Morphofunctional changes following adenotonsillectomy of obstructive sleep apnea children: a case series analysis.

OBJECTIVE: To perform a case series analysis of the changes in the pulmonary artery systolic pressure (PASP), nasal inspiratory flow (NIF), upper airway volume, obstructive apnea/hypopnea index (OAHI), and the maxillomandibular three-dimensional (3D) morphology after adenotonsillectomy (T&A) of obstructive sleep apnea children (OSA). MATERIALS AND METHODS: Retrospective assessment of files from 1002 children screened between 2012 and 2020 in a hospital-based mouth-breather referral center. From this universe, 15 obstructive sleep apnea children (7 females; 8 males), ages 4.1 to 8.9 years old (mean age of 5.4 years ± 1.3), who presented indications of tonsillectomy and/or adenoidectomy were selected. The complete baseline examination (T0) was carried out before T&A and a second complete examination (T1) was made 18.7-month follow-up after T&A (ranging from 12 to 30 months). Eleven patients were submitted to T&A, and four patients had indications but did not receive authorization for surgery from the public health system. According to the protocol of the outpatient clinic for OSA patients, Doppler echocardiography, polysomnography, rhinomanometry, and computed tomography imaging was performed at (T0) and (T1). RESULTS: PASP decreased 16.6% after T&A. NIF increased more in T&A children (40.3%) than in non-T&A children (16.8%). The upper airway volume increased in T&A and non-T&A children, but greater volumetric gain (45.6%) was found in the nasopharynx of T&A patients. OAHI did not change in six T&A children (55%) and three non-T&A children (75%). The maxilla displaced downward and backward relative to the cranial base in six T&A children (55%) and two untreated children (50%). Nine of the T&A children (85%) and three untreated children (75%) presented extensive condylar growth and increased mandibular length. The qualitative 3D assessment showed similar morphological 3D changes in T&A and non-T&A patients. CONCLUSION: Pulmonary artery systolic pressure decreased, nasal inspiratory flow increased, and nasopharynx volume increased following adenotonsillectomy, but obstructive apnea/hypopnea index and maxillomandibular morphology were similar in surgical and non-surgical patients.

Impact of adenotonsilectomy on nasal airflow and pulmonary blood pressure in mouth breathing children.

INTRODUCTION: Adenotonsillar hyperplasia (ATH) causing upper airway obstruction (UAO) may increase pulmonary artery systolic pressure (PASP). Early diagnosis and mouth breathing (MB) management may help in cases of high PASP. Total inspiratory nasal airflow (TINAF) obtained by active anterior rhinomanometry (AARM) is a means to quantify nasal patency. This study aimed to correlate TINAF with high PASP. METHODS: This is a prospective study involving 30 children between two and twelve years of age, with indication for adenotonsillectomy due to ATH, evaluated before and six months after surgery; and 29 nasal breathing (NB) children in the same age group. We obtained the PASP, calculated for tricuspid regurgitation, by means of a transthoracic echocardiography. We assessed nasal patency using the AARM to estimate the TINAF. RESULTS: The mean PASP among mouth breathing children was 25.99 mmHg, with a Standard Deviation of (±) 3.27, p = 0.01 in the preoperative period; and 21.79 mmHg (±2.48; p = 0.01) in the postoperative period. Among nasal breathers, this mean value was 21.64 mmHg (±3.87, p = 0.01). The mean pre-operative TINAF was 266.76 cm3/s (±112.21, p = 0.01); and 498.93 cm3/s (±137.80, p = 0.01) after surgery. Among nasal breathers it was 609.37 cm3/s (±109.16; p = 0.01). The mean nasal patency in the preoperative period was 42.85% (±17.83; p = 0.01); and 79.33% (±21.35; p = 0.01) in the post-op. Among nasal breathers it was 112.94% (±15.88, p = 0.01). There was a significant Spearman correlation value between TINAF and PASP (r = -0.459; p = 0.01) when we analyzed all the groups. CONCLUSION: PASP and TINAF values improved postoperatively and had an inverse correlation. This study suggests that by improving TINAF there was a decrease in PASP.

Maxillary dentoskeletal changes 1-year after adenotonsillectomy.

