Surgery for Otitis Media with Effusion: A Survey of Otolaryngologists Who Treat Children in Brazil

Abstract Introduction Myringotomy and ear tube placement (MTP) is the surgical treatment for otitis media with effusion (OME), and it is the most common surgery performed in children. Several guidelines have been developed to assist in the care of patients who become candidates for MTP. Objectives To evaluate the practice of Brazilian otorhinolarynogologists when performing MTP according to the years of clinical experience. Secondarily, we also want to assess if their practice regarding MTP varied according to the percentage of children treated and the location of their practice. Methods A 30-question survey was sent to otolaryngologists affiliated with the Brazilian Academy of Pediatric Otorhinolaryngology (Academia Brasileira de Otorrinolaringologia Pediátrica, ABOPe, in Portuguese) and/or the Scientific Department of Otorhinolaryngology of the Brazilian Society of Pediatrics (Sociedade Brasileira de Pediatria, SBP, in Portuguese). The questions included were carefully chosen to provide a profile about the practices adopted in the pre-, peri- and postoperative periods of MTP. Results The questionnaire was sent to 208 otolaryngologists, and there were 124 (59.6%) respondents. Of those, 59.7% use antiseptics before surgery. Only 54 otolaryngologists, less than half of the subjects in this study (43.5%), always place a tube during the procedure. More physicians who practice in small cities recommend water precautions after MTP when compared to other physicians (p < 0.001). Conclusions The present study reveals that many respondents do not follow some of the recommendations of the current guidelines of the American Academy of

Efficacy and predictors of success on laryngomalacia surgery: experience from a tertiary pediatric care center in Brazil

Abstract Objectives: Laryngomalacia is the most common congenital cause of stridor; the natural history of the disease runs through to complete resolution by the age of two. Severe cases are characterized by cyanosis, hypoxia, apnea, furcular and/or subcostal retractions, aspirations, pulmonary hypertension, and failure to thrive and must undergo surgery. This study aimed to evaluate the success rates of supraglottoplasty in our hospital and evaluate the predictive factors for surgical success. Methods: Cohort study, prospectively planned. 75 patients undergoing endoscopic surgery from July 2007 to July 2016 were analyzed at the Santo Antônio Children's Hospital. The primary outcome was percentage of surgical success, defined as the absence of respiratory symptoms or presence of a mild stridor without retractions on the first post-operative month (late success). The secondary outcomes were the early surgical success (absence of respiratory symptoms or presence of a mild stridor without retractions on the first post-operative day). Results: 39 (58.2%) were male, with an average of 4.9 months. Surgical success on the first day was 80.6% (n = 54). At the end of the 1st month, surgical success was 88.6%, considering only those who completed assessment. Twenty-one (34%) presented comorbidities. Presence of comorbidities, pharyngomalacia and GERD were associated with a worse result on the 1st postoperative day, whereas, at the end of the first month, presence of comorbidities, concomitant injuries (tracheo and bronchomalacia) and pharyngomalacia were the predictive variables of surgery failure. Conclusion: Supraglottoplasty has high rates of efficacy and low morbidity. The presence of comorbidities and pharyngomalacia has shown association with a worse early and late surgical outcome. Synchronous airway lesions predict a worse surgical result at the end of the first month. GERD was associated with obstructive symptomatology only in the 1st post-operative day. Level of evidence: Level 3 of evidence, according to the "The Oxford 2011 Levels of Evidence" from Oxford Centre for Evidence-Based Medicine.

