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1.
Eur Arch Otorhinolaryngol ; 280(6): 2749-2754, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36625868

RESUMO

PURPOSE: The aim of the study is to compare the operative time and postoperative complication outcomes for bone-anchored hearing aid (BAHA) implants using two different techniques: the C-shaped incision technique and the linear incision technique. METHODS: An analysis was carried out of 38 patients implanted with transcutaneous BAHAs during a 4-year period in a single otolaryngology department. RESULTS: The implantation was carried out under general anesthesia. Operative time was significant lower with the linear technique compared to the C-shaped technique (76.55 min, SD 16.75 vs. 93.17 min, SD 19.82; p = 0.007). There was no difference in postoperative complications between the two techniques. CONCLUSIONS: The use of linear incision for transcutaneous BAHA system implantation is associated with a reduced surgery time compared to the C-shaped technique, with no increase in postoperative complications.


Assuntos
Auxiliares de Audição , Perda Auditiva Condutiva , Humanos , Perda Auditiva Condutiva/cirurgia , Auxiliares de Audição/efeitos adversos , Orelha , Complicações Pós-Operatórias/etiologia , Implantação de Prótese/métodos , Condução Óssea
2.
Eur Arch Otorhinolaryngol ; 280(1): 151-158, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35748934

RESUMO

PURPOSE: The purpose of this study was to compare the effectiveness of endoscopic and microscopic approaches for butterfly cartilage graft inlay tympanoplasty regarding anatomical and hearing outcomes through a systematic review and meta-analysis. METHODS: A search of PubMed, Embase, MEDLINE, and Virtual Health Library was performed from inception to July 3rd, 2021, using keywords, such as tympanoplasty, cartilage graft, and inlay technique. Data from articles that met inclusion criteria were extracted by two authors independently. The PRISMA statement was followed. RoB-2 and ROBINS-I tools were used to assess risk of bias. The primary outcome was tympanic membrane closure rate. The secondary outcome was improvement of the air-bone gap. RESULTS: Five studies were included, one randomized clinical trial and four retrospective cohorts, in which a total of 318 patients were included. Graft take rate was 91.3% in the endoscopic group and 93.6% in the microscopic group (RR 0.98; 95% CI 0.93-1.03; I2 0%; P = 0.68). Four studies provided data about the secondary outcome, all showing significant reductions in air-bone gap, ranging from 5.7 to 11.0 in the endoscope group and from 5.8 to 11.6 in the microscope group, with a mean difference between groups of 0.85 (95% CI - 0.79 to 2.48). CONCLUSION: Although the overall evidence of the included studies was low, endoscopic and microscopic butterfly cartilage graft inlay tympanoplasties have similar results on anatomical and hearing outcomes, making the selection between such approaches an individual choice for the surgeon.


Assuntos
Perfuração da Membrana Timpânica , Timpanoplastia , Humanos , Timpanoplastia/métodos , Estudos Retrospectivos , Resultado do Tratamento , Membrana Timpânica , Perfuração da Membrana Timpânica/cirurgia , Cartilagem/transplante , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Eur Arch Otorhinolaryngol ; 277(9): 2603-2609, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32430771

