Modified extracorporeal septoplasty: prospective study.

OBJECTIVES: This study aimed to evaluate quality-of-life and satisfaction outcomes in patients undergoing the MES using the Portuguese version of the Nasal Obstruction Symptom Evaluation (NOSE-p) and Rhinoplasty Outcome Evaluation (ROE), and also to evaluate the frequency of possible complications of this technique. METHODS: We conducted a single-center prospective study with patients who had the indication for MES, from May 2016 to September 2020 at the Facial Plastic Surgery Clinic of Otolaryngology Department of the Hospital de Clinicas de Porto Alegre. The primary outcome was the relative postoperative change in NOSE-p. Secondary outcome was the variation in ROE, a validated quality-of-life questionnaire for rhinoplasty patients. RESULTS: Of the 31 patients submitted to extracorporeal septorhinoplasty who were evaluated, twenty-seven patients were included. Preoperative and postoperative NOSE-p scale scores were 65.2 ±â€¯29.9 and 23.5 ±â€¯26.7, respectively (mean differences of 42.04; [95% CI 27.35-56.73]; p <  0.0001). Pre and postoperative ROE scores were 38.3 ± 24.3 vs. 67.29 ± 29.7, respectively (mean differences of -29.02; [95% CI -40.5 to -17.5]; p =  0.0001). Residual septal deviation was verified in 2 patients (7.4%). CONCLUSION: Most of the patients submitted to modified extracorporeal septoplasty had a significant improvement in quality of life scores of nasal obstruction, with good aesthetical outcomes and low indices of postoperative complications. LEVEL OF EVIDENCE: Level 3.

Modified extracorporeal septoplasty: prospective study

Abstract Objectives This study aimed to evaluate quality-of-life and satisfaction outcomes in patients undergoing the MES using the Portuguese version of the Nasal Obstruction Symptom Evaluation (NOSE-p) and Rhinoplasty Outcome Evaluation (ROE), and also to evaluate the frequency of possible complications of this technique. Methods We conducted a single-center prospective study with patients who had the indication for MES, from May 2016 to September 2020 at the Facial Plastic Surgery Clinic of Otolaryngology Department of the Hospital de Clinicas de Porto Alegre. The primary outcome was the relative postoperative change in NOSE-p. Secondary outcome was the variation in ROE, a validated quality-of-life questionnaire for rhinoplasty patients. Results Of the 31 patients submitted to extracorporeal septorhinoplasty who were evaluated, twenty-seven patients were included. Preoperative and postoperative NOSE-p scale scores were 65.2 ± 29.9 and 23.5 ± 26.7, respectively (mean differences of 42.04; [95% CI 27.35-56.73]; p< 0.0001). Pre and postoperative ROE scores were 38.3 ± 24.3 vs. 67.29 ± 29.7, respectively (mean differences of −29.02; [95% CI −40.5 to −17.5]; p= 0.0001). Residual septal deviation was verified in 2 patients (7.4%). Conclusion Most of the patients submitted to modified extracorporeal septoplasty had a significant improvement in quality of life scores of nasal obstruction, with good aesthetical outcomes and low indices of postoperative complications. Level of evidence: Level 3.

Evaluation of postoperative satisfaction with rhinoseptoplasty in patients with symptoms of body dysmorphic disorder / Avaliação da satisfação pós-operatória da rinosseptoplastia em pacientes com sintomas de transtorno dismórfico corporal

