Allergic rhinitis and dental caries: A systematic review.

OBJECTIVE: Dental caries is one of the most common chronic diseases affecting millions of people globally. Some studies revealed the presence of bidirectional relationship between allergic rhinitis (AR) and oral diseases, with each disease having a potential impact on the other. In this study we aimed to systematically review the literature and analyze the available evidence regarding whether AR contributes to the development of dental caries. METHODS: Three authors, members of the YO-IFOS rhinology study group, independently analyzed the data sources (Pubmed, the Cochrane Library, EMBASE, SciELO) for papers assessing the relationship between rhinitis and caries, in adult and pediatric patients. RESULTS: Eight studies met the inclusion criteria (87612 participants). Six studies were performed in children. A total of three studies found an association between AR and dental caries. Only two studies had adjusted the measure of effect for potentially confounding variables. Regarding the quality of the selected studies according to the NICE classification, the most observed methodological limitations detected were: (1) the cross-sectional design of the included studies which could have introduced a simultaneity bias, and (2) not clearly reporting the inclusion and exclusion criteria. CONCLUSION: This systematic review can neither confirm nor deny the presence of an association between AR and caries. Despite the evidence is very scarce to conclude a relationship between AR and caries, the option for examining patients with repetitive caries by an otolaryngologist and those with AR by odontologist should be considered, as these examinations do not possess any risk for the patient.

Allergic rhinitis and dental caries: A systematic review

Objective: Dental caries is one of the most common chronic diseases affecting millions of people globally. Some studies revealed the presence of bidirectional relationship between allergic rhinitis (AR) and oral diseases, with each disease having a potential impact on the other. In this study we aimed to systematically review the literature and analyze the available evidence regarding whether AR contributes to the development of dental caries. Methods: Three authors, members of the YO-IFOS rhinology study group, independently analyzed the data sources (Pubmed, the Cochrane Library, EMBASE, SciELO) for papers assessing the relationship between rhinitis and caries, in adult and pediatric patients. Results: Eight studies met the inclusion criteria (87612 participants). Six studies were performed in children. A total of three studies found an association between AR and dental caries. Only two studies had adjusted the measure of effect for potentially confounding variables. Regarding the quality of the selected studies according to the NICE classification, the most observed methodological limitations detected were: (1) the cross-sectional design of the included studies which could have introduced a simultaneity bias, and (2) not clearly reporting the inclusion and exclusion criteria. Conclusion: This systematic review can neither confirm nor deny the presence of an association between AR and caries. Despite the evidence is very scarce to conclude a relationship between AR and caries, the option for examining patients with repetitive caries by an otolaryngologist and those with AR by odontologist should be considered, as these examinations do not possess any risk for the patient (AU)

Rhinomanometry with and without decongestant used to select children for adenoidectomy: a cohort study.

OBJECTIVE: Adenoid hypertrophy may coexist, and often does, with rhinitis. Therefore, in some cases, adenoidectomy alone, despite the fact that it reduces nasal resistance, may be insufficient to restore nasal breathing. Juliusson et al. suggested using rhinomanometry with and without nasal decongestant as a method for selecting patients for adenoidectomy. In this study, we aim to assess whether the decongestant test, when using normative data, is useful to select children for adenoidectomy. METHODS: Children between 4 and 15 years old undergoing adenoidectomy were selected from two tertiary referral university hospitals. Participants underwent anterior active rhinomanometry with and without nasal decongestant before and after surgery. Parents fill in the sinus and nasal quality-of-life survey (SN5). RESULTS: 47 participants were included, and mean age 6.5 ± 2.15. 2 cohorts were defined according to the result of the nasal decongestant test (> 40% improvement in nasal resistance or not). There is a statistically significant difference between groups, with a higher improvement in nasal resistance and airflow after adenoidectomy in the group with less than 40% improvement in nasal resistance. CONCLUSIONS: In conclusion, this study supports the use of the decongestant test with rhinomanometry to select children for adenoidectomy; especially as it has proven to be a simple technique, harmless, fast, and easily performed on collaborative children.

Safety of tongue base procedures for sleep apnoea in adults: A systematic review and metanalysis from the YO-IFOS study group.

