Diagnostic accuracy of the video otoscope in tympanic membrane perforation

Abstract Objective The video otoscope has already proven to be useful for the diagnosis of several pathologies, so the objective of this study was to evaluate the diagnostic accuracy of the video otoscope in cases of tympanic membrane perforation. Methods This is a diagnostic accuracy study performed at the hearing health division of a tertiary-level referral hospital. Patients older than 8 years of age who had any symptom that could be related to perforation (otalgia, otorrhea, tinnitus, and/or hypoacusis) were invited to participate in the study. Participants were evaluated by three different diagnostic methods (otomicroscope, conventional otoscope, and video otoscope) performed by three different evaluators in a blind fashion. The microscope was considered the reference standard. Results 176 patients were evaluated, totaling 352 tympanic membranes. Twenty-seven tympanic membrane perforations were diagnosed by the microscope, a prevalence of 7.7%. The video otoscope showed a sensitivity of 85.2% (95% CI 81.5%‒88.9%), specificity of 98.1% (95% CI 96.7%‒99.5%) and accuracy of 97.1% (95% CI 95.4 %-98.8 %). The conventional otoscope showed a sensitivity of 96.3% (95% CI 94.3-98.3), specificity of 98.8% (95% CI 97.7-99.9) and accuracy of 98.6% (95% CI 97.4-99.8). The Kappa value between the microscope and the video otoscope was 0.8 and between the microscope and the conventional otoscope was 0.9. Regarding the participants' perception, 53.4% (p < 0.001) considered the video otoscope as the best method for understanding the tympanic membrane condition presented by them. Conclusions The video otoscope showed relevant sensitivity and specificity for clinical practice in the diagnosis of tympanic membrane perforation. Moreover, this is an equipment that can facilitate the patient's understanding of the otologic pathology presented by him/her. In this regard, this method may be important for better patient compliance, requiring further studies to evaluate this hypothesis. Level of evidence Is this diagnostic or monitoring test accurate? (Diagnosis)—Level 2 (Individual cross-sectional studies with consistently applied reference standard and blinding).

Analysis of Otorhinolaryngology Practices-Challenges of Specialists and Facilties-in sub-Saharan Africa

Background: More than 95% of the population in sub-Saharan Africa (S.S.A.) does not have ready access to safe, affordable surgical care, and there is a desperate need for E.N.T. (ear, nose, and throat), audiology, and speech therapy services. Therefore, from an international outlook, the most significant challenge confronting hearing and cancer care delivery is not high-technology and high-cost medicine but the lack of access to even the most elementary E.N.T. care Materials and Methods: A literature search for studies on the analysis of trends and outcomes of otorhinolaryngology practices in sub-Saharan Africa was performed using Google Scholar search database, PubMed, Medline, and ScienceDirect. The bibliographies of included studies were also searched for additional references. About 95 articles were identified. Twenty-one articles were considered suitable for the review. The whole residents of the 22Results: countries illustrated in a study reviewed were 720,500,000; this symbolizes 75% of the population of sub-Saharan Africa. Among the 22 countries that were tested, 847 ENT surgeons, 580 audiologists, 906 speech therapists, 264 ENT clinical officers, and 320 oncologists were reported. When data have combined the sample, the regional ratio was 1.2 million people per E.N.T. surgeon, 0.8 million people per audiologist, and 1.3 million people per speech therapist. Conclusion: Basic E.N.T. and airway-related interventions are possible in most countries that responded; life-saving procedures such as tracheostomy (and tracheostomy tubes), bronchoscopy, and balloon dilatation were not readily available in all countries. Access to hearing screening was very poor in most countries, highlighting the undocumented burden of disease of hearing loss in Africa and other LMICs, estimated at 5% of the world's population

Biomateriales y tecnologías de impresión 3D en entrenamiento quirúrgico en otorrinolaringología: una revisión

La tecnología de fabricación aditiva o impresión 3D se ha posicionado como una herramienta transversal y de uso creciente en el mundo productivo y científico que ha otorgado la posibilidad de diseñar y crear elementos y modelos de diversa complejidad. En el área biomédica ha presentado un aumento significativo de sus aplicaciones a través del tiempo, actualmente teniendo relevancia en ámbitos como el planeamiento quirúrgico, la creación de prótesis, modelos anatómicos para educación y entrenamiento quirúrgico. Actualmente existen diversas dificultades que limitan la formación quirúrgica, especialmente en ciertas áreas de la otorrinolaringología como la cirugía de oído. El objetivo de la presente revisión narrativa fue actualizar los usos de la tecnología de impresión 3D para la creación de modelos para entrenamiento quirúrgico en otorrinolaringología, destacando sus potenciales usos en otología, rinología, cirugía de base de cráneo y vía aérea.

