Journal of Clinical Medicine

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has recently caused a pandemic that has involved Italy as the second worldwide nation in terms of infected patients and deaths. The clinical manifestation of Covid-19 ranges from asymptomatic carrier status to severe pneumonia. Asymptomatic individuals in Covid-19 are those who are carriers of the virus but do not show clinical symptoms and are able to transmit the disease in the same degree as symptomatic carriers. In order to contain contagions is of supreme importance to identify asymptomatic patients because this subpopulation is one of the main factors contributing to the spread of this disease. We report on six Italian patients with COVID-19 who presented sudden hyposmia as the only or most prominent disease manifestation, without upper or lower respiratory tract involvement or other major features of the disease. A supra-threshold olfaction test confirmed the hyposmia in all patients. The onset of hyposmia during a Covid-19 outbreak should be considered as a warning sign of an infection that requires a diagnostic test for Covid-19

BACKGROUNDMenieres Disease (MD) is a debilitating disorder with episodic and variable ear symptoms. Diagnosis can be challenging and there is no current consensus regarding monitoring of disease progression. A psychometric instrument may aid the assessment of subjective hearing impairment and the associated burden in daily life over the course of the disease. However, evidence in this regard is lacking. OBJECTIVETo evaluate a German-language short form of the Speech, Spatial and Qualities of Hearing Scale (SSQ) for hearing-related disability in MD. METHODSData was collected from a multicenter prospective patient registry for long-term follow up of MD patients. Hearing was assessed by pure tone and speech audiometry. The applied version of the SSQ contained 17 items. RESULTS97 consecutive patients with unilateral MD had a mean age of 56.2 {+/-} 5.0 years. 55 individuals (57.3%) were female, 72 (75.0%) were categorized as definite MD. Average total score of the SSQ was 6.0 {+/-} 2.1. Cronbachs alpha for internal consistency was 0.960 for the total score. We did not observe undue floor or ceiling effects. SSQ values showed a negative correlation with hearing thresholds and a positive correlation with speech recognition scores. CONCLUSIONSThe short form of the SSQ provides insight into hearing-specific disability in patients with MD. Thereby, it may be informative regarding disease stage and rehabilitation needs.

There is a relationship between smell and taste disturbances and coronavirus infection. These symptoms have been considered the best predictor of coronavirus infection, for this reason, it was decided to evaluate the predictive value of the smell and taste test and its association with the results of SARS-CoV-2 PCR-RT and rapid diagnostic tests. in the diagnosis of pathology. Methodology: 248 patients divided into 3 groups: asymptomatic, symptomatic without chemosensory disorders, and chemosensory disorders alone. All of them underwent SARS-CoV-2 PCR-RT, a rapid diagnostic test and a test of Venezuelan smell and basic taste at the beginning. Weekly follow-up with smell and taste test and SARS-CoV-2 PCR-RT until recovery. Results: 20.56% of patients had smell and taste disorders to a variable degree and were positive by SARS-CoV-PCR-RT. 2.15.3% of patients with chemosensory disorders were negative for COVID-19. The positive predictive value of the smell and taste test was 57.3; Sensitivity 41.13% and specificity 69.35%. There were no statistically significant differences by age, sex and chemosensory disorders. The predominant chemosensory disorder was the combination of mild hyposmia and hypogeusia and appeared in the company of other symptoms. Recovery occurred in an average of 8.5 days, asynchronously with the SARS-CoV-2 RT-PCR negativization, which occurred up to more than 15 days after the senses recovered. Maximum time of negativization of the RT-PCR of 34 days. Conclusion: chemosensory disorders are a symptom and / or sign of coronavirus disease but cannot be considered as predictors of said disease in this population studied. The gold standard remains the SARS-CoV-2 PCR-RT test. Rapid diagnostic tests should be used for follow-up. Recommendations: it is necessary to expand the sample, include routine psychophysical smell and taste tests to screen cases and take race and virus mutations into consideration to explain behavior in certain populations.