RESUMO

PURPOSE: Nausea and vomiting occur in up to 70% of children after adenotonsillectomy, ingested blood during procedure being one of the reasons for emesis. Hypopharyngeal packing (HP) is a common practice among otolaryngologists to prevent blood from being swallowed, but studies in nasal surgeries in adults failed to show efficacy of this technique in reducing postoperative nausea and vomiting (PONV). There are no studies evaluating the effect of HP in adenotonsillectomy in children. The aim of this study is to evaluate the efficacy HP during adenotonsillectomy in children in the prevention of PONV. METHODS: This is a randomized, double-blinded, controlled trial. Children aged 4-16 years, scheduled for adenotonsillectomy due to sleep-disordered breathing were enrolled in Hospital da Criança Santo Antônio (Brazil). 192 participants were screened, while 129 were enrolled and completed follow-up for primary outcome. Patients were randomized in a consecutive manner to receive HP or not during adenotonsillectomy. PONV occurrence was assessed in the first 24 h after surgery in HP and control group and relative risk with 95% confidence interval was calculated. RESULTS: There were 129 patients randomized, 64 in the HP and 65 in the control group. Female were 40.3% and mean ± SD age was 7.3 ± 2.9. Baseline characteristics and surgery variables were distributed similarly between the groups. Incidence of PONV was 20.3% in the HP and 23.1% in the control group. The relative risk for PONV was 0.88 (95% CI 0.46-1.70). CONCLUSION: Our results suggest that there is no benefit of HP during adenotonsillectomy in children for the prevention of PONV. TRIAL REGISTRATION: Brazilian Register of Randomized Trials (REBEC) identifier: RBR-3zjn27; Universal Trial Number U1111-1197-7461.


Assuntos
Adenoidectomia , Tonsilectomia , Adolescente , Adulto , Brasil , Criança , Pré-Escolar , Dissecação , Método Duplo-Cego , Feminino , Humanos , Náusea e Vômito Pós-Operatórios/epidemiologia , Náusea e Vômito Pós-Operatórios/etiologia , Náusea e Vômito Pós-Operatórios/prevenção & controle
4.
Clin Otolaryngol ; 43(6): 1560-1565, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30152142

RESUMO

OBJECTIVE (S): To estimate the prevalence and associations among rhinosinusitis symptoms, smoking and chronic obstructive pulmonary disease (COPD). DESIGN: Cross-sectional study. SETTING: Population-based. PARTICIPANTS: All adults aged 40 years or more living in the selected households in the city of Florianópolis (Florianópolis, Santa Catarina, Brazil). MAIN OUTCOME MEASURES: Assessment instruments comprised household interviews, anthropometric measurements and spirometry. Rhinosinusitis symptoms were based on the responses to the 22-item Sinonasal Outcome Test (SNOT-22) questionnaire; smoking status was defined by the criteria of the CDC, and the functional diagnosis of COPD was done by spirometry. RESULTS: The prevalence (n = 1056) of rhinosinusitis symptoms, smoking and COPD was 14.7%, 17.9% and 8.7%, respectively. Multivariate analysis showed that, with the exception of COPD, all other clinical variables (smoking, previous diagnosis of rhinitis, previous diagnosis of gastritis/ulcer/gastroesophageal reflux, and symptoms of depression) remained associated with higher prevalence of rhinosinusitis symptoms. CONCLUSIONS: Rhinosinusitis symptoms were common both in smokers and in patients with COPD. However, only tobacco was significantly associated with rhinosinusitis symptoms and can act as a cofounder in the association between COPD and rhinosinusitis symptoms.


Assuntos
Vigilância da População , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Rinite/complicações , Medição de Risco/métodos , Sinusite/complicações , Fumar/efeitos adversos , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Doença Pulmonar Obstrutiva Crônica/etiologia , Fatores de Risco , Inquéritos e Questionários
5.
Braz J Otorhinolaryngol ; 90(3): 101401, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38428330