COVID-19 in otolaryngologists: a cross-sectional multicenter study

Abstract Introduction: The nose and throat are areas of high viral load, which could place otolaryngologists at an even higher risk for COVID-19 than other health-care workers. Objective: To investigate the prevalence of antibodies against SARS-CoV-2 in otorhinolaryngologists in southern Brazil, its relationship to demographic data, professional practice and reported symptoms of COVID-19, and compare it with official data on other health-care workers of the state and the general population in the same period. Methods: In this cross-sectional multicenter study, otolaryngologists actively practicing officially registered in Rio Grande do Sul were screened for IgM and IgG antibodies against SARS-CoV-2 from August 1 to September 15, 2020. A questionnaire was also applied. Results: We screened 358 (80.1%) of 447 actively practicing otolaryngologists (195 [54.5%] male; mean [SD] age, 47.77 [13.57] years; range, 26-84 years). Twenty-three were positive for IgM and/or IgG (6.4%). This result was significantly associated with reports of infected household contacts (19/315 negatives and 8/23 positives; p<0.001). From 23 seropositive participants, 14 were asymptomatic (60.9%; p< 0.001). There were no significant associations between seroconversion and age, sex, number of patient appointments and surgical procedures, workplace (hospital or private practice), patients with or without respiratory symptoms, or level of personal protective equipment used. The rate of COVID-19 in all health-care workers in the state was 7.69% at the end of the same period. Data from state government seroprevalence was 5.26 (risk ratio [RR]; 95% CI 3.27-8.45) and 4.66 (RR; 95% CI 2.93-7.43) times higher in otolaryngologists than in the general population in August and September, respectively. Conclusion: Otolaryngologists had a higher seroconversion rate than the general population. Using personal protective equipment, the level of occupational exposure did not result in higher rates of infection than other health-care workers, but the presence of infected household contacts was associated with higher rates of seroconversion.

Complications of tracheostomy in children: a systematic review / Complicações de traqueostomia em crianças: uma revisão sistemática

Abstract Introduction: Tracheostomy is a procedure that can be associated with several well-described complications in the literature, which can be divided into transoperative, early postoperative and late postoperative. When performed in children, these risks are more common than in adults. Objective: To perform a systematic review of complications, including deaths, in tracheostomized pediatric patients. Methods: A search was carried out for articles in the Latin American and Caribbean Health Sciences Literature and PubMed databases. Cohort studies and series reports were selected, in addition to systematic reviews, published between January 1978 and June 2020, with patients up to 18 years old, and written in English, Spanish or Portuguese. Results: 1560 articles were found, of which 49 were included in this review. The average complication rate was 40%, which showed an association with age, birth weight, prematurity, comorbidities, and emergency procedures. The most common complications were cutaneous lesions and granulomas. Mortality related to the procedure reached up to 6% in children and was mainly related to cannula obstruction or accidental decannulation. Conclusion: Pediatric tracheostomy is associated with several complications. The tracheostomy-related mortality rate is low, but the overall mortality of tracheostomized patients is not negligible.

Resumo Introdução: A traqueostomia é um procedimento que está associada a diversas complicações já bem descritas na literatura, que podem ser divididas em transoperatórias, pós-operatórias precoces e pós-operatórias tardias. Nas crianças, esses riscos são mais incidentes do que nos adultos. Objetivo: Fazer uma revisão sistemática sobre complicações, inclusive óbitos, em pacientes pediátricos traqueostomizados. Método: Foram pesquisados artigos nas bases de dados da Latin American and Caribbean Health Sciences Literature e PubMed. Foram selecionados coortes e relatos de séries, além de revisões sistemáticas, publicados entre janeiro de 1978 e junho de 2020, com pacientes de até 18 anos, nas línguas inglesa, espanhola ou portuguesa. Resultados: Foram encontrados 1.560 artigos, dos quais 49 foram incluídos nesta revisão. A taxa média de complicações foi de 40%, que mostrou associação com idade, peso ao nascimento, prematuridade, comorbidades e procedimentos feitos em caráter de emergência. As complicações mais comuns foram lesões cutâneas e granulomas. Já a mortalidade relacionada ao procedimento chegou até a 6% em crianças e esteve relacionada principalmente à obstrução da cânula ou decanulação acidental. Conclusão: A traqueostomia pediátrica associa-se a diversas complicações. A mortalidade relacionada à traqueostomia se mostra baixa, mas a mortalidade geral de pacientes traque-ostomizados não é desprezível.

Prevalence of COVID-19 in medical school and residency in Porto Alegre, RS

SUMMARY OBJECTIVE: A multicentric, cross-sectional study was carried out to determine the prevalence and risk factors for Coronavirus disease 2019 in medical students and residents from four universities and affiliated hospitals in Brazil. METHODS: A survey about contamination risk and symptoms was sent to all participants through email and WhatsApp. Prevalence was measured by the self-report of positive polymerase chain reaction or serological test. Univariate and multivariate analyses were performed, and odds ratio and 95% confidence interval were calculated. RESULTS: Prevalence of infection by Sars-CoV-2 was 14.9% (151/1011). The disease was more prevalent in residents and interns than in undergraduate students. Contact with an infected relative outside the hospital or with colleagues without using personal protective equipment was associated with higher contamination. Contact with patients without wearing goggles and higher weekly frequency of contact were the two factors independently associated with the infection by Coronavirus disease 2019 in the multivariate analysis. CONCLUSIONS: Medical students, interns, and residents have a higher prevalence of Coronavirus disease 2019 than the general population, in which the last two groups are significantly at higher risk. Contacting patients at a higher weekly frequency increases the risk for infection. The use of goggles should be reinforced when contacting patients.