INTRODUCTIONVestibular migraine is the main cause of episodic vertigo and the second most common cause of dizziness in adults. Treatment for vestibular migraine encompasses the prevention of crises and the control of acute symptoms. Flunarizine works by preventing the contraction of labyrinthine vessels and altering blood flow, thus preventing symptoms. Due to the high prevalence of the disease, its negative impacts on individual health and increased expenditure on public health, preventive pharmacological and non-pharmacological treatment must be implemented early. PURPOSETo evaluate the efficacy of Flunarizine as a preventive for migraine and vestibular crises compared to other preventive drugs. MATERIAL AND METHODSScientific articles were searched in the databases using the terms (vestibular migraine OR migrainous vertigo) AND (flunarizine) AND (prophylaxis). Subsequently, a systematic literature review and meta-analysis was performed, including 3 randomized clinical trials comparing flunarizine and other preventive drugs in terms of efficacy and safety for preventing migraine vertigo attacks. The studies were analyzed using a ROB table, analysis using the GRADE method and meta-analysis. RESULTSQualitatively, the analysis showed that flunariniza was positive for decreasing the frequency of vertigo in cases of vestibular migraine, with a moderate degree of evidence, a relative risk of 0.34 and a confidence interval of 0.15 to 0.76. CONCLUSIONSThere are few studies available in the scientific literature on the use of flunarizine in vestibular migraine, many of which are heterogeneous among themselves, mainly in the way of evaluating and monitoring patients, carried out mainly through subjective methods. The meta-analysis showed a positive result for flunarizine as a preventive drug for the studied population. Furthermore, in all the studies analyzed, no serious side effects resulting from the use of the medication were reported, which makes it safe for patients to use. Flunarizine is a good drug for the prevention of vestibular migraine, especially in reducing the number of attacks, with a good level of evidence.

BackgroundVestibular schwannoma (VS) often results in persistent dizziness that negatively impacts quality of life (QoL). While physical effects are well-documented, the influence of psychological factors on dizziness severity is less studied. This study investigates how psychological characteristics affect dizziness in VS patients. MethodsIn this cross-sectional study, 93 VS patients were analyzed, with 77 (82.8%) reporting postoperative dizziness. Psychological factors, including premorbid disorders, personality traits, somatization, and current depression and anxiety levels, were assessed using self-report questionnaires. Correlations between these factors and dizziness severity, measured by the Dizziness Handicap Inventory (DHI), were examined. ResultsPatients with postoperative dizziness had higher depression levels and a greater prevalence of preoperative dizziness compared to those without postoperative dizziness. Significant correlations were found between dizziness severity and psychological factors: conscientiousness (r = .30, p = .03), social support (r = .32, p = .03), and the HADS total score (r = .36, p = .01). Emotional aspects of dizziness (DHI-E) were correlated with somatization (r = .27, p = .04) and anxiety (r = .40, p = .01). Functional aspects (DHI-F) were linked to conscientiousness (r = .31, p = .03) and depression (r = .26, p = .06). ConclusionPsychological factors significantly impact dizziness severity in VS patients. Incorporating psychological assessments and interventions, such as cognitive-behavioral therapy and combined vestibular and psychological rehabilitation, may improve treatment outcomes and QoL. Further research is needed to assess the effectiveness of these approaches and their impact on the relationship between psychological factors and dizziness.

