Use of the long-term quality of life assessment in the decision to indicate surgery in patients with chronic rhinosinusitis.

INTRODUCTION: Quality-of-life questionnaires have been used to support decision-making in patients with chronic rhinosinusitis in the past decade. The choice of treatment in practice, however, also considers the patient's decision. OBJECTIVE: To assess the long-term quality of life of patients with chronic rhinosinusitis who decided to avoid surgery. METHODS: This is a prospective longitudinal study with a group of patients with chronic rhinosinusitis, with and without indication for surgery, with application of the questionnaire SNOT-22 in two periods: between 2011 and 2012 and between June and August 2016, via email. RESULTS: Data were collected from 42 patients, of which 13 presented indications for surgery and 29 were not indicated for surgery. The average quality of life score was 42.1 (±16.4) in the group with an indication for surgery and 40.6 (±23.4) in the group without this indication, p=0.84. All the patients were assessed by a single doctor with blinding in relation to the initial score. No differences were detected between the groups. The impact of the chronic rhinosinusitis was reduced even among the patients with the indication for surgery. Both groups scored over 40. CONCLUSION: This study can help predict the impact of the chronic rhinosinusitis over time and better adjust expectations with non-surgical treatment.

Can we use the questionnaire SNOT-22 as a predictor for the indication of surgical treatment in chronic rhinosinusitis?

INTRODUCTION: Chronic rhinosinusitis is a prevalent disease that has a negative impact on the lives of sufferers. SNOT-22 is considered the most appropriate questionnaire for assessing the quality of life of these patients and a very effective method of evaluating therapeutic interventions; however it is not used as a tool for decision-making. OBJECTIVE: To test the hypothesis that the SNOT-22 score can predict the outcome of surgical treatment. METHODS: A retrospective, longitudinal and analytical study. We evaluated the medical records of patients with chronic rhinosinusitis that completed the SNOT-22 at the time of diagnosis. All the patients were consecutively receiving care at an otolaryngology service in Salvador, Bahia from August 2011 to June 2012. The outcomes of the surgical treatment of these patients were obtained from their medical records. The initial score was compared to a group of patients who were not referred for surgery. All the patients completed and signed a consent form. RESULTS: Of the 88 patients with chronic rhinosinusitis, 26 had evolved to surgery over the last 3 years. The groups were homogeneous regarding gender and respiratory and medication allergies. The patients of the surgical group were 44.8+13.8 years old and the patients of the clinical group were 38.2+12.5 years old (p=0.517). The average SNOT-22 score of the case group was 49+19 and the average score of the control group was 49+27 (p=0.927). CONCLUSION: The SNOT-22 was unable to predict the outcome of surgical patients with chronic rhinosinusitis.

Use of the long-term quality of life assessment in the decision to indicate surgery in patients with chronic rhinosinusitis / Uso da avaliação da qualidade de vida em longo prazo na decisão de indicação cirúrgica em pacientes com rinossinusite crônica

Abstract Introduction: Quality-of-life questionnaires have been used to support decision-making in patients with chronic rhinosinusitis in the past decade. The choice of treatment in practice, however, also considers the patient's decision. Objective: To assess the long-term quality of life of patients with chronic rhinosinusitis who decided to avoid surgery. Methods: This is a prospective longitudinal study with a group of patients with chronic rhinosinusitis, with and without indication for surgery, with application of the questionnaire SNOT-22 in two periods: between 2011 and 2012 and between June and August 2016, via email. Results: Data were collected from 42 patients, of which 13 presented indications for surgery and 29 were not indicated for surgery. The average quality of life score was 42.1 (±16.4) in the group with an indication for surgery and 40.6 (±23.4) in the group without this indication, p = 0.84. All the patients were assessed by a single doctor with blinding in relation to the initial score. No differences were detected between the groups. The impact of the chronic rhinosinusitis was reduced even among the patients with the indication for surgery. Both groups scored over 40. Conclusion: This study can help predict the impact of the chronic rhinosinusitis over time and better adjust expectations with non-surgical treatment.