OBJECTIVE: To measure the maxillary dentoskeletal and soft tissue changes of severely obstructed mouth breathing (MB) young children who had their mode of breathing normalized after adenotonsillectomy (T&A), in comparison with a matched group of severely obstructed untreated MB children (CG). METHODS: Seventy patients who had an Ear, Nose, and Throat examination (ENT), including flexible nasal endoscopy, to confirm the severe obstruction of the upper airways and the indication of T&A composed the sample. Cephalograms and dental casts were available from the patient's orthodontic records. Treatment group (TG) and CG included 35 children each. Groups were matched by gender (24 males and 11 females in each group), age (TG, 6.7 ± 1.8 years; CG, 6.9 ± 2.3 years), tooth development (TG, 13 primary dentition, 22 mixed dentition; CG, 14 primary dentition, 21 mixed dentition), and skeletal maturation status. Records were taken at baseline (T0) and 1-year after T&A (T1) for TG; while CG records were taken with a 1-year interval. Dentoskeletal measurements were performed in the lateral cephalograms, and dental casts were used to assess the palatal volume and occlusal changes. RESULTS: TG showed a significant increase (503.3 mm(3), P < 0.001) in the palatal volume (10% of change), while CG palatal volume was stable. No dimensional occlusal changes were detected between T0 and T1 in both groups. Significant downward (point A, 2.1 mm; ANS, 2.1 mm) and forward displacements (point A, 0.7 mm; ANS, 1 mm) of the anterior region of the maxilla were observed in the TG, but CG presented only significant downward displacement (point A, 1.8 mm; ANS, 1.4 mm). The maxillary posterior region (PNS, PTM, and Molar) displaced downward in both groups (P < 0.05), however no sagittal change was found. The palatal plane inclination was stable in both groups. CONCLUSIONS: TG presented significant increase in the palatal volume and in the forward displacement of the maxilla. No other significant maxillary dentoskeletal changes were found.

Are distinct etiologies of upper airway obstruction in mouth-breathing children associated with different cephalometric patterns?

OBJECTIVE: To test the null hypothesis that mouth-breathing (MB) children by distinct obstructive tissues present a similar cephalometric pattern. METHODS: The sample included 226 prepubescent children (113 MB and 113 nasal breathing (NB) controls). An ENT clinical examination, including flexible nasal endoscopy, orthodontic clinical and cephalometric examinations, was performed on the MB population. MB children were grouped into three categories, according to the obstructive tissues: 1) adenoid group (AG), 2) tonsillar group (TG), and 3) adenotonsillar group (ATG). The NB controls were matched by gender, age, sagittal dental relationship and skeletal maturation status. Lateral cephalometric radiography provided the cephalometric pattern comparisons between the MB and NB groups. RESULTS: MB cephalometric measurements were significantly different from those of NB children, exception in the SNB° (P=0.056). All comparisons between the three groups of MB children with the NB children showed a significant difference. Finally, even among the three groups of MB children, a significant difference was observed in the measurements of the SNB° (P<0.036), NSGn° (P<0.028) and PFH/TAFH ratio (posterior facial height/total anterior facial height) (P<0.012). CONCLUSIONS: The cephalometric pattern of MB and NB children was not similar. Cephalometric measurements of the MB group differed according to the etiology of upper airway obstruction. Children with isolated hypertrophy of the palatine tonsils presented with a mandible that was positioned more forward and upward compared to children obstructed only by the enlarged adenoid.

Facial soft tissues of mouth-breathing children: do expectations meet reality?

OBJECTIVE: To quantify the differences between the facial soft tissue morphology of severely obstructed mouth breathing (MB) and that of predominantly nasal breathing (NB) children. METHODS: Soft tissue measurements were performed in the lateral cephalograms of 64 severely obstructed MB children (mean age 6.7 ± 1.6) compared with 64 NB children (mean age 6.5 ± 1.3). Groups were paired by age, gender, skeletal maturation status and sagittal skeletal pattern. Based on the assumption of normality and homoscedasticity, comparison of the means and medians of soft tissue measurements between the two groups was performed. RESULTS: The facial convexity and anterior facial height ratio of MB were similar to NB children. The upper lip of MB children was protruded, and its base was thinner compared with NB; however, the length was not affected. The lower lip was shorter and more protruded in MB children. The nasolabial angle, nasal prominence, and chin thickness were smaller in MB children. CONCLUSIONS: The facial soft tissue of severely obstructed MB children is different than in NB children. Changes in lips, nasolabial angle, nasal prominence, and chin thickness are associated with severe airway obstruction in children.

Mouth breathing children and cephalometric pattern: does the stage of dental development matter?