Micronucleus count in nasal epithelial cells from patients with chronic rhinosinusitis and polyps / Contagem de micronúcleos em células epiteliais nasais de pacientes com rinossinusite crônica e pólipos

Abstract Introduction: Chronic rhinosinusitis with nasal polyps, a prevalent disease affecting around 2% of the world population, is characterized by symptomatic inflammation of the nasal mucosa and impairment of quality of life. Chronic rhinosinusitis with nasal polyps has a multifactorial etiology, involving a dysfunctional host response to environmental factors. Thus, inflammatory models may be useful to shed light on the pathophysiology of this disease. Micronucleus count has been used to screen DNA damage in various tissues. Objective: To investigate the association between frequency of micronucleus in exfoliated cells from the nasal cavity of patients with chronic rhinosinusitis with nasal polyps and disease severity. Methods: This cross-sectional study included 21 patients with chronic rhinosinusitis with nasal polyps and 19 controls without disease. None of the participants were smokers. Results: Mean micronucleus count was 3.690 per 1000 cells (±2.165) in individuals with vs. 1.237 per 1000 cells (±0.806) in controls; (Student's t test = 4.653, p< 0.001). Nasal surgery in the past 5 years and aspirin-exacerbated respiratory disease were not associated with nicronucleus count (p= 0.251). Conclusion: Micronucleus count seems to be linked to chronic rhinosinusitis with nasal polyps, providing a new perspective for the evaluation of this disorder.

Resumo Introdução: A rinossinusite crônica com pólipos nasais, doença prevalente que afeta cerca de 2% da população mundial, é caracterizada por inflamação sintomática da mucosa nasal e comprometimento da qualidade de vida. A rinossinusite crônica com pólipos nasais tem etiologia multifatorial, envolvendo resposta disfuncional do hospedeiro a fatores ambientais. Assim, modelos inflamatórios podem ser úteis para esclarecer a fisiopatologia dessa doença. A contagem de micronúcleos tem sido usada para rastrear danos no DNA em vários tecidos. Objetivo: Investigar a associação entre a frequência de micronúcleos em células esfoliadas da cavidade nasal de pacientes com rinossinusite crônica com pólipos nasais e a gravidade da doença. Método: Estudo transversal que incluiu 21 pacientes com rinossinusite crônica com pólipos nasais e 19 controles sem doença. Nenhum dos participantes era fumante. Resultados: A contagem média de micronúcleos foi de 3,690 por 1.000 células (± 2,165) nos indivíduos doentes e 1,237 por 1.000 células (± 0,806) nos controles (teste t de Student = 4,653; p < 0,001). A cirurgia nasal nos últimos 5 anos e a doença respiratória exacerbada por aspirina não foram associadas à contagem de micronúcleos (p = 0,251). Conclusão: A contagem de micronúcleos parece estar ligada à rinossinusite crônica com pólipos nasais, proporcionando uma nova perspectiva para a avaliação dessa doença.

How to avoid the inappropriate use of antibiotics in upper respiratory tract infections? A position statement from an expert panel / Como evitar o uso inadequado de antibióticos nas infecções de vias aéreas superiores? Posição de um painel de especialistas

Abstract Introduction: Bacterial resistance burden has increased in the past years, mainly due to inappropriate antibiotic use. Recently it has become an urgent public health concern due to its impact on the prolongation of hospitalization, an increase of total cost of treatment and mortality associated with infectious disease. Almost half of the antimicrobial prescriptions in outpatient care visits are prescribed for acute upper respiratory infections, especially rhinosinusitis, otitis media, and pharyngotonsillitis. In this context, otorhinolaryngologists play an important role in orienting patients and non-specialists in the utilization of antibiotics rationally and properly in these infections. Objectives: To review the most recent recommendations and guidelines for the use of antibiotics in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, adapted to our national reality. Methods: A literature review on PubMed database including the medical management in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, followed by a discussion with a panel of specialists. Results: Antibiotics must be judiciously prescribed in uncomplicated acute upper respiratory tract infections. The severity of clinical presentation and the potential risks for evolution to suppurative and non-suppurative complications must be taken into 'consideration'. Conclusions: Periodic revisions on guidelines and recommendations for treatment of the main acute infections are necessary to orient rationale and appropriate use of antibiotics. Continuous medical education and changes in physicians' and patients' behavior are required to modify the paradigm that all upper respiratory infection needs antibiotic therapy, minimizing the consequences of its inadequate and inappropriate use.

