Prospective Evaluation of the Efficacy of Isolated Balloon Eustachian Tuboplasty: Short- and Medium-term Follow-up Results Based on Tubomanometry, ETDQ-7, Tympanometry, and Valsalva Maneuver.

Introduction Balloon eustachian tuboplasty (BET) allows the treatment of the main etiology of eustachian tube disfunction (ETD). Objective To evaluate the efficacy of isolated BET, through objective and subjective results, in the short and medium term, in patients with chronic obstructive ETD. Methods Adult patients diagnosed with chronic obstructive ETD who underwent BET between January 2018 and December 2020 were enrolled in the study. We performed a prospective observational study of BET efficacy, by comparing subjective data, based on the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), and objective data, obtained by tympanometry, objective Valsalva maneuver and tubomanometry, prior to BET with these outcome tools on postprocedure follow-up. Results In total, 30 BETs were performed and analyzed. There were no complications with the procedure. Analysis of BET efficacy was performed in the short-term (average of 7.5 weeks) and in the medium-term (average of 8 months). There was a significant reduction ( p < 0.0001) in the total ETDQ-7 score from baseline to both follow-up periods. A normalization of the ETDQ-7 score was observed in 60 and 83.3% of the performed procedures, in the short- and medium-term, respectively. In tubomanometry, we verified a significant improvement ( p < 0.0001) at all pressures, with a normalization of tubomanometry values in 53.3% and 43.3% of cases in the short- and medium-term, respectively. Tympanogram normalization occurred in 71.4% of patients with abnormal preoperative assessments. Conclusion As an isolated procedure, BET results in significant improvements in symptomatology and objective metric results. This, associated with its safety profile, currently makes BET the most indicated therapeutic option in refractory obstructive ETD.

Prospective Evaluation of the Efficacy of Isolated Balloon Eustachian Tuboplasty: Short- and Medium-term Follow-up Results Based on Tubomanometry, ETDQ-7, Tympanometry, and Valsalva Maneuver

Abstract Introduction Balloon eustachian tuboplasty (BET) allows the treatment of the main etiology of eustachian tube disfunction (ETD). Objective To eval uate the ef ficacy of isolated BET, through objective and subjective results, in the short and medium term, in patients with chronic obstructive ETD. Methods Adult patients diagnosed with chronic obstructive ETD who underwent BET between January 2018 and December 2020 were enrolled in the study. We performeda prospective observational study of BET efficacy, by comparing subjective data, based on the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), and objective data, obtained by tympanometry, objective Valsalva maneuver and tubomanometry, prior to BET with these outcome tools on postprocedure follow-up. Results In total, 30 BETs were performed and analyzed. There were no complications with the procedure. Analysis of BET efficacy was performed in the short-term (average of 7.5 weeks) and in the medium-term (average of 8 months). There was a significant reduction (p < 0.0001) in the total ETDQ-7 score from baseline to both follow-up periods. A normalization of the ETDQ-7 score was observed in 60 and 83.3% of the performed procedures, in the short- and medium-term, respectively. In tubomanometry, we verified a significant improvement (p < 0.0001) at all pressures, with a normalization of tubomanometry values in 53.3% and 43.3% of cases in the short-and medium-term, respectively. Tympanogram normalization occurred in 71.4% of patients with abnormal preoperative assessments. Conclusion As an isolated procedure, BET results in significant improvements in symptomatology and objective metric results. This, associated with its safety profile, currently makes BET the most indicated therapeutic option in refractory obstructive ETD.

Evolution of TOP1 and TOP1MT Topoisomerases in Chordata.

Type IB topoisomerases relax the torsional stress associated with DNA metabolism in the nucleus and mitochondria and constitute important molecular targets of anticancer drugs. Vertebrates stand out among eukaryotes by having two Type IB topoisomerases acting specifically in the nucleus (TOP1) and mitochondria (TOP1MT). Despite their major importance, the origin and evolution of these paralogues remain unknown. Here, we examine the molecular evolutionary processes acting on both TOP1 and TOP1MT in Chordata, taking advantage of the increasing number of available genome sequences. We found that both TOP1 and TOP1MT evolved under strong purifying selection, as expected considering their essential biological functions. Critical active sites, including those associated with resistance to anticancer agents, were found particularly conserved. However, TOP1MT presented a higher rate of molecular evolution than TOP1, possibly related with its specialized activity on the mitochondrial genome and a less critical role in cells. We could place the duplication event that originated the TOP1 and TOP1MT paralogues early in the radiation of vertebrates, most likely associated with the first round of vertebrate tetraploidization (1R). Moreover, our data suggest that cyclostomes present a specialized mitochondrial Type IB topoisomerase. Interestingly, we identified two missense mutations replacing amino acids in the Linker region of TOP1MT in Neanderthals, which appears as a rare event when comparing the genome of both species. In conclusion, TOP1 and TOP1MT differ in their rates of evolution, and their evolutionary histories allowed us to better understand the evolution of chordates.

