Prevalence of nasal polyps in Northern Portugal: a cadaver endoscopic study.

BACKGROUND: Epidemiological studies on chronic rhinosinusitis with nasal polyps are scarce and mostly based on questionnaires. Data obtained with such approaches can be unreliable, thus endoscopy is a prerequisite for an accurate estimate of the prevalence of nasal polyps. The objective of this study was to establish the frequency of nasal polyps in Northern Portugal, using nasal endoscopy in cadavers from a District Hospital. METHODS: The cadaver specimens deposited in the mortuary room of the hospital, every early morning on week days, from December 2012 to August 2013, were submitted to a systematic endoscopic examination of both nasal cavities, using a 25°, 2.y mm rigid endoscope from R.Wolf®. A review of the medical record of the cadavers was done, to search for cause of death, co-morbidities and past ENT history. RESULTS: A group of 200 consecutive Caucasian cadaver specimens were analyzed, 83 women and 117 men, with a mean age of death of 77.23 ± 12.29 years (range 34-97). The prevalence of nasal polyps was 5.5% (95% confidence interval, 2.34-8.66). No statistically significant association between the studied clinical variables (sex, allergic rhinitis, lower respiratory diseases and smoking) and the presence of nasal polyps was identified. CONCLUSION: The study provides the first endoscopic based epidemiological data on nasal polyps in Portugal, showing a prevalence for old age group in accordance with previous studies in Europe.

Systemic Immune Profile in Patients With CRSwNP.

The immune pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP) remains obscure. Our aim was to compare humoral immunity and white blood cell counts in patients with CRSwNP and controls. A prospective case-control study was carried out in 37 patients with CRSwNP and 34 controls without CRS. Clinical data were gathered through a systematic interview. Computed tomography scan, skin prick test, spirometry, and immunological parameters (leukocyte differential count, immunoglobulin classes, and immunoglobulin [Ig] G subclasses) in serum specimens were obtained. Statistical analysis was performed using SPSS v.23. The prevalence of chronic lower respiratory diseases was greater in the CRSwNP group (P < .001), but atopic disease had no significant difference. A significantly higher eosinophil (P < .001) and basophil relative count (P = .022) and a lower relative neutrophil count (P = .013) were found among CRSwNP group. Patients with CRSwNP had higher IgG1 (P = .022), but lower IgG2 (P = .014) and IgG3 (P = .018) serum levels compared to controls; IgG4, total IgG, IgA, IgM, and IgE serum levels did not differ between groups, as well as the prevalence of immunoglobulin classes or IgG subclasses deficiency. The variation observed in peripheral relative leukocyte count and the systemic IgG1 subclass shift are similar to what is known to happen in nasal polyp tissue. A unique systemic immune profile seems to be present in patients with CRSwNP.

Food-Specific IgE and IgG Antibodies in Patients With Chronic Rhinosinusitis With Nasal Polyps: A Case-Control Study.

EPOS 2012 states that investigation is needed to study a possible role for food allergy in the initiation and perpetuation of chronic rhinosinusitis with nasal polyps (CRSwNP). Our main goal was to compare serum levels of food-specific immunoglobulin G (IgG) and IgE antibodies in patients with CRSwNP and controls. A prospective case-control study with 33 patients with CRSwNP and 31 controls without CRS was carried out. Clinical data were gathered through a systematic interview and blood sample was collected. Enzyme-linked immunosorbent assay tests using OmegaDiagnostics kit with 40 food allergens for detection of specific IgG antibodies were performed and food-specific IgE antibodies were determined by immunoassay using ImmunoCAP. Immunoglobulin classes and IgG subclasses levels were also evaluated. Statistical analysis was performed using SPSS v.23. The overall sum of food IgG antibodies was significantly lower in CRSwNP compared to control group, and this difference was also observed for different specific IgG antibodies (corn, soya, grain legumes, pear and apple, berries, citric fruit). In controls, a positive correlation between IgG1 and the sum of food IgG antibodies was seen, but in CRSwNP group a negative correlation was found. In addition, a significant higher level of IgG1 and lower IgG2 and IgG3 was found among patients with CRSwNP. Levels of serum-specific IgE antibodies against multiallergen food mix (fx5) and against shrimp, strawberry, orange, rye, or egg yolk, as well as the sum of food IgE antibodies, did not differ significantly between the groups. These findings suggest that food allergy does not have an important role in CRSwNP etiopathogenesis, whether it is IgG or IgE mediated. Moreover, the observed suppression of specific IgG antibodies against food allergens, its negative correlation with IgG1 and the IgG1 switching in CRSwNP, can be related to deviated IgG responses against other targets (eg, airborne particles) and warrants future investigation.

Endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps: Clinical outcome and predictive factors of recurrence.

BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a highly prevalent disease of the nasal cavity and paranasal sinus, but its exact etiology is still unclear and remains a difficult-to-treat condition. HYPOTHESIS: Endoscopic sinus surgery (ESS) is an effective treatment for medically recalcitrant CRSwNP. There are independent variables that can predict surgical outcomes in patients with CRSwNP. OBJECTIVES: To evaluate ESS efficacy in CRSwNP treatment and to establish prognostic factors for disease recurrence. METHODS: Eighty-five patients with CRSwNP submitted to ESS, and a minimum follow-up of 9 months was selected. Patient demographics, occupational organic exposure (e.g., cotton, fuel gas, wood dust) and inorganic dust exposure (e.g., bleach, metals, cement), comorbidities, previous nasal surgeries, pre- and postoperative symptoms, ear, nose and throat examination findings, computed tomography results, and medical and surgical treatment information were collected from medical records. Statistical analysis was performed. RESULTS: All rhinologic symptoms improved after surgery, in a statistically significant way, with the best recovery rate for nasal obstruction and the worst for hyposmia. The major and minor complications rates were 1.2 and 15.3%, respectively. Disease recurrence occurred in 31% of the patient, but only 7% required surgical reintervention. Multivariate logistic regression analysis identified occupational dust exposure (p = 0.001) and non-immunoglobulin E (IgE) mediated asthma (p = 0.012) as independent predictive variables in CRSwNP recurrence, unlike the other tested variables: age, sex, IgE-mediated asthma, allergic rhinitis, smoking habits, nasal polyps endoscopic grade, Lund-Mackay score, and postoperative topical corticoid use. The adjusted logistic model presented a good discriminatory capacity with a receiver operating characteristic area under the curve of 0.82 (95% confidence interval, 0.73-0.91; p < 0.001). CONCLUSION: ESS proved to be an effective treatment in CRSwNP but with a considerable rate of recurrence. These results indicated an important correlation of occupational dust exposure and non-IgE-mediated asthma with disease recurrence.

Abnormal Congenital Location of Stapes' Superstructure: Clinical and Embryological Implications.

Congenital middle ear malformations are rare. Most part of them are usually associated with other malformations, such as aural atresia, microtia, and dysmorphic craniofacial features. A clinical case of a 24-year-old male with a right-sided conductive hearing loss since his childhood, without craniofacial malformation, is presented. He was proposed for exploratory tympanotomy under the suspicious diagnosis of otosclerosis. The surgery revealed an abnormal location of stapes' superstructure, which was attached to the promontory and had an isolated and mobile osseous footplate in the oval window. A stapes prosthesis was inserted and resulted in closure of the air-bone gap by 25 dB. A review of the literature was also performed using MEDLINE. Two theories diverge on the embryologic origin of the stapes. Our findings seem to be in favour of the theory that defines two different embryologic origins to the stapes.

The Portuguese version of the RhinoQOL Questionnaire: validation and clinical application.