Resumo Introdução: Questionários de qualidade de vida têm sido usados na última década para apoiar a tomada de decisão em pacientes com rinossinusite crônica. Entretanto, na prática, a escolha do tratamento também considera a decisão do paciente. Objetivo: Avaliar a qualidade de vida em longo prazo de pacientes com rinossinusite crônica que decidiram não se submeter à cirurgia. Método: Estudo longitudinal prospectivo com um grupo de pacientes com rinossinusite crônica, com e sem recomendação de cirurgia, com aplicação do questionário Sino-Nasal Outcome Test 22 (SNOT-22, teste de desfecho sinonasal) em dois períodos: entre 2011 e 2012 e entre junho e agosto de 2016, via e-mail. Resultados: Foram coletados dados de 42 pacientes, dos quais 13 tiveram recomendação para cirurgia e 29 não tiveram. O escore médio de qualidade de vida foi de 42,1 (± 16,4) no grupo com indicação de cirurgia e de 40,6 (± 23,4) no grupo sem essa indicação, p = 0,84. Todos os pacientes foram avaliados por um único médico, cegado para o escore inicial. Não foram detectadas diferenças entre os grupos. O impacto da rinossinusite crônica foi reduzido mesmo entre os pacientes com indicação de cirurgia. Ambos os grupos apresentaram um escore acima de 40. Conclusão: Este estudo pode ajudar a prever o impacto da rinossinusite crônica ao longo do tempo e ajustar de forma mais adequada as expectativas com o tratamento não cirúrgico.

Evaluation of the quality of life of patients with chronic rhinosinusitis by means of the SNOT-22 questionnaire.

UNLABELLED: SNOT-22 is a questionnaire used to assess the quality of life of patients with chronic rhinosinusitis (CRS). It is broadly utilized to assess the surgical treatment of patients with CRS. In Brazil there are no studies utilizing the SNOT-22 in non-surgical patients. OBJECTIVE: To use the SNOT-22 questionnaire to assess the quality of life of individuals with chronic rhinosinusitis without previous surgery and with indication for clinical treatment. METHOD: Prospective and analytical cohort and cross-sectional controlled clinical trial. We had 2 groups, one made up of patients with CRS and another one with adult individuals without the sinonasal disease, consecutively seen in an otorhinolaryngology clinic in Salvador, Bahia, between August of 2011 and June of 2012. They all filled out the Consent Form, a registration form and the SNOT-22. RESULTS: 176 patients, 78 with CRS and 98 without the disease, the groups matched as far as gender, medication and respiratory allergies were concerned. Age was 40.7 + 13.5 years in the study group and 37.8 + 12.9 in controls (p = 0.26). The SNOT-22 median value in the study group was 53, compared to 8 in the control group (p = 0.001). CONCLUSION: Chronic rhinosinusitis reduces the quality of life of patients, according to the SNOT-22 questionnaire.

Quality of life in children with sleep-disordered breathing.

UNLABELLED: Children may present sleep-disordered breathing (SDB) and suffer with adverse effects upon their quality of life. OBJECTIVE: This study assessed the quality of life of children with SDB, compared subjects with obstructive sleep apnea syndrome (OSAS) and primary snoring (PS), and identified which areas in the OSA-18 questionnaire are more affected. METHODS: This is a historical cohort cross-sectional study carried out on a consecutive sample of children with history of snoring and adenotonsillar hyperplasia. The subject's quality of life was assessed based on the answers their caregivers gave in the OSA-18 questionnaire and on diagnostic polysomnography tests. RESULTS: A number of 59 children participated in this study with mean age of 6.7 ± 2.26 years. The mean score of the OSA-18 was 77.9 ± 13.22 and the area most affected were "caregiver concerns" (21.8 ± 4.25), "sleep disturbance" (18.8 ± 5.19), "physical suffering" (17.3 ± 5.0). The impact was low in 6 children (10.2%), moderate in 33 (55.9%) and high in 20 (33.9%). PS was found in 44 children (74.6%), OSAS in 15 (25.6%). OSAS had higher score on "physical suffering" area than PS (p = 0.04). The AI (r = 0.22; p = 0.08) and AHI (r = 0.14; p = 0.26) were not correlated with OSA-18. CONCLUSION: Sleep disordered breathing in childhood cause impairment in quality of life and areas most affected the OSA-18 were: "caregiver concerns", "sleep disturbance" and "physical suffering". OSAS has the domain "physical suffering" more affected than primary snorers.

Can we use the questionnaire SNOT-22 as a predictor for the indication of surgical treatment in chronic rhinosinusitis? / Podemos usar o questionário SNOT-22 como preditor para a indicação de tratamento cirúrgico na rinossinusite crônica?

