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ABSTRACT Objective: The aim of this study was to describe the phases of a decannulation protocol and the results from its application in hospitalized children. Methods: This is a retrospective, observational study. Data were collected from medical records of decannulated patients followed up in a pediatric hospital in Belo Horizonte, Minas Gerais between 2011 and 2021. Results: Among the children followed up in the service (n=526), 23% (n=120) were successfully decannulated. Children aged between 2 months and 16 years, with a mean age of 4 years, 69% of whom were male, were evaluated. About 75% of the patients have tracheostomy due to upper airway obstruction and 60% of these due to acquired subglottic stenosis. At the beginning of the decannulation protocol, 5.5% of the patients had moderate oropharyngeal dysphagia, while 80.4% had normal swallowing. Correction in the upper airway pre-decannulation was performed in 39.5% of the patients, dilation in 63.8%, and endoscopic correction was performed in 55.3%. After performing the decannulation, none of the patients had complications. Conclusions: The described decannulation protocol is safe, since no complications such as death and need for recannulation happened.

Introduction and purpose Pregnancy-induced rhinitis (PIR) manifests as nasal congestion, with resolution of symptoms after delivery. Pregnancy-induced rhinitis is a distinct condition from allergic rhinitis, it may not respond to treatment for allergic rhinitis. The first stage in providing adequate and effective management of PIR is to have a clear and appropriate diagnosis. Therefore, each patient-specific management of PIR must take careful consideration of a variety of circumstances. The aim of this study was to conduct a literature review on pregnancy-induced rhinitis. A literature review was carried out in the PubMed, MEDLINE, and Scopus databases using the terms ‘rhinitis and pregnancy’. Brief description of the state of knowledge Physiological factors underlying PIR are not well understood at the moment. There is no single explanation for the pathophysiological mechanism that would account for the changes in PIR. Nasal congestion is the primary nasal symptom in pregnancy-induced rhinitis. It can result in night-time mouth breathing and poor sleep quality. The mother's sleep may be negatively impacted by nasal congestion resulting in maternal hypertension, pre-eclampsia, and intrauterine growth retardation. Increasing awareness not only benefits pregnant patients' quality of life but also has a favourable impact on how a pregnancy turns out. Summary PIR has gained relevance in recent years due to its major effects on maternal quality of life as well as the identification of a relationship with OSAS in the mother and potential harmful consequences on the foetus. The mother's quality of life is significantly impacted by PIR, as shown, thus both the otorhinolaryngologist and the obstetrician must use caution in the early identification and treatment of pregnancy-induced rhinitis.

ABSTRACT Purpose: to compare nasal geometry between two groups of patients with different degrees of obstructive sleep apnea and to correlate apnea-hypopnea index, apnea severity and degree of daytime sleepiness with nasal areas and volume. Methods: a total of 20 adults (15 women and 5 men, mean age of 52.0±11.4 years old) without nasal obstruction were submitted to polysomnography. The subjects were divided into two groups: a) 10 individuals without apnea or with mild-grade apnea; b) 10 with moderate or severe apnea. Nasal geometry was evaluated by acoustic rhinometry. The volume, comprising the distance from the nasal valve to the posterior part of the middle nasal turbinate, and the three sectional areas corresponding to nasal valve, anterior part of the inferior nasal turbinate and posterior part of the inferior nasal turbinate, were considered. The Shapiro-Wilk, Mann-Whitney, Student’s t tests for independent samples and Spearman’s correlation coefficient were used for the analysis, with a significance level lower than 5%. Results: group 2 presented lower values in the area corresponding to the nasal valve (on the right), and higher values in the nasal turbinate areas. There was no correlation between the drowsiness scale and nasal areas and volumes. Conclusion: the area of the nasal valve was unilaterally smaller in the group with moderate and severe apnea. There was no correlation between volumes and nasal areas and excessive daytime sleepiness.

