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Abstract Introduction Septoplasty is standard surgical procedure performed for correction of deviated nasal septum; it affects middle ear ventilation through altering Eustachian tube function. Objective To determine the effect of septoplasty on Eustachian tube function regarding deviation side. Methods A randomized, prospective controlled trial, in which 40 adult patients who underwent septoplasty (80 ears) were divided into: group A: 40 ears in which Eustachian tube function assessment was done on the affected side (deviated nasal septum), and 40 ears in which the function of Eustachian tube assessment was done on the contralateral side "group B". The nasal obstruction symptom evaluation (NOSE) scale was used to analyze surgical satisfaction, ventilation of middle ear was assessed via Eustachian tube functions by the 7-Item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) test scale, insufflation tests (Valsalva and Toynbee), and tympanometry. These parameters were analyzed and compared, before and after septoplasty. Results Among the 40 patients, the mean NOSE score was 13.68 ± 2.69 preoperatively and decreased to 5.76 ± 4.48 postoperatively; ETFQ-7 scores decreased from 12.48 ± 4.78 preoperatively to 7.56 ± 3.4 postoperatively; there were 22 functional Eustachian tubes (55%) preoperatively, which increased to 37 (92.5%) postoperatively, while dysfunctional Eustachian tubes decreased from 18 (45%) preoperatively to 3 (7.5%) postoperatively. Type-A curve tympanogram was (52.5%) preoperatively, which increased to (96.25%) postoperatively, while type-C tympanogram was (47.5%) preoperatively and decreased to (3.75%) postoperatively. Basal middle ear pressure was −33.56 daPA for group A and −29.24 daPA for group B preoperatively, and it changed to −18.96 daPA and −12.18 daPA postoperatively, respectively. Conclusion Septoplasty had a beneficial impact on the Eustachian tube function "ventilation of middle ear".

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Abstract Introduction Oxidative stress plays an important role in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP). The 8-Hydroxydeoxyguanosine (8-OHdG) is a major oxidative DNA adduct, and its levels have been noted as a triggering factor for inflammation-related carcinogenesis, but have not been assessed in CRSwNP. The MAPK/ERK pathway importance in the pathogenesis of CRSwNP has previously been reported. Mutations in RAS family genes occur in neoplastic and non-neoplastic proliferative lesions, and it has been previously demonstrated that KRAS mutations do not occur in CRSwNP. Objective To assess the levels of 8-OHdG in nasal polyps occurring in CRSwNP, to associate these levels with clinicopathological parameters, and to investigate HRAS and NRAS hotspot mutations in the same samples. Methods Both the HRAS (codons 49 and 61) and NRAS (codon 61) mutations were investigated through Sanger sequencing, and the levels of 8-OHdG were determined using ELISA in 14 freshly collected snap-frozen samples of nasal polyps occurring in CRSwNP. The associations between the levels of 8-OHdG and patients' age, presence of asthma, and eosinophil counts in nasal polyps were tested. Results No mutations were detected. The association between higher levels of 8-OHdG and higher eosinophil counts was observed, whereas there was no association between it and age or the presence of asthma. Conclusion Based on the results in the present cohort, higher levels of 8-OHdG, indicative of oxidative stress, are associated with higher eosinophil counts in CRSwNP. Additionally, HRAS and NRAS mutations do not occur in nasal polyps or occur at a very low frequency.

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Abstract Introduction Mealtimes are important for patient's autonomy and independence. They are linked to values and are a source of normality and fulfilment. Independence during mealtimes means eating and drinking safely and independently. However, the presence of oropharyngeal dysphagia (OD) can compromise independence, particularly among patients with neurological conditions. Objective The present cross-sectional study aims to investigate the association between functional independence during meal and multidimensional assessment of neurological subjects with OD. Methods Subjects with OD (DOSS score < 6) and diagnosis of multiple sclerosis, Parkinson's disease, or stroke were recruited. Demographic and clinical data were collected. The swallowing assessment included the Penetration Aspiration Scale (PAS) and the Dysphagia Outcome and Severity Scales (DOSS) during an instrumented assessment, self-reported questionnaire (Eating Assessment Tool-10 - EAT-10), Body Mass Index, a meal observation scored with the Mealtime Assessment Scale (MAS) and cognitive assessment using the Mini-Mental State Examination. The level of independence was assessed using the American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA NOMS) Swallowing Scale. Univariate and multivariate logistic models were used to analyze data. Results Fifty-eight subjects were recruited (18 MS, 20 PD and 20 stroke), among whom 41 (70%) were defined as dependent during mealtime. In the multivariate analysis, EAT-10 score (odds ratio [OR] [95%CI] = 3.25 [1.64–11.08]), diseases duration (OR [95%CI] = 0.87 [0.74–0.97]) and MAS safety (OR [95%CI] = 1.26 [1.06–1.65]) were significantly associated with independence during mealtime. Conclusion Subject's performance during meal, self-reported questionnaire, and diseases duration are independently associated with independence. The present study broadens the focus on dysphagia, underling the importance of identifying all variables able to increase subjects' independence and autonomy at mealtime.

