Research progress and clinical application of allergen nasal provocation test / 临床耳鼻咽喉头颈外科杂志

The allergen nasal provocation testing（NPT）, in which allergens are applied directly to the nasal mucosa under standard and controlled conditions to provoke the main symptoms of allergic rhinitis（AR）, reproduces the response of the upper respiratory tract to natural exposure to allergens under controlled conditions and is the only test currently available to confirm nasal reactivity to allergens. It is invaluable in studying the mechanisms of AR and in assessing the response to novel anti-allergic treatments. The test may play an increasingly important role in clinical practice, especially in the identification of local AR, the diagnosis of occupational AR, the clarification of the composition of allergens, the assessment of the efficacy of AR treatment and the selection of candidates undergoing allergen immunotherapy. This article reviewed the application of NPT in the diagnosis of allergic and non-allergic rhinitis, and also introduces the indications, contraindications, advantages and limitations of NPT in evaluating nasal response.

Una nueva perspectiva en rinosinusitis: EPOS 2020 / A new perspective on rhinosinusitis: EPOS 2020

Resumen EPOS 2020 (European Position Paper on Rhinosinusitis and Nasal Polyps 2020) es una guía clínica desarrollada por un grupo profesionales expertos en el área rinosinusal de la Sociedad Europea de Rinología, que corresponde a la última actualización de sus versiones anteriores (2005, 2007 y 2012). El objetivo principal del documento es entregar recomendaciones claras basadas en la mejor evidencia disponible y algoritmos de manejo concisos para las patologías de rinosinusitis aguda y crónica tanto en adultos como en pacientes pediátricos. Algunas de las novedades más importantes de esta guía, son: nueva clasificación de rinosinusitis crónica en primarias y secundarias, rinosinusitis crónica en pediatría, nuevos conceptos en cirugía sinusal, entre otros. También enfatiza la importancia de manejo multidisciplinario de la patología, incluyendo el autocuidado del paciente, inclusive promoviendo el uso de medicamentos de venta libre, antes del manejo médico en niveles escalonados de atención. El objetivo de esta revisión es dar a conocer de manera resumida el manejo de rinosinusitis aguda y crónica en adultos propuesta en esta guía.

Abstract EPOS 2020 (European Position Paper on Rhinosinusitis and Nasal Polyps 2020) is a clinical guide developed by a group of professional experts in the rhinosinusal area of the European Society of Rhinology, which corresponds to the latest update of its previous versions (2005, 2007 and 2012). The main objective of the document is to bring clear recommendations based on the best available evidence and concise management algorithms for the pathologies of acute and chronic rhinosinusitis in both adults and pediatric patients. Some of the most important novelties of this guide are: new classification of chronic rhinosinusitis in primary and secondary, chronic rhinosinusitis in pediatrics, new concepts in sinus surgery, among others. It also emphasizes the importance of multidisciplinary management of the pathology, including self-care of the patient, promoting the use of over-the-counter medications, before medical management at tiered levels of care. The objective of this review is to present in a summarized way the management of acute and chronic rhinosinusitis in adults proposed in this guide.

Estrogen receptor mRNA determined by Quantitative Real-Time PCR in the nasal mucosa of women taking oral contraceptives / Receptor ARNm de estrógeno determinado por PCR Cuantitativa en Tiempo Real en la mucosa nasal de mujeres tratadas con anticonceptivos orales

SUMMARY: Estrogen receptors (ER) have been identified in human nasal mucosa, but its physiologic and pathologic impacts are not totally established. ER have been demonstrated in nasal mucosa by several authors, mainly by immunohistochemical method in nasal mucosa samples surgically removed. The present study aimed to quantify ERα and ERβ mRNA concentration by using an absolute quantitative real-time PCR in cells from nasal mucosa smear of women under oral contraceptive therapy. Nasal epithelium smear samples were collected from 110 patients divided in two groups: 55 women who present regular menstrual cycle without using contraceptives and 55 women who present regular menstrual cycle and have been using oral contraceptives for more than 3 months. All the patients answered a rhinitis symptoms questionnaire. The current study showed the potential usefulness of nasal turbinate mucosa cell sourcing, collected through swab, for extracting useful RNA for gene expression. We have identified the predominant expression of ERα isoform in a ratio 10-15 times higher compared to ERβ isoform. There is a tendency for positive correlation between the ERb isoform and the rhinitis severity score.