Abstract Introduction: The prevalence of body dysmorphic disorder among candidates for plastic surgery may vary from 6% to 54%. Some studies report discrete benefits with the surgical results, while others show symptomatic exacerbation. Some authors even affirm that body dysmorphic disorder would be a surgical contraindication, against others who suggest satisfactory results. Objective: To describe the prevalence of body dysmorphic disorder in rhinoseptoplasty candidates and to compare outcomes among patients with and without body dysmorphic disorder symptoms. Methods: Cohort study. Individuals ≥ 16 years, candidates for aesthetic and/or functional rhinoseptoplasty were recruited at a university hospital in Brazil. The prevalence of body dysmorphic disorder was assessed through the Body Dysmorphic Disorder Examination (BDDE) and the patients divided into groups: no symptoms of body dysmorphic disorder, mild-moderate and severe symptoms. The specific quality of life outcomes, Nasal Obstruction Symptom Evaluation (NOSE) and Rhinoplasty Outcome Evaluation (ROE) were evaluated before and after 90 and 180 days of the procedure. Results: 131 individuals were included, 59.5% female. The prevalence of preoperative symptoms of body dysmorphic disorder was 38%. There was a reduction in the symptoms of body dysmorphic disorder in the preoperative body dysmorphic disorder examination versus 3 and 6 months in all groups (78.94 ± 2.46 vs. 33.63 ± 6.41 and 35.51 ± 5.92, respectively, p < 0.002). Among patients with severe body dysmorphic disorder symptoms, rhinoplasty outcome evaluation ranged from 21.24 ± 3.88 to 58.59 ± 5.83 at 3 months and 52.02 ± 5.41 at 6 months postoperatively (p < 0.001); while NOSE from 71 ± 8.47 to 36.11 ± 12.10 at 6 months postoperatively (p <0.01). Conclusion: The prevalence of body dysmorphic disorder symptoms in our sample was high. Rhinoseptoplasty was associated with an improvement in quality of life outcomes related to nasal function and aesthetic outcome in all groups, irrespective of the presence and intensity of body dysmorphic disorder symptoms. Rhinoseptoplasty in body dysmorphic disorder symptomatic patients was also associated with a reduction in postoperative body dysmorphic disorder symptoms, even in severe cases.

Resumo Introdução: A prevalência do transtorno dismórfico corporal entre os candidatos à cirurgia plástica pode variar de 6% a 54%. Alguns estudos relatam benefícios discretos com os resultados cirúrgicos, enquanto outros mostram exacerbação dos sintomas. Alguns autores chegam a afirmar que o transtorno dismórfico corporal seria uma contraindicação cirúrgica, contra outros que sugerem resultados satisfatórios. Objetivo: Descrever a prevalência do transtorno dismórfico corporal em candidatos à rinosseptoplastia e comparar os desfechos entre pacientes com e sem sintomas de transtorno dismórfico corporal. Método: Estudo de coorte. Indivíduos ≥ 16 anos, candidatos à rinosseptoplastia estética e/ou funcional, foram recrutados em um hospital universitário no Brasil. A prevalência de transtorno dismórfico corporal foi avaliada por meio do questionário body dysmorphic disorder examination e os pacientes foram divididos nos grupos: sem sintomas de transtorno dismórfico corporal, sintomas leves-moderados e sintomas graves. Os resultados específicos da avaliação de qualidade de vida, com os instrumentos nasal obstruction symptom evaluation, NOSE, e rhinoplasty outcome evaluation, foram avaliados antes, após 90 e 180 dias do procedimento. Resultados: Foram incluídos 131 indivíduos, 59,5% do sexo feminino. A prevalência de sintomas pré-operatórios de transtorno dismórfico corporal foi de 38%. Houve redução dos sintomas de transtorno dismórfico corporal no body dysmorphic disorder examination pré-operatório vs. 3 e 6 meses em todos os grupos (78,94 ± 2,46 vs. 33,63 ± 6,41 e 35,51 ± 5,92, respectivamente, p < 0,002). Entre os pacientes com sintomas graves de transtorno dismórfico corporal, o escore do instrumento rhinoplasty outcome evaluation variou de 21,24 ± 3,88 a 58,59 ± 5,83 em 3 meses e 52,02 ± 5,41 em 6 meses de pós-operatório (p < 0,001); enquanto o escore do NOSE variou de 71 ± 8,47 a 36,11 ± 12,10 aos 6 meses de pós-operatório (p < 0,01). Conclusão: A prevalência de sintomas de transtorno dismórfico corporal em nossa amostra foi alta. A rinosseptoplastia foi associada a uma melhoria nos desfechos de qualidade de vida relacionados à função nasal e estética em todos os grupos, independentemente da presença e intensidade dos sintomas do transtorno dismórfico corporal. A rinosseptoplastia em pacientes com transtorno dismórfico corporal sintomático também foi associada à redução dos sintomas do transtorno dismórfico corporal no pós-operatório, mesmo em casos graves.

