Estudio aleatorizado, doble ciego, sobre la eficacia del tratamiento homeopático en niños con amigdalitis recurrente / Randomized, double-blind study on the efficacy of homeopathic treatment in children with recurrent tonsillitis

La eficacia y seguridad del tratamiento homeopático fueron investigadas en niños con amigdalitis recurrente para la que se indicaba cirugía. Métodos: Estudio clínico prospectivo, aleatorizado, doble ciego, que incluyó 40 niños de entre 3 y 7 años de edad; 20 niños fueron tratados con medicación homeopática y otros 20 niños, con placebo. El seguimiento fue de 4 meses por niño. La evaluación de los resultados fue clínica mediante un cuestionario estándar y examen clínico el primer y último día de tratamiento. La amigdalitis recurrente se definió como ocurrencia de 5 a 7 episodios de amigdalitis bacteriana aguda al año. Resultados: Del grupo de 18 niños que completó el tratamiento homeopático, 14 no presentó episodio alguno de amigdalitis bacteriana aguda; del grupo de 15 niños que recibió placebo, 5 pacientes no presentaron amigdalitis. Esta diferencia fue estadísticamente significativa (p = 0,015). Ninguno de los pacientes presentó efectos secundarios. Conclusiones: El tratamiento homeopático fue efectivo en niños con amigdalitis recurrente, en comparación con el placebo; a 14 niños (78%) ya no se les indicó cirugía. El tratamiento homeopático no se asoció con eventos adversos.

The efficacy and safety of homeopathic treatment was investigated on children with recurrent tonsillitis justifying surgery. Methods: Prospective, randomized,double-blind clinical trial that included 40 children between ages of 3 to 7 years old;20 children were treated with homeopathic medication and 20 children with placebo. Follow up was 4 months per child. Assessment of results was clinical by means of a standard questionnaire and clinical examination on the first and last day of treatment.Recurrent tonsillitis was defined as 5 to 7 episodes of bacterial acute tonsillitis per year. Results: From the group of 18 children who completed homeopathic treatment, 14 did not present any episode of acute bacterial tonsillitis; from the group of 15 children whoreceived placebo 5 patients did not present tonsillitis; this difference was statistically significant (p= 0,015). None of the patient exhibited side effects. Conclusions: Homeopathic treatment was effective in children with recurrent tonsillitis compared to placebo, 14 children (78%) were no longer indicated surgery. Homeopathic treatment was not associated with adverse events.

Randomized, double-blind trial on the efficacy of homeopathic treatment in children with recurrent tonsillitis

OBJECTIVE: The efficacy and safety of homeopathic treatment was investigated onchildren with recurrent tonsillitis justifying surgery. METHODS: Prospective, randomized, double-blind clinical trial that included 40 children between ages of 3 to 7 years old;20 children were treated with homeopathic medication and 20 children with placebo. Follow up was 4 months per child. Assessment of results was clinical by means of astandard questionnaire and clinical examination on the first and last day of treatment. Recurrent tonsillitis was defined as 5 to 7 episodes of bacterial acute tonsillitis per year. RESULTS: From the group of 18 children who completed homeopathic treatment, 14 did not present any episode of acute bacterial tonsillitis; from the group of 15 children who received placebo 5 patients did not present tonsillitis; this difference was statistically significant (p= 0,015). None of the patient exhibited side effects. CONCLUSIONS: Homeopathic treatment was effective in children with recurrent tonsillitis compared toplacebo, 14 children (78%) were no longer indicated surgery. Homeopathic treatment was not associated with adverse events.