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Abstract Introduction Systemic arterial hypertension (SAH) is a multifactorial condition that has the potential to affect inner ear function, thereby leading to sensorineural hearing loss and tinnitus. As the population ages, there is an increasing prevalence of sudden auditory impairment and auditory disorders. Therefore, it is essential to investigate this connection. are Objective To estimate the association between sudden acoustic hearing loss (SAH) and tinnitus/hearing loss, and to evaluate the methodological quality of related research using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. Methods We employed an analytical cross-sectional design, with a review of observational studies published until April 2025 in English, Portuguese, or Spanish. The evaluation of articles was conducted using the STROBE checklist, and the studies were categorized as adequate, inadequate, or insufficient. Results The prevalence of hearing impairment presented a significant correlation with hypertension (57.33%), followed by tinnitus (56.3%). Most of the topics were classified as adequate, even though the "Results" sections of the articles presented 12% of inadequacy, and the "Additional Information" sections demonstrated the most insufficiency (80%). Furthermore, the "Discussion" sections revealed a notable concern, with 12.5% of the respondents expressing dissatisfaction. Conclusion A substantial degree of heterogeneity was observed across studies, underscoring the necessity for standardized future research to facilitate more reliable comparisons.

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Abstract Introduction Early identification of pediatric hearing loss is vital to reduce long-term developmental consequences; however, awareness among future healthcare professionals remains limited in many low- and middle-income countries. Objective To assess the knowledge and perceptions of university students in Jordan regarding pediatric hearing loss. Methods We conducted a cross-sectional study using a questionnaire that evaluated the students' awareness of the common causes and risk factors for hearing loss in children, perceptions of early intervention, and self-reported confidence in identifying and referring potential cases. The awareness and perception items were grouped into two categories, and misconception rates were calculated as the proportion of respondents answering agree or strongly agree to statements that were factually incorrect. Chi-square tests were conducted to examine associations between participant demographics and response patterns, with statistical significance set at p < 0.05. Results A total of 411 students participated (response rate: 84.4%); most were aged from 18 to 25 years (81%) and female (53%), with 65% of them enrolled in the Faculty of Allied Medical Sciences, Al-Ahliyya Amman University, Jordan. Misconceptions were more common in awareness items (mean: 30.4%), with the highest rate observed for the belief that neonatal meningitis or seizures do not cause hearing loss (44%). Perception items showed lower misconception rates (mean :13.4%), with the highest being that parental suspicion should not influence clinical opinion (26%). The Chi-squared analysis revealed that higher awareness was significantly associated with year of study (p < 0.001), major (p < 0.001), and family history (p < 0.05). Conclusion Despite their positive attitudes, students showed limited clinical knowledge. Strengthening audiology education in health science university programs may improve early detection and intervention outcomes in Jordan.

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Abstract Introduction Silicone stents are often employed in dacryocystorhinostomy (DCR) procedures to maintain the patency of the newly created tear drainage passage during the healing stage. These stents are flexible, biocompatible, and generally well tolerated by patients. They help prevent adhesion formation and ensure that the surgical opening remains open as the tissue heals. Use of stents in primary DCR is well documented, but their advantages in revision DCR need further exploration. We evaluated the advantages of silicone stents in revision endoscopic DCR performed at a tertiary care hospital. Objective To compare the surgical success rates of revision endoscopic DCR with and without the use of silicone stents, analyze the incidence of postoperative complications, assess patient satisfaction and quality of life following revision endoscopic DCR using standardized patient questionnaires and evaluate the effectiveness of silicone stents in maintaining ostium patency during the healing process Methods The present prospective, interventional, hospital-based study involved 160 patients with nasolacrimal duct obstruction with patent upper and lower canaliculi with symptoms like epiphora, discharge from the eye, swelling in the lacrimal region, hard stop on lacrimal syringing and previous failed endoscopic endonasal DCR and common canalicular obstruction for 2 years. Results When compared with the non-silicone stent group, the silicone stent group experienced shorter hospital stays, larger anatomical patency, lower recurrence rates, higher satisfaction, and higher success rates. Conclusion In revision DCR, the use of silicone stents greatly improves surgical results, patient satisfaction, recurrence rates, and hospital stays.