RESUMEN: Se han identificado receptores de estrógeno (RE) en la mucosa nasal humana, sin embargo sus impactos fisiológicos y patológicos aún no están totalmente establecidos. Varios autores han demostrado RE en la mucosa nasal, principalmente por método inmunohistoquímico en muestras obtenidas quirúrgicamente. El presente estudio tuvo como objetivo cuantificar la concentración de ARNm de REa y REb mediante el uso de una PCR cuantitativa absoluta en tiempo real en células de frotis de mucosa nasal de mujeres bajo terapia anticonceptiva oral. Se recolectaron muestras de frotis de epitelio nasal de 110 pacientes divididas en dos grupos: 55 mujeres que presentan ciclo menstrual regular sin uso de anticonceptivos y 55 mujeres que presentan ciclo menstrual regular con uso de anticonceptivos orales durante más de 3 meses. Todas las pacientes respondieron un cuestionario de síntomas de rinitis. El estudio actual mostró la utilidad de la obtención de células de la mucosa de la concha nasal, recolectadas a través de un hisopo, para extraer ARN para la expresión génica. Hemos identificado la expresión predominante de la isoforma REμ en una proporción de 10 a 15 veces mayor en comparación con la isoforma REß. Hemos identificado la expresión predominante de la isoforma REα en una proporción de 10 a 15 veces mayor en comparación con la isoforma REß. Existe una tendencia a una correlación positiva entre la isoforma REß y la puntuación de gravedad de la rinitis.

Prevalencia de asma, rinitis, dermatitis atópica en escolares, San Pedro Sula, Honduras, 2020 / Prevalence of asthma, rhinitis, atopic dermatitis in schoolchildren, San Pedro Sula, Honduras, 2020

La prevalencia de las enfermedades atópicas va en aumento de manera impor- tante, especialmente en la población infantil a nivel mundial según la Organización Mundial de la Salud. Dentro de estas enfermedades están incluidas el asma, rinitis y la dermatitis atópica. Objetivo: Determinar la prevalencia de asma, rinitis y dermatitis atópica en escolares de 6 a 12 años en San Pedro Sula, Honduras en el año 2000. Pacientes y Métodos: Estudio descrip- tivo, cuantitativo, no experimental. La muestra fue de 1500 escolares matriculados en diversas escuelas que fueron seleccionadas por un método no probabilístico por conveniencia. La reco- lección de datos se realizó mediante la aplicación de un instrumento tipo encuesta a escolares que cumplían con los criterios de inclusión y contaban con consentimiento informado. Los datos se tabularon en SPSS. Resultados: La prevalencia de asma fue 24.46% (367), rinitis 17% (255) y dermatitis atópica 11.69% (175). Se encontró que 15.73% (236) tenían asma y rinitis; 9.53% (143) asma y dermatitis; y 8.40% (126) padecían rinitis y dermatitis. Además, 7.93% (119) padecían de las tres enfermedades. Conclusión: Los datos de prevalencia de asma y de dermatitis atópica en Escolares de San Pedro Sula son mayores a los encontrados en estudios de prevalencia de dichas enfermedades en Latinoamérica. Sin embargo, la preva- lencia de rinitis en San Pedro Sula es menor en comparación a la señalada en estos estudios...(AU)

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

Predictive diagnostic value of serum 25-hydroxyvitamin D3 in eosinophilic chronic rhinosinusitis with nasal polyps / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the value of 25-hydroxyvitamin D3 (25-(OH)D3) with other clinical parameters in the prediction and diagnosis of eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP). Methods: Eligible chronic rhinosinusitis with nasal polyps (CRSwNP) patients and healthy subjects in the Affiliated Hospital of Guizhou Medical University from January to April of 2021 were included for this study. The age, gender, past history and other basic characteristics of all subjects were recorded. The CRSwNP patients were classified into ECRSwNP and non-eosinophilic chronic rhinosinusitis with nasal polyps (nECRSwNP) endotypes by the percentage of tissue eosinophils. Serum 25-(OH)D3 levels measurements were performed in all subjects. Paranasal sinus CT scans, blood eosinophil counts, and determination of total immunoglobulin E (total IgE), Th1/Th2 plasma cytokines and nasal nitric oxide (nNO) levels were performed before surgery. Logistic regression analysis was used to evaluate the related factors of ECRSwNP. Receiver operating characteristic (ROC) curves was used to evaluate the predictive potential of the clinical parameters. Results: One hundred and twenty-seven CRSwNP patients and 40 healthy subjects were recruited, including 74 males and 93 females of the patients, with the age of (38.73±13.05) years. In patients with ECRSwNP, serum 25-(OH)D3 levels were significantly lower than those in nECRSwNP patients ((26.14±4.58) ng/ml vs (35.71±7.86) ng/ml, t=-8.564, P<0.01). The prevalence of asthma, prevalence of allergic rhinitis, peripheral blood eosinophil counts, total IgE levels, nNO levels and CT scores ratio for ethmoid sinus and maxillary sinus (E/M ratio) of ECRSwNP patients were significantly higher than those in nECRSwNP patients (all P<0.05). However, there was no significant difference in Th1/Th2 cytokines levels between the histological types of CRSwNP (all P>0.05). Among the predictive indicators, 25-(OH)D3 had the highest predictive value, with ROC area under curve (AUC) value of 0.882. The best cut-off point of 28.5 ng/ml for 25-(OH)D3 demonstrated a sensitivity of 0.871 and a specificity of 0.762 for ECRSwNP. Conclusion: Measurement of serum 25-(OH)D3 level may be used as an effective method to distinguish between ECRSwNP and nECRSwNP.

