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Abstract Objectives: To review and provide evidence-based recommendations for the diagnosis and treatment of otosclerosis. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on otosclerosis were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: 1) Diagnosis - audiologic and radiologic; 2) Treatment - hearing AIDS, pharmacological therapy, stapes surgery, and implantable devices - bone-anchored devices, active middle ear implants, and Cochlear Implants (CI). Conclusions: The pathophysiology of otosclerosis has not yet been fully elucidated, but environmental factors and unidentified genes are likely to play a significant role in it. Women with otosclerosis are not at increased risk of worsening clinical condition due to the use of contraceptives or during pregnancy. Drug treatment has shown little benefit. If the patient does not want to undergo stapedotomy, the use of hearing aids is well indicated. Implantable systems should be indicated only in rare cases, and the CI should be indicated in cases of profound deafness.
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Abstract According to an extensive database, the Objective is to compare surgical versus nonsurgical treatment through Propensity Score (PS) for patients with Oropharyngeal Squamous Cell Carcinoma (OPSCC). Methods: We retrospectively evaluated epidemiological data from 8075 patients with OPSCC diagnosed between 2004 and 2014 and used PS matching to analyze possible prognostic factors for its outcomes with regression analyses. Results: Cox multiple regression analysis to study survival after PS matching shows that type of treatment was associated with death with a hazard ratio of 1.753 (p < 0.05) of non-surgical treatment. However, it was not associated with recurrence (p> 0.05). In the surgical treatment group, overall survival was 79.9% at one year, 36.4% at five years, and 20.5% at ten years. Disease-free survival was 90.1%, 64.8%, and 56.0% at 1, 5, and 10-years, respectively. In the non-surgical treatment group, overall survival was 60.6% at one year, 21.8% at five years, and 12.7% at ten years. Disease-free survival was 90.8%, 67.2%, and 57.8% at 1, 5, and 10-years, respectively. Conclusion: Patients in the surgical treatment group had better outcomes related to survival. Recurrence is associated with the survival of OPSCC cancer. Recurrence-free survival is similar to both treatments. Level of evidence: 2C.
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Abstract Objective: To review the literature on the diagnosis and treatment of vestibular schwannoma. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: (1) Diagnosis - audiologic, electrophysiologic tests, and imaging; (2) Treatment - wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. Conclusions: Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.
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Abstract Objectives: To provide an overview of the main evidence-based recommendations for the diagnosis of hearing loss in children and adolescents aged 0-18 years. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on childhood hearing loss were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: (1) treatment of sensorineural hearing loss: individual hearing aids, bilateral cochlear implants, cochlear implants in young children, unilateral hearing loss, and auditory neuropathy spectrum disorder; and (2) treatment of conductive/mixed hearing loss: external/middle ear malformations, ventilation tube insertion, and tympanoplasty in children. Conclusions: In children with hearing loss, in addition to speech therapy, Hearing AIDS (HAs) or implantable systems may be indicated. Even in children with profound hearing loss, both the use of HAs and behavioral assessments while using the device are important.
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Abstract Objective To analyze, by means of a systematic review and meta-analysis, the proportion of patients with Meniere's disease who have altered caloric test and vHIT, as well as to determine the prevalence of altered caloric test and normal vHIT dissociation in the diagnosis of Meniere's disease. Methods The literature search had no restriction regarding the period of publication on the following indexed data platforms: PubMed, PubMed PMC, BVS-Bireme, Web of Science, Embase and Cochrane Library. Articles that evaluated patients with Meniere's disease who underwent caloric test and vHIT were included. Two researchers independently conducted the analysis of the articles, promoting the selection and capture of data, following the recommendations of the PRISMA method, and complying with the criteria for articles inclusion and exclusion defined in the research protocol. In case of disagreement during the selection process, a third researcher was included for analysis. Results From a total of 427 initial studies, the researchers selected 12 articles, published between 2014 and 2021, with a total of 708 patients evaluated, with a mean age of 52.72 years old. The prevalence of patients with Meniere's disease with altered caloric reflex test was 64% (95% CI 57%‒71%), while the prevalence of altered vHIT was only 28% (95% CI 16%-40%). The prevalence of the altered caloric test + normal vHIT dissociation was 47% (95% CI 37%-57%). Conclusion The video head impulse test and the caloric test are valuable tools for vestibular assessment. The dissociation of findings between these two tests in patients with Meniere's disease was more prevalent in this meta-analysis and may be a result of the tonotopy of specialized hair cells in the ampullary crest. The prevalence of altered caloric test was 64% and anormal vHIT was 28%. The dissociation caloric asymmetry and normal vHIT was observed in 47% of the patients. Level of evidence: 1.
