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.

Evaluación de la obstrucción nasal por métodos subjetivos y pico flujo inspiratorio nasal en niños y adolescentes con rinitis crónica / Assessment of nasal obstruction by subjective methods and peak nasal inspiratory flow in children and adolescents with chronic rhinitis

Introducción. La obstrucción nasal (ON) es el síntoma más molesto de la rinitis crónica (RC). Los estudios que correlacionaron métodos subjetivos y objetivos de ON realizados en niños y adultos produjeron resultados contradictorios. Objetivos. Analizar la correlación entre escalas subjetivas de ON con determinaciones de pico flujo inspiratorio nasal (PFIN) y comparar la valoración subjetiva de la ON y el PFIN en niños según su edad. Población y métodos. Participaron pacientes con RC. Se estimó la correlación entre la evaluación subjetiva de la ON mediante una escala visual análoga (ON-EVA, por su sigla en inglés) y la Escala de evaluación de los síntomas de obstrucción nasal (NOSE, por su sigla en inglés) y medición del flujo aéreo nasal pre- y posvasoconstrictor, mediante PFIN. Se analizaron las diferencias entre los grupos de 8 a 11 años y los de 12 a 15 años para la valoración subjetiva de la ON y PFIN. Resultados. Se incluyeron 79 pacientes entre 8 y 15 años. No se comprobó correlación entre ON-EVA y PFIN antes y después del vasoconstrictor (r = -0,19; p = 0,11 y r = -0,18; p = 0,15 respectivamente) ni entre NOSE y PFIN basal (r = -0,23; p = 0,07). Hubo diferencias en el PFIN entre niños de 8-11 años y 12 a 15 años (p = <0,0001), pero no se demostraron diferencias en la percepción subjetiva por ON-EVA (p = 0,7591). Conclusión. No se demostró correlación entre puntajes subjetivos de ON y PFIN en niños y adolescentes con RC. Los niños mayores perciben menos la ON que los de menor edad. Las escalas subjetivas de ON no reemplazan su medición con PFIN en pacientes con rinitis.

Introduction. Nasal obstruction (NO) is the most irritating symptom of chronic rhinitis (CR). The results of studies that correlated subjective and objective methods of NO in children and adults were contradictory. Objectives. To analyze the correlation between subjective NO scales and peak nasal inspiratory flow (PNIF) measurements and compare the subjective NO assessment and PNIF in children by age. Population and methods. Participants were patients with CR. The correlation between the subjective NO assessment using a visual analog scale (NO-VAS) and the Nasal Obstruction Symptom Evaluation (NOSE) and nasal airflow measurement pre- and post-vasoconstrictor administration using the PNIF was estimated. The differences in the subjective NO assessment and PNIF between children aged 8-11 years and 12-15 years were analyzed. Results. A total of 79 patients aged 8-15 years were included. No correlation was established between the NO-VAS and the PNIF before and after vasoconstrictor administration (r = -0.19; p = 0.11 and r = -0.18; p = 0.15 respectively) or between the NOSE and the baseline PNIF (r = -0.23; p = 0.07). Differences were observed in the PNIF between children aged 8-11 years and 12-15 years (p = < 0.0001), but there were no differences in the subjective perception assessed with the NO-VAS (p = 0.7591). Conclusion. No correlation was demonstrated between the subjective NO score and the PNIF in children and adolescents with CR. Older children have a lower perception of NO than younger ones. Subjective NO scales cannot replace the PNIF measurement in patients with rhinitis

Rinoplastía y rinoseptoplastía funcional: mejorando la función nasal más allá de la cirugía del tabique y los cornetes nasales / Functional rhinoplasty and septorhinoplasty: improving nasal function beyond septal and turbinate surgery

Resumen La obstrucción nasal es una de las causas más frecuentes de consulta otorrinolaringológica general. Diversas estructuras juegan un rol en la mantención de una adecuada función respiratoria nasal, incluyendo el tabique, los cornetes, las paredes laterales y las alas nasales. La cirugía del tabique y de los cornetes inferiores son los procedimientos más comúnmente realizados y aunque son efectivos en un gran porcentaje de los casos, en ocasiones se deben intervenir otras estructuras nasales para corregir adecuadamente la obstrucción. La cirugía con fines primariamente funcionales de las válvulas nasales externa e interna, de la punta y/o de la pirámide ósea se ha denominado "rinoplastía funcional". Dada la importancia de estas estructuras para la recuperación de una adecuada permeabilidad nasal estática y dinámica, el diagnóstico y manejo quirúrgico de estas condiciones debe ser de dominio del otorrinolaringólogo.