OBJECTIVE: To test the hypothesis that there is no difference in the cephalometric pattern between mouth breathing children with primary dentition and mixed dentition. METHODS: Cephalometric measurements of 126 mouth breathing children (MB) were compared to 126 nasal breathing controls (NB). Both groups were divided into deciduous dentition (mean age 4 years, 8 months) and mixed dentition (mean age 7 years, 9 months) groups. RESULTS: A statistically significant difference was observed in the dentofacial patterns of MB children compared to NB children. The total length of the mandible was smaller in MB compared to NB children. However, this difference was found only in subjects with mixed dentition. The length of the mandibular corpus is similar in MB and NB children, although older MB children with mixed dentition had significantly smaller measurements. The lower anterior facial height was higher in MB compared to NB children, but this difference was evident only in younger children with primary dentition. Mandibular plane angle, Y-axis angle and lower anterior facial height to total anterior facial height ratio were greater, and posterior facial height to total anterior facial height ratio was smaller in MB than NB children, indicating that mouth breathers had a more vertical facial growth pattern. However, no differences were found in the vertical growth pattern associated with the stage of dental development. The ANB angle was not associated with the maturational status of occlusion. Linear measurements and the gonial angle were significantly different between children with primary and mixed dentition, but such differences were associated with normal vertical growth. CONCLUSIONS: The present investigation rejected the null hypothesis and showed significant cephalometric differences between primary and mixed dentition MB children. Mouth breathing children in the mixed dentition have a smaller mandible (in terms of total length and corpus length) than nasal breathers. In children with primary dentition, the lower anterior facial height is higher in MB than in NB children. There was no significant association between the stage of dental development of mouth breathing children (either in the primary or mixed dentition) and the other cephalometric patterns.

Baixa prevalência de doenças do ouvido médio em pacientes com fibrose cística / Low prevalence of middle ear disease in cystic fibrosis patients

OBJETIVO: Avaliar a prevalência de alterações do ouvido médio em pacientes com fibrose cística (FC). MÉTODOS: Neste estudo descritivo, 120 pacientes com FC com idade entre 5 meses e 18 anos foram avaliados por meio do histórico clínico, da otoscopia e da timpanometria. Dados sobre a colonização por P. aeruginosa e uso de aminoglicosídeos por via parenteral e/ou inalatória também foram coletados a partir dos prontuários médicos. RESULTADOS: O histórico clínico revelou ausência de otite média prévia em 57 por cento dos pacientes. As membranas timpânicas estavam normais em 94 por cento dos pacientes que se submeteram a avaliação otoscópica; foi sugerida otite média crônica em cerca de 1 por cento dos casos, otite média com derrame (OMD) em 2 por cento, e disfunção da tuba auditiva em 3 por cento. Quanto à timpanometria, 91 por cento dos pacientes que se submeteram ao exame apresentaram resultados normais, foi sugerida OMD em 2 por cento dos casos, e disfunção da tuba auditiva em 7 por cento. CONCLUSÃO: Houve uma baixa taxa de prevalência de alterações do ouvido médio na nossa série de pacientes com FC. O uso de aminoglicosídeos e a colonização por P. aeruginosa não tiveram influência na prevalência das alterações do ouvido médio. Nossos resultados sugerem que um histórico clínico detalhado e uma avaliação otoscópica de rotina podem confirmar ou descartar a maior parte das alterações do ouvido médio em pacientes com FC.

OBJECTIVE: To assess the prevalence of middle ear alterations in cystic fibrosis (CF) patients. METHODS: In this descriptive study, 120 CF patients aged 5 months to 18 years were assessed by clinical history, otoscopy, and tympanometry. Data on P. aeruginosa colonization and parenteral and/or inhaled aminoglycoside use were also collected from medical charts. RESULTS: Clinical history revealed absence of previous otitis media in 57 percent of patients. Tympanic membranes were normal in 94 percent of patients who underwent otoscopic evaluation; chronic otitis media was suggested in about 1 percent of the cases, otitis media with effusion (OME) in 2 percent, and Eustachian tube dysfunction in 3 percent. As for tympanometry, 91 percent of patients who underwent the exam showed normal results, OME was suggested in 2 percent of the cases, and Eustachian tube dysfunction in 7 percent. CONCLUSION: There was a low prevalence rate of middle ear alterations in our series of CF patients. The use of aminoglycosides and colonization by P. aeruginosa did not influence the prevalence of middle ear alterations. Our results suggest that a detailed clinical history and a routine otoscopy evaluation may confirm or rule out most middle ear alterations in CF patients.

Low prevalence of middle ear disease in cystic fibrosis patients.