RESUMO

OBJECTIVES: To make recommendations on the diagnosis and treatment of post-extubation laryngitis (PEL) in children with or without other comorbidities. METHODS: A three-iterative modified Delphi method was applied. Specialists were recruited representing pediatric otolaryngologists, pediatric and neonatal intensivists. Questions and statements approached topics encompassing definition, diagnosis, endoscopic airway evaluation, risk factors, comorbidities, management, and follow-up. A consensus was defined as a supermajority >70%. RESULTS: Stridor was considered the most frequent symptom and airway endoscopy was recommended for definitive diagnosis. Gastroesophageal reflux and previous history of intubation were considered risk factors. Specific length of intubation did not achieve a consensus as a risk factor. Systemic corticosteroids should be part of the medical treatment and dexamethasone was the drug of choice. No consensus was achieved regarding dosage of corticosteroids, although endoscopic findings help defining dosage and length of treatment. Non-invasive ventilation, laryngeal rest, and use of comfort sedation scales were recommended. Indications for microlaryngoscopy and bronchoscopy under anesthesia were symptoms progression or failure to improve after the first 72-h of medical treatment post-extubation, after two failed extubations, and/or suspicion of severe lesions on flexible fiberoptic laryngoscopy. CONCLUSIONS: Management of post-extubation laryngitis is challenging and can be facilitated by a multidisciplinary approach. Airway endoscopy is mandatory and impacts decision-making, although there is no consensus regarding dosage and length of treatment.


Assuntos
Extubação , Laringite , Laringoscopia , Humanos , Laringite/etiologia , Laringite/diagnóstico , Laringite/tratamento farmacológico , Extubação/efeitos adversos , Criança , Técnica Delphi , Fatores de Risco
6.
Int Arch Otorhinolaryngol ; 27(2): e256-e265, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37125352

RESUMO

Introduction Myringotomy and ear tube placement (MTP) is the surgical treatment for otitis media with effusion (OME), and it is the most common surgery performed in children. Several guidelines have been developed to assist in the care of patients who become candidates for MTP. Objectives To evaluate the practice of Brazilian otorhinolarynogologists when performing MTP according to the years of clinical experience. Secondarily, we also want to assess if their practice regarding MTP varied according to the percentage of children treated and the location of their practice. Methods A 30-question survey was sent to otolaryngologists affiliated with the Brazilian Academy of Pediatric Otorhinolaryngology (Academia Brasileira de Otorrinolaringologia Pediátrica, ABOPe, in Portuguese) and/or the Scientific Department of Otorhinolaryngology of the Brazilian Society of Pediatrics (Sociedade Brasileira de Pediatria, SBP, in Portuguese). The questions included were carefully chosen to provide a profile about the practices adopted in the pre-, peri- and postoperative periods of MTP. Results The questionnaire was sent to 208 otolaryngologists, and there were 124 (59.6%) respondents. Of those, 59.7% use antiseptics before surgery. Only 54 otolaryngologists, less than half of the subjects in this study (43.5%), always place a tube during the procedure. More physicians who practice in small cities recommend water precautions after MTP when compared to other physicians ( p < 0.001). Conclusion The present study reveals that many respondents do not follow some of the recommendations of the current guidelines of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) on OME, either perioperatively and postoperatively, or regarding the option of placing a ventilation tube. This part of the care also varied depending on the respondents' work location and experience in the medical practice.

7.
Braz J Otorhinolaryngol ; 89(6): 101315, 2023 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-37716096

RESUMO

OBJECTIVES: Laryngomalacia is the most common congenital cause of stridor; the natural history of the disease runs through to complete resolution by the age of two. Severe cases are characterized by cyanosis, hypoxia, apnea, furcular and/or subcostal retractions, aspirations, pulmonary hypertension, and failure to thrive and must undergo surgery. This study aimed to evaluate the success rates of supraglottoplasty in our hospital and evaluate the predictive factors for surgical success. METHODS: Cohort study, prospectively planned. 75 patients undergoing endoscopic surgery from July 2007 to July 2016 were analyzed at the Santo Antônio Children's Hospital. The primary outcome was percentage of surgical success, defined as the absence of respiratory symptoms or presence of a mild stridor without retractions on the first post-operative month (late success). The secondary outcomes were the early surgical success (absence of respiratory symptoms or presence of a mild stridor without retractions on the first post-operative day). RESULTS: 39 (58.2%) were male, with an average of 4.9 months. Surgical success on the first day was 80.6% (n=54). At the end of the 1st month, surgical success was 88.6%, considering only those who completed assessment. Twenty-one (34%) presented comorbidities. Presence of comorbidities, pharyngomalacia and GERD were associated with a worse result on the 1st postoperative day, whereas, at the end of the first month, presence of comorbidities, concomitant injuries (tracheo and bronchomalacia) and pharyngomalacia were the predictive variables of surgery failure. CONCLUSION: Supraglottoplasty has high rates of efficacy and low morbidity. The presence of comorbidities and pharyngomalacia has shown association with a worse early and late surgical outcome. Synchronous airway lesions predict a worse surgical result at the end of the first month. GERD was associated with obstructive symptomatology only in the 1st post-operative day. LEVEL OF EVIDENCE: Level 3 of evidence, according to the "The Oxford 2011 Levels of Evidence" from Oxford Centre for Evidence-Based Medicine.

