Evaluation of subjective scale in allergen nasal provocation test / 临床耳鼻咽喉头颈外科杂志

Objective:To compare the clinical value of visual analogue scale （VAS）, Lebel scale and total nasal symptom scores （TNSS） in evaluating nasal allergen provocation test （NAPT）. Methods:A total of 151 patients suspected of allergic rhinitis admitted to the Department of Otolaryngology-Head and Neck Surgery of our hospital from April 2020 to September 2020 were included, of which 76 were positive for house dust mites and 75 were negative for allergens. Nasal airway resistance（NAR） was measured by active anterior nasal manometry. Nasal symptoms were evaluated by VAS, Lebel and TNSS. House dust mite allergen was used for NAPT by spray method. An increase≥40% in NAR was used as the gold standard for objective evaluation of NAPT. ROC curves of VAS, Lebel and TNSS were drawn to compare the evaluation effectiveness of different subjective evaluation methods, and the optimal critical point of each ROC curve was obtained. Results:With NAR increased by ≥40% as the gold standard, the area under ROC curve of VAS was 0.884, and the sensitivity and specificity were 97.75% and 80.65%, respectively. The area under ROC curve of Lebel was 0.773, and the sensitivity and specificity were 68.54% and 75.81%, respectively. The area under ROC curve of TNSS was 0.792, and the sensitivity and specificity were 68.54% and 79.03%, respectively. There was no significant difference between Lebel and TNSS（P>0.05）. The VAS differed significantly from Lebel and TNSS（P<0.05）. The Kappa values of VAS, Lebel, TNSS and NAR were 0.803, 0.432 and 0.459, respectively. Conclusion:The VAS, Lebel, TNSS subjective scale and NAR are consistent in evaluating the efficacy of NAPT, with the VAS assessment showing highest consistency with NAR. As objective assessment instruments are not widely used in China, subjective assessment method could be adopted to evaluate the efficacy of NAPT in clinical practice, and VAS scale is recommended as a priority.

Peak nasal inspiratory flow in children and adolescents with sickle cell disease: a case-control study

SUMMARY OBJECTIVE: Sickle cell disease is the most frequent of the hereditary hemoglobinopathies and it presents multisystemic effects. A manifestation that is commonly found in sickle cell disease is upper airway obstruction, particularly adenotonsillar hypertrophy. This study aims to evaluate the peak nasal inspiratory flow measurements of children and adolescents with sickle cell disease. METHODS: This is a case-control study on children aged between 8 and 15 years who were diagnosed with sickle cell disease. Peak nasal inspiratory flow measurements were obtained from patients. RESULTS: A total of 279 patients were enrolled in this study, with 93 in the case group and 186 in the control group. The case group had an 82.83% chance of having lower peak nasal inspiratory flow values than the control group. In the case group, 75% of the peak nasal inspiratory flow values were in the lower standards, whereas in the control group, only 25% were in the lower standards. CONCLUSION: This study showed a high prevalence of reduced peak nasal inspiratory flow values in children with sickle cell disease and could certainly be incorporated into the day-to-day clinical evaluation of patients as a screening instrument.

Patência nasal em crianças respiradoras orais / Nasal patency in mouth breathing children

RESUMO Vários estudos mostram a importância da avaliação quantitativa na patência nasal e do estado funcional das vias aéreas superiores para fornecer informações clínicas e diagnósticas em indivíduos respiradores orais, as quais são de grande interesse para a fonoaudiologia. O objetivo deste estudo foi avaliar o efeito da irrigação de solução salina nasal nas vias aéreas superiores através da aeração nasal e rinomanometria anterior ativa em crianças respiradoras orais. Estudo de série de oito casos, realizado em crianças com idades entre 7 e 10 anos, com diagnóstico clínico otorrinolaringológico de respiração oral. O estudo consistiu em três etapas: avaliação inicial; intervenção e avaliação final. Foram aplicados os questionários do Índice de Identificação dos Sinais e Sintomas da Respiração Oral e qualidade de vida específica para doenças em pacientes pediátricos com queixas sinonasais. Realizaram-se as avaliações da aeração nasal e o exame da rinomanometria anterior ativa. A intervenção foi realizada por meio da irrigação de solução salina nasal com 10 ml. Em seguida, os pacientes foram reavaliados pela avaliação da aeração nasal e rinomanometria, para comparar os resultados. Em relação à avaliação da aeração nasal e rinomanometria, das 16 medidas comparativas entre pré e pós-irrigação nasal, constataram-se mudanças significativas na aeração nasal e na resistência nasal. A irrigação nasal resultou em melhora nas medidas da aeração nasal, enquanto para o fluxo nasal da rinomanometria, as medidas permaneceram inalteradas entre pré e pós-irrigação nasal.

ABSTRACT Several studies have shown the importance of quantitative assessment in nasal patency and functional status of the upper airways to provide clinical and diagnostic information in oral breather individuals, which are of great interest to speech therapy. The aim of the study was to evaluate the effect of nasal saline solution irrigation on the upper airways through nasal aeration and active anterior rhinomanometry in oral breathing children. This was an eight case series study, carried out in children aged 7 to 10 years with an otorhinolaryngological clinical diagnosis of mouth breathing. The study consisted of three stages: (I) initial evaluation; (II) intervention; and (III) final evaluation. The questionnaires of the Index for the Identification of Oral Breathing Signs and Symptoms and disease-specific quality of life in pediatric patients with sinonasal complaints were applied, nasal aeration assessments and the anterior active rhinomanometry exam were carried out. The intervention was performed by irrigating nasal saline solution with 10ml. Afterwards, they were re-evaluated by nasal aeration evaluation and rhinomanometry to compare the results. Regarding nasal aeration and rhinomanometry evaluation, from the 16 comparative measurements between pre and post nasal irrigation, we obtained significant changes in nasal aeration and nasal resistance. Nasal irrigation resulted in improvement in nasal aeration measurements while nasal flow measurements from rhinomanometry remained unchanged considering pre and post nasal irrigation.