Overall quality of life impact on candidates for septorhinoplasty according to the World Health Organization quality of life brief questionnaire (WHOQOL-Brief) / Impacto geral na qualidade de vida em candidatos à septorrinoplastia de acordo com o World Health Organization Quality of Life Brief Questionnaire (WHOQOL-Brief)

Abstract Introduction: Quality of life has been an increasingly reference measure in whole health impact of diseases and in septorhinoplasty evaluation as well. It is known that the decision for this elective surgical procedure requires the subjective perception of patients' complaints about their own health and life stage in association with the surgeon's aesthetic and functional perspective of each case. Objective: To define the quality of life of candidates for septorhinoplasty using the World Health Organization quality of life questionnaire, WHOQOL-Brief, and the prevalence of other independent variables for this population. Methods: A cross-sectional study using a sample of candidates for septorhinoplasty was performed. All patients responded to the WHOQOL-Brief during the pre-operative period. A normative population quality of life study was the reference for the sample size and means. Results: A total of 302 patients were included among the 322 eligible patients. Twenty patients did not complete the questionnaire correctly and were excluded from the study. The sample consisted of patients aged between 15 and 78 years (34.7±14 years): the most majority were Caucasian and female. Among this group, 88.1% declared symptoms of nasal obstruction and 77.4% complained of sleeping problems. It was seen that 10.9% patients chose the surgery primarily for aesthetic improvement; 37.1% chose it mainly because of functional symptoms and 52% chose it for both functional and aesthetic reasons. The physical health domain's mean was 62.2 ± 17), which is a higher mean compared to the references' standard one (Μ = 58.9± 10.5, p = 0.002). The social relationship domain mean was 70.8±18.1; that is a lower mean then general population's one (Μ = 76.2± 18.8, p < 0.001). The psychological and the environment domain means revealed no difference when comparing the sample to the norm (μ = 65.3 ±15.1 vs. μ = 65.9 ±10.8, p = 0.530 and μ = 60.3 ±13.1 vs. μ = 59.9 ± 14.9, p = 0.667). Conclusion: The WHOQOL-Brief questionnaire proved an accurate instrument to cross-check different populations in quality of life outcomes. The study provides good evidence of lower quality of life in social relations domain and high prevalence of nasal obstruction and sleeping symptoms in candidates for septorhinoplasty. This study contributes to recent literature with relevant data supporting a more integrative evaluation in this population in the preoperative period. The results may also encourage a multidisciplinary approach for chronic symptoms when associated with nasal obstruction, sleep disorders and aesthetic complaints.

Resumo Introdução: A qualidade de vida tem sido cada vez mais uma medida de referência no impacto total das doenças na saúde e também na avaliação da septorrinoplastia. Sabe-se que a decisão por esse procedimento médico eletivo requer a percepção subjetiva da queixa do paciente sobre sua própria saúde e estágio de vida em associação com a perspectiva estética e funcional do cirurgião de cada caso. Objetivo: Definir a qualidade de vida de pacientes candidatos à septorrinoplastia por meio do questionário de qualidade de vida da OMS, WHOQOL-Brief e a prevalência de outras variáveis independentes para essa população. Método: Foi feito um estudo transversal com uma amostra de candidatos à septorrinoplastia. Todos os pacientes responderam ao WHOQOL-Brief no momento pré-operatório. Um estudo normativo de qualidade de vida populacional foi a referência para o tamanho e as médias da amostra. Resultados: Foram incluídos 302 pacientes entre os 322 elegíveis. Vinte pacientes não preencheram o questionário corretamente e foram excluídos do estudo. A amostra foi composta por pacientes entre 15 e 78 anos (34,7 ± 14 anos) e a maioria era branca e do sexo feminino. Entre todos, 88,1% declararam sintomas de obstrução nasal e 77,4% declararam ter sintomas durante o sono. Observou-se que 10,9% dos pacientes optaram pela cirurgia principalmente para melhoria estética; 37,1% optaram principalmente devido a sintomas funcionais e 52% optaram por queixa funcional e estética. A média do domínio saúde física foi de 62,2 ± 17, uma média mais alta em comparação com o padrão de referências (μ = 58,9 ± 10,5, p = 0,002). A média do domínio do relacionamento social foi de 70,8 ±18,1, uma média inferior à da população geral (μ = 76,2 ± 18,8, p < 0,001). As médias dos domínios psicológico e meio ambiente não diferiram na comparação da amostra com o normativo (μ = 65,3 ±15,1 vs. μ = 65,9 ± 10,8, p = 0,530 e μ = 60,3 ±13,1 vs. μ = 59,9 ± 14,9, p = 0,667). Conclusão: O questionário WHOQOL-Brief demonstrou servir como um instrumento preciso para cruzar diferentes populações nos desfechos de qualidade de vida. O estudo fornece boas evidências de menor qualidade de vida no domínio relações sociais e alta prevalência de obstrução nasal e sintomas durante o sono em candidatos à septorrinoplastia. Este estudo contribui para a literatura recente com dados relevantes que subsidiam uma avaliação mais integrativa nessa população no momento pré-operatório. Os resultados também podem incentivar uma abordagem multidisciplinar para os sintomas crônicos quando associados, como ocorre na obstrução nasal, distúrbios do sono e queixas estéticas.

