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1.
J Med Virol ; 95(1): e28415, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36541735

RESUMO

Respiratory tract infections (RTI) in children remain a cause of disease burden worldwide. Nasopharyngeal (NP) & oropharyngeal (OP) swabs are used for respiratory pathogen detection, but hold disadvantages particularly for children, highlighting the importance and preference for a child friendly detection method. We aimed to evaluate the performance and tolerability of a rhinorrhea swab (RS) in detecting viral pathogens when compared to a combined OP(/NP) or mid-turbinate (MT) nasal swab. This study was conducted between September 2021 and July 2022 in the Netherlands. Children aged 0-5 years, with an upper RTI and nasal discharge, were included and received a combined swab and a RS. Multiplex polymerase chain reaction (PCR) and severe acute respiratory syndrome coronavirus-2 PCR were used for viral pathogen detection. Tolerability was evaluated with a questionnaire and visual analog scale (VAS) scores. During 11 months 88 children were included, with a median age of 1.00 year [interquartile range 0.00-3.00]. In total 122 viral pathogens were detected in 81 children (92%). Sensitivity and specificity of the RS compared to a combined swab were respectively 97% (95% confidence interval [CI] 91%-100%) and 78% (95% CI 45%-94%). Rhinorrhea samples detected more pathogens than the (combined) nasal samples, 112 versus 108 respectively. Median VAS scores were significantly lower for the RS in both children (2 vs. 6) and their parents (0 vs. 5). A RS can therefore just as effectively/reliably detect viral pathogens as the combined swab in young children and is better tolerated by both children and their parents/caregivers.


Assuntos
COVID-19 , Infecções Respiratórias , Humanos , Criança , Pré-Escolar , Nasofaringe , Infecções Respiratórias/diagnóstico , Reação em Cadeia da Polimerase Multiplex/métodos , Rinorreia , Conchas Nasais
2.
Sci Rep ; 12(1): 20819, 2022 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-36460767

RESUMO

The olfaction is related to flow in the olfactory cleft. However, There is a lack of studies on the relationship between flow characteristics of the olfactory cleft and olfactory function. In this study, the anatomical structure of the olfactory cleft was reconstructed in three dimensions using the raw data obtained from the CT scans of sinuses of 32 enrolled volunteers. The Sniffin' Sticks test was used to examine the olfaction. We investigated the correlation between airflow parameters and olfactory function of the olfactory cleft in healthy adults by the computational fluid dynamics method. We found that three parameters, airflow, airflow velocity, and airflow ratio, were highly positively correlated with olfactory function. The mean pressure was not correlated with the olfactory function. Furthermore, there is the strongest correlation between air flow through the olfactory cleft and olfactory function. The correlation between the mean velocity in the anterior olfactory cleft region and olfaction was relatively poor, while the airflow velocity at the posterior olfactory cleft region was enhanced gradually. The correlation between the airflow ratio and olfaction was optimal in the initial position of superior turbinate. The flow parameters in the posterior olfactory cleft area were more stable.


Assuntos
Seios Paranasais , Olfato , Adulto , Humanos , Tórax , Conchas Nasais , Dorso
4.
BMC Ophthalmol ; 22(1): 500, 2022 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-36539768

RESUMO

BACKGROUND: The middle turbinate axilla (MTA) has always been used as a stable anatomic landmark for endoscopic surgeons to locate the lacrimal sac on the lateral nasal wall. Yet, little is known about whether the lacrimal sac size will affect the positioning effect of MTA on lacrimal sac. The aim of this study was to investigate the regularity of lacrimal sac size and lacrimal sac localization through the reference position of the MTA on computed tomographic dacryocystography (CT-DCG) images. METHODS: A series of 192 endoscopic dacryocystorhinostomy (DCR) surgeries were performed. All the patients had been diagnosed as unilateral nasolacrimal duct obstruction and received CT-DCG examinations. According to the maximum transverse diameter of the lacrimal sac on CT-DCG, the patients were classified into three groups. Measurements were taken on CT-DCG parasagittal images. RESULTS: The average distance from the sac superior fundus (SSF) to the MTA was 7.52 mm ± 3.23 mm, and it increased with the increase of the maximum transverse diameter of the sac among groups (p < 0.01). The average distance from the common canaliculus (CC) to the MTA was 3.95 mm ± 2.49 mm. No significant difference was observed among the groups (p = 0.11). The average distance from the CC to the SSF was 3.41 mm ± 1.31 mm, and it increased with the increase of the sac transverse diameter among groups (p < 0.01). CONCLUSIONS: The lacrimal sac can be accurately located on the lateral nasal wall by the reference position of the MTA on CT-DCG images. The distance of the SSF to the MTA and the SSF to the CC is related to the lacrimal sac size. The relative position of the CC to the MTA is relatively stable on CT-DCG images, which make it possible to locate the lacrimal sac of different sizes and the corresponding nasal mucosa incision design in endoscopic DCR.