Objective: The COVID-19 pandemic markedly altered social activity patterns, healthcare utilization, and the epidemiology of infectious diseases. However, its long-term impact on emergency otolaryngologic conditions remains incompletely understood. This study investigated long-term trends in emergency otolaryngologic conditions before, during, and after the COVID-19 pandemic using comprehensive data from a large urban emergency clinic in Osaka, Japan. Methods: All new otolaryngologic outpatients who visited the Chuo Emergency Medical Clinic (CEMC) in Osaka City between 2019 and 2024were retrospectively analyzed. Annual trends in absolute numbers and relative proportions of emergency otolaryngologic conditions were examined by anatomical region and disease category, using 2019 as the pre-pandemic baseline. Results: A total of 99,324 new otolaryngologic outpatients were analyzed. Overall emergency visits declined sharply to approximately half of baseline in 2020, followed by a gradual but incomplete recovery toward pre-pandemic levels by 2024. Most anatomical categories declined to 45-61% of baseline in 2020 and exhibited gradual yet incomplete recovery through 2023; in stark contrast, laryngeal conditions diverged sharply, surging beyond pre-pandemic levels after 2022. Acute infectious otorhinolaryngologic diseases fell to 23-50% of baseline in 2020 and showed variable recovery (69-103%) by 2024. Notably, laryngitis exceeded the baseline, reaching 132% in 2023, whereas epiglottic edema exhibited only a transient increase approaching the baseline in 2021. Non-infectious emergency conditions generally showed only a marginal decrease in 2020 and remained relatively stable throughout the study period, except for sudden sensorineural hearing loss (SSNHL), which dropped sharply to 39% of the baseline in 2020 and remained persistently reduced through 2024. Traumatic emergencies declined variably to 53-81% of the baseline in 2020, followed by an incomplete recovery, reaching only 55-69% by 2024. Conclusion: Emergency otolaryngologic conditions demonstrated heterogeneous recovery trajectories following the COVID-19 pandemic. While most infectious and traumatic conditions gradually but incompletely normalized, laryngeal conditions showed a distinct post-pandemic surge, and SSNHL remained persistently suppressed. These findings reveal heterogeneous, condition-specific recovery trajectories that reflect both genuine shifts in community pathogen burden, true traumatic incidence, and persistent alterations in healthcare-seeking behaviors, insights essential for resource allocation during future public health emergencies.

BackgroundSmell and taste disorders are reported very frequently and at an early stage in the evolution of the infectious disease caused by the SARS-CoV-2. These symptoms could be sensitive and specific to establish the condition of the infection, and may suggest the flow of decisions as to further therapy. We asked whether smell and taste impairment are earlier and more sensitive symptoms than the RT-PCR molecular assays for SARS-CoV-2 detection. MethodologySubjects (N=275) with a probable COVID19 diagnosis were classified as follows: Symptomatic with chemosensory dysfunction, symptomatic without chemosensory dysfunction, and asymptomatic. Subjects received a general clinical and otorhinolaryngology examination. Evaluation of the chemosensory dysfunction was performed by means of the Venezuelan Olfactory Test and taste test. Nasal swabs and blood samples were analyzed by real-time polymerase chain reaction analysis (RT-PCR) and a rapid diagnostic test to detect the SARS-CoV-2 virus and antiviral antibodies, respectively. Patients had access to molecular tests and smell and taste evaluations every 3 to 5 days until they recovered. ResultsOut of 44 patients that were positive for RT-PCR SARS-CoV-2: 45.83% had smell and taste disorders and COVID19 symptoms, 23.61% did not have smell or taste disorders, but had COVID19 symptoms, and 30.55% were asymptomatic. Mild hyposmia and hypogeusia account for the most frequent chemosensory disorders accompanying common SARS-CoV-2 symptoms. Time to recover from the chemosensory dysfunction ranges from 3 to 14 days, up to a maximum of 5 weeks, while RT-PCR becomes negative after 21 days and up to 35 days in some cases. The Venezuelan Olfactory Test and taste test has a 61.68% positive predictive value, 45.83% sensitivity, and 68.7% specificity for SARS-CoV-2 infection. ConclusionsSmell and taste disorders are frequent symptoms of SARS-CoV-2 infection, but not a significant predictor of the disease, as compared to the molecular RT-PCR test.