Abstract Nasal obstruction is one of the most frequent complaints in general otorhinolaryngology practice. Different structures have a role in maintaining an adequate nasal breathing function, including the septum, turbinates, lateral sidewalls and nasal alae. Surgery of the nasal septum and inferior turbinates are the most commonly performed procedures and, although effective in most cases, occasionally other nasal structures must be intervened to correctly address the sites of obstruction. The term "functional rhinoplasty" has been coined for surgery of the external and internal nasal valves, nasal tip and/or bony pyramid, with primarily functional objectives. Given the importance of these structures for restoring an adequate static and dynamic nasal patency, diagnosis and management of these conditions must be dominion of the otorhinolaryngologist.

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.

What is the impact of positive airway pressure in nasal polyposis? An experimental study

Introduction: It has been hypothesized that increasing the interstitial hydrostatic pressure within the sinonasal mucosa of patients with nasal polyposis (NP) might decrease the size of nasal polyps. Objective: To evaluate the effects of positive airway pressure, delivered by a continuous positive airway pressure (CPAP) device, in patients with NP and in control subjects. Methods: Twelve patients with NP and 27 healthy subjects were exposed to CPAP (20 cm H2O) for 2 hours. Visual analog scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE) scale, acoustic rhinometry (AR), peak nasal inspiratory flow (PNIF) and nasal endoscopy (NE-Meltzer polyp grading system) were performed before and after the intervention, for all patients. Results: The control group showed a significant worsening in nasal obstruction symptoms, as measured by VAS and NOSE (p < 0.01), and a significant decrease in nasal patency, as measured by the PNIF and AR (p < 0.01). For the NP group, VAS, NOSE, and AR did not differ significantly (p = 0.72, p = 0.73, and p = 0.17, respectively), but PNIF values worsened (p = 0.04) after exposure to CPAP. There was a statistically significant reduction in the nasal polyps' size (p = 0.04). Conclusions: Positive pressure worsened the nasal obstruction symptoms and decreased objective parameters of nasal patency in control subjects. In patients with NP, exposure to CPAP reduced the nasal polyps' size, and the nasal patency, asmeasured by PNIF. However, it had no significant effects in AR and in nasal obstruction symptoms (AU)

Variables associated with mouth breathing diagnosis in children based on a multidisciplinary assessment / Variáveis associadas ao diagnóstico de respiração oral baseado em uma avaliação multidisciplinar

ABSTRACT Purpose : This study was conducted to identify variables associated with mouth breathing diagnosis in children, based on multidisciplinary domains. Methods 119 children, six to 12 years old, underwent anamnesis, speech therapy (orofacial structures and stomatognathic functions), otorhinolaryngologic (OTRL) with clinical and endoscopic examinations, dental (occlusion) and physiotherapy (body posture and nasal patency) assessments. Nasal patency was evaluated using Peak Nasal Inspiratory Flow (PNIF) and the Nasal Obstruction Symptom Evaluation (NOSE) scale. A multiple logistic regression was performed considering breathing mode as the dependent variable and the co-variables from each multidisciplinary assessment as associated variables. Results Association with MB diagnosis was found in each professional domain with: nasal obstruction report (Odds ratio - OR=5.55), time of pacifier use (OR=1.25), convex facial type (OR=3.78), obtuse nasal angle (OR=4.30), half-open or open lip posture (OR=4.13), tongue position on the mouth floor (OR=5.88), reduced hard palate width (OR=2.99), unexpected contraction during mastication (OR=2.97), obstructive pharyngeal tonsils (OR=8.37), Angle Class II malocclusion (OR=10.85) and regular gingival maintenance (OR=2.89). Conclusion We concluded that a multidisciplinary diagnosis is important, given that each evaluation domain, including OTRL, dental and speech therapy, presented variables associated with MB diagnosis. Body posture and nasal patency variables were not associated with MB.