Rinosinusitis crónica en niños: revisión de la evaluación y manejo actual / Chronic rhinosinusitis in children: review of the evaluation and current management

La rinosinusitis crónica (RSC) en niños corresponde a la inflamación de la mucosa de la cavidad nasal y senos paranasales, presentando síntomas como obstrucción nasal, descarga nasal, presión o dolor facial y tos, presentes por más de 12 semanas. Conlleva una gran carga de morbilidad para quienes la padecen, y un alto costo económico. Su diagnóstico constituye un desafío debido a la sobreposición de síntomas con infecciones respiratorias altas y otras condiciones no infecciosas. En los últimos años se han dilucidado nuevos factores contribuyentes como los biofilms , disfunción del microbioma, y el creciente papel de mecanismos inflamatorios no infecciosos. El estudio imagenológico de elección es la tomografía computarizada, preferentemente en casos de duda diagnóstica, falta de respuesta a tratamiento o sospecha de complicaciones. El tratamiento de primera línea es el manejo médico, basado en irrigación nasal, posible uso de antibióticos prolongados y corticoides nasales. Para casos refractarios se plantean intervenciones quirúrgicas, siendo la adenoidectomía la primera elección, principalmente en niños menores; otras intervenciones incluyen la cirugía endoscópica de cavidades paranasales. Nuevas terapias biológicas están siendo estudiadas basadas en los mecanismos inflamatorios no infecciosos de la RSC y su relación con comorbilidades como el asma.

Chronic rhinosinusitis (CRS) in children is the inflammation of the nasal and sinus mucosa, presenting symptoms such as obstruction, nasal discharge, pressure or facial pain and cough, which extends for more than 12 weeks. It represents a great burden for those affected, with high economic cost. Its diagnosis constitutes a challenge due to the overlap of symptoms with other upper respiratory infections and other non-infectious conditions. In recent years, new contributing factors have been elucidated, such as biofilms, microbiome dysfunction, and the growing role of noninfectious inflammatory mechanisms. Diagnosis depends on the recognition of characteristic symptoms and their duration. The imaging study of choice is computed tomography, especially in cases of diagnostic doubt, lack of response to treatment or suspicion of complications. First-line treatment of is based on nasal irrigation, possible use of prolonged antibiotics and nasal corticosteroids. For refractory cases, surgical intervention is proposed, with adenoidectomy being the first choice, mainly in younger children; other interventions include endoscopic sinus surgery. New biological therapies are being studied based on noninfectious inflammatory mechanisms of CRS and its comorbidities such as asthma.

Rinosinusitis fúngica invasiva aguda: actualización en pacientes adultos y pediátricos / Acute invasive fungal rhinosinusitis: update in adults and pediatric patients

RESUMEN La rinosinusitis fúngica invasiva aguda (RSFIA) es una enfermedad poco frecuente caracterizada por una infiltración fúngica de la submucosa y vasos sanguíneos de las cavidades nasal y paranasal. Afecta a pacientes con grados variables de inmunosupresión, destacando entre estas patologías subyacentes la diabetes mellitus y las neoplasias malignas hematológicas. Presenta una alta tasa de mortalidad, pudiendo reducirse significativamente si el diagnóstico y el tratamiento se realizan precozmente. Este artículo tiene por objetivo presentar una revisión actualizada de la literatura respecto a la presentación clínica, microbiología, factores de riesgos, métodos diagnósticos, tratamiento y pronóstico de la RSFIA, tanto en adultos como en niños.

ABSTRACT Acute invasive fungal rhinosinusitis (AIFS) is a rare disease characterized by fungal infiltration of the submucosa and blood vessels of the nasal y paranasal cavities. It affects almost exclusively patients with different degrees of immunosuppression, with underlying pathologies such as diabetes mellitus and hematological malignancies. AIFS has a high mortality rate, but it can be significantly reduced if the diagnosis and treatment are carried out early in the course of disease. This article aims to present an updated literature review regarding clinical presentation, microbiology, risk factors, diagnostic methods, treatment and prognosis of AIFS, both in adults and children.