Resumo Introdução: A resistência bacteriana a antibióticos nos processos infecciosos é um fato crescente nos últimos anos, especialmente devido ao seu uso inapropriado. Ao longo dos anos vem se tornando um grave problema de saúde pública devido ao prolongamento do tempo de internação, elevação dos custos de tratamento e aumento da mortalidade relacionada às doenças infecciosas. Quase a metade das prescrições de antibióticos em unidades de pronto atendimento é destinada ao tratamento de alguma infecção de vias aéreas superiores, especialmente rinossinusites, otite média aguda supurada e faringotonsilites agudas, sendo que uma significativa parcela dessas prescrições é inapropriada. Nesse contexto, os otorrinolaringologistas têm um papel fundamental na orientação de pacientes e colegas não especialistas, para o uso adequado e racional de antibióticos frente a essas situações clínicas. Objetivos: Realizar uma revisão das atuais recomendações de utilização de antibióticos nas otites médias, rinossinusites e faringotonsilites agudas adaptadas à realidade nacional. Método: Revisão na base PubMed das principais recomendações internacionais de tratamentos das infecções de vias aéreas superiores, seguido de discussão com um painel de especialistas. Resultados: Os antibióticos devem ser utilizados de maneira criteriosa nas infecções agudas de vias aéreas superiores não complicadas, a depender da gravidade da apresentação clínica e dos potenciais riscos associados de complicações supurativas e não supurativas. Conclusões: Constantes revisões a respeito do tratamento das principais infecções agudas são necessárias para que sejam tomadas medidas coletivas no uso racional e apropriado de antibióticos. Somente com orientação e transformações no comportamento de médicos e pacientes é que haverá mudanças do paradigma de que toda infecção de vias aéreas superiores deva ser tratada com antibióticos, minimizando por consequência os efeitos de seu uso inadequado.

First Clinical Consensus and National Recommendations on Tracheostomized Children of the Brazilian Academy of Pediatric Otorhinolaryngology (ABOPe) and Brazilian Society of Pediatrics (SBP) / Primeiro Consenso Clínico e Recomendações Nacionais em Crianças Traqueostomizadas da Academia Brasileira de Otorrinolaringologia Pediátrica (ABOPe) e Sociedade Brasileira de Pediatria (SBP)

Abstract Introduction: Tracheostomy is a procedure that can be performed in any age group, including children under 1 year of age. Unfortunately health professionals in Brazil have great difficulty dealing with this condition due to the lack of standard care orientation. Objective: This clinical consensus by Academia Brasileira de Otorrinolaringologia Pediátrica (ABOPe) and Sociedade Brasileira de Pediatria (SBP) aims to generate national recommendations on the care concerning tracheostomized children. Methods: A group of experts experienced in pediatric tracheostomy (otorhinolaryngologists, intensive care pediatricians, endoscopists, and pediatric pulmonologists) were selected, taking into account the different regions of Brazil and following inclusion and exclusion criteria. Results: The results generated from this document were based on the agreement of the majority of participants regarding the indications, type of cannula, surgical techniques, care, and general guidelines and decannulation. Conclusion: These guidelines can be used as directives for a wide range of health professionals across the country that deal with tracheostomized children.