Assuntos
Dacriocistorinostomia , Aparelho Lacrimal , Obstrução dos Ductos Lacrimais , Ducto Nasolacrimal , Humanos , Ducto Nasolacrimal/diagnóstico por imagem , Ducto Nasolacrimal/cirurgia , Obstrução dos Ductos Lacrimais/diagnóstico por imagem , Conchas Nasais/diagnóstico por imagem , Conchas Nasais/cirurgia , Dacriocistografia , Axila , Valores de Referência , Dacriocistorinostomia/métodos , Tomografia Computadorizada por Raios X
5.
Eur Rev Med Pharmacol Sci ; 26(2 Suppl): 38-48, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36524909

RESUMO

OBJECTIVE: The objective of this study was to evaluate efficacy and safety of a Hypertonic Seawater Solution (2.3% NaCl) containing brown and blue-green Algae (HSS-A) in comparison to Isotonic Saline Solution (ISS) regarding the improvement of nasal breathing in patients that have undergone surgical correction of a deviated nasal septum and radiofrequency turbinate volume reduction. PATIENTS AND METHODS: A total of 101 individuals were enrolled in the study (HSS-A: 57; ISS: 44). Nasal breathing was evaluated using a Peak Nasal Inspiratory Flow (PNIF) measurement device at four timepoints: prior to surgical intervention (up to 30 days pre-surgery) and at the 2nd, 10th and 20th postoperative days. On the 20th postoperative day, patients also answered a Nasal Surgical Questionnaire (NSQ) evaluating breathing ability and overall satisfaction from the use of both nasal sprays. RESULTS: No significant differences were observed in PNIF measurements between groups at different points. On the 20th postoperative day, NSQ analysis showed that ISS-treated patients had more frequently moderate nasal bleeding compared to the HSS-A group (85.7% vs. 14.3%, p=0.038). No other statistically significant differences were observed between groups. When NSQ parameters were evaluated in a binary mode, a trend for reduced crusting scores was seen in the HSS-A group (15.9% vs. 35.5% in ISS, p=0.053). No safety concerns were reported throughout the study. CONCLUSIONS: In patients that have undergone surgical correction of a deviated nasal septum and radiofrequency turbinate volume reduction, PNIF values did not differ significantly in patients receiving HSS-A and ISS solutions. Nasal bleeding was more frequent in ISS patients versus HSS-A. Overall, both solutions provided symptomatic relief and use satisfaction in the absence of side effects.


Assuntos
Obstrução Nasal , Humanos , Conchas Nasais/cirurgia , Epistaxe/cirurgia , Cloreto de Sódio , Septo Nasal/cirurgia , Obstrução Nasal/cirurgia
6.
PLoS One ; 17(11): e0277712, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36395146

RESUMO

Septoturbinoplasty is a surgical procedure that can improve nasal congestion symptoms in patients with nasal septal deviation and inferior turbinate hypertrophy. However, it is unclear which physical domains of nasal airflow after septoturbinoplasty are related to symptomatic improvement. This work employs computational fluid dynamics modeling to identify the physical variables and domains associated with symptomatic improvement. Sixteen numerical models were generated using eight patients' pre- and postoperative computed tomography scans. Changes in unilateral nasal resistance, surface heat flux, relative humidity, and air temperature and their correlations with improvement in the Nasal Obstruction Symptom Evaluation (NOSE) score were analyzed. The NOSE score significantly improved after septoturbinoplasty, from 14.4 ± 3.6 to 4.0 ± 4.2 (p < 0.001). The surgery not only increased the airflow partition on the more obstructed side (MOS) from 31.6 ± 9.6 to 41.9 ± 4.7% (p = 0.043), but also reduced the unilateral nasal resistance in the MOS from 0.200 ± 0.095 to 0.066 ± 0.055 Pa/(mL·s) (p = 0.004). Improvement in the NOSE score correlated significantly with the reduction in unilateral nasal resistance in the preoperative MOS (r = 0.81). Also, improvement in the NOSE score correlated better with the increase in surface heat flux in the preoperative MOS region from the nasal valve to the choanae (r = 0.87) than in the vestibule area (r = 0.63). Therefore, unilateral nasal resistance and mucous cooling in the preoperative MOS can explain the perceived improvement in symptoms after septoturbinoplasty. Moreover, the physical domain between the nasal valve and the choanae might be more relevant to patient-reported patency than the vestibule area.