OBJECTIVE: To assess the prevalence of middle ear alterations in cystic fibrosis (CF) patients. METHODS: In this descriptive study, 120 CF patients aged 5 months to 18 years were assessed by clinical history, otoscopy, and tympanometry. Data on P. aeruginosa colonization and parenteral and/or inhaled aminoglycoside use were also collected from medical charts. RESULTS: Clinical history revealed absence of previous otitis media in 57% of patients. Tympanic membranes were normal in 94% of patients who underwent otoscopic evaluation; chronic otitis media was suggested in about 1% of the cases, otitis media with effusion (OME) in 2%, and Eustachian tube dysfunction in 3%. As for tympanometry, 91% of patients who underwent the exam showed normal results, OME was suggested in 2% of the cases, and Eustachian tube dysfunction in 7%. CONCLUSION: There was a low prevalence rate of middle ear alterations in our series of CF patients. The use of aminoglycosides and colonization by P. aeruginosa did not influence the prevalence of middle ear alterations. Our results suggest that a detailed clinical history and a routine otoscopy evaluation may confirm or rule out most middle ear alterations in CF patients.

Changes in vertical dentofacial morphology after adeno-/tonsillectomy during deciduous and mixed dentitions mouth breathing children--1 year follow-up study.

OBJECTIVE: The aim of this 1 year follow-up study was to investigate, in mouth breathing children, the impact of respiration normalization on vertical dentofacial growth during two stages of dental development after adeno-/tonsillectomy. METHOD: Linear and angular cephalometric measurements, as well as tracing superimposition of serial lateral cephalograms of 39 patients in the treatment group were compared with those of 31 untreated mouth breathing controls. Cephalometric records in the treatment group comprised registrations made at baseline before surgery (T(0)), and then at approximately 1 year post-operatively (T(1)). Corresponding registrations were available for the control group, with a baseline cephalometric radiograph taken approximately 1 year before the second one (T(0) and T(1), respectively). Treatment and untreated groups were divided into deciduous and mixed dentition groups to aid the identification of an optimum timing for normalizing the respiration after T&A, under a vertical dentofacial perspective. RESULTS: After 1 year of follow up, no statistically significant difference on vertical dentofacial growth was observed in deciduous or mixed dentitions treatment groups compared to the same occlusal developmental stage of untreated control groups. CONCLUSION: The results indicate that regarding the vertical dentofacial growth pattern normalization of the mode of respiration after T&A in young children (deciduous dentition) is not more effective than in older children (mixed dentition).

Hearing loss in cystic fibrosis.

OBJECTIVES: To verify the prevalence of hearing loss in cystic fibrosis patients and whether the use of aminoglycosides affects hearing and also to analyze whether the distortion product otoacoustic emissions test is suitable to assess sensorineural hearing loss in cystic fibrosis. METHODS: In this descriptive study 120 cystic fibrosis patients aged five months to 18 years were assessed through questionnaires, audiometric tests and analysis of the distortion product otoacoustic emissions. Assessment of previous use of aminoglycosides was performed by collecting data in medical charts. RESULTS: Audiometric tests show a 4-11% prevalence of sensorineural hearing loss. 89.2% of the patients succeeded in the otoacoustic emissions test, and 42% had used intravenous and/or inhaled aminoglycosides. There was no statistically significant (p=0.48) relation between the use of aminoglycosides and hearing loss. CONCLUSION: Pure tone audiometry and analysis of the distortion product otoacoustic emissions revealed that there was a high prevalence of hearing loss, which makes cystic fibrosis patients a high-risk group which needs periodic assessment by an otorhinolaryngologist. Comparison of the groups with and without aminoglycosides use showed that there was no statistically significant difference among them in analyses, which suggests that the use of aminoglycosides is not the only causal factor for hearing loss in cystic fibrosis.

Prevalence of malocclusion among mouth breathing children: do expectations meet reality?