PRE & POST OPERATIVE ASSESSMENT OF NASAL AIRFLOW BY ACTIVE ANTERIOR RHINOMANOMETRY IN OBSTRUCTIVE NASAL PATHOLOGIES

Nasal obstruction is a common symptom seen across various nasal pathologies, the objective way of measuring nasal obstruction is active rhinomanometry. To measure the difference in the nasal air?ow of cases of nasal pathology with nasal obstruction, a prospective study was undertaken to compare the pre and post-operative rhinomanometry ?ndings in cases presenting with nasal obstruction

Allergic rhinitis improvement after septorhinoplasty in a sample of allergic rhinitis patients with septal deviation: a quasi-experimental study

ABSTRACT BACKGROUND: Allergic rhinitis (AR) is a chronic inflammatory disease that affects almost 30% of the adult population. OBJECTIVE: To describe and compare the evolution of symptoms in patients diagnosed with AR and septal deviation prior to and following septoplasty (STP). DESIGN AND SETTING: Quasi-experimental study developed in A Coruña University Hospital. METHODS: Patients aged 18-65 years who had been diagnosed with AR and septal deviation were recruited. Obstruction airflow was evaluated before and after surgery, by means of anterior rhinomanometry (RNM). Severity symptoms and quality of life were assessed using a visual analogue scale (VAS) and the ESPRINT questionnaire, respectively. RESULTS: A total of 50 subjects underwent STP and 42 were included in this study. Their mean age at the time of surgery was 34.16 ± 9.74 years (range 18-64). Significant reductions in mean VAS and ESPRINT were observed after surgery (P < 0.01). These outcomes were considered to represent an overall improvement in quality of life. The RNM results also improved significantly, from mean values of 478.07 ± 165.4 cm3/s before STP to 826.4 ± 175.5 cm3/s afterwards (P < 0.01). CONCLUSIONS: The negative correlations of VAS and ESPRINT with RNM, from before and to after STP, demonstrate the efficacy of scales and questionnaires as objective methods for determining obstruction in the absence of rhinomanometry. Patients with allergic rhinitis and septal deviation showed improvements in obstruction severity and medication use after STP.

Mímica facial durante a fala em fissura labiopalatina: uma proposta de classificação / Facial grimace during speech in cleft lip and palate: a proposal for classification

RESUMO Objetivo Investigar a efetividade de proposta de classificação da mímica facial (MF), e sua correlação com avaliação objetiva do fechamento velofaríngeo (FVF). Método Vinte indivíduos com fissura labiopalatina reparada foram submetidos à medida da área velofaríngea por meio da rinomanometria e à gravação de amostra de fala. A MF foi classificada em dois momentos, por três fonoaudiólogas. Inicialmente as avaliadoras classificaram a MF, utilizando critérios próprios, em: 1=MF ausente; 2=leve; 3=moderada; 4=grave. Posteriormente, foram submetidas a um treinamento com o estabelecimento dos seguintes critérios de classificação: 1=MF normal; 2=movimento somente de nariz ou terço superior da face; 3=movimento acentuado de nariz ou terço superior da face; 4=movimento de nariz e terço superior da face e, classificaram a MF utilizando os critérios estabelecidos. Concordância intra e interavaliadores foram calculadas pelo coeficiente Kappa ponderado. A correlação entre os resultados das etapas com o FVF foi feita pelo coeficiente de correlação de Spearman. Resultados Na primeira etapa, a concordância interavaliadores variou de regular a substancial e na segunda, de substancial a quase perfeita. A concordância intra-avaliadores variou de moderada a quase perfeita na primeira etapa, e de moderada a substancial, na segunda etapa. A correlação entre a MF e área velofaríngea na primeira e na segunda etapa foi positiva e significativa. Conclusão A proposta de julgamento da MF mostrou-se efetiva na determinação do sintoma e confiável no diagnóstico da gravidade da disfunção velofaríngea. A correlação significativa entre os métodos perceptivo e instrumental sugere que a MF pode ser utilizada na previsão do FVF.

ABSTRACT Purpose To investigate the effectiveness of a proposal for classification of facial grimace (FG) and its correlation with objective evaluation of velopharyngeal closure (VPC). Methods Twenty individuals with repaired cleft lip and palate underwent velopharyngeal area measurement by means of rhinomanometry and speech sample recording. The FG was rated in two steps, by three speech-language pathologists. First the evaluators rated the FG using their own criteria as: 1= absent FG; 2=mild; 3=moderate; 4=severe. Subsequently, they were submitted to a training session that established the following FG rating criteria: 1=absent FG; 2=movement only of the nose or upper third of the face; 3=strong movement of the nose or upper third of the face; 4=movement of the nose and upper third of the face. The evaluators rated the FG using the established criteria. Intra- and inter-rater agreement were calculated using weighted Kappa coefficient. Correlation between the two stage ratings with the VPC was calculated by Spearman's correlation coefficient. Results In the first stage inter-rater agreement ranged from fair to substantial; in the second stage, from substantial to almost perfect. Intra-rater agreement ranged from moderate to almost perfect in the first stage, and from moderate to substantial in the second stage. The correlation between FG and velopharyngeal area was positive and significant in both stages. Conclusion The proposed FG judgement proved to be effective in determining the symptom and reliable in diagnosing the severity of velopharyngeal dysfunction. The significant correlation between perceptual and instrumental methods suggests that FG can be used in predicting VPC.

Repercussão da adenotonsilectomia sobre o estado nutricional em crianças respiradoras orais / Repercussion of adenotonsillectomy on the nutritional status of mouth breathing children

Introdução: a hiperplasia adenotonsilar (HAT) é uma das causas mais comuns da Síndrome do Respirador Oral (SRO) devido à obstrução de via aérea superior em crianças e adolescentes. Tal afecção pode causar alterações ortodônticas, miofuncionais orofaciais, posturais, cardiopulmonares, antropométricas e polissonográficas. O diagnóstico precoce e indicação de Adenotonsilectomia (A&T) é essencial para reversão dessas consequências deletérias da SRO e restauração do bem estar biopsicossocial da criança.Objetivo: avaliar o estado nutricional, patência nasal, distúrbios do sono e fator de crescimento semelhante à insulina tipo 1 (IGF-1) em crianças de dois a doze anos de idade com SRO devido HAT grave e comparar com a reavaliação após seis meses de pós-cirúrgico das crianças operadas e com as demais que permanecem com obstrução da via aérea e aguardam a cirurgia na fila de espera do Sistema Único de Saúde. Métodos: trinta pacientes com SRO por HAT grave e indicação de A&T foram submetidos à avaliação antropométrica, polissonográfica, dosagem do IGF-1, rinomanométrica, teste alérgico cutâneo, questionário de padrão alimentar e prática de atividade física antes da A&T. Dez pacientes repetiram essa avaliação seis meses após o procedimento cirúrgico (grupo intervenção). Vinte pacientes aguardam a cirurgia na fila de espera do SUS e tiveram seus dados antropométricos e de IGF-1 reavaliados após seis meses com obstrução da via aérea (grupo controle). Resultados: trinta crianças realizaram a fase pré-operatória do estudo. A idade média foi de 5,6 anos (±2,17). Dezessete (56,7%) eram do sexo masculino e treze (43,3%) do sexo feminino. O teste cutâneo foi positivo em dezesseis indivíduos (53,3%) As médias dos escores Z de estatura por idade foi de -0,95 (±1,09); peso por idade de 0,17 (±1,42); índice de massa corporal (IMC) por idade de 0,31 (±1,36). A média do fluxo nasal inspiratório total (FNIT) foi de 444,63 ml/s (±161,02) e da patência nasal de 72,9% (±24,76). A média do índice de Apneia e Hipopneia (IAH) do sono foi de 4,95 ev/h (±4,07); da saturação mínima de oxihemoglobina no sono (Nadir de O2) de 78,93% (±6,00); da percentagem de sono com saturação menor que 90% (T90) de 4,16% (±5,48); da porcentagem do sono com ondas lentas (sono N3) de 37,62% (±9,61). A média do escore Z de IGF-1 foi de 0,72 (±1,30). O grupo intervenção e grupo controle não apresentaram alterações dos dados antropométricos com significância estatística. Houve diminuição do IGF-1 após a cirurgia sendo a média do escore Z de IGF-1 pré-operatório de 1,33 (±1,74) e pós-cirúrgico de -0,07 (±0,85); p=0,03. No grupo controle a variação do IGF-1 não foi significativa. O grupo intervenção não apresentou alteração com significância estatística do FNIT e da patência nasal. Nas dez crianças operadas foi constatada uma melhora da média do IAH de 5,25 ev/h (±4,29) para 1,99 ev/h (±1,16) e do T90 de 6,27% (±7,46) para 0,64% (±0,55) com p<0,05. Já o sono N3 e o Nadir de O2 não apresentaram alterações significativas. Não houve mudança qualitativa no padrão alimentar e na prática de atividade física nos dois períodos avaliados na vigência da pandemia de COVID19. Conclusão: Após A&T houve diminuição do IGF-1; p=0,03, melhora do IAH; p=0,03 e do T90; p=0,04. A cirurgia não modificou o estado nutricional com significância estatística nas dez crianças após 6 meses de pós-operatório. No pós-cirúrgico, não houve diferença estatística do FNIT e da patência nasal, assim como nessa amostra também não ocorreram alterações significativas do sono N3 e do Nadir de O2. O padrão alimentar e a prática de atividade física foram semelhantes qualitativamente no pré e no pós-operatório. Vinte crianças no grupo controle não tiveram alterações significativas dos dados antropométricos e do IGF-1 com seis meses de espera pela cirurgia e permanência da obstrução da via aérea. Não houve diferença estatística dos dados antropométricos e do IGF-1 entre o grupo controle e o grupo intervenção.