Respiração oral e alteração de fala em crianças / Oral breathing and speech disorders in children

OBJETIVO: Verificar alterações na fala em crianças respiradoras orais e relacioná-las com o tipo respiratório, a etiologia, o gênero e a idade. MÉTODO: Foram avaliados 439 respiradores orais com idade entre quatro e 12 anos. Considerou-se atraso no desenvolvimento de fala a presença de alterações em crianças acima de cinco anos de idade. As alterações observadas foram interposição de língua (IL), ceceio frontal (CF), troca articulatória (TA), omissões (OM) e ceceio lateral (CL). Relacionou-se etiologia da respiração oral, gênero, idade, tipo respiratório e alterações de fala. RESULTADOS: Alterações de fala foram diagnosticadas em 31,2% dos pacientes sem relação com o tipo respiratório: oral ou misto. Maior frequência de trocas articulatórias e mais de uma alteração de fala ocorreram no gênero masculino. IL foi documentada em 53,3% pacientes, seguida por TA em 26,3% e CF em 21,9%. Concomitância de duas ou mais alterações de fala ocorreu em 24,8% das crianças. CONCLUSÃO: Respirar pela boca pode afetar o desenvolvimento da fala, a socialização e o desempenho escolar. A detecção precoce da respiração oral é essencial para prevenir e minimizar seus efeitos negativos sobre o desenvolvimento global dos indivíduos.

OBJECTIVE: To assess speech alterations in mouth-breathing children, and to correlate Mouth breathing; them with the respiratory type, etiology, gender, and age. METHOD: A total of 439 mouth-breathers were evaluated, aged between 4 and 12 years. The presence of speech alterations in children older than 5 years was considered delayed speech development. The observed alterations were tongue interposition (TI), frontal lisp (FL), articulatory disorders (AD), sound omissions (SO), and lateral lisp (LL). The etiology of mouth breathing, gender, age, respiratory type, and speech disorders were correlated. RESULTS: Speech alterations were diagnosed in 31.2% of patients, unrelated to the respiratory type: oral or mixed. Increased frequency of articulatory disorders and more than one speech disorder were observed in males. TI was observed in 53.3% patients, followed by AD in 26.3%, and by FL in 21.9%. The co-occurrence of two or more speech alterations was observed in 24.8% of the children. CONCLUSION: Mouth breathing can affect speech development, socialization, and school performance. Early detection of mouth breathing is essential to prevent and minimize its negative effects on the overall development of individuals.

Oral breathing and speech disorders in children.

OBJECTIVE: To assess speech alterations in mouth-breathing children, and to correlate them with the respiratory type, etiology, gender, and age. METHOD: A total of 439 mouth-breathers were evaluated, aged between 4 and 12 years. The presence of speech alterations in children older than 5 years was considered delayed speech development. The observed alterations were tongue interposition (TI), frontal lisp (FL), articulatory disorders (AD), sound omissions (SO), and lateral lisp (LL). The etiology of mouth breathing, gender, age, respiratory type, and speech disorders were correlated. RESULTS: Speech alterations were diagnosed in 31.2% of patients, unrelated to the respiratory type: oral or mixed. Increased frequency of articulatory disorders and more than one speech disorder were observed in males. TI was observed in 53.3% patients, followed by AD in 26.3%, and by FL in 21.9%. The co-occurrence of two or more speech alterations was observed in 24.8% of the children. CONCLUSION: Mouth breathing can affect speech development, socialization, and school performance. Early detection of mouth breathing is essential to prevent and minimize its negative effects on the overall development of individuals.

Epithelium and stroma from nasal polyp mucosa exhibits inverse expression of TGF-ß1 as compared with healthy nasal mucosa.

OBJECTIVE: To evaluate TGF-ß1 expression in polypoid mucosa (epithelium and stroma) of patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). METHODS: Cross-sectional study with two groups: 17 patients with nasal polyposis and 11 controls. Polyps and normal nasal mucosa were processed by immunohistochemical methods for TGF-ß1 visualization. Then, the percentage of TGF-ß1 expression in stroma and epithelium was objectively quantified using UT Morph software. RESULTS: A lower percentage of positive expression was found in the epithelium of CRSwNP patients (32.44%) versus normal controls (55.91%) (p < 0.05), and a higher percentage of positive expression in the stroma of CRSwNP patients (23.24%) versus controls (5.88%) (p < 0.05). CONCLUSION: The lower percentage of TGF-ß1 expression in the nasal epithelium of CRSwNP patients may have an impact on epithelium-directed topical treatments employed in this patient population.