OBJECTIVE: The aim of this study was to report epidemiological data on the prevalence of malocclusion among a group of children, consecutively admitted at a referral mouth breathing otorhinolaryngological (ENT) center. We assessed the association between the severity of the obstruction by adenoids/tonsils hyperplasia or the presence of allergic rhinitis and the prevalence of class II malocclusion, anterior open bite and posterior crossbite. METHODS: Cross-sectional, descriptive study, carried out at an Outpatient Clinic for Mouth-Breathers. Dental inter-arch relationship and nasal obstructive variables were diagnosed and the appropriate cross-tabulations were done. RESULTS: Four hundred and one patients were included. Mean age was 6 years and 6 months (S.D.: 2 years and 7 months), ranging from 2 to 12 years. All subjects were evaluated by otorhinolaryngologists to confirm mouth breathing. Adenoid/tonsil obstruction was detected in 71.8% of this sample, regardless of the presence of rhinitis. Allergic rhinitis alone was found in 18.7% of the children. Non-obstructive mouth breathing was diagnosed in 9.5% of this sample. Posterior crossbite was detected in almost 30% of the children during primary and mixed dentitions and 48% in permanent dentition. During mixed and permanent dentitions, anterior open bite and class II malocclusion were highly prevalent. More than 50% of the mouth breathing children carried a normal inter-arch relationship in the sagital, transversal and vertical planes. Univariate analysis showed no significant association between the type of the obstruction (adenoids/tonsils obstructive hyperplasia or the presence of allergic rhinitis) and malocclusions (class II, anterior open bite and posterior crossbite). CONCLUSIONS: The prevalence of posterior crossbite is higher in mouth breathing children than in the general population. During mixed and permanent dentitions, anterior open bite and class II malocclusion were more likely to be present in mouth breathers. Although more children showed these malocclusions, most mouth breathing children evaluated in this study did not match the expected "mouth breathing dental stereotype". In this population of mouth breathing children, the obstructive size of adenoids or tonsils and the presence of rhinitis were not risk factors to the development of class II malocclusion, anterior open bite or posterior crossbite.

Evaluation of atopy among mouth-breathing pediatric patients referred for treatment to a tertiary care center.

OBJECTIVE: A mouth breather is someone who uses his/her oral cavity as the main airway during breathing. This is a syndrome with several etiologies, but allergic rhinitis plays a key role due to its high prevalence. The aim of this study was to assess the presence of atopy among mouth-breathing patients referred to a tertiary care center in the metropolitan region of Belo Horizonte, Brazil. METHODS: Cross-sectional, descriptive study carried out at Hospital das Clínicas of Universidade Federal de Minas Gerais. Patients aged 2 to 12 years, admitted between November 2002 and April 2004, were included. Parents or surrogates completed a comprehensive questionnaire, and patients were submitted to a skin test for inhalant allergens. A total of 140 patients participated in the study. Those with a positive result for at least one allergen were regarded as atopic. The statistical analyses were made using SPSS, with univariate analyses followed by logistic regression. RESULTS: Of 140 patients, 44.3% (62/140) obtained positive results on the allergic test. Mites were the most predominant allergens, with a positive rate of 100% among atopic patients. In the multivariate analysis, atopy was significantly associated with the male sex (p = 0.05), presence of asthma (p = 0.014), lower number of people sleeping in the same room with the patient (p = 0.005), absence of passive smoking (p = 0.005) and absence of sleep apnea (p = 0.003). CONCLUSION: The high prevalence of positive results on the allergic test highlights the importance of allergologic investigation in mouth-breathers, since allergy has specific treatments that may reduce morbidity in these patients when properly used.

Evaluation of atopy among mouth-breathing pediatric patients referred for treatment to a tertiary care center

OBJETIVO: Respirador bucal é o indivíduo que utiliza a cavidade oral como principal via aérea durante a respiração. Trata-se de síndrome de múltiplas etiologias, dentre as quais a rinite alérgica merece destaque por sua alta prevalência. Este trabalho teve como objetivo avaliar a presença de atopia entre respiradores bucais encaminhados a serviço de referência da região metropolitana de Belo Horizonte. MÉTODOS: Estudo transversal e descritivo, realizado no Hospital das Clínicas da Universidade Federal de Minas Gerais. Foram incluídos pacientes de 2 a 12 anos de idade, com período de admissão entre novembro de 2002 e abril de 2004. Os responsáveis responderam a um questionário completo, e os pacientes foram submetidos a teste alérgico cutâneo para inalantes. Houve 140 participantes do estudo. Foram classificados como atópicos aqueles que apresentaram teste positivo para, no mínimo, um alérgeno. As análises estatísticas foram feitas no programa SPSS, usando análises univariadas seguidas pela regressão logística. RESULTADOS: Entre os 140 pacientes, 44,3 por cento (62/140) tiveram teste alérgico positivo. Acaros foram os alérgenos predominantes, apresentando positividade em 100 por cento dos atópicos. Em análise multivariada, atopia esteve significativamente associada ao sexo masculino (p = 0,05), presença de asma (p = 0,014), menor número de pessoas dormindo no mesmo cômodo que o paciente (p = 0,005), ausência de tabagismo passivo (p = 0,005) e ausência de apnéia noturna (p = 0,003). CONCLUSÃO: A alta prevalência de positividade no teste alérgico enfatiza a importância da investigação alergológica em respiradores bucais, pois a alergia tem formas específicas de tratamento que podem reduzir a morbidade desses pacientes quando adequadamente utilizadas.