RESUMO Objetivo Este estudo foi conduzido para identificar as variáveis associadas ao diagnóstico de respiração oral em crianças, baseado nos domínios multidisciplinares. Método Cento e dezenove crianças, de seis a 12 anos, realizaram uma avaliação abrangente composta por uma anamnese e exames fonoaudiológico (estruturas orofaciais e funções estomatognáticas), otorrinolaringológico (avaliação clínica e endoscópica), odontológico (conservação oral e oclusão) e fisioterapêutico (postura corporal e permeabilidade nasal). A permeabilidade nasal foi aferida utilizando-se o Pico de Fluxo Inspiratório Nasal (PFIN) e a escala NOSE (Nasal Obstruction Symptom Evaluation). Foi realizada uma regressão logística múltipla, considerando o modo respiratório como variável dependente e as covariáveis de cada avaliação multidisciplinar como variáveis associadas. Resultados Foi encontrada uma associação do diagnóstico de respiração oral com variáveis de cada domínio profissional: relato de obstrução nasal (Odds ratio - OR=5,55), tempo de uso de chupeta (OR=1,25), tipo facial convexo (OR=3,78), ângulo nasolabial obtuso (OR=4,30), postura de lábios entreabertos e abertos (OR=4,13), postura de língua no assoalho oral (OR=5,88), largura do palato duro reduzida (OR=2,99), contrações inesperadas durante a mastigação (OR=2,97), tonsilas faríngeas obstrutivas (OR=8,37), má oclusão classe II de Angle (OR=10,85) e estado gengival regular (OR=2,89). Conclusão Concluiu-se que o diagnóstico multidisciplinar é importante, uma vez que as avaliações dos domínios fonoaudiológico, otorrinolaringológico e odontológico obtiveram variáveis associadas ao diagnóstico de respiração oral. As variáveis relacionadas à postura corporal e permeabilidade nasal não foram associadas ao diagnóstico de respiração oral.

Válvula nasal en rinoplastía / Nasal valve in rhinoplasty

RESUMEN La obstrucción dependiente de la vía aérea nasal representa un gran impacto en la calidad de vida de los pacientes. Las causas de ésta son múltiples, donde aquellas de tipo estructural son las que requieren frecuentemente cirugía. La obstrucción nasal debido a la disfunción de la válvula nasal puede ser olvidada como única causa de una obstrucción nasal. La decisión sobre qué técnica quirúrgica utilizar para solucionar una insuficiencia valvular es compleja y muchas veces la bibliografía utiliza conceptos anatómicos muy variados que no ayudan a seleccionar una técnica en particular. Se realizó una revisión bibliográfica del tema destacando anatomía, diagnóstico y tratamiento; las técnicas quirúrgicas más frecuentemente utilizadas son descritas.

ABSTRACT Nasal airway obstruction represents a major impact on patients' quality of life. The causes are multiple, where those of a structural type, frequently require surgery. Nasal obstruction due to nasal valve dysfunction may be overlooked as a cause of nasal obstruction. The decision about which surgical technique to use in order to solve a valvular insufficiency is complex and often the literature uses diverse anatomical concepts that do not help to select a particular technique. A literature review of the subject was carried out, highlighting anatomy, diagnosis and treatment; The most frequently used surgical techniques are described.

Estenosis de la apertura piriforme y síndrome de incisivo central único: casos clínicos / Piriform aperture stenosis and solitary median maxillary central incisor: clinical cases

El síndrome incisivo central único es un trastorno que involucra anomalías de la línea media. Se puede presentar con dificultad respiratoria poniendo en peligro la vida del recién nacido, debido a malformaciones nasales. Estas malformaciones incluyen atresia de coanas y la estenosis de la apertura del orificio piriforme. Debe pensarse en esta última en todo recién nacido con estridor y dificultad respiratoria de grado variable, asociado a la dificultad de pasar una sonda a través de la región anterior de las fosas nasales. El diagnóstico se confirma por tomografía computarizada del macizo craneofacial y el examen nasofibroscópico. La conducta terapéutica dependerá de la gravedad de los síntomas, pero en general si es que no hay compromiso respiratorio severo, se prefiere una conducta expectante, y esperar el crecimiento craneofacial del niño, para aumentar permeabilidad nasal. Presentamos dos casos clínicos.

Solitary median maxillary central incisor syndrome is a rare disorder involving midline abnormalities. It may present with life threatening respiratory distress in the neonate secondary to nasal malformations. These include choanal atresia and pyriform aperture stenosis. The last to be thought in any newborn with stridor and respiratory distress associated with the difficulty of passing a tube through the anterior region of the nostrils. The diagnosis is confirmed by craniofacial CT scan and nasolaryngoscope evaluation. The therapeutic approach depends on the severity of symptoms.

Guidelines proposal for clinical recognition of mouth breathing children

INTRODUCTION: Mouth breathing (MB) is an etiological factor for sleep-disordered breathing (SDB) during childhood. The habit of breathing through the mouth may be perpetuated even after airway clearance. Both habit and obstruction may cause facial muscle imbalance and craniofacial changes.OBJECTIVE: The aim of this paper is to propose and test guidelines for clinical recognition of MB and some predisposing factors for SDB in children.METHODS: Semi-structured interviews were conducted with 110 orthodontists regarding their procedures for clinical evaluation of MB and their knowledge about SDB during childhood. Thereafter, based on their answers, guidelines were developed and tested in 687 children aged between 6 and 12 years old and attending elementary schools.RESULTS: There was no standardization for clinical recognition of MB among orthodontists. The most common procedures performed were inefficient to recognize differences between MB by habit or obstruction.CONCLUSIONS: The guidelines proposed herein facilitate clinical recognition of MB, help clinicians to differentiate between habit and obstruction, suggest the most appropriate treatment for each case, and avoid maintenance of mouth breathing patterns during adulthood.