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Abstract Objective: To descriptively analyze the epidemiological data, clinical stage, and outcomes of oropharyngeal squamous cell carcinoma in the state of São Paulo, Brazil, and to estimate the influence of clinical stage and treatment type on overall and disease-free survival. Methods: We retrospectively analyzed epidemiological data from the São Paulo Cancer Center Foundation database relative to patients with oropharyngeal squamous cell carcinoma diagnosed between 2004 and 2014 in the state of São Paulo. Univariate and multivariate Cox regression analyses were performed to assess factors associated with the outcomes. A forward stepwise selection procedure was used. Survival curves were estimated by the Kaplan-Meier method and compared by the Gehan-Breslow-Wilcoxon test. Results: A total of 8075 individuals with oropharyngeal squamous cell carcinoma were identified. Of these, 86.3% were diagnosed at an advanced stage and 13.7% at an early stage. Only 27.2% of patients were treated surgically, whereas 57.5% were treated medically. Patients undergoing surgery had longer overall survival than those receiving medical treatment in both early- and advanced-stage oropharyngeal squamous cell carcinoma. However, there was no significant difference in disease-free survival between surgical and medical treatment. Conclusion: No significant difference in disease-free survival between medical and surgical treatment suggests similar complete remission rates with both approaches. Patients receiving medical treatment had shorter overall survival, which may be due to complications from chemotherapy and radiotherapy. However, we cannot confirm this relationship based on the data provided by the São Paulo Cancer Center Foundation. Prospective studies are warranted to assess whether the lower overall survival rate in patients receiving medical treatment is secondary to complications from chemotherapy and radiotherapy. Level of evidence: 2C.
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Abstract Objectives: This study aims to describe a new secondary tracheoesophageal puncture technique with voice prosthesis insertion under local anesthesia with a low-cost device and evaluate its outcome. Methods: With a transoral flexible transillumination device of aluminum of 2.3 mm with fiberoptic light, the esophagus's anterior wall is visualized through the tracheostomy. A tracheoesophageal fistula is made with a blade and passed through the fistula. Then a bent trocar is introduced into the lumen using the device as a guidewire. Once in the lumen, a thin guide wire is passed through up to the mouth. The voice prosthesis is positioned with retrograde insertion. Then, the patient is discharged without hospitalization. Results: 15 patients submitted to this technique had a successful surgical outcome. There were no complications as pneumothorax, esophageal perforation, bleeding, or hospitalization. Conclusion: The new device is feasible under local anesthesia.
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Abstract Objective: Oral Squamous Cell Carcinoma (OSCC) is conventionally treated by surgical resection, and positive surgical margins strongly increase local recurrence and decrease survival. This study aimed to evaluate whether a Three-Dimensional Segmentation (3DS) image of OSCC confers advantage over Multiplanar Reconstruction (MPR) of OSCC using images of computed tomography scan in surgical planning of tumor resection. Methods: Twenty-six patients with locally advanced OSCC had tumor morphology and dimensions evaluated by MPR images, 3DS images, and Surgical Pathology Specimen (SPS) analyses (gold standard). OSCC resection was performed with curative intent using only MPR images. Results: OSCC morphology was more accurately assessed by 3DS than by MPR images. Similar OSCC volumes and dimensions were obtained when MPR images, 3DS images and SPS measurements were considered. Nevertheless, there was a strong correlation between the OSCC longest axis measured by 3DS and SPS analyses (ICC = 0.82; 95% CI 0.59-0.92), whereas only a moderate correlation was observed between the longest axis of OSCC measured by MPR images and SPS analyses (ICC = 0.51; 95% CI 0.09-0.78). Taking only SPS with positive margins into account, MPR images and 3DS images underestimated the tumor's longest axis in eight out of 11 (72.7%) and 5 out of the 11 (45.5%) cases, respectively. Conclusion: Our data present preliminary evidence that 3DS model represents a useful tool for surgical planning of OSCC resection, but confirmation in a larger cohort of patients is required. Level of evidence: Laboratory study.
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Abstract Introduction: Current Brazilian legislation requires that all workers exposed to noise are to be given an audiogram upon hiring, after 6 months of employment (first periodic test), and annually after the first periodic test. In other countries, the regulations of hearing conservation programs do not include the requirement for audiometric testing at 6 months of employment, but only annually. There is no evidence that the periodicity adopted by Brazilian legislation is the most appropriate. Objective: The present study aimed to evaluate the first 3 occupational audiometric tests of workers exposed to noise. Methods: Historical cohort study with cross-sectional analysis. Participants were all male metallurgy workers aged up to 40 years. The first 3 audiograms of each worker were analyzed: pre-employment audiometric test, periodic audiometric test 1, and periodic audiometric test 2. For each worker, mean frequency thresholds were calculated at 3, 4, and 6 kHz in the left and right ears for each test. Statistical analysis was performed using the nonparametric Wilcoxon test. Results: A total of 988 workers were included. There was a significant difference in auditory thresholds between the pre-employment test and the 2 subsequent periodic tests for the right and left ears. There was no significant difference between Test1 and Test2 in either ear. Conclusion: Given the lack of difference between the first 2 periodic tests, we believe that they could be merged into a single test, i.e., first periodic audiometric testing could be performed at 12 months of employment without compromising workers' health.