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Abstract Introduction Dysphonia is defined as a change in voice timber, pitch, or loudness. Precipitating factors may be occupational or health-related, such as allergy and laryngopharyngeal reflux (LPR). Objective To investigate the association between combined LPR, and allergic rhinitis (AR), and type of dysphonia, that is, functional versus non-functional. Methods A retrospective chart review of all patients with dysphonia who presented to the Voice Unit at a tertiary referral center between November 2018 and February 2022 was conducted. Patients must have previously filled out the Reflux Symptom Index (RSI) and AR questionnaires to be recruited. Based on laryngeal examination, the etiology of dysphonia was stratified as functional versus non-functional (referred to as structural/neurologic). Results A total of 137 patients were included, 65 (47.4%) of whom had a structural voice disorder, 22 (16.1%) had neurologic voice disorders, and 50 (36.5%) had a functional voice disorder. Seventy-eight patients (56.1%) had a positive RSI ≥ 13, suggestive of LPR. In these patients, dysphonia was functional in 31, structural-in 34, and neurologic in 13 (p = 0.568). Sixty-eight patients (48.9%) had a positive AR score ≥ 1, suggestive of allergy, 62% of whom had functional dysphonia, 46.2% had structural dysphonia, and 31.8% had neurologic dysphonia (p = 0.046). Twenty-five of the 50 patients (50%) with functional dysphonia had RSI ≥ 13 and AR ≥ 1 versus 29.3% (19/65) of the structural subgroup and 31.8% (7/22) of the neurologic subgroup (p = 0.063). After adjusting for smoking, patients with both reflux and allergy had 2.913 (95%CI = 1.32–6.442) times the odds having functional dysphonia compared with those having either or none (p = 0.008). Conclusion Patients with dysphonia and history of LPR and allergy are more likely to have a functional underlying etiology.

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Abstract Introduction Although the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) is a complete questionnaire for evaluating BDD, there are few studies in the literature to investigate or screen for dysmorphism in patients undergoing facial plastic surgery. Objective To map and evaluate facial plastic studies that used this questionnaire to research body dysmorphism in their populations. The secondary objectives were to review the criteria and questions assessed by the questionnaire and their applicability. Methods The study selection criteria involved studies that used the BDD-YBOCS in screening studies for dysmorphism in patients who were candidates for or underwent facial plastic surgery. Literature search was carried out in PubMed/electronic database, database Google Scholar data, and Web of Science by the authors. Two independent researchers conducted a citation search of relevant literature. To select appropriate patients for esthetic procedures, validated preoperative BDD screening tools should be used. Results Historically, patients with BDD had contraindications for esthetic procedures and surgeries. However, recent evidence supports more refined decision-making based on disorder severity and patients' overall level of functioning. Conclusion It is reaffirmed that esthetic surgery is not effective in treating BDD, despite declared patient satisfaction. Therefore, the psychological disorder must be treated first because surgical treatment without prior psychological treatment may result in dangerous consequences for surgeons.

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Abstract Introduction Cancer patients undergoing potentially-ototoxic chemotherapy may present a series of hearing disorders and risk factors prior to treatment. Thus, it is necessary to know the profile of these patients to promote preventive actions and guidelines regarding the hearing health of these individuals. Objective To describe and relate the hearing characteristics of patients entering a chemotherapy service before the exposure to potentially-ototoxic drugs. Methods We conducted a cross-sectional study of 261 individuals who started chemotherapy between April and December 2022. All patients filled out a hearing case history and underwent otoscopy. Individuals who had a non-altered otoscopy due to obstructive cerumen underwent distortion-product otoacoustic emissions (DPOAEs) at 2, 4, 6, 8, 10, and 12 kHz in both ears. Results In total, 83% of the patients reported good hearing and 31% described some level of hearing impairment. The most prevalent self-reported hearing issue was tinnitus (35%). Only 12% had a medical diagnosis of hearing loss, and 20% had obstructive cerumen during otoscopy. Individuals who reported hearing impairments such as reduced hearing and difficulty understanding noises demonstrated fewer responses in the DPOAEs at various frequencies. In addition, there were significant differences in DPOAE amplitudes among different age groups. Given the substantial burden of hearing loss with ageing, attention to this population is essential for the possibility of preventing or delaying hearing loss. Conclusion Cancer patients entering a chemotherapy service have a hearing case history of risk factors and hearing alterations prior to exposure to potentially-ototoxic drugs.