8.
Braz J Otorhinolaryngol ; 88(6): 882-890, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-33472759

RESUMO

INTRODUCTION: Tracheostomy is a procedure that can be associated with several well-described complications in the literature, which can be divided into transoperative, early postoperative and late postoperative. When performed in children, these risks are more common than in adults. OBJECTIVE: To perform a systematic review of complications, including deaths, in tracheostomized pediatric patients. METHODS: A search was carried out for articles in the Latin American and Caribbean Health Sciences Literature and PubMed databases. Cohort studies and series reports were selected, in addition to systematic reviews, published between January 1978 and June 2020, with patients up to 18 years old, and written in English, Spanish or Portuguese. RESULTS: 1560 articles were found, of which 49 were included in this review. The average complication rate was 40%, which showed an association with age, birth weight, prematurity, comorbidities, and emergency procedures. The most common complications were cutaneous lesions and granulomas. Mortality related to the procedure reached up to 6% in children and was mainly related to cannula obstruction or accidental decannulation. CONCLUSION: Pediatric tracheostomy is associated with several complications. The tracheostomy-related mortality rate is low, but the overall mortality of tracheostomized patients is not negligible.


Assuntos
Complicações Pós-Operatórias , Traqueostomia , Adulto , Criança , Humanos , Traqueostomia/métodos , Estudos de Coortes , Comorbidade , Estudos Retrospectivos , Complicações Pós-Operatórias/etiologia
9.
OTO Open ; 6(3): 2473974X221108935, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35836497

RESUMO

Objective: To systematically review the results of inlay cartilage butterfly tympanoplasty and standard underlay temporal fascia tympanoplasty for anatomic and functional end points. Data Sources: PubMed, Embase, MEDLINE, and Virtual Health Library (VHL/Lilacs) databases were searched from inception through April 2, 2021. No restrictions on language, publication year, or publication status were applied. Review Methods: The meta-analysis included data from articles that met inclusion criteria and were extracted by 2 authors independently. The PRISMA statement was followed. Risk of Bias 2.0 and Newcastle-Ottawa Scale were used to assess risk of bias. The primary outcome was tympanic membrane closure rate. The secondary outcome was improvement of the air-bone gap. Results: Ten studies were included, 9 cohort studies and 1 randomized clinical trial, with 577 patients. The graft take rate was 82.8% in the butterfly cartilage inlay tympanoplasty group and 85.2% in the temporal fascia underlay tympanoplasty group (relative risk, 1.01; 95% CI, 0.93-1.11; I 2 = 42%, P = .08). The air-bone gap reduction ranged from 6.1 to 11.28 in the butterfly cartilage inlay group and from 5.2 to 12.66 in the temporal fascia underlay group, with a mean difference between groups of -2.08 (95% CI, -3.23 to -0.94; I 2 = 58%, P = .04), favoring temporal fascia underlay. Conclusion: The 2 tympanoplasty techniques analyzed here produced similar results in terms of successful reconstruction of the tympanic membrane and reduction in the air-bone gap. Neither age nor follow-up length of time influenced outcomes.

