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Ciliary dysfunction may result in chronic airway inflammation and infection causing injury and structural changes to the airway epithelium, leading to a variety of diseases, like bronchiectasis and primary diffuse chronic rhinosinusitis (CRS). Currently, ciliary beating analysis has mainly been studied through the measure of the ciliary beating frequency (CBF) by high-speed digital video microscopy (HSDV). However, a normal CBF has been described in different forms of primary and acquired ciliary dyskinesia.
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BACKGROUND: Supportive care is the cornerstone of management of adult and paediatric Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, consensus on the modalities of supportive care is lacking. OBJECTIVES: Our aim in this international multicentric Delphi exercise was to establish a multidisciplinary expert consensus to standardize recommendations regarding supportive care in the acute phase of SJS/TEN. METHODS: Participants were sent a survey via the online tool SurveyMonkey, consisting of 103 statements organized into 11 topics: multidisciplinary team composition, suspect drug management, infection prevention, fluid resuscitation and prevention of hypothermia, nutritional support, pain and psychological distress management, management of acute respiratory failure, local skincare, ophthalmological management, management of other mucosa, and additional measures. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). The results were analysed according to the RAND/UCLA Appropriateness Method. RESULTS: Forty-five participants from 13 countries (on three continents) participated. After the first round, a consensus was obtained for 82.5% of the 103 initially proposed statements. After the second round, a final consensus was obtained for 102 statements. CONCLUSIONS: We have reached an international Delphi-based consensus on best supportive care practice for SJS/TEN. Our expert consensus should help guide physicians in treating patients with SJS/TEN and thereby improve short-term prognosis and the risk of sequelae.
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Síndrome de Stevens-Johnson , Adulto , Criança , Consenso , Humanos , Pesquisa , Estudos Retrospectivos , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/terapiaRESUMO
OBJECTIVE: The aim of this review is to determine an efficient and safe primary strategy care for paediatric epistaxis. DATA SOURCES: We searched PubMed and Cochrane databases for studies referenced with key words 'epistaxis AND childhood'. This search yielded 32 research articles about primary care in childhood epistaxis (from 1989 to 2015). Bibliographic references found in these articles were also examined to identify pertinent literature. We compared our results to the specific management of adult epistaxis classically described in the literature. RESULTS: Epistaxis is one of the most common reasons for referral of children to a hospital ENT outpatient department. The bleeding usually originates from the anterior septum, as opposed to adults. Crusting, digital trauma, foreign bodies and nasal colonisation with Staphylococcus aureus have been suggested as specific nosebleed factors in children. Rare aetiologies as juvenile nasopharyngeal angiofibroma appear later during adolescence. There are different modes of management of mild epistaxis, which begin with clearing out blood clots and bidigital compression. An intranasal topical local anaesthetic and decongestant can be used over 6â years of age. In case of active bleeding, chemical cauterisation is preferred to anterior packing and electric cauterisation but is only feasible if the bleeding site is clearly visible. In case of non-active bleeding in children, and in those with recurrent idiopathic epistaxis, antiseptic cream is easy to apply and can avoid 'acrobatic' cauterisation liable to cause further nasal cavity trauma. CONCLUSIONS: Aetiologies and treatment vary with patient age and the existence or not of active bleeding at the time of the examination. Local treatments are usually easy to perform, but physicians have to ponder their indications depending on the possible complications in order to inform parents and to know paediatric epistaxis specificities.