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Abstract Introduction Facial nerve palsy is the most common complication after vestibular schwannoma surgery. Its etiology is unknown and, in a small group of patients, it can manifest as delayed palsy. Objective To focus on delayed palsy itself and its possible association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods Only patients with primary surgery were included in the current study. Delayed palsy was defined as the new onset of facial nerve palsy that occurred more than 72 hours after surgery. The results were correlated with information from the database of the Institute of Health Information and Statistics of the Czech Republic. Results From January 2017 to December 2022, a total of 194 patients were operated on for vestibular schwannoma, out of whom 143 met the inclusion criteria. Delayed facial nerve palsy occurred in 9 patients, more frequently in the coronavirus disease 2019 (COVID-19)-related years, with a ratio of 1:8 (p = 0.0046) when comparing the periods of 2017 to 2019 and 2020 to 2022. There was a difference in the age of patients with delayed palsy (average: 44.0 years) and those without delayed palsy (average 49.9 years; p = 0.04). The age distribution in the individual years did not differ (p = 0.38); however, the distribution of patients coincided with the overall appearance of SARS-CoV-2 infection in the population across different age groups (p < 0.0001). Conclusion Delayed facial nerve palsy is a rare entity after vestibular schwannoma surgery. The increase in its incidence during the COVID-19 pandemic is evident and corresponds to the general epidemiological situation with respect to age distribution.

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Abstract Introduction Obstructive sleep apnea (OSA) is a breathing disorder that causes hypoxia which, in turn, causes cochlear dysfunction. Objectives To determine whether Positive Airway Pressure (PAP) treatment has a positive or negative effect on hearing during 6-month follow-up of severe OSA. Methods There were 59 patients with severe OSA in the study group and 31 volunteers in the control group. Audiologic tests were performed on both groups before the start of PAP treatment, at the 3rd and 6th month of the PAP treatment. Results The mean ages of the study and control groups were 46.3 ± 7.1 and 43.8 ± 7.7 years, respectively (p = 0.39). The test means for Sleep Efficiency (89.3 ± 4.2), AHI (45.3 ± 16.8), ODI (39.5 ± 20.8), MOS (89.9 ± 3.7), AD (7.6 ± 3.4), LOS (78 ± 8.5), and TDOS (40.7 ± 26) were registered for the study group. High-frequency PTA (HF-PTA) scores were higher in the study group than in the control (p < 0.01); they also decreased in the 3rd month of treatment (p < 0.01) and persisted in the 6th month. There was a correlation between HF-PTA and MOS, AD, and LOS (p < 0.01; 0.05; 0.045, respectively). Also, 8 kHz hearing levels were highly correlated with HF-PTA in the study and control groups (p < 0.01 and ρ = 0.74; p = 0.01 and ρ = 0.58, respectively). Conclusion High-frequency hearing threshold levels may show improvement with the use of PAP therapy. Also, the 8 kHz hearing levels may be used to predict high-frequency hearing loss and early cochlear damage.

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Abstract Introduction Pharyngeal reconstruction is essential after total laryngectomy. Traditionally, manual suturing (MS) is used, but it often involves longer operative times and variable outcomes. Over the years, automatic suturing (AS) has gained attention due to its precision, shorter operative time, and lower complication rates. Objective To compare AS and MS in patients with laryngeal carcinoma who underwent total laryngectomy, focusing on pharyngocutaneous fistula (PCF) incidence, operative time, surgical margins, and hospital stay. Methods A retrospective cohort from 2014 to 2024 at a tertiary center, including 107 patients with laryngeal carcinoma who underwent pharyngeal reconstruction with AS or MS. The suturing choice depended on oncological safety and surgeon preference. Data on demographics, tumor stage, PCF occurrence, hospital stay, and operative time were collected. Results A total of 53 patients underwent AS, and 54, MS. Most were male subjects (96.2%), with similar ages (63.3 versus 62.3 years; p = 0.559). The PCF rates were higher with AS (26.4 versus 18.5%) but not statistically significant (p = 0.328). No correlation was found between salvage laryngectomy and PCF. Negative margins (R0) were more frequently observed in the AS group (82.1 versus 37%; p = 0.04). Operative time was shorter in AS (316.8 versus 367.2 minutes; p = 0.01). Hospital stay and time to oral feeding were similar. Conclusion There was a noted association between AS and shorter operative time and a higher observed rate of negative margins in selected cases, without an increase in PCF. These findings should be interpreted in the context of selection bias and anatomical constraints.