Abstract Introduction: Chronic rhinosinusitis is a prevalent disease that has a negative impact on the lives of sufferers. SNOT-22 is considered the most appropriate questionnaire for assessing the quality of life of these patients and a very effective method of evaluating therapeutic interventions; however it is not used as a tool for decision-making. Objective: To test the hypothesis that the SNOT-22 score can predict the outcome of surgical treatment. Methods: A retrospective, longitudinal and analytical study. We evaluated the medical records of patients with chronic rhinosinusitis that completed the SNOT-22 at the time of diagnosis. All the patients were consecutively receiving care at an otolaryngology service in Salvador, Bahia from August 2011 to June 2012. The outcomes of the surgical treatment of these patients were obtained from their medical records. The initial score was compared to a group of patients who were not referred for surgery. All the patients completed and signed a consent form. Results: Of the 88 patients with chronic rhinosinusitis, 26 had evolved to surgery over the last 3 years. The groups were homogeneous regarding gender and respiratory and medication allergies. The patients of the surgical group were 44.8 + 13.8 years old and the patients of the clinical group were 38.2 + 12.5 years old (p = 0.517). The average SNOT-22 score of the case group was 49 + 19 and the average score of the control group was 49 + 27 (p = 0.927). Conclusion: The SNOT-22 was unable to predict the outcome of surgical patients with chronic rhinosinusitis.

Resumo Introdução: A rinossinusite crônica é uma doença prevalente que tem um impacto negativo sobre a vida dos portadores. O SNOT-22 é considerado o questionário mais adequado para avaliar a qualidade de vida desses pacientes e um método muito eficaz de avaliar intervenções terapêuticas; no entanto, ele não é usado como uma ferramenta para a tomada de decisões. Objetivo: Testar a hipótese de que o escore do SNOT-22 pode prever o desfecho do tratamento cirúrgico. Método: Estudo retrospectivo, longitudinal e analítico. Foram avaliados os prontuários de pacientes com rinossinusite crônica que preencheram o SNOT-22 no momento do diagnóstico. Todos os pacientes foram consecutivamente atendidos em um serviço de otorrinolaringologia em Salvador, Bahia, de agosto de 2011 a junho de 2012. Os desfechos do tratamento cirúrgico desses pacientes foram obtidos a partir de seus prontuários médicos. A pontuação inicial foi comparada com um grupo de pacientes que não foi encaminhado para cirurgia. Todos os pacientes preencheram e assinaram um termo de consentimento informado. Resultados: Dos 88 pacientes com rinossinusite crônica 26 evoluíram para cirurgia nos últimos três anos. Os grupos foram homogêneos quanto a sexo, alergias respiratórias e medicamentos. Os pacientes do grupo cirúrgico tinham 44,8 + 13,8 anos e os do grupo clínico tinham 38,2 + 12,5 (p = 0,517). O escore médio do SNOT-22 do grupo do caso foi de 49 + 19 e o do grupo controle foi de 49 + 27 (p = 0,927) Conclusão: O SNOT-22 foi incapaz de prever o desfecho dos pacientes cirúrgicos com rinossinusite crônica.

Avaliação da qualidade de vida de pacientes com rinossinusite crônica por meio de questionário SNOT-22 / Evaluation of the quality of life of patients with chronic rhinosinusitis by means of the SNOT-22 questionnaire

O SNOT-22 é um questionário para avaliação da qualidade de vida dos pacientes com rinossinusite crônica (RSC). Ele é largamente utilizado para avaliação do tratamento cirúrgico na RSC. No Brasil, não existem estudos utilizando o SNOT-22 em pacientes não cirúrgicos. OBJETIVO: Avaliar por meio do questionário SNOT-22 a qualidade de indivíduos com rinossinusite crônica sem cirurgia prévia e com indicação de tratamento clínico. MÉTODO: Estudo clínico prospectivo e analítico, tipo corte transversal com controle. Foram dois grupos, sendo um constituído de pacientes com RSC e outro por indivíduos sem doença nasossinusal, adultos, atendidos consecutivamente num serviço de otorrinolaringologia em Salvador, Bahia, de agosto de 2011 a junho de 2012. Todos preencheram o termo de consentimento, um cadastro e o SNOT-22. RESULTADOS: Cento e setenta e seis pacientes, sendo 78 com RSC, e 98 sem a doença. Os grupos foram homogêneos quanto ao gênero, alergias medicamentosas e respiratórias. A idade foi de 40,7 + 13,5 anos no grupo caso e 37,8 + 12,9 no controle (p = 0,26). A mediana do SNOT-22 no grupo caso foi 53 contra 8 do controle (p = 0,001). CONCLUSÃO: A rinossinusite crônica reduz a qualidade de vida do paciente de acordo com o questionário SNOT-22.