Assuntos
Obstrução Nasal , Humanos , Obstrução Nasal/cirurgia , Hidrodinâmica , Avaliação de Sintomas , Conchas Nasais/cirurgia , Septo Nasal/cirurgia
7.
Medicine (Baltimore) ; 101(45): e31704, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36397347

RESUMO

To investigate the effect of vidian trunk neurectomy and selective vidian branch neurectomy on treating moderate-to-severe persistent allergic rhinitis. Sixty patients with moderate-to-severe persistent allergic rhinitis treated at Zhejiang Hospital of Integrative Medicine participated in this study from June 2018 to June 2020. The patients in the observation group (n = 40) underwent a vidian trunk neurectomy. The patients in the control group (n = 20) underwent a vidian branch neurectomy. The patients in both groups were followed up after 6 months, 1 year, and 2 years of surgery. The efficacy was evaluated based on the AR diagnostic and the efficacy assessment criteria. The 4 symptoms of sneezing, runny nose, nasal congestion, and nasal itch were scored as efficacy indices before and 6 months, 1 year, and 2 years after surgery. Nasal endoscopy or sinus CT was performed to assess the postoperative inferior turbinate swelling. The postoperative tear secretion was followed up in both groups, and patients with dry eyes were counted in combination with ocular symptoms. The data recorded before and after surgery and between the 2 groups were analyzed statistically. The observation group had signs of 2.73 ±â€…0.452 before surgery, 1.20 ±â€…0.405 6 months after surgery, 1.25 ±â€…0.494 1 year after surgery, and 1.30 ±â€…0.564 2 years after surgery. The control group had signs of 2.75 ±â€…0.444 before surgery, 1.45 ±â€…0.686 6 months after surgery, 1.75 ±â€…0.716 1 year after surgery, and 1.90 ±â€…0.852 2 years after surgery. The between-subjects effect test between the groups showed an overall significant difference (P < .05). The overall effective rate 2 years postoperatively was 38/40 (95.0%) in the observation group and 10/20 (50%) in the control group. Fisher's exact test showed a significant difference between the groups. No patient in either group had dry eyes 1.5 years after surgery. Both vidian trunk neurectomy and selective vidian branch neurectomy have good immediate therapeutic effects, and vidian trunk neurectomy has higher long-term efficacy than selective vidian branch neurectomy.


Assuntos
Rinite Alérgica , Humanos , Resultado do Tratamento , Rinite Alérgica/cirurgia , Denervação , Conchas Nasais , Endoscopia
8.
Gen Dent ; 70(6): 28-33, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36288072

RESUMO

The aim of this study was to investigate the relationship between nasal airway obstruction (NAO) and symptoms of orofacial pain, including temporomandibular joint pathology and primary headaches. This study was a retrospective analysis of consecutive patients seeking care for chronic orofacial pain at 14 North American treatment centers. The standardized evaluation protocol followed for all patients included cone beam computed tomography (CBCT), a comprehensive clinical examination, and a thorough review of the patient's subjective complaints and health history, including pain and sleep pathology. The primary conditions of interest in this study were the following 5 types of NAO: nasal valve compromise (NVC), deviated septum, septal swell body, concha bullosa, and inferior turbinate soft tissue hypertrophy. Descriptive statistics and regression analysis were performed to determine comorbidities between orofacial pain symptoms and NAO observed on CBCT images. The study population consisted of 1393 patients, 253 men (18.2%) and 1140 women (81.8%). The mean age of the patients was 43.3 (SD 18.1) years. NVC was the most prevalent type of NAO found in the study population (n = 1006; 72.2%). NVC showed a statistically significant comorbidity with capsulitis (odds ratio, 3.73) as well as facial and cervical myositis (odds ratio, 6.97). To the author's knowledge, this is first time that these comorbidities have been identified. NAO had a high comorbidity with orofacial pain. Specifically, NVC was a major contributor to NAO. An understanding of the mechanisms of orofacial pain as well as the effects of improper (mouth) breathing, adaptive forward head posture, muscular fatigue, parafunction, and temporomandibular joint pathology will help the clinician to evaluate the role a patient's nose may be playing in orofacial pain.