Resumo Introdução: A legislação brasileira atual exige que todos os trabalhadores expostos a ruído recebam um audiograma na admissão, 6 meses após a admissão (primeiro teste periódico), e anualmente após o primeiro teste periódico, mas em outros países as regulamentações dos programas de conservação auditiva não incluem a exigência de teste audiométrico após 6 meses de admissão, mas apenas anualmente. Não há evidências de que a periodicidade adotada pela legislação brasileira seja a mais adequada. Objetivo: Avaliar os três primeiros exames audiométricos ocupacionais de trabalhadores expostos ao ruído. Método: Estudo de coorte histórica com análise transversal. Os participantes eram todos trabalhadores metalúrgicos do sexo masculino com até 40 anos. Os três primeiros audiogramas de cada trabalhador foram analisados: teste audiométrico pré-admissão, teste audiométrico periódico 1 e teste audiométrico periódico 2. Para cada trabalhador, os limiares de frequência médios foram calculados em 3, 4 e 6 kHz nas orelhas esquerda e direita para cada teste. A análise estatística foi feita através do teste não paramétrico de Wilcoxon. Resultados: Foram incluídos 988 trabalhadores. Houve uma diferença significante nos limiares auditivos entre o teste pré-admissão e os 2 testes periódicos subsequentes para as orelhas direita e esquerda. Não houve diferença significante entre o teste 1 e o teste 2 em nenhuma das orelhas. Conclusão: Dada a falta de diferença entre os 2 primeiros testes periódicos, acreditamos que eles poderiam ser combinados em um único teste, ou seja, o primeiro teste audiométrico periódico poderia ser feito após 12 meses de admissão sem comprometer a saúde dos trabalhadores.
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Abstract Introduction: Caloric testing is the most frequently used test to assess peripheral vestibular function since the beginning of the 20th century. However, the video head impulse test, vHIT, has gained prominence in the field of neurotology, as it is a faster examination, easier to perform and less uncomfortable for the patient. Objective: To compare, through systematic review and meta-analysis, the proportion of altered cases between vHIT tests and caloric testing in patients with chronic dizziness, in addition to assessing the sensitivity and specificity of vHIT, with caloric testing as the gold standard. Methods: The literature search was carried out in the PubMed, Scopus, BVS-Bireme, Web of Science, Embase, Cochrane and ProQuest indexed databases, with no restrictions regarding the publication period. All articles that contained the results of the two tests were included in the evaluation of patients with dizziness. Two researchers independently conducted data selection and extraction from the studies, strictly following the inclusion and exclusion criteria defined in the research protocol. In case of disagreement during the selection, a discussion was carried out with a third evaluator. Results: Eleven of the 1293 initial articles met the eligibility criteria and were analyzed. 2670 patients were evaluated, of which 1112 (41.6%) were males and 1558 (58.4%) females, with a mean age of 51.6 years. The proportion of altered results in the vHIT was 21% (95%CI 9% --33%), and 55% in the caloric testing (95%CI 43% --67%). Conclusion: The vHIT does not substitute for caloric testing. The tests are complementary in assessing the patient with dizziness, as they describe the tonotopy of the ampullary crest at different frequency ranges of stimulation. In chronic cases, the vHIT has a low sensitivity and high diagnostic specificity in comparison to caloric testing.