Introduction: adenotonsillar hyperplasia (ATH) is one of the most common causes of Mouth Breathing Syndrome (MBS) due to upper airway obstruction in children and adolescents. This condition can cause orthodontic, orofacial myofunctional, postural, cardiopulmonary, anthropometric and polysomnographic changes. Early diagnosis and indication of Adenotonsillectomy (T&A) is essential to revert these deleterious consequences of MBS and restore the child's biopsychosocial well-being. Objective: to evaluate the nutritional status, nasal patency, sleep disorders and insulin-like growth factor 1 (IGF-1) in children aged two to twelve years old with MBS due to severe ATH and compare with reassessment after six months post-surgical care of operated children and others who remain with airway obstruction and are waiting for surgery on the Unified Health System (UHS) waiting list. Methods: Thirty patients with MBS due to severe ATH and indication for T&A were submitted to anthropometric, polysomnographic, IGF-1 dosage, rhinomanometric, allergic skin test, dietary pattern questionnaire and physical activity practice before T&A. Ten patients repeated this evaluation six months after the surgical procedure (intervention group). Twenty patients were waiting for surgery on the UHS waiting list and had their anthropometric and IGF-1 data reassessed after six months with airway obstruction (control group). Results: Thirty children underwent the preoperative phase of the study. The mean age was 5.6 years (±2.17). Seventeen (56.7%) were male and thirteen (43.3%) were female. The skin test was positive in sixteen individuals (53.3%) The average Z-scores for height for age were -0.95 (±1.09); weight for age 0.17 (±1.42); body mass index (BMI) for age of 0.31 (±1.36). The mean total inspiratory nasal flow (TINF) was 444.63 ml/s (±161.02) and nasal patency was 72.9% (±24.76). The average sleep apnea and hypopnea index (AHI) was 4.95 ev/h (±4.07); minimum oxyhemoglobin saturation during sleep (O2 Nadir) of 78.93% (±6.00); percentage of sleep with saturation lower than 90% (T90) of 4.16% (±5.48); percentage of sleep with slow waves (N3) of 37.62% (±9.61). The mean IGF-1 Z-score was 0.72 (±1.30). The intervention group and control group did not show statistically significant changes in anthropometric data. There was a decrease in IGF-1 after surgery, with a mean preoperative IGF-1 Z-score of 1.33 (±1.74) and postoperative value of -0.07 (±0.85); p=0.03. In the control group, the IGF-1 variation was not significant. The intervention group did not show statistically significant changes in TINF and nasal patency. In the ten operated children, an improvement in the mean AHI from 5.25 ev/h (±4.29) to 1.99 ev/h (±1.16) and T90 of 6.27% (±7. 46) to 0.64% (±0.55) with p<0.05. On the other hand, N3 sleep and O2 Nadir showed no significant changes. There was no qualitative change in dietary patterns and physical activity in the two periods evaluated during the COVID19 pandemic. Conclusion: After T&A there was a decrease in IGF-1; p=0.03, AHI improvement; p=0.03 and T90 too; p=0.04. The surgery did not change the nutritional status with statistical significance in the ten children after 6 months postoperatively. Post-surgery, there was no statistical difference in TINF and nasal patency, as well as in this sample there were no significant changes in N3 sleep and O2 Nadir either. The dietary pattern and the practice of physical activity were qualitatively similar before and after the operation. Twenty children in the control group did not have significant alterations in anthropometric data and IGF-1 after six months of waiting for the surgery and the remaining airway obstruction. There was no statistical difference in anthropometric and IGF-1 data between the control and intervention groups.

Análisis facial en la rinoseptoplastia funcional. Estudio descriptivo / Facial analysis in functional rhinoseptoplasty. Descriptive study

Objetivo: analizar las características del perfil facial como herramienta fundamental en la rinoseptoplastia funcional de los pacientes que consultan en la Unidad de Rinología del Servicio de Otorrinolaringología del Hospital Militar Dr. Carlos Arvelo, entre enero y abril de 2016. El rostro está formado por estructuras anatómicas que le proporcionan características determinadas. La nariz ocupa un lugar central, el diagnóstico preciso de las alteraciones nasales es el paso más importante y complejo de una rinoseptoplastia funcional. El propósito de la restauración quirúrgica de la nariz es asegurar el buen funcionamiento y la armonía en la forma, por lo que los ángulos del perfil facial son relevantes en la valoración prequirúrgica. Materiales y métodos: estudio descriptivo ­ observacional de corte transversal. La muestra estuvo conformada por 25 pacientes que accedieron voluntariamente a realizar estudio fotográfico y rinomanometría. Resultados: predominio del sexo femenino con 72% de la muestra total. El grupo etario preponderante estuvo conformado en un 92% por adultos jóvenes. En cuanto a los ángulos nasolabial y nasofacial, presentaron alteraciones el 56% y el 24% respectivamente. Se practicó rinomanometría a la población evidenciando 100% alteración (factor valvular), de los cuales un 80% presentaron modificación de los ángulos nasofacial y nasolabial. Conclusiones: la correlación entre la variación de los ángulos nasofacial y nasolabial con la permeabilidad nasal, establece que el análisis facial puede considerarse como herramienta fundamental para la determinación de correcciones estéticas y funcionales en la rinoseptoplastia funcional..Au