Mucormicosis Rinocerebral asociado a Cetoacidosis diabética / Rhinocerebral Mucormycosis associated to diabetic ketoacidosis

Mucormycosis is an infrequent fungal infection This infection is difficult to diagnose and treat and have a high morbility and mortality and affects immunocompromised patients, especially those patients with decompensated diabetes mellitus. We report the case of a 60 years old diabetic patient with poor metabolic control who was admitted for diabetic ketoacidosis and days later present right periorbital swelling and pain, is diagnosed of mucomycosis and is successfully treated with amphoterin B and surgery.

Rhinitis and pregnancy: literature review / Rinite na gestação: revisão de literatura

ABSTRACT INTRODUCTION: There is a controversy concerning the terminology and definition of rhinitis in pregnancy. Gestational rhinitis is a relatively common condition, which has drawn increasing interest in recent years due to a possible association with maternal obstructive sleep apnea syndrome (OSAS) and unfavorable fetal outcomes. OBJECTIVE: To review the current knowledge on gestacional rhinitis, and to assess its evidence. METHODS: Structured literature search. RESULTS: Gestational rhinitis and rhinitis "during pregnancy" are somewhat similar conditions regarding their physiopathology and treatment, but differ regarding definition and prognosis. Hormonal changes have a presumed etiological role, but knowledge about the physiopathology of gestational rhinitis is still lacking. Management of rhinitis during pregnancy focuses on the minimal intervention required for symptom relief. CONCLUSION: As it has a great impact on maternal quality of life, both the otorhinolaryngologist and the obstetrician must be careful concerning the early diagnosis and treatment of gestational rhinitis, considering the safety of treatment measures and drugs and their current level of evidence.

RESUMO INTRODUÇÃO: Há grande confusão quanto à terminologia e definição da rinite na gestação. A rinite gestacional é uma condição relativamente comum que vem ganhando importância nos últimos anos pela descoberta de sua associação com a SAOS materna e possíveis desfechos desfavoráveis ao feto. Há pouca evidência na literatura nacional sobre o tema. OBJETIVO: Revisar o conhecimento científico atual sobre a rinite na gestação e suas evidências disponíveis. MÉTODO: Revisão de literatura estruturada. RESULTADOS: A rinite gestacional e a rinite "durante a gestação" são condições com alguns pontos de fisiopatologia e tratamento semelhantes, mas com definições e prognósticos diferentes. O papel dos hormônios nessas condições vem sendo sugerido por muitos trabalhos, mas o conhecimento sobre a fisiopatogenia da rinite gestacional ainda é escasso. O manejo da rinite na gestação requer o mínimo de intervenção com o maior alívio sintomático possível. CONCLUSÃO: Dado o grande impacto na qualidade de vida da gestante, tanto o otorrinolaringologista quanto o obstetra devem estar atentos para o diagnóstico precoce e manejo desta entidade, considerando o perfil de segurança e o nível de evidência das medidas e medicamentos disponíveis atualmente.

Acurácia do exame clínico no diagnóstico da rinossinusite agudaem adultos: estudo comparativo com raio x de seios da face etomografia computadorizada / Accuracy of clinical examination in the diagnosis of acute rhinosinusitis in adults: a comparative study with plain sinus radiography and computed tomography

JUSTIFICATIVA E OBJETIVOS: A rinossinusite é o processoinflamatório do revestimento da cavidade paranasal. O objetivodo presente estudo foi estimar o rendimento do exame clínico nodiagnóstico da rinossinusite aguda, comparando-o com técnicasde imagem. MÉTODOS: Foi realizado um estudo transversal,incluindo 55 pacientes com suspeita clínica de rinossinusite. Aanamnese e o exame físico para o diagnóstico de rinossinusiteforam realizados por um avaliador. As imagens foram avaliadaspor dois radiologistas, sem conhecimento dos dados clínicos.RESULTADOS: Dos 55 pacientes, 30 (45,5%) eram do sexomasculino, com média de idade de 35 anos (DP±13). O Rx deseios paranasais apresentou uma sensibilidade de 76%, especificidadede 29%, acurácia de 63%, tomando-se como padrãoáureo a tomografia computadorizada. O índice de concordânciaKappa entre os dois exames foi de 0,31. A dor à palpação dosseios da face apresentou a melhor acurácia (74%). Dos critériosmaiores, os mais frequentes foram o peso na face (100%) e ador facial (94%). Quanto aos critérios menores, a febre esteveausente nos pacientes estudados, cefaleia esteve presente em97% e tosse em 83%. O gotejamento pós-nasal esteve presenteem 58% dos indivíduos, e o gotejamento pós-nasal associado aopeso na face à inclinação do tronco presente em 63%. CONCLUSÕES:A anamnese e o exame físico apresentam boa acuráciano diagnóstico da rinossinusite aguda. O Raio X de seiosda face não apresentou bom rendimento diagnóstico quandocomparado com sinais e sintomas e com a Tomografia Computadorizadade seios da face.(AU)

