Publications by authors named "Luís Castelhano"

7 Publications

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Tracheostomy in COVID-19 Patients: Experience at a Tertiary Center in the First 11 Months of the Pandemic.

Indian J Otolaryngol Head Neck Surg 2021 Aug 15:1-7. Epub 2021 Aug 15.

Department of Otorhinolaryngology, Egas Moniz Hospital, Centro Hospitalar de Lisboa Ocidental (CHLO), NOVA Medical School - Faculdade de Ciências Médicas, Rua da Junqueira, 126, 1340-019 Lisbon, Portugal.

This study aimed to evaluate the experience of tracheostomy in COVID-19 patients in a Southern Europe tertiary hospital. Retrospective observational study in tracheostomized patients from April 1, 2020 to February 28, 2021. Data related to tracheostomy were evaluated in patients with and without COVID-19, including infections in healthcare professionals involved in patient care. Forty-two tracheostomies were performed in COVID-19 patients aged 68.4 ± 11.1 years, predominantly men (71%) and caucasians (81%). They had at least 1 comorbidity (93%), on average 3. The most frequent were heart disease (71%), age > 65 years (67%) diabetes (40%) and obesity (33%). The greater number of comorbidities was associated with the lesser probability of the patient's recovery ( = .001). Age ( = .047) and renal failure ( = .013) were associated with higher mortality. Patients were tracheostomized by prolonged endo-tracheal intubation (50%), pneumonia (33%) and extubation failure (10%). Ventilation time before the tracheostomy (22.9 ± 6.5 days) was higher than ventilation time after the tracheostomy (7.1 ± 15.1 days) ( < 0.001). No differences were found in ventilation time ( = 0.094) and tracheostomy time ( = 0.514) in the different indications. There were 3 minor complications (7.1%), 25 discharges (60%) and 11 deaths (26%). During the same period 49 tracheostomies were performed in patients without COVID-19, with a homogeneous gender and age distribution, 31% without comorbidities, with an average of 1 comorbidity per patient and higher mortality (43%). Tracheostomy in COVID-19 patients proved to be a safe procedure for both patients and healthcare professionals and improves the clinical outcome of patients with severe infection. The 21-day procedure timing seems adequate. Comorbidities played an essential role in patient´s recovery. Age and renal failure are associated with a worse vital prognosis.
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August 2021

Characterization of a Portuguese family with Charcot-Marie-Tooth disease type 1E due to a novel point mutation in the PMP22 gene.

Clin Neurol Neurosurg 2021 Sep 21;208:106829. Epub 2021 Jul 21.

Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Rua da Junqueira 126, 1349-019 Lisbon, Portugal; CEDOC Chronic Diseases Research Centre, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.

Introduction: Point mutations in the Peripheral Myelin Protein 22 (PMP22) gene comprise less than 5% of the Charcot-Marie-Tooth (CMT) type 1 cases, and individualize either the CMT 1E subtype, or Hereditary Neuropathy with Liability to Pressure Palsy. The phenotype of CMT 1E presents with a severe early-onset polyneuropathy associated with deafness, although the clinical spectrum is broad.

Case Report: We describe a novel PMP22 gene point mutation (c.84G>T;p.(Trp28Cys)) in three patients of a Portuguese family with variable phenotypes, ranging from asymptomatic to mild complaints of distal limb numbness and gait difficulties, with the age of onset of symptoms ranging from mid-twenties to late-sixties, and no associated disability. In all affected patients, there was evidence of diffuse demyelinating sensorimotor polyneuropathy. Hearing loss does not seem to be associated with this variant, albeit neuropathic pain was reported.

Conclusions: These findings suggest that this particular point mutation in the PMP22 gene is associated with a mild phenotype, further emphasizing that there are still unknown mechanisms (genetic and/or epigenetic) that may play a role in the clinical spectrum of CMT1E patients. Next generation sequencing panels including commonly mutated genes in CMT should be considered in CMT1 cases negative for PMP22 gene duplication.
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September 2021

Lateral semicircular canal-BPPV: Prospective randomized study on the efficacy of four repositioning maneuvers.

Acta Otorrinolaringol Esp (Engl Ed) 2021 Jan 22. Epub 2021 Jan 22.

Serviço de Otorrinolaringologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.

Introduction: Multiple repositioning maneuvers have been described to treat lateral semi-circular canal Benign Paroxysmal Positional Vertigo (LC-BPPV) patients. In this study, we compare efficacy of four therapeutic repositioning maneuvers for LC-BPPV patients and aim to identify clinical variables associated with persistent disease.