Tinnitus and Otosclerosis: An Exploratory Study about the Prevalence, Features and Impact in Daily Life

Abstract Introduction Tinnitus is experienced by a significant part of the patients suffering from otosclerosis. Objective To assess the prevalence of tinnitus in otosclerosis, its main features, and the impact on the daily life. Methods Patients diagnosed with otosclerosis in 2019 in a tertiary hospital were enrolled in the study. Demographic data were retrieved and, besides a regular audiometric evaluation, the patients underwent acuphenometry to assess the psychoacoustic measurements (pitch and loudness), and the Tinnitus Handicap Inventory (THI). Results In total, 66 patients fulfilled the inclusion criteria, with a female predominance (63.6%; n = 42), and a mean age of 48.7 years. The mean air-bone gap was of 26.3 dB. A total of 72.7% complained of tinnitus; it was mostly unilateral, identified in the low frequencies, namely 500 Hz, with median loudness of 7.5 dB. The median score on the THI score was of 37; most patients had a mild handicap (33.3%, n = 16), followed by those with a severe handicap (22.9%; n = 11). The female gender had a statistically significant association with the presence of tinnitus. The THI scores were higher in middle-aged patients (age groups: 40 to 49 and 50 to 59 years), which was statistically significant. No correlation was found between audiometry results and the prevalence of tinnitus or score on the THI. On the other hand, high-pitched tinnitus, compared to low pitched-tinnitus, was associated with larger air-bone gaps. Conclusion The prevalence of tinnitus in our population was in line with the prevalences reported in the literature. It caused a catastrophic handicap in 22.9% of the patients. High-pitched tinnitus was associated with higher handicap. Nonetheless, the existence of tinnitus and its severity were not associated with the degree of hearing loss.

Tinnitus and Otosclerosis: An Exploratory Study about the Prevalence, Features and Impact in Daily Life.

Introduction Tinnitus is experienced by a significant part of the patients suffering from otosclerosis. Objective To assess the prevalence of tinnitus in otosclerosis, its main features, and the impact on the daily life. Methods Patients diagnosed with otosclerosis in 2019 in a tertiary hospital were enrolled in the study. Demographic data were retrieved and, besides a regular audiometric evaluation, the patients underwent acuphenometry to assess the psychoacoustic measurements (pitch and loudness), and the Tinnitus Handicap Inventory (THI). Results In total, 66 patients fulfilled the inclusion criteria, with a female predominance (63.6%; n = 42), and a mean age of 48.7 years. The mean air-bone gap was of 26.3 dB. A total of 72.7% complained of tinnitus; it was mostly unilateral, identified in the low frequencies, namely 500 Hz, with median loudness of 7.5 dB. The median score on the THI score was of 37; most patients had a mild handicap (33.3%, n = 16), followed by those with a severe handicap (22.9%; n = 11). The female gender had a statistically significant association with the presence of tinnitus. The THI scores were higher in middle-aged patients (age groups: 40 to 49 and 50 to 59 years), which was statistically significant. No correlation was found between audiometry results and the prevalence of tinnitus or score on the THI. On the other hand, high-pitched tinnitus, compared to low pitched-tinnitus, was associated with larger air-bone gaps. Conclusion The prevalence of tinnitus in our population was in line with the prevalences reported in the literature. It caused a catastrophic handicap in 22.9% of the patients. High-pitched tinnitus was associated with higher handicap. Nonetheless, the existence of tinnitus and its severity were not associated with the degree of hearing loss.

Evolutionary History of TOPIIA Topoisomerases in Animals.