Assuntos
Obstrução Nasal , Masculino , Humanos , Feminino , Adulto , Obstrução Nasal/complicações , Estudos Retrospectivos , Conchas Nasais/patologia , Dor Facial/etiologia , Articulação Temporomandibular
9.
Artigo em Chinês | MEDLINE | ID: mdl-36217654

RESUMO

Objective:This study aimed to investigate the long-term clinical efficacy and safety of inferior turbinate submucosal plasma ablation combined with or without tonsillar and adenoid surgery in children with allergic rhinitis(AR) combined with obstructive sleep apnea syndrome(OSAS) who were ineffective after conservative systemic treatment. Methods:A total of 43 children with AR complicated with OSAS who met the inclusion criteria among 68 children hospitalized from January 2019 to February 2022 were retrospectively analyzed. The data were collected, including the clinical characteristics, surgical methods perioperative management and prevention and treatment of complications. Moreover, one year follow-up was performed to compare the VAS scores of children before and after surgery, and to evaluate their mid-term and long-term outcomes. Results:The average operation time was 36 minutes, meanwhile, the intraoperative blood was limited. The symptoms of nasal congestion, runny nose, sleep snoring, and mouth breathing were significantly improved after operation, and the results were satisfactory after one-year follow-up without complications such as bleeding, hematoma, intraoperative adhesion, and nasal dryness. Conclusion:Submucosal plasma ablation of inferior turbinate with or without tonsillectomy adenoidectomy in children with AR can effectively improve the clinical symptoms of AR combined with OSAS children who are ineffective after conservative treatment. It can improve the symptoms of sleep-disordered breathing such as sleep snoring and mouth breathing, with good mid-and long-term curative effects and fewer complications, which is an effective and safe treatment for children with AR combined with OSAS.


Assuntos
Rinite Alérgica , Apneia Obstrutiva do Sono , Tonsilectomia , Adenoidectomia/efeitos adversos , Criança , Humanos , Respiração Bucal/complicações , Respiração Bucal/cirurgia , Estudos Retrospectivos , Rinite Alérgica/complicações , Rinite Alérgica/cirurgia , Apneia Obstrutiva do Sono/diagnóstico , Ronco/complicações , Tonsilectomia/efeitos adversos , Conchas Nasais/cirurgia
10.
Rhinology ; 60(6): 411-420, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36150153

RESUMO

INTRODUCTION: Compensatory inferior turbinate hypertrophy is a common accompanying manifestation in patients with nasal obstruction due to deviated nasal septum (DNS). The grounds for inferior turbinate reduction (ITR) in this population are still not well established. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of septoplasty with ITR versus septoplasty alone. METHODS: Computerised search in Medline, Embase, and CENTRAL was performed. Eligible for inclusion were randomised controlled trials (RCTs) comparing septoplasty to septoplasty with unilateral, contralateral, ITR in adults with DNS. Primary outcomes were health-related quality of life and nasal patency. The secondary outcome was the occurrence of adverse events. Standardised mean differences (SMD) and odds ratios (OR) with 95% confidence intervals were calculated. RESULTS: Twelve RCTs that enrolled 775 participants were found eligible. Data were reported at follow-up periods ranging from 1 month to 48 months. The pooled effect estimate showed a statistically significant improvement with unilateral, contralateral, ITR in Nasal Obstruction Symptom Evaluation scale (NOSE) scores. The rate of adverse events was significantly higher with ITR. CONCLUSIONS: Unilateral reduction of the hypertrophied contralateral inferior turbinate during septoplasty resulted in better subjective relief of nasal obstruction in adults with DNS than septoplasty alone. However, caution is warranted since only few well-designed RCTs were identified.