Additive manufacturing technology or 3D printing has positioned itself as a cross-cutting tool of increasing use in the productive and scientific world that has given the possibility of designing and creating different elements and models of varying complexity. In the biomedical area, it has presented a significant increase in its applications over time, currently having relevance in areas such as surgical planning, the creation of prostheses, anatomical models for education and surgical training. Currently there are various difficulties that limit surgical training, especially in certain areas of otorhinolaryngology such as ear surgery. The objective of this narrative review was to update the uses of 3D printing technology for the creation of models for surgical training in otorhinolaryngology, highlighting its potential uses in otology, rhinology, skull base and airway surgery.

Application of "three-dimensional knowledge-objective" teaching combined with immersive clinical experience in nursing practice teaching in the operating room of department of ophthalmology and otorhinolaryngology / 中华医学教育探索杂志

Objective:To investigate the application of "three-dimensional knowledge-objective" teaching combined with immersive clinical experience in nursing practice teaching in the operating room of department of ophthalmology and otorhinolaryngology.Methods:A total of 86 nursing students who received practice teaching in the operating room of Department of Ophthalmology and Otorhinolaryngology in our hospital were selected as research subjects and were divided into control group and observation group using a simple random number table, with 43 students in each group. The students in the control group received traditional teaching, and those in the observation group received "three-dimensional knowledge-objective" teaching and immersive clinical experience. The two groups were assessed in terms of the effectiveness of classroom teaching, nursing quality score, and the score of the ability to handle nurse-patient dispute. SPSS 22.0 was used to perform the chi-square test and the t-test. Results:After training, both groups had significant increases in the scores of basic nursing, specialized nursing, equipment management, equipment coordination ability, patrol coordination ability, and document recording ability and the total score of all dimensions, and the observation group had significantly higher scores than the control group ( P<0.05). After training, both groups had significant increases in the scores of dispute identification ability, the ability of emergency response to dispute, nurse-patient communication skills, the awareness of nursing laws and regulations, and psychological stress adjustment ability and the total score of all dimensions, and the observation group had significantly higher scores than the control group ( P<0.05). Conclusion:In the nursing practice teaching in the operating room of the department of ophthalmology and otorhinolaryngology, "three-dimensional knowledge-objective" teaching combined with immersive clinical experience can improve the effectiveness of classroom teaching, enhance nursing quality, and strengthen the ability to handle nurse-patient dispute.

Prevalencia de infección por COVID-19 por serología positiva (IgG/IgM) en personal médico de la cátedra y servicio de otorrinolaringología del Hospital de Clínicas / Prevalence of COVID-19 infection by positive serology (IgG/IgM) in medical personnel of the chair and service of otorhinolaryngology of the Hospital de Clínicas

Resumen Introducción: El personal de otorrinolaringología presenta una elevada exposición al virus SARS-CoV-2, debido a los procedimientos que lleva a cabo. Es fundamental tomar las medidas de protección adecuadas. Determinar la seroprevalencia nos dará un mejor panorama sobre la exposición, contagios y efectividad de medidas de protección adoptadas. Objetivo: Determinar la prevalencia de resultados serológicos positivos en personal médico que presta servicio en la Cátedra de Otorrinolaringología de marzo del 2020 a marzo de 2021. Material y Método: Estudio observacional, descriptivo, corte transversal, retrospectivo con asociación cruzada. Muestreo no probabilístico de casos consecutivos. La población total fue de 38 médicos del Servicio de Otorrinolaringología del Hospital de Clínicas. Resultados: La media de edades fue 37,4 años, 63,5% refirió haber atendido a paciente conocido portador de COVID-19. Un 42% refirió no haber cumplido con todas las medidas de protección personal, mientras que un 23,7% de los sujetos de estudio dio positivo para IgG, interpretándose como infección previa por COVID-19. Conclusión: Más de las dos terceras partes de los médicos refirió dar consulta a paciente COVID-19 positivo. Casi la cuarta parte de los médicos resultó ser positivo para COVID-19 según la prueba de serología anti-N. No se halló asociación entre consulta ni cirugía a pacientes portadores de COVID-19 y el contagio al personal médico.

Abstract Introduction: Otolaryngology personnel have a high exposure to SARS-CoV-2 virus due to the procedures they perform. It is essential to take appropriate protective measures. Determining seroprevalence will give us a better picture of exposure, contagion and effectiveness of protective measures adopted. Aim: To determine the prevalence of positive serological results in medical staff serving in the otolaryngology department from March 2020 to March 2021. Material and Method: Observational, descriptive, cross-sectional, retrospective, retrospective study with cross-association. Non-probability sampling of consecutive cases. The total population was 38 physicians of the Otolaryngology Service of the Hospital de Clinicas. Results: The mean age was 37.4. 63.5% reported having seen a patient known to be a COVID-19 carrier, while 42% reported not having complied with all personal protection measures. A 23.68% of the study subjects tested positive for IgG, interpreting previous COVID-19 infection. Conclusion: More than two-thirds of the physicians referred to giving consultation to COVID-19 positive patients. Almost a quarter of the physicians were positive for COVID-19 according to the Anti-N serology test. No association was found between consultation or surgery of patients with COVID-19 and infection of medical personnel.

