Evaluation of postoperative satisfaction with rhinoseptoplasty in patients with symptoms of body dysmorphic disorder / Avaliação da satisfação pós-operatória da rinosseptoplastia em pacientes com sintomas de transtorno dismórfico corporal

Abstract Introduction: The prevalence of body dysmorphic disorder among candidates for plastic surgery may vary from 6% to 54%. Some studies report discrete benefits with the surgical results, while others show symptomatic exacerbation. Some authors even affirm that body dysmorphic disorder would be a surgical contraindication, against others who suggest satisfactory results. Objective: To describe the prevalence of body dysmorphic disorder in rhinoseptoplasty candidates and to compare outcomes among patients with and without body dysmorphic disorder symptoms. Methods: Cohort study. Individuals ≥ 16 years, candidates for aesthetic and/or functional rhinoseptoplasty were recruited at a university hospital in Brazil. The prevalence of body dysmorphic disorder was assessed through the Body Dysmorphic Disorder Examination (BDDE) and the patients divided into groups: no symptoms of body dysmorphic disorder, mild-moderate and severe symptoms. The specific quality of life outcomes, Nasal Obstruction Symptom Evaluation (NOSE) and Rhinoplasty Outcome Evaluation (ROE) were evaluated before and after 90 and 180 days of the procedure. Results: 131 individuals were included, 59.5% female. The prevalence of preoperative symptoms of body dysmorphic disorder was 38%. There was a reduction in the symptoms of body dysmorphic disorder in the preoperative body dysmorphic disorder examination versus 3 and 6 months in all groups (78.94 ± 2.46 vs. 33.63 ± 6.41 and 35.51 ± 5.92, respectively, p < 0.002). Among patients with severe body dysmorphic disorder symptoms, rhinoplasty outcome evaluation ranged from 21.24 ± 3.88 to 58.59 ± 5.83 at 3 months and 52.02 ± 5.41 at 6 months postoperatively (p < 0.001); while NOSE from 71 ± 8.47 to 36.11 ± 12.10 at 6 months postoperatively (p <0.01). Conclusion: The prevalence of body dysmorphic disorder symptoms in our sample was high. Rhinoseptoplasty was associated with an improvement in quality of life outcomes related to nasal function and aesthetic outcome in all groups, irrespective of the presence and intensity of body dysmorphic disorder symptoms. Rhinoseptoplasty in body dysmorphic disorder symptomatic patients was also associated with a reduction in postoperative body dysmorphic disorder symptoms, even in severe cases.

Resumo Introdução: A prevalência do transtorno dismórfico corporal entre os candidatos à cirurgia plástica pode variar de 6% a 54%. Alguns estudos relatam benefícios discretos com os resultados cirúrgicos, enquanto outros mostram exacerbação dos sintomas. Alguns autores chegam a afirmar que o transtorno dismórfico corporal seria uma contraindicação cirúrgica, contra outros que sugerem resultados satisfatórios. Objetivo: Descrever a prevalência do transtorno dismórfico corporal em candidatos à rinosseptoplastia e comparar os desfechos entre pacientes com e sem sintomas de transtorno dismórfico corporal. Método: Estudo de coorte. Indivíduos ≥ 16 anos, candidatos à rinosseptoplastia estética e/ou funcional, foram recrutados em um hospital universitário no Brasil. A prevalência de transtorno dismórfico corporal foi avaliada por meio do questionário body dysmorphic disorder examination e os pacientes foram divididos nos grupos: sem sintomas de transtorno dismórfico corporal, sintomas leves-moderados e sintomas graves. Os resultados específicos da avaliação de qualidade de vida, com os instrumentos nasal obstruction symptom evaluation, NOSE, e rhinoplasty outcome evaluation, foram avaliados antes, após 90 e 180 dias do procedimento. Resultados: Foram incluídos 131 indivíduos, 59,5% do sexo feminino. A prevalência de sintomas pré-operatórios de transtorno dismórfico corporal foi de 38%. Houve redução dos sintomas de transtorno dismórfico corporal no body dysmorphic disorder examination pré-operatório vs. 3 e 6 meses em todos os grupos (78,94 ± 2,46 vs. 33,63 ± 6,41 e 35,51 ± 5,92, respectivamente, p < 0,002). Entre os pacientes com sintomas graves de transtorno dismórfico corporal, o escore do instrumento rhinoplasty outcome evaluation variou de 21,24 ± 3,88 a 58,59 ± 5,83 em 3 meses e 52,02 ± 5,41 em 6 meses de pós-operatório (p < 0,001); enquanto o escore do NOSE variou de 71 ± 8,47 a 36,11 ± 12,10 aos 6 meses de pós-operatório (p < 0,01). Conclusão: A prevalência de sintomas de transtorno dismórfico corporal em nossa amostra foi alta. A rinosseptoplastia foi associada a uma melhoria nos desfechos de qualidade de vida relacionados à função nasal e estética em todos os grupos, independentemente da presença e intensidade dos sintomas do transtorno dismórfico corporal. A rinosseptoplastia em pacientes com transtorno dismórfico corporal sintomático também foi associada à redução dos sintomas do transtorno dismórfico corporal no pós-operatório, mesmo em casos graves.

