Nasal polyposis: more than a chronic inflammatory disorder-a disease of mechanical dysfunction - the São paulo position

Introduction: The importance of our study lies in the fact that we have demonstrated the occurrence ofmechanical dysfunction within polypoid tissues, which promotes the development of polyps in the nasal cavity. Objective: To change the paradigm of nasal polyposis (NP). In this new conception, the chronic nasal inflammatory process that occurs in response to allergies, to pollution, to changes in the epithelial barrier, or to other factors is merely the trigger of the development of the disease in individuals with a genetic predisposition to an abnormal tissue remodeling process, which leads to a derangement of the mechanical properties of the nasal mucosa and, consequently, allows it to grow unchecked. Data: Synthesis We propose a fundamentally new approach to intervening in the pathological process of NP, addressing biomechanical properties, fluid dynamics, and the concept of surface tension. Conclusion: The incorporation of biomechanical knowledge into our understanding of NP provides a new perspective to help elucidate the physiology and the pathology of nasal polyps, and new avenues for the treatment and cure of NP (AU)

A new cultural adaptation of the University of Pennsylvania Smell Identification Test

OBJECTIVES: The University of Pennsylvania Smell Identification Test, a test of olfactory function that is widely used by otolaryngologists, geriatricians, and neurologists, has been translated into more than a dozen languages. In some instances, cultural and socioeconomic factors have necessitated changes in the odorant items or the response alternatives to make the test scores congruent with North American norms. The objective of this study was to compare the performance of Brazilian subjects on a new Portuguese language version of the University of Pennsylvania Smell Identification Test with their performance on an earlier Portuguese language version of the test, as well as to assess the influences of gender, age, ethnicity, and economic status on the test scores. METHODS: Based on pilot data, several response alternatives of the earlier Portuguese language version of the test were altered in an effort to improve test performance. Forty-nine healthy Brazilian volunteers, who represented several economic classes, were tested. The test scores of the study cohort who received the newer version of the test were compared with those of a group of 25 subjects who received the earlier version of the test. RESULTS: The mean score for the new version [35 (2.1)] was significantly (p = 0.002) higher than that for the earlier version [32.5 (3.5)]. Although no apparent influence of socioeconomic status was observed, the female participants outperformed the male participants in the current subject cohort. CONCLUSION: The changes made in the new cultural adaptation of the Portuguese version of the University of Pennsylvania Smell Identification Test were effective in increasing the average test scores of the participants. Overall, the female subjects outperformed the male subjects on the test.

Avaliação da qualidade de vida após sinusectomia endoscópica para rinossinusite crônica / Assessment of quality of life after endoscopic sinus surgery for chronic rhinosinusitis

A rinossinusite crônica é uma doença de etiologia não definida que impacta significativamente a qualidade de vida dos pacientes. A sinusectomia endoscópica foi demonstrada como um tratamento eficaz em melhorar a qualidade de vida dos pacientes em outros países; contudo, não existem estudos nacionais. OBJETIVO: Avaliar a associação cirurgia endoscópica nasossinusal com a qualidade de vida doença-específica dos pacientes com rinossinusite crônica com e sem polipose nasossinusal pelo SNOT-20. Desenho: Estudo prospectivo. PACIENTES E MÉTODOS: Pacientes submetidos à sinusectomia endoscópica após ausência de melhora ao tratamento medicamentoso foram avaliados pelo questionário SNOT-20p antes e 12 meses após a cirurgia. Avaliou-se a melhora na pontuação total e nos cinco itens considerados mais importantes por cada paciente. Avaliamos também a presença de correlação entre a pontuação pré-operatória e a melhora pós-operatória e se havia diferença entre a melhora segundo sexo. RESULTADOS: Incluímos 43 pacientes com idade de 44 (19), md (IIQ); e 60,5% (26/43) do sexo masculino. Os pacientes apresentaram melhora estatisticamente significativa no SNOT-20 e SNOT-20 (5+), e correlação entre a pontuação pré-operatória e a melhora da pontuação (p<0.001). Não houve diferença entre melhora da pontuação na qualidade de vida segundo o sexo. CONCLUSÃO: A sinusectomia endoscópica em pacientes com rinossinusite crônica apresenta associação com melhora da QV doença-específica estatisticamente significativa.

Chronic rhinosinusitis is a disease of undefined etiology that significantly impacts the quality of life of its patients. Various studies carried out in countries other than Brazil have shown endoscopic sinus surgery as an effective means of treating this condition. OBJECTIVE: This study aims to analyze, with the aid of SNOT-20, the association between endoscopic sinus surgery and disease-specific quality of life of Brazilian patients treated for chronic rhinosinusitis accompanied or not by nasal polyps. MATERIALS AND METHODS: This prospective study enrolled patients submitted to endoscopic sinus surgery after drug therapy failed to improve their symptoms. They were assessed based on questionnaire SNOT-20p before and 12 months after surgery. Improvement on total scores and on the five items deemed more important by each patient were assessed. The study also looked into the correlation between preoperative scores and postoperative improvement and if there were any gender-related improvement differences. RESULTS: Forty-three patients aged 44 (19), md (IQR), 65% of whom (26/43) were males. Statistically significant improvement was seen on SNOT-20 and SNOT-20(5+) and a correlation was established between preoperative scores and postoperative improved scores (p<0.001). No gender-related differences were observed in quality of life. CONCLUSION: Endoscopic sinus surgery in patients with chronic rhinosinusitis is associated with statistically significant improvements in disease-specific quality of life.