TOPIIA topoisomerases are required for the regulation of DNA topology by DNA cleavage and re-ligation and are important targets of antibiotic and anticancer agents. Humans possess two TOPIIA paralogue genes (TOP2A and TOP2B) with high sequence and structural similarity but distinct cellular functions. Despite their functional and clinical relevance, the evolutionary history of TOPIIA is still poorly understood. Here we show that TOPIIA is highly conserved in Metazoa. We also found that TOPIIA paralogues from jawed and jawless vertebrates had different origins related with tetraploidization events. After duplication, TOP2B evolved under a stronger purifying selection than TOP2A, perhaps promoted by the more specialized role of TOP2B in postmitotic cells. We also detected genetic signatures of positive selection in the highly variable C-terminal domain (CTD), possibly associated with adaptation to cellular interactions. By comparing TOPIIA from modern and archaic humans, we found two amino acid substitutions in the TOP2A CTD, suggesting that TOP2A may have contributed to the evolution of present-day humans, as proposed for other cell cycle-related genes. Finally, we identified six residues conferring resistance to chemotherapy differing between TOP2A and TOP2B. These six residues could be targets for the development of TOP2A-specific inhibitors that would avoid the side effects caused by inhibiting TOP2B. Altogether, our findings clarify the origin, diversification and selection pressures governing the evolution of animal TOPIIA.

Nasal septum deviation and Eustachian tube function: A prospective case-control study based on tympanometry, tubomanometry, and ETDQ-7.

INTRODUCTION: The influence of isolated nasal septum deviation (NSD) in the Eustachian Tube (ET) function is still undetermined. OBJECTIVE: compare ET function between patients with severe NSD and patients with adequate nasal patency in terms of symptomology and objective exams and assess the impact of septoplasty in ET function in patients with severe NSD. METHODS AND METHODOLOGY: a prospective study was conducted. In the first phase of the study, two opportunistic samples were selected: 35 patients with severe NSD for group A and 35 patients with adequate nasal patency for group B. Both groups were evaluated through Nasal obstruction Subjective Questionnaire (NOSE) and ET dysfunction questionnaire 7 (ETDQ7) -, and through two objective exams to assess ET function - tympanometry, and tubomanometry (TMM); results were compared between group A and B. In the second phase of the study, the patients from group A underwent septoplasty and were re-evaluated through ETDQ7, tympanometry and TMM; results were compared before and after surgery. RESULTS: we found a statistically significant difference between patients with NSD and patients with adequate nasal patency in NOSE and ETDQ7 (higher scores in the latter), and TMM (worse results in patients with NSD); the difference in tympanometry was not statistically significant. The side of the NSD did not correlate with the side of the dysfunction. After septoplasty, patients from group A had statistically significant lower scores in ETDQ7 and a lower proportion of patients with findings compatible with ET dysfunction using TMM. CONCLUSION: according to our results, severe NSD alone is a cause of ET dysfunction; septal surgery might improve ET function in these patients.

Desviación del septo nasal y función de la trompa de Eustaquio: estudio prospectivo de control de casos basado en timpanometría, tubomanometría y ETDQ-7 / Nasal septum deviation and Eustachian tube function: A prospective case-control study based on tympanometry, tubomanometry, and ETDQ-7

Introduction: The influence of isolated nasal septum deviation (NSD) in the Eustachian Tube (ET) function is still undetermined. Objective: compare ET function between patients with severe NSD and patients with adequate nasal patency in terms of symptomology and objective exams and assess the impact of septoplasty in ET function in patients with severe NSD. Methods and methodology: a prospective study was conducted. In the first phase of the study, two opportunistic samples were selected: 35 patients with severe NSD for group A and 35 patients with adequate nasal patency for group B. Both groups were evaluated through Nasal obstruction Subjective Questionnaire (NOSE) and ET dysfunction questionnaire 7 (ETDQ7) –, and through two objective exams to assess ET function – tympanometry, and tubomanometry (TMM); results were compared between group A and B. In the second phase of the study, the patients from group A underwent septoplasty and were re-evaluated through ETDQ7, tympanometry and TMM; results were compared before and after surgery. Results: we found a statistically significant difference between patients with NSD and patients with adequate nasal patency in NOSE and ETDQ7 (higher scores in the latter), and TMM (worse results in patients with NSD); the difference in tympanometry was not statistically significant. The side of the NSD did not correlate with the side of the dysfunction. After septoplasty, patients from group A had statistically significant lower scores in ETDQ7 and a lower proportion of patients with findings compatible with ET dysfunction using TMM. Conclusion: according to our results, severe NSD alone is a cause of ET dysfunction; septal surgery might improve ET function in these patients. (AU)