Inferior Turbinate Reduction during Rhinoplasty: Is There Any Effect on Rhinitis Symptoms?

Abstract Introduction Inferior turbinate surgery is often performed concomitantly with rhinoseptoplasty. As inferior turbinates play a major role in allergic rhinitis, it seems reasonable to suggest that inferior turbinate surgery reduces allergy. Objective To assess the impact of nasal turbinate surgery on non-obstructive allergic symptoms (nasal discharge, sneezing, pruritus, and allergic conjunctivitis) and on the use of allergic medication in patients with allergic rhinitis undergoing rhinoseptoplasty. Methods Secondary analysis of aggregated data from two randomized controlled trials. Participants with allergic rhinitis aged 2: 16 years were recruited. Data from two groups were analyzed: patients with rhinoseptoplasty and concomitant turbinate reduction (intervention group) and patients with rhinoseptoplasty only (control group). The 90-day postoperative frequency of non-obstructive allergic symptoms and of nasal steroid and oral antihistamine use were analyzed. Results A total of 100 patients were studied. The groups were similar in terms of allergic symptom intensity and mean age. The frequency of non-obstructive allergic symptoms decreased 90 days postoperative in both groups (p < 0.01). There was no difference between the groups in the frequency of non-obstructive allergic symptoms at 90 days (p = 0.835). Topical nasal steroid and oral histamine antagonist use decreased in the intervention group at 90 days (p < 0.05). Conclusions Ninety days after the surgery, turbinate reduction performed in association with rhinoseptoplasty did not reduce the frequency of non-obstructive allergic symptoms more than rhinoplasty alone. However, the observed decrease in nasal steroid and oral antihistamine use suggests an impact of turbinate reduction on medication use in patients with allergic rhinitis undergoing rhinoseptoplasty. Trial Registration ClinicalTrials.gov database (NCT01457638 and NCT02231216).

Inferior Turbinate Reduction during Rhinoplasty: Is There Any Effect on Rhinitis Symptoms?

Introduction Inferior turbinate surgery is often performed concomitantly with rhinoseptoplasty. As inferior turbinates play a major role in allergic rhinitis, it seems reasonable to suggest that inferior turbinate surgery reduces allergy. Objective To assess the impact of nasal turbinate surgery on non-obstructive allergic symptoms (nasal discharge, sneezing, pruritus, and allergic conjunctivitis) and on the use of allergic medication in patients with allergic rhinitis undergoing rhinoseptoplasty. Methods Secondary analysis of aggregated data from two randomized controlled trials. Participants with allergic rhinitis aged ≥ 16 years were recruited. Data from two groups were analyzed: patients with rhinoseptoplasty and concomitant turbinate reduction (intervention group) and patients with rhinoseptoplasty only (control group). The 90-day postoperative frequency of non-obstructive allergic symptoms and of nasal steroid and oral antihistamine use were analyzed. Results A total of 100 patients were studied. The groups were similar in terms of allergic symptom intensity and mean age. The frequency of non-obstructive allergic symptoms decreased 90 days postoperative in both groups ( p < 0.01). There was no difference between the groups in the frequency of non-obstructive allergic symptoms at 90 days ( p = 0.835). Topical nasal steroid and oral histamine antagonist use decreased in the intervention group at 90 days ( p < 0.05). Conclusions Ninety days after the surgery, turbinate reduction performed in association with rhinoseptoplasty did not reduce the frequency of non-obstructive allergic symptoms more than rhinoplasty alone. However, the observed decrease in nasal steroid and oral antihistamine use suggests an impact of turbinate reduction on medication use in patients with allergic rhinitis undergoing rhinoseptoplasty. Trial Registration ClinicalTrials.gov database (NCT01457638 and NCT02231216).

