Computational fluid dynamics and NOSE scale to assess nasal respiratory function, and correlation with linear maxillary measurements after surgically assisted rapid maxillary expansion.

Nasal obstruction is common in patients with a transverse maxillary deficiency. The aim of this study was to determine the variation in nasal airway resistance in adult patients with a transverse maxillary deficiency before and after surgically assisted rapid maxillary expansion (SARME) by computational fluid dynamics (CFD) using computed tomography scans, and to correlate this variation with maxillary linear measurements obtained by means of plaster models. The subjective symptoms of nasal obstruction were also analysed using a visual analogue scale (VAS) for nasal breathing and the Nasal Obstruction Symptom Evaluation (NOSE) scale. There was a median reduction of 21% in nasal airway resistance post SARME (P = 0.002). The NOSE scale score decreased (P < 0.001) and nasal breathing quality VAS scores increased in both nostrils (P < 0.001). Transverse measurements between the upper canines (C-C), premolars (PM-PM), and molars (M-M), and maxillary perimeter showed significant increases (P < 0.001), while the anteroposterior maxillary arch length showed a significant decrease (P = 0.016). An inverse proportional correlation was found between PM-PM and nasal airway resistance (r = -0.395; P = 0.034) and between M-M and nasal airway resistance (r = -0.383; P = 0.040). These results demonstrate that surgically expanding the posterior region of the maxilla results in decreased nasal airway resistance, decreased obstructive symptoms, and improved patient respiratory quality.

Evaluation of the Impact of Exposure To Heat and to By-Products of Combustion on the Health of Firefighters.

Firefighters are often exposed to high temperatures and by-products of combustion, which can affect their health. In this study, we assessed the impact of acute exposure of firefighters in fire simulators. Twenty male firefighters were exposed to fire simulators, and observed in four phases: pre-exposure (group 0, control) and after the end of the first (group 1), second (group 2), and fourth (group 3) weeks of training. Blood samples were collected and dosed to evaluate the response of the immune, inflammatory (C-reactive protein, IL6, and IL10), and endocrine systems (cortisone, total testosterone, free testosterone, SHBG, bioavailable testosterone, TSH, and free T4). In groups 0, 1, and 3, a thermographic evaluation was also carried out to study the temperature and body heat flow of the participants. Regarding the inflammatory process, an increase in C-reactive protein and a reduction in IL-10 were observed. With respect to hormonal markers, an increase in cortisol and reduced levels of free T4 and bioavailable testosterone were found after exposure, with recovery of testosterone levels in the final week of training. Thermoregulatory adaptation of the organism has been associated with changes in heat flow in the organism in people subjected to extreme temperatures, with emphasis on the performance of the lower limbs. Our findings demonstrate an inflammatory response with hormonal changes after exposure to fire and an adaptive response of thermal balance, which could aid understanding of the physiology of the human body in extreme situations.

Les sapeurs-pompiers (SP) sont régulièrement exposés à la chaleur et aux produits de combustion, qui peuvent avoir un retentissement sur leur santé. Nous avons évalué l'effet d'une exposition aiguë de 22 SP (tous des hommes) à incendie simulé grâce à la répétition à 4 reprises d'une même batterie d'examens (avant- T0, et à la fin des 1ère -T1 2ème - T2 et 3ème - T3 semaines d'entraînement). Des paramètres sanguins relatifs à l'inflammation et l'immunité (CRP, IL6, IL10) ainsi qu'au système endocrinien (cortisol, testostérones totale, libre et biodisponible, SHBG, TSH et T4 libre) étaient prélevés à chaque évaluation. Une étude thermographique, évaluant la température corporelle et le flux thermique corporel était réalisée à T0, T1 et T3. On constatait une augmentation de la CRP et une baisse de IL10. On observait une augmentation de la cortisolémie ainsi qu'une baisse de thyroxine libre et testostérone biodisponible, cette dernière se normalisant à T3. L'adaptation corporelle à la chaleur se traduit par une augmentation du flux thermique, en particulier aux membres inférieurs. Nous observons donc des réponses inflammatoire comme endocrinienne et une adaptation de la thermorégulation en cas d'exposition à un incendie, constatations pouvant contribuer à la compréhension de la physiologie humaine en situations extrêmes.

