Management of laryngopharyngeal reflux in Brazil: a national survey.

INTRODUCTION: Studies assessing the management of laryngopharyngeal reflux by otolaryngologists have reported an important heterogeneity regarding the definition, diagnosis, and treatment, which leads to discrepancies in the management of the patient. Information about the current knowledge and practices of Brazilian otolaryngologists in laryngopharyngeal reflux is lacking. OBJECTIVE: To investigate the trends in management of laryngopharyngeal reflux disease among Brazilian otolaryngologists. METHODS: A survey was sent by email to the members of the Brazilian Association of Otolaryngology-Head Neck Surgery. This survey has initially been conducted by the laryngopharyngeal reflux study group of young otolaryngologists of the International Federation of Otolaryngological Societies. RESULTS: According to the survey responders, the prevalence of laryngopharyngeal reflux was estimated to be 26.8% of patients consulting in otolaryngology and the most common symptoms were globus sensation, throat clearing, cough and stomach acid reflux. Nasal obstruction, Eustachian tube dysfunction, acute and chronic otitis media, vocal fold nodules and hemorrhage were considered not associated with laryngopharyngeal reflux by the majority of responders. About 2/3 of Brazilian otolaryngologists based the diagnosis of laryngopharyngeal reflux on the assessment of both symptoms and findings and a positive response to empiric therapeutic trials. Proton pump inhibitor utilized once or twice daily, was the most commonly used therapeutic scheme. Only 21.4% of Brazilian otolaryngologists have heard about nonacid and mixed laryngopharyngeal reflux and the awareness about the usefulness of multichannel intraluminal impedance pH monitoring (MII-pH) was minimal; 30.5% of responders did not consider themselves as well-informed about laryngopharyngeal reflux. CONCLUSION: Although the laryngopharyngeal reflux-related symptoms, main diagnostic and treatment approaches referred by Brazilian otolaryngologists are consistent with the literature, the survey identified some limitations, such as the insufficient awareness of the role of laryngopharyngeal reflux in many otolaryngological conditions and of the possibility of non-acid or mixed reflux in refractory cases. Future studies are needed to establish international recommendations for the management of laryngopharyngeal reflux disease.

Impact of subspecialty training on management of laryngopharyngeal reflux: results of a worldwide survey.

OBJECTIVE: To study the management of laryngopharyngeal reflux (LPR) among the subspecialties of practicing otolaryngology-head and neck surgeons and their trainees. METHODS: A survey was sent to over 8000 otolaryngologists (OTOHNS) over 65 countries, utilizing membership lists of participating otolaryngological societies. The outcomes were answers to questions regarding LPR knowledge and practice patterns, and included queries about its definition, prevalence, clinical presentation, diagnosis, and treatment. RESULTS: Of the 824 respondents, 658 practiced in one specific otolaryngologic subspecialty. The symptoms and findings thought to be the most related to LPR varied significantly between subspecialists. Extra-laryngeal findings were considered less by laryngologists while more experienced OTOHNS did not often consider digestive complaints. Compared with colleagues, otologists, rhinologists and laryngologists were less aware of the involvement of LPR in otological, rhinological and laryngological disorders, respectively. Irrespective of subspecialty, OTOHNS consider symptoms and signs and a positive response to empirical therapeutic trial to establish a LPR diagnosis. Awareness regarding the usefulness of impedance pH-studies is low in all groups. The therapeutic approach significantly varies between groups, although all were in agreement for the treatment duration. The management of non-responder patients demonstrated significant differences among laryngologists who performed additional examinations. The majority of participants (37.1%) admitted to being less than knowledgeable about LPR management. CONCLUSIONS: LPR knowledge and management vary significantly across otolaryngology subspecialties. International guidelines on LPR management appear necessary to improve knowledge and management of LPR across all subspecialties of otolaryngology.

Incomplete and late recovery of sudden olfactory dysfunction in COVID-19.

