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Introduction: Chronic rhinosinusitis is an inflammatory condition of the nasal cavity and the paranasal sinuses that requires multifactorial treatment. Xylitol can be employed with nasal irrigation and can provide better control of the disease. Objective: To evaluate the association between the effects of nasal lavage with saline solution compared to nasal lavage with a xylitol solution. Methods: Fifty-two patients, divided into two groups (n = 26 in the “Xylitol” group and n = 26 in the “Saline solution” group) answered questionnaires validated in Portuguese (NOSE and SNOT-22) about their nasal symptoms and general symptoms, before and after endonasal endoscopic surgery and after a period of 30 days of nasal irrigation. Results: The “Xylitol” group showed significant improvement in pain relief and nasal symptom reduction after surgery and nasal irrigation with xylitol solution (p < 0.001). The “Saline solution” group also showed symptom improvement, but on a smaller scale. Conclusion: This study suggests that the xylitol solution can be useful in the postoperative period after endonasal endoscopic surgery, because it leads to a greater reduction in nasal symptoms.

Introduction: Functional endonasal endoscopic surgery is a frequent surgical procedure among otorhinolaryngologists. In 2014, the European Society of Rhinology published the “European Position Paper on the Anatomical Terminology of the Internal Nose and Paranasal Sinuses”, aiming to unify the terms in the English language. We do not yet have a unified terminology in the Portuguese language. Objective: Transcultural adaptation of the anatomical terms of the nose and paranasal cavities of the “European Anatomical Terminology of the Internal Nose and Paranasal Sinuses” to Portuguese. Methods: A group of rhinologists from diverse parts of Brazil, all experienced in endoscopic endonasal surgery, was invited to participate in the creation of this position paper on the anatomical terms of the nose and paranasal sinuses in the Portuguese language according to the methodology adapted from that previously described by Rudmik and Smith. Results: The results of this document were generated based on the agreement of the majority of the participants according to the most popular suggestions among the rhinologists. A cross-cultural adaptation of the sinonasal anatomical terminology was consolidated. We suggest the terms “inferior turbinate”, “nasal septum”, “(bone/cartilaginous) part of the nasal septum”, “(middle/inferior) nasal meatus”, “frontal sinus drainage pathway”, “frontal recess” and “uncinate process” be standardized. Conclusion: We have consolidated a Portuguese version of the European Anatomical Terminology of the Internal Nose and Paranasal Sinuses, which will help in the publication of technical announcements, scientific publications and the teaching of the internal anatomical terms of the nose and paranasal sinuses in Brazil. Resumo: Introdução: A cirurgia endoscópica funcional endonasal é um procedimento cirúrgico frequente entre os otorrinolaringologistas. Em 2014, a Sociedade Europeia de Rinologia publicou o “Documento Europeu para Posicionamento sobre a Terminologia Anatômica Interna do Nariz e das Cavidades Paranasais” com o objetivo de unificar os termos na língua inglesa. Ainda não dispomos de uma terminologia unificada na língua portuguesa. Objetivo: Adaptação transcultural dos termos anatômicos do nariz e das cavidades paranasais para o português da “European Anatomical Terminology of the Internal Nose and Paranasal Sinuses”. Método: Um grupo de rinologistas de todo o Brasil, com experiência em cirurgia endoscópica endonasal, foi convidado a participar da elaboração desse posicionamento sobre os termos anatômicos do nariz e das cavidades paranasais para o português conforme metodologia adaptada da previamente descrita por Rudmik e Smith. Resultados: Os resultados desse documento foram gerados a partir da concordância da maioria dos participantes conforme as sugestões mais populares entre os rinologistas. Uma adaptação transcultural da terminologia anatômica nasossinusal foi consolidada. Sugerimos que se busque uniformizar termos como “concha inferior”, “septo nasal”, “porção (óssea/cartilagionasa) do septo nasal”, “meato (médio/ inferior) nasal”, “via da drenagem do seio frontal”,“recesso frontal” e “processo uncinado”. Conclusão: Consolidamos uma versão adaptada em português da “European Anatomical Terminology of the Internal Nose and Paranasal Sinuses” que auxiliará a publicação de comunicados técnicos, publicações científicas e o ensino dos termos anatômicos internos do nariz e das cavidades paranasais no Brasil. Keywords: Cross-cultural adaptation, Anatomy, Nose, Paranasal sinus, Consensus, Palavras-chave: Adaptação transcultural, Anatomia, Nariz, Cavidades paranasais, Consenso