Analysis of Determinants of Postoperative Satisfaction After Rhinoplasty.

OBJECTIVES/HYPOTHESIS: To analyze different variables that influence postrhinoplasty quality of life outcomes to ascertain the determinants of postoperative satisfaction. STUDY DESIGN: Prospective, observational study. METHODS: This was a prospective, observational study where patients were divided into two groups based on the postoperative Rhinoplasty Outcome Evaluation (ROE) score: high satisfaction group, when postoperative ROE scores were >50, and low satisfaction group, when postoperative ROE scores were ≤50. Patients' general characteristics, Portuguese version of the Nasal Obstruction Symptom Evaluation (NOSE-p) score, the Body Dysmorphic Disorder Examination, nasal angles, and measures from the esthetic facial analysis of postoperative photographs were compared between the groups. RESULTS: Seventy-eight patients were included: 19 in the low satisfaction group and 58 in the high satisfaction group. The median reduction in the NOSE-p score was -45 (interquartile range [IIQ] -20 to -60) (P < .001) in the high satisfaction group and -10 (IIQ -10 to -30) in the low satisfaction group (P = .053). The high satisfaction group had a significantly higher reduction in NOSE-p scores. There was no significant difference between the groups in terms of the analyzed facial parameters, although a significant difference was found when comparing them with the ones established in the literature as a pattern. Previous rhinoplasty, preoperative crooked nose, and higher NOSE-p scores were significantly associated with lower ROE scores (P < .05) in the robust Poisson regression model. CONCLUSION: Functional results play an important role in satisfaction after rhinoplasty. Neoclassical canons were not fulfilled even in a group of patients with a high postoperative satisfaction evaluation. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:1569-1575, 2022.

Evaluation of postoperative satisfaction with rhinoseptoplasty in patients with symptoms of body dysmorphic disorder.

INTRODUCTION: The prevalence of body dysmorphic disorder among candidates for plastic surgery may vary from 6% to 54%. Some studies report discrete benefits with the surgical results, while others show symptomatic exacerbation. Some authors even affirm that body dysmorphic disorder would be a surgical contraindication, against others who suggest satisfactory results. OBJECTIVE: To describe the prevalence of body dysmorphic disorder in rhinoseptoplasty candidates and to compare outcomes among patients with and without body dysmorphic disorder symptoms. METHODS: Cohort study. Individuals ≥ 16 years, candidates for aesthetic and/or functional rhinoseptoplasty were recruited at a university hospital in Brazil. The prevalence of body dysmorphic disorder was assessed through the Body Dysmorphic Disorder Examination (BDDE) and the patients divided into groups: no symptoms of body dysmorphic disorder, mild-moderate and severe symptoms. The specific quality of life outcomes, Nasal Obstruction Symptom Evaluation (NOSE) and Rhinoplasty Outcome Evaluation (ROE) were evaluated before and after 90 and 180 days of the procedure. RESULTS: 131 individuals were included, 59.5% female. The prevalence of preoperative symptoms of body dysmorphic disorder was 38%. There was a reduction in the symptoms of body dysmorphic disorder in the preoperative body dysmorphic disorder examination versus 3 and 6 months in all groups (78.94 ±â€¯2.46 vs. 33.63 ±â€¯6.41 and 35.51 ±â€¯5.92, respectively, p < 0.002). Among patients with severe body dysmorphic disorder symptoms, rhinoplasty outcome evaluation ranged from 21.24 ±â€¯3.88 to 58.59 ±â€¯5.83 at 3 months and 52.02 ±â€¯5.41 at 6 months postoperatively (p < 0.001); while NOSE from 71 ±â€¯8.47 to 36.11 ±â€¯12.10 at 6 months postoperatively (p < 0.01). CONCLUSION: The prevalence of body dysmorphic disorder symptoms in our sample was high. Rhinoseptoplasty was associated with an improvement in quality of life outcomes related to nasal function and aesthetic outcome in all groups, irrespective of the presence and intensity of body dysmorphic disorder symptoms. Rhinoseptoplasty in body dysmorphic disorder symptomatic patients was also associated with a reduction in postoperative body dysmorphic disorder symptoms, even in severe cases.