INTRODUÇÃO: a respiração bucal (RB) é um fator etiológico para os distúrbios respiratórios do sono (DRS) na infância. O hábito de respirar pela boca pode ser perpetuado mesmo depois da desobstrução das vias aéreas. Tanto o hábito quanto a obstrução podem causar desequilíbrios da musculatura facial e alterações craniofaciais. O objetivo deste trabalho é propor e testar uma diretriz para o reconhecimento clínico da RB e de alguns fatores predisponentes aos DRS em crianças.MÉTODOS: entrevistas semiestruturadas foram realizadas com 110 ortodontistas, com relação aos seus procedimentos para avaliação clínica da RB e aos seus conhecimentos sobre DRS na infância. A partir daí, com base nas respostas obtidas, uma diretriz foi desenvolvida e testada em 687 crianças, com 6 a 12 anos, oriundas de escolas de ensino fundamental.RESULTADOS: não existe padronização para o reconhecimento clínico da RB pelos ortodontistas. Os procedimentos mais comumente realizados foram ineficientes para reconhecer a diferença entre a RB por hábito e a por obstrução.CONCLUSÕES: a diretriz proposta facilita o reconhecimento clínico da RB, diferencia entre RB por hábito e por obstrução, sugere o tratamento mais adequado para cada caso, e evita a manutenção do padrão de respiração bucal na idade adulta.

Síndrome de nariz vacía / Empty nose syndrome

El síndrome de nariz vacía es una enfermedad de reciente descripción, que no tiene una definición clínica clara. Se puede originar como complicación de la cirugía de resección de cornetes, en especial del inferior. La fisiopatología no está del todo definida, pero es probable que posterior a la resección de cornetes se altere la permeabilidad nasal, interfiriendo con los mecanismos neurosensitivos y con las funciones de los cornetes. Su síntoma principal, es la obstrucción nasal paradójica. El diagnóstico es clínico, basado en los síntomas con los hallazgos de una cavidad nasal amplia posterior a la cirugía nasal. El tratamiento es difícil por lo subjetivo de los síntomas, prefiriendo en un comienzo el tratamiento médico y reservando la cirugía para casos más severos. Lo más importante es la prevención, realizando cirugías lo más conservadora posibles de la anatomía de la cavidad nasal.

The Empty Nose Syndrome is a recently described disease, which has no clear clinical definition. It is a rare complication of turbinate surgery especially in the inferior turbinectomy. The pathophysiology is unclear, but after turbinectomy the nasal patency could be affected and this can interfere with neurosensory mechanisms and functions of the turbinates. The most common symptom is the paradoxical nasal obstruction. The diagnosis is clinical, based on symptoms with the discovery of a wide nasal cavity after nasal surgery. Treatment is difficult because of the subjective symptoms, initially preferring medical treatment and surgery is reserved for more severe cases. Most important is the prevention, being as conservative as possible with the nasal cavity.

Respiratory mode, nasal patency and palatine dimensions / Modo respiratório, patência nasal e dimensões palatinas

Purpose: To investigate the influence of breathing mode and nasal patency in the dimensions of the hard palate by comparing mouth breathing (MB) and nasal breathing (NB) adults. Methods: Seventy-seven individuals, distributed into the MB group (n=38) and the NB group (n=39), of both genders and aged between 18 and 30 years old, took part in the study. The respiratory mode diagnosis was based on anamnesis, physical characteristics, and otorhinolaryngological examination. The volunteers were evaluated in terms of nasal patency, with a peak nasal inspiratory flow (PNIF) meter, and obstruction symptoms, by a Nasal Obstruction Symptom Evaluation (NOSE) scale, and had their transversal and vertical hard palate dimensions measured with a digital caliper in plaster models. Results: Comparing both groups, the MB group presented significantly higher values in the NOSE scale, lower values in the PNIF, lower values in the transversal distance of the palate in the intercanine region, and significantly higher values in the vertical distance in the regions of the first and second premolars and molars. There was a negative correlation between PNIF and NOSE, and a positive correlation between PNIF and transversal distance of the palate in the region of the first premolars. Conclusion: MB adults presented reduced nasal patency and a higher degree of nasal obstruction symptoms. The hard palate was morphologically narrower and deeper in adults with the MB mode compared to the NB mode. Moreover, it was concluded that the smaller the nasal patency, the greater the obstruction symptoms and the narrower the hard palate. .