Material And Methods: A prospective study was conducted at a tertiary center, between January 2017 and September 2019. Patients diagnosed with LC-BPPV were randomly treated with Gufoni or barbecue-roll maneuvers (for the geotropic variant) and Gufoni-Appiani, barbecue-roll or Zuma-e-Maia maneuvers (for the apogeotropic form). Efficacy was compared and statistical analysis was performed to find clinical factors associated with no response.

Results: Forty-eight patients and 82 maneuvers were included. Female patients and right side were more commonly affected. The mean age was 67 years. Seven cases (14.6%) resulted from a canal-switch. One single maneuver resolved 23 cases (47.9%) and the success rate rose to 75% at the end of the first visit (after up to 4 maneuvers) and to 93.8% after a-week of follow-up. Success rates were significantly better with Gufoni (68%) than with barbecue roll (34.8%; p=0.021) in geotropic LC-BPPV and better with Gufoni-Appiani (71.4%) than barbecue roll and Zuma-e-Maia maneuvers (33.3%; p=0.239) in apogeotropic LC-BPPV. Higher rates of persistent disease after first visit were found with older patients, left side and apogeotropic LC-BPPV and with longer latency and duration diagnostic nystagmus.

Conclusion: Our study suggests that Gufoni and Gufoni-Appiani maneuvers may be the most efficacious treatment for geotropic and apogeotropic LC-BPPV, respectively, compared to barbecue-roll and Zuma-e-Maia maneuvers.
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January 2021

Personality and psychopathology in Ménière's disease.

Acta Otorrinolaringol Esp (Engl Ed) 2020 Oct 12. Epub 2020 Oct 12.

Serviço de Otorrinolaringologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Nova Medical School, Universidade Nova, Lisboa, Portugal.

Introduction And Objectives: Psychological factors in vertigo patients have been extensively studied but the role of anxiety and personality traits in the clinical course of Ménière's disease (MD) is unknown. The objectives of this study are to identify and characterize psychopathology in MD and to find risk factors for an increased rate and intensity of crisis and chronic symptoms.

Materials And Methods: We performed a transversal study in all patients diagnosed with definite MD in our department during a 5-year period. Sample subjects were interviewed in 3 steps: first, an otorhinolaryngologist collected information about clinical and pharmacological background of MD; second, a psychiatrist screened for mood, anxiety and personality disorders; in a third stage, the patient completed the DHI (Dizziness Handicap Inventory), STAI-Y (State Trait Anxiety Inventory), NEO-PI-R (Neo Personality Inventory Reviewed) and VAS (Visual Analogue Scale) for vertigo and dizziness. Statistical analysis was performed to search for risk factors for multiple and intense crisis and chronic symptoms.

Results: Thirty-four patients completed all 3 phases of the study. A predominant dysfunctional personality trait was identified in 80% of patients (predominantly cluster C type), 35% were being treated with psychiatric medication and 34.4% had a considerable mood or anxiety disorder. All patients scored high (>7) in VAS during crisis. There was a statistically significant positive correlation between crisis rate and STAI, anxiety-subscale (N1) in NEO-PI-R, VAS and DHI scores (p<.044). Crises were more common in bilateral MD (p=.041). DHI scores were higher with higher STAI and N1 (p=.001). Disease duration and pure tone average were found to have a positive moderate correlation (p=.017).

Conclusions: The positive correlations between crisis rate, chronic dizziness and anxiety-related personality traits reveal a bidirectional and intimate relationship between personality, anxiety and MD, affecting these patients' quality of life. These results support the relevance of prospecting adjuvant psychological and psychiatric approaches to these patients.
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October 2020

Contralateral occlusion test: The effect of external ear canal occlusion on predicting conductive hearing loss.

Acta Otorrinolaringol Esp (Engl Ed) 2020 Jul - Aug;71(4):235-241. Epub 2019 Dec 31.

Department of Otorhinolaryngology, Head and Neck Surgery, Egas Moniz Hospital, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisbon, Portugal; Department of Otorhinolaryngology, NOVA Medical School - Faculdade de Ciências Médicas, Lisbon, Portugal.

Introduction And Objectives: The contralateral occlusion test (COT) has the potential to allow the quantitative evaluation of unilateral conductive hearing loss. The purpose of this study was to determine the accuracy of the test in predicting the degree of hearing loss.

Materials And Methods: Fifty-three subjects with unilateral conductive hearing loss were recruited from an otolaryngology department of a tertiary hospital. The COT was performed using 128, 256, 512, 1024 and 2048Hz tuning forks with the non-affected ear canal totally occluded to determine lateralization. Pure-tone audiometry was performed to establish the presence and degree of the air-bone gap (ABG) and the pure-tone average (PTA). The tuning fork responses were correlated with the ABG and the PTA to determine their accuracy.