El buceo recreativo y la otorrinolaringología: ¿qué sabemos y deberíamos saber? / Recreational diving and otolaryngology: what do we know and should we know?

El buceo recreativo es una práctica cada vez más popular en la población mundial, sin embargo, no está exenta de riesgos. A medida que transcurre una inmersión, el buzo es susceptible a una serie de cambios de presión que afectan las distintas cavidades que contienen aire dentro del cuerpo humano, tales como el oído, cavidades paranasales y los pulmones. Existe un gran espectro de patologías asociadas al buceo, explicándose la mayoría de ellas por el barotrauma asociado, cuya gravedad depende de la magnitud del daño asociado, pudiendo presentar desde manifestaciones a nivel local, así como también a nivel sistémico. Las patologías otológicas suelen ser las más frecuentes y el principal motivo de consulta en este tipo de pacientes. Sin embargo, las afecciones otoneurológicas, rinosinusales, de vía aérea y sistémicas pueden ser comunes dependiendo de cada perfil de buceo. Actualmente no existen recomendaciones locales sobre esta práctica, por lo que el conocimiento de la fisiología, fisiopatología y el tratamiento de las patologías otorrinolaringológicas asociadas deben ser conocidas a medida que este deporte se vuelve cada vez más popular. Se realizó una revisión de la literatura sobre las distintas afecciones otorrinolaringológicas con el fin de sistematizarlas y elaborar recomendaciones para establecer una práctica segura.

Recreational diving is an increasingly popular practice in the world; however, it is not without risks. As a dive progresses, the diver is susceptible to a series of pressure changes that affect the air-containing cavities, such as the ear, paranasal cavities, and lungs. There is a large spectrum of pathologies associated with diving, most of them being explained by associated barotrauma, the severity of which depends on the magnitude of the associated damage, could present local manifestations, as well as at systemic level. Otological pathologies are usually the most frequent and the main reason for consultation in this type of patients, however, otoneurological, rhinosinusal, airway and systemic conditions can be common depending on each diving profile. Currently there are no local recommendations on this practice, therefore, knowledge of the physiology, pathophysiology and treatment of associated otorhinolaryngological pathologies should be known as this sport becomes increasingly popular. A review of the literature on the different ear, nose and throat conditions was carried out in order to systematize them and develop recommendations to establish a safe practice.

Trastorno del procesamiento sensorial. Una mirada conjunta desde la terapia ocupacional y la otorrinolaringología / Sensory processing disorder. A vision statement from occupational therapy and otolaryngology

Resumen El trastorno del procesamiento sensorial (TPS) es una condición frecuente, pero poco conocida por muchos profesionales de la salud. El procesamiento sensorial se define como la capacidad que posee el sistema nervioso central de interpretar y organizar las sensaciones del propio cuerpo y del ambiente, para su uso efectivo en el entorno mediante respuestas adaptativas. Por lo tanto, cualquier disfunción en el procesamiento (registro, modulación y/o discriminación) de estos estímulos se expresa como una respuesta desadaptativa, siendo significativo cuando esta impacta en la vida diaria del paciente. Es deber del médico sospechar este trastorno, acogiendo al paciente y su familia, derivando oportunamente a terapia ocupacional para su correcta evaluación y eventual manejo de acuerdo con las necesidades de cada paciente.

Abstract Sensory processing disorder (SPD) is an unknown condition for many health care professionals. Sensory processing is defined as the capacity of the central nervous system to interpretate and organize sensations from our own body and from the environment, for their proper use by adaptive responses. Any dysfunction in this processing (registration, modulation and or discrimination) is expressed by a maladaptive response, being considered abnormal when this response has a negative impact in the patient's daily activities. Is our duty as health care workers to suspect this disorder, help our patients and their families by doing a proper referral to an occupational therapist for their evaluation and management, according to each patient needs.

SPECIAL ARTICLE COVID-19: ENT Manifestations in Patients Suffering from COVID- 19: Study from a COVID Hospital in North India

Abstract Introduction COVID-19 has been one of the worst pandemics faced by the human civilization, and otorhinolaryngological manifestations are commonly seen in this disease. Objective The present study was done to profile the ear, nose, and throat (ENT) manifestations in patients diagnosed with COVID-19. An attempt has also been made to assess whether there was any difference between the symptoms of different strains of COVID-19. A brief review of the current knowledge of the transmission of the disease and its treatment has also been done. Methods A cross-sectional, record-based study was conducted in a COVID hospital of India between May and July 2020. Descriptive statistics were used and appropriate parametric/nonparametric tests were applied to assess the association between various variables. Results Out of 250 patients, 80 cases were asymptomatic and 170 were symptomatic. Most of the symptomatic patients had sore throat and nasal congestion. Conclusion Knowledge of the ENT manifestations of COVID-19 is essential for its early identification and to devise appropriate prevention protocols for the benefit of health care workers (HCWs) and of the general population.

