rate was higher in left RLNs. Malignancy was statistically associated with permanent paralysis (p = 0.017). The rate of overall and permanent paralysis was higher in patients with negative results of first, second response, first, and second laryngeal twitch examinations. The means of the first and second responses of the paralyzed RLNs were lower (p = 0.016, p < 0.01, respectively). The sensitivity of the IONM increased when the new thresholds of the first and second responses were determined to be 155 and 170 µv, respectively, by ROC analysis. Conclusions This study demonstrates that voltage variation and magnitude obtained from IONM can be predictive and sensitivity can be increased by using a threshold higher than 100 µV and patients in this range may be at risk for RLN paralysis. Our results may guide future studies of IONM and risk scoring systems to be developed for RLN paralysis.

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Abstract Objective To compare the performance of two types of supra-aural headphones in both silence and noise in automated hearing screening in adults via tablet computers. Methods Basic audiological assessments and audiometry screenings via tablet were conducted in silence and noise in 35 participants. The hearing screening application assesses frequencies of 1, 2, and 4 kHz (20 dBHL) and 0.5 kHz (30 dBHL) in each ear separately. Two different headphones were tested: TDH 39 (Telephonics Corporation) and Sennheiser HD 280 PRO (Sennheiser) (with passive noise cancellation)—in silence, white noise, and cafeteria noise, emitted in a free field. The screening results were compared with the gold standard (audiometry). Results The results of the 35 participants with Sennheiser HD 280 PRO were compatible with the gold standard in the 3 situations. With TDH 39, the results of 33 individuals in silence and 34 in white noise were compatible with the gold standard. Both headphones, in automated screening in silence and noise, had 100% sensitivity, more than 93% specificity, and more than 94% accuracy. Conclusion Both headphones performed well in the tablet automated hearing screening in the three situations. The HD 280 PRO performed better in silence and noise regarding specificity and accuracy. In cafeteria noise, there was no difference between the two headphones.

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Abstract Introduction Children with allergic rhinitis (AR) may develop comorbidities due to chronic inflammation affecting other systems. Surveillance, early detection, and prompt treatment are essential in managing these conditions. Objectives To investigate the prevalence and associated characteristics of ear, nose, and throat (ENT) disorders, particularly adenoid hypertrophy (AH), tonsillar hypertrophy (TH), otitis media with effusion (OME), and rhinosinusitis (RS) in children with AR. Also, to assess potential risk factors associated with these comorbidities. Methods A total of 100 children aged 2 to 14 years with AR were enrolled. All patients underwent history taking, physical examination, and lateral skull X-ray processes by a pediatric otorhinolaryngologist. Results There was a significantly higher incidence of TH in patients with moderate-to-severe persistent AR (54.5%) compared with those with mild intermittent AR (17.2%; p = 0.006). Furthermore, AH was observed in 51.7% of children with mild intermittent AR, significantly more than in other severity groups (p = 0.037). The prevalence of TH, AH, OME, and RS was 41, 39, 8, and 1%, respectively. Additionally, OME was more common in suburban residents (14.3%) than in urban dwellers (2%; p = 0.029). The most common aeroallergen was the house dust mite Dermatophagoides pteronyssinus (89%). Conclusion The most common ENT comorbidity in AR children is TH, being related substantially to the level of severity. The most prevalent aeroallergen was found to be house dust mite. The pattern of association between AR and ENT comorbidities highlights the essence of our research findings.

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Abstract Introduction The tongue is one of the most important organs in the swallowing process, since impaired tongue function can decrease swallowing effectiveness and safety. Therefore, assessing tongue function is essential to help determine and treat swallowing disorders. Objectives To assess tongue strength and endurance in healthy Brazilian adults and to analyze likely variations related to age range and sex. Methods In total, 219 individuals > 18 years old, equally divided into age groups (18 to 39 years old, 40 to 60 years old, and > 60 years old, each group comprising 73 individuals), were assessed using the Iowa Oral Performance Instrument (IOPI) to measure tongue strength and endurance. Results Tongue strength was significantly lower in older individuals (45.84 kilopascals [kPa]) than in the younger groups (54.16 kPa for young individuals and 54.36 kPa for middle-aged individuals). Similarly, tongue endurance was significantly lower in older individuals. Regarding sex, the assessed parameter only presented significant difference between men and women in the young adult group (men recorded tongue strength 10 kPa higher than that of women). Conclusion Normal values for tongue strength in the healthy Brazilian population were established. These values changed based on age group as older individuals presented lower tongue strength and endurance than younger ones. These results highlight the importance of taking age and sex into consideration when assessing tongue strength.