INTRODUCTION: Rhinosinusitis constitutes an important health problem, with significant interference in personal, professional, and social functioning. This study presents the validation process of the Portuguese version of the RhinoQOL, to be used as a routine procedure in the assessment of patients with chronic rhinosinusitis. OBJECTIVE: To demonstrate that the Portuguese version of the RhinoQOL is as valid as the English version to measure symptoms and health-related quality of life in chronic rhinosinusitis. METHODS: The Portuguese version of the RhinoQOL was administered consecutively to 58 patients with chronic rhinosinusitis with and without nasal polyps, assessed for endoscopic sinus surgery. A follow-up survey was completed three months after surgery. Statistical analysis was performed to determine its psychometric properties. RESULTS: Face and content validity were confirmed by similar internal consistency as the original questionnaire for each sub-scale, and strong correlation between individual items and total score. The questionnaire was easy and quick to administer (5.5min). At three months, there was a significant decrease from baseline for all sub-scale scores, indicating clinical improvement, with an effect size considered as large. CONCLUSION: This study provides a questionnaire that is equivalent to the original English version, with good responsiveness to change, which can be especially valuable to measure the outcome of surgery.

Application of the Portuguese version of the Obstructive Sleep Apnea-18 survey to children.

UNLABELLED: Despite the significant prevalence of obstructive sleep apnea syndrome (OSAS) in children, the diagnosis and treatment of this condition is still challenging due to the difficulties inherent to objectively assessing the disease's severity. OBJECTIVE: To verify whether the Portuguese version of the Obstructive Sleep Apnea-18 (OSA-18) survey is as valid as its original version in English. METHOD: Prospective study. The OSA-18 was translated into Portuguese, culturally adapted, and tested in the Portuguese population. The caregivers of 51 children (aged from 2 to 12 years) diagnosed with OSAS answered the OSA-18-pv survey. Statistical analysis was used to assess the psychometric properties of the survey. RESULTS: Reliability analysis yielded a Cronbach's alpha of 0.821, confirming the survey's consistency. Converging validity was assessed using Pearson's correlation coefficient, which revealed a statistically significant correlation between individual data and total results. The survey can be easily and quickly answered (7.26 min). The outcomes of the OSA-18-pv showed that quality of life was poor in 14 children with OSAS (28%), moderate in 22 (43%), and high in 15 (29%). CONCLUSION: the OSA-18-pv is a valid tool and can be used to assess the impact on the quality of life of Portuguese children with OSAS.

The Portuguese version of the RhinoQOL Questionnaire: validation and clinical application, / Versão portuguesa do Questionário RhinoQOL: validação e aplicação clínica

ABSTRACT INTRODUCTION: Rhinosinusitis constitutes an important health problem, with significant interference in personal, professional, and social functioning. This study presents the validation process of the Portuguese version of the RhinoQOL, to be used as a routine procedure in the assessment of patients with chronic rhinosinusitis. OBJECTIVE: To demonstrate that the Portuguese version of the RhinoQOL is as valid as the English version to measure symptoms and health-related quality of life in chronic rhinosinusitis. METHODS: The Portuguese version of the RhinoQOL was administered consecutively to 58 patients with chronic rhinosinusitis with and without nasal polyps, assessed for endoscopic sinus surgery. A follow-up survey was completed three months after surgery. Statistical analysis was performed to determine its psychometric properties. RESULTS: Face and content validity were confirmed by similar internal consistency as the original questionnaire for each sub-scale, and strong correlation between individual items and total score. The questionnaire was easy and quick to administer (5.5 min). At three months, there was a significant decrease from baseline for all sub-scale scores, indicating clinical improvement, with an effect size considered as large. CONCLUSION: This study provides a questionnaire that is equivalent to the original English version, with good responsiveness to change, which can be especially valuable to measure the outcome of surgery.