OBJECTIVE: A mouth breather is someone who uses his/her oral cavity as main airway during breathing. This is a syndrome with several etiologies, but allergic rhinitis plays a key role due to its high prevalence. The aim of this study was to assess the presence of atopy among mouth-breathing patients referred to a tertiary care center in the metropolitan region of Belo Horizonte, Brazil. METHODS: Cross-sectional, descriptive study carried out at Hospital das Clínicas of Universidade Federal de Minas Gerais. Patients aged 2 to 12 years, admitted between November 2002 and April 2004, were included. Parents or surrogates completed a comprehensive questionnaire, and patients were submitted to a skin test for inhalant allergens. A total of 140 patients participated in the study. Those with a positive result for at least one allergen were regarded as atopic. The statistical analyses were made using SPSS, with univariate analyses followed by logistic regression. RESULTS: Of 140 patients, 44.3 percent (62/140) obtained positive results on the allergic test. Mites were the most predominant allergens, with a positive rate of 100 percent among atopic patients. In the multivariate analysis, atopy was significantly associated with the male sex (p = 0.05), presence of asthma (p = 0.014), lower number of people sleeping in the same room with the patient (p = 0.005), absence of passive smoking (p = 0.005) and absence of sleep apnea (p = 0.003). CONCLUSION:The high prevalence of positive results on the allergic test highlights the importance of allergologic investigation in mouth-breathers, since allergy has specific treatments that may reduce morbidity in these patients when properly used.

Efeito da mitomicina C em cultura de estroma de pólipos nasais eosinofílicos: indução de apoptose em eosinófilos / Effect of mitomicin C in eosinofilic nasal polyps estromal culture: induction of apoptosis in eosinophil

A polipose nasossinusal eosinofílica é uma afecção comum a várias doenças, determina acometimento extenso dos seios paranasais e possui grande tendência à recidiva após tratamento. Os eosinófilos exercem papel essencial na patogênese, relacionada a baixo índice de apoptose e a longa permanência destas células ativas nos tecidos. OBJETIVO: Este estudo teve por objetivo avaliar o efeito da mitomicina C na indução de apoptose em eosinófilos presentes no estroma de pólipos nasais eosinofílicos. FORMA DE ESTUDO: Caso controle. MATERIAL E MÉTODO: O estudo foi auto-pareado, com 9 amostras cultivadas em meio RPMI 1640 e avaliadas em zero, 12 e 24 horas. O grupo estudo recebeu mitomicina C numa concentração de 400æg/ml durante 5 minutos. Em cada tempo as duas culturas, controle e estudo, foram submetidas a estudo histopatológico para determinação do índice apoptótico. Utilizou-se a coloração hematoxilina-eosina com aumento microscópico de 1000x. RESULTADO: Pela análise de 674 campos digitalizados observou-se que as culturas tratadas com mitomicina C apresentaram índice apoptótico em 12 horas significativamente maior em relação ao grupo controle (p< 0,001). CONCLUSÃO: Concluiu-se que a mitomicina C é eficaz na indução de apoptose em eosinófilos presentes em estroma de pólipos nasais eosinofílicos.

Avaliação da tomografia computadorizada e da cisternotomografia computadorizada com Lopamidol no topodiagnóstico da fístula liquórica e comparação com os achados cirúrgicos / Evaluation of computerized tomography and computed tomographic Lopamidol cisternography on the topographic diagnosis of cerebrospinal fluid rhinorrhea and comparison with surgical findings

Desde que a abordagem por via microendoscópica nasal se tornou uma rotina no tratamento da fístula liquórica da base anterior do crânio, a necessidade do topodiagnóstico preciso aumentou grandemente. A localização pré-operatória da fistula com métodos de imagem torna o ato cirúrgico mais rápido e direcionado. OBJETIVO: O objetivo deste estudo é avaliar a eficácia da cisternotomografia (CTG) e da tomografia computadorizada (TC) na localização da fístula liquórica de acordo com os achados cirúrgicos. FORMA DE ESTUDO: Observacional coorte com corte transversal. MATERIAL E MÉTODO: Quarenta e seis pacientes com diagnóstico clínico de fístula liquórica foram avaliados com TC, e destes, 38 também foram submetidos à CTG contrastada com Lopamidol. RESULTADO: A cisternotomografia apontou corretamente o local exato da fístula em 71 por cento dos casos enquanto a tomografia o fez em 52 por cento destes. A cisternotomografia foi importante na localização da fístula em 84,15 por cento. CONCLUSÃO: Ainda não há um método considerado padrão de referência no topodiagnóstico da fístula liquórica. Nesse propósito a CTG com Lopamidol é um método valoroso.