Overall quality of life impact on candidates for septorhinoplasty according to the World Health Organization quality of life brief questionnaire (WHOQOL-Brief) / Impacto geral na qualidade de vida em candidatos à septorrinoplastia de acordo com o World Health Organization Quality of Life Brief Questionnaire (WHOQOL-Brief)

Abstract Introduction: Quality of life has been an increasingly reference measure in whole health impact of diseases and in septorhinoplasty evaluation as well. It is known that the decision for this elective surgical procedure requires the subjective perception of patients' complaints about their own health and life stage in association with the surgeon's aesthetic and functional perspective of each case. Objective: To define the quality of life of candidates for septorhinoplasty using the World Health Organization quality of life questionnaire, WHOQOL-Brief, and the prevalence of other independent variables for this population. Methods: A cross-sectional study using a sample of candidates for septorhinoplasty was performed. All patients responded to the WHOQOL-Brief during the pre-operative period. A normative population quality of life study was the reference for the sample size and means. Results: A total of 302 patients were included among the 322 eligible patients. Twenty patients did not complete the questionnaire correctly and were excluded from the study. The sample consisted of patients aged between 15 and 78 years (34.7±14 years): the most majority were Caucasian and female. Among this group, 88.1% declared symptoms of nasal obstruction and 77.4% complained of sleeping problems. It was seen that 10.9% patients chose the surgery primarily for aesthetic improvement; 37.1% chose it mainly because of functional symptoms and 52% chose it for both functional and aesthetic reasons. The physical health domain's mean was 62.2 ± 17), which is a higher mean compared to the references' standard one (Μ = 58.9± 10.5, p = 0.002). The social relationship domain mean was 70.8±18.1; that is a lower mean then general population's one (Μ = 76.2± 18.8, p < 0.001). The psychological and the environment domain means revealed no difference when comparing the sample to the norm (μ = 65.3 ±15.1 vs. μ = 65.9 ±10.8, p = 0.530 and μ = 60.3 ±13.1 vs. μ = 59.9 ± 14.9, p = 0.667). Conclusion: The WHOQOL-Brief questionnaire proved an accurate instrument to cross-check different populations in quality of life outcomes. The study provides good evidence of lower quality of life in social relations domain and high prevalence of nasal obstruction and sleeping symptoms in candidates for septorhinoplasty. This study contributes to recent literature with relevant data supporting a more integrative evaluation in this population in the preoperative period. The results may also encourage a multidisciplinary approach for chronic symptoms when associated with nasal obstruction, sleep disorders and aesthetic complaints.

Resumo Introdução: A qualidade de vida tem sido cada vez mais uma medida de referência no impacto total das doenças na saúde e também na avaliação da septorrinoplastia. Sabe-se que a decisão por esse procedimento médico eletivo requer a percepção subjetiva da queixa do paciente sobre sua própria saúde e estágio de vida em associação com a perspectiva estética e funcional do cirurgião de cada caso. Objetivo: Definir a qualidade de vida de pacientes candidatos à septorrinoplastia por meio do questionário de qualidade de vida da OMS, WHOQOL-Brief e a prevalência de outras variáveis independentes para essa população. Método: Foi feito um estudo transversal com uma amostra de candidatos à septorrinoplastia. Todos os pacientes responderam ao WHOQOL-Brief no momento pré-operatório. Um estudo normativo de qualidade de vida populacional foi a referência para o tamanho e as médias da amostra. Resultados: Foram incluídos 302 pacientes entre os 322 elegíveis. Vinte pacientes não preencheram o questionário corretamente e foram excluídos do estudo. A amostra foi composta por pacientes entre 15 e 78 anos (34,7 ± 14 anos) e a maioria era branca e do sexo feminino. Entre todos, 88,1% declararam sintomas de obstrução nasal e 77,4% declararam ter sintomas durante o sono. Observou-se que 10,9% dos pacientes optaram pela cirurgia principalmente para melhoria estética; 37,1% optaram principalmente devido a sintomas funcionais e 52% optaram por queixa funcional e estética. A média do domínio saúde física foi de 62,2 ± 17, uma média mais alta em comparação com o padrão de referências (μ = 58,9 ± 10,5, p = 0,002). A média do domínio do relacionamento social foi de 70,8 ±18,1, uma média inferior à da população geral (μ = 76,2 ± 18,8, p < 0,001). As médias dos domínios psicológico e meio ambiente não diferiram na comparação da amostra com o normativo (μ = 65,3 ±15,1 vs. μ = 65,9 ± 10,8, p = 0,530 e μ = 60,3 ±13,1 vs. μ = 59,9 ± 14,9, p = 0,667). Conclusão: O questionário WHOQOL-Brief demonstrou servir como um instrumento preciso para cruzar diferentes populações nos desfechos de qualidade de vida. O estudo fornece boas evidências de menor qualidade de vida no domínio relações sociais e alta prevalência de obstrução nasal e sintomas durante o sono em candidatos à septorrinoplastia. Este estudo contribui para a literatura recente com dados relevantes que subsidiam uma avaliação mais integrativa nessa população no momento pré-operatório. Os resultados também podem incentivar uma abordagem multidisciplinar para os sintomas crônicos quando associados, como ocorre na obstrução nasal, distúrbios do sono e queixas estéticas.