Objective: to analyze the characteristics of the facial profile as a fundamental tool in functional rhinoseptoplasty of patients who consult in the Rhinology Unit of the Otolaryngology Service of the Hospital Militar Dr. Carlos Arvelo, between January and April 2016. The face is made up of structures anatomical that provide certain characteristics. The nose occupies a central place, the precise diagnosis of nasal alterations is the most important and complex step of a functional rhinoseptoplasty. The purpose of the surgical restoration of the nose is to ensure proper function and harmony in shape, so the angles of the facial profile are relevant in the presurgical assessment. Materials and methods: descriptive-observational cross-sectional study. The sample consisted of 25 patients who voluntarily agreed to carry out a photographic study and rhinomanometry.Results: prevalence of the female sex with 72% of the total sample. The preponderant age group was made up of 92% young adults. Regarding the nasolabial and nasofacial angles, 56% and 24% presented alterations respectively. Rhinomanometry was performed on the population showing 100% alteration (valvular factor), of which 80% presented modification of the nasofacial and nasolabial angles. Conclusions: the correlation between the variation of the nasofacial and nasolabial angles with nasal patency establishes that facial analysis can be considered as a fundamental tool for determining aesthetic and functional corrections in functional rhinoseptoplasty..Au

Effects of oral isotretinoin therapy on the nasal cavities / Efeitos nasais da terapia com isotretinoína oral

Abstract Introduction Isotretinoin (13 cis-retinoic acid) is the most effective treatment for acne vulgaris and is the only treatment option that can provide either remission or a permanent cure. Objective The aim of this study was to use both subjective and objective methods to assess the nasal complaints of patients with severe acne who received oral isotretinoin therapy. Methods Fifty-four subjects were enrolled in the study. All the subjects were assessed with subjective (NOSE and VAS questionnaires) and objective (rhinomanometry and saccharine) tests to determine the severity of their nasal complaints. Results The mean severity scores (min: 0; max: 100) for nasal dryness/crusting and epistaxis were 0.47 ± 1.48 (0-5); 0.35 ± 1.30 (0-5) at admission, 3.57 ± 4.45 (0-10); 2.26 ± 4.71 (0-20) at the first month, and 4.28 ± 6 (0-20); 2.26 ± 4.71 (0-20) at the third month of the treatment respectively. Total nasal resistance of 0.195 ± 0.079 (0.12-0.56) Pa/cm3/s at admission, 0.21 ± 0.084 (0.12-0.54) Pa/cm3/s at the first month, and 0.216 ± 0.081 (0.14-0.54) Pa/cm3/s at the third month. Conclusion Oral isotretinoin therapy can cause the complaint of nasal obstruction. In addition, nasal complaints, such as dryness/crusting and epistaxis, significantly increase in patients during the therapy schedule.

Resumo Introdução A isotretinoína (ácido-13 cis-retinóico) é o tratamento por via oral mais eficaz para acne vulgar e é a única opção de tratamento que pode produzir remissão ou cura permanente. Objetivo Usar métodos subjetivos e objetivos para avaliar as queixas nasais de pacientes com acne grave que receberam terapia com isotretinoína oral. Método Foram incluídos no estudo 54 indivíduos. Todos os indivíduos foram avaliados por meio de testes subjetivos (questionários NOSE e escala EVA) e objetivos (rinomanometria e teste de sacarina) para determinar a gravidade de suas queixas nasais. Resultados Os escores médios de gravidade (min: 0; max: 100) para ressecamento/crostas e epistaxe nasal foram de 0,47 ± 1,48 (0-5); 0,35 ± 1,30 (0-5) no início, 3,57 ± 4,45 (0-10); 2,26 ± 4,71 (0-20) no primeiro mês e 4,28 ± 6 (0-20); 2,26 ± 4,71 (0-20) no terceiro mês do tratamento, respectivamente. A resistência nasal total foi de 0,195 ± 0,079 (0,12 a 0,56) Pa/cm3/s no início, 0,21 ± 0,084 (0,12 a 0,54) Pa/cm3/s no primeiro mês e 0,216 ± 0,081 (0,14 a 0,54) Pa/cm3/s no terceiro mês. Conclusão A terapia com isotretinoína por via oral pode resultar em queixa de obstrução nasal. Além disso, queixas nasais, tais como ressecamento/formação de crostas e epistaxe, aumentam significativamente nos pacientes durante o esquema terapêutico.

Nasality Changes With Age in Normal Korean-Speaking Adults

OBJECTIVES: This study was performed to investigate the effects of aging on nasality and the influence of age-related changes in nasal cavity volume and nasal patency on nasality. METHODS: A total of 180 healthy Korean-speaking adult volunteers, who had no nasal or voice-related complaints, were enrolled in this study. Nasometry, acoustic rhinometry, and rhinomanometry were performed to obtain the nasalance score, nasal cavity volume, and nasal resistance, respectively. Changes in these parameters with age were analyzed. RESULTS: Nasal cavity volume increased significantly, and nasal resistance decreased significantly, with age. The nasalance scores for the nasal passage and oronasal passage decreased significantly with age, while there were no age-related changes in nasalance scores for the oral passage. CONCLUSION: Nasalance scores for the passages containing nasal consonants decreased with age although significant increases were observed in nasal cavity volume and nasal patency with age. Therefore, the age-related decreases in nasalance scores may result from factors other than changes in the nasal cavity.

Evaluation of pre- and post-pyriform plasty nasal airflow / Avaliação do fluxo aéreo nasal pré e pós-piriformeplastia

Abstract Introduction: Nasal obstruction is a frequent complaint in otorhinolaryngology outpatient clinics, and nasal valve incompetence is the cause in most cases. Scientific publications describing surgical techniques on the upper and lower lateral cartilages to improve the nasal valve are also quite frequent. Relatively few authors currently describe surgical procedures in the piriform aperture for nasal valve augmentation. We describe the surgical technique called pyriform plasty and evaluate its effectiveness subjectively through the NOSE questionnaire and objectively through the rhinomanometry evaluation. Objective: To compare pre- and post-pyriform plasty nasal airflow variations using rhinomanometry and the NOSE questionnaire. Methods: Eight patients submitted to pyriform surgery were studied. These patients were screened in the otorhinolaryngology outpatient clinic among those who complained of nasal obstruction, and who had a positive response to Cottle maneuver. They answered the NOSE questionnaire and were submitted to preoperative rhinomanometry. After 90 days, they were reassessed through the NOSE questionnaire and the postoperative rhinomanometry. The results of these two parameters were compared pre- and postoperatively. Results: Regarding the subjective measure, the NOSE questionnaire, seven patients reported improvement, of which two reported marked improvement, and one patient reported an unchanged obstructive condition. Regarding the rhinomanometry assessment, of 96 comparative measurements between the preoperative and postoperative periods, we obtained 68 measurements with an increase in nasal airflow in the postoperative period, 26 negative results, and two cases that remained unaltered between the preoperative and postoperative periods. Conclusion: When analyzing the results obtained in this study, we can conclude that the piriform plasty surgical procedure resulted in nasal airflow improvement in most of the obtained measurements.