Overall quality of life impact on candidates for septorhinoplasty according to the World Health Organization quality of life brief questionnaire (WHOQOL-Brief).

INTRODUCTION: Quality of life has been an increasingly reference measure in whole health impact of diseases and in septorhinoplasty evaluation as well. It is known that the decision for this elective surgical procedure requires the subjective perception of patients' complaints about their own health and life stage in association with the surgeon's aesthetic and functional perspective of each case. OBJECTIVE: To define the quality of life of candidates for septorhinoplasty using the World Health Organization quality of life questionnaire, WHOQOL-Brief, and the prevalence of other independent variables for this population. METHODS: A cross-sectional study using a sample of candidates for septorhinoplasty was performed. All patients responded to the WHOQOL-Brief during the pre-operative period. A normative population quality of life study was the reference for the sample size and means. RESULTS: A total of 302 patients were included among the 322 eligible patients. Twenty patients did not complete the questionnaire correctly and were excluded from the study. The sample consisted of patients aged between 15 and 78 years (34.7 ±â€¯14 years): the most majority were Caucasian and female. Among this group, 88.1% declared symptoms of nasal obstruction and 77.4% complained of sleeping problems. It was seen that 10.9% patients chose the surgery primarily for aesthetic improvement; 37.1% chose it mainly because of functional symptoms and 52% chose it for both functional and aesthetic reasons. The physical health domain's mean was 62.2 ±â€¯17), which is a higher mean compared to the references' standard one (µâ€¯= 58.9 ±â€¯10.5, p = 0.002). The social relationship domain mean was 70.8 ±â€¯18.1; that is a lower mean then general population's one (µâ€¯= 76.2 ±â€¯18.8, p < 0.001). The psychological and the environment domain means revealed no difference when comparing the sample to the norm (µâ€¯= 65.3 ±â€¯15.1 vs. µâ€¯= 65.9 ±â€¯10.8, p = 0.530 and µâ€¯= 60.3 ±â€¯13.1 vs. µâ€¯= 59.9 ±â€¯14.9, p = 0.667). CONCLUSION: The WHOQOL-Brief questionnaire proved an accurate instrument to cross-check different populations in quality of life outcomes. The study provides good evidence of lower quality of life in social relations domain and high prevalence of nasal obstruction and sleeping symptoms in candidates for septorhinoplasty. This study contributes to recent literature with relevant data supporting a more integrative evaluation in this population in the preoperative period. The results may also encourage a multidisciplinary approach for chronic symptoms when associated with nasal obstruction, sleep disorders and aesthetic complaints.

Chronic rhinosinusitis and nasal polyposis in cystic fibrosis: update on diagnosis and treatment.

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.

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.

An experimental model of chronic rhinosinusitis in rabbits without bacterial inoculation.

PURPOSE: Evaluate and compare two different experimental techniques of maxillary sinus ostium occlusion using N-butyl cyanoacrylate in developing chronic histological findings without the inoculation of pathogenic bacteria among rabbits. METHODS: In a randomized study, sixteen New Zealand rabbits were assigned for occlusion of the right maxillary sinus through a transmaxillary approach or through the roof of the nasal cavity. The contralateral sinus served as a control. After 12 weeks, the animals were sacrificed for blinded histopathological analysis of the maxillary sinus mucosa. RESULTS: Histopathological changes consistent with CRS were found in eight (100%) of the maxillary sinuses approached transmaxillary and three of those through the roof of the nasal cavity (37.5%), p 0.008 and 0.250, respectively, comparing with the control side. Chronic mucosal changes were significantly better induced using the transmaxillary approach (p 0.026). CONCLUSION: It is possible to induce a model of chronic sinusitis among rabbits with transmaxillary sinus occlusion without bacterial inoculation. This model can be replicated for future cellular studies.