Inferior Turbinate Reduction during Rhinoplasty: Is There Any Effect on Rhinitis Symptoms?

Abstract Introduction Inferior turbinate surgery is often performed concomitantly with rhinoseptoplasty. As inferior turbinates play a major role in allergic rhinitis, it seems reasonable to suggest that inferior turbinate surgery reduces allergy. Objective To assess the impact of nasal turbinate surgery on non-obstructive allergic symptoms (nasal discharge, sneezing, pruritus, and allergic conjunctivitis) and on the use of allergic medication in patients with allergic rhinitis undergoing rhinoseptoplasty. Methods Secondary analysis of aggregated data from two randomized controlled trials. Participants with allergic rhinitis aged 2: 16 years were recruited. Data from two groups were analyzed: patients with rhinoseptoplasty and concomitant turbinate reduction (intervention group) and patients with rhinoseptoplasty only (control group). The 90-day postoperative frequency of non-obstructive allergic symptoms and of nasal steroid and oral antihistamine use were analyzed. Results A total of 100 patients were studied. The groups were similar in terms of allergic symptom intensity and mean age. The frequency of non-obstructive allergic symptoms decreased 90 days postoperative in both groups (p < 0.01). There was no difference between the groups in the frequency of non-obstructive allergic symptoms at 90 days (p = 0.835). Topical nasal steroid and oral histamine antagonist use decreased in the intervention group at 90 days (p < 0.05). Conclusions Ninety days after the surgery, turbinate reduction performed in association with rhinoseptoplasty did not reduce the frequency of non-obstructive allergic symptoms more than rhinoplasty alone. However, the observed decrease in nasal steroid and oral antihistamine use suggests an impact of turbinate reduction on medication use in patients with allergic rhinitis undergoing rhinoseptoplasty. Trial Registration ClinicalTrials.gov database (NCT01457638 and NCT02231216).

Inferior Turbinate Reduction during Rhinoplasty: Is There Any Effect on Rhinitis Symptoms?

Introduction Inferior turbinate surgery is often performed concomitantly with rhinoseptoplasty. As inferior turbinates play a major role in allergic rhinitis, it seems reasonable to suggest that inferior turbinate surgery reduces allergy. Objective To assess the impact of nasal turbinate surgery on non-obstructive allergic symptoms (nasal discharge, sneezing, pruritus, and allergic conjunctivitis) and on the use of allergic medication in patients with allergic rhinitis undergoing rhinoseptoplasty. Methods Secondary analysis of aggregated data from two randomized controlled trials. Participants with allergic rhinitis aged ≥ 16 years were recruited. Data from two groups were analyzed: patients with rhinoseptoplasty and concomitant turbinate reduction (intervention group) and patients with rhinoseptoplasty only (control group). The 90-day postoperative frequency of non-obstructive allergic symptoms and of nasal steroid and oral antihistamine use were analyzed. Results A total of 100 patients were studied. The groups were similar in terms of allergic symptom intensity and mean age. The frequency of non-obstructive allergic symptoms decreased 90 days postoperative in both groups ( p < 0.01). There was no difference between the groups in the frequency of non-obstructive allergic symptoms at 90 days ( p = 0.835). Topical nasal steroid and oral histamine antagonist use decreased in the intervention group at 90 days ( p < 0.05). Conclusions Ninety days after the surgery, turbinate reduction performed in association with rhinoseptoplasty did not reduce the frequency of non-obstructive allergic symptoms more than rhinoplasty alone. However, the observed decrease in nasal steroid and oral antihistamine use suggests an impact of turbinate reduction on medication use in patients with allergic rhinitis undergoing rhinoseptoplasty. Trial Registration ClinicalTrials.gov database (NCT01457638 and NCT02231216).

