António Miguéis

Background/Objectives: Age-related hearing loss (ARHL) is highly prevalent among older adults and has been linked to cognitive decline. However, the specific cognitive domains most vulnerable to ARHL and whether these associations exhibit lateralized effects remain unclear, which is critical for understanding and mitigating its broader impact on neurocognitive function. This study aimed to characterize the clinical profile of ARHL and examine associations between hearing thresholds and cognitive performance across domains, including the influence of educational attainment as a proxy for cognitive reserve. Methods: Audiometric assessments and cognitive screening using the Mini-Mental State Examination were conducted in older adults, including normal-hearing listeners (NHL, n = 31, mean age 71.4) and those with hearing loss (HL, n = 46, mean age 73.1). Associations between pure-tone averages, clinical complaints, and cognitive domains were analyzed while considering educational attainment. Results: HL participants exhibited a higher prevalence of tinnitus (NHL: 33.3% vs. HL: 65.2%) and slightly more frequent dizziness compared to their normal-hearing peers. Cognitive assessment revealed that decreased cognitive performance was strongly associated with hearing loss (p < 0.05), and this association was influenced by low educational level. Orientation was the most affected domain (p < 0.01), while recall and language were also significantly associated with low- and high-frequency pure-tone averages, respectively. Conclusions: These findings reinforce the relationship between ARHL and cognitive decline, suggesting an attentional basis whereby higher listening effort to decode the degraded auditory input may affect cognitive performance. The results also highlight the influence of educational attainment as a moderating factor.

Introduction and Objectives: Complications of acute rhinosinusitis (ARS) are more common in children and are divided, in decreasing order of frequency, into orbital, intracranial, and bony. The aim is to analyze the impact of SARS-CoV-2 on complicated ARS at a tertiary children’s hospital. Methods: A retrospective, observational study of a five-year period, categorized based on the SARS-CoV-2 pandemic into pre-COVID-19 (2018/2019), COVID-19 (2020/2021), and post-COVID-19 (2022). We included patients up to 18 years of age, who were admitted to the otorhinolaryngology (ENT) ward with ARS. Socio-demographic and clinical data were collected and analyzed. Results: Thirty-four children were admitted to our hospital with ARS. The incidence decreased during the COVID-19 period (N = 5) and increased in the post-COVID-19 period (N = 12). The mean Lund-Mackay score was 12.9, with no significant difference between periods. The rate of complications was 73.5% for orbital, 8.8% for intracranial, and 8.8% for bone complications. Orbital complications were more frequent in younger patients, while intracranial complications occurred more often in older children (p < 0.05). There were no intracranial complications in the pre-COVID-19 period and 66.7% of these occurred in the COVID-19 period. The leukocyte count and C-reactive protein (CRP) levels were higher in the nine patients requiring surgical treatment (p < 0.013 and p < 0.014), with the majority (55.6%) occurring in the post-COVID-19 period. Discussion: Consistent with other studies, we report an increase in severe infections since the COVID-19 pandemic. This increase could be related to the immunological impact of the social distancing measures implemented during the various lockdowns in our country throughout the first year of the SARS-CoV-2 pandemic.

Background: Hypoparathyroidism is a worrying complication following thyroid surgery. Early recognition of patients at risk of developing postoperative hypoparathyroidism is of utmost importance in thyroid surgery. This study aimed to determine the risk factors that influence the preservation of parathyroid gland (PTG) vascular supply and their function after thyroidectomy and evaluate the value of indocyanine green fluorescence angiography (ICG-FA) in the prediction of the occurrence of postoperative hypoparathyroidism. Methods: A prospective observational study was conducted on 87 patients undergoing total thyroidectomy. PTG vascularization was assessed using intraoperative ICG-FA. Demographic, histopathological and intraoperative data and biochemical values were collected. Two scores were proposed to access the accuracy of ICG-FA to predict postoperative hypoparathyroidism: total fluorescence score (sum of the scores of all recognized PTG during surgery) and mean fluorescence score (mean of the fluorescence scores of the recognized PTG). Biochemical hypoparathyroidism was defined as values of parathormone (PTH) Results: There were 14 cases (16.1%) of postoperative hypoparathyroidism, all temporary. Demographic data, histopathological variables, preoperative biochemical values and number of recognized and autotransplanted PTGs didn’t differ between patients with and without postoperative hypoparathyroidism. The PTG remaining in situ (PGRIS) score was significantly different (P=0.03). It was established a correlation between the location of the PTGs regarding the thyroid lobe and the intensity of ICG fluorescence after thyroid resection, especially in the inferior PTGs (PConclusions: The location of PTG regarding the thyroid lobe significantly affects the preservation of their vascularization and thus their function after total thyroidectomy. The ICG fluorescence-based scores proposed in this study are a helpful tool to predict postoperative hypoparathyroidism, especially the mean fluorescence score, that does not depend on the number of recognized PTG. The mean fluorescence score may take part of the management of patients after thyroidectomy by guiding the need to use calcium supplementation and time of hospital discharge.