ObjectiveObjective To study the age distribution characteristics of otitis media with effusion in children and provide a basis for the selection of the timing of tympanic membrane perforation repair in children. MethodsA total of 1915 children with otitis media with effusion who visited our hospital from 2017 to 2022 were collected and divided into 4 groups according to age, namely, infant group, preschool group, school-age group and adolescent group, to study the distribution characteristics of the age of onset of children with otitis media with effusion. ResultsThe peak age of children with otitis media with effusion in the preschool period of 4-6 years old was the peak age of children with otitis media with effusion. The number of visits for otitis media with effusion in children aged 7 years old showed an obvious decline "inflection point", and the number of visits for otitis media with effusion in adolescent children after the age of 13 years old tended to be stable. ConclusionThe incidence of otitis media with effusion in children decreased significantly after the age of 7, and the number of visits for otitis media with effusion in children aged 13 years was close to that of adults. This conclusion provides a theoretical basis for the timing of tympanic membrane perforation repair in children. Short summaryThis study aims to investigate the characteristics of otitis media with effusion otitis media with effusion (OME) in children, focusing on the peak periods for treatment and surgical intervention, the "inflection point" in treatment trends, and the overall changing trends in OME. The findings will provide a foundation for determining the appropriate timing for surgical intervention in pediatric OME cases.

ObjectiveOral care is effective for preventing pneumonia, but objective evaluation of its effect on swallowing is lacking. Oral assessment scores, such as the Oral Health Assessment Tool (OHAT), are used to evaluate the oral environment to monitor oral care. Methods: We investigated the relationship between OHAT score and swallowing function in 24 patients aged 64-97 years. ResultsThe OHAT score did not correlate with the video endoscopy (VE) or video fluorography (VF) scores. Furthermore, the OHAT score was not significantly different between the multiple and no or single pneumonia episode groups. The group with multiple episodes of pneumonia had lower VE and VF scores than that with no or a single episode of pneumonia (p < 0.01). ConclusionsOral assessment, VE, and VF scores are necessary to evaluate swallowing in patients with suspected dysphagia. In addition, recurrent pneumonia among patients with a good oral environment has multiple contributing factors, including subclinical aspiration, pharyngeal clearance, and delayed activation of the gag reflex.

Early identification and treatment of hearing impairments are essential for childrens development. International guidelines recommend a stepwise approach for conductive hearing screening in newborns. However, while the majority of countries around the world implemented universal newborn hearing screening, inconsistencies remain in terms of procedures and data management. In particular, Level 3 of the screening pathway--comprising diagnostic confirmation and therapeutic management--has received limited attention in the literature, despite its central role in determining program effectiveness and patient outcomes. This study investigates the clinical and organizational aspects of Level 3 within the neonatal hearing screening program of the Friuli-Venezia Giulia Region in Italy, analyzing data from 106 children enrolled between 2019 and 2023. The analysis considers the regional protocol, the roles of birthing centers, pediatricians, hospitals, and the Regional Center for Pediatric Hearing Loss Care, and subdivides Level 3 into four Phases (A-D) reflecting both organizational and diagnostic functions. By examining patient flow, false positives, loss to follow-up/documentation, and management practices, the study highlights how organizational factors--particularly the coordination between local and specialized facilities-- produce "cascade" outcomes directly affecting diagnostic timelines and treatment initiation. Findings provide critical insights into weaknesses of the current system and propose directions for improving program efficiency, accuracy, and overall quality of care.

Autoimmune inner ear disease (AIED) is a rare cause of sensorineural hearing loss, typically characterized by progressive bilateral hearing loss and vestibular symptoms. Diagnosing AIED is challenging due to the lack of specific biomarkers and its overlapping clinical features with other causes of hearing loss. This scoping review examines the recent advancements in the diagnostic approaches for AIED from 2020 to 2024, focusing on studies indexed in SCI, MEDLINE, and INSPEC. The review highlights progress in laboratory tests, imaging techniques, and genetic assessments, and discusses the implications of these advances in improving early diagnosis and treatment outcomes.

