Impacto da fluticasona intranasal em pacientes com apneia obstrutiva do sono: um estudo prospectivo / The impact of intranasal fluticasone on patients with obstructive sleep apnea: a prospective study

Resumo Introdução: A apneia obstrutiva do sono é o tipo mais comum de apneia do sono, causada por obstrução completa ou parcial da via aérea superior. A obstrução nasal também é considerada como um dos fatores de risco independentes da apneia obstrutiva do sono. Objetivo: Avaliar pacientes com apneia obstrutiva do sono. Método: Pacientes com apneia obstrutiva do sono foram incluídos no estudo de junho a dezembro de 2015, tratados com spray de corticosteroide intranasal por quatro semanas. Vários parâmetros foram obtidos antes e após o tratamento, inclusive os escores da escala Nasal Obstruction Symptom Evaluation, do Pittsburgh Sleep Quality Index e do questionário Escala de Sonolência de Epworth. Resultados: Cinquenta pacientes completaram os questionários antes e após o tratamento intranasal com fluticasona. A média de idade era de 39,7 ± 15,6 anos, com uma proporção de homens para mulheres de 3:2. Os escores pós-tratamento da Escala de Sonolência de Epworth, do Pittsburgh Sleep Quality Index e do Nasal Obstruction Symptom Evaluation indicaram uma diminuição em comparação aos escores pré-tratamento, de 10,4 para 8,74, 7,86 para 6,66 e 9,08 para 6,48, respectivamente. Uma diminuição significativa foi observada no grupo Nasal Obstruction Symptom Evaluation ≥ 10 em todas as três categorias, mas não no grupo Nasal Obstruction Symptom Evaluation <10. Conclusões: Os autores concluíram que o tratamento com fluticasona intranasal pode ser útil em pacientes com apneia obstrutiva do sono relacionada a obstrução nasal para melhorar a qualidade do sono e limitar a disfunção diurna.

The impact of intranasal fluticasone on patients with obstructive sleep apnea: a prospective study.

INTRODUCTION: Obstructive sleep apnea is the most common type of sleep apnea, which is caused by complete or partial obstructions of the upper airway. Nasal obstruction is also considered as one of the independent risk factors of obstructive sleep apnea. OBJECTIVE: Patients with obstructive sleep apnea. METHODS: We enrolled patients with obstructive sleep apnea from June to December 2015 and treated them with intranasal corticosteroid spray for four weeks. Several parameters were obtained before and after the treatment, including Nasal Obstruction Symptom Evaluation scores, Pittsburgh Sleep Quality Index questionnaire and Epworth Sleepiness Scale questionnaire. RESULTS: Fifty patients completed questionnaires prior to and following the intranasal fluticasone treatments. The average age was 39.7 ±â€¯15.6 y, with a male to female ratio of 3:2. The post-treatment Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and Nasal Obstruction Symptom Evaluation scores all indicated a decrease compared to pre-treatment scores, from 10.4 to 8.74, 7.86 to 6.66 and 9.08 to 6.48, respectively. A significant decrease was observed in the Nasal Obstruction Symptom Evaluation ≥10 group in all three categories, but not in the Nasal Obstruction Symptom Evaluation <10 group. CONCLUSIONS: Intranasal fluticasone treatment may be useful for patients with nasal obstruction-related obstructive sleep apnea to improve sleep quality and limit daytime dysfunction.

Pneumocephalus Following Self-Inflicted Penetrating Brain Injury.

OBJECTIVE: Pneumocephalus is a rare complication that often occurs after traumatic skull base injury, leading to morbidity and mortality. MATERIAL AND METHOD: We present the case of a 42-year-old healthy man who injured himself when he stuck a metal stick into his left nasal cavity to relieve prolonged nasal obstruction. Immediate cerebrospinal fluid rhinorrhea and subsequent meningitis and pneumocephalus occurred later. He was presented at our hospital with fever and meningeal signs. RESULT: Computed tomography scans revealed left rhinosinusitis and air collection in the subarachnoid space. The patient received the conservative treatment of bed rest, intravenous hydration, head elevation, and broad-spectrum intravenous antibiotics. Pneumocephalus and meningitis resolved without any surgery, and he experienced no other sequela or complication. CONCLUSION: Pneumocephalus is a rare incidence and can lead to high morbidity and mortality. Prompt diagnosis and adequate treatment of pneumocephalus and meningitis proved beneficial for our patient who recovered without any complication or surgery.