Clinical Evidence on Treatment of Otorhinolaryngologic Diseases with Oral Chinese Patent Medicine： A Scoping Review / 中国实验方剂学杂志

This paper aims to systematically retrieve and summarize the clinical evidence on oral Chinese patent medicine in otorhinolaryngology by scoping review and analyze the distribution of the evidence， which is expected to serve as a reference for clinical practice and healthcare decision-making. Seven databases were searched （from inception to March 2022） for the clinical evidence of oral Chinese patent medicine in the prevention and treatment of otorhinolaryngologic diseases， and the distribution of the evidence was discussed. A total of 248 papers from core journals/SCI were included： 238 clinical studies （185 randomized controlled trials， 46 semi-/non-randomized controlled trials， 7 case series studies）， 5 systematic reviews， 4 guidelines/expert consensuses， and 1 pharmacoeconomic study. The papers covered 26 oral Chinese patent medicines and 40 otorhinolaryngological diseases （5 ear diseases， 22 nose diseases， and 13 throat diseases）. The majority of the clinical studies included 100-300 cases. The combination of Chinese patent medicine and western medicine is the common intervention in the experimental group. The outcomes were mainly “cure rate” and improvement of clinical symptoms. Common adverse events were nausea， vomiting， rash， headache， gastrointestinal discomfort， fatigue， etc. In summary， there is a lack of high-quality clinical evidence on oral Chinese patent medicine in otorhinolaryngology. In addition， the available studies have such problems as seldom use of recognized outcomes， low quality of clinical studies， and lack of pharmacoeconomic study. In future， efforts should be made to carry out more rigorous primary and secondary research and enhance the pharmacoeconomic evaluation， in a bid to explore the advantages of Chinese patent medicine in the treatment of otorhinolaryngologic diseases and promote the more rational allocation and application of health resources.

Perfil clínico e audiológico de pacientes submetidos a timpanostomia e inserção de tubo de ventilação / Clinical and audiological features in patients undergoing tympanostomy tube placement

Introdução: A presença de líquido na orelha médiapode causar perdas auditivas de condução e atrasos no desenvolvimento da criança. A timpanotomia e colocação do tubo de ventilação é o tratamento para casos em que o acúmulo de secreção é persistente. Objetivo: Avaliar o perfil epidemiológico e audiológico dos pacientes submetidos a timpanotomia e colocação do tubo de ventilação. Métodos: Estudo observacional, retrospectivo e transversal baseado em revisão de prontuários. Resultados: Foram incluídos 69 pacientes que realizaram o procedimento. O sexo masculino correspondeu a 64% e a média de idade foi de 8 anos. Otite média secretora foi o diagnóstico predominante. Pelo menos uma comorbidade foi encontrada em 63 pacientes, com predomínio de rinite alérgica. A maioria realizou apenas 1 operação. A bilateralidade da colocação do tubo ocorreu em 57%. Amigdalectomia e/ou adenoidectomia foram frequentemente adicionadas. Hipoacusia, roncopatia, prurido nasal, obstrução nasal e respiração oral noturna foram as queixas predominantes. Em relação à audiometria, 68% evoluíram para limiares normais; já na timpanometria 62% mostraram melhora no timpanograma. Conclusão: No tratamento com colocação de tubo de ventilação bilateral houve melhora pós-operatória na audiometria e timpanometria na maioria dos casos.

Introduction: The presence of fluid in the middle ear can cause conductive hearing loss and developmental delays in children. Tympanotomy and ventilation tube placement is the treatment for cases where secretion accumulation is persistent. Objective: To evaluate the epidemiological and audiological profile of patients submitted to tympanotomy and ventilation tube placement. Methods: Observational, retrospective and cross-sectional study based on medical records. Results: 69 patients who underwent the procedure were included. Males accounted for 64% and the mean age was 8 years. Secretory otitis media was the predominant diagnosis. At least one comorbidity was found in 63 patients, with a predominance of allergic rhinitis. Most performed only 1 operation. Bilateral tube placement occurred in 57%. Tonsillectomy and/or adenoidectomy were frequently added. Hypoacusis, snoring, nasal itching, nasal obstruction and nocturnal oral breathing were the predominant complaints. Regarding audiometry, 68% evolved to normal thresholds; in the tympanometry 62% showed improvement in the tympanogram. Conclusion: In the treatment with placement of a bilateral ventilation tube, there was postoperative improvement in audiometry and tympanometry in most cases.