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Abstract Introduction Hearing loss is genetically diverse, as it is caused by alterations in many genes and diverse inheritance patterns. While most causative variants are found in coding regions, noncoding regulatory variants can alter gene expression and may not be detected by standard exome sequencing analysis. Objective To identify the genetic cause of autosomal dominant postlingual hearing loss in a large Brazilian family with 39 affected individuals and to describe their clinical features. Methods Comprehensive audiological and imaging evaluations were conducted. Whole-exome sequencing on four affected subjects, supplemented by structural-variant analysis, identified a candidate variant later confirmed by quantitative polymerase chain reaction (qPCR), PCR, and Sanger sequencing. Results Audiological testing of 61 relatives identified 31 individuals with progressive sensorineural hearing loss or auditory neuropathy linked to autosomal dominant inheritance. Genetic analysis revealed a DIAPH3 5'UTR deletion-insertion (c.-216_-46delinsAAGAA) that perfectly cosegregated with this specific phenotype. Notably, eight other affected relatives exhibited different clinical forms of hearing loss but did not carry the DIAPH3 variant, suggesting separate underlying causes for their symptoms. Conclusion Identification of this regulatory structural variant supports the role of DIAPH3 in the etiological diagnosis of postlingual hearing loss and auditory neuropathy, with direct implications for genetic counseling and clinical management.

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Abstract Introduction Non-technical hearing screening using a self-assessment questionnaire in a mobile app offers a low-cost solution for at-risk populations. The present study developed Kannada-language hearing questions using health literacy principles—plain language, simple phrasing, and dialect inclusion—to improve accessibility for underserved groups. Objective To evaluate the effectiveness of culturally relevant Kannada hearing questions in detecting hearing loss compared with technical screening. The objectives were to assess the content validity of the new questionnaire, compare the accuracy of technical and non-technical screening apps against conventional pure-tone audiometry, and measure client satisfaction. Study Sample and Design Eighty-four participants aged 20 to 45 years with minimal-to- moderate hearing loss were evaluated using a comparative research design. Methods A standardised adult hearing questionnaire was developed and content-validated. Each participant underwent hearing screening with both technical and non-technical mobile apps, followed by a client satisfaction survey. Conventional pure-tone audiometry (0.5–8 kHz) was used to determine hearing thresholds. Results The technical screening app demonstrated 97% sensitivity and accuracy, with 95% specificity. Although the non-technical app initially showed lower accuracy, employing a two-refer threshold improved its performance to 86% sensitivity, 100% specificity, and 97% accuracy. Additionally, user satisfaction ratings were higher for the non-technical app. Conclusion With a two-refer threshold, the accuracy of the Kannada non-technical screening app was comparable to that of the technical screening method. Clinical Relevance The self-guided technical app benefits individuals with technical proficiency, while the non-technical screening is ideal for native speakers with dexterity issues or limited technical skills.

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Abstract Introduction Allergic rhinitis (AR) is an IgE-mediated inflammatory reaction of the nasal mucosa triggered by various allergens, leading to nasal congestion, rhinorrhoea, sneezing, nasal itching, ocular redness, lacrimation, and postnasal dripping. This condition can also cause sleep disturbances and fatigue, which can affect productivity at work and academic performance, therefore posing substantial economic burden. Positive outcomes rely on efficacy of medications, potential adverse effects of medication, treatment response, and overall prognosis. Objective To investigate the utility of the Rhinitis Control Assessment Test (RCAT) as a clinical tool in Urdu for evaluating and monitoring allergic rhinitis. Methods The RCAT is a self-administered questionnaire consisting of six questions addressing specific rhinitis symptoms. Results The study included 60 (35 male and 25 female) patients with ages ranging from 18 to 55 (mean: 35) years. The RCAT demonstrated acceptable internal consistency with a Cronbach's alpha of 0.759. Interitem correlations supported that the questionnaire items reflected related constructs. Paired sample t-tests showed statistically significant improvements in all RCAT items posttreatment (p < 0.001), except for the compliance-related item (q5; p = 0.166). The overall score increased significantly (mean difference = 9.28; p < 0.001), indicating improved rhinitis control. Conclusion The RCAT has proven to be a valuable tool for assessing allergic rhinitis control. Its ease of use and adaptability across languages make it an excellent choice for routine monitoring and management of AR. The successful application of RCAT in Urdu further enhances its accessibility and effectiveness for native speakers.