ABSTRACT Changes in head posture have been observed as a compensatory mechanism for the nasal airflow impairment. This study aimed to compare the craniocervical posture between children with normal and decreased nasal patency and correlate nasal patency with craniocervical posture. Children aging from six to twelve years went through nasal patency and craniocervical assessments. The biophotogrammetric measures of craniocervical posture used were Cervical Distance (CD), Head Horizontal Alignment (HHA) and Flexion-Extension Head Position (FE), evaluated by SAPO software (v.0.68). Nasal patency was measured using Peak Nasal Inspiratory Flow meter (PNIF) and Nasal Obstruction Symptom Evaluation (NOSE) scale. One hundred thirty-three children were distributed into two groups: G1 (normal nasal patency - PNIF higher than 80% of predicted value) with 90 children; G2 (decreased nasal patency - PNIF lower than 80% of predicted value) with 43 children. Differences between groups were not found in CD and HHA measures. FE was significantly higher in G2 than G1 (p=0.023). Negative weak correlation between FE and %PNIF (r=-0.266; p=0.002) and positive weak correlation between CD and PNIF (r=0.209; p=0.016) were found. NOSE scores negatively correlated with PNIF (r=-0.179; p=0.039). Children with decreased nasal patency presented greater head extension. This postural deviation is prone to increase as nasal airflow decreases, thus indicating the relationship between craniocervical posture and nasal patency. Lower values of PNIF reflected on additional problems caused by nasal obstruction symptoms.

Concha bullosa (CB) and nasal septum deviation (NSD) can be a congenital trait or be linked to respiratory pathologies. Symptoms include snoring, sleep apnea, and other respiratory disorders that can be easily recognized by relatives and partners. CB and NSD are easy to identify and can be very applicable in the human identification process during routine forensic anthropological investigations. A physical-anthropological analysis was carried out by observing the presence of NSD and CB in 57 skulls from a Brazilian skull collection. Of the 57 skulls, 14 (24.6%) showed septal deviation, 19.3% to the right side and 5.3% to the left side. Regarding CB, this trait was observed in 16 skulls (34.8%) unilaterally and bilaterally in 9 skulls (19.6%). Our results are compatible with the literature and we suggest that CB influences contralateral NSD. The frequency and clinical aspects of these traits may be considered in a forensic investigation.

TEMA: identificar as alterações morfofuncionais decorrentes de quinze anos de obstrução nasal total em um caso de sinéquia de palato mole e paredes faríngeas pós blastomicose. PROCEDIMENTOS: o trabalho foi baseado no estudo de caso de um adulto do gênero feminino, de 26 anos de idade, que chegou a um centro especializado em deformidades craniofaciais, com a queixa de não conseguir respirar pelo nariz. Sua dificuldade respiratória é decorrente de uma aderência total do palato mole com as paredes faríngeas, como sequela da blastomicose que teve no palato aos 11 anos de idade. RESULTADOS: na entrevista, a paciente relatou queixa de cefaléia, halitose, pouco rendimento físico, sonolência diurna e sono agitado durante a noite. Referiu também anosmia, mastigação lenta e engasgos frequentes. Durante a avaliação, observou-se respiração exclusivamente oral do tipo superior, mastigação bilateral alternada e lenta, deglutição adaptada e ressonância hiponasal de grau grave. Observou-se ainda face longa, perfil convexo, mandíbula retruída e olheiras. Os lábios da paciente encontravam-se entreabertos e ressecados, sendo o superior fino e o inferior evertido e avolumado e o palato duro apresenta-se atrésico, estreito e profundo. CONCLUSÃO: as características da paciente em questão são compatíveis com a Síndrome do Respirador Oral e pode-se supor que sejam consequências morfofuncionais de uma obstrução nasal total.BACKGROUND: to identify the consequences that arising from fifteen years of total nasal obstruction in a case of post blastomicose palato and pharynx's lesion. PROCEDURES: this article was based on a case report of a 26-years-old female subject, who came to a specialized center on craniofacial deformities, complaining about her mouth breathing. Her respiratory difficulty stems from a total tack of palate and pharynx, as a blastomicose sequel that she had when 11-year-old. RESULTS: during the interview, the patient said that she had poor physical conditioning, daytime sleepiness, slow chewing and choking during the swallowing process. At evaluation, it was noted exclusive oral breath of the superior type, alternate chew on both sides, adapted swallowing and serious hyponasal resonance. we also noted long face, with convex profile, retruded jaw and dark circles under the eyes. Her lips were half-opened and dried up, with the upper one thinner and the lower part turned round and augmented. The patient's palate is atresic, strait and deep. CONCLUSION: the patient's characteristics are compatible with Oral Breath Syndrome and anatomic-functional consequences of a total nasal obstruction.