Results: The COT showed a better association between hearing loss and the lateralization response using the 512Hz tuning fork (p=0.001). The sensitivity of the 512Hz fork in detecting a PTA of at least 35.6dB was 94.6% and the specificity was 75.0% for a positive predictive value of 89.7% and a negative predictive value of 85.7%, assuming a pretest prevalence of 69.8%.

Conclusions: The overall accuracy of the COT in predicting the degree of unilateral conductive hearing loss was significant. The COT had significant power in one direction: if lateralization to the affected ear occurred, it was almost certain evidence of a moderate or severe conductive hearing loss.
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July 2021

Contralateral Occlusion Test (COT): the effect of external ear canal occlusion with aging.

Codas 2019 18;31(3):e20180058. Epub 2019 Apr 18.

Departamento de Otorrinolaringologia, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental - CHLO, NOVA Medical School, Faculdade de Ciências Médicas - Lisboa, Portugal.

Purpose: This study aimed to evaluate the effects of complete external ear canal occlusion on hearing thresholds with aging. The goal was to decide which tuning fork is more appropriate to use for the contralateral occlusion test (COT), in individuals of different ages.

Methods: Forty-two normal hearing subjects between 21 and 67 years were divided into three age groups (20-30 years, 40-50 years, and 60-70 years). Participants underwent sound field audiometry tests with warble tones, with and without ear canal occlusion. Each ear was tested with the standard frequencies (250, 500, 1000, and 2000 Hz). The contralateral ear was suppressed by masking.

Results: Hearing thresholds showed an increase as the frequency increased from 20.85 dB (250 Hz, 20-30 years group) to 48 dB (2000 Hz, 60-70 years group). The threshold differences between occlusion and no occlusion conditions were statistically significant and increased ranging from 11.1 dB (250 Hz, 20-30 years group) to 32 dB (2000 Hz, 20-30 years group). We found statistically significant differences for the three age groups and for all evaluations except to 500 Hz difference and average difference. The mean hearing loss produced by occlusion at 500 Hz was approximately 19 dB. We found no statistically significant differences between right and left ears and gender for all measurements.

Conclusion: We conclude that the use of the 512 Hz tuning fork is the most suitable for COT, and its use may allow clinicians to distinguish mild from moderate unilateral conductive hearing loss.
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July 2019

Epidemiology of epistaxis in the emergency department of a southern European tertiary care hospital.

Acta Otorrinolaringol Esp (Engl Ed) 2018 Nov - Dec;69(6):331-338. Epub 2018 May 5.

Department of Otolaryngology of Egas Moniz Hospital, Centro Hospitalar de Lisboa Ocidental (CHLO), NOVA Medical School - Faculdade de Ciências Médicas, Lisbon, Portugal.

Objective: Epistaxis is the most common rhinological emergency seen in the emergency department. The purpose of this study was to evaluate epidemiological data of epistaxis in a southern European tertiary care hospital.

Methods: A retrospective study was conducted during the period between January 2009 and December 2015. We analyzed the distribution by cross-referencing the demographic variables, destination after medical discharge, inpatient characteristics (major comorbid diseases, medication, bleeding localization and treatment) and health-care costs with the disease.

Results: Epistaxis accounted for approximately 1 in 30 visits to the ED and 77 out of a population of 100,000 was served by that ED. Overall, 71,624 patients were treated and 2371 patients presented with epistaxis (3.31%). One-thousand three-hundred and twenty-seven cases were male and 1044 female (p <.001). The mean age was 56 years (±26). Age distribution was bimodal, with peaks among those <10 years and >70 (p <.001). Epistaxis was more common in the winter months (p < 0.001). The main referral destinations (6.8%) included outpatient (2.9%) and inpatient (1.9%) services. Hospitalization was more frequent between the ages of 60 and 80 years (p =.029), and the major comorbidity was hypertension (47.8%). Medication interfering with haemostasis was documented in 30.4%. Most inpatient epistaxis was managed in a non-interventional manner and only. 5% of patients needed surgery. The mean total health-care cost was 69.8 € per episode.

Conclusion: Emergency epistaxis was more frequent in men, the elderly, patients with underlying comorbidities, during the winter months, and showed a higher risk of referral and hospitalization with increasing age (as a result of an aging population in western countries). The main hospital expenses for epistaxis are related to hospitalization and health care costs.
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August 2019