Comparison of the Efficacy of Septoplasty with Nonsurgical Management in Improving Nasal Obstruction in Patients with Deviated Nasal Septum - A Randomized Clinical Trial

Abstract Introduction In the current era, the major indication for septoplasty is nasal obstruction due to deviated nasal septum (DNS). Even though septoplasty is a commonly performed surgery, its effectiveness in relieving nasal obstruction in DNS has not been proven. Objective The present study involved the measurement of both objective (nasal patency) and subjective (quality of life measures) outcome measures for the evaluation of the efficacy of septoplasty as compared with medical management. Methods Patients with DNS presenting with nasal obstruction were included and randomized into a septoplasty group or into a nonsurgical management group, with 70 patients in each group. The improvement in nasal obstruction was assessed subjectively by the visual analogue scale (VAS), and the sino-nasal outcome test-22 (SNOT-22) and the nasal obstruction symptom evaluation (NOSE) questionnaires and was measured objectively by assessment of nasal patency by peak nasal inspiratory flow (PNIF) at 0, 1, 3, and 6 months of treatment in both groups. Results The average VAS, SNOT-22 and NOSE scores for the septoplasty versus the nonsurgical group before treatment were 6.28 versus 6.0, 19.5 versus 15, and 14 versus 12, respectively, and at 6 months post-treatment, the scores were 2.9 versus 5.26, 10 versus 12, and 8 versus 10 (p= 0.001), respectively. The average PNIF scores at 0 and 6 months were 60/50 l/min and 70/60 l/min, respectively, in the septoplasty group (p= 0.001); the scores at 0 and 6 months in the nonsurgical management group were 60/60 l/min and 70/70 l/min, respectively (p= 0.001). Conclusion Surgical correction of DNS by septoplasty improves nasal obstruction better than nonsurgical management at 6 months postsurgery.

Medical adherence to intranasal corticosteroids in adult patients / Adesão clínica a corticosteroides intranasais em pacientes adultos

Abstract Introduction: The adherence to medical treatment in allergic rhinitis is poorly evaluated in clinical practice. Objectives: To evaluate adherence to intranasal corticosteroids in the treatment of allergic rhinitis patients. Methods: This prospective study was conducted on adult patients who were admitted to the outpatient clinic of the otolaryngology department tertiary hospital. Patients diagnosed with moderate to severe persistent AR and who had not used any nasal sprays were enrolled in the study. The patients were provided with mometasone furoate nasal sprays. On the 30th day, all participants filled out a questionnaire regarding the factors that may have influenced their adherence to the treatment. Afterwards, each patient filled out the Turkish-language-validated Morisky Medical Adherence Scale (MMAS-8) form. Each factor that may have affected adherence to the prescribed medication was evaluated according to the MMAS-8 score and all variables were analyzed statistically. Results: Fifty-nine adult patients with a mean age of 32.5 years (range 21-52 years) were included in the study. The mean overall MMAS-8 score was 3.64. Two factors were significantly related to low adherence: number of dependent children (p = 0.001) and benefit from the medication (p = 0.001). In addition, patients with higher education levels seemed to be more adherent than the rest of the group. Conclusion: Clinicians must keep in mind the factors related to non-adherence in order to achieve better treatment outcomes. Therefore, based on our results, patients must be informed that medications should be taken properly regardless of the benefit, and the treatment should be scheduled with respect to daily activities, particularly for patients caring for more than two children.

Resumo Introdução: A adesão ao tratamento clínico de rinite alérgica é mal avaliada na prática clínica. Objetivos: Avaliar a adesão aos corticosteroides intranasais no tratamento de pacientes com rinite alérgica. Método: Este estudo prospectivo foi realizado com pacientes adultos admitidos no ambulatório do setor de otorrinolaringologia de um hospital terciário. Os pacientes diagnosticados com rinite alérgica moderada a persistente grave que não haviam ainda usado spray nasal foram incluídos no estudo. Os pacientes receberam sprays nasais de furoato de mometasona. No 30° dia, todos preencheram um questionário sobre os fatores que podem ter influenciado a sua adesão ao tratamento. Depois disso, cada paciente preencheu o formulário da Escala de Adesão Clínica Morisky validado para a língua turca (MMAS-8). Cada fator que pode ter afetado a adesão à medicação prescrita foi avaliado de acordo com o escore de MMAS-8 e todas as variáveis foram analisadas estatisticamente. Resultados: Foram incluídos no estudo 59 pacientes adultos com média de 32,5 anos (variação de 21-52). O escore total médio de MMAS-8 foi de 3,64. Dois fatores foram significantemente relacionados com a baixa adesão: número de dependentes infantis (p = 0,001) e benefício da medicação (p = 0,001). Além disso, os pacientes com níveis de ensino mais elevados pareceram ser mais adesistas do que o restante do grupo. Conclusão: Os médicos devem estar cientes dos fatores relacionados à falta de adesão, a fim de alcançar melhores resultados do tratamento. Portanto, com base em nossos resultados, os pacientes devem ser informados de que os medicamentos devem ser usados adequadamente independentemente do benefício, e o tratamento deve ser programado com relação às atividades diárias, especialmente para os pacientes que cuidam de mais de dois filhos.