BACKGROUND AND OBJECTIVES: Rhinosinusitis isinflammation of the lining of the paranasal sinus. The aim of thisstudy was to estimate the performance of clinical examinationin the diagnosis of acute rhinosinusitis, compared with imagingtechniques. METHODS: A cross-sectional study was performed, including 55 patients with suspected rhinosinusitis. The historyand physical examination for the diagnosis of rhinosinusitiswas conducted by an appraiser. The images were evaluated bytwo radiologists blinded to the clinical data. RESULTS: Ofthe 55 patients, 30 (45.5%) were male, with mean age 35 years(SD±13). The Rx of the paranasal sinuses showed a sensitivity of76%, specificity of 29%, and accuracy of 63%, with computedthomography by gold standard. Kappa index between the twoexams was 0.31. The symptom of pain on palpation of thesinus of the face showed the highest accuracy (74%). The mostcommon major criterion were the weight on the face (100%)and facial pain (94%). As for the minor criteria, fever was absentin the patients, headache was present in 97% and cough in 83%.The post-nasal drip was present in 58% of subjects, and postnasaldrip associated with weight in relation to inclination of thetrunk present in 63%. CONCLUSIONS: The clinical historyand physical examination show good accuracy in the diagnosisof acute rhinosinusitis. The X-ray doesn´t show good accuracycompared with signs, symptoms and computed tomography.(AU)

Chronic rhinosinusitis and nasal polyposis in cystic fibrosis: update on diagnosis and treatment / Rinossinusite crônica e polipose nasossinusal na fibrose cística: atualização sobre diagnóstico e tratamento

Although cystic fibrosis (CF) is an irreversible genetic disease, advances in treatment have increased the life expectancy of CF patients. Upper airway involvement, which is mainly due to pathological changes in the paranasal sinuses, is prevalent in CF patients, although many are only mildly symptomatic (with few symptoms). The objective of this literature review was to discuss the pathophysiology and current therapeutic management of chronic rhinosinusitis (CRS) in CF patients. The review was based on current evidence, which was classified in accordance with the Oxford Centre for Evidence-Based Medicine criteria. When symptomatic, CRS with nasal polyps can affect quality of life and can lead to pulmonary exacerbations, given that the paranasal sinuses can be colonized with pathogenic bacteria, especially Pseudomonas aeruginosa. Infection with P. aeruginosa plays a crucial role in morbidity and mortality after lung transplantation in CF patients. Although clinical treatment of the upper airways is recommended as initial management, this recommendation is often extrapolated from studies of CRS in the general population. When sinonasal disease is refractory to noninvasive therapy, surgery is indicated. Further studies are needed in order to gain a better understanding of upper airway involvement and improve the management of CRS in CF patients, with the objective of preserving lung function and avoiding unnecessary invasive procedures.

A fibrose cística (FC) é uma doença genética irreversível, mas os avanços no tratamento têm aumentado a expectativa de vida dos pacientes. O acometimento das vias aéreas superiores, principalmente por alterações patológicas dos seios paranasais, é prevalente nesses pacientes, embora muitos apresentem poucos sintomas. O objetivo desta revisão é discutir a fisiopatologia e o manejo terapêutico atual da rinossinusite crônica (RSC) na FC. A revisão fundamentou-se nas evidências mais recentes, classificadas em conformidade com os critérios do Oxford Centre for Evidence-Based Medicine. Quando sintomática, a RSC com pólipos nasais pode afetar a qualidade de vida e as exacerbações pulmonares, já que os seios paranasais podem ser colonizados por bactérias patogênicas, principalmente a Pseudomonas aeruginosa. Essa bactéria tem papel crucial na morbidade e mortalidade após o transplante pulmonar em pacientes com FC. Embora o tratamento clínico das vias aéreas superiores seja indicado no manejo inicial, a indicação é muitas vezes extrapolada de estudos sobre RSC na população geral. A cirurgia é a alternativa quando o quadro nasossinusal é refratário à terapia não invasiva. Mais estudos são necessários para compreender melhor o acometimento das vias aéreas superiores e melhorar o manejo da RSC na FC, a fim de preservar a função pulmonar e evitar procedimentos invasivos desnecessários.