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Abstract Introduction The prevalence of temporomandibular disorders in the population with chronic or recurrent headaches is too high for a relationship not to exist. Publications propose the examination of the masticatory system in all patients with headache. Objective To introduce a new entity within temporomandibular disorders, temporomandibular joint compromise (TMJC), mandibular movement limiting pathology of extra-articular traumatic cause, and evaluate the response rate and safety of treatment. The limiting cause of mandibular movement is the lack of space between the mandibular ramus and maxilla. The main symptoms of TMJC include headache, dizziness, and tinnitus. In many cases, the headache is previously diagnosed as a migraine. Methods Data were collected from 54 patients aged between 6 and 59 years who had a confirmed diagnosis of migraine (according to the the International Classification of Headache Disorders, 3rd edition [ICHD3]) and were treated for TMJC in a dental clinic. They also presented other otolaryngological symptoms. A retrospective quasi-experimental study without a control group was carried out due to ethical considerations related to the harmless nature of the treatment. Results After treatment of TMJC, migraine symptoms disappeared in 52 patients (96.3%, p < 0.001) and persisted, although with clinical improvement, in 2 (3.7%). There was also an improvement in the other associated symptoms: dizziness disappeared in 23 out of the 27 affected patients (85.21%, p < 0.001) and tinnitus disappeared in the 31 affected patients (100%, p < 0.001). No significant treatment-related side effects were observed. Conclusion The present study shows the high rate of response and safety of the treatment of TMJC.

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Abstract Introduction Understanding the relationship between blood groups (A, B, AB, and O) and auditory functioning can provide valuable insights into individual differences in hearing ability and potential risks for hearing loss. Objective To assess the impact of blood group on auditory functions. It examined contralateral suppression of transient evoked otoacoustic emissions (TEOAEs), speech perception in noise (SPIN), and binaural integration using the dichotic consonant-vowel (DCV) test. Methods There were 60 female participants, from the blood groups A, B, AB, and O, aged 18 to 30 years with normal hearing were included. This study's preliminary assessments included pure-tone audiometry, immittance audiometry, and otoscopy to exclude hearing loss and middle ear dysfunction. Suppression of TEOAE was measured with and without contralateral broadband noise, while SPIN was tested at signal-to-noise ratios (SNRs) of −10, 0, and +10 dB. The DCV test assessed binaural integration with the presentation of prerecorded consonant-vowel stimuli simultaneously. Results The Kruskal-Wallis H test showed no significant differences in TEOAE suppression amplitudes, SPIN scores across SNRs, or DCV scores across the four blood groups. Conclusion These findings suggest that blood type has no discernible effect on central auditory functions, such as binaural integration, speech perception in noisy environments, or efferent auditory system functioning. This research, thus, highlights the need for further investigation with diverse methodologies and larger cohorts, to better understand the role of blood groups in auditory processing.

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Abstract Introduction Prevalence of elongated styloid process (SP) is 4% and only 4–10% of these patients are symptomatic. In this study morphology was assessed among the patients unlike the dry skulls. Comparison of elongation and angulation of SP between the case and control groups, as well as symptomatic correlation was done. This study also imparts information regarding symptomatic outcomes following medical and surgical management. Objective To compare the anatomical variations in SP morphology and symptomatology in patients with and without stylalgia. Methods A prospective study was done over a period of 1.5 years on 84 participants. The required details were recorded. Radio-imaging was done through Towne's and lateral view of skull X-rays to measure length, as well as medial and anterior angulations. Pain assessment was done with the visual analogue scale before and after conservative or surgical managements. Results Mean age of participants was 37.2 ± 8.8 years, with a female preponderance. The most common symptom was recurrent oropharyngeal pain (67.8%). Elongated SP was observed in the case group with a mean length of 4.07 cm, compared with 2.36 cm in controls. The mean medial angulation of the SP was of 21.28° in the case group and of 16.77° in the controls. Anterior angulation in the case group was of 32.19°, compared with 21.74° in the controls. A statistically significant difference was noted in in length, medial and anterior angulations in the case group when compared with controls. Conclusion Symptomatic elongated SP is a complex condition for many patients. Its precise identification will aid in early recovery from symptoms. Surgical management showed better symptomatic outcomes. Level of Evidence Level 3.