OBJECTIVE: Tongue base and hypopharynx are the major sites of obstruction in OSA patients with failed palatal surgery. In recent years, several minimally invasive procedures have been developed to address tongue base obstruction. However, the research focus has consistently been on the effectiveness of surgery in reducing obstructive sleep apnoea rather than on postoperative complications. In this systematic review and metanalysis we aim to review the complication rate of minimally invasive base of tongue procedures for OSAS in adults. DATA SOURCES: PubMed (Medline), the Cochrane Library, EMBASE, Scopus, SciELO and Trip Database. REVIEW METHODS: Data sources were checked by three authors of the YO-IFOS sleep apnoea study group. Three authors extracted the data. Main outcome was expressed as the complication rate and 95% confidence interval for each surgical technique. RESULTS: 20 studies (542 patients) met the inclusion criteria. The mean complication rate is 12.79%; 4.65% for minor complications, 6.42% if they are moderate, and 1.77% if severe. The most reported complication overall is infection, in 1.95% of cases, followed by transient swallowing disorder, occurring in 1.30% of the total sample. CONCLUSION: The heterogeneity amongst the included studies prevents us from obtaining solid conclusions. The available evidence suggests that minimally invasive base of tongue procedures may present a wide spectrum of complication rates, ranging from 4.4% in tongue base radiofrequency to up to 42.42% in tongue base ablation.

Safety of tongue base procedures for sleep apnoea in adults: A systematic review and metanalysis from the YO-IFOS study group

Objective: Tongue base and hypopharynx are the major sites of obstruction in OSA patients with failed palatal surgery. In recent years, several minimally invasive procedures have been developed to address tongue base obstruction. However, the research focus has consistently been on the effectiveness of surgery in reducing obstructive sleep apnoea rather than on postoperative complications. In this systematic review and metanalysis we aim to review the complication rate of minimally invasive base of tongue procedures for OSAS in adults.Data sourcesPubMed (Medline), the Cochrane Library, EMBASE, Scopus, SciELO and Trip Database.Review methodsData sources were checked by three authors of the YO-IFOS sleep apnoea study group. Three authors extracted the data. Main outcome was expressed as the complication rate and 95% confidence interval for each surgical technique.Results20 studies (542 patients) met the inclusion criteria. The mean complication rate is 12.79%; 4.65% for minor complications, 6.42% if they are moderate, and 1.77% if severe. The most reported complication overall is infection, in 1.95% of cases, followed by transient swallowing disorder, occurring in 1.30% of the total sample.ConclusionThe heterogeneity amongst the included studies prevents us from obtaining solid conclusions. The available evidence suggests that minimally invasive base of tongue procedures may present a wide spectrum of complication rates, ranging from 4.4% in tongue base radiofrequency to up to 42.42% in tongue base ablation. (AU)

Objetivo: La base de la lengua y la hipofaringe son los principales sitios de obstrucción en pacientes con AOS persistente tras una faringoplastia. En los últimos años se han desarrollado numerosas técnicas de cirugía mínimamente invasiva con el objetivo de tratar la obstrucción en este nivel. Sin embargo, el foco de los investigadores se ha situado habitualmente en la efectividad de la técnica para reducir el número de eventos obstructivos, más que en sus complicaciones. En esta revisión sistemática y metaanálisis se evalúa la incidencia de complicaciones de procedimientos mínimamente invasivos para la base de la lengua en pacientes adultos con AOS.Bases de datosPubMed (Medline), Cochrane Library, EMBASE, Scopus, SciELO y Trip Database.Método de revisiónLas bases de datos fueron evaluadas por 3 autores del grupo de investigación en apnea YO-IFOS. Tres autores extrajeron la información. Los resultados principales se expresaron como porcentaje de complicación e intervalo de confianza al 95% para cada técnica quirúrgica.ResultadosVeinte estudios (542 pacientes) cumplieron los criterios de inclusión. La incidencia media de complicaciones fue del 12,79%; un 4,65% fueron menores, un 6,42% moderadas y un 1,77% severas. La complicación más habitual fue infección en el 1,95% de los casos, seguida por alteración transitoria de la deglución en un 1,30%.ConclusiónLa heterogeneidad de los artículos incluidos no permite obtener conclusiones firmes. La evidencia disponible muestra que la cirugía mínimamente invasiva de la base de la lengua presenta un intervalo amplio de complicaciones que varía entre el 4,4% en la radiofrecuencia de la base de la lengua y el 42,42% en la ablación de la base de la lengua. (AU)

Assessing the ability of children and parents to rate their nasal patency. A cross sectional study.