INTRODUCTION: Sudden olfactory dysfunction is a new symptom related to COVID-19, with little data on its duration or recovery rate. OBJECTIVE: To characterize patients with sudden olfactory dysfunction during the COVID-19 pandemic, especially their recovery data. METHODS: An online survey was conducted by the Brazilian Society of Otorhinolaryngology and Cervico-Facial Surgery, and Brazilian Academy of Rhinology, including doctors who assessed sudden olfactory dysfunction patients starting after February 1st, 2020. Participants were posteriorly asked by e-mail to verify data on the recovery of sudden olfactory loss and test for COVID-19 at the end of the data collection period. RESULTS: 253 sudden olfactory dysfunction patients were included, of which 59.1% were females with median age of 36 years, with a median follow-up period of 31 days. 183 patients (72.3%) had been tested for COVID-19, and of those 145 (79.2%) tested positive. Patients that tested positive for COVID-19 more frequently showed non-specific inflammatory symptoms (89.7% vs. 73.7%; p=0.02), a lower rate of total recovery of sudden olfactory dysfunction (52.6% vs. 70.3%; p=0.05) and a longer duration to achieve total recovery (15 days vs. 10 days; p=0.0006) than the ones who tested negative for COVID-19. Considering only positive-COVID-19 patients, individuals with sudden hyposmia completely recovered more often than the ones with sudden anosmia (68.4% vs. 50.0%; p=0.04). CONCLUSION: Positive-COVID-19 patients with sudden olfactory dysfunction showed lower total recovery rate and longer duration than negative-COVID-19 patients. Additionally, total recovery was seen more frequently in positive-COVID-19 patients with sudden hyposmia than the ones with sudden anosmia.

An update on COVID-19 for the otorhinolaryngologist - a Brazilian Association of Otolaryngology and Cervicofacial Surgery (ABORL-CCF) Position Statement.

INTRODUCTION: We are facing a pandemic with a great impact worldwide, as a result of the rapid spread of the novel coronavirus (COVID-19). The medical community is still getting to know behavior of this virus and the consequences from a population point of view. All this knowledge is extremely dynamic, so some behaviors are still not well established. Otorhinolaryngologists have a central role in the management of this situation, in which they must assess the patient, avoid contamination to and by health professionals and other patients. Thus, the recommendations of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery (ABORL-CCF) have the main objective of reducing the spread of the new coronavirus during otorhinolaryngological care and assisting in the management of these patients. METHODS: Review of the main recommendations of national and international scientific societies, decisions by government agencies and class councils. The topics will be related to the general aspects of COVID-19, personal protective equipment, care in patient assistance, endoscopic exam routines and the management of sinonasal, otological and pediatric evaluations related to COVID-19. RESULTS: The use of personal protective equipment is considered crucial in routine ENT care. We recommend postponing appointments, exams and elective surgeries to reduce the spread of COVID-19. Similarly, we recommend changing routines in several areas of otolaryngology. Additionally, guidance is provided on the use of telemedicine resources during the pandemic period. CONCLUSIONS: We are still at the beginning of the COVID-19 pandemic and scientific evidence is still scarce and incomplete, so these ABORL-CCF recommendations for otorhinolaryngologists may be updated based on new knowledge and the pattern of the new coronavirus spread.

Manejo conservador no tratamento de fístula liquórica nasal iatrogênica / Conservative treatment of iatrogenic nasal CSF fistula

A fístula liquórica nasal, identificada pela presença de líquido cefalorraquidiano na cavidade nasal, é uma condição de risco para o desenvolvimento de meningite. Tal entidade, quando de etiologia iatrogênica, é de incidência significativa naqueles pacientes submetidos a cirurgias endoscópicas nasais e cirurgias da base do crânio. O otorrinolaringologista tem exercido o crucial papel de realizar o diagnóstico e prover o tratamento dessa entidade, com o objetivo de evitar as complicações da infecção meníngea e suas sequelas. No presente estudo descrevemos o caso de um paciente submetido à cirurgia nasal que apresentou rinoliquorreia no período pós-operatório de cirurgia nasal não especificada. O paciente apresentou evolução favorável com manejo conservador. É de suma importância o conhecimento das particularidades diagnósticas e terapêuticas dessa condição devido à sua incidência significativa e às suas complicações potencialmente deletérias (AU)

Nasal CSF leak, identified by the presence of cerebrospinal fluid in the nasal cavity, is a risk factor for the development of meningitis. Such an entity, if iatrogenic, is significantly incident in patients undergoing nasal endoscopic surgery and skull base surgery. The otolaryngologist has played a crucial role in making a diagnosis and provide treatment for such entity, in order to avoid the complications of meningeal infection and its sequelae. In the present study we report the case of a patient undergoing nasal surgery who had CSF leak in the postoperative period of unspecified nasal surgery. The patient presented favorable evolution with conservative management of the condition, with evidence of fistula closure through control cisternotomography. Knowledge of the diagnostic and therapeutic characteristics of this condition is very important due to its significant incidence and its potentially harmful complications (AU)

Analysis of estrogenic activity in environmental waters in Rio de Janeiro state (Brazil) using the yeast estrogen screen.