Resumo Introdução: A obstrução nasal é queixa frequente nos ambulatórios de otorrinolaringologia, e a incompetência da válvula nasal é responsável em grande parte dos casos. São bastante frequente também as publicações de trabalhos científicos descrevendo técnicas cirúrgicas sobre as cartilagens laterais superiores e inferiores para melhorar a válvula nasal. Relativamente poucos autores descrevem atualmente procedimentos cirúrgicos na abertura piriforme para incremento da válvula nasal. Descrevemos a técnica cirúrgica chamada piriformeplastia e avaliamos a sua eficácia de forma subjetiva através do questionário NOSE e de forma objetiva através do exame rinomanometria. Objetivo: Comparar as variações do fluxo aéreo nasal pré e pós-piriformeplastia através da rinomanometria e do questionário NOSE. Método: Foram estudados 8 pacientes submetidos à piriformeplastia. Estes pacientes foram triados no ambulatório de otorrinolaringologia, pacientes estes que se queixavam de obstrução nasal, e que apresentavam resposta positiva a manobra de Cottle. Responderam ao questionário NOSE e foram submetidos a rinomanometria no pré-operatório. Após 90 dias foram reavaliados pelo questionário NOSE e pela rinomanometria pós-operatória. Os resultados desses dois parâmetros foram comparados pré e pós-operatoriamente. Resultados: Em relação a medida subjetiva, questionário NOSE, sete pacientes referiram melhora, sendo que dois deles referiram melhora acentuada, e um paciente referiu quadro obstrutivo inalterado. Em relação ao exame rinomanometria, de 96 medidas comparativas entre o pré e o pós-operatório, obtivemos 68 medidas com incremento ao fluxo aéreo nasal no pós-operatório, 26 resultados negativos, e dois casos inalterados entre pré e pós-operatório. Conclusão: O procedimento cirúrgico piriformeplastia conferiu melhoria do fluxo aéreo nasal na maioria das medidas obtidas.

Functional results in airflow improvement using a "flip-flap" alar technique: our experience / Resultados funcionais na melhora do fluxo de ar utilizando uma técnica alar em flip-flap: nossa experiência

Abstract Introduction Pinched nasal point can be arising as congenital malformation or as results of unsuccessfully surgery. The nasal valve alteration due to this problem is not only an esthetic problem but also a functional one because can modify the nasal airflow. Several surgical techniques were proposed in literature, we proposed our. Objective The purpose of the study is the evaluation of nose airway flow using our flip-flap technique for correction of pinched nasal tip. Methods This is a retrospective study conducted on twelve patients. Tip cartilages were remodeled by means of autologous alar cartilage grafting. The patients underwent a rhinomanometry pre and post-surgery to evaluate the results, and they performed a self-survey to evaluate their degree of satisfaction in term of airflow sensation improvement. Results Rhinomanometry showed improved nasal air flow (range from 25% to 75%) in all patients. No significant differences were showed between unilateral and bilateral alar malformation (p = 0.49). Patient's satisfaction reached the 87.5%. Conclusion Our analysis on the combined results (rhinomanometry and surveys) showed that this technique leads to improvement of nasal flow in patients affected by pinched nasal tip in all cases.

Resumo Introdução A ponta nasal comprimida pode surgir como malformação congênita ou como o desfecho de uma cirurgia malsucedida. A alteração da válvula nasal devido a esse problema não é apenas um problema estético, mas também funcional, porque pode modificar o fluxo aéreo nasal. Várias técnicas cirúrgicas têm sido propostas na literatura; aqui, propomos a nossa. Objetivo O objetivo do estudo é a avaliação do fluxo das vias aéreas nasais utilizando nossa técnica de flip-flap para correção da ponta nasal comprimida. Métodos Este é um estudo retrospectivo realizado em doze pacientes. As cartilagens da ponta nasal foram remodeladas através de enxerto de cartilagem alar autóloga. Os pacientes foram submetidos à rinomanometria pré e pós-cirúrgica para avaliar os resultados, e realizaram uma auto-avaliação para avaliar seu grau de satisfação em termos de melhora da sensação do fluxo aéreo. Resultados e conclusão Nossa análise dos resultados combinados (rinomanometria e autoavaliação) mostrou que essa técnica melhora o fluxo nasal em pacientes afetados por ponta nasal comprimida em todos os casos. A satisfação do paciente atingiu os 87,5%.

Dimensões nasofaríngeas em indivíduos sem anomalias craniofaciais: dados normativos / Nasopharyngeal dimensions in normal individuals: normative data

RESUMO Objetivo Determinar os valores controles da área de secção transversa mínima nasofaríngea de indivíduos sem anomalias craniofaciais e em diferentes faixas etárias. Material e Método Participaram do estudo 96 indivíduos sem anomalias craniofaciais, de ambos os sexos, com índice de massa corpórea e circunferência cervical normais, subdivididos em 4 grupos etários: crianças com idade entre 6 e 10 anos (G1), adolescentes de 11 a 17 anos (G2), adultos jovens entre 18 e 39 anos (G3) e adultos de meia-idade entre 40 e 59 anos (G4). A área seccional transversa mínima nasofaríngea (área nasofaríngea – ANF) foi determinada por meio de rinomanometria anterior modificada (técnica fluxo-pressão), utilizando o sistema PERCI-SARS (versão 3.50 – Microtronics Corp.). Resultados Os valores médios±DP da ANF foram de 1,025±0,054cm2, 1,055±0,081cm2, 1,050±0,083cm2 e 1,054±0,081cm2, respectivamente, para G1, G2, G3 e G4, não havendo diferença entre as 4 faixas etárias. Conclusão Os valores controles da ANF foram determinados para indivíduos sem anomalias craniofaciais de diferentes faixas etárias e servirão de referência na rotina clínica e em estudos envolvendo diagnóstico de obstrução nasofaríngea, principalmente na presença de anomalias craniofaciais.

ABSTRACT Objective To establish normative values of minimum cross-sectional nasopharyngeal area in individuals without craniofacial anomalies at different age ranges. Material and Method Ninety-six individuals of both genders, without craniofacial anomalies, and with normal body mass index and neck circumference were evaluated. Participants were divided into 4 age groups: children, aged 6 to 10 years (G1); adolescents, aged 11 to 17 years (G2); young adults, 18 to 39 years (G3), and middle-aged adults, 40 to 59 years (G4). Minimum cross-sectional nasopharyngeal area (nasopharyngeal area – NPA) was assessed by means of modified anterior rhinomanometry (pressure-flow technique) using a PERCI-SARS system (version 3.50 – Microtronics Corp.). Results Mean±SD values of NPA were 1.025±0.054cm2, 1.055±0.081cm2, 1.050±0.083cm2, and 1.054±0.081cm2, respectively for groups G1, G2, G3, and G4, showing that there were no differences between the four age groups. Conclusion Normative data of NPA were established for individuals without craniofacial anomalies from different age ranges, and they may be used as reference values in the clinical routine and for future studies regarding nasopharyngeal obstruction diagnosis, particularly in cases of craniofacial anomalies.