Introducción: Aún sigue sin determinarse la influencia aislada de la desviación del septo nasal (DSN) en la función de la trompa de Eustaquio (TE). Objetivo: Comparar la función de la TE entre los pacientes con DSN grave y los pacientes con patencia nasal adecuada, en términos de sintomatología y exámenes objetivos, y evaluar el impacto de la septoplastia en la función de la TE en pacientes con DSN grave. Métodos y metodología: Se realizó un estudio prospectivo seleccionándose 2 muestras oportunistas en la primera fase del mismo: 35 pacientes con DSN grave en el grupo A, y 35 pacientes con patencia nasal adecuada en el grupo B. Se evaluó a ambos grupos utilizando los cuestionarios Nasal Obstruction Subjective Questionnaire (NOSE) y disfunción de TE (ETDQ7), así como mediante 2 exámenes objetivos, para evaluar la función de la TE: timpanometría y tubomanometría (TMM), comparándose los resultados entre los grupos A y B. En la segunda fase del estudio, los pacientes del grupo A fueron sometidos a septoplastia y reevaluados mediante ETDQ7, timpanometría y TMM, comparándose los resultados de antes y después de la cirugía. Resultados: Encontramos una diferencia estadísticamente significativa en NOSE y ETDQ7 entre los pacientes con DSN y los pacientes con patencia nasal adecuada (con puntuaciones superiores en este último), y TMM (con peores resultados en los pacientes con DSN), no siendo estadísticamente significativa la diferencia en la timpanometría. El lado de DNS no se correlacionó con el lado de la disfunción. Tras la septoplastia, los pacientes del grupo A reflejaron puntuaciones menores en ETDQ7 con significación estadística, y existió una menor proporción de pacientes con hallazgos compatibles con la disfunción de la TE utilizando TMM. Conclusión: Con arreglo a nuestros resultados, la DNS en solitario es una causa de disfunción de la TE, pudiendo mejorar la septoplastia la función de la TE en estos pacientes. (AU)

[Vestibular Disorders in the Pediatric Age: Retrospective Analysis and Review of the Literature]. / Patologia Vestibular em Idade Pediátrica: Análise Retrospetiva e Revisão da Literatura.

INTRODUCTION: Vestibular disorders in pediatric patients is still a controversial subject but has gained relevance over the years. In recent studies, its prevalence varied between 0.7% and 15%. Nevertheless, the true prevalence can be underestimated given that its clinical presentation is expressed compared to adults; it can present as rotatory vertigo, but It can also cause vision complaints, headaches, motor delay, and learning disability. Although middle ear effusion is considered the main cause of vestibular dysfunction in this age group, other diagnoses should be considered. The aim of this study was to describe clinical features of the pediatric population referred to a subspecialist Otorhinolaryngology vertigo clinic in a tertiary hospital between 2013 and 2017. We also aimed to compare the results and carry out a literature about the most common causes, diagnostic features and treatment approach. MATERIAL AND METHODS: Clinical records of patients referred to a subspecialist Otorhinolaryngology vertigo clinic with suspicion of vestibular dysfunction aged between 0 and 18 years old were reviewed. Patients with middle ear effusion were excluded. RESULTS: Thirty-seven patients met the inclusion criteria. From these, 59% were female, with a mean age of 10.9 years old during the first consultation. The most common reason for referral was rotatory vertigo. Nausea and headache were also frequent complaints in our population. All patients performed audiometry; videonistagmography was performed in 41% of the cases; imaging studies were done in 59% of patients. The most common causes of vestibular dysfunction were vestibular migraine and benign paroxysmal vertigo of childhood (both in 27% of the cases), followed by vestibular neuritis (in 22% of the cases). DISCUSSION: Although our findings partially concur with the literature, compared with other specialist centers, the range of reasons for referral and of conditions is not as diverse, which may suggest that there is underdiagnosis of vestibular dysfunction in this age group. CONCLUSION: Vestibular dysfunction in the pediatric age can have several causes; pediatricians, neurologists, physiatrists, family doctors and otorhinolaryngologists must be aware of the different forms of presentation. Referral and evaluation protocols addressing pediatric patients should be created.