Association of nasal inflammation and lower airway responsiveness in schoolchildren based on an epidemiological survey

BACKGROUND/AIMS: We sought to increase our understanding of the rhinitis-asthma relationship and improve strategies for the treatment of patients with these diseases. The aim of this study was to identify a connection between upper airway inflammation and lower airway responsiveness. METHODS: We counted eosinophils on nasal smears, and performed spirometry, allergic skin tests, and methacholine challenge tests in 308 schoolchildren plus a questionnaire on respiratory symptoms. The methacholine concentration causing a 20% fall in forced expiratory volume in 1 second (PC20 0.05). No difference in BHR was detected when comparing subjects with and without nasal eosinophils. There were significant differences in the PC20 between subjects with greater than 50% nasal eosinophils and without nasal eosinophils (11.01 +/- 2.92 mg/mL vs. 17.38 +/- 0.61 mg/mL; p < 0.001). CONCLUSIONS: These findings demonstrated that nasal eosinophilic inflammation might contribute to lower airway responsiveness in schoolchildren, based on an epidemiological survey.

Prevalence of rhinitis among 6 and 7-year old students in Fortaleza / Prevalência de rinite em escolares de 6 e 7 anos de Fortaleza

Objective: to evaluate the prevalence of rhinitis symptoms among 6 and 7-year old schoolchildren in Fortaleza, Brazil. Methods: a cross-sectional study using the rhinitis module of the ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire. The sample included 2,020 students from public and private schools, in 2010. Results: the prevalence of cumulative rhinitis, active rhinitis, allergic rhinoconjunctivitis and physician-diagnosed rhinitis was 49.9%, 42%, 15.4% and 28.1%, respectively, being significantly more prevalent among private school students (OR = 0.55, 95CI: 0.46 - 0.66, p < 0.001; OR = 0.50, 95CI: 0.41 - 0.60, p < 0.001; OR = 0.67, 95CI: 0.52 - 0.85, p < 0.001; OR = 0.15, 95CI: 0.12 - 0.19, p < 0.001, respectively), without differences between genders. Interference with daily activities was reported by 25.3%, while 5.7% reported to be moderately or severely affected, without a difference between genders. Conclusion: the prevalence of rhinitis symptoms and associated morbidity among 6-7-year old schoolchildren in Fortaleza was above the Brazilian average, with predominance among private school students, without difference between genders. It was observed that rhinitis was underdiagnosed in this population. .

Objetivo: avaliar a prevalência de sintomas de rinite em crianças de 6 e 7 anos de idade, em Fortaleza. Métodos: foi aplicado o questionário ISAAC (International Study of Asthma and Allergies in Childhood), módulo rinite, em estudo de desenho transversal de base populacional, com amostragem probabilística de 2.020 escolares de escolas públicas e privadas, em 2010. Resultados: a prevalência de rinite cumulativa, rinite ativa, rinoconjuntivite alérgica e rinite diagnosticada foi, respectivamente, 49,9, 42, 15,4 e 28,1%, com predomínio de forma significativa entre as crianças das escolas particulares (RC = 0,55, IC95%: 0,46 a 0,66, p < 0,001; RC = 0,50, IC95%: 0,41 a 0,60, p < 0,001; RC = 0,67, IC95%: 0,52 a 0,85, p < 0,001; RC = 0,15, IC95%: 0,12 a 0,19, p < 0,001, respectivamente), e sem diferença entre os gêneros. Interferência dos sintomas com as atividades diárias foi relatada por 25,3% dos pesquisados, e 5,7% relataram ser moderada ou intensamente afetados, sem diferença entre os gêneros. Conclusão: a prevalência de sintomas de rinite e da morbidade associada, entre crianças de 6 e 7 anos de idade, em Fortaleza, mostrou-se acima da média nacional, com predomínio no grupo das escolas privadas, e sem diferença entre os gêneros. Observou-se também que rinite é subdiagnosticada entre as crianças de 6 e 7 anos de idade, em Fortaleza. .