Standardization of the registration and analysis of mastication: proposal for clinical application.

The purpose of this study was to verify the inter-rater agreement level as a means of obtaining an efficiency measure of a standard mastication evaluation through video recordings. The studied population included oral breathing children and teenagers with maxillary atresia. The chewing aspects studied were mode of chewing and preferential chewing side. A white tag was placed on half the subjects' chins while the recordings were made. Two expert evaluators analyzed 54 video recordings at regular viewing speed. The lead author analyzed the same video recordings both at reduced speed and at reduced speed linked through graphical computing techniques. The analysis was conducted on chewing cycles with the viewing angle of the frontal plane. Findings indicated that when comparing the data for the three manners of watching the video recordings, the agreement level was higher for videos with the tag on the chin watched at reduced speed. It was also determined that alternating and bilateral mastication modes were prevalent (64.7%) in this sample.

[Local application of cidofovir as adjuvant therapy in recurrent laryngeal papillomatosis in children]. / Aplicação local de cidofovir como tratamento adjuvante na papilomatose laríngea recorrente em crianças.

OBJECTIVE: Evaluate the efficacy of local application of cidofovir in association with surgical treatment of recurrent laryngeal papillomatosis in children. STUDY DESIGN: Prospective. METHODS: Fourteen patients, with an average age of 4.7 years and with two or more relapses after surgical treatment, were submitted to resection of the papillomas and injection of 22.5 mg of cidofovir (7.5 mg/ml) in the tissue where the lesions had been removed. After 2 to 3 week intervals, the same dose of cidofovir was repeated two or three times. In the case of relapse, a new cycle of surgery followed by local applications of cidofovir was repeated. Five children presented HPV-6 and five HPV-11, while in four, the type was not determined. RESULTS: Before beginning of the study, patients were submitted, on the average, to 2 operations a year for control of relapses. After treatment with cidofovir, the annual rate for surgery dropped to 1.1 (p = 0.013). The average interval between relapses before beginning of the study was 1.4 months; at the end of the study, the interval reached 4.4 months (p = 0.014). Patients with HPV-6 did not show a significant change in the intervals between relapses after treatment with cidofovir, while 60% of the children with HPV-11 were disease free at the study end. CONCLUSION: Cidofovir was found to be an effective adjuvant in the treatment of recurrent laryngeal papillomatosis in children, when used in the form of local applications in association with surgical resection of the lesions. HPV-11 may be more susceptible to the beneficial effects of cidofovir.

Aplicação local de cidofovir como tratamento adjuvante na papilomatose laríngea recorrente em crianças / Local application of cidofovir as adjuvant therapy in recurrent laryngeal papillomatosis in children