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Epistaxe/terapia , Pediatria/métodos , Adolescente , Anestésicos/farmacologia , Anestésicos/uso terapêutico , Cauterização/instrumentação , Cauterização/métodos , Criança , Pré-Escolar , Eletrocoagulação/instrumentação , Eletrocoagulação/métodos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Epistaxe/fisiopatologia , Feminino , Humanos , Lidocaína/efeitos adversos , Lidocaína/farmacologia , Lidocaína/uso terapêutico , Masculino , Pediatria/estatística & dados numéricos , Nitrato de Prata/efeitos adversos , Nitrato de Prata/uso terapêuticoAssuntos
Mucosa Nasal/fisiopatologia , Rinite/diagnóstico , Rinite/fisiopatologia , Adulto , Resistência das Vias Respiratórias , Estudos de Casos e Controles , Complacência (Medida de Distensibilidade) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Adulto JovemAssuntos
Endoscopia , Seio Frontal , Mucocele/diagnóstico por imagem , Mucocele/cirurgia , Doenças dos Seios Paranasais/diagnóstico por imagem , Doenças dos Seios Paranasais/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
Diagnosis in rhinology is currently based on the concept of inflammation (chronic rhinosinusitis [CRS]) or the clinical concept of chronic nasal dysfunction (CND). The complementarity between these two approaches can be discussed by a critical review of the literature structured by the analysis of the fundamental and diagnostic bases and the therapeutic implications linked to each. The concept of CRS is based on the anatomical continuity of the nasal and sinus respiratory mucosa and molecular biology data, seeking to analyze the mechanisms of chronic inflammation and to identify proteins and biomarkers involved in the different supposed endotypes of chronic inflammation of this mucosa. The concept of CND seeks to analyze medical, instrumental or surgical diagnostic and therapeutic strategies, taking account of both inflammatory and non-inflammatory causes impacting the anatomy or physiology of each of the three noses (olfactory, respiratory and sinus) that make up the mid-face sinonasal organ of evolution-development (Evo-Devo) theory. Thus, the concept of CRS offers an endotypic approach, based on biological characterization of mucosal inflammation, while the concept of CND offers a compartmentalized phenotypic and pathophysiological approach to sinonasal diseases. The joint contribution of these two concepts in characterizing nasal functional pathology could in future improve the medical service provided to patients.
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Pólipos Nasais , Rinite , Sinusite , Humanos , Rinite/diagnóstico , Rinite/terapia , Pólipos Nasais/diagnóstico , Inflamação , Sinusite/diagnóstico , Sinusite/terapia , Nariz , Doença CrônicaRESUMO
OBJECTIVES: To determine the indications, anesthesiological and surgical procedure and interest of drug-induced sleep endoscopy in the treatment of adult obstructive sleep apnea syndrome. DESIGN: A redactional committee of 17 experts was set up. Conflicts of interest were disclosed and followed up throughout the process of drawing up the guidelines. The work received no funding from any firm dealing in health products (drugs or devices). The GRADE (Grading of Recommendations Assessment, Development and Evaluation) method was applied to assess the quality of the data on which the guidelines were founded. It was stressed that strong recommendations should not be made on the basis of poor-quality or insufficient data. METHODS: The committee studied 29 questions on 5 topics: indications and contraindications, anesthetic technique, surgical technique, interpretation and reporting of results, and management guided by results. RESULTS: Expert review and application of the GRADE method led to 30 guidelines: 10 with high level of evidence (Grade 1+ or 1-), 19 with low level (GRADE 2+ or 2-) and 1 expert opinion. CONCLUSION: Experts fully agreed on the strong guidelines formalizing the indications and modalities of drug-induced sleep endoscopy for adult obstructive sleep apnea syndrome.
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Apneia Obstrutiva do Sono , Adulto , Endoscopia/métodos , Humanos , Nariz , Sono , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/cirurgiaRESUMO
INTRODUCTION: Chronic rhinosinusitis with nasal polyps (CRSwNP) is one of the categories of chronic rhinosinusitis and is defined by the presence of bilateral polyps. It is frequently associated with other conditions (asthma, atopy, aspirin intolerance), which worsen its prognosis. STATE OF ART: The pathophysiology of CRSwNP is still poorly understood. The genesis of polyps is thought to be based on an initial epithelial lesion caused by environmental factors in the context of self-maintained chronic local inflammation. Multiple local and general factors can be involved in this inflammation, which is mainly of Th2 type in Europe. Abnormalities of the epithelial barrier and the immune system (eosinophilia, cytokines, T and B lymphocytes), genetic factors and pathogens, including Staphylococcus aureus, have been incriminated. The treatment of CRSwNP is mainly based on the application of local corticosteroids. Surgery remains an important part of patient management where CRSwNP becomes resistant to topical therapy. The management of CRSwNP may be at a turning point thanks to the arrival of biological therapies (anti-IgE, anti-IL-5, anti-IL-4/IL-13) the initial results of which are promising. PERSPECTIVES/CONCLUSIONS: With the new concept of endotypes, current avenues of research are moving towards a better understanding of the inflammatory mechanisms of CRSwNP. Immunotherapy appears to be a promising future for the treatment of CRSwNP.