Aplicabilidade do teste de identificação de olfato da Universidade da Pensilvânia (SIT) para brasileiros: estudo piloto / Applicability of the University of Pennsylvania Smell Identification Test (SIT) in Brazilians: pilot study

O teste de identificação do olfato da Universidade da Pensilvânia (SIT) é o exame olfatório mais citado na literatura devido a sua fácil aplicação e alta confiabilidade teste-reteste. Ainda não foram normatizados seus valores de olfação normal para a população brasileira. OBJETIVO: Verificar o escore no SIT alcançado por um grupo de brasileiros e o nível de dificuldade encontrado para a execução do teste. FORMA DE ESTUDO: Transversal. MATERIAL E MÉTODO: O SIT foi aplicado a 25 voluntários brasileiros de diversas classes econômicas, sem queixas olfatórias prévias. Após a aplicação do teste, todos preencheram um questionário com uma escala visual analógica (VAS) referente ao nível de dificuldade encontrado na realização do teste. RESULTADOS: O escore médio da amostra de brasileiros foi 32,5 (desvio-padrão:3,48) de 40, abaixo do considerado normal para a população americana. O nível de dificuldade médio encontrado foi 26mm (desvio padrão: 24,68) segundo a VAS, tendendo a facilidade, e 4(16 por cento) participantes não conheciam algum dos odores escritos nas alternativas. CONCLUSÃO: Nesse estudo piloto, houve indícios de boa aplicabilidade do teste, com o escore dos brasileiros pouco abaixo da normosmia. São necessários estudos futuros para confirmar a existência de diferença de pontuação entre pessoas de diferente classe econômica.

The University of Pennsylvania Smell Identification Test (SIT) is the most cited olfactory test in the literature because it is easy to perform and there is high test-retest reliability. There were no standardized olfaction values in a normal Brazilian population. AIM: To measure the SIT score in a group of Brazilians, and to assess the level of difficulty when implementing the test. STUDY DESIGN: A cross-sectional study. MATERIALS AND METHODS: The SIT was applied in 25 Brazilian volunteers of various income levels who presented no olfactory complaints. Following the test, subjects answered a questionnaire with a visual analog scale (VAS) for the level of difficulty. RESULTS: The mean in the sample of Brazilians was 32.5 (SD: 3.48) our of 40; this is below what is considered normal for US citizens. The level of difficulty was on average 26 mm (SD: 24.68) in the VAS, but it trended towards easy; 4(16 percent) participants did not recognize some of the odors under 'alternatives'. CONCLUSION: In this pilot study, there was evidence of good test applicability; the score of the sample of Brazilians was just below normosmia. Further studies are needed to confirm the existence of differences between people of different income levels.

Sinusoplastia por balão: revisão da literatura / Balloon sinuplasty: literature review

Introdução: A cirurgia nasossinusal apresentou um rápido desenvolvimento nas duas últimas décadas, porém, estenoses cicatriciais secundárias à manipulação cirúrgica ainda ocorrem, mesmo nas mãos de cirurgiões experientes e, principalmente, em regiões estreitas como o recesso do frontal. A sinusoplastia por balão utiliza o princípio da dilatação dos óstios sinusais por balões guiados por cateter. Objetivo: Apresentar e discutir a técnica cirúrgica, indicações, custos e resultados da sinusoplastia por balão, através de artigos publicados até agora sobre o assunto. Revisão da Literatura: A sinusoplastia por balão é uma alternativa no tratamento da rinossinusite crônica. Não é substituto da cirurgia funcional dos seios paranasais. O uso do balão combinado à abordagem cirúrgica endoscópica pode minimizar complicações cirúrgicas como as estenoses cicatriciais, principalmente em regiões como o recesso do frontal. Pacientes de UTI que tem um risco anestésico maior e que apresentam doença esfenoidal isolada também podem beneficiar-se com o uso do balão. A possibilidade de realizar-se a dilatação com anestesia local é outra vantagem. Com relação aos riscos, estes parecem ser baixos, apesar de existir a possibilidade de lesão de estruturas nobres como a órbita e a base do crânio. Comentários Finais: A sinusoplastia por balão parece ser uma tecnologia viável, segura e eficiente em pacientes selecionados. Apresenta-se como uma terapia auxiliar e complementar à cirurgia funcional. Possui maiores perspectivas no tratamento da doença relacionada ao recesso do frontal, pacientes febris de UTI com foco sinusal e pacientes com alto risco anestésico e de sangramento.

Introduction: The nasosinusal surgery showed a rapid development over the past two decades; but cicatricial stenoses secondary to surgical manipulation still occur, even in the hands of experienced surgeons and, especially, in narrow regions such as the frontal recess. The balloon sinuplasty uses the principle of dilatation of the sinus ostia by balloons guided by catheter. Objective: To present and discuss the surgical technique, indications, costs and results of the balloon sinuplasty, through articles published so far on the subject. Literature's Review: The balloon sinuplasty is an alternative in the treatment of chronic rhinosinusitis. It is not substitute for the functional paranasal sinuses surgery. The use of balloon combined with endoscopic surgical approach may minimize surgical complications such as cicatricial stenosis, especially in regions such as the frontal recess. ICU Patients with a higher anesthetic risk and presenting isolated sphenoid disease may also benefit from the use of the balloon. The possibility of carrying out the dilation with local anesthesia is another advantage. As for the risks, they appear to be low, although there is a possibility of lesion to noble structures as the orbit and skull base. Conclusions: The balloon sinuplasty appears to be a feasible, safe and effective procedure in selected patients. It presents itself as an ancillary therapy and complementary to FESS. It has greater prospects in the treatment of the disease related to the frontal recess, febrile patients in ICU with sinus focus and patients at high anesthetic and bleeding risk.