Fire simulator exposure alters the innate epithelial response and inflammatory status in the airways of firefighters.

BACKGROUND: Firefighters are often exposed to high temperatures and by-products of combustion, which can compromise their health. We aimed to evaluate the effect of fire exposure in fire simulators on the airways of firefighters at different time-points. METHODOLOGY: Thirty-seven male firefighters exposed to fire simulators were evaluated in three phases: pre-exposure, at the end of the first week, and 4 weeks after. Pulmonary function by spirometry, nasal mucociliary clearance; peripheral oxygen saturation, inflammatory markers in the nasal lavage and CC16 in the sputum, nasal obstruction, and quality of life (using the questionnaires NOSE and SNOT-22) were assessed. RESULTS: Higher levels of IL-8, IL-10, and exhaled carbon monoxide were found more in phase 2 than in phase 1. Higher CC16 levels and lower peripheral oxygen saturation were observed in phase 3 as compared to phase 1. Lower levels of IL-2 and peripheral oxygen saturation were found in phase 3 than in phase 2. Higher nasal mucociliary clearance, as well as the worst quality of life and nasal obstruction, were observed in phases 2 and 3 as compared to phase 1. CONCLUSIONS: The firefighters’ exposures to high temperatures and by-products of combustion in the fire simulators elicit an inflammatory process in the airways with impairment in the innate epithelial response of the upper airway lining. Furthermore, changes in O2 transport affected the professionals’ quality of life negatively.

Prospective open-label evaluation of long-term low-dose doxycycline for difficult-to-treat chronic rhinosinusitis with nasal polyps.

BACKGROUND: This study aimed to assess clinical outcomes of long-term low-dose oral doxycycline therapy in difficult-to-treat chronic rhinosinusitis with polyps (CRSwNP). METHODS: This was a prospective, open-label study of 60 patients with difficult-to-treat CRSwNP who had undergone endoscopic sinus surgery. Patients were divided into two groups: 28 received nasal steroids, saline irrigation, and doxycycline (200 mg on the first day, followed by 100 mg once daily) for 12 weeks, while 30 received only nasal steroids and saline irrigation. The main outcome measure was an adequate effect size of doxycycline treatment on clinically meaningful significant improvement of SNOT-20. Other outcome measures were the SNOT-20, NOSE, and Lund-Kennedy scores. The following parameters were also analyzed: asthma, rhinitis, non-steroidal-exacerbated respiratory disease (NERD), and baseline serum IgG, IgA, IgE, IgM, ANCA, and eosinophil count. RESULTS: There was an adequate effect size of doxycycline treatment on clinically meaningful significant improvement of SNOT-20. Patients who received doxycycline also had significantly better outcomes regarding SNOT-20, NOSE, and Lund-Kennedy scores. There was a negative association among a clinically significant improvement of SNOT-20 and presence of asthma, NERD, and elevated serum IgE levels before treatment. CONCLUSION: These findings suggest that doxycycline may have a beneficial role for CRSwNP patients, especially for patients without asthma, NERD or high levels of serum IgE before treatment.

Mechanical disfunction in the mucosal oedema formation of patients with nasal polyps.