Objetivo: Verificar a influência do modo respiratório e da patência nasal nas dimensões palatinas, comparando adultos respiradores orais (ROs) e respiradores nasais (RNs). Métodos: Participaram do estudo 77 indivíduos, distribuídos em grupo de ROs (n=38) e grupo de RNs (n=39), de ambos os gêneros e idade entre 18 e 30 anos. O diagnóstico do modo respiratório se baseou na anamnese, nas características físicas e no exame otorrinolaringológico. Os voluntários foram avaliados quanto à patência nasal com um medidor do pico de fluxo inspiratório nasal (PFIN) e à sintomatologia de obstrução (escala NOSE - Nasal Obstruction Symptom Evaluation Scale), e tiveram as dimensões vertical e transversal do palato duro medidas por meio de um paquímetro digital em modelos de gesso. Resultados: Na comparação entre os grupos, os ROs apresentaram valores significativamente maiores na escala NOSE, menores no PFIN, menores na distância transversal do palato na região intercanina e maiores na distância vertical na região dos primeiros e segundos pré-molares e dos molares. O PFIN apresentou correlação inversa com a escala NOSE e direta com a distância transversal do palato na região dos primeiros pré-molares. Conclusão: Os adultos ROs apresentaram redução na patência nasal e maior grau de sintomatologia de obstrução nasal. O palato duro se apresentou mais estreito e alto nos adultos com modo respiratório oral, quando comparados aos com modo nasal. Ainda, concluiu-se que quanto menor a patência nasal, maior a sintomatologia de obstrução e mais estreito o palato duro. .

Acoustic rhinometry in mouth breathing patients: a systematic review / O uso da rinometria acústica em respiração oral: revisão sistemática

INTRODUCTION: When there is a change in the physiological pattern of nasal breathing, mouth breathing may already be present. The diagnosis of mouth breathing is related to nasal patency. One way to access nasal patency is by acoustic rhinometry. OBJECTIVE: To systematically review the effectiveness of acoustic rhinometry for the diagnosis of patients with mouth breathing. METHODS: Electronic databases LILACS, MEDLINE via PubMed and Bireme, SciELO, Web of Science, Scopus, PsycInfo, CINAHL, and Science Direct, from August to December 2013, were consulted. 11,439 articles were found: 30 from LILACS, 54 from MEDLINE via Bireme, 5558 from MEDLINE via PubMed, 11 from SciELO, 2056 from Web of Science, 1734 from Scopus, 13 from PsycInfo, 1108 from CINAHL, and 875 from Science Direct. Of these, two articles were selected. RESULTS: The heterogeneity in the use of equipment and materials for the assessment of respiratory mode in these studies reveals that there is not yet consensus in the assessment and diagnosis of patients with mouth breathing. CONCLUSION: According to the articles, acoustic rhinometry has been used for almost twenty years, but controlled studies attesting to the efficacy of measuring the geometry of nasal cavities for complementary diagnosis of respiratory mode are warranted. .

INTRODUÇÃO: Quando há alteração no padrão respiratório nasal fisiológico, a respiração oral de suplência já pode estar presente. O diagnóstico da respiração oral vincula-se à permeabilidade nasal. Uma das possibilidades para avaliação da permeabilidade nasal é a rinometria acústica. OBJETIVO: Revisar, de forma sistemática, a eficácia da rinometria acústica no auxílio diagnóstico de pacientes com respiração oral. MÉTODO: Foram consultadas as bases de dados eletrônicas LILACS, MEDLINE via Bireme e via PUBMED, SciELO, Web of Science, Scopus, PsycInfo, CINAHL e Science Direct, de agosto a dezembro de 2013. Foram encontrados 11.439 artigos, sendo 30 da LILACS, 54 da MEDLINE via Bireme, 5.558 da MEDLINE via Pubmed, 11 da Scielo, 2.056 da Web of Science, 1.734 da Scopus, 13 da PyscInfo, 1.108 da CINAHL e 875 Science Direct. Desses, foram selecionados dois artigos. RESULTADOS: A heterogeneidade no uso dos equipamentos e materiais utilizados para a avaliação do modo respiratório nesses estudos mostra que ainda não há um consenso na avaliação e diagnóstico de indivíduos com respiração oral. CONCLUSÃO: De acordo com os artigos, a rinometria acústica é utilizada há quase vinte anos, porém são necessários estudos controlados que atestem a eficácia da mensuração da geometria das cavidades nasais como auxílio diagnóstico do modo respiratório. .