ImportanceVogt-Koyanagi-Harada disease (VKH) is a severe ocular disorder with multi-organ affection including the ear. Few studies have evaluated otolaryngologic manifestations. Current classification criteria of uveitis only includes tinnitus and disacusis. ObjectiveTo describe audiological and vestibular findings of VKH in Chile, and determine correlations with disease activity. DesignCross sectional study of Chilean patients with VKH. SettingPatients assessed between 2018 and 2021 with demographics, ophthalmologic, audiological and otolithic evaluations. ParticipantsSubjects accomplishing VKH diagnostic criteria of the International Nomenclature Committee in Uveitis recruited in a referral academic center in Santiago, Chile. Main Outcome and MeasuresPrimary outcome was the correlation between VKH activity and neurotologic symptoms. Demographics, symptoms and signs were assessed by structured survey and physical examination. Disability was assessed by DHI and HIIE-S. Neuro-otologic diagnostics tests were cVEMP, audiogram, suprathreshold click ABR, MLAEP, and DPOAE. Complete case correlation analysis was performed. Results54 patients were evaluated. 65% reported ear symptoms at disease presentation. 32% of ear symptoms started synchronically and 30% started before eye symptoms. Ear and vestibular symptoms produced predominantly mild disability. The history of nausea, falls or hyperacusis during presentation correlated with disease activity at study evaluation. Hyperacusis at evaluation correlated with active or chronic-recurrent VKH. Neurotologic tests revealed mild ear impairment and few correlations with eye disease. ConclusionsOtolaryngology features are frequent in VKH and may precede eye disease. Hyperacusis at evaluation may indicate current or persistent ocular disease. A broader spectrum of neurotologic symptoms must be considered in current classification of uveitis. Key PointsO_ST_ABSQuestionC_ST_ABSAre there characteristic findings in the hearing and otolithic function of patients with Vogt-Koyanagi-Harada disease (VKH), and do they correlate to the eye disease activity? FindingsIn a cross sectional study of 54 patients with VKH, a high frequency of neuro-otologic manifestations, and some associations to activity, chronicity and recurrence of VKH were found. Importantly, some of the ear symptoms may precede VKH diagnosis. MeaningVKH has neurotologic features that can aid diagnosis and staging of the disease. Thus, physicians must be aware of these manifestations.

BackgroundAuditory steady-state responses (ASSRs) provide an objective method for estimating hearing thresholds in individuals unable to provide behavioural responses. Bone conduction (BC) testing is required to differentiate conductive from sensorineural hearing loss. Accurate BC ASSR threshold estimation relies on "correction" factors, which are not yet well established. This meta-analysis evaluated the reliability of BC ASSR thresholds to estimate hearing thresholds at 500, 1000, 2000 and 4000 Hz. MethodsA systematic search of PubMed, the Cochrane Library, and Embase was conducted to identify studies involving normal-hearing (NH) and hearing-impaired (HI) participants of all ages. Outcomes were (1) the difference between ASSR behavioural and ASSR thresholds, and (2) ASSR thresholds. The risk of bias was evaluated using the Newcastle-Ottawa Scale. The mean and 95% confidence intervals (CI) were calculated for the thresholds at the four frequencies. The certainty of the evidence was assessed using GRADE approach. ResultsOf records identified, 11 records met the inclusion criteria, yielding a total of 27 studies. Sample sizes ranged from 60 to 249 participants across frequencies and age groups. The quality of records ranged from low to high. Data were synthesised using random-effects models due to heterogeneity. In NH adults, the mean differences ({+/-}95% CI) between BC ASSR thresholds and behavioural thresholds were 17.0 ({+/-}4.8), 15.5 ({+/-}6.0), 13.4 ({+/-}3.3), and 12.1 ({+/-}4.1) dB at 500, 1000, 2000, and 4000 Hz, respectively. In NH infants, mean ({+/-}95% CI) BC ASSR thresholds were 17.2 ({+/-}2.2), 10.5 ({+/-}3.6), 26.4 ({+/-}2.7), and 19.9 ({+/-}4.0) dB HL at the same frequencies. The certainty of the evidence was very low. ConclusionsBC ASSR can be a reliable method for estimating BC thresholds. However, age and frequency significantly impact BC ASSR thresholds, highlighting the need to develop of "correction" factors to accurately predict BC behavioural thresholds. RegistrationPROSPERO CRD42023422150.