Introdução: A patologia vestibular na população pediátrica é um tema bastante controverso, mas que tem ganho cada vez mais destaque. A prevalência reportada nesta população varia entre 0,7% e 15%. No entanto, este valor pode estar subestimado, uma vez que a sua forma de expressão na população pediátrica é muito diferente da dos adultos, podendo ir desde a vertigem rotatória até queixas de alterações da visão, cefaleias, atraso motor ou dificuldades na aprendizagem. Embora na literatura a otite média com efusão seja considerada a principal causa de disfunção vestibular nesta faixa etária, existem outras que devem ser consideradas. O objetivo deste estudo foi descrever as características clínicas da população pediátrica encaminhada para avaliação em consulta de Otorrinolaringologia num hospital terciário, por suspeita de disfunção vestibular, desde o ano de 2013 até 2017; Também se pretendeu comparar os resultados e realizar uma revisão da literatura acerca das etiologias mais frequentes, características diagnósticas e abordagem terapêutica.Material e Métodos: Foram analisados de forma retrospetiva os processos clínicos dos doentes observados na consulta de subespecialidade de Vertigem de Otorrinolaringologia com idades entre 0 e 18 anos. Foram excluídos os doentes com diagnóstico de otite média com efusão.Resultados: Cumpriam os critérios de inclusão 37 doentes, dos quais 59% eram do sexo feminino, sendo a idade média da primeira consulta de 10,9 anos. O motivo mais frequente de referenciação foi a vertigem rotatória. As náuseas e cefaleias foram também sintomas frequentemente descritos. Todos os doentes foram submetidos a audiometria tonal; a videonistagmografia foi realizada em 41% dos casos; exames de imagem foram realizados em 59% dos doentes. No que respeita às etiologias do quadro, as mais frequentes foram a enxaqueca vestibular e a vertigem paroxística benigna da infância (ambas em 27% dos casos), seguida da neuronite vestibular (em 22% dos casos).Discussão: Embora os resultados sejam, em parte, sobreponíveis à literatura, comparativamente a outros centros de referência a diversidade de motivos de referenciação e de patologias é menor, o que pode apontar para o subdiagnóstico da disfunção vestibular nesta faixa etária.Conclusão: A disfunção vestibular em idade pediátrica pode ter uma multiplicidade de etiologias, pelo que pediatras, neurologistas, fisiatras, médicos de família e otorrinolaringologistas devem estar alerta para as diversas formas de apresentação desta entidade. Deverão ser criados protocolos de referenciação e avaliação adequados para esta população.

Molecular Evolution of DNA Topoisomerase III Beta (TOP3B) in Metazoa.

DNA topoisomerase III beta (TOP3B) is unique by operating on both DNA and RNA substrates to regulate gene expression and genomic stability. Mutations in human TOP3B are linked to neurodevelopmental and cognitive disorders, highlighting its relevance for human health. Despite the emerging importance of TOP3B, its precise cellular functions and evolutionary history remain poorly understood. Here, we show that TOP3B is conserved across main metazoan groups and evolved under strong purifying selection. Subdomain IV was identified as the most conserved TOP3B region, in agreement with its role in providing the structural foundation of the protein. On the contrary, subdomain II is the less conserved, possibly because it is the most structurally flexible region of all TOP3B regions. Interestingly, TOP3B residue at position 472, previously associated with schizophrenia, is highly variable across animals, suggesting a more specific role in humans and related species. Finally, we show that all TOP3B CXXC zinc finger motifs previously identified at the protein C-terminal region are retained across metazoans. We also found that the two major methylation sites known to regulate TOP3B activity are located in the most conserved region of the C-terminal arginine-glycine-glycine (RGG) box, suggesting that a similar regulatory mechanism may operate throughout animals. Overall, our results provide a better understanding of the evolution and functional roles of TOP3B.

Clustering of adenosine A2B receptors with ectonucleotidases in caveolin-rich lipid rafts underlies immunomodulation by Leishmania amazonensis.