Tratamento cirúrgico da otite média com efusão: tubo de ventilação versus aplicação tópica de mitomicina C / Surgical treatment of otitis media with effusion: ventilation tube versus topical application of mitomycin C

O uso do tubo de ventilaçäo (TV) da orelha média, tratamento cirúrgico eleito da otite média com efusäo (OME), näo é isento de complicaçöes, promovendo ainda limitaçäo social pela necessidade de abandono dos banhos de imersäo. A mitomicina C (MMC) é um antineoblástico, cuja aplicaçäo tópica retarda a fibrose e previne a estenose cicatricial. Em cobaias, retardou o fechamento de timpanotomias, permitindo maior tempo de aeraçäo da orelha média, à semelhança dos tubos de ventilaçäo. FORMA DE ESTUDO: Clínico prospectivo. OBJETIVO: Comparar a eficácia entre timpanotomia, aspirado da efusäo e inserçäo de tubo de ventilaçäo (grupo TV) versus timpanotomia, aspirado da efusäo e aplicaçäo tópica de mitomicina C (grupo MMC). Comparar o tempo de manutençäo da timpanotomia e a incidência de complicaçöes nos dois grupos. RESULTADOS: O grupo MMC apresentou eficácia significativamente menor (52 por cento versus 80 por cento) que o grupo TV (p= 0,34). A presença de timpanometria tipo "B" e a ausência de comprometimento do óstio faríngeo tubário pelo tecido adenóide no pré-operatório representaram fatores de mau prognóstico. A aplicaçäo tópica de MMC nas bordas da timpanotomia proporcionou um tempo de abertura da membrana timpânica por duas a três semanas. No grupo TV, a otorréia foi observada em 13,3 por cento dos pacientes. No grupo MMC, apesar da menor eficácia, nenhum paciente apresentou complicaçöes nem sofreu prolongada proibiçäo dos banhos de imersäo. CONCLUSÄO: Apesar de concluirmos que o TV apresenta maior eficácia, novos estudos utilizando maior concentraçäo, maior tempo de aplicaçäo ou o uso seriado de MMC no tratamento da otite média com efusäo devem ser realizados

Perfil de citocinas e tipificação de HLA em pacientes com polipose nasossinusal tolerantes e intolerantes a aspirina / Cytokines profile and HLA typing in tolerant and non-tolerant patients to aspirin with nasossinusal polyposis

A infiltraçäo eosinofílica do pólipo nasossinusal (PNS) associado à intolerância aspirínica (IA) é característica relevante. Diversos mediadores participam da migraçäo dos eosinófilos para os tecidos. A IA decorre do aumento da síntese de leucotrienos em indivíduos geneticamente susceptíveis. OBJETIVO: Analisar o perfil de citocinas e a tipificaçäo de HLA-A, B e DR em pacientes com PNS tolerantes e intolerantes à aspirina. FORMA DE ESTUDO: Estudo de coorte transversal. MATERIAL E MÉTODO: selecionando-se 45 pacientes: 15 portadores de PNS eosinofílica tolerantes à aspirina (grupo TA); 15 de PNS eosinofílica associada à intolerância aspirínica, manifestada por broncoespasmo (grupo IA) e 15 sem PNS, que apresentavam desvio de septo nasal (grupo controle). O perfil de citocinas (IL-2; IL-4; IL-5; IL-6; IL-8; IL-10; IFN-gama e TNF-alfa) foi pesquisado nos fragmentos de pólipo nasal ou de mucosa de concha média (grupo controle) através da reaçäo reversa da cadeia de polimerase (RT-PCR). A tipificaçäo de HLA-A, B e DR foi realizada através de teste sorológico de microcitotoxicidade ou por amplificaçäo de DNA pela reaçäo em cadeia da polimerase (PCR). RESULTADOS: A expressäo de RNAm para as interleucinas 4, 5, 6, 8, 10, IFN-gama e TNF-alfa foi semelhante nos três grupos. A expressäo de RNAm para IL-2 associou-se com a IA. Os pacientes portadores dos antígenos A11, B49, DR15 e DR13 apresentaram uma maior probabilidade de desenvolver polipose nasossinusal näo relacionada à IA, enquanto os portadores de DR17 apresentaram uma maior probabilidade de desenvolver polipose nasossinusal associada à intolerância aspirínica (Tríade Aspirínica). CONCLUSÄO: A polipose nasossinusal associada à intolerância aspirínica (Tríade Aspirínica) mostrou associaçäo significante com HLA- DR17 e IL-2, sugerindo um perfil de citocinas TH1