ObjectiveAggregate published data on the imaging of pulsatile tinnitus as a step toward building a framework for an evidence-based approach to diagnostic imaging for this symptom. Materials & MethodsA systematic review was performed. PUBMED and EMBASE were searched on December 1, 2021 for English-language articles on diagnostic imaging of pulsatile tinnitus. Articles that involved non-standard imaging techniques and those that focused on management of pulsatile tinnitus were excluded. Extracted data included: number of males and females; signs, symptoms, and physical examination findings with associated patient counts; imaging findings; count of patients with imaging-identified cause of pulsatile tinnitus; reported associated interventions and outcomes. Results41 articles were included with a total of 2,633 reported patients. 10 studies were prospective. MRA appears to be capable of identifying many of the same pathologies traditionally diagnosed with DSA. Few head-to-head comparisons were performed. In head-to-head comparisons of MRI and MRA, MRA was often able to identify more pathology. There was no clear relationship identified between specific symptoms and the imaging modality chosen, indicating that the imaging evaluation of pulsatile tinnitus is likely sensitive to the preferences of the evaluating provider. ConclusionThere is limited evidence to inform best practices for the initial imaging evaluation of pulsatile tinnitus and preference-sensitive provider decisions will continue to guide the pulsatile tinnitus workup. We encourage prospective studies with multimodality imaging comparisons to build evidence that would support the development of more effective, efficient, and equitable protocols and pathways for the imaging evaluation of pulsatile tinnitus. Clinical Relevance StatementEvidence is not available in support of any single optimal imaging evaluation of pulsatile tinnitus, but prudent imaging will include evaluation for life-threatening causes such as dural arteriovenous fistula and arteriovenous malformation. Key Points- Many imaging findings associated with pulsatile tinnitus may not be causal. - Current evidence is insufficient to indicate the optimal imaging evaluation. - Local preference-based imaging algorithms are reasonable in the absence of new high-level evidence.

Aim of studyThe present study aimed to evaluate anti-inflammatory and immunomodulating properties of BNO 1030 (Tonsilgon(R) N) and its direct effect on the indicators of the local immunity of oropharyngeal mucosa in patients with acute tonsillopharyngitis (TP) or exacerbation of chronic TP without evident systemic inflammatory syndrome. Materials and methodsA total of 60 adult patients with acute TP or exacerbation of chronic TP without severe systemic inflammatory syndrome were randomly divided into 2 groups: Group 1 L 30 patients took BNO 1030 (Tonsilgon(R) N), Group 2 L 30 patients took sage tablets according to the summary of product characteristics during 7 days. During 3 visits (day 1, day 3, day 7) symptoms and oropharyngeal mucosa condition were evaluated using a 10-point visual analogue scale (VAS). Local immunity parameters of oropharyngeal mucosa (cytokines: IL-1{beta}, IL-6, IL-8, IL-10, IL-17, TNF-, and lysozyme, lactoferrin, sIgA) were determined by ELISA and by real time polymerase chain reaction. ResultsReduction of the main symptoms was significantly faster under BNO 1030 therapy than under sage therapy. In BNO 1030 group reduction of clinical symptoms correlated with the onset of action and the local immunological parameters. During BNO 1030 treatment IL-1{beta}, IL-6, and IL-8 mRNA levels decreased below the levels in healthy controls, while, the immune factors lysozyme, lactoferrin and sIgA increased. Therapy with sage tablets did not affect local immunity parameters. ConclusionBoth treatment regimens resulted in elimination of clinical signs and mucosal pharyngeal barrier regeneration. In contrast to the sage tablets, BNO 1030 can also affect local mucosal immunity via regulating the balance of pro- and anti-inflammatory factors. Study highlightsO_LIThis study can answer the question regarding influence on main local immunity parameters of subjects with tonsillitis C_LIO_LIThe one of main task of this study is to evaluate what local immune parameters of oral cavity are most changeable C_LIO_LITonsilgon N usage is not decrease main local immunity parameters such as IL-1{beta}, IL-8, lysozyme and lactoferrin C_LIO_LIThis study evaluated the functional condition of mucosal immunity of oral cavity in subjects with tonsillopharingitis C_LI