Introduction: Bacterial resistance burden has increased in the past years, mainly due to inappropriate antibiotic use. Recently it has become an urgent public health concern due to its impact on the prolongation of hospitalization, an increase of total cost of treatment and mortality associated with infectious disease. Almost half of the antimicrobial prescriptions in outpatient care visits are prescribed for acute upper respiratory infections, especially rhinosinusitis, otitis media, and pharyngotonsillitis. In this context, otorhinolaryngologists play an important role in orienting patients and non-specialists in the utilization of antibiotics rationally and properly in these infections. Objectives: To review the most recent recommendations and guidelines for the use of antibiotics in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, adapted to our national reality. Methods: A literature review on PubMed database including the medical management in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, followed by a discussion with a panel of specialists. Results: Antibiotics must be judiciously prescribed in uncomplicated acute upper respiratory tract infections. The severity of clinical presentation and the potential risks for evolution to suppurative and non-suppurative complications must be taken into ‘consideration'. Conclusions: Periodic revisions on guidelines and recommendations for treatment of the main acute infections are necessary to orient rationale and appropriate use of antibiotics. Continuous medical education and changes in physicians' and patients' behavior are required to modify the paradigm that all upper respiratory infection needs antibiotic therapy, minimizing the consequences of its inadequate and inappropriate use. Resumo Introdução: A resistência bacteriana a antibióticos nos processos infecciosos é um fato crescente nos últimos anos, especialmente devido ao seu uso inapropriado. Ao longo dos anos vem se tornando um grave problema de saúde pública devido ao prolongamento do tempo de internação, elevação dos custos de tratamento e aumento da mortalidade relacionada às doenças infecciosas. Quase a metade das prescrições de antibióticos em unidades de pronto atendimento é destinada ao tratamento de alguma infecção de vias aéreas superiores, especialmente rinossinusites, otite média aguda supurada e faringotonsilites agudas, sendo que uma significativa parcela dessas prescrições é inapropriada. Nesse contexto, os otorrinolaringologistas têm um papel fundamental na orientação de pacientes e colegas não especialistas, para o uso adequado e racional de antibióticos frente a essas situações clínicas. Objetivos: Realizar uma revisão das atuais recomendações de utilização de antibióticos nas otites médias, rinossinusites e faringotonsilites agudas adaptadas à realidade nacional. Método: Revisão na base PubMed das principais recomendações internacionais de tratamentos das infecções de vias aéreas superiores, seguido de discussão com um painel de especialistas. Resultados: Os antibióticos devem ser utilizados de maneira criteriosa nas infecções agudas de vias aéreas superiores não complicadas, a depender da gravidade da apresentação clínica e dos potenciais riscos associados de complicações supurativas e não supurativas. Conclusões: Constantes revisões a respeito do tratamento das principais infecções agudas são necessárias para que sejam tomadas medidas coletivas no uso racional e apropriado de antibióticos. Somente com orientação e transformações no comportamento de médicos e pacientes é que haverá mudanças do paradigma de que toda infecção de vias aéreas superiores deva ser tratada com antibióticos, minimizando por consequência os efeitos de seu uso inadequado.