Research on the application effect of OBE concept on the teaching of otorhinolaryngology nursing / 中华医学教育探索杂志

Objective:To observe the application effect of outcome-based education (OBE) concept on the teaching of otorhinolaryngology nursing.Methods:A total of 97 nursing interns from the Department of Otorhinolaryngology in The Second Affiliated Hospital of Army Medical University were selected as the research objects. Among them, 46 ones from March 2017 to February 2019 were collected as the control group, and 51 ones from March 2019 to February 2021 as the observation group. The control group adopted traditional nursing clinical teaching, and the observation group adopted the nursing clinical teaching based on the OBE concept. All the nursing students had an internship for 3 weeks, and had an evaluation in terms of the clinical communication ability of the two groups of nursing students when they leave the department (the nursing students' clinical communication ability assessment scale), the daily life problem solving ability (simplified Chinese version of the daily life problem solving questionnaire), theoretical and operational assessment results, and the internship satisfaction (nursing student internship satisfaction scale). SPSS 19.0 was used for independent-sample t test. Results:When leaving the department, the observation group's clinical communication ability scores were significantly higher than those of the control group in such dimensions as establishing a harmonious relationship, keen listening, confirming patient problems, participating together, transmitting effective information, and verifying feelings ( P<0.05). The scores of simplified Chinese version of the daily life problem solving questionnaire of rational problem solving and positive problem orientation of the observation group were significantly higher than those of the control group ( P<0.05), while the scores of negative problem orientation, avoidance style and impulsivity/carelessness style were significantly lower than those of the control group ( P<0.05). The scores of theoretical and operational evaluations of the observation group were significantly higher than those of the control group ( P<0.05). The practice satisfaction scores on each dimension of the observation group, including clinical teaching, classroom teaching, and internship plan, support and resources were significantly higher than those of the control group ( P<0.05). Conclusion:The OBE concept applied in the teaching of otorhinolaryngology nursing can enhance the clinical communication ability and daily life problem-solving ability of nursing students, increase the theoretical and operational assessment results, and improve the satisfaction of internship.

Manifestaciones otorrinolaringológicas en la infección por virus de inmunodeficiencia humana

Resumen La infección por el virus de la inmunodeficiencia humana (VIH) es una pandemia global que afecta a 38 millones de personas en el mundo. En Chile, se ha visto un alza sostenida en la incidencia de VIH, aumentando un 57% entre 2010 y 2019, reportándose 74.000 personas que viven con VIH en el país. Las manifestaciones en cabeza y cuello ascienden a un 80% de los pacientes con VIH. Éstas pueden presentarse durante el síndrome retroviral agudo, en etapas más avanzadas, incluso como forma de debut, o aparecer en casos de falla de tratamiento o complicaciones derivadas del síndrome inflamatorio de reconstitución inmune. Con la mayor cobertura de terapia antirretroviral (TARV) se ha visto a lo largo del tiempo un cambio en la frecuencia de las manifestaciones otorrinolaringológicas. Las lesiones de la cavidad oral han representado un signo de avance de la enfermedad o de falla al tratamiento, siendo más frecuentes la candidiasis y la leucoplasia vellosa. En el área rinosinusal predominan la rinitis y rinosinusitis, en el cuello las linfadenopatías e hipertrofia parotídea, y en el oído la hipoacusia, alteraciones vestibulares y del oído medio. Para la especialidad de otorrinolaringología es fundamental conocer estas manifestaciones para mantener un alto índice de sospecha del diagnóstico. De esta forma, se permite un diagnóstico precoz y tratamiento oportuno para así mejorar la calidad de vida del paciente. Además, se requiere un seguimiento cercano de forma de detectar signos tempranos de falla al tratamiento o progresión a etapas más avanzadas.

Abstract The human immunodeficiency virus (HIV) infection is a global pandemic, affecting 38 million people worldwide. In Chile, its incidence has risen continuously, increasing to 57% from 2010 to 2019, with 74,000 infected people in the country. Head and neck manifestations account to 80% of HIV patients. These manifestations may be present during the acute retroviral syndrome, in more advanced stages, even as a debut, or appear in treatment failure or complications secondary to the immune reconstitution inflammatory syndrome. With the increase in antiretroviral therapy (ART) coverage, the prevalence of otorhinolaryngological manifestations has changed. Oral lesions may be an early sign for advanced stages or treatment failure, with a predominance of candidiasis and hairy leukoplakia. Rhinitis and rhinosinusitis are the main manifestations in the sinonasal area, lymphadenopathy and parotid hypertrophy in the neck, and hearing loss, vestibular and middle ear disorders in the ear. It is essential for otorhinolaryngologists to be aware of these manifestations in order to maintain a high index of clinical suspicion, allowing an early diagnosis and opportune treatment to improve the patient's quality of life. In addition, a close follow-up is required to identify early signs of treatment failure or progression to more advanced stages.