Resumo Introdução: A prova calórica é o exame mais usado para avaliação da função vestibular periférica desde os primórdios do século XX. Porém, o vídeo teste de impulso cefálico, vHIT, tem ganhado destaque no campo da otoneurologia por ser um exame mais rápido, de fácil execução e menos desconfortável para o paciente. Objetivo: Comparar, através de revisão sistemática e metanálise, a proporção de casos alterados entre os exames vHIT e prova calórica nos pacientes com tontura crônica, além de avaliar a sensibilidade e especificidade do vHIT, tendo a prova calórica como padrão-ouro. Método: A busca na literatura foi feita nas bases de dados indexadas PubMed, Scopus, BVS-Bireme, Web of Science, Embase, Cochrane e ProQuest, sem restrições quanto ao período da publicação. Foram incluídos todos os artigos que tivessem os resultados dos dois exames na avaliação de pacientes com tontura. Dois pesquisadores conduziram de forma independente a seleção e extração de dados dos estudos, obedeceram rigorosamente os critérios de inclusão e exclusão definidos no protocolo de pesquisa. Em caso de discordância na seleção, fez-se discussão com um terceiro avaliador. Resultados: Onze dos 1.293 artigos iniciais preencheram os critérios de elegibilidade e foram analisados. Foram avaliados 2.670 pacientes, 1.112 (41,6%) do sexo masculino e 1.558 (58,4%) do feminino, com média de 51,6 anos. A proporção de exames alterados no vHIT foi de 21% (95% IC 9%-33%) e na prova calórica foi de 55% (95% IC 43%-67%). Conclusão: O vHIT não substitui a prova calórica. Ambos os testes são complementares na avaliação do paciente com tontura, pois descrevem a tonotopia da crista ampular em diferentes faixas de frequência de estimulação. Nos quadros crônicos, o vHIT tem baixa sensibilidade e alta especificidade diagnóstica em relação à prova calórica.
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Humanos , Masculino , Femenino , Enfermedades Vestibulares/diagnóstico , Prueba de Impulso Cefálico , Reflejo Vestibuloocular , Pruebas Calóricas , Mareo/diagnóstico , Persona de Mediana EdadRESUMEN
Abstract Introduction: We are facing a pandemic with a great impact worldwide, as a result of the rapid spread of the novel coronavirus (COVID-19). The medical community is still getting to know behavior of this virus and the consequences from a population point of view. All this knowledge is extremely dynamic, so some behaviors are still not well established. Otorhinolaryngologists have a central role in the management of this situation, in which they must assess the patient, avoid contamination to and by health professionals and other patients. Thus, the recommendations of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery (ABORL-CCF) have the main objective of reducing the spread of the new coronavirus during otorhinolaryngological care and assisting in the management of these patients. Methods: Review of the main recommendations of national and international scientific societies, decisions by government agencies and class councils. The topics will be related to the general aspects of COVID-19, personal protective equipment, care in patient assistance, endoscopic exam routines and the management of sinonasal, otological and pediatric evaluations related to COVID-19. Results: The use of personal protective equipment is considered crucial in routine ENT care. We recommend postponing appointments, exams and elective surgeries to reduce the spread of COVID-19. Similarly, we recommend changing routines in several areas of otolaryngology. Additionally, guidance is provided on the use of telemedicine resources during the pandemic period. Conclusions: We are still at the beginning of the COVID-19 pandemic and scientific evidence is still scarce and incomplete, so these ABORL-CCF recommendations for otorhinolaryngologists may be updated based on new knowledge and the pattern of the new coronavirus spread.
Resumo: Introdução: Estamos diante de uma pandemia de grande impacto mundial como resultado da rápida propagação do novo coronavírus, COVID-19. A comunidade médica está ainda conhecendo o comportamento desse vírus e as repercussões do ponto de vista populacional. Todo esse conhecimento é extremamente dinâmico, por isso algumas condutas ainda não estão bem estabelecidas. O otorrinolaringologista tem um papel central no manejo dessa situação em que deve avaliar o paciente e evitar a contaminação dos profissionais da saúde e dos demais pacientes. Dessa forma, as recomendações da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF) têm por objetivo principal reduzir a propagação do novo coronavírus durante o atendimento otorrinolaringológico e auxiliar no manejo desses pacientes. Método: Revisão das principais recomendações das sociedades científicas nacionais, internacionais, decisões de órgãos governamentais e de conselhos de classe. Os tópicos serão relativos aos aspectos gerais do COVID-19, equipamentos de proteção individual, cuidados no atendimento ao paciente, as rotinas dos exames endoscópicos e o manejo de aspectos nasossinusais, otológicos e pediátricos relacionados ao COVID-19. Resultados: É considerado crucial o uso de equipamento de proteção individual no atendimento otorrinolaringológico de rotina. Recomendamos postergar atendimentos, exames e cirurgias eletivas para diminuir a propagação do COVID-19. Da mesma forma, recomendamos mudança de rotinas em diversas áreas da otorrinolaringologia. Além disso, orientações sobre o uso do recurso da telemedicina durante o período de vigência da pandemia. Conclusões: Estamos ainda no início da pandemia do COVID-19 e as evidências científicas são ainda escassas, por isso essas recomendações da ABORL-CCF para os otorrinolaringologistas podem sofrer atualizações baseadas nos novos conhecimentos e no padrão de disseminação do novo coronavírus.
