Nasal Septum Perforation Associated to Histoplasmosis: A Retrospective Study

Abstract Objective: To determine the prevalence of nasal septum perforation associated to Histoplasma sp. Material and Methods: A retrospective descriptive study was conducted with patients who developed nasal septum perforation associated to histoplasmosis. The diagnosis was made based on clinical manifestations and confirmed with mycological direct examination with Giemsa stain, culture, serologic tests (immunodiffusion method), and histopathology with hematoxylin-eosin, Grocott methenamine (GMS) and Periodic Acid-Schiff stain (PAS). Results: Out of 1654 medical records reviewed with diagnosis of histoplasmosis in the study period, we found 22 cases with nasal septum perforation. Autoimmune disease was present in 6 patients; all six were on immunosuppressive treatment. Two patients had HIV/AIDS, one of them had also paracoccidiodomycoses and the remaining had no apparent underlying disease or conditions. Conclusion: Physicians of endemic areas such as Venezuela, must consider this entity in the differential diagnosis with other diseases.

A new classification for septal perforation and effects of treatment methods on quality of life / Nova classificação para perfuração septal e efeitos dos métodos de tratamento na qualidade de vida

Abstract Introduction: Septal perforation is a condition characterized by loss of cartilage and/or bony structures along with the mucoperichondrium and mucoperiosteum lining them. The etiology includes a history of nasal surgery or trauma, nose picking, bilateral septal cauterization, overuse of nasal sprays, cocaine abuse, vasculitis, and malignancies. Objective: Comparison of quality of life in patients with septal perforation after conservative or surgical treatment, and a new approach for the determination of the diameter of the perforation from a different point of view. Methods: The diameter of septal perforation, total vertical diameter of septum, and horizontal diameter of the perforation were measured in a total of 34 patients. Nineteen of the patients underwent surgical septal perforation repair, and 15 of them received septal button application. The patients were asked to complete the Glasgow Benefit Inventory quality of life questionnaire. Results: The septal perforation successfully healed in 18 of 19 patients who underwent surgical treatment. The quality of life scores were statistically significantly higher in the surgical treatment group when compared to the button group (p < 0.05). Conclusion: The septal perforation classification we propose would be beneficial for providing realistic dimensions, treatment methods, and surgical techniques.

Resumo Introdução: A perfuração septal é uma condição caracterizada pela perda de estruturas cartilaginosas e/ou ósseas, juntamente com o mucopericôndrio e o mucoperiósteo que as revestem. A etiologia inclui um histórico de cirurgia nasal ou trauma, cutucar o nariz, cauterização septal bilateral, uso excessivo de sprays nasais, abuso de cocaína, vasculite e neoplasias malignas. Objetivo: Comparar a qualidade de vida em pacientes com perfuração septal após tratamento conservador ou cirúrgico e uma nova abordagem para a determinação do diâmetro da perfuração sob um diferente ponto de vista. Método: O diâmetro da perfuração septal, o diâmetro vertical total do septo e o diâmetro horizontal da perfuração foram medidos em 34 pacientes; 19 foram submetidos ao reparo cirúrgico da perfuração septal e 15 receberam a aplicação do botão septal. Os pacientes foram solicitados a preencher o questionário de qualidade de vida Glasgow Benefit Inventory. Resultados: A perfuração septal cicatrizou com sucesso em 18 de 19 pacientes submetidos a tratamento cirúrgico. Os escores de qualidade de vida foram estatisticamente significativamente maiores no grupo de tratamento cirúrgico quando comparados aos do grupo que recebeu o botão septal (p < 0,05). Conclusão: A classificação de perfuração septal que fizemos seria benéfica para fornecer dimensões, métodos de tratamento e técnicas cirúrgicas realistas.