Richard Louis Voegels

The sense of smell plays an essential role in well-being, influencing relationships, the formation of emotional memories, and protection against toxic substances in food and the environment. Post-traumatic olfactory loss is among the leading causes of olfactory alterations, especially in contact sports like Mixed Martial Arts (MMA), which involve frequent physical trauma, particularly to the head. To date, the relationship between olfactory dysfunction and head trauma in fighters remains underexplored.To evaluate possible olfactory, gustatory, and cognitive dysfunctions in MMA fighters. Methods: Fourteen MMA fighters and 14 control participants, matched for sex and age, were recruited. The participants underwent tests to evaluate olfaction (Visual Analog Scale (VAS) and the University of Pennsylvania Smell Identification Test (UPSIT), taste (Modified Global Gustatory Test), cognition (Montreal Cognitive Assessment, MoCA) and quality of life (The 36-Item Short Form Health Survey questionnaire, SF-36).A statistically significant difference was found in olfactory function between the groups (p = 0.021), with fighters having a lower mean score than the control group (fighters: 28.5 ± 4.4 vs. controls: 31.8 ± 2.4). Additionally, MMA fighters showed cognitive decline and impairment in quality of life aspects. No difference was observed in gustatory function between the groups (p = 0.508).The results indicate that MMA fighters exhibit impairments in olfactory function, as well as in cognition and quality of life. Further studies with larger sample sizes are needed for a more in-depth analysis of the impact of this sport on athletes' lives.

The University of Pennsylvania Smell Identification Test (UPSIT^®) is a reliable olfactory test that is easy and quick to apply. It is a one-time use test and its reuse is not recommended by the manufacturer. Because in high-demand healthcare facilities testing all patients with UPSIT^® can be costly, in this present study we sought to assess the feasibility of reusing the UPSIT. Two hundred and ninety healthy volunteers aged 18 and 40 without olfactory complaints participated in the study. Two hundred and forty volunteers underwent the UPSIT^® scratching the small strip of the test doing only 2 Z-shaped scratches (“2 Zs” protocol); each UPSIT^® was used 20 times by same-sex participants. The remaining fifty patients performed the UPSIT^® in the standard single-use fashion. Adjusted multiple regressions relating to the olfactory test score, number of times the test was applied, and demographic variables were performed. The mean scores using the UPSIT^® repeatedly were lower than those done in the single-use standard fashion. Despite this, the scores remained stable until the tenth time the test was applied. When patients perform the UPSIT^® in the “2 Zs” protocol, a correction factor of more 3 points was required in the final score. UPSIT^® reuse up to 10 times is feasible when a 3-point correction factor is added to the final score. The “2 Zs” protocol described is an alternative to reduce costs in epidemiological studies. This study, however, is limited as it was carried out only with healthy individuals. Received: 13 June 2024 Accepted: 24 May 2025 Article published online: 26 September 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua Rego Freitas, 175, loja 1, República, São Paulo, SP, CEP 01220-010, Brazil

Highlights ■ The use of a pedicled palatal flap via the soft palate offers the advantage of low harvesting complexity. ■ The flap demonstrates highly positive metric data supporting its technical feasibility for reconstructing the skull base and adjacent regions. ■ Drilling is not necessary to enlarge the greater palatine foramen in this technique, which reduces the chances of injury to the vascular pedicle and surgical time. ABSTRACT Objective: Given the importance of vascularized flaps, this study presents a new

Introduction The coronavirus disease 2019 (COVID-19) pandemic has prompted a transformation in medical practice, including the adoption of telemedicine in Brazil and globally. Otorhinolaryngology, a field at high risk of viral transmission, has witnessed an increasing use of telemedicine tools. However, the extent and challenges of telemedicine in this field in Brazil are not well understood. In the present study, we applied a questionnaire to Brazilian otorhinolaryngologists during the pandemic to assess telemedicine's advantages and challenges, shedding light on its integration and persistent issues in the field. Objective To assess the usage profile of telemedicine in the clinical practice of otolaryngology in Brazil. Methods The present was a cross-sectional observational study with convenience sampling. It was conducted as a web-based questionnaire distributed and advertised to Brazilian otorhinolaryngologists through social media posts on WhatsApp (Meta Platforms, Inc., Menlo Park, CA, USA), Instagram (Meta Platforms, Inc.), Facebook (Meta Platforms, Inc.), as well as direct messaging and email. Results The sample size was 186 participants. A total of 69% of them had already provided or were currently providing telemedicine services, and 34% considered it a frequent or very frequent form of work at the time of data collection. In total, 90% of the respondents considered the lack of physical examination a problem in otolaryngological teleconsultations, while 64% reported frequently or very frequently resolving patient problems through teleconsultations. Conclusion Telemedicine emerged in the context of the COVID-19 pandemic as a promising tool for remote patient care. More studies are needed to elucidate its role in the context of limited physical examination.