Evaluation of postoperative satisfaction with rhinoseptoplasty in patients with symptoms of body dysmorphic disorder.

INTRODUCTION: The prevalence of body dysmorphic disorder among candidates for plastic surgery may vary from 6% to 54%. Some studies report discrete benefits with the surgical results, while others show symptomatic exacerbation. Some authors even affirm that body dysmorphic disorder would be a surgical contraindication, against others who suggest satisfactory results. OBJECTIVE: To describe the prevalence of body dysmorphic disorder in rhinoseptoplasty candidates and to compare outcomes among patients with and without body dysmorphic disorder symptoms. METHODS: Cohort study. Individuals ≥ 16 years, candidates for aesthetic and/or functional rhinoseptoplasty were recruited at a university hospital in Brazil. The prevalence of body dysmorphic disorder was assessed through the Body Dysmorphic Disorder Examination (BDDE) and the patients divided into groups: no symptoms of body dysmorphic disorder, mild-moderate and severe symptoms. The specific quality of life outcomes, Nasal Obstruction Symptom Evaluation (NOSE) and Rhinoplasty Outcome Evaluation (ROE) were evaluated before and after 90 and 180 days of the procedure. RESULTS: 131 individuals were included, 59.5% female. The prevalence of preoperative symptoms of body dysmorphic disorder was 38%. There was a reduction in the symptoms of body dysmorphic disorder in the preoperative body dysmorphic disorder examination versus 3 and 6 months in all groups (78.94 ±â€¯2.46 vs. 33.63 ±â€¯6.41 and 35.51 ±â€¯5.92, respectively, p < 0.002). Among patients with severe body dysmorphic disorder symptoms, rhinoplasty outcome evaluation ranged from 21.24 ±â€¯3.88 to 58.59 ±â€¯5.83 at 3 months and 52.02 ±â€¯5.41 at 6 months postoperatively (p < 0.001); while NOSE from 71 ±â€¯8.47 to 36.11 ±â€¯12.10 at 6 months postoperatively (p < 0.01). CONCLUSION: The prevalence of body dysmorphic disorder symptoms in our sample was high. Rhinoseptoplasty was associated with an improvement in quality of life outcomes related to nasal function and aesthetic outcome in all groups, irrespective of the presence and intensity of body dysmorphic disorder symptoms. Rhinoseptoplasty in body dysmorphic disorder symptomatic patients was also associated with a reduction in postoperative body dysmorphic disorder symptoms, even in severe cases.

Overall quality of life impact on candidates for septorhinoplasty according to the World Health Organization quality of life brief questionnaire (WHOQOL-Brief).

INTRODUCTION: Quality of life has been an increasingly reference measure in whole health impact of diseases and in septorhinoplasty evaluation as well. It is known that the decision for this elective surgical procedure requires the subjective perception of patients' complaints about their own health and life stage in association with the surgeon's aesthetic and functional perspective of each case. OBJECTIVE: To define the quality of life of candidates for septorhinoplasty using the World Health Organization quality of life questionnaire, WHOQOL-Brief, and the prevalence of other independent variables for this population. METHODS: A cross-sectional study using a sample of candidates for septorhinoplasty was performed. All patients responded to the WHOQOL-Brief during the pre-operative period. A normative population quality of life study was the reference for the sample size and means. RESULTS: A total of 302 patients were included among the 322 eligible patients. Twenty patients did not complete the questionnaire correctly and were excluded from the study. The sample consisted of patients aged between 15 and 78 years (34.7 ±â€¯14 years): the most majority were Caucasian and female. Among this group, 88.1% declared symptoms of nasal obstruction and 77.4% complained of sleeping problems. It was seen that 10.9% patients chose the surgery primarily for aesthetic improvement; 37.1% chose it mainly because of functional symptoms and 52% chose it for both functional and aesthetic reasons. The physical health domain's mean was 62.2 ±â€¯17), which is a higher mean compared to the references' standard one (µâ€¯= 58.9 ±â€¯10.5, p = 0.002). The social relationship domain mean was 70.8 ±â€¯18.1; that is a lower mean then general population's one (µâ€¯= 76.2 ±â€¯18.8, p < 0.001). The psychological and the environment domain means revealed no difference when comparing the sample to the norm (µâ€¯= 65.3 ±â€¯15.1 vs. µâ€¯= 65.9 ±â€¯10.8, p = 0.530 and µâ€¯= 60.3 ±â€¯13.1 vs. µâ€¯= 59.9 ±â€¯14.9, p = 0.667). CONCLUSION: The WHOQOL-Brief questionnaire proved an accurate instrument to cross-check different populations in quality of life outcomes. The study provides good evidence of lower quality of life in social relations domain and high prevalence of nasal obstruction and sleeping symptoms in candidates for septorhinoplasty. This study contributes to recent literature with relevant data supporting a more integrative evaluation in this population in the preoperative period. The results may also encourage a multidisciplinary approach for chronic symptoms when associated with nasal obstruction, sleep disorders and aesthetic complaints.