INTRODUÇÃO: A limpeza prévia de endoscópios rígidos (ER) seguida de desinfecção de nível intermediário com álcool etílico a 70% p/v após o exame de endoscopia nasal é uma prática adotada em muitos serviços de otorrinolaringologia. A literatura atual, no entanto, recomenda a esterilização ou desinfecção de alto nível como o método de descontaminação mais aceito para produtos para saúde classificados como semicríticos. No entanto, há que se fazer distinção entre equipamentos de alta complexidade e sua invasividade como os endoscópios flexíveis com lumens longos e estreitos utilizados na endoscopia digestiva, daqueles de conformação simples sem lumens de baixa invasividade como os endoscópios rígidos utilizados em otorrinolaringologia. OBJETIVO: Avaliar a segurança da desinfecção de nível intermediário com álcool etílico 70% p/v, após limpeza prévia dos endoscópios rígidos utilizados em procedimentos clínicos de endoscopia nasal considerando a carga microbiológica recuperada após o uso. MÉTODO: Imediatamente após a realização do exame, uma gaze úmida foi utilizada para o arraste da carga biológica do endoscópio rígido, gerando as amostras do Controle Positivo e, após a aplicação do POP, um novo arraste para constituir as amostras do Grupo Experimental. Estas gazes foram inicialmente submetidas à sonicação e agitação imersas em soro fisiológico e em seguida a solução foi submetida a uma técnica de extração de carga microbiológica por filtragem por meio de uma Membrana de Celulose de 0,22um de poro que foi, em seguida, semeada nos meios de ágar Sangue, Chocolate, Sabouraud, Löwenstein-Jensen e Tioglicolato. Estes meios ficaram incubados em estufa a 37ºC ± 2ºC e avaliados, no máximo, até por 60 dias conforme o perfil de crescimento dos diferentes microrganismos de interesse; foram analisados de maneira quantitativa e qualitativa para identificação e classificação dos micro-organismos recuperados após as semeaduras. RESULTADO: Os resultados da análise estatística evidenciaram diferença significativa entre Controle Positivo e Grupo Experimental quando comparados em relação à presença de Streptococcus coagulase negativa (p < 0,001), Bacillus spp (p < 0,001) e Staphylococcus aureus (p=0,001). No Controle Positivo, foram encontradas presença desses micro-organismos respectivamente na seguinte frequência: 63,2%, 28,9% e 28,9%, enquanto que, no Grupo Experimental, não foi houve recuperação microbiana alguma. CONCLUSÃO: Os resultados desta pesquisa demonstram a eficiência, na prática diária, da desinfecção de nível intermediário dos endoscópios utilizados na otorrinolaringologia por meio da fricção com álcool etílico 70% p/v por 90 segundos, com protocolo de limpeza prévia INTRODUCTION: Prior cleaning of rigid endoscopes (REs) followed by intermediate-level disinfection with 70% ethyl alcohol (w/v) after nasal endoscopy is a common practice in many otolaryngology services. Current literature, in turn, recommends high-level sterilization or disinfection as the most accepted decontamination method for health products classified as semi-critical. However, it is necessary to distinguish highly complex equipment according to their invasiveness, e.g., flexible endoscopes with long and narrow lumens used in digestive endoscopy and those with a simple conformation without lumens of low invasiveness, such as rigid endoscopes used in otorhinolaryngology. OBJECTIVE: To evaluate the safety of intermediate-level disinfection with 70% ethyl alcohol (w/v) after cleaning of REs used in clinical procedures of nasal endoscopy considering the microbiological load recovered after use. METHOD: Immediately after the test, a wet gauze was used to drag the biological load from the RE, generating positive control samples; after applying POP, dragging was carried out again to generate samples of the experimental group. These gasses were initially subjected to sonication and shaking while immersed in physiological saline; the solution was then subjected to the microbiological loading technique by filtration through a 0.22-um pore cellulose membrane and then cultivated on blood, chocolate, Sabouraud, Löwenstein-Jensen, and thioglycolate agar media. These media were incubated at 37ºC ± 2ºC and evaluated for up to 60 days, according to the growth profile of the different microorganisms of interest. A quantitative and qualitative analysis was performed for the identification and classification of microorganisms recovered after cultivation. RESULTS: The results of statistical analysis showed a significant difference between the positive control and experimental groups for the presence of coagulase-negative Streptococcus (p < 0.001), Bacillus spp (p < 0.001), and Staphylococcus aureus (p=0.001). In the positive control group, these microorganisms were found in the following proportions: 63.2%, 28.9%, and 28.9%, respectively, whereas in the experimental group, no microorganisms were recovered. CONCLUSION: The results of this study demonstrate the efficiency of the daily practice of intermediate-level disinfection of endoscopes used in otorhinolaryngology by means of treatment with 70% ethyl alcohol (w/v) for 90 seconds, using a previous cleaning protocol