OBJETIVO: Avaliar a eficácia da aplicação local de cidofovir em associação com o tratamento cirúrgico na papilomatose laríngea recorrente (PLR) em crianças. Desenho do estudo: Prospectivo. MÉTODOS: Quatorze pacientes, com idade média de 4.7 anos e com duas ou mais recidivas após tratamento cirúrgico, foram submetidos à ressecção dos papilomas e injeção de 22.5 mg de cidofovir (7,5 mg/ml) no tecido de onde as lesões foram removidas. Após intervalos de 2-3 semanas, a mesma dose de cidofovir foi repetida duas ou três vezes. Em caso de recidiva, um novo ciclo de cirurgia seguido de aplicações locais de cidofovir era reiniciado. Cinco crianças apresentavam HPV-6 e cinco HPV-11; em quatro casos a tipagem não foi realizada. RESULTADOS: Antes do início do estudo, os pacientes eram submetidos, em média, a duas cirurgias por ano para o controle das recidivas; após o tratamento com cidofovir, a taxa anual de cirurgia diminuiu para 1,1 (p = 0,013). O intervalo médio entre as recidivas antes do início do estudo era de 1.6 meses; ao final do estudo, o intervalo aumentou para 4,4 meses (p = 0,014). Os pacientes com HPV-6 não apresentaram alteração significante nos intervalos entre as recidivas após o tratamento com cidofovir, enquanto 60 por cento das crianças com HPV-11 encontravam-se livres de doença ao final do estudo. CONCLUSÃO: O cidofovir é um adjuvante eficaz no tratamento da PLR em crianças, quando utilizado sob a forma de aplicações locais em associação com a ressecção cirúrgica das lesões. O HPV-11 pode ser mais susceptível aos efeitos benéficos do cidofovir.

OBJECTIVE: Evaluate the efficacy of local application of cidofovir in association with surgical treatment of recurrent laryngeal papillomatosis in children. Study design: Prospective. METHODS: Fourteen patients, with an average age of 4.7 years and with two or more relapses after surgical treatment, were submitted to resection of the papillomas and injection of 22.5 mg of cidofovir (7.5 mg/ml) in the tissue where the lesions had been removed. After 2 to 3 week intervals, the same dose of cidofovir was repeated two or three times. In the case of relapse, a new cycle of surgery followed by local applications of cidofovir was repeated. Five children presented HPV-6 and five HPV-11, while in four, the type was not determined. RESULTS: Before beginning of the study, patients were submitted, on the average, to 2 operations a year for control of relapses. After treatment with cidofovir, the annual rate for surgery dropped to 1.1 (p = 0.013). The average interval between relapses before beginning of the study was 1.4 months; at the end of the study, the interval reached 4.4 months (p = 0.014). Patients with HPV-6 did not show a significant change in the intervals between relapses after treatment with cidofovir, while 60 percent of the children with HPV-11 were disease free at the study end. CONCLUSION: Cidofovir was found to be an effective adjuvant in the treatment of recurrent laryngeal papillomatosis in children, when used in the form of local applications in association with surgical resection of the lesions. HPV-11 may be more susceptible to the beneficial effects of cidofovir.

Microarray cDNA to identify inflammatory genes in nasal polyposis.

BACKGROUND: The objective of this study was to investigate the spectrum of inflammatory gene expression in patients with nasal polyposis. METHODS: The cDNA microarray technique was used to identify gene expression in tissue samples from nasal polyps and adjacent inflammatory nasal mucosa of 21 patients with nonallergic nasal polyposis. To validate the microarray analysis, we compared the expression of five genes by reverse transcription-polymerase chain reaction (RT-PCR): tumor necrosis factor, IL-5, IL-9, fibroblast growth factor, and transforming growth factor (TGF)-beta1. RESULTS: We tested 96 different inflammatory genes in our samples. Thirty-six genes exhibited differences in expression between the two tissue types. In all 36 genes the level of expression was greater in the inflammatory mucosa than the polyps. The RT-PCR confirmed the cDNA results. CONCLUSION: We believe that the high expression of TGF-beta1 in inflammatory mucosa compared with the low expression in polyps may reflect an important role in the inhibitory mechanisms of nasal polyposis.

Auditory processing assessment in children with obstructive sleep apnea syndrome.