BACKGROUND: Nasal polyposis (NP) is characterized by an anomalous tissue growth with oedema and a lack of extracellular matrix. In this study, we investigated whether a mechanical disfunction of the forces that act in oedema formation is present in NP. METHODS: We compared the interstitial hydrostatic pressure behaviour during a saline solution infusion between healthy nasal mucosa (inferior and middle turbinate from 10 patients) and inflamed nasal mucosa from NP patients (inferior, middle turbinate and a nasal polyp from 6 patients). We used Controlled Disc Stimulation equipment to compare the curve Pressure/Volume created during the saline solution infusion. RESULTS: The pressure at 0.2 ml infusion was lower in the middle turbinate of NP patients than in the middle turbinate of control patients. The lowest P/V mean assessed was in the polypoid tissue. CONCLUSIONS: The interstitial hydrostatic pressure showed different behaviour during liquid infusion in nasal mucosa from NP patients when compared with healthy nasal mucosa. This study allows us to cogitate on a new pathophysiological mechanism contributing to the development of the NP.

Prevalence of chronic rhinosinusitis in Sao Paulo.

INTRODUCTION: Studies designed to investigate chronic rhinosinusitis (CRS) epidemiology play an important role to assess population`s distribution and risk factors to result in the development and promotion of public health policies. METHOD: This study design is a survey carried out with a complex two-stage cluster sampling plan. Personal interviews were carried out with 2,003 individuals. The questionnaire included the epidemiological criteria for CRS. Demographic data, history of physician-diagnosed respiratory diseases (asthma, sinusitis, rhinitis), smoking, family income, educational attainment, and household characteristics were also evaluated. RESULTS: The overall response rate was 93.9% of the households. Mean age was 39.8 +- 21 years; 45.33% were male. The overall prevalence of CRS in the city of Sao Paulo was 5.51%. We found a significant association between diagnosis of CRS and diagnosis of asthma and CRS and diagnosis of rhinitis and a significant association between presence of CRS and belonging to the low-income subgroup. CONCLUSION: The municipality of Sao Paulo has an urban population of 11 million. According to the present study, the prevalence of CRS is 5.51%, which represents more than 500,000 individuals affected by this condition in the city.

Juvenile angiofibroma: major and minor complications of preoperative embolization.

INTRODUCTION: Juvenile angiofibromas (JA) are highly vascular, benign tumours for which surgery is the treatment of choice. In most services, embolisation is performed prior to resection. Nevertheless, there are few data on the complications of preoperative embolisation for JA. AIM: To describe major and minor complications of preoperative embolisation in a 32-year experience of patients undergoing surgical resection of JA at a tertiary hospital. METHODS: Retrospective chart review study of 170 patients who underwent surgical resection of JA at a tertiary hospital between September 1976 and July 2008. RESULTS: All patients were male. Age ranged from 9 to 26 years. Ninety-one patients had no complications after embolisation. Overall, 105 complication events occurred of which four major and 101 minor. CONCLUSION: In our series, preoperative embolisation for JA produced no irreversible complications and no aesthetic or functional sequelae. The vast majority of complications were transient and amenable to clinical management.

Orthodontic measurements and nasal respiratory function after surgically assisted rapid maxillary expansion: an acoustic rhinometry and rhinomanometry study.

The present study sought to assess nasal respiratory function in adult patients with maxillary constriction who underwent surgically assisted rapid maxillary expansion (SARME) and to determine correlations between orthodontic measurements and changes in nasal area, volume, resistance, and airflow. Twenty-seven patients were assessed by acoustic rhinometry, rhinomanometry, orthodontic measurements, and use of a visual analogue scale at three time points: before surgery; after activation of a preoperatively applied palatal expander; and 4 months post-SARME. Results showed a statistically significant increase (p<0.001) in all orthodontic measurements. The overall area of the nasal cavity increased after surgery (p<0.036). The mean volume increased between assessments, but not significantly. Expiratory and inspiratory flow increased over time (p<0.001). Airway resistance decreased between assessments (p<0.004). Subjective analysis of the feeling of breathing exclusively through the nose increased significantly from one point in time to the next (p<0.05). There was a statistical correlation between increased arch perimeter and decreased airway resistance. Respiratory flow was the only variable to behave differently between sides. The authors conclude that the SARME procedure produces major changes in the oral and nasal cavity; when combined, these changes improve patients' quality of breathing.