Assuntos
Obstrução Nasal , Rinoplastia , Adulto , Humanos , Obstrução Nasal/etiologia , Obstrução Nasal/cirurgia , Conchas Nasais/cirurgia , Septo Nasal/cirurgia , Resultado do Tratamento , Rinoplastia/métodos , Hipertrofia/complicações , Hipertrofia/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
World J Surg Oncol ; 20(1): 288, 2022 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-36076218

RESUMO

BACKGROUND: Although syringoma is a common benign tumour of the sudoriferous gland, there is also an extremely rare malignant form known as syringoid eccrine carcinoma (SEC). SEC usually exhibits slow growth with deep invasion and a frequent tendency to relapse. The treatment of choice is radical wide resection, which poses a difficult reconstructive problem, especially when the tumour is located in the centre of the face. CASE PRESENTATION: In this case, a 70-year-old man was diagnosed with an SEC at the same location as a benign syringoma of the upper lip and nasal base that had undergone primary excision 7 years prior. Primary radical resection was performed with immediate Abbé flap reconstruction. Nevertheless, histology revealed positive margins, and 3 additional re-excisions were needed to achieve clear margins. Four months after the initial resection, the patient had undergone an innovative reconstruction technique including not only the Abbé flap but also a turbinate flap harvested with functional endonasal surgery and a three-stage forehead flap. CONCLUSION: To the best of our knowledge, this is the first case report of a suspect malignant transformation of a benign syringoma after 7 years. In addition, from oncoplastic and reconstructive points of view, the bilateral use of the turbinate flap for reconstructing the intranasal lining of the alar base is unusual, and the use of functional endonasal surgery in nasal reconstruction for reducing the risk of damaging the vascular supply of the flap is innovative.


Assuntos
Carcinoma , Neoplasias das Glândulas Sudoríparas , Siringoma , Idoso , Carcinoma/cirurgia , Testa/cirurgia , Humanos , Lábio/cirurgia , Masculino , Recidiva Local de Neoplasia/cirurgia , Neoplasias de Anexos e de Apêndices Cutâneos , Neoplasias Cutâneas , Neoplasias das Glândulas Sudoríparas/cirurgia , Siringoma/cirurgia , Conchas Nasais/cirurgia
12.
Neurosurg Rev ; 45(6): 3641-3646, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36166111

RESUMO

Even the most delicate endonasal surgery for skull base lesion causes changes in the nasal cavity, some of them permanent. Morphological changes in the nasal cavity and their consequences (changes in nasal airflow) are often studied by advanced numerical analysis called computational fluid dynamics. This review summarizes current knowledge of endoscopic transsphenoidal skull base surgery effects on nasal airflow. Several studies have shown that endoscopic skull base surgery changes nasal anatomy to the extent that nasal airflow changes significantly postoperatively. Removing any intranasal structure increases the cross-sectional area of the respective nasal meatus, leading to increased nasal airflow in this area while airflow in the narrower periphery decreases. Middle turbinate resection increases airflow in the middle meatus and reduces airflow in the superior and inferior meatus. Small posterior septectomy does not cause a significant change in nasal airflow. Nasal septum deviation is an important factor in airflow changes. Current studies describe nasal changes after rather extensive procedures (e.g., middle turbinectomy, ethmoidectomy) that are unnecessary in routine pituitary adenoma surgery. No studies have compared changes using pre- and postoperative scans of the same patients after actual surgery.


Assuntos
Endoscopia , Base do Crânio , Humanos , Endoscopia/métodos , Base do Crânio/cirurgia , Cavidade Nasal/cirurgia , Cavidade Nasal/anatomia & histologia , Septo Nasal/cirurgia , Conchas Nasais/cirurgia
13.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 47(7): 895-901, 2022 Jul 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-36039586

RESUMO

OBJECTIVES: Nasal congestion is often the main symptom of the patients with non-allergic rhinitis, who have inferior turbinate hypertrophy if getting poor treatment effect. Plasma treatment for inferior turbinate hypertrophy can effectively improve nasal obstruction. Generally, plasma treatment with multiple puncture sites, makes patients intraoperative painful and postoperative bleeding, which let patients often fear of surgery. Postoperative nasal adhesion or lower turbinate scar and other complications sometimes happened, and some patients still feel nasal obstruction due to severe mucosal damage and scar formation. We innovatively used one-point-three-side plasma turbinate volume reduction in the treatment of inferior turbinate hypertrophy, in order to reduce complication, improve symptoms, and enhance curative effect. METHODS: A total of 111 patients with non-allergic rhinitis with complete data due to hypertrophy of inferior turbinate and poor drug treatment from Nov. 2011 to Oct. 2019. The hypertrophic inferior turbinate of patients with non-allergic rhinitis was ablated by plasma turbinate volume reduction, and the symptom scores of patients were evaluated by visual analog scales (VAS) before surgery, 1 week, 1 month, 3 months, and 6 months after surgery. The intraoperative pain was scored by VAS. The pathological morphology of nasal mucosa was observed before and after operation in some patients. RESULTS: The nasal obstruction score of the patients was significantly lower at 1 week, 1 month, 3 months and 6 months after the operation (all P<0.05). The distribution of submucosal blood vessels and glands was improved by postoperative pathological observation. CONCLUSIONS: Plasma turbinate volume reduction with one-point-three-side is effective with minimally invasion, and less complication, which is worthy of clinical promotion.