Effect of Septoplasty on Voice Quality: A Prospective-Controlled Trial

OBJECTIVES: The purpose is to investigate effect of septoplasty and widened nasal patency on voice quality. METHODS: Fifty patients who undergone septoplasty were included in the study. Thirty-three people who had similar age and distribution were enrolled as control group. Before and 1 and 3 months after surgery, anterior rhinomanometry, voice analysis by Multi-Dimensional Voice Program, and spectrographic analysis were performed to patients. The recordings of /a/ vowel were used to evaluate average fundamental frequency (F0), jitter percent, and shimmer percent. In spectrographic analyses, F3–F4 values for the vowels /i, e, a, o, and u/, nasal formant frequencies of the consonants /m/ and /n/ in the word /mini/, and 4 formant frequencies (F1, F2, F3, and F4) for nasalized /i/ vowel following a nasal consonant /n/ in the word /mini/ were compared. The differences in nasal resonance were evaluated. All patients were asked whether change in their voices after the surgery. Preoperative and postoperative voice parameters and anterior rhinomanometry results were compared separately with the control group as well as in the patient group itself. RESULTS: Preoperative total nasal resistance (TNR) values of patients were higher than the control group (P=0.001). TNR values of patients measured one day before surgery and after surgery in the 1st and 3rd months were different and these differences were significant statistically (P=0.001). There was no significant difference between the voice analysis parameters in preoperative, postoperative 1st, and 3rd months. As a result of their subjective reviews, 12 patients (36%) noted their voices were better than before surgery and 20 patients (61%) noted no change before and after surgery. CONCLUSION: Providing widened nasal cavity has no effect on voice quality.

Análise comparativa da atividade velofaríngea aferida por rinometria acústica e rinomanometria / Comparative analysis of velopharyngeal activity assessed by acoustic rhinometry and rhinomanometry

RESUMO Objetivo: Analisar a atividade velofaríngea (VF) de indivíduos com disfunção velofaríngea (DVF) aferida por rinometria acústica, comparativamente à rinomanometria. Métodos: Estudo clínico prospectivo em 41 adultos, de ambos os gêneros, com fissura de palato±lábio previamente operada e DVF residual ao exame clínico, sem articulação compensatória nas plosivas surdas [p], [t] e [k]. Variáveis analisadas: (1) variação volumétrica da nasofaringe (∆V) na produção das três plosivas, relativamente ao repouso, por rinometria acústica (reduções <3 cm3 foram consideradas como ausência de atividade velofaríngea); (2) área do orifício velofaríngeo (área VF), por rinomanometria anterior modificada; áreas ≥0,05 cm2 foram consideradas como fechamento inadequado. Na comparação das técnicas foi utilizada a plosiva [p] (n=24). Resultados: Observou-se: (1) ∆V médio de 18% no [k], significantemente menor (p<0,05) que a redução relatada para normais (30%); valores de ∆V sugestivos de DVF constatados em 59% dos casos. Resultados similares foram obtidos no [p] e [t], mostrando-se mais apropriados para o exame rinométrico, por não envolverem a participação da língua no fechamento velofaríngeo, diferentemente da plosiva velar [k]; (2) fechamento VF inadequado em 85% dos casos. Não houve correlação significativa entre o ∆V e a área do orifício velofaríngeo. A concordância de diagnóstico entre os métodos ocorreu em 51% dos casos. Conclusão: A rinometria acústica não apresentou boa acurácia como método de diagnóstico da DVF frente ao método padrão. Demonstrou, contudo, potencial como método de acompanhamento dos resultados de intervenções clínico-cirúrgicas que levem à maior atividade velar e faríngea.

ABSTRACT Purpose: To analyze the velopharyngeal (VP) activity of subjects with velopharyngeal dysfunction (VPD) by acoustic rhinometry, as compared to rhinomanometry. Methods: This was a prospective clinical study conducted in 41 adults, both genders, with repaired cleft palate, with or without a previously repaired cleft lip, and residual VPD on clinical assessment, without compensatory articulations for [p], [t], and [k]. The outcome measures were as follows: (1) on acoustic rhinometry, nasopharyngeal volumetric change (ΔV) during [p], [t], and [k], relatively to rest condition (decreases by <3 cm3 considered as absence of VP activity); (2) on modified anterior rhinomanometry, VP orifice area (areas ≥0.05 cm2 considered as inadequate closure). The plosive [p] was used when comparing the techniques (n=24). Results: (1) A mean ΔV decrease of 18% was observed during [k], which was significantly lower (p<0.05) than the decrease reported for individuals without VPD (30%). ΔV values suggesting VPD were observed in 59% subjects. Similar results were obtained for [p] and [t], which shall be used as stimulus, given that they do not involve the use of the tongue to lift the velum during VP closure, differently from the velar plosive [k]. (2) Inadequate closure was seen in 85% subjects. No correlation was observed between ∆V and VP orifice area. Agreement between techniques was observed in 51% cases. Conclusion: Acoustic rhinometry had low accuracy as a diagnostic method of VPD when compared to the gold standard method. Nevertheless, the technique shows potential as a method for monitoring the outcomes of clinical and surgical treatment of VPD aimed at increasing velar and pharyngeal activity.

Relationship between velopharyngeal closure, hypernasality, nasal air emission and nasal rustle in subjects with repaired cleft palate / Correlação entre o fechamento velofaríngeo, hipernasalidade, emissão de ar nasal e ronco nasal em indivíduos com fissura de palato reparada

PURPOSE: To investigate the correlation among velopharyngeal closure, hypernasality, audible nasal air emission (NAE) and nasal rustle (NR), in individuals with repaired cleft palate. METHODS: One hundred patients with repaired cleft palate and lip, submitted to pressure-flow study for measurement of velopharyngeal orifice area (velopharyngeal area) and speech sample recordings. Velopharyngeal area was estimated during the production of the sound /p/ inserted in a sentence, and the velopharyngeal closure was classified as adequate, borderline or inadequate. Hypernasality was rated using a 4-point scale, NAE and NR were rated as absent or present, by three speech language pathologists, using recorded speech samples. Inter and intra-judge agreements were established. Statistical analysis was performed using the Spearman correlation coefficient considering p<0.05. An ordinal logistic regression model was developed to investigate whether the characteristics of speech can predict velopharyngeal closure. For this, the speech samples included in this analysis were those that obtained 100% agreement among raters as to the degree of hypernasality (43 out of 100). RESULTS: Significant correlation was found between hypernasality and velopharyngeal area; audible NAE and velopharyngeal area. A negative correlation was observed between the NR and velopharyngeal area. The regression analysis showed that the perceptual speech characteristics contributed significantly to predict the velopharyngeal closure. CONCLUSION: There is significant correlation between velopharyngeal closure and hypernasality, NAE and NR. It suggests that the perceptual speech characteristics can predict velopharyngeal closure, favoring the diagnosis and the definition of treatment conduct of velopharyngeal dysfunction. .