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Eosinofilia , Pólipos Nasais , Rinite , Sinusite , Adulto , Doença Crônica , Europa (Continente) , Humanos , Pólipos Nasais/terapia , Rinite/terapiaRESUMO
The present article reviews the molecular and cellular mechanisms involved in the pathophysiology of chronic rhinosinusitis with nasal polyps (CRSwCRSwNP) and underlying the action mechanisms of biotherapies. Biotherapy uses substances naturally produced by the organism or their specific antagonists targeting a proinflammatory mechanism. CRSwCRSwNP is a form of chronic rhinosinusitis (CRS), which is classically subdivided in to 2 types according to the presence of polyps. In recent years, the concept of endotypes emerged, with a more exhaustive definition of the types of CRS according to inflammatory mechanism, with a view to developing personalized treatments. CRSwNP pathophysiology is poorly understood. Polyps arise from a primary epithelial lesion in a context of chronic local inflammation, mainly type 2 in Europe, implicating eosinophils, IgE, Th2 cytokines (IL-4/IL-13, IL-5) and T and B cells. Biotherapy seems promising in CRSwNP. The present review details the various pathophysiological pathways underlying the action mechanisms of biotherapies, and the various published studies, assessing efficacy and mode of action in the treatment of CRSwNP.
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Pólipos Nasais , Rinite , Sinusite , Adulto , Terapia Biológica , Doença Crônica , Humanos , Pólipos Nasais/terapia , Rinite/terapia , Sinusite/terapiaRESUMO
The treatment of sleep disorders has been strongly impacted by the COVID-19 pandemic. When the lockdown is over, resumption of usual patient care will require precautions to limit the risk of contamination for patients and caregivers. In this document, the French Association of Otorhinolaryngology and Sleep disorders (AFSORL) and the French Society of Otorhinolaryngology (SFORL) put forward a summary of the measures for continuing the treatment of sleep apnoea syndrome in these new practice conditions. Emphasis is placed on teleconsultation, methods of nocturnal sleep studies, the conditions for treatment by continuous positive airway pressure (CPAP) ventilation, and the postponement of more invasive treatments.
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Pressão Positiva Contínua nas Vias Aéreas , Infecções por Coronavirus/epidemiologia , Otolaringologia , Pneumonia Viral/epidemiologia , Síndromes da Apneia do Sono/terapia , COVID-19 , Humanos , Pandemias , Síndromes da Apneia do Sono/diagnósticoRESUMO
In Otorhinolaryngology - Head and Neck Surgery, clinical examination and invasive procedures on the respiratory tract and on airway-connected cavities, such as paranasal sinuses and the middle ear, expose people to direct transmission of SARS-CoV-2 by inhalation or ocular projection of contaminated droplets, and to indirect transmission by contact with contaminated hands, objects or surfaces. Estimating an R0 of COVID-19 at around 3 justified postponing non-urgent face-to-face consultations and expanding the use of teleconsultation in order to limit the risks of SARS-CoV-2 infection of patients or health workers and comply with the lockdown. The health authority recommends cancellation of all medical or surgical activities, which are not urgent as long as this does not involve a loss of chance for the patient. The purpose of this cancellation is to significantly increase critical care capacity, prioritise the reception of patients with COVID-19, prioritise the allocation of staff and provision of the equipment necessary for their medical or surgical management, and contribute to the smooth running of downstream critical care within their establishment. Another goal is to reduce the risks of patient contamination within healthcare facilities. This document provides guidance on how to proceed with and adapt ENT surgery in the current pandemic context, as well as on the management of postponed operations. This best practice advice must of course be adapted in each region according to the development of the epidemic and pre-existing arrangements. Their local application can only be decided within the framework of collaboration between the ENT teams, the operational hygiene units and all the other specialties concerned.
