Carla Pinto Moura

Predictive factors for the postlaryngectomy pharyngocutaneous fistula development: systematic review,

OBJECTIVE Pharyngocutaneous fistula is considered one of the major complications in the postoperative period after total laryngectomy/pharyngolaryngectomy, leading to a severe adverse impact for the patient and society. This study aimed to identify all the described pharyngocutaneous fistula predictive factors and risk classifications. METHODS Research was conducted to identify all the studies assessing predictive factors and risk classification for pharyngocutaneous fistula development published until April of 2012 (n = 846). The included studies were analyzed and data regarding their identification, methodological quality and results were recorded. RESULTS A total of 39 studies were included. The variables consistently reported as associated with fistula development were nutritional deficiency, American Society of Anesthesiologists (ASA) classification, high consumption of alcohol, anemia and hypoalbuminemia, co-morbidities, advanced N stage, location and extent of primary tumor, pre-radiotherapy and pre-chemoradiotherapy treatment, emergency tracheotomy, surgical margin status, surgerys duration, surgeons experience, local complications of the wound, performance of intraoperative blood transfusion and relationship between nasogastric tube and oral feeding. CONCLUSION Several risk factors were associated with pharyngocutaneous fistula formation in the included studies. However, there is still no consensus in the most pertinent selection. Only two classification systems were retrieved and they were not able to accurately predict pharyngocutaneous fistula.

The Portuguese version of the RhinoQOL Questionnaire: validation and clinical application,

INTRODUCTION Rhinosinusitis constitutes an important health problem, with significant interference in personal, professional, and social functioning. This study presents the validation process of the Portuguese version of the RhinoQOL, to be used as a routine procedure in the assessment of patients with chronic rhinosinusitis. OBJECTIVE To demonstrate that the Portuguese version of the RhinoQOL is as valid as the English version to measure symptoms and health-related quality of life in chronic rhinosinusitis. METHODS The Portuguese version of the RhinoQOL was administered consecutively to 58 patients with chronic rhinosinusitis with and without nasal polyps, assessed for endoscopic sinus surgery. A follow-up survey was completed three months after surgery. Statistical analysis was performed to determine its psychometric properties. RESULTS Face and content validity were confirmed by similar internal consistency as the original questionnaire for each sub-scale, and strong correlation between individual items and total score. The questionnaire was easy and quick to administer (5.5min). At three months, there was a significant decrease from baseline for all sub-scale scores, indicating clinical improvement, with an effect size considered as large. CONCLUSION This study provides a questionnaire that is equivalent to the original English version, with good responsiveness to change, which can be especially valuable to measure the outcome of surgery.

Risk factors for the occurrence of epistaxis: Prospective study

OBJECTIVE Analyse and compare the characteristics of patients with epistaxis admitted to the otolaryngology emergency department with those provided by a control group. Establish a model to identify epistaxis predictive factors. METHODS Prospective analysis of 283 consecutive adults, admitted to the otolaryngology emergency department of a tertiary referral centre between 25 January and 25 February 2014. Comparison of gender, age, co-morbidities, usual medication, history of epistaxis or nasal trauma, presence of septal deviation and blood pressure value on admission, between the elements that were admitted to the emergency due to epistaxis (group 1) and a group composed of patients with other symptoms (group 2). Intergroup variations were analyzed using t student and chi-square tests. Multivariate logistic regression and a receiver operating characteristic curve were used to establish a predictive model and test its suitability. RESULTS Male gender (OR=2.57, 95% CI 1.1-6.0, p=0.029), older age (OR=1.03, 95% CI 1.0-1.1, p=0.002), existence of peripheral vascular disease (OR=13.47, 95% CI 1.9-95.3, p=0.009), cardiovascular disease (OR=3.91, 95% CI 1.6-9.7, p=0.003) and previous history of epistaxis (OR=5.53, 95% CI 2.5-12.1, p<0.001) were predictors of epistaxis when adjusted for the presence of elevated blood pressure, history of hypertension, cerebrovascular disease and chronic use of anticoagulants or antiplatelet drugs. The model revealed a good applicability (area under the curve of 0.852). CONCLUSIONS The only predictive factors of admission to the emergency department due to epistaxis were male gender, older age, peripheral vascular disease, cardiovascular disease and history of epistaxis.