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Abstract Introduction Salivary gland tumors (SGTs) are uncommon lesions that account for 3 to 6% of head and neck cancers. Objective To investigate mismatch repair (MMR) proteins, tumor-infiltrating lymphocytes (TILs), and CD45RO expression in salivary gland tumors (SGTs). Methods Proteins MLH1, MSH2, MSH6, and PMS2 of the MMR proteins family and CD45RO were evaluated using immunohistochemistry (IHC). Hematoxylin and eosin-stained sections were scored to explore the rate of TILs. Results None of the malignant and benign SGTs had partial or complete loss of at least one of the MMR proteins. Mucoepidermoid carcinomas, adenoid cystic carcinomas, salivary ductal carcinomas, and acinic cell carcinomas as malignant tumor types, and pleomorphic adenoma and Warthin's tumors as the most common benign tumors showed considerable differences in terms of the infiltration of TILs and CD45RO. Malignant tumors exhibited a notable difference in the infiltration of CD45RO+ cells compared to benign ones. Both the tumor, node, metastasis (TNM) stage and the histological grade were shown to be linked with the infiltration status of CD45RO+ cells. Conclusion Our results show that MMR deficiency might be insignificant and less relevant in SGTs. However, differences in TIL rate and CD45RO expression indicate that each of the SGT tumor types may have distinguished immune microenvironments. Malignant SGTs have higher infiltration of activated immune cells, and, thereby, these cells can be considered as good indicators of patient's status.

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Abstract Objective To assess the quality of life in patients with unilateral otosclerosis treated surgically with stapedotomy. Both objective indicators (hearing thresholds and air-bone gap) and subjective patient assessment of quality of life were considered. Methods We included 84 patients with unilateral otosclerosis who underwent stapes surgery. There were 24 men and 60 women, aged between 22 and 73 (mean = 44.1 ± 10.5) years. Pure tone audiometry (frequency range: 0.125–8 kHz) was performed preoperatively and 6 and 12 months postoperatively. Quality of life was assessed with the Assessment of Quality of Life – 8 Dimensions (AQoL-8D) questionnaire. Results The preoperative air-conduction hearing thresholds were on average 56.6 dB HL and improved significantly to 31.3 dB HL 6 months after stapes surgery. Air-bone gap before surgery was on average 29.8 dB HL and improved significantly to 9.9 dB 6 months after stapes surgery. Hearing thresholds were stable for 12 months after stapes surgery. Overall quality of life significantly increased after surgery, with improvements occurring in several domains: independent living, senses, mental health, coping, and relationships. Conclusion Stapedotomy is an effective treatment for patients with unilateral otosclerosis. As well as improving hearing thresholds, it significantly enhances overall quality of life.

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Abstract Introduction Understanding surgical outcomes in diverse settings is crucial for safe delivery of healthcare to underserved communities. Insufficient research has been done analyzing postoperative complications in regions with limited access to healthcare resources. Objective To compare postoperative complications from tonsillectomies and adenoidectomies on global health trips to an underserved community to those of a tertiary academic medical center (TAMC). Methods Data was collected via phone survey with patients from 2 2023 surgical trips to Azua, in the Dominican Republic (DR), sponsored by a TAMC, including surgery type, postoperative healthcare visits, and postoperative complications. The same data was collected via retrospective chart review from patients at a TAMC in 2023. The surgeries included were tonsillectomy adenoidectomy (T&A), tonsillectomy (T), and adenoidectomy (A). A statistical analysis compared non-routine healthcare visits and postoperative complications between populations using the Fisher's exact test. Results In the DR, 168 patients (mean age: 8 years) underwent T&A (n = 113), T (n = 34), and A (n = 21). At the TAMC, 520 patients (mean age: 7.8 years) underwent T&A (n = 288), T (n = 123), and A (n = 109). No patients from the DR reported postoperative bleeding within 2 weeks of surgery, compared to 23 patients from the TAMC (p < 0.001). There was no statistical difference in trouble swallowing and uncontrolled pain within 2 weeks between the populations (p = 0.673 and 0.465). Conclusion The T&A procedures on global health trips to underserved communities were not associated with increased rates of life-threatening complications compared with a TAMC. Surgical trips can provide safe and effective otolaryngologic care to patients in underserved communities.