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Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Procedimentos Cirúrgicos Otorrinolaringológicos/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus/isolamento & purificação , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , França/epidemiologia , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias de Cabeça e Pescoço/virologia , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Otolaringologia/métodos , Otolaringologia/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , SARS-CoV-2RESUMO
The purpose of this article is to give rhinologists advice on how to adapt their standard practice during the COVID-19 pandemic. The main goal of these recommendations is to protect healthcare workers against COVID-19 while continuing to provide emergency care so as to prevent loss of chance for patients. We reviewed our recommendations concerning consultations, medical prescriptions and surgical activity in rhinology.
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Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Otorrinolaringopatias , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , COVID-19 , Infecções por Coronavirus/transmissão , Árvores de Decisões , Humanos , Salas Cirúrgicas , Otolaringologia/normas , Otorrinolaringopatias/diagnóstico , Otorrinolaringopatias/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos , Pneumonia Viral/transmissão , Guias de Prática Clínica como AssuntoRESUMO
AIMS: Unilateral Recurrent Laryngeal Nerve (RLN) palsy is responsible for dysphonia and difficulties in swallowing. The role of unilateral RLN palsy on dyspnea is not fully elucidated. Our hypothesis is that air leak could be responsible for development of hyperventilation syndrome (HVS). OBJECTIVE: The objective of this study was to determine in patients with unilateral RLN palsy if dyspnea could be associated with HVS. MATERIAL AND METHODS: Over a 12-month period, all patients with permanent unilateral RLN palsy after thyroidectomy complaining from the onset of unexplained dyspnea were tested. Measurement of Nijmegen score, an hyperventilation test, an arterial blood gas, lung function and cardiac tests were performed. The diagnosis of HVS was defined if at least two criteria were present among: Nijmegen score>23; reproduction of at least 2 usual symptoms during hyperventilation test; an expirated pressure of CO2 (EpCO2)<30mmHg or<90% of the initial EpCO2 after a 5minutes recovery period following a 3minutes voluntary hyperventilation. RESULTS: Ten out of 366 patients with thyroidectomy for benign disease had permanent unilateral RLN palsy and dyspnea. Among 10 patients included, 8 were diagnosed having HVS on the hyperventilation test without cardiac/lung dysfunction. CONCLUSION: In summary, this study is a proof of concept that HVS might be involved in dyspnea associated with unilateral RLN palsy.
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Hiperventilação/diagnóstico , Tireoidectomia/efeitos adversos , Paralisia das Pregas Vocais/etiologia , Adulto , Idoso , Alcalose Respiratória/etiologia , Gasometria , Dispneia/etiologia , Feminino , Humanos , Hiperventilação/etiologia , Hipocapnia/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Síndrome , Paralisia das Pregas Vocais/complicaçõesRESUMO
Surgical results in obstructive sleep apnea syndrome (OSAS) vary greatly, whatever the surgical technique or site treated. Most authors agree that rigorous patient selection is logical and mandatory. Drug-induced sleep endoscopy (DISE) was introduced in 1991 and has been rediscovered and used extensively since the 2000s. It mimics sleep in order to observe the upper airway on flexible endoscopy. A review of the DISE literature was performed, and is reported in two parts. The present first part describes the technique: drugs, practical anesthesiologic and ENT modalities, reproducibility, and limitations.
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Obstrução das Vias Respiratórias/diagnóstico , Endoscopia , Hipnóticos e Sedativos/administração & dosagem , Apneia Obstrutiva do Sono/diagnóstico , Sono , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/terapia , Endoscopia/métodos , Humanos , Seleção de Pacientes , Polissonografia , Valores de Referência , Reprodutibilidade dos Testes , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapiaRESUMO
Surgical results in obstructive sleep apnea syndrome (OSAS) vary greatly, whatever the surgical technique or site. Most authors agree that rigorous patient selection is logical and mandatory. Drug-induced sleep endoscopy (DISE) was introduced in 1991 and has been rediscovered and used extensively since the 2000s. It attempts to mimic natural sleep in order to observe the upper airway on flexible endoscopy in a situation in which obstruction may occur. A review of the DISE literature was performed, and is reported in two parts. The present second part reports DISE results concerning obstruction sites, impact on treatment efficacy and the consequent indications for this exploration.