10.
Rev Assoc Med Bras (1992) ; 68(2): 206-211, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35239883

RESUMO

OBJECTIVE: A multicentric, cross-sectional study was carried out to determine the prevalence and risk factors for Coronavirus disease 2019 in medical students and residents from four universities and affiliated hospitals in Brazil. METHODS: A survey about contamination risk and symptoms was sent to all participants through email and WhatsApp. Prevalence was measured by the self-report of positive polymerase chain reaction or serological test. Univariate and multivariate analyses were performed, and odds ratio and 95% confidence interval were calculated. RESULTS: Prevalence of infection by Sars-CoV-2 was 14.9% (151/1011). The disease was more prevalent in residents and interns than in undergraduate students. Contact with an infected relative outside the hospital or with colleagues without using personal protective equipment was associated with higher contamination. Contact with patients without wearing goggles and higher weekly frequency of contact were the two factors independently associated with the infection by Coronavirus disease 2019 in the multivariate analysis. CONCLUSIONS: Medical students, interns, and residents have a higher prevalence of Coronavirus disease 2019 than the general population, in which the last two groups are significantly at higher risk. Contacting patients at a higher weekly frequency increases the risk for infection. The use of goggles should be reinforced when contacting patients.


Assuntos
COVID-19 , Internato e Residência , Estudantes de Medicina , Centros Médicos Acadêmicos/estatística & dados numéricos , Brasil/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/etiologia , COVID-19/prevenção & controle , Estudos Transversais , Humanos , Internato e Residência/estatística & dados numéricos , Equipamento de Proteção Individual , Prevalência , Fatores de Risco , SARS-CoV-2 , Faculdades de Medicina/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários
11.
Braz J Otorhinolaryngol ; 88 Suppl 5: S4-S11, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34364822

RESUMO

INTRODUCTION: The nose and throat are areas of high viral load, which could place otolaryngologists at an even higher risk for COVID-19 than other health-care workers. OBJECTIVE: To investigate the prevalence of antibodies against SARS-CoV-2 in otorhinolaryngologists in southern Brazil, its relationship to demographic data, professional practice and reported symptoms of COVID-19, and compare it with official data on other health-care workers of the state and the general population in the same period. METHODS: In this cross-sectional multicenter study, otolaryngologists actively practicing officially registered in Rio Grande do Sul were screened for IgM and IgG antibodies against SARS-CoV-2 from August 1 to September 15, 2020. A questionnaire was also applied. RESULTS: We screened 358 (80.1%) of 447 actively practicing otolaryngologists (195 [54.5%] male; mean [SD] age, 47.77 [13.57] years; range, 26-84 years). Twenty-three were positive for IgM and/or IgG (6.4%). This result was significantly associated with reports of infected household contacts (19/315 negatives and 8/23 positives; p < 0.001). From 23 seropositive participants, 14 were asymptomatic (60.9%; p < 0.001). There were no significant associations between seroconversion and age, sex, number of patient appointments and surgical procedures, workplace (hospital or private practice), patients with or without respiratory symptoms, or level of personal protective equipment used. The rate of COVID-19 in all health-care workers in the state was 7.69% at the end of the same period. Data from state government seroprevalence was 5.26 (risk ratio [RR]; 95% CI 3.27-8.45) and 4.66 (RR; 95% CI 2.93-7.43) times higher in otolaryngologists than in the general population in August and September, respectively. CONCLUSION: Otolaryngologists had a higher seroconversion rate than the general population. Using personal protective equipment, the level of occupational exposure did not result in higher rates of infection than other health-care workers, but the presence of infected household contacts was associated with higher rates of seroconversion.