Analysis of Determinants of Postoperative Satisfaction After Rhinoplasty.

OBJECTIVES/HYPOTHESIS: To analyze different variables that influence postrhinoplasty quality of life outcomes to ascertain the determinants of postoperative satisfaction. STUDY DESIGN: Prospective, observational study. METHODS: This was a prospective, observational study where patients were divided into two groups based on the postoperative Rhinoplasty Outcome Evaluation (ROE) score: high satisfaction group, when postoperative ROE scores were >50, and low satisfaction group, when postoperative ROE scores were ≤50. Patients' general characteristics, Portuguese version of the Nasal Obstruction Symptom Evaluation (NOSE-p) score, the Body Dysmorphic Disorder Examination, nasal angles, and measures from the esthetic facial analysis of postoperative photographs were compared between the groups. RESULTS: Seventy-eight patients were included: 19 in the low satisfaction group and 58 in the high satisfaction group. The median reduction in the NOSE-p score was -45 (interquartile range [IIQ] -20 to -60) (P < .001) in the high satisfaction group and -10 (IIQ -10 to -30) in the low satisfaction group (P = .053). The high satisfaction group had a significantly higher reduction in NOSE-p scores. There was no significant difference between the groups in terms of the analyzed facial parameters, although a significant difference was found when comparing them with the ones established in the literature as a pattern. Previous rhinoplasty, preoperative crooked nose, and higher NOSE-p scores were significantly associated with lower ROE scores (P < .05) in the robust Poisson regression model. CONCLUSION: Functional results play an important role in satisfaction after rhinoplasty. Neoclassical canons were not fulfilled even in a group of patients with a high postoperative satisfaction evaluation. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:1569-1575, 2022.

Partial inferior turbinectomy in rhinoseptoplasty has no effect in quality-of-life outcomes: A randomized clinical trial.

OBJECTIVE: Evaluate the impact of endoscopic partial inferior turbinectomy (EPIT) associated with primary rhinoseptoplasty on quality-of-life outcomes (QOL), complications, and surgical duration. STUDY DESIGN: Randomized clinical trial. METHODS: Individuals with nasal obstruction aged ≥ 16 years who were candidates for functional and aesthetics primary rhinoseptoplasty were evaluated from March 2014 through May 2015. Eligible participants were randomly allocated to rhinoseptoplasty with or without EPIT (excision of one-third of the inferior turbinates). RESULTS: Fifty patients were studied. Most were Caucasian and had moderate/severe allergic rhinitis symptoms. Mean age was 36 ( ± 14.5) years. Rhinoseptoplasty was associated with improvement in all QOL scores irrespective of turbinate intervention (P < 0.001). Analysis of covariance was conducted to control for potential confounders. There was no difference between the groups in absolute score changes for Nasal Obstruction Symptom Evaluation-Portuguese (NOSE-p) (-50.5 vs. -47.6; P = 0.723), Rhinoplasty Outcome Evaluation (ROE) (47 vs. 44.8; P = 0.742), and all World Health Organization Quality of Life Scale-Abbreviated (WHOQOL-bref) score domains (P > 0.05). There were no differences between the groups regarding presence of the complications. Surgical duration was higher in the EPIT group (212 minutes ± 7.8 vs. 159.1 ± 5.6; P ? 0.001). CONCLUSIONS: Turbinate reduction through EPIT during primary rhinoseptoplasty did not improve short-term general and specific QOL outcomes. The use of EPIT increases surgical time considerably without improving QOL scores. There was no difference in postoperative incidence of complications, suggesting that EPIT is a safe technique. LEVEL OF EVIDENCE: 1b. Laryngoscope, 128:57-63, 2018.

Differentiation between Posterior Sinuses Using the Medial Orbital Floor as a Landmark.