Extracellular adenosine plays important roles in modulating the immune responses. We have previously demonstrated that infection of dendritic cells (DC) by Leishmania amazonensis leads to increased expression of CD39 and CD73 and to the selective activation of the low affinity A2B receptors (A2B R), which contributes to DC inhibition, without involvement of the high affinity A2A R. To understand this apparent paradox, we now characterized the alterations of both adenosine receptors in infected cells. With this aim, bone marrow-derived DC from C57BL/6J mice were infected with metacyclic promastigotes of L. amazonensis. Fluorescence microscopy revealed that L. amazonensis infection stimulates the recruitment of A2B R, but not of A2A R, to the surface of infected DC, without altering the amount of mRNA or the total A2B R density, an effect dependent on lipophosphoglycan (LPG). Log-phase promastigotes or axenic amastigotes of L. amazonensis do not stimulate A2B R recruitment. A2B R clusters are localized in caveolin-rich lipid rafts and the disruption of these membrane domains impairs A2B R recruitment and activation. More importantly, our results show that A2B R co-localize with CD39 and CD73 forming a "purinergic cluster" that allows for the production of extracellular adenosine in close proximity with these receptors. We conclude that A2B R activation by locally produced adenosine constitutes an elegant and powerful evasion mechanism used by L. amazonensis to down-modulate the DC activation.

Nasal septum deviation and Eustachian tube function: A prospective case-control study based on tympanometry, tubomanometry, and ETDQ-7.

INTRODUCTION: The influence of isolated nasal septum deviation (NSD) in the Eustachian Tube (ET) function is still undetermined. OBJECTIVE: compare ET function between patients with severe NSD and patients with adequate nasal patency in terms of symptomology and objective exams and assess the impact of septoplasty in ET function in patients with severe NSD. METHODS AND METHODOLOGY: a prospective study was conducted. In the first phase of the study, two opportunistic samples were selected: 35 patients with severe NSD for group A and 35 patients with adequate nasal patency for group B. Both groups were evaluated through Nasal obstruction Subjective Questionnaire (NOSE) and ET dysfunction questionnaire 7 (ETDQ7) -, and through two objective exams to assess ET function - tympanometry, and tubomanometry (TMM); results were compared between group A and B. In the second phase of the study, the patients from group A underwent septoplasty and were re-evaluated through ETDQ7, tympanometry and TMM; results were compared before and after surgery. RESULTS: we found a statistically significant difference between patients with NSD and patients with adequate nasal patency in NOSE and ETDQ7 (higher scores in the latter), and TMM (worse results in patients with NSD); the difference in tympanometry was not statistically significant. The side of the NSD did not correlate with the side of the dysfunction. After septoplasty, patients from group A had statistically significant lower scores in ETDQ7 and a lower proportion of patients with findings compatible with ET dysfunction using TMM. CONCLUSION: according to our results, severe NSD alone is a cause of ET dysfunction; septal surgery might improve ET function in these patients.

Effectiveness of medical ethics education: a systematic review.

This article was migrated. The article was marked as recommended. Background Medical ethics is universally accepted as a fundamental part of medical education. One of the current challenges lies in assessing its effectiveness. The primary objective is to analyze the impact of training in medical ethics, and secondly to describe educational practices and discuss the most effective and appropriate pedagogical models. Methods The PubMed and EMBASE databases were searched for studies up June 2019. Studies with a focus on assessing teaching medical ethics were considered. The included population were medical students, residents or faculty physicians with quantitative measured outcomes with at least one of the following criteria: i) pre and post intervention evaluation or ii) a comparison with a control group that did not receive the educational intervention. Results A total of 26 studies ranging from 1990 to 2017 were included: 12 (46%) with medical students, 12 (46%) with residents and 2 (8%) with faculty physicians. The most common outcomes are Knowledge, Confidence and Attitudes/ Behaviour. Assessment instruments are knowledge tests, self-assessment questionnaires, reviewing clinical charts and OSCE. Positive statistically significant differences were found in outcomes in 19 (73%) studies. Conclusions A great heterogeneity was found in the way of teaching, assessment and measured outcomes. Most studies focus in medical students or residents. Very few studies present follow-up measures, simulation training and validated and standardized assessment tools with behavioural components. Therefore, the evidence to support the positive impact remains weak. Future research on medical ethical training ought to place similar effort and rigour as other clinical competence skills.

Is pediatric cholesteatoma more aggressive in children than in adults? A comparative study using the EAONO/JOS classification.