Assuntos
Obstrução Nasal , Doenças dos Seios Paranasais , Rinite , Cicatriz/patologia , Humanos , Hipertrofia , Obstrução Nasal/complicações , Obstrução Nasal/cirurgia , Doenças dos Seios Paranasais/patologia , Rinite/complicações , Rinite/patologia , Rinite/cirurgia , Resultado do Tratamento , Conchas Nasais/patologia , Conchas Nasais/cirurgia
14.
Acta Biomed ; 93(4): e2022249, 2022 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-36043980

RESUMO

BACKGROUND AND AIM: Allergic rhinitis (AR) and non-allergic rhinitis (NAR) belong to field of vasomotor rhinitis, characterized by nasal hyper-reactivity. Since AR and NAR are two separate nosological entities, these rhinopaties can coexist in the same patient in up to 15-20% of cases. Overlapped rhinitis (ORs) are associated with intense and persistent symptoms and are often misdiagnosed. Typically, when medical treatment fails, patients undergo turbinate surgery. We evaluated which rhinopaties are most at risk of undergoing turbinate surgery and established the percentage of ORs.  Methods: The study included 120 patients undergoing turbinate surgery for turbinate hypertrophy. Anterior rhinoscopy, nasal endoscopy, nasal cytology, skin prick tests (SPT) and/or specific IgE serum assays (CAP-RAST) were performed preoperative on all patients. RESULTS: Among patients with indication for turbinate surgery, 75% suffered from AR, whereas 25% of them had NAR. On closer analysis, only 7 (8%) of allergic patients presented a "pure" allergy.  NAR with eosinophils and mast cells (NARESMA) represented the most common type of superimposed rhinitis (62.5%), while NAR with mast cells (NARMA) and with eosinophils (NARES) represented 25% and 12.5% of the superimposed forms, respectively. CONCLUSION: Most of the patients undergoing turbinate surgery actually have complex forms of rhinitis. The non-allergic component of ORs often causes therapeutic failure. NARESMAs overlapping ARs are at most risk of undergoing turbinate surgery. Correctly framing a rhino-allergological patient is essential in order to guarantee the most adequate treatment. Hence the importance of introducing in clinical practice investigations, including allergy tests and nasal cytology.


Assuntos
Rinite Alérgica , Rinite , Eosinófilos , Humanos , Rinite/diagnóstico , Rinite/cirurgia , Rinite Alérgica/cirurgia , Testes Cutâneos , Conchas Nasais/cirurgia
15.
J Occup Environ Med ; 64(9): e575-e578, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35902375

RESUMO

OBJECTIVE: The aim of this study was to determine whether mid-turbinate specimens reliably detect active infection in asymptomatic adults undergoing regular COVID-19 PCR testing. METHODS: Qualitative agreement between 2481 paired nasopharyngeal and mid-turbinate PCR results was assessed. Mean cycle threshold values for each positive result were evaluated as an indicator of active infection. RESULTS: Overall agreement between nasopharyngeal and mid-turbinate tests was 98.4%. Positive percent agreement was 37.2%, and negative percent agreement was ~100%. Test pairs with lower cycle thresholds (≤30 and ≤25) reached 67% and 100% positive percent agreement, respectively. CONCLUSIONS: SARS-CoV-2 infections with high viral loads were detected regardless of specimen type. Mid-turbinate swabs reduced staff discomfort and may decrease repeated positive test results weeks or months after initial infection. Discordant pairs generally had high cycle threshold values (>30) indicating low viral load and little risk of transmitting COVID-19.