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Abstract Introduction There are concerns about addiction to opioids due to excessive prescription after surgery. Objective We compared the impact of dexmedetomidine as an additive to ropivacaine for bilateral cervical plexus block to that of ropivacaine alone for postoperative analgesia in patients undergoing thyroidectomy. Methods A total of 60 patients were randomized in 2 groups: those submitted to bilateral superficial cervical plexus block (BSCPB) using 0.375% ropivacaine (group BSCPB-R, the control group) and those submitted to BSCPB using 0.375% ropivacaine with 1mcg/kg of dexmedetomidine (group BSCPB-RD, the study group). The resultant postoperative analgesia was compared by the morphine milligram equivalents (MMEs) required by each patient. Results Only 3 (10%) patients in the BSCPB-R group and 2 (6.6%) patients in the BSCPB-RD group required opioid analgesia. The mean total rescue opioid required in the first 24 hours was significantly higher in group BSCPB-R compared to group BSCPB-RD (20 ± 8.14 versus 8 ± 2.85 MME respectively; p = 0.0001). Similarly, the mean total MMEs required during the first 5 days after surgery was of 38 ± 16.4 for group BSCPB-R and 18 ± 8 for group BSCPB-RD (p = 0.0001). Conclusion The combination of dexmedetomidine and ropivacaine in the BSCPB protocol results in a lower requirement of opioids for pain in the postoperative period, and very few (if any) patients undergoing thyroid surgery require postoperative opioids with this strategy.

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Abstract Introduction The present study aimed to evaluate the adherence of Brazilian otolaryngologists to key recommendations from contemporary international tonsillectomy guidelines, particularly the 2019 Clinical Practice Guideline by Mitchell et al. Objective To evaluate how Brazilian otorhinolaryngologists perform tonsillectomies and manage potential postoperative complications. Methods An online questionnaire was developed and completed by otorhinolaryngologists affiliated with relevant medical associations. Results Revealed that 40.4% of surgeons had over 20 years of experience, indicating substantial expertise. Primary indications for tonsillectomy included snoring, hypertrophy, and recurrent tonsillitis. Diagnostic criteria for acute bacterial tonsillitis and obstructive sleep apnea were analyzed, with 35% of respondents considering episode frequency a key criterion. Polysomnography was requested in specific cases, reflecting concerns about respiratory severity. Conclusion The present study provides the first comprehensive analysis of the adoption of international guidelines for tonsillectomy in Brazil. We conclude that, although the Brazilian otolaryngology community has adopted key recommendations regarding diagnosis and postoperative care, deeply entrenched deviations persist in technical aspects and intraoperative medication. These latter aspects represent opportunities for educational interventions, resource mobilization, and the development of adapted national guidelines that take local realities into account, with the ultimate goal of standardizing and improving the quality of care for all children undergoing tonsillectomy in the country.

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Abstract Introduction A ringing sensation in the ear is referred to as tinnitus. It is one of the common symptoms associated with hearing loss. It can be associated even with loudness-related conditions, such as hyperacusis. Objective To investigate the relationship between tinnitus and hyperacusis in individuals with normal hearing and up-to-mild hearing loss, focusing on the manifestation of loudness intolerance. Methods The Tinnitus Handicap Inventory (THI) was administered among 35 adults having primary complaints of tinnitus with normal hearing and up-to-mild hearing loss. Further, the Modified Khalfa Hyperacusis Questionnaire (M-HQ) was used to evaluate the hyperacusis severity among the same individuals. Spearman's correlation coefficient was used to check the correlation between tinnitus and hyperacusis severity. Results Of the 35 adults who reported tinnitus, 18 (51.4%) of them reported having hyperacusis. The outcome of Spearman's correlation indicated a moderate positive correlation between the THI and M-HQ scores rs = 0.401(p = 0.017). Conclusion The results obtained suggest that tinnitus is associated with hyperacusis. With the subjective evaluation, it is clear that the change in the severity of tinnitus perception is interconnected with the perception of hyperacusis severity. But this relationship is not a completely overlapping one. Future research on the comorbid interplay of tinnitus severity and hyperacusis severity may shed further light on this link.