Barrier for Particle Dispersion Control During Mastoidectomy

Abstract Introduction The China Health Authority alerted the World Health Organization (WHO) of several cases of pneumonia, and the WHO has declared the novel coronavirus (COVID-19) a global pandemic. Mastoidectomy is a high-risk aerosol generating procedure with the potential to expose the surgeon to infectious particles. Objective Aim to develop a low-cost prototype for a barrier device that can be used during mastoidectomy. Methods Describe the steps involved during otological emergency, requiring immediate surgical procedure, in untested patients. The Otorhinolaryngology Surgical Team of Walter Cantídio Hospital developed the barrier for particle dispersion presented here. Results During surgery, the prototype did not compromise visualization of the surgical field and instrumentation. Microscope repositioning was not compromised or limited by tent Instrumentation and instrument pouch under the Microscope-Tent (MT) performed surgery. After surgery, the plastic sheet was removed simply, without requiring strength. Bone dust and irrigation droplets were collected on the tent. Conclusion Our team developed and practiced, in an otologic emergency, a low-cost and reproducible barrier device that can be used in mastoidectomy in COVID-19 patients. Further tests on efficacy may be necessary.

Bruxismo y su relación con otorrinolaringología: una revisión de la literatura

Resumen El bruxismo es una condición que se observa frecuentemente en los pacientes y estos a menudo consultan por sus consecuencias físicas, como pueden ser el desgaste o destrucción dentaria, el dolor orofacial, así como también por el deterioro de la calidad de vida tanto de ellos mismos como de las personas cercanas. En la última década han aumentado en forma importante las investigaciones en torno a esta condición, así como los consensos en cuanto a su definición, clasificación y manejo clínico. Los dentistas son quienes actualmente reconocen esta actividad parafuncional y manejan estos problemas, pero es importante que los profesionales de otras áreas de la salud, como médicos y en especial otorrinolaringólogos, puedan identificar los signos, síntomas y consecuencias del bruxismo, ayudando en la detección de esta condición. Así, el objetivo de esta revisión es establecer un estado del arte sobre bruxismo e incentivar la formación de equipos multidisciplinares que ayuden en el diagnóstico y la terapéutica de esta condición.

Abstract Bruxism is a condition that is frequently observed in patients, and they often consult for physical consequences, such as teeth wear or destruction, orofacial pain, as well as for the decrease of the quality of life, of both patients and their loved ones. In the last decade, research on this phenomenon has increased significantly, as well as the consensus in terms of definition, classification and clinical management. Dentists are those who at present recognize this parafunctional activity and manage these problems, but it is important that professionals from other health areas, such as medical doctors, and specially otolaryngologists, can identify signs, symptoms and consequences of bruxism, helping in the detection of this condition. Thus, the objective of this review is to establish a state of the art about bruxism and encourage the formation of multidisciplinary teams that help to in the diagnosis and better management of this condition.

Análise de zumbido em pacientes com diagnóstico de alça Vascular De VIII par craniano à ressonância nuclear magnética / Analysis of tinnitus in patients diagnosed with vascular loop of the viii cranial nerve on magnetic resonance imaging

Analisar e correlacionar sinais e sintomas auditivos, com ênfase no zumbido, achados audiológicos e sua incidência em indivíduos com alça vascular (AV) de VII/VIII par demonstrado por imagens de RNM de ângulo ponto cerebelar, classificando-os segundo Chavda. Estudo retrospectivo e transversal por meio da análise de dados clínicos dos prontuários de 15 pacientes, correlacionando queixas auditivas e otológicas com resultados encontrados nos exames complementares de Audiometria e RNM a que foram submetidos. Os pacientes que apresentavam alteração do trajeto dos vasos que penetram no MAI, formando alça vascular de VII e/ou VIII par craniano, foram classificados segundo Chavda. Todos os pacientes tinham exame de RNM com diagnóstico de alça vascular do VIII par. Onze deles (73,33%) eram bilaterais. Em 5 pacientes, houve concordância da queixa com os achados à RNM: sintomas bilaterais e alça vascular bilateral. O zumbido gerado pelas estruturas para-auditivas vasculares também são denominados zumbidos pulsáteis. Esses estados levam a fluxo turbulento, gerando o zumbido, que por sua vez é síncrono com o pulso do paciente. Há estudos demonstrando que não há correlação entre zumbido e contato vascular com o VIII par. Encontramos presença de zumbido em aproximadamente 80% dos pacientes com alça vascular, mas nem sempre a queixa coincidiu com a patologia, sendo difícil, portanto, correlacionar queixa e patologia. A presença de alça vascular na RNM não é patológica, mas um achado de exame. A presença do conflito neurovascular do VII/VIII par craniano nas imagens de RNM não justificou por si só os sinais e sintomas otoneurológicos e as al-terações audiovestibulares encontradas nos indivíduos avaliados neste estudo.