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Humanos , Otolaringología/normas , Neumonía Viral/prevención & control , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Equipo de Protección Personal/normas , Betacoronavirus , Sociedades Médicas , Pautas de la Práctica en Medicina , Guías de Práctica Clínica como Asunto , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Infecciones por CoronavirusRESUMEN
Abstract Introduction: Although the incidence of Deep Cervical Abscess (DCA) has decreased mainly for the availability of antibiotics, this infection still occurs with considerable frequency and can be associated with high morbidity and mortality. Objective: This study aimed to present our clinical-surgical experience with deep neck abscesses. Methods: A retrospective study analyzed 101 patients diagnosed with deep neck abscesses caused by multiple etiologies, assisted at a medical school hospital during 6 years. One hundred one patients were included and 27 (26.7%) were younger than 18 years old (the children group), 74 patients (73.3%) were older than 18 years old (the adults group). The following clinical features were analyzed and compared: age, gender, clinical symptoms, leukocyte count, the affected cervical area, lifestyle habits, antibiotic therapy, comorbidities, etiology, bacterial culture, time of hospitalization, the need of tracheostomy and complications. Results: There was predominance in the male gender (55.5%) and young people (mean age 28.1 years). All of the 51 patients with associated disease comorbidity were adults. The most frequent etiologies were bacterial tonsillitis (31.68%) and odontogenic infections (23.7%). The most common cervical areas affected were the peritonsillar (26.7%), submandibular/mouth floor (22.7%) and parapharyngeal spaces (18.8%). In children group, the site most commonly involved was the peritonsillar space (10 patients, 37%). In adults group, the site most commonly involved was multispace (31 patients, 41.8%). Streptococcus pyogenes (23.3%) was the most common microorganism present. Amoxicillin associated with clavulanate (82.1%) was the more used antibiotic. The main complications of abscesses were septic shock (16.8%), pneumonia (10.8%) and mediastinitis (1.98%). Tracheostomy was necessary in 16.8% of patients. The mortality rate was 1.98%. Conclusion: The clinical features and severity of DCA varied according to different age groups, perhaps due to the location of the infection and a higher incidence of comorbidity in adults. Thus, DCA in adults is more facile to have multispace involvement and lead to complications and seems to be more serious than that in children.
Resumo Introdução: Embora a incidência dos abscessos cervicais profundos (ACP) tenha diminuído, principalmente pela disponibilidade dos antibióticos, essa infecção ainda ocorre com frequência considerável e pode estar associada a alta morbidade e mortalidade. Objetivo: Este estudo teve como objetivo apresentar nossa experiência clínico-cirúrgica com os abcessos cervicais profundos. Método: Um estudo retrospectivo realizado em um hospital universitário analisou 101 pacientes, durante seis anos, diagnosticados com abscessos cervicais profundos causados por múltiplas etiologias. Foram incluídos 101 pacientes, sendo que 27 (26,7%) tinham menos de 18 anos (grupo das crianças) e 74 (73,3%) tinham mais de 18 anos (grupo dos adultos). As seguintes características clínicas foram analisadas e comparadas: idade, sexo, sintomas clínicos, área cervical acometida, hábitos de vida, antibioticoterapia, comorbidades, etiologia, cultura bacteriana, tempo de internação, necessidade de traqueotomia e complicações. Resultados: Houve predominância do sexo masculino (55,5%) e de jovens (idade média de 28,1 anos). Todos os 51 pacientes com comorbidade associada eram adultos. As etiologias mais frequentes foram tonsilite bacteriana (31,68%) e infecções odontogênicas (23,7%). As áreas cervicais acometidas mais comuns foram a peritonsilar (26,7%), submandibular/assoalho da boca (22,7%) e os espaços parafaríngeos (18,8%). No grupo das crianças, o local mais comumente envolvido foi o espaço peritonsilar (10 pacientes, 37%). No grupo dos adultos, houve predomínio de acometimento de múltiplos espaços cervicais (31 pacientes, 41,8%). Streptococcus pyogenes foi o microrganismo presente mais comum (23,3%). A amoxicilina associada ao clavulanato foi o antibiótico mais usado (82,1%). As principais complicações dos abscessos foram choque séptico (16,8%), pneumonia (10,8%) e mediastinite (1,98%). A traqueostomia foi necessária em 16,8% dos pacientes. A taxa de mortalidade foi de 1,98%. Conclusão: As características clínicas e a gravidade dos ACP variam de acordo com as diferentes faixas etárias, possivelmente devido à localização da infecção e à maior incidência de comorbidades em adultos. Assim, o ACP em adultos acomete mais facilmente múltiplos espaços, apresenta mais complicações e parece ser também mais grave do que em crianças.