Assuntos
COVID-19 , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , COVID-19/epidemiologia , COVID-19/diagnóstico , SARS-CoV-2 , Estudos Soroepidemiológicos , Otorrinolaringologistas , Estudos Transversais , Imunoglobulina G , Imunoglobulina M
12.
Braz J Otorhinolaryngol ; 87(2): 227-236, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33485779

RESUMO

INTRODUCTION: Tonsillectomy is the 2nd most common outpatient surgery performed on children in the United States of America. Its main complication is pain, which varies in intensity from moderate to severe. Dipyrone is one of the most widely used painkillers in the postoperative period in children. Its use, however, is controversial in the literature, to the point that it is banned in many countries due to its potential severe adverse effects. Because of this controversy, reviewing the analgesic use of dipyrone in the postoperative period of tonsillectomy in children is essential. OBJECTIVE: The aim of this study was to review the analgesic use of dipyrone in the postoperative period of tonsillectomy in children. METHODS: Systematic review of the literature, involving an evaluation of the quality of articles in the databases MEDLINE/Pubmed, EMBASE and Virtual Health Library, selected with a preestablished search strategy. Only studies with a randomised clinical trial design evaluating the use of dipyrone in the postoperative period of tonsillectomy in children were included. RESULTS AND CONCLUSION: Only 2 randomised clinical trials were found. Both compared dipyrone, paracetamol, and placebo. We were unable to carry out a metanalysis because the studies were too heterogenous (dipyrone was used as pre-emptive analgesic in one and only postoperatively in another). The analgesic effect of dipyrone, measured by validated pain scales in childhood, was shown to be superior to placebo and similar to paracetamol. It appears that dipyrone exhibits a profile suitable for use in children. However, the scarcity of randomised clinical trials evaluating its analgesic effect in this age group leads to the conclusion that more well-designed studies are still needed to establish the role of dipyrone in the postoperative period of tonsillectomy in children.


Assuntos
Analgesia , Tonsilectomia , Criança , Dipirona , Humanos , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Tonsilectomia/efeitos adversos
13.
Braz J Otorhinolaryngol ; 86(6): 743-747, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31285184

RESUMO

INTRODUCTION: Chronic rhinosinusitis with nasal polyps, a prevalent disease affecting around 2% of the world population, is characterized by symptomatic inflammation of the nasal mucosa and impairment of quality of life. Chronic rhinosinusitis with nasal polyps has a multifactorial etiology, involving a dysfunctional host response to environmental factors. Thus, inflammatory models may be useful to shed light on the pathophysiology of this disease. Micronucleus count has been used to screen DNA damage in various tissues. OBJECTIVE: To investigate the association between frequency of micronucleus in exfoliated cells from the nasal cavity of patients with chronic rhinosinusitis with nasal polyps and disease severity. METHODS: This cross-sectional study included 21 patients with chronic rhinosinusitis with nasal polyps and 19 controls without disease. None of the participants were smokers. RESULTS: Mean micronucleus count was 3.690 per 1000 cells (±2.165) in individuals with vs. 1.237 per 1000 cells (±0.806) in controls; (Student's t test = 4.653, p < 0.001). Nasal surgery in the past 5 years and aspirin-exacerbated respiratory disease were not associated with nicronucleus count (p = 0.251). CONCLUSION: Micronucleus count seems to be linked to chronic rhinosinusitis with nasal polyps, providing a new perspective for the evaluation of this disorder.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Doença Crônica , Estudos Transversais , Células Epiteliais , Humanos , Pólipos Nasais/complicações , Qualidade de Vida , Rinite/complicações , Sinusite/complicações
14.
Otolaryngol Head Neck Surg ; 141(3): 322-8, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19716007