RESUMO INTRODUÇÃO: A rinossinusite constitui um importante problema de saúde, com interferência significante na vida pessoal, e sócio-profissional dos pacientes. Este estudo apresenta o processo de validação da versão do RhinoQOL na língua portuguesa para ser usado em pacientes portadores de rinossinusite crônica. OBJETIVO: Demonstrar que a versão do RhinoQOL na língua portuguesa é tão válida quanto a versão inglesa na medição dos sintomas e qualidade de vida dos pacientes com rinossinusite crônica. MÉTODO: A versão em português do RhinoQOL foi aplicada consecutivamente a 58 pacientes com rinossinusite crônica, com e sem pólipos nasais, previamente à cirurgia endoscópica nasal, tendo sido reavaliados aos 3 meses de pós-operatório. Análise estatística foi realizada para determinar as suas propriedades psicométricas. RESULTADO: A validade de conteúdo foi confirmada por uma consistência interna similar à do questionário original, para cada sub-escala, e por uma forte correlação entre cada item e o score total. A aplicação do questionário foi fácil e rápida (5,5 min). Aos 3 meses, verificou-se uma redução significativa dos scores de todas as sub-escalas, indicando melhoria clínica, com um tamanho de efeito considerado grande. CONCLUSÃO: Este estudo fornece um questionário que é equivalente à versão original, com boa sensibilidade à mudança, o que pode ser especialmente útil na medição do impacto da cirurgia.

Questionario da Sindrome da Apneia Obstrutiva na Crianca-18: versao portuguesa / Application of the Portuguese version of the Obstructive Sleep Apnea-18 survey to children

Apesar da grande prevalência da Síndrome de Apneia Obstrutiva do Sono (SAOS) infantil, o seu diagnóstico e tratamento constituem um desafio devido à dificuldade em avaliar objetivamente a sua gravidade. OBJETIVO: Demonstrar que a versão portuguesa do questionário da Síndrome de Apneia Obstrutiva do Sono-18 (OSA-18) é um instrumento tão válido como a versão original, de língua inglesa. MÉTODO: Estudo prospectivo. O OSA-18 foi traduzido para a língua portuguesa, adaptado culturalmente e testado na nossa população. Os cuidadores de 51 crianças (dos 2 aos 12 anos de idade) com diagnóstico clínico de SAOS preencheram o OSA-18-pv. Foi realizada análise estatística para determinar as propriedades psicométricas do teste. RESULTADOS: A análise de confiabilidade demonstrou um valor de Cronbach α = 0,821, que confirma uma alta consistência. A validade convergente utilizando a correlação de Pearson demonstrou correlação estatisticamente significativa entre dados individuais e resultados totais. O questionário é facilmente e rapidamente realizado (7,26 min). Com base no resultado no OSA-18-pv, o impacto da SAOS na qualidade de vida é baixo em 14 casos (28%), moderado em 22 (43%) e alto em 15 crianças (29%). CONCLUSÃO: Validamos o questionário OSA-18-pv para o seu uso na avaliação do impacto na qualidade de vida das crianças com SAOS na população portuguesa. .

Despite the significant prevalence of obstructive sleep apnea syndrome (OSAS) in children, the diagnosis and treatment of this condition is still challenging due to the difficulties inherent to objectively assessing the disease's severity. OBJECTIVE: To verify whether the Portuguese version of the Obstructive Sleep Apnea-18 (OSA-18) survey is as valid as its original version in English. METHOD: Prospective study. The OSA-18 was translated into Portuguese, culturally adapted, and tested in the Portuguese population. The caregivers of 51 children (aged from 2 to 12 years) diagnosed with OSAS answered the OSA-18-pv survey. Statistical analysis was used to assess the psychometric properties of the survey. RESULTS: Reliability analysis yielded a Cronbach's alpha of 0.821, confirming the survey's consistency. Converging validity was assessed using Pearson's correlation coefficient, which revealed a statistically significant correlation between individual data and total results. The survey can be easily and quickly answered (7.26 min). The outcomes of the OSA-18-pv showed that quality of life was poor in 14 children with OSAS (28%), moderate in 22 (43%), and high in 15 (29%). CONCLUSION: the OSA-18-pv is a valid tool and can be used to assess the impact on the quality of life of Portuguese children with OSAS. .