Objectives This study aims to evaluate the difference in height between the floors of the posterior ethmoid and sphenoid sinuses with respect to the medial orbital floor (MOF) to confirm this difference as a landmark for identification of the posterior sinuses. It also aims to describe this difference regarding the type of pneumatization of the sphenoid sinus (conchal, presellar, and sellar). Design A cross-sectional study was conducted. Study Center The study was conducted at the Department of Radiology of Hospital de Clínicas de Porto Alegre, a tertiary care university hospital in Southern Brazil. Materials and Methods A standardized and computerized analysis of 100 tomography scans of sinuses (200 sides), in patients older than 18 years, was carried out. Results Mean vertical distance (height) from the MOF to the floor of the posterior ethmoid and sphenoid sinuses was 0.72 ± 1.85 mm and 9.48 ± 3.81 mm, respectively. There was no statistically significant difference as compared with sex and side. We found conchal-type sphenoid sinus pneumatization in 1.5% (n = 3), presellar in 13.5% (n = 27), and sellar in 85% (n = 170), whereas the vertical distance between the MOF and the floor of the sphenoid sinus was 2.04 ± 0.81 in the conchal-type sinuses, 5.71 ± 2.49 in the presellar sinuses, and 10.21 ± 3.52 in the sellar sinuses. No sphenoid sinus showed its floor above the MOF, regardless of the type of pneumatization. Discussion and Conclusion The present study demonstrates that there is a difference between the floor of the posterior sphenoid and ethmoid sinuses in adults, which is more evident when the sphenoid sinus is well pneumatized. These data suggest that the difference in height between the floors of the sinus investigated in our study may be considered during endoscopic sinus surgery to guide adequate localization, but the surgeon should be aware of the type of pneumatization of the sphenoid sinus to use this landmark.

Vertical dome division: a quality-of-life outcome study.

OBJECTIVE: To assess quality-of-life outcomes in patients undergoing nasal tip surgery with the vertical dome division technique using validated instruments (Rhinoplasty Outcome Evaluation [ROE] and Nasal Obstruction Symptom Evaluation [NOSE]). STUDY DESIGN: Case series with planned data collection. SETTING: Tertiary university center. SUBJECT AND METHODS: Patients undergoing primary cosmetic and functional rhinoseptoplasty using vertical dome division were consecutively evaluated. The ROE, NOSE, and 100-mm visual analog scale (VAS) were administered pre- and postoperatively. RESULTS: Forty-four patients were included and completed pre- and postoperative questionnaires. Their median age was 28 years, 27 (61%) were female, and the median duration of follow-up was 5 months (range, 3-9 months). Median postoperative ROE, NOSE, and VAS scores (79 [66; 87], 20 [15; 23], and 88 [61; 97], respectively) showed significant improvement compared with preoperative scores (29 [16; 41], 75 [60; 95], and 65 [46; 82], respectively; P < .001). The change in median ROE score was significantly greater in normal- and thin-skinned patients than in thick-skinned patients (54 vs 33; P = .033). Median changes in NOSE-p (-48.5 vs -68.0; P = .10) and VAS (69.0 vs 48.0; P =.083) scores did not differ between normal-/thin- and thick-skinned patients. CONCLUSION: Vertical dome division is a versatile technique for nasal tip refinement that resulted in significant improvement in quality-of-life outcomes related to rhinoplasty and nasal obstruction, as well as satisfaction with nasal appearance in a short-term follow-up period. The vertical dome division technique does not seem to be indicated only in patients with thick skin.

Effect of turbinate surgery in rhinoseptoplasty on quality-of-life and acoustic rhinometry outcomes: a randomized clinical trial.