INTRODUCTION: The obstructive sleep apnea syndrome (OSAS) is a respiratory disorder that occurs during sleep and it is relatively common in children. AIM: The goal of this paper is to verify if there is a relationship between the obstructive sleep apnea syndrome (OSAS) and auditory processing. METHODS: In order to do that, three groups of children ranging in age from 5 to 11 were studied, including a normal group. Twenty subjects who made up the study group were submitted to ear, nose and throat (ENT) exams and to polysomnography (PSG), and were divided in two groups: GROUP I (RO) comprised of 10 children who presented oral breathing and displayed normal PSG, and GROUP II (SAS) comprised of 10 children who presented oral breathing and displayed abnormal PSG. Their performance was compared to the performance of the third group--GROUP III (REN) comprised of 10 children who did not refer ENT difficulties. All the subjects completed a basic audiometric assessment as well as an auditory processing diagnosis. RESULTS: The analyses of the results revealed a statistically significant difference in ENT exams related to the turbinate and the palatine tonsils. Group II presented a higher incidence of turbinate hypertrophy levels II and III (p<0.001) and palatine tonsils hypertrophy grades III and IV (p 0.007). Regarding the auditory processing assessment, a statistically significant difference (p<0.001) was obtained in the dichotic digits test. Group II performed worse than group III. Also, for the non-verbal sequence memory test, Group II obtained a worse result (p<0.022) than Group I. CONCLUSION: Subjects with OSAS obtained worse results in auditory processing tests.

Avaliação do processamento auditivo em crianças com síndrome da apnéia/hipopnéia obstrutiva do sono / Auditory processing assessment in children with obstructive sleep apnea syndrome

INTRODUÇÃO: síndrome da apnéia/hipopnéia obstrutiva do sono (SAHOS) é uma desordem de respiração durante o sono e tem sido descrita como uma condição relativamente comum em crianças. OBJETIVO: Verificar se existe relação entre a presença da Síndrome da Apnéia/Hipopnéia Obstrutiva do Sono e alteração de processamento auditivo. MÉTODOS: Foram avaliados 3 grupos de crianças na faixa etária de 5 a 11 anos, incluindo um grupo controle. Vinte indivíduos que constituíram o grupo de estudo foram submetidos à avaliação otorrinolaringológica e ao exame de polissonografia (PSG) e foram divididos em dois grupos: Grupo I (RO) constituído por 10 indivíduos respiradores orais e PSG normal e Grupo II (SAS) constituído por 10 indivíduos respiradores orais e PSG alterado. O desempenho destes indivíduos foi comparado a um terceiro grupo - Grupo III (REN) composto de 10 crianças sem queixas otorrinolaringológicas. Todos os sujeitos foram submetidos à avaliação audiológica básica e à avaliação do PA. RESULTADOS: Quanto à avaliação otorrinolaringológica, houve diferença estatisticamente significante no que se refere à avaliação dos cornetos nasais e das tonsilas palatinas. No grupo II, verificou-se maior número de indivíduos com hipertrofia de cornetos nasais grau II e III (p < 0,001) e com hipertrofia de tonsila palatina grau III e IV (p 0,007). Em relação à avaliação de PA, os resultados mostraram que houve diferença estatisticamente significante (p < 0,001) no teste dicótico de dígitos, tendo o grupo II apresentado pior desempenho do que o grupo III e, no resultado do teste de memória para sons não-verbais em seqüência (p < 0,022), tendo o grupo II apresentado pior desempenho do que o grupo I. CONCLUSÃO: A presença da SAHOS relacionou-se positivamente com a alteração de processamento auditivo.