OBJETIVO: identificar a presença de sinais de alterações na expiração de crianças asmáticas. MÉTODO: este estudo foi realizado com 30 crianças com idades entre 6 e 10 anos de ambos os sexos com diagnóstico clínico de asma confirmado pelo prontuário médico e 30 crianças não asmáticas também de ambos os sexos na mesma faixa etária. Foi avaliada a aeração nasal com o espelho milimetrado de Altmann, sendo mensurado o escape de ar nasal objetivando a verificação da saída uni ou bilateral do ar e a relação de simetria entre a narina direita e a esquerda. As imagens foram importadas para o computador por meio do scanner HP da série Scanjet 2400. A análise foi realizada no software Scion Image for Windows (Alpha 4.0.3.2). Para análise das variáveis quantitativas entre grupos foi aplicado o teste t-student e para a análise intragrupos foi aplicado o teste t-Student pareado.Todas as conclusões foram tomadas ao nível de significância de 5%, sendo usados o Excel 2000 e o SPSS v8.0, para as análises. RESULTADOS: não foram encontradas diferenças estatisticamente significantes entre as crianças asmáticas e não-ásmáticas, acerca das mensurações quanto à área total e quanto às áreas das narinas direita e esquerda. CONCLUSÃO: não foi identificada a presença de sinais de alterações na expiração de crianças asmáticas, desta forma, faz-se necessário um estudo mais específico das funções nasal e pulmonar.PURPOSE: to identify the symptoms of changes in the exhalation of asthmatic children. METHOD: this study was conducted with 30 children from 6 to 10 year-old, of both genders and with asthma clinical diagnosis confirmed by medical records and 30 non-asthmatic children from 6 to 10 year-old, of both genders, and with same age. We evaluated the nasal ventilation with Altmann millimeter nasal mirror measuring the nasal air escape in order to check their unilateral or bilateral air output and the relation of symmetry between the right and left nostril. The images were imported into the computer through HP scanner - Scanjet 2400 series. The analysis was performed by the Scion Image software for Windows (Alpha 4.0.3.2). All conclusions were based on a significance level of 5%, using Excel 2000 and SPSS v8.0 for the analysis. RESULTS: there were no significant differences between asthmatic and non-asthmatic children about the measurements of total area and the right and left nostril areas. CONCLUSION: there were no symptoms of changes in the exhalation of asthmatic children, being necessary a more specific study as for the nasal and pulmonary functions.

Objective: to describe the management and surgical options used in the service of Otorhinolaryngology, Hospital Universitario del Caribe for the management of juvenile nasopharyngeal angiofibroma (JNA).Methodology: case series of patients with JNA, during the years 2007-2010, which were staged according to the classification of FISCH (1983). The extent of tumor, preoperative studies, surgical approach, results and complications were evaluated. Results: six male patients were diagnosed and treated, with an age range of 15 to 24. The surgical approachs were: endoscopic transnasal resection for lesions in stage I and II, and midfacial degloving for stage III, both of them with good results.Conclusion: the surgical approach of ANJ must be determined considering the size and location of the tumor, extensión to surrounding tissues and the experience of the surgical team.RESUMENObjetivo: describir el manejo y diferentes opciones quirúrgicas utilizadas en el servicio de Otorrinolaringología del Hospital Universitario del Caribe para el manejo del Angiofibroma Nasofaríngeo Juvenil (ANJ).Metodología: serie de casos de pacientes con diagnóstico de ANJ, durante los años 2007-2010, los cuales fueron estadificados según la clasificación de FISCH (1983). Se evaluaron: la extensión tumoral, los estudios preoperatorios, el abordaje quirúrgico, los resultados y las complicaciones.Resultados: seis pacientes masculinos fueron diagnosticados e intervenidos, con un rango de edad de 15 a 24 años. Se utilizaron dos abordajes quirúrgicos, para las lesiones en estadios I y II se realizó resección endoscópica transnasal y para el estadio III degloving mediofacial, con buenos resultados.Conclusión: el abordaje quirúrgico más apropiado para el ANJ debe ser determinado considerando el tamaño y la localización del tumor, extensión a estructuras adyacentes y experiencia del equipo quirúrgico.