Avaliação do respirador oral: uso do espelho de Glatzel e do peak nasal inspiratory flow / Mouth breathing evaluation: use of Glatzel mirror and peak nasal inspiratory flow

OBJETIVO: Comparar o uso do espelho de Glatzel e do peak nasal inspiratory flow na avaliação de indivíduos respiradores orais, bem como analisar a correlação dos dois instrumentos. MÉTODOS: Foram avaliadas 64 crianças, sendo 32 respiradoras orais e 32 respiradoras nasais, na faixa etária de 4 a 12 anos. Os respiradores orais, diagnosticados de acordo com equipe multiprofissional, foram subdivididos de acordo com a causa da obstrução. Foram utilizados o espelho de Glatzel e o peak nasal inspiratory flow nos dois grupos para avaliação da permeabilidade e fluxo aéreo nasal. Os dados foram submetidos à análise estatística. RESULTADOS: O espelho de Glatzel diferenciou o modo respiratório considerando-se os estratos gênero, faixa etária, peso, altura e índice de massa corporal da amostra. Entretanto, não foi capaz de dar indícios sobre a causa da respiração oral. Com o uso do peak nasal inspiratory flow, não foi possível diferenciar o modo respiratório e tampouco a causa da respiração oral. Na amostra pesquisada, não houve correlação entre os instrumentos utilizados. CONCLUSÃO: O espelho de Glatzel mostrou ser capaz de identificar indivíduos com e sem obstrução nasal, embora não tenha sido possível diferenciar os subgrupos de respiradores orais entre si com o uso do instrumento. Já o peak nasal inspiratory flow mostrou-se capaz de diferenciar apenas respiradores nasais de respiradores orais cirúrgicos. Foi encontrada baixa correlação entre os dois instrumentos.

PURPOSE: To compare the use of the Glatzel mirror and peak nasal inspiratory flow in the evaluation of mouth-breathing participants and to analyze the correlation between these instruments. METHODS: Sixty-four children were evaluated - 32 mouth breathers and 32 nasal breathers; the children were aged 4 to 12 years. The mouth breathers were subdivided according to the cause of obstruction by a multidisciplinary team. The Glatzel mirror and peak nasal inspiratory flow were used in both groups to evaluate patency and nasal airflow. Data were then subjected for statistical analysis. RESULTS: The Glatzel mirror allowed us to differentiate the breathing mode considering gender, age, weight, height, and body mass index, but it did not help in identifying the cause of mouth breathing. The peak nasal inspiratory flow did not allow differentiation of the breathing mode and identification of the cause of mouth breathing. In our sample, there was no correlation between the instruments used. CONCLUSION: The Glatzel mirror was reliable in identifying participants with and without nasal obstruction, although it was not possible to differentiate subgroups of mouth breathers using this instrument. The peak nasal inspiratory flow showed differences only between nasal breathers and surgical mouth breathers. Low correlation was found between these two instruments.

Avaliações objetiva e subjetiva da obstrução nasal em crianças e adolescentes com rinite alérgica / Objective and subjective assessments of nasal obstruction in children and adolescents with allergic rhinitis

OBJETIVO: Relacionar a avaliação objetiva da obstrução nasal por rinometria acústica (volume dos cinco primeiros centímetros da cavidade nasal) e rinomanometria anterior ativa (resistência nasal total) com a avaliação subjetiva (escore de obstrução). MÉTODO: Participaram do estudo 30 pacientes (7 a 18 anos) com rinite alérgica persistente e 30 controles. O escore foi referido para cavidade nasal total e narinas em separado. As três variáveis foram mensuradas nos momentos basal e após indução de obstrução nasal. RESULTADOS: Houve correlações significantes e negativas entre resistência e volume nasal em todos os grupos e situações de avaliação, exceto para narina mais obstruída, grupo controle, pós-obstrução. Para a cavidade nasal total, não houve correlação significante entre as variáveis objetivas e subjetiva, exceto entre escore e volume na cavidade nasal total no grupo controle pós-obstrução. Na narina mais obstruída, houve correlação significante e negativa para escore e resistência e significante e positiva para escore e volume nasal no grupo total, momento basal. Não houve diferença nítida nos coeficientes de correlação entre pacientes e controles, e estes não se alteraram após a indução de obstrução nasal. CONCLUSÕES: Avaliação objetiva da obstrução nasal não apresentou correlação significativa com a avaliação subjetiva na cavidade nasal total, mas sim na avaliação unilateral. Houve correlação entre avaliações objetivas. Rinite alérgica ou obstrução nasal aguda não interferiram na correlação entre as avaliações objetiva e subjetiva da obstrução nasal. Sugere-se utilidade no acréscimo de métodos objetivos para avaliação da obstrução nasal em pesquisas e, na sua impossibilidade, avaliação das narinas em separado.