Increased expression of α7nAChR in chronic rhinosinusitis: The intranasal cholinergic anti-inflammatory hypothesis.

OBJECTIVE Chronic rhinosinusitis results from a dysfunctional host-environment interaction at the site of interface, in the nose and paranasal sinuses. A parasympathetic-mediated anti-inflammatory reflex is known to have a pivotal role in the control of damage induced by immune response to injury and infection; acetylcholine released by peripheral nerves interacts with nicotinic acetylcholine receptor subunit α7 - α7nAChR - of innate immune cells, inhibiting pro-inflammatory signalling. This work aims to investigate whether cholinergic function is implicated in chronic rhinosinusitis. METHODS α7nAChR mRNA and protein levels were measured in nasal biopsy specimens of 14 patients with CRSwNP, 8 with CRSsNP and 10 control subjects, undergoing surgery. RESULTS Gene expression levels of α7nAChR did not differ between groups; protein expression was significantly higher in CRSwNP than in CRSsNP (p=0.041), and both of these patient groups showed significant higher levels than controls (CRSwNP vs Controls - p=0.001; CRSsNP vs Controls - p=0.041). CONCLUSION Elevated α7nAChR protein levels suggest that the cholinergic system is involved in the inflammatory response of chronic rhinosinusitis. This can shed light on both, the disease pathophysiology and the development of future treatment options.

Derivation of a clinical decision rule for predictive factors for the development of pharyngocutaneous fistula postlaryngectomy

INTRODUCTION Pharyngocutaneous fistula after larynx and hypopharynx cancer surgery can cause several damages. This studys aim was to derive a clinical decision rule to predict pharyngocutaneous fistula development after pharyngolaryngeal cancer surgery. METHODS A retrospective cohort study was conducted, including all patients performing total laryngectomy/pharyngolaryngectomy (n=171). Association between pertinent variables and pharyngocutaneous fistula development was assessed and a predictive model proposed. RESULTS American Society of Anesthesiologists scale, chemoradiotherapy, and tracheotomy before surgery were associated with fistula in the univariate analysis. In the multivariate analysis, only American Society of Anesthesiologists maintained statistical significance. Using logistic regression, a predictive model including the following was derived: American Society of Anesthesiologists, alcohol, chemoradiotherapy, tracheotomy, hemoglobin and albumin pre-surgery, local extension, N-classification, and diabetes mellitus. The models score area under the curve was 0.76 (95% CI 0.64-0.87). The high-risk group presented specificity of 93%, positive likelihood ratio of 7.10, and positive predictive value of 76%. Including the medium-low, medium-high, and high-risk groups, a sensitivity of 92%, negative likelihood ratio of 0.25, and negative predictive value of 89% were observed. CONCLUSION A clinical decision rule was created to identify patients with high risk of pharyngocutaneous fistula development. Prognostic accuracy measures were substantial. Nevertheless, it is essential to conduct larger prospective studies for validation and refinement.