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Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Absceso Retrofaríngeo/cirugía , Absceso Retrofaríngeo/complicaciones , Absceso Retrofaríngeo/microbiología , Índice de Severidad de la Enfermedad , Estudios Retrospectivos , Distribución por EdadRESUMEN
ABSTRACT INTRODUCTION: Most patients with laryngeal carcinoma present tumors in the glottis that can be treated by different treatment modalities. Some authors consider open partial laryngectomy as obsolete, while others still deem this as a viable and cost-efficient option. OBJECTIVES: To compare the oncological and functional results of a series of patients undergoing partial laryngectomy vs. external radiotherapy for the treatment of glottic cancer. METHODS: Historical cohort study with a series of glottic carcinoma patients undergoing partial laryngectomy or external radiotherapy during a period of ten years. RESULTS: Sixty-two patients with glottic carcinoma were included. Group A comprised those submitted to partial laryngectomy (n = 30), and Group B, those who underwent radiotherapy (n = 32). They were homogeneous in the comparison of mean age, 56.4 vs. 60.4 years (p = 0.12) and distribution in pathological stage (p = 0.91). With regard to oncological outcome, there were no differences in distant metastasis rates, or second primary tumor between groups (p = 1.0), as well as in disease-free time, laryngeal rescue-free time, and overall five-year survival. Severe complication rates were also similar between groups. CONCLUSION: Open partial laryngectomy had complication rates and oncological results similar to those of radiotherapy for patients with glottic carcinomas and should still be considered among the main available therapeutic options.
Resumo Introdução: A maioria dos pacientes com carcinoma de laringe apresentam tumores na região glótica suscetíveis a diferentes modalidades de tratamento. Alguns autores consideram a laringectomia parcial aberta em desuso enquanto outros ainda a indicam como uma opção viável e custo eficiente. Objetivos: Comparar os resultados oncológicos e funcionais de uma série de pacientes submetidos à laringectomia parcial versus radioterapia externa para o tratamento do câncer glótico. Método: Estudo tipo coorte histórica com uma série de pacientes com carcinoma glótico submetidos à laringectomia parcial ou radioterapia externa em período de 10 anos. Resultados: Foram incluídos 62 pacientes com carcinoma glótico distribuídos em Grupo A: submetido à laringectomia parcial (n = 30) e Grupo B submetido a radioterapia (n = 32) que se mostraram homogêneos na comparação de média de idade de 56,4 vs. 60,4 (p = 0,12) e distribuição em estadios patológicos (p = 0,91). Com relação ao desfecho oncológico, não foram observadas diferenças nas taxas de metástase à distancia, ou segundo primário entre os grupos (p = 1,0) assim como no tempo livre de doença, tempo livre de resgate laríngeo e sobrevida geral em 5 anos. As taxas de complicações severas também foram semelhantes entre os grupos. Conclusão: A laringectomia parcial aberta apresentou taxas de complicações e resultados oncológicos semelhante àqueles do tratamento radioterápico para pacientes com carcinomas glóticos e ainda deve ser considera entre as principais opções terapêuticas disponíveis.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Escamosas/radioterapia , Neoplasias Laríngeas/cirugía , Neoplasias Laríngeas/radioterapia , Complicaciones Posoperatorias , Recurrencia , Tasa de Supervivencia , Estudios Longitudinales , Glotis , Laringectomía/efectos adversos , Laringectomía/métodos , Estadificación de NeoplasiasRESUMEN
Introduction: Squamous cell carcinoma is the most common neoplasm of the larynx, and its evolution depends on tumor staging. Vascular endothelial growth factor is a marker of angiogenesis, and its expression may be related to increased tumor aggressiveness, as evidenced by the presence of cervical lymphatic metastases. Objectives: To evaluate the expression of the vascular endothelial growth factor marker in non-glottic advanced squamous cell carcinoma of the larynx (T3/T4) and correlate it with the presence of cervical lymph node metastases. Methods: Retrospective clinical study and immunohistochemical analysis of vascular endothelial growth factor through the German scale of immunoreactivity in products of non-glottic squamous cell carcinomas. Results: This study analyzed 15 cases of advanced non-glottic laryngeal tumors (T3/T4), four of which exhibited cervical lymphatic metastases. There was no correlation between vascular endothelial growth factor expression and the presence of cervical metastases. Conclusion: Although vascular endothelial growth factor was expressed in a few cases, there was no correlation with the spread of cervical lymph metastases. .