RESUMO

OBJECTIVES: Tonsillectomy, with or without adenoidectomy, is one of the most common surgical procedures in pediatric otolaryngology. Despite its relative simplicity, pain is the main cause of morbidity in the postoperative period. We determined the effect of topical sucralfate on reduction of oropharyngeal pain in children submitted to adenotonsillectomy. Secondary outcomes were otalgia, analgesic use, type of diet, secondary bleeding, vomiting, fever, and weight loss. STUDY DESIGN: Double-blind, randomized clinical trial. SETTING: Tertiary hospital. SUBJECTS AND METHODS: Eighty-two children of both sexes between four and 12 years old submitted to adenotonsillectomy were evaluated. They were allocated to receive topical sucralfate or placebo in intraoperative and postoperative periods four times a day for five days. Pain was measured through faces pain scale. RESULTS: Reduction in oropharyngeal pain was significant with use of sucralfate during five days of evaluation (mean, 95% confidence interval, and P value); day 1: 2.05, 1.53-2.58, P = 0.000; day 2: 2.1, 1.51-2.70, P = 0.001; day 3: 1.44, 0.88-1.99, P = 0.003; day 4: 1.13, 0.58-1.55, P = 0.027; day 5: 0.67, 0.26-1.04, P = 0.021). There was no difference in secondary outcomes. CONCLUSION: We found beneficial effect of use of sucralfate in reduction of oropharyngeal pain in the postoperative period of adenotonsillectomy. However, topical sucralfate does not have a potent effect to the point of being utilized as a single analgesic treatment. Because it is simple, safe, tolerated, and low-cost, it is an important tool as adjuvant treatment of post-tonsillectomy pain.


Assuntos
Adenoidectomia/métodos , Analgesia/métodos , Dor Pós-Operatória/prevenção & controle , Doenças Faríngeas/cirurgia , Sucralfato/administração & dosagem , Tonsilectomia/métodos , Administração Tópica , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Medição da Dor , Resultado do Tratamento
16.
Ann Otol Rhinol Laryngol ; 117(6): 425-9, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18646438

RESUMO

OBJECTIVES: We performed a cross-sectional study to investigate whether the obstruction of the eustachian tube orifice due to adenoid hyperplasia changes the pressures in the middle ear. METHOD: Fifty consecutive children 2 to 12 years of age with nasal obstruction were examined from May to October 2005. Adenoid size and status of the eustachian tube orifice were assessed with nasal flexible fiberoptic endoscopy. Tympanometry was used to evaluate the middle ear. RESULTS: In children with occlusion of the eustachian tube orifice by adenoid tissue, 87% had abnormal pressure in the middle ear according to tympanograms. When orifices were not occluded, 86% of the tympanograms were normal (p < .001). CONCLUSIONS: Obstruction of the eustachian tube orifice by adenoid tissue was associated with tympanograms suggestive of abnormal pressure in the middle ear. Future studies with a larger sample size are necessary to clarify this association.


Assuntos
Orelha Média/fisiopatologia , Tuba Auditiva/patologia , Testes de Impedância Acústica , Tonsila Faríngea/patologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Hiperplasia , Masculino , Pressão
17.
Int J Pediatr Otorhinolaryngol ; 72(1): 63-7, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17983669

RESUMO

OBJECTIVE: To evaluate nasal flexible fiberoptic endoscopy as a diagnostic test of adenoid hypertrophy in children with nasal obstruction. METHODS: One hundred and thirty consecutive children aged 2-12 years were examined from May to October 2005. A questionnaire answered by parents or guardians was used to obtain a symptom score. Adenoid size was measured on radiographs of the nasal cavity using the Cohen and Konak method, and by nasal flexible fiberoptic endoscopy using the Wornald and Prescott classification. The criterion standard was the adenoid size demonstrated on radiograph. RESULTS: The sensitivity of nasal flexible fiberoptic endoscopy was 92% (95% CI, 0.90-0.93), and specificity, 71% (95% CI, 0.70-0.72). The area under the ROC curve was 0.83 (95% CI, 0.76-0.90) at a p<0.001 level of significance. Kappa values were 0.94 (p<0.001) for interobserver agreement, 0.95 (p<0.001) for intraobserver agreement, and 0.54 (p<0.001) for agreement between tests. CONCLUSIONS: Results suggest that nasal flexible fiberoptic endoscopy is a highly accurate diagnostic method. This examination can be performed easily in cooperative children; it is safe, objective and dynamic, and helps to establish diagnoses in difficult cases.