BackgroundThis study aimed to analyze the systemic-immune inflammation index (SII)s diagnostic performance in diagnosing acute appendicitis (AA) and discriminating between complicated acute appendicitis (CAA) and non-complicated acute appendicitis (NCAA). MethodsThis review was registered in PROSPERO (CRD42024587430). We included prospective or retrospective original clinical studies evaluating the diagnostic performance of SII in AA. A search was conducted in PubMed, Web of Science, Scopus, and OVID. Search terms and keywords were: (appendicitis OR appendectomy) AND (systemic-immune inflammation index OR SII). Two independent reviewers selected the articles and extracted relevant data. Methodological quality was assessed using the QUADAS2 index. A synthesis of the results, standardization of the metrics, four random-effect meta-analyses, and two Diagnostic Test Accuracy (DTA) meta-analyses were performed. ResultsThirteen studies with data from 9083 participants, including 5255 patients with a confirmed diagnosis of AA and 3828 controls (CG), were included in this review. The random-effect meta-analysis of SII (AA vs. CG) included ten articles (3733 AA and 3510 controls) and resulted in a significant mean difference [95% CI] of 1072.46 [750.55,1394.37] (p<0.001). The random-effect meta-analysis of SII (CAA vs. NCAA) included nine articles (1116 CAA and 2984 NCAA) and resulted in a significant mean difference [95% CI] of 1294.2 [731.54,1856.86] (p<0.001). Subgroup meta-analysis for studies conducted in pediatric-only populations maintained statistical significance. The DTA meta-analysis (AA vs. CG) yielded a pooled sensitivity and specificity [95% CI] of 81.8 [75.2,86.9] % and 79.9 [68.2,88.1] %. The DTA meta-analysis (NCAA vs. CAA) resulted in a pooled sensitivity and specificity [95% CI] of 72.5 [49.6,87.6] % and 82.5 [65.1,92.2] %. ConclusionsSII emerges as a robust tool for diagnosing AA and differentiating between NCAA and CAA. The retrospective nature of most of the included studies and their limited geographical distribution warrant further prospective multicenter studies to validate these findings. FundingNone RegistrationPROSPERO (CRD42024587430).

IntroductionThe COVID 19 pandemic was highlighted by a rise in hospital admissions secondary to respiratory decompensation. This was accompanied by an increase in ICU admissions, endotracheal intubation and mechanical ventilation. As a consequence, tracheostomies became essential in preventing complications of prolonged intubation and to facilitate weaning from sedation and mechanical ventilation. With the lack of international consensus on tracheostomy technique and optimal timing, we present our experience with 377 percutaneous tracheostomies performed on critically ill COVID 19 patients. ObjectiveTo report the outcomes of critically ill patients with COVID-19 who underwent percutaneous tracheostomy during a period of 24 months. MethodsA retrospective single-center electronic chart review was performed on all ICU patients who underwent percutaneous tracheostomy after respiratory failure secondary to COVID-19 between March 2020 to March 2022. ResultsA total of 377 percutaneous tracheostomies were performed. The mean duration between intubation and percutaneous tracheostomy was 17.4 days (3-61). The study included 222 males (59%) and 155 females (41%). The mean age of patients was 56.2 years (17-94), with a mean BMI was 31.3 (14-68). The commonest comorbidities among patients were diabetes mellitus (50%) and hypertension (48%). Complications were encountered in 85 cases (23%), with the commonest overall complication being minor bleeding. 203 patients (54%) were weaned from sedation. The mean duration between tracheostomy and weaning from sedation was 7.5 days (1 - 47 days). 156 patients (41%) were weaned from MV. The mean duration between tracheostomy and weaning from MV was 12.9 days (1 - 58 days). There was a total of 236 (63%) deaths reported during the period of this study. No deaths were attributable to the surgical procedure. ConclusionPercutaneous tracheostomy can be safely performed in patients with COVID-19. With lack of conclusive objective data regarding the optimal timing for tracheostomy, we recommend that tracheostomy be performed as soon as possible after the 7th day endotracheal intubation.