The estrogenicity of waters collected from an important hydrological system in Brazil (Paraiba do Sul and Guandu Rivers) was assessed using the yeast estrogen screen (YES) assay. Sampling was performed in rivers and at the outlets of conventional water treatment plants (WTP). The removal of estrogenic activity by ozonation and chlorination after conventional water treatment (clarification and sand filtration) was investigated employing samples of the Guandu River spiked with estrogens and bisphenol A (BPA). The results revealed a preoccupying incidence of estrogenic activity at levels higher than 1ngL(-1) along some points of the rivers. Another matter of concern was the number of samples from WTPs presenting estrogenicity surpassing 1ngL(-1). The oxidation techniques (ozonation and chlorination) were effective for the removal of estrogenic activity and the combination of both techniques led to good results using less amounts of oxidants.

Evaluation of nasal patency by acoustic rhinometry after repair of complete unilateral cleft lip and palate.

PURPOSE: The aim of the current study was to evaluate nasal patency by acoustic rhinometry in children aged 4-8 years with repaired complete unilateral cleft lip and palate (UCLP) compared with an age-matched control group without cleft lip and palate (CLP). METHODS: This comparative cross-sectional study was conducted at a tertiary care teaching hospital and a private ENT clinic in Porto Alegre, southern Brazil. The case group consisted of 38 children who had undergone surgery for complete UCLP (mean age, 6.44 years), and the control group of 21 children without CLP (mean age, 6.21 years) recruited among patients seeking medical care for ear diseases at the private clinic. Acoustic rhinometry was performed in all children after administration of oxymetazoline hydrochloride (2 × 0.25 mg/mL) for nasal vasoconstriction. RESULTS: The minimal cross-sectional area and nasal volume of the cleft side were smaller than those of the non-cleft side in the case group (p = 0.001). When the two groups were compared, the non-cleft side in the case group did not differ from the control group (p = 0.175), but the minimal cross-sectional area and volume of the cleft nasal cavity were smaller than the mean values of the two nostrils of controls (p = 0.001). CONCLUSION: In conclusion, our findings show that nasal patency on the cleft side is impaired in children surgically treated for complete UCLP.

Análise quantitativa da configuração da prega vestibular por método de mensuração dos ângulos: aplicação em mulheres normais e com nódulos vocais / Quantitative analysis of the vestibular fold through angles measurement method: application in females without laryngeal lesions and females with vocal fold nodules

Introdução: O papel da região supraglótica na fonação em humanos ainda é motivo de especulação. A atividade supraglótica, através de suas principais estruturas - as pregas vestibulares - é observada em indivíduos normais e com alterações na voz. São esparsos na literatura estudos que descrevam uma mensuração objetiva da atividade supraglótica. Objetivos: O desenvolvimento de método de quantificação da conformação das PVest, mediante mensuração de ângulos na curvatura da borda livre e dos ângulos das inserções anterior e posterior, visando também definir se existem diferenças nas PVest de mulheres normais e com nódulos vocais. Método: Foram analisadas oitenta e oito imagens digitalizadas de laringoscopias por telescópio de 51 mulheres sem queixas vocais e sem lesões laríngeas e 37 mulheres com nódulos vocais. Um programa de análise de imagens foi utilizado para determinar e interpolar a curvatura das pregas vestibulares. Esta curvatura foi dividida em 10 retas e, entre elas, mediu-se o ângulo. Também foi desenhado um triângulo de conformação unindo-se o ponto de inserção anterior, o ponto de inserção posterior o ponto de maior afastamento de cada prega vestibular. Os ângulos deste triângulo também foram medidos em graus. As pregas vestibulares foram divididas, qualitativamente, em côncavas, lineares e convexas e os parâmetros foram estudados. Resultados: Os nove ângulos de curvatura das pregas vestibulares côncavas são maiores do que as lineares. Os ângulos das pregas vestibulares convexas têm valores menores do que as côncavas, porém apresentam curvatura negativa.