OBJECTIVE: To correlate objective assessment of nasal obstruction, as measured by acoustic rhinometry (volume of the first 5 cm of the nasal cavity) and active anterior rhinomanometry (total nasal airway resistance), with its subjective evaluation (obstruction scores). METHOD: Thirty patients, aged 7 to 18 years, with persistent allergic rhinitis and thirty controls were enrolled. The obstruction score was reported for the whole nasal cavity and for each nostril separately. The three variables were measured at baseline and after induction of nasal obstruction. RESULTS: There were significant and negative correlations between resistance and nasal volume in all groups and scenarios, except for the most obstructed nostril, in the control group, post-obstruction. For the whole nasal cavity, there was no significant correlation between objective and subjective variables except between score and total nasal cavity volume in the control group, post-obstruction. Regarding the most obstructed nostril, we found a significant negative correlation between score and resistance and a significant positive correlation between score and volume for the total group at baseline. There were no clear differences in the correlation coefficients found in patients and controls. The correlation coefficients did not change after induction of nasal obstruction. CONCLUSIONS: Objective assessment of nasal obstruction did not correlate significantly with subjective evaluation for the nasal cavity as a whole, but there was a correlation for unilateral assessments. There was correlation between the objective evaluations. Allergic rhinitis and acute induction of nasal obstruction did not affect the correlation between objective and subjective assessments of nasal obstruction. Addition of an objective method for evaluation of nasal obstruction could be useful in the research setting; if no such method can be used, each nostril should be evaluated separately.

Obstrucción nasal unilateral en niños: Síndrome de Pai / Unilateral nasal obstruction in children: Pai syndrome

La obstrucción unilateral de las fosas nasales en niños es causada principalmente por la introducción de cuerpos extraños, se manifiesta con rinorrea y olor fétido. Con menor frecuencia, puede ser de origen traumático, neoplásico, malformativo congénito o iatrogénico. Los síntomas de una masa intranasal congénita pueden manifestarse desde el nacimiento, o pasar desapercibidos y ser un hallazgo en un examen pediátrico de rutina. La evaluación del paciente debe incluir estudios por imágenes para orientar al diagnóstico y descartar una extensión intracraneal. Un síndrome asociado al tumor nasal congénito debe sospecharse cuando existen otras anomalías. El síndrome de Pai es un trastorno genético raro. Sus manifestaciones son craneofaciales y su marcador principal es el pólipo nasal congénito. Presentamos un paciente con insuficiencia ventilatoria nasal unilateral secundaria a un lipoma nasal congénito, junto a anomalías craneofaciales del síndrome de Pai. La obstrucción nasal fue resuelta quirúrgicamente en forma exitosa.

Unilateral obstruction of the nasal cavity in children is mainly caused by the introduction of foreign bodies further stated with rhinorrhea and fetid odor. Less commonly, it can be traumatic, neoplastic, due to congenital malformation or iatrogenic. Symptoms of congenital intranasal mass may present at birth, or go unnoticed and be a finding in a routine pediatric examination. Patient evaluation should include imaging studies to guide the diagnosis and rule out intracranial extension. A syndrome associated with congenital nasal tumor should be suspected when other abnormalities are present. Pai syndrome is a rare genetic disorder. Its manifestations are craniofacial being congenital nasal polyp his main marker. We present a patient with unilateral nasal respiratory failure secondary to congenital nasal lipoma, with craniofacial anomalies belonging to Pai syndrome. Nasal obstruction was successfully surgically resolved.