INTRODUCTION: The obstructive sleep apnea syndrome (OSAS) is a respiratory disorder that occurs during sleep and it is relatively common in children. AIM: The goal of this paper is to verify if there is a relationship between the obstructive sleep apnea syndrome (OSAS) and auditory processing. METHOD: In order to do that, three groups of children ranging in age from 5 to 11 were studied, including a normal group. Twenty subjects who made up the study group were submitted to ear, nose and throat (ENT) exams and to polysomnography (PSG), and were divided in two groups: GROUP I (RO) comprised of 10 children who presented oral breathing and displayed normal PSG, and GROUP II (SAS) comprised of 10 children who presented oral breathing and displayed abnormal PSG. Their performance was compared to the performance of the third group - GROUP III (REN) comprised of 10 children who did not refer ENT difficulties. All the subjects completed a basic audiometric assessment as well as an auditory processing diagnosis. RESULTS: The analyses of the results revealed a statistically significant difference in ENT exams related to the turbinate and the palatine tonsils. Group II presented a higher incidence of turbinate hypertrophy levels II and III (p < 0.001) and palatine tonsils hypertrophy grades III and IV (p 0.007). Regarding the auditory processing assessment, a statistically significant difference (p < 0.001) was obtained in the dichotic digits test. Group II performed worse than group III. Also, for the non-verbal sequence memory test, Group II obtained a worse result (p < 0.022) than Group I. CONCLUSIONS: Subjects with OSAS obtained worse results in auditory processing tests.

O tratamento da laringomalácia: experiência em 22 casos

A Laringomalácia é a causa mais comum de estridor na infância, com resolução espontânea até os 2 anos de idade na maioria dos casos. Cerca de 10 por cento dos casos (laringomalácia severa) necessitam de intervenção cirúrgica. O diagnóstico é estabelecido com o exame de videonasofibroscopia, na qual se observa encurtamento da prega ariepiglótica, e/ou excesso de mucosa das aritenóides, e/ou queda da epiglote no sentido ântero-posterior. A etiologia ainda permanece desconhecida. OBJETIVO: Verificar as principais alterações clínicas e anatômicas assim como identificar os principais parâmetros clínicos no acompanhamento e na indicação cirúrgica de pacientes portadores de laringomalácia. FORMA DE ESTUDO: Estudo de coorte transversal. MATERIAL E MÉTODO: Foram incluídos neste estudo 22 crianças com diagnóstico de laringomalácia do ambulatório de otorrinolaringologia pediátrica da UNIFESP-EPM, entre janeiro de 2001 a dezembro de 2003, assistidas pelo mesmo examinador. RESULTADOS: Das 22 crianças com diagnóstico de laringomalácia, duas (9,1 por cento) apresentavam laringomalácia severa com depressão torácica (tórax escavado). O estridor inspiratório e o encurtamento das pregas ariepiglóticas foram encontrados em todos pacientes. A polissonografia, nenhuma criança apresentou evento respiratório significativo durante o sono. As duas crianças com laringomalácia severa foram submetidas à supraglotoplastia com secção das pregas ariepiglóticas. CONCLUSÃO: O estridor respiratório e o encurtamento das pregas ariepiglóticas fazem parte preponderante do quadro clínico. A polissonografia não mostrou ser um parâmetro importante, nem para o acompanhamento clínico nem para a indicação cirúrgica, ao contrário da falta de ganho de peso e da presença de tórax escavado. A secção cirúrgica das pregas ariepiglóticas é efetiva e com baixo índice de morbidade.

OSAS in children: correlation between endoscopic and polysomnographic findings.

OBJECTIVES: To correlate polysomnographic findings with clinical history of apnea, the degree of obstruction caused by tonsillar hypertrophy, and to age group. STUDY DESIGN AND SETTING: 267 children with a clinical diagnosis of obstructive sleep apnea (OSAS) were evaluated. Patients were divided into preschool- and school-age categories, and subdivided in 3 additional groups, according to tonsillar hypertrophy. Polysomnographic findings were compared within groups. RESULTS: 34% of children had history of OSAS and normal polysomnographic findings. Tonsillar hypertrophy was correlated to more severe apnea among preschool-age children, but not among school-age children. Among children with tonsillar hypertrophy, more severe apnea was observed in preschool-age children than in school-age children. CONCLUSIONS: There is little correlation between polysomnographic and clinical findings in children with OSAS. SIGNIFICANCE: Adenotonsillar hypertrophy leads to more severe polysomnographic patterns in preschool-age children. More severe apnea is observed in younger children with adenotonsillar hypertrophy than in older ones.