Assuntos
Tonsila Faríngea/patologia , Endoscopia , Tonsila Faríngea/diagnóstico por imagem , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Hipertrofia/diagnóstico , Masculino , Obstrução Nasal/diagnóstico , Nariz , Variações Dependentes do Observador , Radiografia , Sensibilidade e Especificidade , Inquéritos e Questionários
18.
Int. arch. otorhinolaryngol. (Impr.) ; 27(2): 256-265, April-June 2023. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1440211

RESUMO

Abstract Introduction Myringotomy and ear tube placement (MTP) is the surgical treatment for otitis media with effusion (OME), and it is the most common surgery performed in children. Several guidelines have been developed to assist in the care of patients who become candidates for MTP. Objectives To evaluate the practice of Brazilian otorhinolarynogologists when performing MTP according to the years of clinical experience. Secondarily, we also want to assess if their practice regarding MTP varied according to the percentage of children treated and the location of their practice. Methods A 30-question survey was sent to otolaryngologists affiliated with the Brazilian Academy of Pediatric Otorhinolaryngology (Academia Brasileira de Otorrinolaringologia Pediátrica, ABOPe, in Portuguese) and/or the Scientific Department of Otorhinolaryngology of the Brazilian Society of Pediatrics (Sociedade Brasileira de Pediatria, SBP, in Portuguese). The questions included were carefully chosen to provide a profile about the practices adopted in the pre-, peri- and postoperative periods of MTP. Results The questionnaire was sent to 208 otolaryngologists, and there were 124 (59.6%) respondents. Of those, 59.7% use antiseptics before surgery. Only 54 otolaryngologists, less than half of the subjects in this study (43.5%), always place a tube during the procedure. More physicians who practice in small cities recommend water precautions after MTP when compared to other physicians (p < 0.001). Conclusions The present study reveals that many respondents do not follow some of the recommendations of the current guidelines of the American Academy of

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Braz. j. otorhinolaryngol. (Impr.) ; 89(6): 101315, Jan.-Feb. 2023. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1528121

RESUMO

Abstract Objectives: Laryngomalacia is the most common congenital cause of stridor; the natural history of the disease runs through to complete resolution by the age of two. Severe cases are characterized by cyanosis, hypoxia, apnea, furcular and/or subcostal retractions, aspirations, pulmonary hypertension, and failure to thrive and must undergo surgery. This study aimed to evaluate the success rates of supraglottoplasty in our hospital and evaluate the predictive factors for surgical success. Methods: Cohort study, prospectively planned. 75 patients undergoing endoscopic surgery from July 2007 to July 2016 were analyzed at the Santo Antônio Children's Hospital. The primary outcome was percentage of surgical success, defined as the absence of respiratory symptoms or presence of a mild stridor without retractions on the first post-operative month (late success). The secondary outcomes were the early surgical success (absence of respiratory symptoms or presence of a mild stridor without retractions on the first post-operative day). Results: 39 (58.2%) were male, with an average of 4.9 months. Surgical success on the first day was 80.6% (n = 54). At the end of the 1st month, surgical success was 88.6%, considering only those who completed assessment. Twenty-one (34%) presented comorbidities. Presence of comorbidities, pharyngomalacia and GERD were associated with a worse result on the 1st postoperative day, whereas, at the end of the first month, presence of comorbidities, concomitant injuries (tracheo and bronchomalacia) and pharyngomalacia were the predictive variables of surgery failure. Conclusion: Supraglottoplasty has high rates of efficacy and low morbidity. The presence of comorbidities and pharyngomalacia has shown association with a worse early and late surgical outcome. Synchronous airway lesions predict a worse surgical result at the end of the first month. GERD was associated with obstructive symptomatology only in the 1st post-operative day. Level of evidence: Level 3 of evidence, according to the "The Oxford 2011 Levels of Evidence" from Oxford Centre for Evidence-Based Medicine.

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