Management of Rhinitis: Allergic and Non-Allergic

Rhinitis is a global problem and is defined as the presence of at least one of the following: congestion, rhinorrhea, sneezing, nasal itching, and nasal obstruction. The two major classifications are allergic and nonallergic rhinitis (NAR). Allergic rhinitis occurs when an allergen is the trigger for the nasal symptoms. NAR is when obstruction and rhinorrhea occurs in relation to nonallergic, noninfectious triggers such as change in the weather, exposure to caustic odors or cigarette smoke, barometric pressure differences, etc. There is a lack of concomitant allergic disease, determined by negative skin prick test for relevant allergens and/or negative allergen-specific antibody tests. Both are highly prevalent diseases that have a significant economic burden on society and negative impact on patient quality of life. Treatment of allergic rhinitis includes allergen avoidance, antihistamines (oral and intranasal), intranasal corticosteroids, intranasal cromones, leukotriene receptor antagonists, and immunotherapy. Occasional systemic corticosteroids and decongestants (oral and topical) are also used. NAR has 8 major subtypes which includes nonallergic rhinopathy (previously known as vasomotor rhinitis), nonallergic rhinitis with eosinophilia, atrophic rhinitis, senile rhinitis, gustatory rhinitis, drug-induced rhinitis, hormonal-induced rhinitis, and cerebral spinal fluid leak. The mainstay of treatment for NAR are intranasal corticosteroids. Topical antihistamines have also been found to be efficacious. Topical anticholinergics such as ipratropium bromide (0.03%) nasal spray are effective in treating rhinorrhea symptoms. Adjunct therapy includes decongestants and nasal saline. Investigational therapies in the treatment of NAR discussed include capsaicin, silver nitrate, and acupuncture.

Lactentes sibilante: prevalência e fatores de risco / Wheezing infant: prevalence and risk factors

Objetivo: Revisar a literatura sobre prevalência, gravidade e fatores de risco para sibilância e asma em lactentes. Fontes de dados: Artigos originais, revisões e consensos indexados nos bancos de dados PubMed, MEDLINE, LILACS, SCIELO e publicações on tine, nos últimos 20 anos.Resultados: Neste trabalho são apresentadas pesquisas sobre a epidemiologia da sibilância e da asma nos primeiros anos de vida, as quais utilizaram diferentes métodos para definição de sibilância na infância e identificação dos seus fatores de risco. No entanto, a interação de fatores genéticos e ambientais foi unanimemente apontada como condição necessária para o desenvolvimento de sibilância e asma na infância. A maioria dos estudos encontrados foram realizados em países desenvolvidos Comentários: O conhecimento da prevalência, da gravidade e dos fatores de risco para sibilância e asma em lactentes é de grande interesse da comunidade médica do mundo todo. O aprofundamento de pesquisas sobre o tema é necessário para esclarecer as diferenças epidemiológicas e facilitar a implantação de medidas preventivas, o diagnóstico precoce da asma e seu tratamento mais adequado.

Objective: To review the literature on the prevalence, severity and risk factors for asthma and wheezing in infants.Sources: Original articles, reviews and consensus indexed in PubMed, MEDLINE, LILACS and SCIELO databases and online publications in the last 20 years. Results: This paper presents epidemiologic studles on asthma and wheezing in infants, which used different criteria to define childhood wheezing and identify their risk factors. However, these researches pointed the interaction of genetic and environmental factors as a condttlon for the development of wheezing and childhood asthma, without exception. Most studies were conducted in affluent countries. Comments: Knowledge of the prevalence, severity and risk factors for wheezing and asthma in infants is of great interest in the medicai community worldwide. More research on the subject are required to clarify the epidemiological differences and favor the establishment of preventive actions, early diagnosis of asthma and opportune treatment for this condition.

Corticosteroides intranasais / Intranasal corticosteroids

Objetivo: Revisar as características farmacológicas dos corticosteroides tópicos nasais (CI) e suas implicações clínicas e terapêuticas.Método: Revisão da literatura sobre os CI disponíveis comercialmente, como: acetonido de triancinolona, budesonida, dipropionato de beclometasona, ciclesonida, propionato de f1uticasona, furoato de mometasona e furoato de f1uticasona. Foram avaliados dados sobre indicações, formulações, farmacocinética, eventos adversos, comparação com outros tratamentos, eficácia em sintomas nasais e extra-nasais, qualidade de vida e o uso na população pediátrica. Resultados: CI são eficazes no tratamento da rinite alérgica, rinossinusite e pólipos nasais. Os ésteres propionato e o furoato são mais Iipofílicos e com maior absorção na mucosa nasal. CI são auxiliares no controle da asma e na melhora da qualidade de vida. O furoato de rnornetasona, furoato de f1uticasona, acetonido de triancinolona e a ciclesonida podem ser utilizados em crianças a partir de dois anos de idade. Conclusões: CI é a classe farmacológica mais efetiva para o tratamento da rinite alérgica, com, bom perfil de segurança, inclusive na população pediátrica.

To review pharmacologic profile, clinicai and therapeutic implications of topical intranasal corticosteroids (CI).Methods: The available literature was searched on CI such as triamcinolone acetonide, budesonide, beclomethasone dipropionate, clclesoníde, f1uticasone propionate, mometasone furoate and f1uticasone furoate. Data on clinicai indications, formulations, pharmacokinetic, adverse events, comparison with other drugs, nasal and extra-nasal symptoms efficacy, quality of Iife and pediatric use were díscussed.Results: Intranasal corticosteroids are effective treatment for allergic rhinttís, rhinosinusitis and nasal polyposis. The ester propionate and furoato are more lipophilic with better absorption on nasal mucosa. Additionally, CI may help to control asthma and improve quality of life. Mometasone furoato, f1uticasona furoate, triancinolone acetonide and ciclesonide can be used in children older than 2 years.Conclusions: Intranasal corticosteroids are the most effective drugs to treat allergic rhinitis and have a good safety profile, including for pediatric population.