Cross-cultural adaptation and validation of a quality of life questionnaire: the Nasal Obstruction Symptom Evaluation questionnaire.

BACKGROUND: The Nasal Obstruction Symptom Evaluation (NOSE) instrument is a disease-specific questionnaire for assessing the outcome of an intervention in nasal obstruction in trials. This instrument is only available in the English language and cross-culturally valid questionnaires are very important for all research, including nasal obstruction. The aim of the current study was to reproduce the cross-cultural adaptation process for the NOSE questionnaire in the Portuguese language (NOSE-p). METHODOLOGY/PRINCIPAL: Cross-cultural adaptation and validation of the instrument were divided into two stages. Stage 1 involved four bilingual professionals, an expert committee and the author of the original instrument. In Stage 2, the NOSE-p was tested on 33 patients undergoing septoplasty for internal consistency, test-retest reliability, construct validity, discriminant validity, criterion validity, and response sensitivity. RESULTS: The cross-cultural adaptation process was completed and the NOSE-p was demonstrated to be a valid instrument with satisfactory construct validity. It showed an adequate internal consistency reliability and adequate test-retest reliability. It could discriminate between patients with and without nasal obstruction and it has a high response sensitivity to change. CONCLUSIONS: The cross-cultural adaptation and validation process demonstrated to be valid and the NOSE-p proved to be applicable in Brazil.

Nasal cavity vascular leiomyoma: case report and literature review.

Liomyomas of the nasal cavity and paranasal sinuses are rare. They make up less than 1% of all leiomyomas in the human body. This is due to the paucity of smooth muscle in the nose. They are classified in three groups: leiomyoma, angiomyoma and epithelioid leiomyoma. Only 15 cases of vascular leiomyomas have been found in the literature. The treatment of choice is surgical excision. Hereby we present a new case and review the literature.

Angioleiomioma de cavidade nasal: relato de um caso e revisão de literatura / Nasal cavity vascular leiomyoma: case report and literature review

Leiomioma de cavidade nasal e seios paranasais é raro. Ele constitui menos de 1 por cento de todos os leiomiomas do corpo humano. Isto se deve à escassez de células musculares no nariz. Estas neoplasias podem ser classificadas em três grupos: leiomioma, angiomioma e leiomioma epitelióide. Somente 15 casos de angiomioma foram encontrados na literatura. O tratamento de escolha é a excisão cirúrgica. Um novo caso e a revisão da literatura são apresentados.

Liomyomas of the nasal cavity and paranasal sinuses are rare. They make up less than 1 percent of all leiomyomas in the human body. This is due to the paucity of smooth muscle in the nose. They are classified in three groups: leiomyoma, angiomyoma and epithelioid leiomyoma. Only 15 cases of vascular leiomyomas have been found in the literature. The treatment of choice is surgical excision. Hereby we present a new case and review the literature.

Prednisolona e Clarirtromicina no tratamento da rinossinusite aguda - estudo multicêntrico brasileiro / Predisolone and Clarythromicin in the treatment of acute rhinosinusitis - brazilian multicenter study

A rinossinusite bacteriana aguda é uma afecção de alta prevalência, na sua maioria originada de viroses das vias aéreas superiores. A terapia antimicrobiana com a claritromicina está bem estabelecida na literatura e corticoterapia sistêmica contribui como adjuvante no controle da inflamação, diminuindo o edema, facilitando a drenagem das secreções e a manutenção da permeabilidade dos óstios, favorecendo assim a cura clínica.

Endoscopic ligature of the sphenopalatine artery for severe posterior epistaxis.

OBJECTIVE: To present our experience with endoscopic ligature of the sphenopalatine artery in the treatment of severe posterior epistaxis of patients who had previously undergone conservative procedures. METHODS: Eleven patients with severe posterior epistaxis were treated during a 25-month period with an endoscopic ligature of the sphenopalatine artery. The basic principle of the surgical technique is to identify the branches of the sphenopalatine artery through an endoscopic endonasal approach and to apply a titanium clip under direct vision. RESULTS: The endoscopic ligature of the sphenopalatine artery was performed unilaterally in 10 patients and bilaterally in 1 patient, with a total of 12 ligatures. It was possible to identify the sphenopalatine artery in all cases with a successful outcome using this surgical technique alone. CONCLUSION: Endonasal endoscopic ligature of the sphenopalatine artery has been an effective surgical technique for treating severe posterior epistaxis.