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Endoscopia , Hipnóticos e Sedativos/administração & dosagem , Polissonografia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Endoscopia/instrumentação , Endoscopia/métodos , Humanos , Seleção de Pacientes , Apneia Obstrutiva do Sono/etiologia , Resultado do TratamentoRESUMO
OBJECTIVES: The authors present the guidelines of the French Oto-Rhino-Laryngology - Head and Neck Surgery Society (Société Française d'Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou: SFORL) on epistaxis in high blood pressure. METHODS: A multidisciplinary work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members' individual experience. They were then read over by an editorial group independent of the work group. The final version was established in a coordination meeting. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence. RESULTS: It is recommended to measure the blood pressure of patients in acute-phase epistaxis (Grade A); to control high blood pressure medically in the acute phase of bleeding, to reduce its duration; to monitor blood pressure at the waning of nosebleed; and to control high blood pressure medically in the waning phase to reduce the risk of recurrence. In case of persistent high blood pressure on waning of severe epistaxis, it is recommended to prescribe cardiovascular evaluation to screen for underlying hypertensive disease (Grade B).
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Epistaxe/etiologia , Hipertensão/complicações , Epistaxe/prevenção & controle , Humanos , Hipertensão/terapia , Prevenção Secundária , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: The authors present the guidelines of the French Society of Otorhinolaryngology concerning the management of epistaxis during antithrombotic therapy. METHODS: A review of the literature was performed by a multidisciplinary work group. Guidelines were drafted, then re-edited by a reading group independent of the work group to produce the final text. The proposed recommendations were graded A, B, C or expert opinion, on decreasing levels of evidence. RESULTS: Before any decision to modify antithrombotic treatment, it is recommended to screen for overdose and assess the risk of thrombosis. In stented patients, dual antiplatelet therapy must be maintained during the month following stenting and, if possible, for 3 months. In epistaxis with antivitamin K (AVK) overdose controlled by packing, corrective measures are based on the International Normalized Ratio (INR). In uncontrolled epistaxis, it is recommended to stop AVK, administer antidotes and regularly monitor INR. In case of intravascular embolization, it is not recommended to alter anticoagulant treatment.
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Anticoagulantes/efeitos adversos , Transtornos da Coagulação Sanguínea , Epistaxe/induzido quimicamente , Epistaxe/terapia , Otolaringologia , Sociedades Médicas , Anticoagulantes/administração & dosagem , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Medicina Baseada em Evidências , França , Humanos , Trombose/prevenção & controleRESUMO
OBJECTIVES: The authors present the guidelines of the French Oto-Rhino-Laryngology - Head and Neck Surgery Society (Société Française d'Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou: SFORL) on second-line treatment of epistaxis in adults, after failure of anterior and/or anterior-posterior nasal packing. METHODS: A multidisciplinary work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members' individual experience. They were then read over by an editorial group independent of the work group. The final version was established in a coordination meeting. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence. RESULTS: Arterial embolization should be performed by an experienced interventional neuroradiologist with adequate technical facilities, to reduce the risk of complications. Cerebral and supra-aortic vessel CT angiography should be performed in case of post-traumatic epistaxis with suspected internal carotid injury. In case of persistent bleeding despite endoscopic hemostasis of the sphenopalatine artery, anterior ethmoidal artery hemostasis should be performed via a medial canthal incision, with endoscopic assistance as needed. In case of persistent epistaxis despite the usual surgical and neuroradiological procedures, surgical exploration of the sinonasal cavities should be performed, with elective coagulation in case of bleeding from secondary branches, and/or ethmoidectomy in case of diffuse bleeding. A decision-tree was drawn up for the management of second-line treatment of epistaxis.