INTRODUCTION: chronic otitis media with cholesteatoma (COMC) is a serious condition that may cause severe complications. According to the literature, in pediatric patients this entity can have a more aggressive behavior, leading to higher rates of morbidity. Consensus regarding the definition of aggressive and extensive cholesteatoma was lacking until recently. European Academy of Otology and Neurotology/Japan Otologic Society (EAONO/JOS) proposed a classification and staging system which was highly accepted by a group of otology experts. OBJECTIVE: to compare cholesteatoma characteristics between pediatric and adult patients using the EAONO/JOS stating system. MATERIAL AND METHODS: a retrospective analysis of the patients who underwent surgery for cholesteatoma treatment in a tertiary hospital was performed using EAONO/JOS classification. Congenital cholesteatoma, revision surgery, and follow-up losses were excluded. The patients were further divided into two cohorts: a pediatric group (<16 years old) and an adult group (>16 years old). The results were compared between them. RESULTS: 134 patients fulfilled the inclusion criteria, 27 were pediatric, and 107 adult patients. We found a significant difference in supratubal recess, with higher rates of extension to this location in the pediatric group. Also in the pediatric cohort, COMC was accompanied by malleus erosion in a higher frequency, with a significant difference from adults; it also presented in higher stages of the disease according to EAONO/JOS classification. We found no differences in hearing gain post-operatively. Moreover, we found that age younger than 16 years was an independent risk factor for relapse with time. DISCUSSION AND CONCLUSIONS: according to our data, cholesteatoma in pediatric age has a more aggressive and extensive nature than in adults, and age younger than 16-years-old is an independent risk factor for relapse.

Translation and Validation of the "7-Item Eustachian Tube Dysfunction Questionnaire" to European Portuguese (PT).

INTRODUCTION: Eustachian tube dysfunction is a common cause of morbidity in both adults and children, associated with nasal and otologic symptoms. Symptomatic evaluation is very important for the correct diagnosis and evaluation of the treatment efficacy of this entity. The "7-item Eustachian Tube Dysfunction Questionnaire" was described and validated by McCoul et al and proved to be a useful tool, easy to apply, with good validity in the evaluation of eustachian tube dysfunction symptoms. This study presents the validation process of the European Portuguese version of the "7-item Eustachian Tube Dysfunction Questionnaire". The aim of this study was to translate and validate the European Portuguese version of "Eustachian Tube Dysfunction Questionnaire-7". MATERIAL AND METHODS: The "7-item Eustachian Tube Dysfunction Questionnaire" was adapted and translated to European Portuguese using standard validation methodology. The European Portuguese version of "7-item Eustachian Tube Dysfunction Questionnaire" was completed by a group of 50 consecutive adult patients diagnosed with eustachian tube dysfunction and 25 healthy patients who served as a control group. All respondents in the Eustachian tube dysfunction group repeated the "7-item Eustachian Tube Dysfunction Questionnaire" in a two week-period. Statistical analysis was performed to determine its psychometric properties (reliability -internal consistency and test-retest reproducibility, and discriminant validity). RESULTS: Face and content validity were confirmed, and reliability testing revealed similar internal consistency for the entire instrument as the original questionnaire, and strong correlation between individual items and total score. The questionnaire was easy and quick to administer. Test-retest reliability of the European Portuguese version was adequate, with excellent intraclass correlation coefficients and without significant differences between the total score from the first and second evaluations. Discriminative validity was confirmed by statistically significant differences between scores of the test and control groups. DISCUSSION: This study presents the European Portuguese version of the "7-item Eustachian Tube Dysfunction Questionnaire" questionnaire, an adapted, validated and well-accepted instrument to evaluate the symptoms of eustachian tube dysfunction in the European Portuguese speaking population. CONCLUSION: The European Portuguese version of the "7-item Eustachian Tube Dysfunction Questionnaire" is recommended as a routine procedure in the assessment of patients with eustachian tube dysfunction in the European Portuguese speaking population and for the evaluation of treatment outcome.