Voiding dysfunction in patients with nasal congestion treated with pseudoephedrine: a prospective study.

BACKGROUND: Pseudoephedrine is a sympathomimetic drug widely used as a nasal decongestant. However, it can cause adverse effects, such as voiding dysfunction. The risk of voiding dysfunction remains uncertain in patients without subjective voiding problems. METHODOLOGY: We prospectively enrolled patients with nasal congestion who required treatment with pseudoephedrine from May to August 2015. All patients denied concomitant subjective voiding problem. The International Prostate Symptom Score (IPSS) questionnaire was used to evaluate voiding function before and 1 week after the pseudoephedrine treatment. The results of the IPSS questionnaire were analyzed as the total (IPSS-T), voiding (IPSS-V), storage (IPSS-S), and quality of life due to urinary symptom scores. RESULTS: We enrolled 131 males with a mean age of 42.0±14.3 years. The IPSS-T, IPSS-V, and IPSS-S scores slightly increased after the medication (IPSS-T increased from 6.49 to 6.77, IPSS-V from 3.33 to 3.53, and IPSS-S from 3.17 to 3.24). The quality of life due to urinary symptom score nonsignificantly decreased from 2.02 to 1.87. We observed that older age and a higher premedication IPSS-V score yielded significant differences (P<0.05) for subclinical voiding dysfunction and unchanged voiding function. In patients aged ≥50 years, the IPSS-T, IPSS-V, and IPSS-S scores significantly increased after the pseudoephedrine treatment (IPSS-T increased from 9.95 to 11.45, IPSS-V from 5.38 to 6.07, and IPSS-S 4.57 to 5.38), whereas the quality of life due to urinary symptom score nonsignificantly decreased from 2.71 to 2.48 (P=0.057). In patients aged <50 years, all scores did not significantly differ. CONCLUSION: Pseudoephedrine treatment for nasal congestion requires extra precautions in males >50 years, even without subjective voiding symptoms.

The effect of nocturia on sleep quality and daytime function in patients with lower urinary tract symptoms: a cross-sectional study.

BACKGROUND: Nocturia has been proven to have a negative impact on the quality of life and sleep quality in general elderly population. However, there are limited studies on the quantitative effect of nocturia on sleep quality and daytime dysfunction, specifically in patients with lower urinary tract symptoms. PATIENTS AND METHODS: During March 1, 2015 to December 31, 2015, a total of 728 patients who visited our urology department due to voiding dysfunction and experienced nocturia at least once per night were enrolled. Three questionnaires were administered to them after obtaining their written consents. Pittsburgh Sleep Quality Index (PSQI) questionnaire, Epworth Sleepiness Scale (ESS) questionnaire, and International Prostate Symptom Score (IPSS) questionnaire were applied to evaluate their sleep quality, daytime dysfunction, and voiding problems, respectively. Statistical analysis of the impact of nocturia on sleep quality and daytime dysfunction was performed. RESULTS: The mean age of patients was 61 years, with a male-to-female ratio of 2.7. The mean nocturia number was 3.03. The IPSS, PSQI, and ESS scores were 17.56, 8.35, and 8.22, respectively. The nocturia number increased with age and was significantly correlated to ESS score (daytime dysfunction) and PSQI total score (sleep quality) in overall group. Among subgroups divided by age and sex, there was a significant correlation between nocturia number and daytime dysfunction in male patients or patients younger than 65 years. CONCLUSION: In patients with lower urinary tract symptoms, nocturia number increased with age and was significantly correlated with poor sleep quality. Nocturia plays an important role in patients younger than 65 years in daytime dysfunction.

The clinicopathological features of sinonasal angiomatous polyps.