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Abstract Introduction Cells in diabetes mellitus (DM) respond to low oxygen by increasing hypoxia-inducible factor-1 (HIF-1), which impacts vascular endothelial growth factor (VEGF). Although curcuminoids show therapeutic promise, no validated options are available to repair organ of Corti damage caused by DM. Objective The present study aims to evaluate the effects of curcuminoid administration on the signal-to-noise ratio (SNR) and plasma levels of HIF-1α and VEGF-A in a DM model using Rattus norvegicus. Methods An in vivo experimental design was employed with a double-blind control set up. Twenty-five male Wistar rats were divided into 5 groups: group 1 (DM without curcuminoids), groups 2 and 3 (DM with curcuminoids at 200 and 400 mg/kg body weight for 10 days), and groups 4 and 5 (DM with curcuminoids at 200 and 400 mg/kg body weight for 13 days). Diabetes mellitus was induced through an intraperitoneal injection of alloxan (150 mg/kg body weight). Distortion product otoacoustic emission (DPOAE) tests were performed. Enzyme-linked immunosorbent assay (ELISA) was used to measure plasma levels of HIF-1α and VEGF-A. Results Significant differences were observed in SNR values, HIF-1α, and VEGF-A (p < 0.05). A significant correlation was found between SNR and HIF-1α (r = −0.553; p = 0.004) and VEGF-A (r = −0.564; p = 0.003), indicating that lower levels of these factors were associated with higher SNR. Conclusion Curcuminoids can prevent and treat outer hair cell damage in the organ of Corti due to DM, as shown by improvements in plasma HIF-1α, VEGF-A levels, and SNR values.

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Abstract Introduction Traumatic brain injury (TBI) can result in peripheral or central injury, causing hearing loss. Objective To identify possible hearing and balance disorders in adult patients with a history of TBI. Methods Observational cross-sectional study conducted in a public hospital. The sample consisted of 34 individuals aged 18 to 60 years old who had suffered mild to severe TBI more than 6 months before. They underwent an otoscopy and a medical history survey, recording their clinical history, as well as their previous and current hearing and balance complaints. Next, their hearing was screened at 1,000, 2,000, and 4,000 Hz, and their balance was assessed using the Classic and Sharpened Romberg tests, as well as the Timed Up and Go test. Results The present study assessed 34 patients, of whom 35.3% failed the right ear and 38.2% failed the left ear in the hearing screening, highlighting a statistically significant difference between the pre- and post-trauma results. Regarding balance, 3.1% had a positive result on the right and 3.1% positive on the left in the Classic Romberg test. The Sharpened test found a higher result of 9.4 positive on the left and front. The Timed Up and Go test results were normal for 75.0% and abnormal for 25% of the participants, revealing a risk of falling. Conclusion The present study demonstrated that adults after TBI may have hearing and balance complaints and changes, highlighting the importance of referral to an otorhinolaryngologist and subsequent clinical diagnosis in this population.

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Abstract Introduction Headache is a common complaint among otolaryngology patients, often presenting with an apparent diagnosis of secondary headache due to sinusitis. However, associated symptoms may also be linked to primary headache disorders such as migraines. The overlapping symptomatology of various headache causes poses a diagnostic challenge. The present study aims to evaluate the headache profiles of patients visiting the otolaryngology department. Objective The present study aims to evaluate the headache profiles of patients visiting the otolaryngology department. Methods A cross-sectional study was conducted on 128 otolaryngology patients presenting with headaches. The headaches were categorized according to the International Classification of Headache Disorders, third edition (ICHD-3), based on detailed history, examination, nasal endoscopy, and imaging studies. Results Primary headaches were diagnosed in 45.31% of the cases, while 54.69% presented secondary headaches. Sinusitis was the most common diagnosis, found in 40.63% of the patients. Various causes of primary and secondary headaches were correlated and were found to be statistically significant ( p < 0.001 each). Statistical significance was observed when correlating primary headache with laterality ( p < 0.001). The correlation of secondary headache with laterality and age range also showed statistical significance ( p < 0.001 and 0.035 respectively). Conclusion Sinonasal symptoms may accompany headaches, with or without a direct causal link. The accurate diagnosis and treatment of headache disorders requires a thorough understanding of the latest guidelines and a multidisciplinary approach. This comprehensive strategy is essential to provide high-quality healthcare and significantly improve the quality of life of individuals suffering from this common and often debilitating condition.