To analyze and correlate auditory signs and symptoms, emphasising tinnitus, audiological findings, and their incidence in individuals with vascular loop (AV) of VII/VIII pair demonstrated by MRI images of the cerebellopontine angle, classifying them according to Chavda. A retrospective and cross-sectional study by analyzing clinical data from the medical records of 15 patients, correlating hearing and otological complaints with results found in the complementary tests of Audiometry and MRI. Patients who presented alterations in the path of the vessels that penetrate the IAC, forming a vascular loop of the VII and/or VIII cranial nerve, were classified according to Chavda. All patients had an MRI with a vascular loop of the VIII pair diagnosed. Eleven of them (73.33%) were bilateral. In 5 patients, there was an agreement between the complaint and the MRI findings: bilateral symptoms and bilateral vascular loop. Tinnitus generated by vascular para-auditory structures is also called pulsatile tinnitus. These conditions lead to turbulent flow that causes tinnitus, synchronous with the patient's pulse. There are studies demonstrating there is no correlation between tinnitus and vascular contact with the VIII pair. We found the presence of tinnitus in approximately 80% of patients with vascular loop, but the complaint did not always coincide with the pathology, making it hard to correlate complaints and pathology. The presence of a vascular loop on MRI is not pathological but an examination finding. The neurovascular conflict of the VII/VIII cranial nerve present in the MRI images did not alone justify the otoneurological signs and symptoms and the audiovestibular alterations found in the individuals evaluated in this study.

Construção de consenso Delphi das competências otorrinolaringológicas preconizadas ao egresso de Medicina / Building a Delphi consensus on Otorhinolaryngological skills for the medical graduate

Resumo: Introdução: Afecções otorrinolaringológicas são destaques entre as enfermidades mais frequentes na atenção primária. Acredita-se que a sobrecarga na atenção secundária seja consequência da baixa resolução dos problemas na atenção primária. Uma possível explicação para esse fato seria a deficiência na capacitação médica durante a graduação. Estima-se que a carga horária média de otorrinolaringologia seja 0,6% da carga horaria média total, após análise de 141 matrizes curriculares, correspondendo a aproximadamente 70,5% do total das escolas médicas em funcionamento em 2013. Nessa área, poucos estudos têm sido realizados em relação ao ensino e à necessidade de reavaliação curricular. Objetivo: O presente estudo tem o intuito de buscar um consenso sobre as competências necessárias ao generalista na especialidade de otorrinolaringologia. Métodos: Criou-se um questionário inicial que abordava as competências otorrinolaringológicas pertinentes à prática clínica dos médicos da atenção primária. Por meio da metodologia Delphi, no formato eletrônico, o questionário foi enviado para 20 especialistas com formações distintas: médicos generalistas, otorrinolaringologistas e médicos de família e comunidade. Essa heterogeneidade entre os especialistas contribuiu para garantir a confiabilidade dos resultados. Os resultados obtidos após cada rodada eram analisados pelos pesquisadores, que observavam as tendências e as opiniões dissonantes, bem como suas justificativas. Ao final da sistematização e compilação dos resultados, um novo questionário era elaborado e reenviado, iniciando uma nova rodada até que o consenso fosse estabelecido em todas competências. Resultados: Realizaram-se cinco rodadas para o estabelecimento do consenso em todas as 17 competências otorrinolaringológicas avaliadas pelas proposições, o possibilitou a definição do nível de competência dos conteúdos e procedimentos otorrinolaringológicos preconizados ao egresso de Medicina. Conclusão: Os dados obtidos neste trabalho podem servir para o embasamento, direcionamento e desenvolvimento do currículo otorrinolaringológico nos cursos de graduação de Medicina, visto que não se encontrou na literatura consenso estabelecendo as competências mínimas otorrinolaringológicas na formação curricular da graduação.

Abstract: Introduction: Otorhinolaryngological disorders are amongst the most prominent frequent diseases in primary care. The overload in secondary care is thought to be a consequence of the low resolution of these problems in primary care. A deficiency in undergraduate medical training may explain this fact. The average estimated time spent studying otorhinolaryngological practice is estimated to be 0.6% of the total average practice hours after analysis of data from 141 medical course syllabuses in Brazil, corresponding to approximately 70.5% of all the medical schools in operation in 2013. Few studies have been conducted in this area and regarding teaching and the need for curriculum reassessment. Objectives: This study seeks to ascertain a consensus on the skills required by the general practitioner in the specialty of otorhinolaryngology. Methods: An initial questionnaire was devised addressing the otorhinolaryngological skills relevant to primary care clinical practice. Using the Delphi method, the questionnaire was sent in electronic format to 20 specialists with training in three different specialties; this heterogeneity of the survey sample helped ensure the reliability of the results. The results obtained after each round were analyzed by one researcher and validated by another, observing any discrepant trends and opinions, as well as their justifications. Once the results had all been compiled and systematized, a new questionnaire was devised and sent out, starting a new round until consensus had been established for all the skills. Results: Five rounds were completed until a consensus was established for all 17 otorhinolaryngological skills evaluated by the propositions. Conclusions: The data obtained by this work can serve as a basis and guideline for developing an otorhinolaryngological curriculum for undergraduate medical training since no consensus was found in the literature establishing such a minimum skill set.