Nasal polyposis and allergy: is there a correlation?

Nasal polyposis (NP) is a chronic inflammatory disease of the nasal mucosa. The etiology and formation of NP are still not elucidated and have been debated for many years. The objective of the present study was to investigate the role of nasal allergy in the development of NP. The following aspects were analyzed: age, sex, and patient's symptoms; correlation between asthma, aspirin intolerance, and NP; serum immunoglobulin levels and eosinophilia; and concentration of interleukins 1beta, 3, and 4 in NP. Thirty-nine patients with NP were selected, 13 of them allergic and 26 non-allergic. A control group of 11 individuals was also studied. The concentrations of interleukins 1beta, 3, and 4 were measured by enzyme-linked immunosorbent assay (ELISA). There was a higher incidence of NP after the fourth decade of life and among men. We found no correlation of asthma or aspirin intolerance with the presence or absence of allergy. Serum levels of IgE and eosinophils were significantly higher in patients with allergy and NP and the concentrations of interleukins 3 and 4 were positively correlated with NP. There was no difference in interleukin 3 and 4 concentration between the non-allergic group with NP and the control group, suggesting that these interleukins do not play an important role in the etiology and formation of NP. These results suggest that the immunologic pathway involved in the etiology of NP is differentfrom the one correlated with allergy (IgE-mediated).

Bilateral ethmoidal mucocele in cystic fibrosis: report of a case.

The purpose of this study is to report a rare and interesting case of a 10-month-old boy who presented a bilateral ethmoidal mucocele associated with cystic fibrosis and to discuss, according to the literature, the sinonasal involvement in this disease. Only nine pediatric patients with both disorders have been reported previously in literature, and all of these cases were older than 1 year 4 months and presented with a unilateral mucocele.

Transnasal endoscopic removal of an extensive immature teratoma in a three-month-old child.

The use of endoscopy in the paranasal sinuses has grown and diversified in the past few years. We present a case of an immature malignant teratoma originating from the sinuses, with intracranial extension to the middle and posterior fossae, that was managed and removed endoscopically. At the age of 2 months, the patient was hospitalized for respiratory instability. Diagnosis was made with biopsy, and chemotherapy was introduced. After 4 weeks, an endonasal endoscopic approach was performed, and a complete macroscopic removal of the tumor was achieved without complications. Follow-up for 10 months with magnetic resonance imaging and endoscopic examination has not revealed recurrence. In selected cases, the endonasal endoscopic technique may be a good alternative to the external approach, reducing the operative trauma and mortality.

Frontoethmoidal mucocele with intracranial extension: a case report.

Mucoceles with intracranial extension are often reported by otolaryngologists and neurosurgeons. The authors present a case of a large frontoethmoidal mucocele with intracranial and intraorbital extension exerting a mass effect on the anterior cranial fossa. The patient experienced spontaneous drainage of the mucocele without evidence of recurrence of the lesion after a one-year period, suggesting that mucoceles, regardless of size, can be treated with conservative procedures such as functional endoscopic sinus surgery.

Otological lesions in pachyonychia congenita syndrome.

The authors report a case of a patient with pachyonychia congenita syndrome, a rare genodermatosis inherited as an autosomal dominant trait, who also had otological lesions beyond the other classic signs and symptoms of the syndrome. Many kinds of treatment have already been proposed, but all failed to show satisfactory results. A new, cheap and easy-to-use treatment was developed in this study, using keratoplastics interpolated with humectant lotion for 90 days. The results after three years of follow-up are still thoroughly satisfactory.