Escala de sonolência de Epworth em pacientes com diferentes valores na monitorizaçäo ambulatorial de pressäo arterial / Epworth's sleepiness scale in outpatients with different values of arterial blood pressure

OBJECTIVE: To compare sleepiness scores of the Epworth scale in patients with different levels of arterial pressure when undergoing outpatient monitoring within the context of clinical evaluation. METHODS: A total of 157 patients selected for outpatient monitoring of arterial pressure during hypertension evaluation were divided into 3 groups: group 1 - normotensive; group 2 - hypertensive; group 3 - resistant hypertensive. For analysis, values > or = 11 were considered as associated with respiratory disturbances during sleep. RESULTS: Seventeen (10.8 percent) patients in group 1, 112 (71.3 percent) in group 2, and 28 (17.8 percent) in group 3, which was composed of aged, more severely hypertensive individuals, were analyzed. Groups were similar relative to sex and body mass index, but different in relation to systolic and diastolic pressure levels and age. Despite an absolute difference, no statistically significant difference occurred between Epworth scores and in the proportion of patients with values > or = 11 (5.9 percent vs. 18.8 percent vs. 212.4 percent; P=0.37). Despite the positive association between degree of sleepiness measured with the scale and the severity of the hypertension, no statistical significance occurred following control by age (p=0.18). CONCLUSION: A positive correlation exists between degree of sleepiness and hypertension severity. The absence of a statistical significance shown in the present study could be due to a beta type of error. Instruments that render this complaint into an objective finding could help in the pursuit of an investigation of respiratory disturbances during sleep in more severely hypertensive patients, and should therefore be studied better

Tratamento cirúrgico do ronco e da Síndrome da apnéia obstrutiva do sono / Surgical treatment for snoring and obstructive sleep apnea syndrome

A causa do ronco e da Síndrome da apnéia obstrutiva do sono é a obstrução ou colapso da via aérea superior durante o sono. Apresentamos uma revisão da literatura sobre a avaliação clínica e as modalidades terapêuticas para pacientes com essas alterações

Dor pós-tonsilectomia: comparação entre pacientes com diferentes idades / Post-Tonsillectomy Pain: Comparison Between Different Ages

Introdução e objetivos: Tonsilectomia é um procedimento doloroso que causa considerável desconforto pós-operatório para os pacientes. Objetivamos comparar o padrão de dor pós-operatória em pacientes submetidos à tonsilectomia conforme a idade dos mesmos. Material e métodos: O estudo foi realizado com 58 pacientes entre cinco e 59 anos submetidos à tonsilectomia, realizada pela técnica convencional, para avaliarmos a dor pós-operatória. Os pacientes foram divididos em dois grupos: I (pacientes entre cinco e 10 anos) e II (pacientes maiores ele 10 anos). Os anestésicos e analgésicos pós-operatórios foram padronizados. A avaliação da dor pós-operatória foi realizada mediante uma escala analógica visual preenchida pelo próprio paciente, quantificação dos analgésicos ingeridos nas 24 horas e qualidade da dieta ingerida. Esta avaliação foi realizada durante 12 dias. Os resultados foram avaliados através do teste de Mann-Whitney Rank Sum ou teste do qui-quadrado (p<0.05). Resultados: A média ele idade do grupo I foi de 7.68 anos (n=29) e grupo II de 24.34 anos (n=26). Três pacientes do grupo II foram excluídos deste estudo por terem usado analgesia não padronizada. Ao avaliar a dor pós-operatória e ingestão de analgésicos, observamos que os pacientes cio grupo I apresentaram menor dor e menor ingestão de analgésicos do que os pacientes do grupo II em todos os dias de seguimento, exceto no primeiro dia pós-operatório, quando não houve diferença entre os grupos (p<0.05). Os pacientes do grupo I voltaram a ingerir uma dieta normal no quinto dia pós-operatório e grupo II no nono dia pós-operatório (p<0.05). Conclusão: Com base nesses resultados, podemos afirmar que as crianças sentem menos dor pós-tonsilectomia do que adolescentes e adultos, necessitando de uma menor quantidade de analgésicos e retornando mais precocemente à uma dieta normal.

Backgrounds and aims: Tonsillectomy is a painful procedure that produces remarkable post-operative discomfort. The aim of this study was to compare the post-operative pain patterns of younger and older patients. Material and methods: Tonsillectomy was carried out in 58 patients by convencional technique to evaluate post-operative pain. The scores for those patients 10 years or younger (group 1) were compared with those older than 10 (group 11). The anaesthetic and perioperative analgesic regimes were standardized. Patients were asked to score their pain on a linear analogue scale, to record the total number of analgesics required in the previous 24h and whether they had been able to eat normal diet. This evaluation lasted for 12 days. Results were analized by Mann-Whitney Rank Sum test or Chi-square (p<0.05). Results: Mean age was 7.68 years in group I (n=29) and 24.34 years in group II (n=26). There patients in the group II were excluded from this study due to use non-standardized analgesic regimes. In the group of patients of 10 years or younger the severity of post-operative pain was lower that in older patients and less analgesia was required in the follow-up, except at the first day post-operatively when no difference was observed between groups (p<0.05). The mean time for return to normal diet was five days in the younger age group and nine days in the older group (p<0.05). Conclusion: These findings suggest that there is a significant difference in the pattern of pain experienced following tonsillectomy in children under 10 years of age compared to older patients. Thus, less analgesia is required and earlier return to normal diet is observed in younger age group.