Peak nasal inspiratory flow evaluation as an objective method of measuring nasal airflow / Avaliação do peak flow nasal inspiratório como método objetivo de mensuração do fluxo de ar nasal

Acoustic rhinometry, rhinomanometry and Inspiratory Peak Nasal Flow (IPNF) are used in order to objectively assess nasal patency. These are expensive not very practical tests, except for IPNF, which is a fast, simple and low cost method. OBJECTIVE: To assess IPNF in healthy individuals complaining of nose obstruction caused by allergic rhinitis. METHOD: IPNF use in 78 individuals with and without rhinitis symptoms. STUDY DESIGN: Contemporary cross-sectional cohort. RESULTS: IPNF showed significant results for nasal obstruction, rhinorrhea, pruritus, sneezes and tearing (p < 0. 001). There was no correlation between the presence of nasal septum deviation and IPNF (p = 0. 561). We found a positive correlation between IPNF and the Visual Analogue Scale (VAS) for nasal obstruction (p = 0. 002). In the multiple linear regression model, there was a statistical significance between the values found in IPNF with allergic rhinitis and age (p = 0. 005 and p = 0. 023 respectively). CONCLUSIONS: IPNF proved to be a reliable method to detect changes in nasal patency, by obstructive causes as well as inflammatory causes, with an acceptable level of statistical significance, simple, easy to handle, inexpensive and reproducible.

A rinometria acústica, rinomanometria e o peak flow nasal inspiratório (PFNI) são utilizados para a avaliação objetiva da patência nasal. Estes exames são dispendiosos e pouco práticos, exceto o PFNI, que se apresenta como um método rápido, de baixo custo e simples. OBJETIVO: Avaliar o PFNI em indivíduos saudáveis e com queixas nasais obstrutivas por rinite alérgica. MéTODO: Aplicação do PFNI em 78 sujeitos com e sem sintomas de rinite. FORMA DE ESTUDO: Estudo de coorte contemporâneo com corte transversal. RESULTADOS: O PFNI mostrou resultados significantes para obstrução nasal, rinorreia, prurido, espirros e lacrimejamento (p < 0,001). Não houve correlação entre a presença de desvio de septo nasal e PFNI (p = 0,561). Encontrou-se uma correlação positiva entre PFNI e Escala Visual Analógica - EAV- para obstrução nasal (p = 0,002). No modelo de regressão linear múltipla, houve significância estatística entre os valores encontrados no PFNI com rinite alérgica e idade (p = 0,005 e p = 0,023 respectivamente). CONCLUSÃO: O PFNI mostrou ser um método confiável para detecção das alterações da patência nasal, tanto por causas obstrutivas quanto por causas inflamatórias, com um nível de significância estatística aceitável, simples, fácil de manusear, pouco dispendioso e reprodutível.

Cornaje del recién nacido por estenosis congénita de la apertura piriforme: serie de casos / Stertor in the newborn due to congenital nasal pyriform aperture estenosis: case series

El cornaje es un ruido generado por la alteración del flujo de aire al pasar por las fosas nasales. La principal causa en recién nacidos y lactantes es la rinitis inflamatoria o infecciosa. Con menor frecuencia, puede ser de origen congénito, neoplásico, traumático o iatrogénico.La estenosis congénita de la apertura piriforme es una etiología infrecuente de obstrucción nasal en el neonato. El diagnóstico precoz y el tratamiento apropiado son esenciales debido a surespiración nasal obligada. La dificultad o la imposibilidad de hacer progresar una sonda de 2,8 mm (sonda K30) a través de la región anterior de las fosas nasales, permiten sospecharla.El diagnóstico debe ser confirmado por una tomografía computada del macizo craneofacial. La conducta terapéutica dependerá de la gravedad de los síntomas.Describimos nuestra experiencia con 9 pacientes que presentaban esta patología cuya corrección quirúrgica fue exitosa.

Stertor is a noise generated by the disturbance of the air flow passing through the nose. Its main cause –in newborns and infants– is inflammatory or infectious rhinitis. Congenital,neoplastic, traumatic or iatrogenic causes are less frequent. Congenital stenosis of the pyriform aperture is a rare etiology of nasal obstruction in the neonates. Early diagnosis and appropriate treatment are essential because of their exclusive nasal breathing. Suspicion might arise when a difficulty or even an impossibility to pass a probe of 2.8 mm (K30 tube) through anterior nares, exists. Diagnosis should be confirmed by a computed tomography of the craniofacial massif. The therapeutic behavior will depend on the severity of symptoms. We describe our experience with nine patients with this conditionwhose surgical correction was successful.

Obstrução nasal / Nasal obstruction

A obstrução nasal, apesar de ser uma queixa bastante frequente na prática médica, nem sempre é valorizada, podendo refletir alterações da anatomia e fisiologia nasal tanto em indivíduos saudáveis quanto em algumas doenças, como veremos a seguir.A investigação de suas causas pode levar a vários diagnósticos, desde a um simples resfriado, que habitualmente não exige tratamento específico, até tumores cujo tratamento pode necessitar de grandes intervenções cirúrgicas. Neste artigo as autoras discorrem sobre as causas mais frequentes de obstrução nasal, os principais métodos de investigação e a abordagem terapêutica geral.