Sinonasal disorders in hematopoietic stem cell transplantation / Afecções nasossinusais em pacientes transplantados de células-tronco hematopoiéticas,

INTRODUCTION: hematopoietic stem cell transplantation (HSCT) is associated with more respiratory infections due to immunosuppression. OBJECTIVE: this study aimed to verify the frequency of rhinosinusitis after HSCT, and the association between rhinosinusitis and chronic graft vs. host disease (GVHD) and type of transplantation, clinical treatment, surgical treatment, and survival. METHODS: this was a retrospective study in a tertiary university hospital. A total of 95 patients with hematological diseases undergoing HSCT between 1996 and 2011 were selected. RESULTS: chronic myeloid leukemia was the most prevalent disease. The type of transplant most often performed was the allogenic type (85.26%). The frequency of rhinosinusitis was 36%, with no difference between the autologous and the allogenic types. Chronic GVHD occurred in 30% of patients. Patients with GVHD had a higher frequency and recurrence of rhinosinusitis, in addition to more frequent need for endoscopic sinusectomy and decreased overall survival. CONCLUSION: there was a higher frequency of rhinosinusitis in HSCT and GVHD. The type of transplant does not appear to predispose to the occurrence of rhinosinusitis. GVHD seems to be an aggravating factor and requires a more stringent treatment. .

INTRODUÇÃO: O transplante de células troncas hematopoiéticas (TCTH) associa-se a mais infecções respiratórias devido a imunossupressão. OBJETIVO: Este trabalho tem o objetivo de verificar a frequência das rinossinusites pós-TCTH, a associação entre a rinossinusite e a doença do enxerto contra hospedeiro (DECH) crônico e o tipo de transplante e o tratamento clinico e o tratamento cirúrgico e a sobrevida. MÉTODO: Estudo retrospectivo em hospital universitário terciário. Foram selecionados 95 pacientes com doença hematológica submetidos a TCTH entre 1996 a 2011. RESULTADOS: A leucemia mieloide crônica foi a doença mais prevalente. O tipo de transplante mais realizado foi o alogênico (85,26%). A frequência de rinossinusite foi de 36%, sem diferença entre os tipos de transplante autólogo e alogênico. A DECH crônica ocorreu em 30% dos pacientes. Os pacientes com DECH tiveram maior frequência e recorrência de rinossinusite, além de mais necessidade de sinusectomia endoscópica e de diminuição da sobrevida global. CONCLUSÃO: Houve maior frequência de rinossinusite no TCTH e DECH. O tipo de transplante não parece predispor a ocorrência da rinossinusite. A DECH parece ser um fator agravante e necessita de tratamento mais rigoroso. .

Gripe ou resfriado? Sinusite ou rinite? / Influenza or cold? Sinusitis or rhinitis?

Resfriado comum e gripe são habitualmente confundidos, principalmente se o resfriado for mais intenso. Coriza é rotulada tanto como alergia como sinusite. Os processos inflamatórios das vias aéreas superiores envolvidos nessas entidades clínicas conjugam fatores comuns, embora tenham etiologias diferentes. Graças a isso, diagnósticos equivocados geram tratamento inadequado, geralmente com emprego desnecessário de antibióticos. O resfriado comum e a gripe (influenza) são infecções virais do trato respiratório, assim como a maioria das rinossinusites. Já a rinite é, em sua maior parte, manifestação da atopia respiratória.

Common cold and flu are usually confused, especially if the cold is more intense. Many times, coryza is labeled as being allergy or sinusitis. The inflammation of the upper airways involved in these clinical entities combine common factors, although they have different etiologies. As a result, misdiagnosis generates inadequate treatment, usually with unnecessary use of antibiotics. The common cold and the flu (influenza) are viral infections of the respiratory tract, as well as most cases of rhinosinusitis. On the other hand, rhinitis is, most of the time, a manifestation of respiratory atopy.

Evaluation of atopy in patients with COPD / Avaliação de atopia em portadores de DPOC

OBJECTIVE: To determine the prevalence of atopy and to evaluate clinical, laboratory, and radiological profiles in patients with COPD. METHODS: This was a cross-sectional study involving outpatients with stable COPD (defined by the clinical history and a post-bronchodilator FEV1/FVC < 70% of the predicted value). The patients completed a questionnaire regarding clinical characteristics and atopy, after which they underwent nasal lavage cytology, skin prick testing, chest X-rays, arterial blood gas analyses, and determination of total serum IgE. RESULTS: Of the 149 subjects studied, 53 (35.6%), 49 (32.8%), and 88 (59.1%) presented with nasal eosinophilia, a positive skin prick test result, and symptoms of allergic rhinitis, respectively. Correspondence analysis confirmed these findings, showing two distinct patterns of disease expression: atopy in patients with COPD that was less severe; and no evidence of atopy in those with COPD that was more severe (reduced FEV1 and hyperinflation). There was a statistically significant association between nasal eosinophilia and a positive bronchodilator response. CONCLUSIONS: Using simple and reproducible methods, we were able to show that there is a high frequency of atopy in patients with COPD. Monitoring inflammation in the upper airways can be a useful tool for evaluating respiratory diseases in the elderly and in those with concomitant asthma and COPD, a clinical entity not yet fully understood. .