OBJETIVO: Investigar a correlação entre as dimensões do orifício velofaríngeo, hipernasalidade, emissão de ar nasal (EAN) audível e ronco nasal (RN), em indivíduos com fissura palatina reparada. MÉTODOS: Foram avaliados cem pacientes com fissura labiopalatina reparada, submetidos à medida da área do orifício velofaríngeo (área velofaríngea) por meio da técnica fluxo-pressão e à gravação de fala. A partir da área velofaríngea, determinada durante a produção de /p/ inserido numa frase, o fechamento velofaríngeo foi classificado em adequado, marginal e inadequado. A hipernasalidade foi classificada em escala de quatro pontos, EAN e RN em presente-ausente, por três fonoaudiólogas utilizando amostra de fala gravada. A concordância inter e intra-avaliadores foi estabelecida e a correlação entre as variáveis foi analisada por meio do coeficiente de correlação de Spearman, considerando p<0,05. Um modelo de regressão logística ordinal foi elaborado para investigar se as características da fala podem predizer o fechamento velofaríngeo. Para tanto, foram incluídas somente 43 amostras de fala que obtiveram 100% de concordância quanto ao grau de hipernasalidade entre as avaliadoras. RESULTADOS: Correlação significativa entre hipernasalidade e área velofaríngea; EAN audível e área velofaríngea. Correlação negativa foi verificada entre RN e área velofaríngea. O modelo logístico mostrou que as características da fala contribuíram significativamente para a previsão do fechamento velofaríngeo. CONCLUSÃO: Existe correlação entre dimensões do orifício velofaríngeo e hipernasalidade, EAN e RN, sugerindo que as características perceptivas da fala podem predizer o fechamento velofaríngeo, favorecendo o diagnóstico e a definição de conduta de tratamento da disfunção velofaríngea. .

Comparação entre cirurgia do retalho faríngeo e esfincteroplastia: análise nasométrica e aerodinâmica / Comparison between pharyngeal flap surgery and sphincteroplasty: nasometric and aerodynamic analysis

OBJETIVO: comparar o efeito do retalho faríngeo e da esfincteroplastia sobre a hipernasalidade da fala e o fechamento velofaríngeo no tratamento de indivíduos com insuficiência velofaríngea residual, por meio de avaliação instrumental. MÉTODOS: foram avaliados 30 pacientes, com fissura de palato±lábio reparada, submetidos à correção cirúrgica da insuficiência velofaríngea (15 com retalho faríngeo e 15 com esfincteroplastia), avaliados antes e, no mínimo, 1 ano após a cirurgia. A hipernasalidade foi estimada a partir dos escores de nasalância (correlato físico da nasalidade) obtidos por meio da nasometria, durante a leitura de 5 sentenças contendo, exclusivamente, sons orais, considerando como limite de normalidade o escore de 27%. O fechamento velofaríngeo foi aferido a partir da medida da área velofaríngea obtida por meio da técnica fluxo-pressão e foi classificado em: 0-4,9mm2=adequado; 5-19,9mm2=marginal e, >20mm2=inadequado. Diferenças entre as duas técnicas foram consideradas estatisticamente significantes ao nível de 5%. RESULTADOS: antes da cirurgia, os valores médios de nasalância foram de 43±8,4% e 45±14,2% e de área velofaríngea foram 51±35,4mm2, e 69±29,2mm2, para os grupos retalho faríngeo e esfincteroplastia, respectivamente. Após a cirurgia, os valores médios de nasalância reduziram para 27±10,1% e 31±14,2% e de área velofaríngea para 3,6±5,5mm2 e 24±32,7mm2 para os grupos retalho faríngeo e esfincteroplastia, respectivamente. A redução dos valores de nasalância e área velofaríngea foi estatisticamente significante nos dois grupos. CONCLUSÃO: estes resultados sugerem que o retalho faríngeo foi mais eficiente do que a esfincteroplastia na eliminação da hipernasalidade e adequação do fechamento velofaríngeo nos pacientes estudados. .

PURPOSE: to compare the effect of pharyngeal flap surgery and sphincteroplasty on hypernasality and velopharyngeal closure in velopharyngeal insufficiency management, by means of instrumental assessment. METHODS: thirty patients with repaired cleft palate±lip, submitted to surgical treatment for velopharyngeal insufficiency (15 pharyngeal flap and 15 sphincteroplasty) were evaluated before and, at least, 1 year after surgery. Hypernasality was estimated by means of nasalance scores (acoustic correlate of nasality) obtained by nasometry considering a cutoff score of 27%. Velopharyngeal closure was determined by the velopharyngeal area measurement. Nasalance scores were obtained by nasometry, during the reading of a set of 5 sentences containing exclusively oral sounds, considering the cutoff value of 27%. Velopharyngeal area was provided by the measurement of velopharyngeal area by means of pressure-flow technique and was classified as: 0 to 4.9 mm2=adequate; 5 to 19.9 mm2=borderline and ≥20mm2 inadequate. Differences between the two techniques were accepted as significant when p < 0.05. RESULTS: before surgery. nasalance mean scores were 43±8.4% and 45±14.2% and velopharyngeal area mean were 51±35.4mm2 and 69±29.2mm2 for the pharyngeal flap and sphincteroplasty groups, respectively. After surgery, nasalance mean scores were 27±10.1% and 31±14.2% and velopharyngeal area mean were 3.6±5.5mm2 and 24±32.7mm2 for the pharyngeal flap and sphincteroplasty groups, respectively. The reduction of the nasalance scores and velopharyngeal area was statistically significant in both groups. CONCLUSION: these results suggest that pharyngeal flap demonstrated to be more efficient than sphincteroplasty in the elimination of hypernasality and adequacy of velopharyngeal closure in the patients studied. .

A New Approach to Objective Evaluation of the Success of Nasal Septum Perforation

BACKGROUND: Perforations in the nasal septum (NSP) give rise not only to disintegration of the septum anatomy but also impairment in normal nasal physiology. The successes of these surgical techniques are usually equated to anatomical closure of the perforation. The goal of this study is to evaluate the subjective and objective results of our surgical technique for septal perforation surgery. METHODS: All NSPs in the six patients were closed by inferior turbinate flap. The Nasal Obstruction Symptom Evaluation (NOSE) instrument was used to evaluate the preoperative and postoperative subjective sensation of nasal obstruction. Measurement of preoperative and postoperative nasal airway resistance was performed using active anterior rhinomanometry which is an objective test. Wilcoxson signed rank test and Spearman correlation test were used to analyze correlation between NOSE scores and rhinomanometric measurements. RESULTS: The full closure of the septal perforations was noted in 100% of patients. The total NOSE score was 14 preoperatively and one postoperatively. The improvement in NOSE scores was statistically significant (P< or =0.002). The mean preoperative total resistance (ResT150) value was 0.13 Pa/cm(3)s(-1), which is below the normal range (0.16-0.31 Pa/cm(3)s(-1)), while the mean postoperative ResT150 value was 0.27 Pa/cm3s-1. The correlation between the improvement in NOSE scores and improvements in ResT150 values was statistically significant. CONCLUSIONS: Surgical approaches should aim to solve both the anatomical and physiological problems of NSP. The application of subjective and objective tests in the postoperative period will help surgeons assess the applied techniques.