SNOT-22 is a questionnaire used to assess the quality of life of patients with chronic rhinosinusitis (CRS). It is broadly utilized to assess the surgical treatment of patients with CRS. In Brazil there are no studies utilizing the SNOT-22 in non-surgical patients. OBJECTIVE: To use the SNOT-22 questionnaire to assess the quality of life of individuals with chronic rhinosinusitis without previous surgery and with indication for clinical treatment. METHOD: Prospective and analytical cohort and cross-sectional controlled clinical trial. We had 2 groups, one made up of patients with CRS and another one with adult individuals without the sinonasal disease, consecutively seen in an otorhinolaryngology clinic in Salvador, Bahia, between August of 2011 and June of 2012. They all filled out the Consent Form, a registration form and the SNOT-22. RESULTS: 176 patients, 78 with CRS and 98 without the disease, the groups matched as far as gender, medication and respiratory allergies were concerned. Age was 40.7 + 13.5 years in the study group and 37.8 + 12.9 in controls (p = 0.26). The SNOT-22 median value in the study group was 53, compared to 8 in the control group (p = 0.001). CONCLUSION: Chronic rhinosinusitis reduces the quality of life of patients, according to the SNOT-22 questionnaire.

Qualidade de vida em crianças com distúrbios respiratórios do sono / Quality of life in children with sleep-disordered breathing

Crianças podem apresentar distúrbios respiratórios do sono (DRS) com repercussões na qualidade de vida. OBJETIVO: Avaliar a qualidade de vida de crianças com DRS, comparar crianças com Síndrome da Apneia Obstrutiva do Sono (SAOS) e Ronco Primário (RP) e identificar quais os domínios do OSA-18 estão mais comprometidos. MÉTODOS: Estudo de coorte histórica com corte transversal em crianças com história de ronco e hiperplasia adenotonsilar. Para avaliar qualidade de vida foi aplicado o questionário OSA-18 aos cuidadores e realizado polissonografia para diagnóstico. RESULTADOS: Participaram 59 crianças com média de idade de 6,7 ± 2,26 anos. O escore médio do OSA-18 foi 77,9 ± 13,22 e os domínios mais afetados foram: "preocupação dos responsáveis" (21,8 ± 4,25), "perturbação do sono" (18,8 ± 5,19), "sofrimento físico" (17,3 ± 5,0). O impacto foi pequeno em seis crianças (10,2%), moderado em 33 (55,9%) e grande em 20 (33,9%). RP foi encontrado em 44 crianças (74,6%), SAOS em 15 (25,6%). SAOS tem escore maior no domínio "sofrimento físico" que RP (p = 0,04). CONCLUSÃO: Distúrbios respiratórios do sono na infância causam comprometimento na qualidade de vida e os domínios mais comprometidos do OSA-18 foram: "preocupação dos responsáveis", "perturbação do sono" e "sofrimento físico". SAOS tem o domínio "sofrimento físico" mais afetado que roncadores primários.

Children may present sleep-disordered breathing (SDB) and suffer with adverse effects upon their quality of life. OBJECTIVE: This study assessed the quality of life of children with SDB, compared subjects with obstructive sleep apnea syndrome (OSAS) and primary snoring (PS), and identified which areas in the OSA-18 questionnaire are more affected. METHODS: This is a historical cohort cross-sectional study carried out on a consecutive sample of children with history of snoring and adenotonsillar hyperplasia. The subject's quality of life was assessed based on the answers their caregivers gave in the OSA-18 questionnaire and on diagnostic polysomnography tests. RESULTS: A number of 59 children participated in this study with mean age of 6.7 ± 2.26 years. The mean score of the OSA-18 was 77.9 ± 13.22 and the area most affected were "caregiver concerns" (21.8 ± 4.25), "sleep disturbance" (18.8 ± 5.19), "physical suffering" (17.3 ± 5.0). The impact was low in 6 children (10.2%), moderate in 33 (55.9%) and high in 20 (33.9%). PS was found in 44 children (74.6%), OSAS in 15 (25.6%). OSAS had higher score on "physical suffering" area than PS (p = 0.04). The AI (r = 0.22; p = 0.08) and AHI (r = 0.14; p = 0.26) were not correlated with OSA-18. CONCLUSION: Sleep disordered breathing in childhood cause impairment in quality of life and areas most affected the OSA-18 were: "caregiver concerns", "sleep disturbance" and "physical suffering". OSAS has the domain "physical suffering" more affected than primary snorers.