Resumo Introdução: A traqueostomia é um procedimento que pode ser feito em qualquer faixa etária, inclusive em crianças abaixo de um ano. Infelizmente no Brasil existe uma enorme dificuldade dos profissionais de saúde em lidar com esta condição e uma falta de padronização dos cuidados. Objetivo: Este consenso clínico realizado pela Academia Brasileira de Otorrinolaringologia Pediátrica (ABOPe) e Sociedade Brasileira de Pediatria (SBP) tem como objetivo gerar recomendações nacionais sobre os cuidados e condutas diante das crianças traqueostomizadas. Método: Foram selecionados um grupo de especialistas com experiência em traqueostomia na infância (otorrinolaringologistas, pediatras intensivistas, endoscopistas, pneumopediatras) que tivessem comprovada atuação prática no assunto, e que também contemplassem as diversas regiões do Brasil, de acordo com os critérios de inclusão e exclusão. Resultados: Os resultados gerados neste documento foram obtidos a partir da concordância da maioria dos participantes em relação as indicações, tipo de cânula, técnicas cirúrgicas, cuidados e orientações gerais e decanulação. Conclusão: Estas diretrizes poderão servir como norteadoras para os mais diversos profissionais de saúde em todo país que lidam com as dificuldades das crianças traqueostomizadas.

Hemangioma apresentando-se como massa de canal auditivo externo / Hemangioma presenting as external ear canal mass

Lesões tumorais do meato acústico externo são achados pouco comuns na prática otorrinolaringológica diária. A possibilidade de hemangioma deve ser sempre lembrada. Descrever o caso de um paciente com hemangioma no conduto auditivo externo...

Tumoral lesions of external ear canal are uncommon findings in dailly. The possibility of hemangioma should always be remembered. To report a case of a patient with hemangioma in external ear canal...

O efeito da adenotonsilectomia na saturação de oxigênio em crianças com distúrbios respiratórios do sono / The effect of adenotonsillectomy on oxygen saturation in children with sleep disordered breathing

OBJETIVO: Realizar uma avaliação do efeito da adenotonsilectomia na saturação de oxigênio medida por oximetria de pulso noturna em crianças com distúrbios respiratórios do sono. MÉTODOS: Foi realizado um estudo tipo antes e após a intervenção cirúrgica, utilizando a oximetria de pulso noturna como método de avaliação. Foram avaliadas 31 crianças com suspeita de distúrbios respiratórios do sono e indicação clínica de adenotonsilectomia. RESULTADOS: Vinte e sete crianças completaram o estudo. A idade média foi de 5,2 ± 1,8 anos. Dezoito eram do sexo masculino (66,7 por cento). Vinte e três (85,2 por cento) crianças apresentavam, no exame físico, hiperplasia das tonsilas palatinas graus 3 e 4. Houve melhora significativa no índice de dessaturação de oxigênio (IDO) pós-operatório quando comparado com o pré-operatório (p < 0,001). CONCLUSÃO: A adenotonsilectomia melhorou significativamente a saturação de oxigênio, medida pela oximetria de pulso noturna em crianças com distúrbios respiratórios do sono.

OBJECTIVE: To evaluate the effect of adenotonsillectomy on oxygen saturation measured through nocturnal pulse oximetry in children with sleep disordered breathing. METHODS: A pre- and post-intervention study was carried out using nocturnal pulse oximetry. The study involved 31 children who were suspected of having sleep disordered breathing and had been referred for adenotonsillectomy. RESULTS: A total of 27 children completed the study. The mean age was 5.2 ± 1.8 years, and 18 (66.7 percent) of them were male. Upon physical examination, 23 (85.2 percent) of the children presented class III or class IV hyperplasia of the palatine tonsils. There was significant improvement in the post-operative period over the pre-operative period in terms of the oxygen desaturation rate (OR = 0.65; 95 percent CI: 0.5-1.3 vs. OR = 1.63; 95 percent CI: 1.1-2.4; p < 0.001). CONCLUSION: Adenotonsillectomy significantly improved oxygen saturation, as measured through nocturnal pulse oximetry, in children with sleep disordered breathing.

Systematic literature review of modifiable risk factors for recurrent acute otitis media in childhood