Introdução: A disfunção da trompa de Eustáquio é uma patologia comum associada a sintomas nasais e otológicos. A avaliação sintomática desta patologia é importante para o seu correto diagnóstico e avaliação da resposta ao tratamento implementado. O "7-item Eustachian Tube Dysfunction Questionnaire", descrito e validado por McCoul et al, demonstrou tratar-se de uma ferramenta adequada, de fácil e rápida aplicação, com boa reprodutibilidade na avaliação dos sintomas de disfunção da trompa de Eustáquio. Este estudo apresenta o processo validação da versão Portuguesa do "7-item Eustachian Tube Dysfunction Questionnaire". O objectivo deste trabalho foi a adaptação e validação do "7-item Eustachian Tube Dysfunction Questionnaire" para a língua portuguesa. Material e Métodos: O "7-item Eustachian Tube Dysfunction Questionnaire" foi traduzido e adaptado para língua portuguesa, de acordo com a metodologia recomendada na literatura científica. A versão portuguesa foi aplicada a um grupo teste de 50 doentes consecutivos com o diagnóstico de disfunção da trompa de Eustáquio e a um grupo de controlo de 25 pessoas. Todos os doentes com disfunção da trompa de Eustáquio repetiram o questionário num período de duas semanas. Foi realizada análise estatística para determinar as suas propriedades psicométricas (consistência interna, reprodutibilidade teste-reteste e validade discriminatória). Resultados: O "7-item Eustachian Tube Dysfunction Questionnaire" traduzido apresentou uma consistência interna similar à do questionário original para cada item e uma forte correlação item-total. A aplicação do questionário foi fácil e rápida. Verificou-se boa reprodutibilidade teste- reteste da versão traduzida do questionário, com excelentes coeficientes de correlação intraclasse e sem diferenças significativas entre o valor total das primeira e segunda medições. A validade discriminatória foi confirmada através da diferença estatisticamente significativa entre a pontuação do grupo teste e grupo controlo. Discussão: Este estudo demonstra que a versão portuguesa do "7-item Eustachian Tube Dysfunction Questionnaire", é um instrumento adaptado, validado e bem aceite para a avaliação dos sintomas de disfunção da trompa de Eustáquio na população portuguesa. Conclusão: A versão portuguesa do "7-item Eustachian Tube Dysfunction Questionnaire" é recomendada para o rastreio de disfunção da trompa de Eustáquio na população Portuguesa e para a monitorização da resposta ao seu tratamento.

Incisive dental implant migration into the nasal septum.

We report the clinical case of a female patient who presented to our emergency department due to a septal abscess caused by the displacement of a dental implant into the nasal septum. The patient underwent surgical treatment for endoscopic foreign body excision and septal abscess drainage. Despite the presence of septal cartilage destruction, the L-shaped structure was preserved and no reconstruction was required. Postoperative healing was uneventful.

Cervical Ganglioneuroma in Pediatric Age: A Case Report.

Ganglioneuroma is a rare, benign, non-invasive tumor emerging from the sympathetic system. Of these tumors, only 8% occur in the neck. In this report, we present a case of a 13-year-old girl with a 2-year history of enlarging neck mass. Her only complaint, aside from neck swelling, was dysphagia. Physical and radiological examinations revealed a large mass centered in the right carotid space. A transcervical approach was used to excise the tumor emerging from the sympathetic ganglia. The patient developed temporary Horner's syndrome postoperatively. In a few weeks, she was completely asymptomatic. Histological examination was compatible with ganglioneuroma. Surgical excision is the only definite treatment of cervical ganglioneuroma and is also the only way to confirm the diagnosis. Injury during surgery may result in significant morbidity.

Cetuximab plus platinum-based chemotherapy in head and neck squamous cell carcinoma: a retrospective study in a single comprehensive European cancer institution.

BACKGROUND: The use of cetuximab in combination with platinum (P) plus 5-fluorouracil (F) has previously been demonstrated to be effective in the treatment of metastatic squamous cell cancer of head and neck (SCCHN). We investigated the efficacy and outcome of this protocol as a first-line treatment for patients with recurrent or metastatic disease. We evaluated overall-survival (OS), progression-free-survival (PFS), overall response rate (ORR) and the treatment toxicity profile in a retrospective cohort. PATIENTS AND METHODS: This study enrolled 121 patients with untreated recurrent or metastatic SCCHN. The patients received PF+ cetuximab every 3 weeks for a maximum of 6 cycles. Patients with stable disease who received PF+ cetuximab continued to receive cetuximab until disease progressed or unacceptable toxic effects were experienced, whichever occurred first. RESULTS: The median patient age was 53 (37-78) years. The patient cohort was 86.8% male. The addition of cetuximab to PF in the recurrent or metastatic setting provided an OS of 11 months (Confidential Interval, CI, 95%, 8.684-13.316) and PFS of 8 months (CI 95%, 6.051-9.949). The disease control rate was 48.9%, and the ORR was 23.91%. The most common grade 3 or 4 adverse events in the PF+ cetuximab regimen were febrile neutropenia (5.7%), skin rash (3.8%) and mucosistis (3.8%). CONCLUSIONS: The results of this study suggest that cetuximab plus platinum-fluorouracil chemotherapy is a good option for systemic treatment in advanced SSCHN patients. This regimen has a well-tolerated toxicity profile.