OBJECTIVES/HYPOTHESIS: To evaluate the role of inferior turbinate reduction during rhinoseptoplasty in quality-of-life outcomes and nasal airway cross-sectional area. STUDY DESIGN: Randomized clinical trial. METHODS: Individuals over 16 years with nasal obstruction, candidates to functional and aesthetics primary rhinoseptoplasty, were evaluated from December 2010 though January 2012 at a tertiary University Hospital, Brazil. Eligible participants were randomly allocated to rhinoseptoplasty with or inferior turbinate reduction through submucosal diathermy. OUTCOMES: Relative changes ([postop-preop]/preop score) in specific (Nasal Obstruction Symptom Evaluation; NOSE) and general quality-of-life instruments (WHOQOL-bref), nasal obstruction visual analogue scale (NO-VAS) and nasal area measurements in acoustic rhinometry. OUTCOMES were blindly assessed 3 months postoperatively. Protocol was registered at ClinicalTrials.gov (NCT01457638). RESULTS: 50 patients were included, mainly Caucasians with moderate/severe allergic rhinitis symptoms. Mean age was 32 ± 12 yr and 58% were female. Rhinoseptoplasty improved specific and general quality-of-life scores irrespective of turbinate intervention (P < 0.001).There was no difference between subjects submitted or not to inferior turbinate reduction in NOSE score (-75% vs. -73%; P = 0.893); all WHOQOL-bref score domains (P > 0.05), NO-VAS (-88% vs. -81%; P = 0.89) and acoustic rhinometry recordings (P > 0.05).During follow-up less patients in the rhinoplasty with inferior turbinate reduction group were using topical corticosteroids (6[24%] vs. 13[54%]; P = 0.03). Multivariable analyses, adjusting for postoperative topical corticosteroid use and previous nasal fracture, had no effect on these results. CONCLUSIONS: Turbinate reduction through submucosal diathermy during primary rhinoseptoplasty did not improve short-term general and specific quality-of-life outcomes and acoustic rhinometry recordings. The role of turbinate reduction in sparing chronic corticosteroid use should be confirmed in long-term follow-up studies.

Transcanal cochleostomy in cochlear implant surgery: long-term results of a cohort study.

UNLABELLED: The combined approach technique (CAT) is a variation of the classical the mastoidectomy-posterior tympanotomy technique (MPTA) that combines a transcanal approach to cochleostomy with a reduced posterior tympanotomy for insertion of electrodes. AIM: To compare and evaluate long-term safety and effectiveness outcomes obtained with the CAT and with MPTA approach in patients submitted to cochlear implant (CI) surgery. DESIGN: series study. METHODS: Patients who underwent CI using CAT or MPTA at a Brazilian center were followed in a cohort study. Main outcomes were complications,audiometric performance and radiological evaluation of electrode position. RESULTS: Fourty-four patients were implanted using CAT and 31 MPTA. There were no cases of facial nerve paralysis, mastoiditis, cholesteatoma or cerebrospinal fluid leaks after 3.4±1.0 years. Radiological evaluation of electrode position revealed that the median number of electrodes outside the cochlea was 0 in CAT and 3 in MPTA groups (p < 0.001). There were no differences between both surgical approaches in terms of mean pure-tone thresholds with CI at all frequencies. CONCLUSION: Long-term follow-up data showed that the transcanal route to cochleostomy, combined with a reduced posterior tympanotomy, is a safe alternative approach in cochlear implant surgery, with no related major complications and fewer cases of electrode migration when compared with the MPTA. These findings encourage the use of the transcanal route to cochleostomy as an alternative approach option.

Cocleostomia transcanal: resultados em longo prazo de um estudo de coorte / Transcanal cochleostomy in cochlear implant surgery: long-term results of a cohort study

A técnica de acesso combinado (TAC) ao implante coclear (IC) é uma variação da técnica clássica de mastoidectomia e timpanotomia posterior (MPTA). A TAC combina um acesso transcanal à cocleostomia com uma timpanotomia posterior reduzida para a inserção dos eletrodos. OBJETIVO: Avaliar e comparar a segurança e efetividade em longo prazo alcançados com a TAC e MPTA em pacientes submetidos a IC em um centro brasileiro. Desenho científico: Estudo de série. MATERIAL E MÉTODO: Pacientes submetidos a IC usando TAC e MPTA foram acompanhados em um estudo de coorte. Os desfechos avaliados foram complicações, avaliação audiométrica e radiológica pós-operatórias. RESULTADOS: Quarenta e quatro pacientes foram implantados usando a TAC e 31 usando MPTA. Não houve casos de paralisia facial, mastoidite, colesteatoma ou fístula após 3,4±1,0 anos. A avaliação radiológica da posição dos eletrodos a mediana de eletrodos fora da cóclea foi de 0 no grupo TAC e de 3 no MPTA (p < 0,001). Não houve diferença entre os grupos em termos de desempenho audiológico no pós-operatório. CONCLUSÃO: A cocleostomia via transcanal combinada com uma timpanotomia posterior reduzida é um acesso alternativo ao IC que demonstrou segurança e menor migração de eletrodos em longo prazo. Esses achados encorajam o uso da via transcanal para a cocleostomia como uma opção alternativa de acesso ao IC.