OBJECTIVE: Review evidence about modifiable risk factors for recurrent acute otitis media.SOURCE OF DATA: MEDLINE with no language restriction, from January 1966 to July 2005, using descriptors "acute otitis media/risk factors". Two hundred and fifty-seven articles were obtained. These included randomized clinical trials, cohorts, case-control and cross-sectional studies that contained analyses of modifiable risk factors for the development of recurrent acute otitis media as the main objective and with samples of individuals up to the age of 18 years. Except when relevant, the following were excluded: non-systematic reviews, reports of cases, series of cases, and medical society guidelines. SUMMARY OF DATA: Nine risk factors linked to the host and eight linked to the environment were identified. Of the first group, allergy, craniofacial abnormalities, gastroesophageal reflux and the presence of adenoids were classified as modifiable. In the second category, upper airway infections, day care center attendance, presence of siblings/family size, passive smoking, breastfeeding and use of pacifiers were included. Afterwards, the risk factors were classified in accordance with levels of evidence. CONCLUSIONS: The risk factors established for recurrent acute otitis media and capable of being modified were the use of pacifiers and care in daycare centers. The probable risk factors were privation of mother's milk, presence of siblings, craniofacial abnormalities, passive smoking and presence of adenoids. No modifiable factor was classified as unlikely. Among those that need further study are allergy, gastroesophageal reflux and passive smoking during gestation.

O que há de novo no campo da genética molecular da surdez: descoberta de genes para surdez / What is new in the field of molecular genetics of deafness: discovery of deafness genes

Objetivo: Sumarizar o que há de novo na área da genética molecular da surdez näo sindrômica e preparar o otorrinolaringologista para esse novo tipo de abordagem da surdez hereditária. Métodos: Análise de artigos originais e de revisäo publicados na última década tratando das descobertas no campo da genÚtica molecular da surdez hereditßria, com Ûnfase no tipo näo sindrômico. Resultados: Identificaram-se, desde 1992, data da primeira publicaçäo de estudo de ligaçäo de surdez hereditária näo sindrômica, 15 formas de perda auditiva de transmissäo autossômica dominante (DFNA), 19 de transmissäo autossômica recessiva (DFNB), G de transmissäo ligada ao cromossomo X (DFN)e 2 de transmissäo mitocondrial. No mínimo, 9 genes responsáveis por surdez já foram identificados e sequenciados, 8 destes já publicados. Conclusäo: O progresso na identificaçäo dos genes responsáveis pelas diferentes formas de perda auditiva tem impacto tanto na prática clínica quanto no estudo dos mecanismos normais de funcionamento da audiçäo. A identificaçäo de diferentes genes para cada tipo de perda auditiva abre perspectivas para tratamentos cada vez mais específicos e melhores para a perda auditiva, tanto de origem genética quanto ambiental

Associaçao entre doença coronariana e pregas no lobo da orelha (PLO) / Association between coronary disease and ear lobe creases (ELC)

Este artigo de revisao comenta inicialmente o papel da prega no lobo da orelha (PLO) na seleçao de pacientes com maior risco para acidentes coronarianos. Em seguida, detém-se na apresentaçao das evidências da associaçao entre esses dois achados. Finalmente, concluindo-se que a PLO deve ser valorizada na identificaçao dos indivíduos com doença coronariana, principalmente pela simplicidade deste exame

A hipertensäo arterial sistêmica é fator de risco para epistaxe? / Is systemic arterial hypertension a risk factor for epistaxis?

Os autores revisam as evidências sobre a associação entre epistaxe e hipertensão arterial sistêmica (HAS). A HAS é o mais importante e prevalente fator de risco cardiovascular, presente em até 11 por cento das pessoas adultas no Rio Grande do Sul. Em torno de 14 por cento da população já tiveram ao menos um episódio de epistaxe, a qual é a causa mais freqüente de internação de urgência em muitos serviços otorrinolaringológicos. Existem vários estudos testando a associação entre epistaxe e HAS com resultados conflitantes. De uma maneira geral, os estudos que mostraram associação entre os dois fatores foram os que mais incorreram em erros metodológicos, comprometendo sua validade. Conclui-se que, ao menos em populações não selecionadas, a HAS não é fator de risco para epistaxe

Manifestaçöes rino-sinusais durante a gestaçäo / Rhinosinusal manifestations during pregnancy

A relação entre as alterações da mucosa nasal e a gestação tem sido tema de interesse para vários autores durante o decorrer dos tempos, desde a época de Hipócrates. Apesar de não haver dúvidas a respeito da existência desta relação, permanecem, entretanto, algumas indagações sobre a sua fisiopatologia. Neste trabalho é feito um estudo prospectivo onde são analisadas as queixas rino-sinusais de 151 nulheres puérperas, comparadas com os dados da literatura. Os autores concluem que a gravidez pode influenciar as queixas rino-sinusais, porém estudos com quantificação objetiva destas manifestações e melhor desenhados ainda são necessários