Se presenta el caso de un paciente de 45 años de edad, raza blanca, con antecedentes de salud, valorado en la consulta externa delPoliclínico Universitario "Fermín Valdés Domínguez" del municipio Viñales en Pinar del Río, en enero de 2007, que se presenta con una lesión tumoral a nivel de partes blandas de la mejilla derecha de un año de evolución, acompañado de obstrucción nasal, rinolalia, diplopia y buen estado general. Examen físico: aumento de volumen de la hemicara derecha de consistencia sólida, múltiples adenopatías cervicales derechas y estrabismo divergente del ojo derecho con reducción de la hendidura palpebral, la tomografía axial computarizada, reveló una opacidad tumoral del seno maxilar derecho que destruye paredes anterior, superior y posterior, la biopsia informó un diagnóstico de linfoma no hodgkin agresivo, difuso de células grandes tipo B y le fue indicado tratamiento quimioterápico y radioterápico. Dada la evolución clínica favorable del paciente, se reevaluó radiológicamente al año, persistiendo engrosamiento óseo del techo del seno maxilar. Se presentan las experiencias derivadas de la atención del caso y revisan la literatura médica con especial referencia al diagnóstico y tratamiento.A 45 years-old, Caucasian patient with a past health was examined at "Fermin Valdes Dominguez" outpatient clinic in Viñales, Pinar del Rio (January 2007) presenting a tumoral lesion in the soft tissues of the right cheek with a year of natural history which was present with nasal obstruction, rinolalia, diplopia and good general status; finding at physical examination an enhancement of volume in the right hemi-face of solid consistency, multiple right cervical adenopathies and divergent strabismus of the right eye with a reduction of the palpebral cleft. Axial Computerized Tomography revealed a tumoral opacity of the right maxillary sinus destroying the superior, anterior and posterior walls. The results of the biopsy showed the diagnosis of a diffuse aggressive no-Hodgkin lymphoma of type-B cells; indicating chemotherapy and radiotherapy. The patient's clinical progress was favorable having a radiological re-evaluation at a year of treatment, the osseous thickness of the roof in the maxillary sinus persisted. The authors presented the experiences derived from the case and the review of the medical literature making specific reference to the diagnosis and treatment.

Se realizó un estudio observacional de tipo transversal en la Mina-Planta de Zeolita Tasajeras, que pertenece al municipio de Ranchuelo, Villa Clara, en el período comprendido entre junio y septiembre de 1997, con el objetivo de determinar el estado clínico y funcional ventilatorio de los trabajadores. A los 73 pacientes con 2 o más años en la fábrica se les aplicó un cuestionario, y se les realizó un examen físico y una prueba funcional ventilatoria. Los resultados más relevantes corroboran que los trabajadores del área de mayor exposición al polvo refieren un mayor número de síntomas respiratorios, sobre todo los fumadores. Sin embargo, el 94,5 % presenta un examen físico de tórax negativo, el 68,8 % de los pacientes con prueba funcional ventilatoria patológica integran el área planta, son fumadores el 62,5 %, y el 63,1 % no usa con frecuencia el filtro respiratorio como medio de protección individualA croos-sectional observational study was carried out at the mine-plant zeolite in Tasajeras, municipality of Ranchuelo, Villa Clara, from June to September, 1997, aimed at determining the clinical and functional ventilatory status of the workers. 73 patients with 2 or more years in the factory answered a questionnarie and underwent a physical examination and a functional ventilatory test. According to the results, those workers that were more exposed to dust had a higher number of respiratory symptoms, mainly smokers. However, 94,5 % had a negative chest physical examination. 68.8 % of the area patients with pathological functional ventilatory test work in the of the plant. 62.5 % are smokers and 63.1 % do not use frequently the respiratory filter as a menas of individual protection.