P106: Fabry Disease: Hearing Loss on Enzyme Replacement Therapy

OBJECTIVES: To evaluate Fabry disease (FD)-related hearing loss on enzyme replacement therapy (ERT). FD involves progressive glycosphingolipids (GSL) accumulation, predominantly in ganglion neural and vascular endothelial cells. Otological symptoms include high frequencies progressive sensorineural hearing loss (SNHL), sudden deafness, tinnitus, and dizziness. Temporal bone histopathology describes GSL accumulation in the ear vascular endothelial and ganglion cells, stria vascularis and spiral ligament atrophy, loss of spiral ganglion cells and of hair cells mainly of the basal turns. METHODS: A 46-year-old man, with FD diagnosed at age 16, was on chronic haemodialysis since age 25. In July 2002, at age 45, he began ERT with algasidase beta, initially at the dose of 0.77mg/Kg, later increased to 1.5mg/Kg, every two weeks. He had been complaining of progressive word discrimination HL for several years, and was first observed at the Otolaryngology Department two months later. RESULTS: A bilateral sloping SNHL was found at audiological evaluation, with a normal tympanogram. Ear CT revealed enlargement of the intradiploic vascular channels, principally in the petrous bone. Subsequent audiological evaluations documented progressive worsening of HL, mainly of high frequencies. CONCLUSIONS: A progressive narrowing, ischaemia, and occlusion of vessels feeding the cochlea may be the main etiological factor. This may be amplified by the cumulative effects of the prothrombotic state described in FD and chronic haemodialysis. ERT has been reported to improve the hearing defect of FD but in this patient there had been audiological deterioration during ERT. This suggests there may be an irreversibility point in the pathogenesis of FD-related HL. P107 Quality of Life & Hearing Preservation in Acoustic Neuroma Arunachalam Perumkulam Iyer, MS (ENT) DLO FRCS (presenter); Robert Gunn, FRACS; Hamish Sillars, FRACS Sheffield UK; Auckland New Zealand

P147: Down syndrome: Rapid Maxillary Expansion and ENT Evolution

OBJECTIVES: 1. Learn an effective method of endotracheal intubation of a patient with a difficult airway due to the anatomical manifestations of Klippel-Feil syndrome. 2. Understand the relevant anatomical features of Klippel-Feil syndrome. METHODS: A case report was prepared of an intubation event that took place in August 2005. It describes a single use of a Seldinger technique of flexible bronchoscopic intubation of a child with Klippel-Feil syndrome. The outcome was successful intubation after other attempts using standard techniques had failed. RESULTS: Under flexible nasotracheal bronchoscopic guidance, an endotracheal tube was successfully passed over a guidewire into the subglottic airway of an eight-year-old child with Klippel-Feil syndrome. The technique is straightforward and uses materials readily available in an operative suite. The case report describes the technique as well as features of the Klippel-Feil syndrome. In addition, the case report includes a review of previously reported intubations of patients with Klippel-Feil syndrome and previous reports of similar Seldingertype intubation techniques. CONCLUSIONS: Anatomical features of the upper airway in patients with Klippel-Feil syndrome make endotracheal intubation by standard techniques difficult or even impossible. The technique described may be successful in other patients with Klippel-Feil syndrome or with similar anatomical features.

Rapid maxillary expansion and nasal patency of the down syndrome pediatric population

Abstract Objectives: Down syndrome (DS) is the most common aneuploid disorder at birth. Phenotypic characteristics include general axial hypotonia and maxillary hypoplasia with relative macroglossia contributing to constricted maxillary arch and nasal obstruction. This prospective study assesses the effect of rapid maxillary expansion (RME) on nasal permeability of DS children using acoustic rhinometry (AR) data. To our knowledge this is the first such study performed in a DS population. Methods: AR have been performed in 24 DS children aged between 5 and 12 years (who were randomly allocated to RME and control groups) prior to expansion (T0), immediately after maximum expansion (approximately 1 month) (T1) and after a 5-month period of retention (T2); the data between the 2 groups were compared. Results: On average, RME children showed a significant increase in the nasal volume from T0 to T1, which persisted through T2. A significant difference was noticed in the evolution of the minimal cross-sectional area (MCA) for RME children. Children in the control group did not show any significant improvement. The distance from the MCA does not show any significant difference with time in both groups. Nevertheless, in the RME group a noticeable change is observed, becoming more anterior, between T0 and T1, with almost no change at the last stage (T2); in contrast, results from the control group are not consistent with time. Conclusion: Rapid maxillary expansion produced a significant augmentation of nasal volume, P