Introdução: O carcinoma de células escamosas é a neoplasia mais frequente da laringe e seu prognóstico depende do estadiamento. A progressão da doença está relacionada a fatores intrínsecos celulares do câncer, não conhecidos. O VEGF (vascular endothelial growth factor) é um marcador de angiogênese e sua expressão pode estar relacionada a uma maior agressividade tumoral, evidenciada pela presença de metástases linfáticas cervicais. Objetivos: Avaliar a expressão do marcador VEGF em carcinoma de células escamosas da laringe avançados (T3/T4), não glóticos e correlacionar quanto à presença de metástases linfáticas cervicais. Método: Estudo clínico retrospectivo de análise imunohistoquimica do VEGF através da escala Germânica de imunorreatividade em produtos de carcinomas epidermóides não glóticos. Resultados: Analisados 15 casos de tumores avançados de laringe (T3/T4) não glóticos, sendo sete com presença de metástases linfáticas cervicais. Não houve correlação entre a expressão do VEGF e a presença de metástases cervicais. Conclusão: O VEGF foi pouco expressado nos casos estudados e não foi observada sua correlação com a disseminação de metástase linfática cervical. .
Asunto(s)
Humanos , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/secundario , Neoplasias Laríngeas/patología , Factor A de Crecimiento Endotelial Vascular/sangre , Biomarcadores de Tumor/sangre , Carcinoma de Células Escamosas/sangre , Inmunohistoquímica , Metástasis Linfática , Neoplasias Laríngeas/sangre , Estadificación de Neoplasias , Estudios RetrospectivosRESUMEN
INTRODUCTION: Treatment for patients with larynx cancer often results in a negative impact on their physical, social and psychological functions. OBJECTIVE: To evaluate quality of life and voice in patients treated for advanced laryngeal cancer as a consequence of surgery or exclusive chemoradiation. METHODS: Retrospective cohort study with 30 patients free of disease: 10 total laryngectomy patients without production of esophageal speech (EVS); 10 Total laryngectomy patients with tracheoesophageal voice (TEV) and 10 patients with laryngeal voice. Quality of life was measured by SF-36; Voice-Related Quality of Life (V-RQOL) and Voice Handicap Index (VHI) protocols, applied on the same day. RESULTS: The SF-36 demonstrated that patients who received chemoradiotherapy exclusively enjoyed a feature better quality of life than the group of TEV and EVS. In V-RQOL it was observed that the quality of life related to voice is lower than in the EVS. In the VHI group EVS presented higher scores for overall VHI, emotional, functional and organic. DISCUSSION: Quality of life and voice in patients treated with chemoradiotherapy was better than in patients treated surgically. CONCLUSION: The type of medical treatment selected in patients with laryngeal cancer can influence changes in quality of life and voice. .
INTRODUÇÃO: Tratamentos para pacientes com câncer de laringe podem ter grande impacto negativo na função física, social e psicológica. OBJETIVO: Avaliar qualidade de vida e voz de pacientes tratados de câncer avançado de laringe por meio cirúrgico ou quimioradioterapia exclusiva. MÉTODOS: Estudo coorte retrospectivo com 30 pacientes livres da doença: sendo 10 laringectomizados totais sem produção de voz esofágica (SVE); 10 laringectomizados totais com voz traqueoesofágica (VTE) e 10 com voz laríngea. A qualidade de vida foi mensurada pelos protocolos SF-36; Qualidade de Vida em Voz (QVV) e Índice de Desvantagem Vocal (IDV), aplicados no mesmo dia. RESULTADOS: No SF-36, observou-se que pacientes que receberam quimioradioterapia exclusiva apresentaram melhor qualidade de vida do que o grupo de VTE e SVE. No QVV observou-se que a qualidade de vida relacionada à voz é menor no grupo SVE. No IDV grupo, SVE apresentou escore maior para IDV total, emocional, funcional e orgânica. DISCUSSÃO: Qualidade de vida e voz dos pacientes tratados com quimioradioterapia e melhor do que os pacientes tratados cirurgicamente. CONCLUSÃO: O tipo de tratamento médico utilizado em pacientes com câncer de laringe pode trazer alterações na qualidade de vida e voz. .
Asunto(s)
Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Laríngeas/psicología , Calidad de Vida/psicología , Calidad de la Voz , Estudios de Cohortes , Neoplasias Laríngeas/terapia , Estadificación de Neoplasias , Estudios Retrospectivos , Encuestas y Cuestionarios , Voz Esofágica/psicologíaRESUMEN
INTRODUCTION: The recently-proposed Bethesda reporting system has offered clinical recommendations for each category of reported thyroid cytology, including repeated fine-needle aspiration (FNA) for non-diagnostic and atypia/follicular lesions of undetermined significance, but there are no sound indications for repeated examination after an initial benign exam. OBJECTIVE: To investigate the clinical validity of repeated FNA in the management of patients with thyroid nodules. METHOD: The present study evaluated 412 consecutive patients who had repeated aspiration biopsies of thyroid nodules after an initial non-diagnostic, atypia/follicular lesion of undetermined significance, or benign cytology. RESULTS: The majority of patients were female (93.5%) ranging from 13 to 83 years. Non-diagnostic cytology was the most common indication for a repeated examination in 237 patients (57.5%), followed by benign (36.8%), and A/FLUS (5.6%) cytology. A repeated examination altered the initial diagnosis in 70.5% and 78.3% of the non-diagnostic and A/FLUS patients, respectively, whereas only 28.9% of patients with a benign cytology presented with a different diagnosis on a sequential FNA. CONCLUSIONS: Repeat FNA is a valuable procedure in cases with initial non-diagnostic or A/FLUS cytology, but its routine use for patients with an initial benign examination appears to not increase the expected likelihood of a malignant finding. .