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Abstract Introduction One of the main factors that lead to increased hearing loss consequences and progression is inadequate knowledge and practice of hearing screening and hearing loss management modalities. In Saudi Arabia, ear, nose, and throat (ENT) physicians are the primary source of knowledge about hearing loss and its management. The aim of the present study is to assess the knowledge and practice of hearing screening and hearing loss management among ENT physicians in Saudi Arabia. Objective The aim of the present study is to assess the knowledge and practice of hearing screening and hearing loss management among ENT physicians in Saudi Arabia. Methods We conducted a cross-sectional descriptive study with 106 ENT physicians working at different hospitals in Saudi Arabia from January to May 2023. A questionnaire consisting of 2 sections with 20 questions was used to assess the knowledge and practice of hearing screening and hearing loss management for children. Results The current study showed inadequate knowledge of hearing loss and its management. The mean knowledge score was of 12.4 ± 2.12. The knowledge scores of the different types of ENT professionals were compared, and no statistically significant differences were observed ( p = 0.489). Conclusion More research should be conducted to assess the practice of hearing screening in Saudi Arabia. Our recommendation is the provision of more educational sessions about the recent guidelines on hearing loss screening.

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Abstract Introduction Developing region-specific clinical practice guidelines (CPGs) for ear, nose, and throat (ENT) diseases is crucial in Pakistan's primary care, given their significant contribution to clinical cases, aiming to enhance healthcare standards through evidence-based practices with local adaptations. Objectives To ensure the standardization of primary healthcare and reduce unnecessary specialist referrals by creating CPGs that are appropriate to our region. Methods We selected eight guidelines regarding epistaxis, neck masses, hearing loss, Ménière's disease, dysphonia, allergic rhinitis, acute otitis externa, and rhinosinusitis from the American Academy of Otolaryngology–Head and Neck Surgery Foundation as the source guidelines, and employed the Grading of Recommendations, Assessment, Development, and Evaluation–Adoption, Adaptation, and De Novo Development (GRADE-ADOLOPMENT) approach to contextualize guidelines by adopting, adapting, or excluding recommendations from them. Clinical-referral algorithms were created using recommendations from the CPGs created, with additional recommendations sought through a best-evidence review process. Results We developed local CPGs for eight ENT conditions using the GRADE-ADOLOPMENT approach. While most recommendations were adopted in the local CPGs, one recommendation for acute otitis externa, hearing loss, and epistaxis and two for allergic rhinitis were adopted with minor changes. Six recommendations were excluded due to service limitations in Pakistan. Additionally, we created 8 clinical-referral algorithms, incorporating 17 additional recommendations to address gaps in practice, distributed across various conditions. Conclusion The newly-established CPGs are instrumental in delivering standardized, high-quality care at the primary care level. Simultaneously, the development of clinical referral pathways empowers general physicians to manage patients effectively and make timely, appropriate referrals to ENT specialists.

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Abstract Introduction Hearing loss, especially age-related, affects speech perception and quality of life. Despite its prevalence, many individuals remain undiagnosed due to low awareness and limited access to screening tools. The Digit Triplet Test (DTT) is a proven speech-in-noise screening tool adapted into many languages. In India, the Kannada DTT was developed to address the need for a regional screening method. The present study aims to evaluate the effectiveness of the Kannada DTT to identify older adults with hearing loss. Objective To determine the sensitivity and specificity of the Kannada DTT in identifying older adults with mild-to-moderate sensorineural hearing loss (SNHL). Methods A total of 125 native Kannada-speaking participants aged 50 to 84 years were divided into 2 groups: 57 with normal hearing and 68 with mild-to-moderate hearing loss. Pure tone audiometry and speech identification scores were recorded. Participants underwent the Kannada DTT monaurally in both ears using an adaptive protocol. Results The DTT scores were significantly poorer in the hearing loss group. A moderate positive correlation (r ≈ 0.68) was observed between pure tone average and DTT score. The receiver operating characteristic (ROC) curve analysis revealed that a DTT cutoff score of −11.05 dB provided the best classification accuracy, with sensitivity and specificity of 79.4% and 82.5% for the right ear, and 83.8% and 86% for the left ear, respectively. Conclusion The Kannada DTT demonstrates good sensitivity and specificity in identifying older adults with mild-to-moderate SNHL and can be considered a reliable screening tool for early detection.