BACKGROUND: Sinonasal angiomatous polyp (SAP) is a rare subtype of sinonasal polyp that might be misdiagnosed as a malignant lesion due to its clinical symptoms. METHODS: We retrospectively enrolled the patients who were diagnosed with SAP in our hospital during 2008-2015. We analyzed the clinical symptoms, radiological findings, and pathological features of all patients diagnosed with SAP. RESULTS: Unilateral nasal obstruction, rhinorrhea, and epistaxis were the common symptoms. SAPs all originated from maxillary sinus and extended to nasal cavity with or without involving the nasopharynx. Expansile mass with surrounding bony destruction is typical on computed tomography imaging but specific for SAPs. The magnetic resonance revealed high signal intensity on T1-weighted images and hypointense rim on T2-weighted images. CONCLUSION: Computed tomography and magnetic resonance together might give rise to more accurate diagnosis of SAP. Incisional biopsy does help if the clinician suspects a malignant lesion. To treat SAP, complete removal is the optimal choice.

Evaluation of depression and anxiety in empty nose syndrome after surgical treatment.

OBJECTIVES/HYPOTHESIS: Empty nose syndrome (ENS) is often associated with psychological symptoms. With the absence of psychiatric instruments utilized in the current literature, the assessment of psychological disorder is limited, and the effectiveness of surgical intervention in improving such disorders in ENS are not well understood. The aim of this study was to evaluate the change in depression and anxiety before and after surgical treatment for ENS STUDY DESIGN: Prospective cohort study in a tertiary medical center. METHODS: ENS patients indicated for surgical treatment were enrolled. The Beck Depression Inventory II (BDI-II) and Beck Anxiety Inventory (BAI) questionnaires were completed by these patients before and after surgery to assess the level of depression and anxiety. RESULTS: A total of 20 patients completed the BDI-II and BAI before and after surgical treatment. A majority of patients developed depression and anxiety prior to surgical treatment. The severity of depression and anxiety were significantly decreased following the surgery; the mean scores of both the BDI-II and BAI improved from moderate severity to normal (both P < .001). The preoperative total score was found to be a powerful predictor for the postoperative improvement in both BDI-II and BAI (P < .001). Female patients had significantly worse preoperative scores (P = .005) and greater postoperative improvement (P = .012) in the BDI-II. CONCLUSIONS: Depression and anxiety are psychological disorders prevalent among ENS patients. Surgical treatment for ENS is effective in improving depression and anxiety. Patients with worse preoperative BDI-II and BAI scores as well as female patients may be better candidates for surgical intervention. LEVEL OF EVIDENCE: 4 Laryngoscope, 126:1284-1289, 2016.

Unilateral high vagal paralysis: relationship of the severity of swallowing disturbance and types of injuries.

OBJECTIVE: To evaluate the prognoses of high vagal lesions and their association with their clinical presentation, and seek to determine the best strategy of management for each patient. STUDY DESIGN: Retrospective case series with chart review. MATERIALS AND METHODS: Patients following laryngoplasty from 2001 to 2008 at a tertiary referral voice and swallowing center in Taiwan were reviewed. They were divided into two groups according to the etiologies of high vagal trauma. The pre- and posttreatment voice and swallowing functions were reviewed; swallowing status was compared between patient groups. RESULTS: Of 186 consecutive patients who underwent laryngoplasty, 8 females and 9 males were diagnosed of unilateral high vagal damage. One group of 11 patients suffered vagal damaging suddenly from skull base trauma, cerebrovascular accidents, and surgical complications; symptoms of vagal paralysis occurred immediately after those events. The second group was comprised of six patients who lost their high vagal functions gradually from a skull base tumor or mass compression. Feeding tube status was significantly different between the groups. All except one patient in group 2 recovered their voice and swallowing abilities after appropriate laryngoplasty. CONCLUSIONS: High vagal nerve damage from skull base surgery or trauma leads to a higher incidence of feeding tube dependency than that from skull base tumor compression. Patients can be treated successfully with an appropriate injection or medialization thyroplasty. Immediate laryngoplasty is suggested for cases right after skull base surgery or trauma.