Introduction: Inflammatory conditions of the nose and paranasal sinuses are very prevalent in the general population, resulting in marked loss of quality of life in affected patients, as well as significant work, leisure, and social activity losses. These patients require specific and specialized treatment. A wide range of oral medications are available. Objective: The present document is aimed to clarify, for professionals treating patients with inflammatory sinonasal diseases, both specialists and general practitioners, specific oral therapies in noninfectious nasal inflammatory conditions. Methods: The methodology used to create this article included the search for the key words: oral corticosteroids, antihistamines, antileukotrienes, rhinitis, rhinosinusitis in the MEDLINE and EMBASE databases in the last 5 years. Since no relevant article was found for the text on the subject of interest in the last 5 years, the search was extended for another 5 years, and so on, according to the authors' needs. Results: Relevant literature was found regarding the use of antihistamines, antileukotrienes and oral corticosteroids in these conditions. The Brazilian Academy of Rhinology emphasizes, after extensive discussion by the collegiate, key points in the treatment with these drugs. Conclusion: There is support in the literature for the use of these drugs however, final considerations about the role of each of them have been made. (C) 2017 Published by Elsevier Editora Ltda. on behalf of Associacao Brasileira de Otorrino-laringologia e Cirurgia Cervico-Facial. Univ Sao Paulo, Disciplina Otorrinolaringol, Sao Paulo, SP, Brazil Univ Sao Paulo, Fac Med, Sao Paulo, SP, Brazil Univ Sao Paulo, Fac Med, Dept Otorrinolaringol, Sao Paulo, SP, Brazil Univ Sao Paulo, Fac Med Ribeirao Preto, Dept Otorrinolaringol, Ribeirao Preto, SP, Brazil Univ Fed Sao Paulo, Ciencias Saude, Sao Paulo, SP, Brazil Univ Fed Sao Paulo, Otorrinolaringol, Sao Paulo, SP, Brazil Univ Fed Minas Gerais, Fac Med, Belo Horizonte, MG, Brazil Univ Sao Paulo, Fac Med Ribeirao Preto, Ribeirao Preto, SP, Brazil Univ Fed Bahia, Fac Med, Disciplina Otorrinolaringol, Salvador, BA, Brazil Hosp Inst Paranaense Otorrinolaringol, Centro Rinite & Alergia, Curitiba, PR, Brazil Univ Estado Rio De Janeiro, Rio De Janeiro, RJ, Brazil Univ Brasilia, Fac Med, Brasilia, DF, Brazil Univ Fed Sao Paulo, Dept Otorrinolaringol & Cabeca & Pescoco, Sao Paulo, SP, Brazil Univ Luterana Brasil, Fac Med, Otorrinolaringol, Canoas, RS, Brazil Mt Sinai Hosp, Dept Othorhinolaryngol, Toronto, ON, Canada Univ Sao Paulo, Fac Med, Ciencias, Sao Paulo, SP, Brazil Univ Sao Paulo, Fac Med Ribeirao Preto, Dept Oftalmol Otorrinolaringol & Cirurgia Cabeca, Ribeirao Preto, SP, Brazil Univ Fed Sao Paulo, Ciencias Saude, Sao Paulo, SP, Brazil Univ Fed Sao Paulo, Otorrinolaringol, Sao Paulo, SP, Brazil Univ Fed Sao Paulo, Dept Otorrinolaringol & Cabeca & Pescoco, Sao Paulo, SP, Brazil Web of Science

The youthful upper eyelid shows no depression because the orbital contents are firm and the eyelids are tightly stretched across the bony socket. With progressive aging, there is skeletonization of the orbit as the periorbital tissues undergo laxity or absorption. With aging, hollowing of the eyes results in a deep upper eyelid sulcus. Most surgical procedures that address the aging appearance of the eyes involve excision of excess skin and removal of fat, with resultant volume disproportion that may lead to further hollowing and older appearance. Few procedures have been introduced that address age-related periorbital volume disproportion. We discuss a newly developed surgical technique for the correction of this major orbital aesthetic problem. In this surgical technique, the orbital rim periosteum, periorbita, and released superior extraconal orbital fat are used to fill the superior periorbital space, improving the patient's appearance.

