Journal of Otorhinolaryngology, Hearing and Balance Medicine

Background and Objectives: Speech-in-noise testing is essential for evaluating functional hearing abilities in clinical practice. Although the Quick Speech-in-Noise test (QuickSIN) is widely used, no equivalent tool existed for European Portuguese. This study aimed to develop a Speech-in-Noise Test for European Portuguese (SiN-EP), linguistically adapted and calibrated for native speakers, to support clinical assessment of speech perception in realistic listening environments. Materials and Methods: The SiN-EP was developed through a multi-stage process. Sentences were drafted to reflect natural speech patterns and reviewed by native speakers for clarity and grammatical accuracy. Selected sentences were recorded by a female native speaker in a controlled acoustic environment and mixed with multi-talker babble at signal-to-noise ratios (SNR (dB)) from 25 to 0 SNR (dB). A pre-test in a free-field setting at 65 dB SPL was conducted with fifteen normal-hearing young adults. Participants repeated each sentence, and their responses were analyzed to refine list composition, adjust difficulty, and ensure phonetic balance. Results: Intelligibility decreased systematically as SNR (dB) worsened, with ceiling effects at 25 and 20 SNR (dB). At 5 SNR (dB), high variability was observed, with set 5 showing disproportionate difficulty and set 14 containing an incomplete sentence; both were removed. At 0 SNR (dB), all sets demonstrated expected low intelligibility. The final test comprises thirteen lists of six sentences, each maintaining stable intelligibility, phonetic representativeness, and consistent difficulty across SNRs (dB). Conclusions: The SiN-EP provides a linguistically appropriate, phonetically balanced, and SNR (dB) calibrated instrument for assessing speech-in-noise perception in European Portuguese. The refinement process improved reliability and list equivalence, supporting the test’s clinical and research applicability. The SiN-EP fills a critical gap in assessing speech-in-noise perception in European Portuguese speakers, providing a reliable tool for both clinical and research applications.

Background and Clinical Significance: Otitis media with effusion (OME) is characterized by persistent middle ear effusion without acute infection. Type 2 inflammation, mediated by IL-4 and IL-13 signaling via the IL-4Rα receptor, has been implicated in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and possibly OME. Refractory OME in adults remains a therapeutic challenge, as conventional treatments often fail to achieve long-term resolution. Targeted biologic therapies that modulate type 2 inflammation may offer a novel treatment option. Case Presentation: We report the case of a 60-year-old man with a 15-year history of allergic rhinitis and CRSwNP, complicated by recurrent asthma exacerbations, who presented with bilateral aural fullness, hearing loss, and tinnitus. His symptoms persisted despite repeated tympanic punctures, Eustachian tube insufflation, and corticosteroid therapy. Otoscopy revealed dull tympanic membranes with effusion, and audiometry showed conductive hearing loss with a B-type tympanogram on the left. Laboratory findings demonstrated mild peripheral eosinophilia. The patient was diagnosed with OME, likely secondary to type 2 inflammation. After nine biweekly injections of Stapokibart (CM310)—a humanized monoclonal antibody targeting IL-4Rα—aural fullness completely resolved. Otoscopic findings and tympanograms normalized, and hearing thresholds improved significantly. Retrospective evaluation using Iino’s diagnostic framework suggested that the patient did not meet the full criteria for eosinophilic otitis media (EOM); nevertheless, marked symptomatic and functional improvement was achieved. No recurrence or adverse effects were observed during follow-up. Conclusions: This case suggests that IL-4Rα blockade with Stapokibart may be effective in treating refractory OME associated with type 2 inflammation, even in patients who do not fulfill the diagnostic criteria for EOM. These findings highlight the potential of anti-IL-4Rα biologics as a novel therapeutic option for middle ear diseases driven by type 2 inflammation.

Background/Objectives: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by calcification and ossification of ligaments and tendons, primarily affecting the spine. While often asymptomatic, DISH in the cervical spine can cause dysphagia and, more rarely, vocal cord paralysis due to compression of the recurrent laryngeal nerve at the cricothyroid joint. Here, we report cases of unilateral vocal fold paresis in two patients with DISH. Case Presentation: Our first case is an 80-year-old male presented with two months of dysphonia. Strobovideolaryngoscopy found left vocal fold paresis with glottic insufficiency. Computed Tomography (CT) imaging showed DISH with large anteriorly projecting osteophytes in the cervical spine causing rightward deviation of the laryngeal structures and compressing the cricothyroid joint. Second, a 30-year-old female with Turner Syndrome and subglottic stenosis who developed progressively worsening dysphonia over 6 months, characterized by diminished voice projection and clarity. Strobovideolaryngoscopy revealed a mild-to-moderate right vocal fold paresis. CT of the neck demonstrated multiple right-sided osteophytes projecting into the right tracheoesophageal groove, along the course of the right recurrent laryngeal nerve, in the absence of significant disc degeneration. Discussion and Conclusions: On our review of the literature, no other similar instances of unilateral vocal fold paresis were found. We present these cases to emphasize the need for early recognition and treatment to prevent symptom progression of DISH.