OBJETIVO: Determinar a prevalência de atopia e avaliar o perfil clínico, laboratorial e radiológico de pacientes com DPOC. MÉTODOS: Estudo de corte transversal com pacientes ambulatoriais portadores de DPOC estável (definida pela história clínica e relação VEF1/CVF < 70% do previsto após broncodilatador). Os pacientes responderam um questionário clínico e de atopia e foram submetidos a citologia de lavado nasal, teste cutâneo de alergia, radiografia de tórax, hemogasometria arterial e dosagem de IgE total. RESULTADOS: Dos 149 indivíduos avaliados, 53 (35,6%), 49 (32,8%) e 88 (59,1%), respectivamente, apresentavam eosinofilia no lavado nasal, teste cutâneo positivo e sintomas de rinite alérgica. A análise de correspondência confirmou esses achados, evidenciando dois perfis distintos de doença: a presença de atopia em pacientes com estágios mais leves de DPOC, e a ausência de características de atopia em pacientes com aspectos de doença mais grave (VEF1 reduzido e hiperinsuflação). Houve uma associação estatisticamente significante entre eosinofilia no lavado nasal e prova farmacodinâmica positiva. CONCLUSÕES: Este estudo identificou uma alta frequência de atopia em pacientes com DPOC, utilizando ferramentas simples e reprodutíveis. A monitorização inflamatória de vias aéreas parece ser uma ferramenta útil para avaliar as doenças respiratórias em idosos, assim como em pacientes com sobreposição de asma e DPOC, entidade clínica ainda pouco compreendida. .

Recirculación en rinosinusitis maxilar / Mucus recirculation in maxillary rhinosinusitis

Introducción: La recirculación de moco entre el ostium natural del seno maxilar y otras aberturas en el seno, altera el transporte mucociliar normal, favorece su acumula-ción y sobreinfección, perpetuando el fenómeno inflamatorio. Objetivo: Describir nuestra experiencia en el diagnóstico y tratamiento de pacientes con rinosinusitis maxilar crónica y/o aguda recurrente cuyo estudio reveló recirculación maxilar. Material y método: Estudio retrospectivo descriptivo. Se revisaron historias clínicas, nasofibroscopías, informes radiológicos y hallazgos operatorios. Resultados: Ocho pacientes con edad promedio de 43 años. El 100%% presentó antecedente de cirugía que involucraba el seno maxilar. Todos se presentaron como rinosinusitis maxilar crónica y/o aguda con reagudizaciones frecuentes (3 episodios/ año). El diagnóstico se realizó mediante nasofibroscopía que evidenció recirculación de moco entre ostium natural y accesorio. Cinco pacientes se sometieron a cirugía endoscópica para unir el ostium accesorio (OA) al natural, disminuyendo el número de exacerbaciones. Conclusión: La recirculación maxilar se debe sospechar en pacientes con diagnóstico de rinosinusitis maxilar crónica y/o aguda recurrente con antecedente de cirugías que involucren el seno maxilar. Su diagnóstico se basa en la observación de recirculación de moco a la nasofibroscopía. El manejo es quirúrgico y dependerá de la ubicación del OA y de la permeabilidad del ostium natural.

Introduction: Recirculation of mucus between the maxillary sinus natural ostium and adjacent openings disturbs mucociliary clearence leading to secretions accumulation and persistent infection, perpetuating the inflammatory phenomenon. Aim: Describe our experience in the diagnosis and treatment ofpatients with maxillary rhinosinusitis (chronic or acute recurrent) and maxillary recirculation. Material and method: Descriptive and retrospective study. Clinical records, radiologic characteristic, nasal endoscopies and surgical findings were reviewed. Results: 8 patients, mean age of 43 years. All of them had prior history of maxillary sinus surgery. Clinical presentation was maxillary rhinosinusitis, chronic or acute, with frequent episodes ofreagudization (3 episodes/year). The diagnosis was made by endoscopic nasal examination that showed mucus recirculation between natural and accessory ostium. Endoscopic sinus surgery was done in 5patients in order to communicate the accessory to the natural ostium, leading to a decrease in the number of exacerbations. Conclusions: Maxillary recirculation must be suspected in patients with maxillary rhinosinusitis (chronic or acute recurrent) who have had prior surgical procedures that involve the maxillary sinus. The diagnosis is based on the observation of the recirculation phenomenon in the nasal endoscopy. The treatment is surgical and depends on the location of the accessory ostium and the permeability of the natural ostium.