OBJECTIVE: Nasal obstruction is a common complaint in pediatric otolaryngology. There are several concerns about how nasal obstruction should be measured. This debate is even more important in children, as they can experience difficulties in being sensitive to their symptoms or even expressing them. In this research we aim to explore the ability of children (and their parents) to assess their nasal obstruction. PARTICIPANTS: AND METHODS: An observational cross-sectional study was performed. Four cohorts of children were consecutively selected from a third level referral Hospital. Cohort A (children suffering solely turbinate enlargement), B (adenoid enlargement only), and C (adenoid and turbinate enlargement), while cohort D were healthy controls. Children and parents were asked to rate nasal patency through a Likert scale from 0 (no patency, complete obstruction of the nose) to 10 (complete patency, it is easy to breathe through the nose). All participants underwent rhinomanometry. Results of nasal resistance were relativized according to pediatric reference values per each age subgroup. RESULTS: 146 participants were included. Cohort A (54), B (40), C (28), D (24). There is a poor but significant correlation between parents' assessment and nasal resistance (rho = -0.28; p = 0.004). In children, there is no significant correlation with nasal resistance (rho = -0.14; p = 0.17). Stratified by severity, only children (and their parents) with good nasal breathing demonstrated good correlation values with the visual analogue score (VAS). Stratified by age, the correlation is only significant for parents of children older than 12 years old. CONCLUSIONS: This study has demonstrated a good ability to rate nasal patency by healthy children and their parents, but a poor ability for children suffering from impaired nasal breathing. We suggest combining subjective assessment of nasal patency with objective measurements such as rhinomanometry in children.

What is the relationship between the size of the adenoids and nasal obstruction? A systematic review.

OBJECTIVE: adenoidectomy is one of the most common surgical procedure in pediatric otolaryngology practice. Clinical guidelines (such as the Spanish or American) suggest adenoidectomy when the enlargement of the adenoids is associated with nasal obstruction. Nasal endoscopy and cephalograms are adequate methods to estimate the size of the adenoids. However, they do not measure nasal patency. This systematic review is designed with the objective of exploring the relationship between adenoid size and nasal ventilation through rhinomanometry. REVIEW METHODS: 3 authors members of the YO-IFOS rhinology study group independently analyzed the data sources (Pubmed, the Cochrane Library, EMBASE, SciELO) for papers assessing both nasal resistance and/or nasal airflow in rhinomanometry and adenoid size by any method (endoscopy, cephalogram, direct examination). RESULTS: A total of 10 studies with a total population of 969 participants met the inclusion criteria. 5 authors explored the size of the adenoids through endoscopy. 4 authors explored the adenoids through lateral cephalograms. Finally, a further 2 authors explored adenoid size studying the resected tissue. Five studies explored the correlation between adenoid size and nasal resistance in rhinomanometry, which ranged from 0.20 to 0.84. Finally, 5 studies used nasal decongestant. It was found higher sensitivity and specificity, a higher area under the curve for the receiver operating characteristic curve, and higher correlation with adenoid size for rhinomanometry under nasal decongestion. CONCLUSION: Up to now, there is no ideal diagnostic method for adenoid hypertrophy. Therefore, it seems prudent to use a combination of all currently available tools, as they provide complementary, rather than supplementary information. Available evidence suggests that rhinomanometry combined with nasal decongestant could help to elucidate the existence of nasal obstruction in intermediate cases of adenoid hypertrophy, as well as throw light on other possible causes for nasal obstruction, mainly turbinate hypertrophy.

Cross-cultural adaptation of the sinus and nasal quality of life survey (SN-5) to Spanish.

OBJECTIVE: There is a high prevalence for rhinitis with an increasing trend. However, there is a lack of specific quality of life pediatric questionnaires for sinonasal symptoms. The Sinus and Nasal Quality of Life Survey (SN-5) is the only validated instrument specifically designed with this objective. In this work we have translated and validated the Spanish version of the SN5 questionnaire. METHODS: The SN5 was translated according to the World Health Organization recommendation for the translation and adaptation of instruments. The final version of the Sp-SN5 was administered twice (day 0 and day 7) to 137 participants with and without sinonasal symptoms. Reliability was measured with Cronbach α, temporal stability was measured with intraclass correlation coefficient. External validity was assessed with a ROC curve comparing a cohort of cases (children going to turbinate radiofrequency ablation) and controls (asymptomatic children). RESULTS: A Spearman correlation between the total result of the Sp-SN-5 questionnaire and the QOL score showed a strong negative correlation in the general sample and all the age subgroups. Internal consistency measured with Cronbach α was 0.87 for 5 items and was still over 0.83 after removing each item of the test. The intraclass correlation coefficient (ICC) for test-retest measurements was 0.94. The receiver operating characteristic (ROC) curve for all the included participants showed a very high area under the curve (0.998). CONCLUSIONS: The Sp-SN-5 questionnaire was successfully translated and cross-culturally adapted into Spanish, and the translated version exhibited adequate properties. The survey was effective in assessing the quality of life of pediatric patients with sinonasal complaints and can be used for this purpose both in a clinical setting and in future research.