An experimental model of chronic rhinosinusitis in rabbits without bacterial inoculation

Evaluate and compare two different experimental techniques of maxillary sinus ostium occlusion using N-butyl cyanoacrylate in developing chronic histological findings without the inoculation of pathogenic bacteria among rabbits. In a randomized study, sixteen New Zealand rabbits were assigned for occlusion of the right maxillary sinus through a transmaxillary approach or through the roof of the nasal cavity. The contralateral sinus served as a control. After 12 weeks, the animals were sacrificed for blinded histopathological analysis of the maxillary sinus mucosa. Histopathological changes consistent with CRS were found in eight (100%) of the maxillary sinuses approached transmaxillary and three of those through the roof of the nasal cavity (37.5%), p 0.008 and 0.250, respectively, comparing with the control side. Chronic mucosal changes were significantly better induced using the transmaxillary approach (p 0.026). It is possible to induce a model of chronic sinusitis among rabbits with transmaxillary sinus occlusion without bacterial inoculation. This model can be replicated for future cellular studies.(AU)

An experimental model of chronic rhinosinusitis in rabbits without bacterial inoculation

PURPOSE: Evaluate and compare two different experimental techniques of maxillary sinus ostium occlusion using N-butyl cyanoacrylate in developing chronic histological findings without the inoculation of pathogenic bacteria among rabbits. METHODS: In a randomized study, sixteen New Zealand rabbits were assigned for occlusion of the right maxillary sinus through a transmaxillary approach or through the roof of the nasal cavity. The contralateral sinus served as a control. After 12 weeks, the animals were sacrificed for blinded histopathological analysis of the maxillary sinus mucosa. RESULTS: Histopathological changes consistent with CRS were found in eight (100%) of the maxillary sinuses approached transmaxillary and three of those through the roof of the nasal cavity (37.5%), p 0.008 and 0.250, respectively, comparing with the control side. Chronic mucosal changes were significantly better induced using the transmaxillary approach (p 0.026). CONCLUSION: It is possible to induce a model of chronic sinusitis among rabbits with transmaxillary sinus occlusion without bacterial inoculation. This model can be replicated for future cellular studies. .

Rinossinusite fúngica invasiva aguda com desfecho favorável / Acute invasive fungal rhinosinusitis with favorable outcome

A rinossinusite fúngica invasiva aguda é uma patologia que afeta principalmente pacientes imunocomprometidos, tendo morbidade e mortalidade elevadas.Apresentamos um caso de aspergilose invasiva aguda em paciente imunocomprometido, que apresentou bom desfecho pelo diagnóstico precoce e rápida intervenção. Relato de caso: Menina de 13 anos com diagnóstico de leucemia mieloide aguda interna por neutropenia febril após quimioterapia. TCseios da face mostrou opacificação parcial dos seios à esquerda. Leucograma revelou contagem de 880 leucócitos totais. À endoscopia nasal, constatou-se corneto médio isquêmico à esquerda. Levada de urgência ao bloco cirúrgico e realizado debridamento amplo. Anatomopatológico revelou áreas de necrose isquêmica e estruturas fúngicas angioinvasivas, compatíveis com aspergilose.Exame de cultura de fungo confirmou Aspergillus flavus. Iniciado tratamento com voriconazol. Paciente realiza acompanhamento com a Oncologia Pediátrica,mantendo-se em remissão oncológica e sem recidiva fúngica. A frequência das infecções micóticas do nariz e seios paranasais vem aumentando nas últimas décadas. Há um quadro febril, com ou sem sintomas nasais, sem resposta a antibióticos. Endoscopia nasal é o exame mais importante. O corneto médio costuma ser mais acometido. Não há sinais patognomônicos na TC, servindo mais como um instrumento de diagnóstico diferencial, planejamento emonitoramento pós-terapêutico. A correção concomitante de qualquer distúrbio metabólico ou imunológico subjacente é o fator prognóstico mais importante.Deve ser introduzida terapia antifúngica associada ao debridamento cirúrgico. O risco de contaminação fúngica pode ser minimizado com cuidados de exposição do paciente neutropênico e com a implantação de unidades de internação com filtros HEPA.