Expert Consensus on Otorhinolaryngology Head and Neck Diseases Responding Specifically to Traditional Chinese Medicine / 中国实验方剂学杂志

Traditional Chinese medicine （TCM） and western medicine have their respective advantages and limitations in the diagnosis and treatment of common otorhinolaryngology head and neck diseases. Although the integrated TCM and western medicine exhibits definite curative effects， there is no consensus on the otorhinolaryngology head and neck diseases responding specifically to TCM or integrated TCM and western medicine， as well as the diagnosis and treatment schemes. The China Association of Chinese Medicine （CACM） thus organized the otorhinolaryngology head and neck specialists of both TCM and western medicine to discuss the etiology， pathogenesis， and clinical diagnosis and treatment methods of common otorhinolaryngology head and neck diseases with the results of multiple clinical trials taken into account. The acute pharyngitis， chronic pharyngolaryngitis， paraesthesia pharyngis， hysterical aphasia， allergic rhinitis， subjective tinnitus， and otogenic vertigo were confirmed to respond specifically to TCM or integrated TCM and western medicine. Then a mutually agreed diagnosis and treatment scheme and recommendation with integrated TCM and western medicine was formulated as a reference for clinical practice， thus benefiting more patients.

Head and Neck Practice in the COVID-19 Pandemics Today: A Rapid Systematic Review

Abstract Introduction Head and neck specialists and otorhinolaryngologists are greatly exposed to coronavirus disease 2019 (COVID-19) transmission in their everyday praxis. Many articles are being published regarding medical staff protection and patient management during the pandemic. Objective To provide an easy access to and a trustful review of the main aspects that have changed in the head and neck surgery and otorhinolaryngology practice due to the COVID-19 pandemic. Data Synthesis The search terms used were: (head and neck or otorhinolaryngology or ORL or thyroid) AND (severe acute respiratory syndrome coronavirus 2 [SARS-COV-2] or COVID-19 or CORONAVIRUS). The results were limited to the year of 2020. Articles were read in English, Portuguese, French, German, and Spanish or translated from Chinese. All included articles were read by at least two authors. Thirty-five articles were included. Most articles suggest postponing elective surgeries, with exception to cancer surgeries, which should be evaluated separately. Twenty-five articles recommended some kind of screening prior to surgery, using polymerase chain reaction (PCR) tests and epidemiological data. Extra precautions, such as use of personal protective equipment (PPE), are suggested for both tracheostomies and endoscopies. Fifteen articles give recommendation on how to use telemedicine. Conclusion The use of PPE (N95 or powered air-purifying respirator [PAPR]) during procedures should be mandatory. Patients should be evaluated about their COVID-19 status before hospital admission. Cancer should be treated. Tracheostomy tube cuff should be inflated inside the tracheal incision. All COVID-19 precautions should be kept until there is a validated antiviral treatment or an available vaccine.

Factores predisponentes de la disfonía por hiperfunción laríngea en pacientes adultos: Hospital Universitario Dr. Luis Gómez López / Predisposing factors of laryngeal hyperfunction dysphonia in adult patients: Dr. Luis Gómez López University Hospital

Se realizó un estudio retrospectivo de revisión de 95 historias clínicas con el objetivo de determinar los factores predisponentes a la disfonía por hiperfunción laríngea en pacientes adultos que asistieron a la consulta de Otorrinolaringología del Hospital Universitario Dr. Luis Gómez López durante el lapso enero-diciembre 2016 a Junio 2017. Entre los resultados se encontró una predominancia del sexo masculino (82,4%) y una edad entre 37 a 44 años en 96,8% de los casos; 38% de los pacientes son profesionales expuestos a contaminación ambiental, 25% son profesionales de la voz; 79% no refiere tener hábito tabáquico; 38% refirió abusar de la voz, siendo las principales causas el hablar en exceso, cantar y gritar. El 67,4% de los pacientes están expuestos a vapores tóxicos, 86,3% al humo del tabaco y 82,1% al humo de la leña. El grado de disfonía más frecuente diagnosticado por nasofibrolaringoscopía fue grado II (60%). Es importante la detección temprana de los factores predisponentes asociados a la disfonía por hiperfunción laríngea de forma de implementar acciones que favorezcan las condiciones laborales y ambientales y mitiguen su influencia en la fisiología de la voz(AU)

A retrospective review of 95 medical charts was carried out with the objective of determining the predisposing factors for laryngeal hyperfunction dysphonia in adult patients attending the otorhinolaryngology consult of the Hospital Universitario Dr. Luis Gómez López, during the period January-December 2016 to June 2017. The results show a male predominance (82.4%) and an age between 37 to 44 years in 96.8% of cases; 38% of patients are professionals exposed to environmental pollution and 25% are voice professionals; 79% of patients don't smoke; 38% of cases abuse voice by speaking frequently, singing and shouting. 67.4% of patients have been exposed to vapors, 86.3% to tobacco smoke and 82.1% to firewood. Degree of dysphonia diagnosed by nasofibrolaryngoscopy was grade II (60%). Early detection of predisposing factors associated to laryngeal hyperfunction dysphonia is important in order to implement environmental actions to mitigate their influence in voice physiology(AU)