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Abstract Introduction Acute otitis media (AOM) is associated with the development of permanent sensorineural hearing loss (SNHL). The potential role of steroids in preventing cochlear damage secondary to AOM has been discussed. Objective To critically analyze the current evidence on the use of steroids to prevent AOM-associated SNHL. Data synthesis A total of 15 studies was categorized into 3 groups: 1) studies on histopathological changes in the inner ear secondary to AOM (n 5); 2) those on the relationship between AOM and hearing outcomes (n = 5); and 3) studies on the (hearing or histological) outcomes of AOM treatment using steroids (n = 5). Experimental studies in animals and human temporal bones revealed that AOM is associated with the upregulation of proinflammatory cytokines in the middle and inner ears, resulting in an inflammatory process. Inflammatory cytokines and bacterial toxins translocate from the middle to the inner ears through the semipermeable round window membrane, causing structural damage to the neuroepithelium, mainly in the cochlear basal turn. In experimental studies, the use of steroids has been shown to reduce the expression of inflammatory cells and cytokines and the structural damage affecting the stria vascularis and hair cells. One study clinically evaluated the effects of steroids on AOM patients with SNHL, and it demonstrated significant improvements in hearing thresholds. Conclusion Experimental data demonstrate that steroids can reduce the expression of inflammatory cytokines and reduce structural damage to the cochlear neurosensory epithelium. However, these findings have yet to be translated to a clinical setting due to the lack of high-level evidence.

Resumo em Inglês:

Abstract Introduction Virtual reality is a tool used in the rehabilitation of neurodegenerative diseases and vestibular disorders, enabling immersion in a playful and illusory world. Objective To determine the effects of vestibular rehabilitation with virtual reality in adults with vestibular disorders. Data Synthesis Appropriate word combinations were selected and tailored specifically to seven electronic databases. Studies that investigated vestibular rehabilitation with virtual reality in individuals > 18-years-old and diagnosed with vestibular dysfunction were included. The risk of bias and the certainty of the evidence was assessed. A random-effects meta-analysis was performed, with a total of 18 articles included. There was an improvement in the level of confidence in balance scores between baseline and postintervention of 11.22 (95% CI = 8.55–13.88; I2 = 18%). An improvement in the disabling effects caused by dizziness was also observed, with a difference between means in relation to the two periods of −22.76 (95% CI = −28.70 to −16.82; I2 = 88%). The certainty of evidence assessment was very low. Conclusion Virtual reality therapy in vestibular disorders has shown efficient results, being a useful, low-cost, and motivating tool in the treatment of these disorders.

Resumo em Inglês:

Abstract Introduction Robotic-assisted surgery (RAS) is increasingly used in skull-base procedures due to its enhanced visualization, precision, and ergonomics, particularly in anatomically-constrained regions. The present narrative review explores the current role and emerging frontiers of RAS in anterior and lateral skull-base surgeries within otolaryngology and neurosurgery. Methods We conducted a comprehensive narrative review of studies published throughout the past 2 decades on the PubMed, Scopus, and Web of Science databases using keywords such as robotic skull-base surgery, transoral robotic surgery, and robotics in otolaryngology. We included studies detailing robotic interventions in anterior and lateral skull-base pathology. Results Robotic platforms—such as the da Vinci and KUKA systems—have demonstrated efficacy in pituitary-adenoma resection, sinonasal-tumor management, cochlear implantation, and mastoid drilling. The benefits reported include improved access, reduced instrument collision, tremor filtration, and enhanced surgical ergonomics. Institutional data and case studies indicate outcomes comparable or superior to those of the traditional approaches in select cases. Nonetheless, challenges remain, including high costs, limited training availability, and technical complexity. Conclusion Robotic-assisted surgery has demonstrated clinical value in skull-base surgery, and it has the potential of improving outcomes while minimizing surgeon fatigue. Broader adoption will depend on cost reduction, widespread training, and technological advancements. Emerging innovations—including the integration of artificial intelligence, image-guided navigation, and instrument miniaturization—may further expand its usefulness in complex skull-base interventions.