Assuntos
COVID-19 , SARS-CoV-2 , Adulto , COVID-19/diagnóstico , Teste para COVID-19 , Humanos , Nasofaringe , Reação em Cadeia da Polimerase , Sensibilidade e Especificidade , Conchas Nasais
16.
Rhinology ; 60(5): 377-383, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-35856790

RESUMO

BACKGROUND: The pathogenesis of maxillary sinus fungal ball (MSFB) is explained by aerogenic and odontogenic factors. We evaluated the predisposing factors, including intranasal anatomical and dental factors for increased diagnostic accuracy. METHODOLOGY: In this study, 117 patients who underwent endoscopic sinus surgery for unilateral MSFB were included. Preoperative computed tomography (CT) scans were used to analyze the presence of anatomical variations (anterior and posterior nasal septal deviation (NSD), concha bullosa (CB), infraorbital cell (haller cell), paradoxical middle turbinate, everted uncinate process and MS size). Dental factors including history of dental procedures and findings on CT scans were reviewed. RESULTS: Anterior and posterior NSD toward non-affected side were significantly associated with the presence of FB. The presence of CB and infraorbital cell was higher in the non-affected side rather than in the lesion side. Compared to non-affected MS, FB-presence MS was shallower and had a larger height to depth ratio. The presence of dental history was significantly higher on FB-presence MS than non-affected MS. In multivariable analysis, posterior NSD toward non-affected side, dental history increased the aOR of MSFB, while the presence of CB and infraorbital cell decreased the aOR of MSFB. CONCLUSIONS: The occurrence of MSFB seems to be associated with ipsilateral odontogenic factors, followed by anatomic variations including posterior NSD toward non-affected side and absence of CB and infraorbital cell.


Assuntos
Corpos Estranhos , Doenças Nasais , Causalidade , Humanos , Seio Maxilar/diagnóstico por imagem , Septo Nasal , Conchas Nasais
17.
Plast Reconstr Surg ; 150(2): 439e-454e, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35895523

RESUMO

LEARNING OBJECTIVES: After studying this article, the participant should be able to: (1) understand the functional significance of nasal anatomy as it relates to rhinoplasty and perform a comprehensive functional nasal assessment. (2) Identify the anatomical level of obstruction based on the authors' algorithmic approach and understand the current evidence supporting operative techniques for correcting nasal airway obstruction from septal deformity, inferior turbinate hypertrophy, internal nasal valve collapse, external nasal valve collapse. (3) Understand the current evidence supporting operative techniques for correcting nasal airway obstruction from septal deformity, inferior turbinate hypertrophy, internal nasal valve collapse, and external nasal valve collapse. (4) Appreciate the objective assessment tools for functional nasal surgery from a clinical and research perspective. SUMMARY: The intent of functional rhinoplasty is to improve nasal airflow (and the perception thereof) by surgically correcting the anatomical sources of obstruction in the nasal airway. Cosmetic and functional rhinoplasty are not mutually exclusive entities, and the techniques that address one area, inevitably may affect the another. The rate of functional problems after cosmetic rhinoplasty range from 15 to 68 percent with nasal airway obstruction found to be the most common indication for secondary surgery. The objective of this CME article is to provide readers with an understanding of the (1) functional components of nasal anatomy, (2) clinical functional assessment, and (3) the current evidence supporting corrective maneuvers for each component.


Assuntos
Obstrução Nasal , Rinoplastia , Humanos , Hipertrofia/cirurgia , Obstrução Nasal/etiologia , Obstrução Nasal/cirurgia , Septo Nasal/cirurgia , Rinoplastia/efeitos adversos , Rinoplastia/métodos , Conchas Nasais/cirurgia
18.
Rhinology ; 60(5): 335-346, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-35726828

RESUMO

BACKGROUND: Nasal endoscopy is increasingly accessible to ENT surgeons. The characteristics of the allergic upper airway are not well recognised. METHODOLOGY: MEDLINE (1946-2021), EMBASE (1974-2021), and the Cochrane Library were searched on 16th November 2021 to identify articles that reported endoscopic findings of patients with documented allergy who had undergone nasal endoscopy. The review followed the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Meta-analysis was performed by pooling sensitivities and specificities using the hierarchical summary receiver operating characteristics model. RESULTS: A total of 4108 articles were identified, of which 15 manuscripts met the inclusion criteria. The included studies involved 4660 patients who had undergone nasal endoscopy. Middle turbinate (diffuse/polypoid) oedema (sensitivity 58.0%, specificity 84.5%), watery secretions (sensitivity 65.7%, specificity 76.5%), inferior turbinate hypertrophy (sensitivity 86.2%, specificity 32.2%), and unspecified turbinate hypertrophy (sensitivity 82.0%, specificity 42.9%) were identified as the features with the highest predictive value of inhalant allergy. CONCLUSIONS: Diffuse or polypoid oedema of the middle turbinate or watery secretions seen on nasal endoscopy can be a useful adjunct in the identification and diagnosis of inhalant allergy. These clinical features should be part of the diagnostic workup for patients that includes a clinical history and surrogate markers of allergic sensitisation from the skin and serum.