The combined approach technique (CAT) is a variation of the classical the mastoidectomy-posterior tympanotomy technique (MPTA) that combines a transcanal approach to cochleostomy with a reduced posterior tympanotomy for insertion of electrodes. AIM: To compare and evaluate long-term safety and effectiveness outcomes obtained with the CAT and with MPTA approach in patients submitted to cochlear implant (CI) surgery. Design: series study. METHODS: Patients who underwent CI using CAT or MPTA at a Brazilian center were followed in a cohort study. Main outcomes were complications,audiometric performance and radiological evaluation of electrode position. RESULTS: Fourty-four patients were implanted using CAT and 31 MPTA. There were no cases of facial nerve paralysis, mastoiditis, cholesteatoma or cerebrospinal fluid leaks after 3.4±1.0 years. Radiological evaluation of electrode position revealed that the median number of electrodes outside the cochlea was 0 in CAT and 3 in MPTA groups (p < 0.001). There were no differences between both surgical approaches in terms of mean pure-tone thresholds with CI at all frequencies. CONCLUSION: Long-term follow-up data showed that the transcanal route to cochleostomy, combined with a reduced posterior tympanotomy, is a safe alternative approach in cochlear implant surgery, with no related major complications and fewer cases of electrode migration when compared with the MPTA. These findings encourage the use of the transcanal route to cochleostomy as an alternative approach option.

Prevalence of the 35delG mutation in deaf South Brazilian infants submitted to cochlear implantation.

OBJECTIVE: Determine the prevalence of 35delG mutation in GJB2 gene in patients with prelingual deafness of no defined etiology whose underwent cochlear implant in the Otolaryngology Department at the Hospital de Clínicas de Porto Alegre and compare the speech recognition index using an open-set of sentences according to the presence or absence of the 35delG mutation. METHODS: Cross-sectional study nested in a cohort. Were analyzed 37 patients with indeterminate etiology for deafness that underwent to cochlear implant. DNA was extracted and the mutations were studied using Polymerase Chain Reaction followed by gene sequencing. RESULTS: The prevalence of 35delG mutation was 11%. The speech recognition index was 72% in the group with 35delG mutation, and 30% in the group without this mutation (p>0.05). CONCLUSIONS: Prevalence of 35delG mutation in this study confirmed findings in the Brazilian literature. There was a clinically significant difference in hearing performance in patients with 35delG. Absence of statistical significance in this result might be attributed to the small number of patients with 35delG in our sample.

Controlled study of the frequency of anti-HSP 70 with the ELISA and the Western Blot methods in patients with Ménière Disease.

OBJECTIVES: To establish the frequency of auto-antibodies anti-HSP 70 using ELISA and Western Blot (WB) methods and to compare the results of each method among patients with the Ménière's Disease (MD) and internal ear diseases (IED) who do not fulfill criteria for MD. Sensibility, specificity and predictive values of anti-HSP70 test in diagnosis of MD were calculated. STUDY: Prospective, case-control. METHODS: Blood samples were collected from 31 patients with MD and 78 patients with non Ménière IED. Data regarding cochlear and vestibular symptoms were obtained and blood sample was tested. RESULTS: ELISA tests results were positive in 4(13%) patients and results of WB were positive in 8(26%) patients. Among patients with positive ELISA results, 1 patient presented active disease and in the remaining 3 patients the disease was inactive. Among the 8 WB positive patients, only 2 patients presented active disease. Statistical analyses did not establish any association between serologic findings and clinical factors of MD. CONCLUSION: The presence of anti-HSP70 using the ELISA and the WB methods did not demonstrate clinical value for the diagnosis of MD. We did not find association between idiopathic MD nor unspecific etiology MD and the presence of anti-HSP70 auto-antibodies.

Transcanal cochleostomy in cochlear implantation: experience with 50 cases.

The traditional access route for cochlear implantation was initially proposed by William House in 1961. Alternatives to this surgical approach have been suggested by many authors. The combined approach technique (CAT) is a variation of the traditional mastoidectomy-posterior tympanotomy method, which uses a transcanal approach to cochleostomy combined with a small mastoidectomy and an equally small posterior tympanotomy for the insertion of electrodes. This paper presents a detailed description of this alternative procedure, reporting our experience with 50 cases, and adds our contribution regarding possible advantages and implications of using a transcanal cochleostomy. The subjects had profound and severe bilateral hearing loss and had not benefited from external hearing aids. They underwent cochlear implantation at Hospital de Clinicas de Porto Alegre from May 2003. The median follow-up was 29 months. All cases were successfully implanted using CAT. No major complications, such as facial paralysis or paresis, meningitis, cholesteatoma, or cerebrospinal fluid leaks, were observed in any patient. The CAT is a safe and efficient variation of cochlear implantation surgery, which is especially appropriate if cochlear calcification or malformations are present, or whenever cochleostomy has to be performed anteriorly, and when the position of the facial nerve prevents an adequate posterior tympanotomy.