Purpose The aim of this work was to study the vascularization of parathyroid glands (PTG) and determine the features that may influence its preservation. Based on those findings we propose surgical strategies to preserve the parathyroid vascular supply in thyroid surgery. Methods A study of the vascular supply of 110 PTG was performed in 30 cadaver specimens. The thyroid arteries were cannulated and injected with an isoprene polymer. Data collection included: number and location of PTG and information about their vascular supply: origin, number of arteries, length, course, relation with recurrent laryngeal nerve (RLN) and thyroid lobe. There were determined the most variable features and the most consistent features about PTG arteries. Results The vascular supply of PTG was provided by a terminal artery. The PTG’s hilum was related to the thyroid surface. The PTG received 1 vessel in most cases, with no significant difference between the superior and inferior PTG (P = 0.111). The superior PTG received a vessel from the posterior branch of inferior thyroid artery (ITA) in 49 cases (87.5%) and the inferior PTG received a vessel from the anterior branch of ITA in all 54 cases (100%). The length of the arteries was on average 7 mm and the arteries to inferior PTG were smaller (P = 0.004). The artery to superior PTG described a cranial course in 40 cases (71.4%) and the artery to the inferior PTG described a caudal course in 31 cases (57.4%) (P < 0.001). The parathyroid arteries were located anterior to the RLN in most cases. The arteries to superior PTG were all posterior to the thyroid lobe and the arteries for inferior PTG were posterior to the thyroid lobe in 48 cases (88.9%) and course through the thyroid parenchyma in 6 cases (11,1%). All PTG arteries were located lateral to the attachment of the pretracheal layer of the deep cervical fascia to the trachea. Conclusions The origin, number, course and length of the parathyroid arteries are variable, which influence its preservation. There are some consistent features that can guide thyroidectomy. The PTG should be retracted from medial-to-lateral direction from the thyroid surface to protect their hilum. The PTG located anterior to the thyroid lobe may need to be re-implanted, once their artery crosses thyroid parenchyma. The area posterior to the thyroid lobe, anterior to the recurrent laryngeal nerve and lateral to the pretracheal layer of the deep cervical fascia should be spared from dissection and vessel ligation, once is the main territory for PTG arteries.

We report the case of a 44-year-old female patient undergoing immunosuppression due to a liver transplant. Four months after the transplant, she developed headaches refractory to treatment, with no pathological findings on the cranial magnetic resonance imaging (MRI) performed. Over the course of seven months, she continued to experience refractory headaches despite different therapeutic regimens for migraines. Gradually, she developed diplopia and decreased visual acuity, prompting a repeat imaging study. The new cranial MRI revealed cavernous sinus thrombosis, raising suspicion of invasive fungal sphenoidal sinusitis. The patient underwent medical treatment ( amphotericin B followed by voriconazole, for a total of 12 weeks) and surgical intervention (endoscopic sphenoidotomy with debridement of the fungal lesion). The day after the surgical procedure, the patient reported immediate relief from headaches. After two years of follow-up, despite ophthalmologic sequelae (limited abduction of the left ocular globe), there was a complete resolution of the headaches.

Inverted papilloma is a histologically benign tumor. Nonetheless, it has a high rate of recurrence, local aggressiveness, and the potential for malignant transformation, especially into squamous cell carcinoma. Location in the sphenoid sinus is associated with a higher recurrence rate and complications due to the adjacent vital structures. We report a patient with symptoms of bilateral nasal obstruction, bloody nasal secretions, and occipital headache over several years. The computed tomography and magnetic resonance imaging of the paranasal sinuses suggested the hypothesis of an inverted papilloma of the sphenoid sinus. The patient was referred for endoscopic excisional biopsy for histologic diagnosis and treatment. The lesion was completely excised without complications. Histopathologic analysis confirmed the hypothesis of inverted papilloma. The patient has had no recurrence up to date. The aim of this report is to emphasize that rare diagnoses should be considered. Early treatment makes surgery easier and may prevent complications.