Manifestaçöes rino-sinusais durante a gestaçäo / Rhinosinusal manifestations during pregnancy

A relação entre as alterações da mucosa nasal e a gestação tem sido tema de interesse para vários autores durante o decorrer dos tempos, desde a época de Hipócrates. Apesar de não haver dúvidas a respeito da existência desta relação, permanecem, entretanto, algumas indagações sobre a sua fisiopatologia. Neste trabalho é feito um estudo prospectivo onde são analisadas as queixas rino-sinusais de 151 nulheres puérperas, comparadas com os dados da literatura. Os autores concluem que a gravidez pode influenciar as queixas rino-sinusais, porém estudos com quantificação objetiva destas manifestações e melhor desenhados ainda são necessários

Ingestäo de substâncias cáusticas: abordagem inicial / Caustic ingestion accidents: first measures

Os autores fazem uma revisäo relativa ao manejo incial dos acidentes de ingestäo de substâncias cáusticas. Säo ressaltados tópicos referentes a dados epidemiológicos, substâncias mais freqüentemente envolvidas, achados clínicos e condutas iniciais. Os autores concluem que é necessária uma conduta inicial sistemática nestes acidentes

Complicaçöes intracranianas das otites médias crônicas supurativas: uma realidade / Intracranial complications of chronic suppurative otitis media: a reality

Os autores fazem uma revisao acerca das complicaçoes intracranianas das otites médias crônicas supurativas, chamando a atençao para a ainda alta incidência das mesmas e de sua potencialmente elevada morbi-mortalidade, ilustrando com apresentaçao de casos.

Vertigem / Vertigo

Os autores revisam os principais fatores que devem ser considerados na investigaçäo da vertigem, enfatizando a complexidade do sistema do equilíbrio e suas relaçöes. Também referem algumas das principais doenças em que esse sintoma está presente.

Rinoliquorréia espontânea: apresentaçäo de um caso e revisäo da literatura / Spontaneous CSF rhinorrhea: report of a case and review of the literature

Os autores relatam um caso de fístula liquórica nasal espontânea, cuja investigaçao radiológica foi negativa para identificaçao do local da fístula, tendo sido curada com tratamento cirúrgico via trans-esfenoidal. Os métodos diagnósticos de eleiçao sao apresentados, bem como as várias técnicas de abordagem cirúrgica, de acordo com o sítio e fluxo da fístula.

Manifestaçöes otorrinolaringológicas na síndrome de imunodeficiência adquirida / Otorhinolaryngologic manifestations of acquired immunodeficiency syndrome

Foram analisados retrospectivamente 161 pacientes com Síndrome da Imunodeficiência Adquirida internados no Hospital das Clínicas de Porto Alelgre. Desses, 115 (71,4%) apresentavam lesöes em áreas anatômicas tratadas pelos otorrinolaringologistas. Observou-se que 92,2% eram do sexo masculino. A maioria dos pacientes era branca (93,0%) e tinha entre 20 e 50 anos de idade (88,7%). O grupo de risco mais freqüente foi o de homossexuais e bissexuais (72,2%). Das lesöes que ocorreram na cabeça e pescoço, candidíase orofaringeana foi a mais prevalente (86,0%). Sinusites em 19,1%, Sacoma de Kaposi em 7,8%, sendo o palato duro o sítio de maior freqüência. Ressalta-se a importância do reconhecimento dessas manifestaçöes pelos otottinolaringologistas a fim de que possam ser precocemente diagnosticadas e tratadas

Desnutriçäo e peso de nascimento em vila periférica de Porto Alegre / Malnutrition and birth weight in peripheral area of Porto Alegre

Foram estudadas 151 crianças de 0 a 6 anos incompletos em uma vila periférica de Porto Alegre, quanto à correlaçäo entre peso de nascimento e desnutriçäo infantil (avaliada pela medida do perímetro braquial médio). Näo se encontrou associaçäo significativa entre ambos