Acute invasive fungal sinusitis is a disease that affects primarily immunocompromised patients causing high morbidity and mortality. We present a case of acute invasive aspergillosis in an immunocompromised patient that evolved with a good outcome resulting from early diagnosis and rapid intervention. Case report: a thirteen year-old girl diagnosed with acute myeloid leukemia admitted for febrile neutropenia after chemotherapy. Sinus CT revealed partial opacification of left sinuses. Blood tests showed a number of total leukocytes, count 880. In the nasal endoscopy, we found a left middle turbinate ischemia. Patient was taken to surgical emergency and submitted to extensive debridement. Pathological examination revealed areas of ischemic necrosis and angioinvasive fungal structures consistent with aspergillosis. Examination confirmed Aspergillus flavus; Voriconazole was introduced. Follow-up was performed by pediatric oncology; cancer kept in remission without fungal recurrence. The incidence of fungal infections of the nose and paranasal sinuses has been increasing in recent decades. Fever unresponsive to antibiotics,with or without nasal symptoms, is the most suggestive sign of this disease that typically affects the middle turbinate. Nasal endoscopy is its most effective diagnostic test. There are no pathognomonic signs using CT, which serves moreas a post-treatment tool for differential diagnosis, planning, and monitoring.Concomitant correction of any underlying metabolic or immune disorder is the most important prognostic factor. Antifungal therapy should be introduced and associated with surgical debridement. Risk of fungal contamination can be minimized with care of exposure of neutropenic patients, and with the implantation of hospitalization units with HEPA filters.

Aparelhos intraorais: uma opção no tratamento do ronco e da síndrome da apneia-hipopneia obstrutiva do sono / Intraoral appliances: an option in the treatment of snoring and sleep obstructive apnea /hipopnea

A síndrome da apneia-hipopneia obstrutiva do sono (SAHOS) é considerada uma doença evolutiva e com alta taxa de morbimortalidade. O uso dos aparelhos intraorais (AIO) tem importante papel no tratamento da SAHOS, especialmente nos casos leves e moderados. O presente artigo faz uma revisão das causas da SAHOS, seu diagnóstico e opções terapêuticas, segundo diretrizes baseadas em evidências atualizadas. Embora os AIOs ainda apresentem resultados inferiores em relação aos aparelhos com continuous positive airway pressure (CPAP), costumam ser melhor tolerados pelos pacientes, uma vez que são menores e esteticamente mais aceitáveis. Os AIOs, especialmente os de avanço mandibular, são alternativas de tratamento para a SAHOS leve e moderada.

Estimation of truncal adiposity using waist circumference or the sum of trunk skinfolds: a pilot study for insulin resistance screening in hirsute patients with or without polycystic ovary syndrome.

Insulin resistance (IR) is an independent risk factor for cardiovascular disease and is a prevalent metabolic disturbance among women with polycystic ovary syndrome (PCOS). Central adiposity, a marker of IR and an accurate anthropometric method to estimate truncal adiposity, may represent a key clinical tool for IR screening in subpopulations at higher metabolic and cardiovascular risk, such as women with PCOS. The aims of the present study were (1) to investigate the influence of androgens on IR and central obesity in overweight or obese hirsute women with or without PCOS and (2) to test the reliability of the sum of trunk skinfolds (subscapular, suprailiac, and abdominal) to estimate truncal adiposity. This observational, cross-sectional study included 37 hirsute patients with body mass index of 25 kg/m(2) or greater and aged between 14 and 41 years. Twenty-four had PCOS, and 13 had ovulatory cycles, normal androgen levels, and isolated hirsutism, named idiopathic hirsutism (IH). Nutritional, anthropometric, clinical, and laboratory evaluations were performed. Body composition was assessed by measurement of waist circumference and skinfold thickness and by dual-energy x-ray absorptiometry (DXA). Both groups presented similar ages, body mass index, and hirsutism score. The PCOS group had higher androgen levels, homeostasis model assessment (HOMA) index, and fasting insulin levels. Free androgen index was positively associated with HOMA, independent of truncal adiposity (r = 0.441, P = .009). Strong correlations were also observed between truncal adiposity measured by DXA and both the sum of trunk skinfolds (r = 0.863, P = .0001) and waist circumference in hirsute patients (r = 0.947, P = .0001). In our study, IR (HOMA index >/=3.8) was associated with truncal obesity, with a more androgenic profile, and with an unfavorable lipid profile. In conclusion, hirsutism per se appears not to be a risk for IR and related cardiovascular disease unless there is presence of central adiposity and/or abnormal androgen profile as observed in patients with PCOS. Waist circumference and the sum of trunk skinfolds represent accurate methods to estimate truncal adiposity, but waist circumference measurement seems to be the simplest method of clinical screening for IR in hirsute women.