Osteoma gigante do seio etmoidal / Giant osteoma of the ethmoidal sinus

Introdução: Os osteomas são lesões ósseas com crescimento lento e assintomático que na maioria das vezes é um achado em exames radiológicos solicitados por outro motivo. É a neoplasia benigna mais frequente dos seios paranasais. Os osteomas localizam-se, sobretudo no seio frontal (57 a 80%), seguido dos seios etmoidais (20%), maxilares e raramente no seio esfenoidal. Apresenta discreta predominância no sexo masculino 1,5 e sua incidência é maior nas 3ª e 4ª décadas de vida. O tratamento é cirúrgico independente do tamanho. Objetivo: Descrever um caso de osteoma gigante do seio etmoide mais uma breve revisão da literatura. Relato do Caso: JDA, masculino, 33 anos, apresentava obstrução nasal constante a direita há 01 ano. Ao exame, apresentava assimetria facial à custa da lateralização do globo ocular direito. A tomografia computadorizada dos seios paranasais mostrava lesão com densidade de partes moles ocupando parcialmente à fossa nasal direita, seio etmoide e maxilar direito. O paciente foi submetido à cirurgia com exérese total da lesão. O exame anatomopatológico confirmou osteoma. O paciente evoluiu sem evidências de recorrência da lesão. Comentários Finais: Os osteomas situados no seio etmoidal, independentemente do tamanho, e devidos o risco de complicações, devem ser operados.

Introduction: The osteomas are osseous lesions with slow and asymptomatic growth that most of the times is a finding in radiological exams requested for other reason. It's the most common benign neoplasm of the paranasal sinuses. The osteomas are located mainly in the frontal sinus (57% to 80%), followed by the ethmoidal sinuses (20%), maxillary sinuses and rarely in the sphenoid sinus. It has a discreet predominance in the male sex 1.5 and its incidence is higher in the 3rd and 4th decades of life. The treatment is surgical no matter the size. Objective: To describe a case of giant osteoma of the ethmoidal sinus including a brief literature review. Case Report: JDA, male, 33 years old, presented with a right constant nasal obstruction for 01 year. Upon exam, he presented with facial asymmetry with lateralization of the right ocular globe. The computed tomography of the paranasal sinuses showed a lesion with density of soft parts occupying partially the right nasal cavity, ethmoid sinus and right maxillary. The patient was submitted to surgery with full exeresis of the lesion. The anatomopathological exam confirmed osteoma. The patient evolved without evidences of the lesion recurrence. Final Comments: The osteomas in the ethmoidal sinus, irrespectively of the size and due to the risk of complications, must be operated.

Carcinoma adenóide cístico do seio esfenóide / Sphenoid sinus adenoid cystic carcinoma

Introdução: O carcinoma adenóide cístico do esfenóide é uma neoplasia maligna rara, na cabeça e pescoço, e quando localizado nos seios paranasais, tem origem nas glândulas salivares menores. Apresenta crescimento lento, e é caracterizado por uma grande invasão dos tecidos adjacentes, além de grande capacidade de metástases. A cirurgia associada à radioterapia pós-operatória é utilizada como tratamento. Objetivo: Descrever um caso de carcinoma adenóide cístico do seio esfenóide em um paciente do sexo masculino, negro de 62 anos. Relato do Caso: N. L. B., 62 anos, masculino, apresentava rinorréia sanguinolenta há seis meses associada obstrução nasal bilateral. Na nasofibroscopia mostrava lesão aspecto polipóide em fossa nasal esquerda. Foi submetido à biopsia e o anatomopatológico demonstrou carcinoma adenóide cístico sendo o paciente encaminhado para oncologia. Conclusões: A importância de se realizar o diagnóstico diferencial entre infecção crônica nasossinusal e tumores nasossinusais.

Introduction: The sphenoid adenoid cystic carcinoma is a rare malign neoplasm, in the head and neck and when located in the paranasal sinuses, it is formed in the minor salivary glands. It grows slowly and is characterized by a large invasion of the adjacent tissues, and also has a large capacity of metastasis. The surgery associated with post-operative radiotherapy is used as treatment. Objective: To describe a case of sphenoid sinus adenoid cystic carcinoma in a male, black, 62 year patient. Case Report: N.L.B., 62 years of age, male, had bloody rhinorrhea for 6 months associated with bilateral nasal obstruction. The nasofibroscopy showed lesion of polypoid aspect in the left nasal cavity. He was submitted to biopsy and the anatomopathological exam showed adenoid cystic carcinoma and the patient was forwarded to oncology. Conclusions: The importance of conducting the differential diagnosis between chronic nasosinusal infection and nasosinusal tumors.

Hemangioma cavernoso de seio maxilar: relato de caso / Cavernous hemangioma of maxilar sinus: case report

Os hemangiomas são lesões benignas congênitas relativamente comuns e que ocorrem predominantemente na região de cabeça e pescoço. Embora comuns, ocorrem infrequentemente nos seios paranasais...

The hemangioma are congenital benign lesions relatively common and that happen predominantly in head's and neck area. Although common, they happen infrequently in the paranasal sinuses...