Marcela Mafra

Objective: To evaluate hearing outcomes in postneonatal treatment of congenital cytomegalovirus (cCMV) infection and assess the effect of treatment initiated after the first month of life. Data Sources: PubMed, Embase, Web of Science, and Cochrane Library were systematically searched. Review Methods: Articles reporting antiviral treatment of cCMV, with Ganciclovir (GCV) or Valganciclovir (VGCV) in the postneonatal period were included. Outcomes of interest included viral load (urine and plasma), neutropenia, and hearing outcomes (return to normal hearing, improvement, deterioration, and no change). Mean difference (MD) was used for continuous outcomes and proportions for binary endpoints, with 95% confidence intervals (CI). Results: Eight studies with 192 patients met inclusion criteria. Oral VGCV was associated with a reduction in viral load during the first 2 months. At 2 months, pooled MD for urine viral load was −3.67 (95% CI −4.33 to −3.02, I ² = 75.4%), and for plasma was −0.80 (95% CI −1.08 to −0.52, I ² = 31.6%). Among patients with hearing loss, normalization occurred in 42.29% (95% CI 13.48 to 77.51, I ² = 84.3%) and improvement in 38.48% (95% CI 16.77 to 66.00, I ² = 88.2%) of total ears. Hearing deterioration was uncommon, affecting 5.47% of total ears (95% CI 2.15 to 13.25, I ² = 60.9%). Neutropenia was infrequent, with 9.09% experiencing grade 1–2 and 3.67% grade 3–4. Conclusion: Postneonatal antiviral treatment for cCMV may reduce viral load and improve hearing in a substantial proportion of patients, with low rates of adverse events. However, long‐term outcomes remain unclear, and larger prospective studies are needed to confirm efficacy. Level of Evidence: N/A.

Objectives: Severe recurrent acute tonsillitis (RAT) is commonly treated by removing the palatine tonsils, namely tonsillectomy (TE). Laser TE has been suggested as an alternative to cold steel dissection, although its efficacy and safety for the surgical treatment of RAT remain unclear. Therefore, we conducted a systematic review and meta‐analysis comparing laser TE to cold steel dissection TE in patients with RAT.Methods: We systematically searched PubMed, Embase, and Cochrane Central for eligible studies. Outcomes of interest were intraoperative blood loss, operation time, quality of life, postoperative pain, and postoperative hemorrhage. Subgroup and sensitivity analyses were performed. RStudio v4.1.0 and Review Manager v5.4 were used for statistical analysis. A prospective protocol was registered in PROSPERO (CRD42024533742).Results: Nine studies, including six randomized trials, met eligibility criteria, comprising 612 patients with RAT. In total, 1224 tonsils were excised; 612 (50%) were submitted to laser TE, and the remaining to cold steel dissection. Laser was associated with lower intraoperative blood loss (mean difference [MD] −35.89; 95% confidence interval [CI] [−53.08, −18.71]; p < 0.01; I² = 100%) and operation time (MD −10.46; 95% CI [−16.63, −4.29]; p < 0.01; I² = 99%). No significant differences between interventions were found in postoperative pain, quality of life, or postoperative hemorrhage.Conclusions: In patients with RAT, laser TE yielded reduced intraoperative blood loss and operation time, with comparable hemorrhage risk, postoperative pain, and quality of life to cold steel dissection. Yet, the occurrence of post‐surgery sore throat remains uncertain, highlighting the need for further randomized trials reporting long‐term outcomes after tonsil surgery.

Background: In vivo visualization of malignant tumors remains the main challenge during head and neck cancer surgery. This can result in inadequate tumor margin assessment and incomplete tumor resection, adversely affecting patient outcomes. Hyperspectral imaging (HSI) is a promising approach to address this issue. However, its application in surgery has been limited by the lack of medically approved HSI devices compliant with MDR regulations, as well as challenges regarding the integration into the surgical workflow. Methods: In this feasibility study, we employed endoscopic HSI during surgery to visualize the tumor sites of 12 head and neck cancer patients. We optimized the HSI workflow to minimize time required during surgery and to reduce the adaptation period needed for surgeons to adjust to the new workflow. Additionally, we implemented data processing to enable real-time classification and visualization of HSI within the intraoperative setting. HSI evaluation was conducted using principal component analysis and k-means clustering, with this clustering validated through comparison with expert annotations. Results: Our complete HSI workflow requires two to three minutes, with each HSI measurement—including evaluation and visualization—taking less than 10 s, achieving an accuracy of 79%, sensitivity of 72%, and specificity of 84%. Medical personnel became proficient with the HSI system after two surgeries. Conclusions: This study presents an HSI workflow for in vivo tissue differentiation during head and neck cancer surgery, providing accurate and visually accessible results within minimal time. This approach enhances the in vivo evaluation of tumor margins, leading to more clear margins and, consequently, improved patient outcomes.