Surgical outcome of pharyngeal flap surgery and intravelar veloplasty on the velopharyngeal function / Resultado cirurgico do retalho faringeo e da veloplastia intravelar sobre a funcao velofaringea

PURPOSE: To investigate the postoperative outcomes of pharyngeal flap surgery (PF) and secondary palatoplasty with intravelar veloplasty (IV) in the velopharyngeal insufficiency management regarding nasalance scores and velopharyngeal area. METHODS: Seventy-eight patients with cleft palate±lips submitted to surgical treatment for velopharyngeal insufficiency, for 14 months on an average, were evaluated: 40 with PF and 38 with IV, of both genders, aged between 6 and 52 years old. Hypernasality was estimated by means of nasalance scores obtained by nasometry with a cutoff score of 27%. The measurement of velopharyngeal orifice area was provided by the pressure-flow technique and velopharyngeal closure was classified as: adequate (0.000-0.049 cm2), adequate/borderline (0.050-0.099 cm2), borderline/inadequate (0.100-0.199 cm2), and inadequate (≥0.200 cm2). RESULTS: Absence of hypernasality was observed in 70% of the cases and adequate velopharyngeal closure was observed in 80% of the cases, in the PF group. In the IV group, absence of hypernasality was observed in 34% and adequate velopharyngeal closure was observed in 50% of the patients. Statistically significant differences were obtained between the two techniques for both evaluations. CONCLUSION: PF was more efficient than the secondary palatoplasty with IV to reduce hypernasality and get adequate velopharyngeal closure. .

OBJETIVO: Investigar os resultados cirúrgicos do retalho faríngeo (RF) e da palatoplastia secundária com veloplastia intravelar (VI) no tratamento de indivíduos com insuficiência velofaríngea (IVF) secundária quanto ao escore de nasalância e à área velofaríngea. MÉTODOS: Foram avaliados 78 pacientes com fissura de palato±lábio submetidos ao tratamento cirúrgico da IVF há 14 meses, em média, sendo 40 com RF e 38 com VI, de ambos os sexos, faixa etária de seis a 52 anos. A hipernasalidade foi estimada a partir da medida de nasalância obtida por meio da nasometria, considerando-se o escore de 27% como limite de normalidade. A medida da área do orifício velofaríngeo foi obtida por meio da técnica fluxo-pressão, sendo o fechamento velofaríngeo classificado em: adequado (0,000-0,049 cm2); adequado/marginal (0,050-0,099 cm2); marginal/inadequado (0,100-0,199 cm2); e inadequado (≥0,200 cm2). RESULTADOS: Ausência de hipernasalidade foi observada em 70%, e fechamento velofaríngeo adequado em 80% dos casos no grupo RF. No grupo VI, ausência de hipernasalidade foi observada em 34% e fechamento velofaríngeo adequado em 50% dos casos. Diferenças estatisticamente significantes foram obtidas entre as duas técnicas cirúrgicas nas duas modalidades de avaliação. CONCLUSÃO: A cirurgia de retalho faríngeo foi mais eficiente do que a palatoplastia secundária com veloplastia intravelar na redução da hipernasalidade e na adequação do fechamento velofaríngeo. .

Dimensões nasofaríngeas e sintomas respiratórios após a cirurgia de retalho faríngeo em crianças e adultos / Nasopharyngeal dimensions and respiratory symptoms after pharyngeal flap surgery in children and adults

OBJETIVO: Verificar a influência da idade sobre as dimensões nasofaríngeas e os sintomas respiratórios em pacientes submetidos à cirurgia para a correção da insuficiência velofaríngea pela técnica de retalho faríngeo. MÉTODOS: Amostra formada por 103 indivíduos distribuídos em três grupos: crianças (6 a 12 anos), adultos jovens (18 a 30 anos) e adultos de meia-idade (≥40 anos). Trata-se de estudo retrospectivo que analisou os valores da área nasofaríngea (técnica fluxo-pressão, valor de referência 0,570 cm²) e os sintomas de respiração oral, ronco e dificuldade respiratória durante sono, obtidos, em média, 12 meses após a cirurgia. A área nasofaríngea foi comparada entre os grupos por análise de variância e os sintomas respiratórios pelo teste Qui-quadrado (p<0,05). RESULTADOS: Os valores médios da área nasofaríngea após a cirurgia foram 0,527±0,215 cm², 0,599±0,213 cm² e 0,488±0,276 cm², respectivamente para crianças, adultos jovens e adultos de meia-idade, não havendo diferença entre os grupos. As proporções de respiração oral, ronco e dificuldade respiratória durante o sono foram, respectivamente, 66%, 69% e 9% nas crianças, 51%, 49% e 7% nos adultos jovens e 75%, 75% e 19% nos adultos de meia-idade, com maior frequência de ronco nos adultos de meia-idade. CONCLUSÃO: A idade não interferiu nas dimensões nasofaríngeas na presença de retalho faríngeo, mas foi um fator agravante de sintomas respiratórios, principalmente nos indivíduos mais velhos.

PURPOSE: To investigate the influence of age on nasopharyngeal dimensions and respiratory symptoms in patients undergoing surgery to correct velopharyngeal insufficiency using the pharyngeal flap technique. METHODS: A sample comprising 103 individuals divided into three groups: children (6-12 years old), young adults (18-30 years old) and middle-aged adults (≥ 40 years old). This was a retrospective study that analyzed the values for the nasopharyngeal area (pressure-flow technique, reference value: 0.570 cm²) and the symptoms of oral respiration, snoring and respiratory difficulties during sleep. The values were obtained, on average, 12 months after surgery. The nasopharyngeal area was compared between the groups using analysis of variance, and respiratory symptoms were compared using the chi-squared test (p<0.05). RESULTS: The mean nasopharyngeal area values after surgery were 0.527±0.215 cm², 0.599±0.213 cm² and 0.488±0.276 cm² for children, young adults and middle-aged adults, respectively, with no differences between groups. The proportions of oral respiration, snoring and breathing difficulty during sleep were, respectively, 66%, 69% and 9% in children; 51%, 49% and 7% in young adults; and 75%, 75% and 19% in middle-aged adults, with a higher frequency of snoring in middle-aged adults. CONCLUSION: Age did not affect nasopharyngeal dimensions in the presence of a pharyngeal flap, but it was an aggravating factor for respiratory symptoms, especially in older individuals.