INTRODUÇÃO: A classificação de Bethesda para relatórios citológicos de tireoide oferece recomendações clínicas para cada categoria diagnóstica, incluindo a repetição do exame de punção para exames citológicos não diagnósticos (ND) e atipia/lesão folicular de significado indeterminado (A/FLUS). Todavia, a repetição da punção para pacientes com exame citológico inicial benigno ainda é discutida. OBJETIVO: Investigar a validade da punção repetida para o manejo de pacientes com nódulos tireoidianos. MÉTODO: Estudo longitudinal histórico avaliando 412 pacientes consecutivos com biópsias aspirativas repetidas de nódulos da tireoide após exame inicial ND, A/FLUS, ou benigno. RESULTADOS: A citologia não diagnóstica foi a indicação mais comum para um exame repetido em 237 pacientes (57,5%), seguida por citologia inicial benigna (36,8%) e A/FLUS (5,6%). Um exame repetido alterou o diagnóstico inicial de 70,5% e 78,3% dos pacientes com citologia inicial não diagnóstica e A/FLUS, respectivamente, enquanto apenas 28,9% dos pacientes com uma citologia inicial benigna apresentaram um diagnóstico diferente em uma punção sequencial. CONCLUSÕES: Repetir a punção aspirativa é um procedimento válido para pacientes com citologia inicial não diagnóstica ou atipia/lesão folicular de significado indeterminado, mas seu uso rotineiro em pacientes com exame inicial benigno parece não aumentar a probabilidade de malignidade para este grupo. .
Asunto(s)
Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Biopsia con Aguja Fina/métodos , Glándula Tiroides/patología , Neoplasias de la Tiroides/patología , Nódulo Tiroideo/patología , Estudios de Cohortes , Diagnóstico Diferencial , Estudios Longitudinales , Estudios RetrospectivosRESUMEN
INTRODUCTION: Squamous cell carcinoma is the most common neoplasm of the larynx and glottis, and its prognosis depends on the size of the lesion, level of local invasion, cervical lymphatic spread, and presence of distant metastases. Ki-67 (MKI67) is a protein present in the core, whose function is related to cell proliferation. AIM: To evaluate the expression of marker Ki-67 in squamous cell carcinoma of the larynx and glottis and its correlation to pathological findings. METHODS: Experimental study with immunohistochemistry analysis of Ki-67, calculating the percentage of the cell proliferation index in glottic squamous cell carcinomas. RESULTS: Sixteen cases were analyzed, with six well-differentiated and 10 poorly/moderately differentiated tumors. There was a correlation between cell proliferation index and degree of cell differentiation, with higher proliferation in poorly/moderately differentiated tumors. CONCLUSION: The cell proliferation index, as measured by Ki-67, may be useful in the characterization of histological degree in glottic squamous cell tumors. .
INTRODUÇÃO: O carcinoma de células escamosas é a neoplasia mais frequente da laringe e da região glótica, seu prognóstico depende do tamanho da lesão, do nível de invasão local, disseminação cervical linfática e da existência de metástases à distância. Ki-67 (MKI67) é uma proteína presente no núcleo, cuja função está relacionada com a proliferação celular. OBJETIVOS: Avaliar a expressão do marcador Ki-67 em carcinoma de células escamosas da laringe glóticos e correlacionar sua expressão com os achados anatomopatológicos. MÉTODO: Trabalho experimental de análise imunohistoquímica do Ki 67 através do cálculo percentual do índice de proliferação celular em produtos de carcinomas epidermóides glóticos. RESULTADOS: Dezesseis casos foram analisados, sendo seis bem diferenciados e dez pouco/moderadamente diferenciados. Houve correlação entre o índice de proliferação celular e o grau de diferenciação celular, sendo a proliferação maior nos pouco/moderadamente diferenciados. CONCLUSÃO: O índice de proliferação celular, medido pelo Ki-67 pode ser útil na caracterização do grau histológico em tumores glóticos de células escamosas. .