Introduction The nonspecific hyperreactivity of rhinitis has been attributed to neurotrophins activating sensory nerves and inflammatory cells. The relationship between these markers and the intensity of the symptoms is not well established and few studies have evaluated individuals with idiopathic rhinitis. Objective The present study aims to evaluate whether perivascular innervation and nerve growth factor (NGF) are related to the intensity of the clinical conditions in allergic rhinitis (AR) and idiopathic rhinitis (IR). Methods A total of 15 patients with AR and 15 patients with IR with the indication for inferior turbinectomy (associated or not with septoplasty) were selected. The patients received a score according to their signs and symptoms. After the surgery, we quantified eosinophils, mast cells, NGF, and nerve fibers in the nasal turbinate. Results The score of the signs and symptoms was higher in the AR group. Nerve growth factor was found in the cytoplasm of inflammatory cells in the submucosa in greater quantity in the AR group. The nerve fibers were distributed throughout the tissue, mainly in the subepithelial, glandular, and vascular regions, and there was no difference between the groups. Greater perivascular innervation was associated with a higher signs and symptoms score. Conclusions We concluded that these findings suggest that the NGF produced by submucosal inflammatory cells stimulates increased perivascular innervation in rhinitis, thus directly reflecting in more intense clinical conditions, especially in AR.

Introduction The advent of the endoscope has enabled the use of the endonasal approach for a variety of diseases. Studying the ethmoidal canals is important for surgeries of the paranasal sinuses and the anterior base of the skull. Objective To investigate the ethmoidal canals and evaluate their structure, the presence of vessels and nerves, their location, and to perform an anatomopathological study of their contents. Methods We evaluated 20 cadavers (20 left and 20 right nasal cavities) through endoscopic dissection of the anterior base of the skull and exposure of the medial periorbita and dura mater; then, the ethmoidal canals were located and measured in relation to the anterior wall of the sphenoid sinus and between the ethmoidal canals, followed by removal of their content for histological analysis. Results Vessels were present in 75% of the left anterior ethmoidal canals, 70% of the left posterior ethmoidal canals, 75% of the left middle ethmoidal canals, 85% of the right anterior ethmoid canals, and 64.5% of the right posterior ethmoid canals; 50% of the right middle ethmoidal canals contained one vessel. Conclusion The ethmoidal canal does not necessarily contain an ethmoidal artery. Studies with a larger sample should be performed to quantify the correct proportion of arteries and ethmoidal canals.

Introduction Primary ciliary dyskinesia (PCD) is a rare inherited disease associated with impairment of mucociliary transport and, consequently, with a high incidence of chronic rhinosinusitis. For patients with chronic rhinosinusitis who remain symptomatic despite medical treatment, endoscopic sinus surgery is a safe and effective therapeutic option. However, to date, no studies have been found evaluating the effect of surgery on the quality of life associated with the effect on olfaction and nasal endoscopy findings of patients with primary ciliary dyskinesia and chronic rhinosinusitis. Objective To describe the effect of endoscopic sinus surgery on the quality of life, on olfaction, and on nasal endoscopy findings of adults with PCD and chronic rhinosinusitis. Methods Four patients who underwent endoscopic sinus surgery were included. The Sinonasal Outcome Test-22 (SNOT-22) score, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and the Lund-Kennedy score were collected preoperatively and at 3 and 6 months postoperatively. The olfaction as assessed with the University of Pennsylvania Smell Identification Test (UPSIT), which was administered preoperatively and 3 months postoperatively. Results A total of 4 patients with a mean age of 39.3 years old (3 men and 1 woman) completed the study. All patients showed clinically significant improvement in the SNOT-22, NOSE, and Lund-Kennedy scores at 3 months postoperatively, and this improvement was sustained throughout the follow-up period. However, olfaction did not improve after surgery. Conclusion The endoscopic sinus surgery treatment of chronic rhinosinusitis in adults with PCD was associated with improvement in quality of life and endoscopic findings. However, no improvement in olfaction was demonstrated. Studies with a larger number of patients and control groups should help confirm these findings.

Previous studies demonstrated the difficulty of patients with Head and Neck Cancer (HNC) in sensing food taste, a function in which olfaction has a significant role. However, neither study employed... 背景：先前的研究证明了头颈癌(HNC) 患者在感知食物味道方面的困难, 嗅觉在这一功能上起着重要作用。 然而, 这些研究还没有采用心理物理测试或控制组来确定此类主诉的真实性。目的：在这项研究中, 我们定量测试了 HNC 患者的嗅觉功能, 并将其与健康对照组进行了比较。方法：使用宾夕法尼亚大学气味识别测试 (UPSIT) 对 31 名 HNC 初治患者和 31 名对照组进行了性别、年龄、教育和...