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Abstract Introduction Herpes Zoster Oticus is etiologically associated with the reactivation of the Varicella-Zoster virus in the geniculate ganglion. Its primary manifestation includes pain, vesicles in the external auditory canal, and peripheral facial paralysis. The prognosis of the syndrome remains under scrutiny and debate, fluctuating based on symptom severity and clinical manifestation. The scarcity of articles accurately correlating clinical presentation and prognosis, coupled with individual factors and the syndrome's rarity, constrains more comprehensive analyses. Objectives To conduct a systematic review to determine whether it is possible to predict the prognosis of RHS based on clinical factors. Data synthesis This study identified a total of 6,464 articles within the databases, which were subsequently evaluated by two independent researchers. Sixty-two articles underwent full-text examinations, and following meticulous selection criteria, twelve articles were ultimately incorporated into this study. Factors such as age, onset of House-Brackmann degree, dizziness, hearing loss, time to treatment initiation, and comorbidities appear to exert influence on prognosis. The articles exhibit methodological limitations and discrepancies among them, stemming from variations in prognostic concepts, treatment protocols, evaluation timing, or reported outcomes. These variations hinder the possibility of conducting a methodologically sound comparison, regardless of how closely aligned the trials are with the theme. Conclusion The review concludes that it is not possible to definitively assert the presence of a clinical parameter defining the prognosis in Herpes Zoster Oticus.

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Abstract Introduction Tinnitus is the perception of sound without an external source. Various treatments and therapeutic strategies for tinnitus have been used. More recently, this includes music therapy (MT), which aims to mask tinnitus using specific musical elements such as rhythm, melody, harmony, and tempo. Objective To identify evidence in the literature regarding the use of MT for the treatment of tinnitus, the techniques employed, and the outcomes achieved. Data Synthesis In the present systematic review, we searched for articles in the PubMed, Scopus, Web of Science, MEDLINE, LILACS, and SciELO databases, up until January 2024. The search included articles published in English, Portuguese, and German. Articles on the use of MT for the treatment of tinnitus were included. Duplicates, literature reviews, case reports, letters, and editorials were excluded. The descriptors used were "music therapy", "acoustic stimulation" and "tinnitus". Random effects models using the restricted maximum likelihood method were used to estimate the proportion of patients with favorable outcomes. The seardescriptions resulted in the initial selection of 552 articles containing one or more descriptors in the article title. We selected 211 for abstract review, and 48 were selected for full-text review. Finally, 23 articles published between 2005 and 2022 were selected for meta-analysis. Conclusion As an effective method for the treatment of tinnitus, MT stimulates the peripheral and central auditory pathways as well as central para-auditory pathways (related to attention, concentration, memory, and emotions).

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Abstract Introduction Posterior nasal neurectomy (PNN), a procedure used to manage intractable allergic rhinitis, requires precise identification of the posterior nasal nerve and associated neurovascular bundles within the posterior nasal region, including the sphenoid artery. Mastery of reliable surgical techniques and considerable experience are imperative for successful execution. Objectives We describe a novel surgical strategy for posterior nasal neurectomy that circumvents the need to directly identify the posterior nasal nerve directly. Methods To clarify the effects of PNN, pre- and post-operative symptoms, including rhinorrhea, sneezing, and nasal obstruction, were evaluated in patients who underwent PNN using scores derived from the Practical Guidelines for Management of Allergic Rhinitis in Japan 2020. Additionally, preoperative and postoperative (>12 months) medication status and postoperative PNN complications were meticulously documented. Results This retrospective study included 80 patients who underwent PNN between January 2016 and December 2021; 46 of the 80 patients agreed to participate in the survey questionnaire, and the responses of these 46 patients were used for the analysis. Postoperatively, all patients were followed up in the outpatient clinic for >12 months (mean, 18 months). Among the 46 patients, the scores for all allergic symptoms showed significant improvement at 12 months postoperatively compared with the preoperative scores. The proportion of patients who received daily anti-allergic medications decreased from 93.5% (43/46) preoperatively to 15.2% (7/46) postoperatively. No severe complications occurred in any patient. Conclusions This innovative surgical approach demonstrated efficacy in ameliorating the symptoms associated with allergic rhinitis without concomitantly escalating procedural risks.