Assuntos
Hipersensibilidade , Conchas Nasais , Biomarcadores , Edema , Endoscopia , Humanos , Hipertrofia
19.
J Craniofac Surg ; 33(3): e318-e320, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35727659

RESUMO

ABSTRACT: Although endoscopic skull-base reconstruction protocols to reduce cerebrospinal fluid (CSF) leakage are reported, the most effective management strategies have not been determined. We describe the successful repair of a spontaneous CSF leak using a vascularized middle turbinate flap (MTF) via an endonasal endoscopic approach and also discuss the effective reconstruction with other available pedicled flaps. An 11-year-old girl had a 5-month history of intermittent CSF rhinorrhea. Endoscopic endonasal skull base reconstruction was performed using the pedicled MTF technique, which sufficiently covered the unilateral cribriform plate and ethmoidal fovea including suspicious leakage site. Middle turbinate flaps may be good for repairing spontaneous CSF leaks, which commonly have small, low-flow CSF fistulas around a cribriform plate. As spontaneous CSF leaks are known to have a higher recurrence rate, MTF may be advantageous because more of the normal structures are retained.


Assuntos
Rinorreia de Líquido Cefalorraquidiano , Vazamento de Líquido Cefalorraquidiano/cirurgia , Rinorreia de Líquido Cefalorraquidiano/diagnóstico por imagem , Rinorreia de Líquido Cefalorraquidiano/etiologia , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Criança , Endoscopia/métodos , Feminino , Humanos , Estudos Retrospectivos , Base do Crânio/cirurgia , Retalhos Cirúrgicos/cirurgia , Conchas Nasais/cirurgia
20.
Am J Case Rep ; 23: e935362, 2022 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-35642551

RESUMO

BACKGROUND The immunomodulatory and pharmacokinetic effects of cyclosporine A are used to treat diverse disease entities in different medical fields, including organ transplantation and/or autoimmune diseases. It is also applied in patients with nephrotic range proteinuria as an adjunct to steroids and supportive antihypertensive/antiproteinuric medications. Cyclosporine has a small therapeutic window and is dosed with respect to the underlying disease entity and severity via trough level adaptations. Among its most frequent adverse effects are hypertension, nephrotoxicity, neurotoxicity, and electrolyte disturbances. Hypertrichosis and gingival hyperplasia are obvious and widely recognized adverse effects. CASE REPORT We report on a 66-year-old woman who was treated with cyclosporine A for primary membranous nephropathy. During treatment with cyclosporine, she developed hirsutism and gingival hyperplasia. Later, she reported having impaired nasal breathing and dyspnea on mild physical exercise. Clinical, rhinoscopic, and radiological evaluations showed marked conchal hyperplasia as a potential cause of her symptoms. An extensive medical work-up did not show evidence of allergic, immunologic, or other drug adverse effects, suggesting cyclosporine-induced hyperplasia of the turbinates as a hypothetical causative factor. Dose reductions did not lead to resolution of symptoms but resulted in increasing proteinuria. Therefore, cyclosporine was stopped, and the patient was treated with rituximab. Thereafter, hirsutism and gingival and conchal hyperplasia gradually regressed over 2-4 months, showing complete resolution of conchal hyperplasia on computed-tomography follow-up after 6 months. CONCLUSIONS Cyclosporine can not only result in gingival hyperplasia but also in hyperplasia of the turbinates leading to impaired nasal breathing and shortness of breath on exertion. An extensive search for many other known causes of conchal swelling is warranted to finally suggest an adverse effect of cyclosporine. Discontinuation of cyclosporine resulted in complete remission of conchal hyperplasia as well as other adverse effects.


Assuntos
Hiperplasia Gengival , Glomerulonefrite Membranosa , Obstrução Nasal , Idoso , Ciclosporina/efeitos adversos , Feminino , Hiperplasia Gengival/induzido quimicamente , Hiperplasia Gengival/tratamento farmacológico , Glomerulonefrite Membranosa/induzido quimicamente , Glomerulonefrite Membranosa/complicações , Glomerulonefrite Membranosa/tratamento farmacológico , Hirsutismo/induzido quimicamente , Hirsutismo/tratamento farmacológico , Humanos , Hiperplasia , Imunossupressores/efeitos adversos , Proteinúria/tratamento farmacológico , Conchas Nasais
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