IntroductionThe effectiveness of tinnitus treatment represents a huge gap in the medical science. Acamprosate is a glutamatergic antagonist drug and GABA-agonist that could be used to control tinnitus due to its action on peripheral and central neurotransmission. PurposeTo assess the effectiveness of acamprosate in the treatment of tinnitus. Material and MethodsThis is a systematic review and we searched for randomized clinical trials linking acamprosate to tinnitus in six databases: Cochrane - Central Register of Controlled Trials - CENTRAL (2021), PUBMED (1966-2021), EMBASE (1974-2021), IBECS (1982-2021), QINSIGHT (2021) and SCOPUS (2021). Two researchers independently extracted the data and assessed the quality of the studies. ResultsTwo trials involving 121 patients were included. The methodological quality of these studies was low. Both studies evaluated as primary outcome the efficacy of acamprosate in improving tinnitus. The meta-analysis by random model resulted in no significant difference between the groups treated with acamprosate and placebo (RR = 3,69, 95% CI 0,87-15,62; p=0,08), considering tinnitus improvement. Conclusions: There is no evidence that acamprosate is effective for tinnitus treatment. We recommend new trials using rigorous methodology. Randomization and blinding should be of the highest quality, given the subjective nature of tinnitus and the strong likelihood of a placebo response. The CONSORT statement should be used in the design and reporting of future studies.

An increasing number of studies highlight the role of saccadic remodulation in compensatory mechanisms following vestibular injury, and the reappearance of SHIMP saccades correlates with symptom improvement measured by the Dizziness Handicap Inventory (DHI). To investigate the influence of attentional processes and working memory on visuo-vestibular interaction, three independent but interrelated experiments were conducted. In the first two experiments, healthy subjects and patients with unilateral or bilateral vestibular deficits underwent vHIT in SHIMP mode and the Functional Head Impulse Test (fHIT), performed first separately and subsequently simultaneously. Mean latency and clustering of SHIMP saccades, together with Landolt C recognition rates, were analyzed. Differences between separate and combined protocols were assessed, and, in patients, correlated with symptom severity measured by the DHI, to determine whether the near-simultaneous execution of tasks mediated by shared parietal cortical substrates influenced performance. In the third experiment, vHIT in HIMP mode and fHIT were performed using separate and combined protocols to evaluate whether recognition-related cognitive load affected recovery saccade latency and clustering. Results suggest that visual recognition modulates visuo-vestibular interaction, supporting integrated dual-task protocols for ecological balance assessment and helping explain clinical discrepancies.

IntroductionAllergic rhinitis is a condition of high prevalence in the population and widely studied, with several treatments being consecrated for its control. Spirulina is a dietary supplement that modulates immune function, and has been shown to modulate the inflammatory response of allergic rhinitis. PurposeTo evaluate spirulina in the treatment and control of allergic rhinitis. Material and MethodsThis is a systematic review of randomized clinical trials. Searches were performed for randomized clinical trials relating spirulina to allergic rhinitis in five electronic databases: Cochrane - Central Register of Controlled Trials - CENTRAL (2021), PUBMED (1966-2021), EMBASE (1974-2021), LILACS (1982-2021) AND SCOPUS (2021). Two investigators independently extracted data and assessed trial quality. ResultsTwo clinical trials involving a total of 215 patients were included. Both studies assessed the efficacy of spirulina in improving allergic rhinitis as the primary outcome. The first study described a significant reduction in runny nose, nasal congestion and itching over time of medication use (p<0.001) and in the second study the prevalence of rhinorrhea (P = 0.021), nasal congestion or obstruction (P = 0.039) and decreased smell (P = 0.030) were significantly less in the experimental group than in the control group. ConclusionsThe included studies were in favor of the use of spirrulina. However, the level of evidence is very low and limited. We should have caution due to the small number of clinical trials and participants in these studies. It is recommended to carry out new RCTs following the CONSORT standardization.