Uso de analgésicos e antiinflamatórios em pacientes portadores de polipose nasossinusal eosinofílica tolerantes e intolerantes à aspirina / Use of analgesics and anti-inflammatory drugs in patients with eosinophilic nasal polyposis tolerant and intolerant to aspirin

Com a introdução da aspirina como medicamento foram descritos diversos relatos de reaçöes adversas. A associaçäo de intolerância aspirínica (IA), polipose nasal (PNS) e asma foi inicialmente observada por Widals et al.(1922)¹, e posteriormente Samter & Beers (1967)². Esta intolerância se manifesta principalmente por obstruçäo nasal e/ou broncoespasmo, decorrente da inibiçäo da ciclooxigenase-1 (COX-1) e conseqüente aumento de leucotrienos (LT). A intolerância também ocorre após a ingestäo de outros antiinflamatórios näo-esteróides (AINE), analgésicos, acetaminofen, corantes e aditivos alimentares e álcool. OBJETIVO: Analisar o risco do uso de analgésicos e antiinflamatórios em pacientes tolerantes e intolerantes à aspirina. Forma de Estudo: Estudo de coorte transversal. MATERIAL E MÉTODO: Selecionou-se 45 pacientes näo alérgicos, sendo 15 pacientes portadores de polipose nasossinusal eosinofílica tolerantes a aspirina (grupo TA), 15 pacientes portadores de polipose nasossinusal eosinofílica associada a IA, manifestada por broncoespasmo (grupo IA), e 15 pacientes sem polipose nasossinusal, que apresentavam desvio de septo nasal (grupo controle). A pesquisa de reaçöes aos analgésicos (aspirina, dipirona e acetaminofen), a outros AINE, ao álcool, aos corantes e aditivos alimentares bem como de alguma outra droga ou químico, foi realizada através de interrogatório. Para se confirmar a ausência de IA no grupo TA e controle realizou-se teste de provocaçäo oral a aspirina. RESULTADOS: Broncoespasmo foi a principal reaçäo à aspirina nos pacientes portadores de polipose nasossinusal eosinofílica e esta manifestaçäo ocorreu também com uso de acetaminofen (20 por cento), álcool (27 por cento), antiinflamatório näo-esteróides (47 por cento) e dipirona (47 por cento). CONCLUSÄO: Nos pacientes portadores de polipose nasossinusal intolerantes à aspirina o diagnóstico de intolerância a outras drogas é importante. É também destacada a intolerância a dipirona e ao álcool, respectivamente, em quase metade e um terço destes pacientes

Rinite vasomotora pós-cirúrgica: diagnóstico diferencial de rinoliquorréia / Vasomotor rhinitis post-operative: differencial diagnosis of cerebral spinal fluid rhinorrhea

A fístula liquórica é complicaçäo presente em cerca de 30 por cento dos casos de cirurgias em base de crânio e deve ser diagnosticada corretamente a fim de evitar complicaçöes graves, como, por exemplo, a meningite. Nas últimas décadas o otorrinolaringologista tem exercido importante papel no diagnóstico e tratamento desta entidade através da correçäo da fístula. Relatamos neste trabalho o caso de uma paciente submetida à cirurgia de base de crânio com acesso endonasal que apresentou uma evoluçäo similar à fístula liquórica. Acredita-se que esta pseudo fístula liquórica ocorre nesses pacientes por uma alteraçäo do suprimento autonômico das glândulas nasais com predomínio do parassimpático. O otorrinolaringologista deve estar atento para esta manifestaçäo e tê-la sempre em mente ao fazer o diagnóstico de fístula liquórica. A dosagem de glicose no líquido nasal na suspeita de fístula liquórica é um importante meio diagnóstico e deve ser realizada, sempre que possível, antes da cirurgia corretiva

Melanoma maligno da mucosa nasossinusal: revisão da literatura e relato de dois casos / Malignant melanoma of the sinonasal mucosa: literature review and report of two cases

O melanoma maligno da mucosa nasossinusal é um tumor indubitavelmente raro e agressivo que acomete pacientes acima dos sessenta anos e não tem associação com o sexo. A obstrução nasal e a epistaxe são os sintomas mais frequentemente relatados, embora a sintomatologia seja tardia e inespecífica, o que retarda o diagnóstico e piora o prognóstico. A abordagem tradicional tem sido o tratamento cirurgico; a radioterapia é também utilizada, entretanto sua eficácia ainda é discutida. O objetivo desse trabalho é relatar dois casos da doença em mucosa nasossinusal e realizar uma revisão da literatura sobre o assunto