INTRODUCAO: A cirurgia endoscopica nasal (FESS) e encarada atualmente como o padrao ouro no tratamento da rinossinusite cronica (RNSC), associada ou nao a polipose nasal, refrataria ao tratamento clinico otimizado. OBJETIVO: Avaliar a melhora dos sintomas da RNSC apos FESS, atraves de um questionario dirigido. METODO: Trata-se de um estudo prospectivo, em que foram incluidos 34 pacientes submetidos a FESS durante o ano de 2009, no servico de Otorrinolaringologia do Hospital de Clinicas/UFPR. Desses, 22 tinham o diagnostico de RNSC e 12 apresentavam RNSC associada a polipose nasal. Todos os pacientes foram submetidos a um questionario sobre a sintomatologia pre-operatoria, comorbidades e grau de melhora dos sintomas no pos-operatorio, 6 meses apos o procedimento. RESULTADOS: A melhora percentual dos sintomas mais prevalentes no grupo com RNSC foi a seguinte: obstrucao nasal 87,4%; cefaleia 80,5%; dor/pressao facial 91,6%; secrecao nasal posterior 81,2%. No grupo com polipose associada, a melhora foi: obstrucao nasal 76,6%; secrecao nasal posterior 76,6%; hiposmia 68,7%; cefaleia 83%. Em nosso estudo encontramos uma melhora global dos sintomas de 83,74% nos pacientes com RNSC e de 80,5% nos pacientes com polipose nasal associada. CONCLUSAO: A FESS e altamente eficiente no controle dos sintomas da RNSC, associada ou nao a polipose, sendo, em nosso estudo, sua eficacia semelhante a encontrada na literatura internacional. Com relacao aos portadores de polipose nasal, sao necessarios estudos com seguimento maior, visto que essa patologia apresenta alto grau de recorrencia.

Objectives/Hypothesis: Surgical resection of intradural pathology through an endonasal corridor creates defects that communicate the subarachnoid space with the sinonasal tract. Reconstruction of these defects with vascularized tissue is superior to any other method. The purpose of this study is to describe a novel vascularized pedicled flap from the middle turbinate (MT) mucosa and to assess its feasibility using a cadaveric model. Methods: Twelve middle turbinate flaps (MTFs) were raised in six fresh cadaveric heads previously injected with colored silicone. Arteries supplying the MT were identified as the turbinate mucoperiosteum was harvested from both its medial and lateral aspects. Length and surface area of the flaps, as well as their ability to cover dural defects of the sella, planum sphenoidale, and fovea ethmoidalis reach were noted. Results: All MTFs adequately covered defects of the planum and fovea ethmoidalis; however, two of the twelve MTFs were not suitable to cover a sellar defect. The mean surface area of the MTFs was 5.6 cm2. As an independent factor surface area did not correlate with the ability of the flap to cover the sellar defects. However, those flaps that were not suitable for sellar repair were less than 4.0 cm in length. Conclusions: Harvesting of a vascular pedicle flap from the MT is feasible, albeit technically demanding. It should be considered as an alternative for the reconstruction of small defects of the fovea ethmoidalis, planum, and sella, particularly for patients for whom a reconstruction with vascularized tissue is desirable but the nasoseptal flap is not available. Laryngoscope, 2009

This documents aims at educating those who treat sinonasal diseases - both general practitioners and specialists - about topical nasal treatments. By means of scientific evidence reviews, the Brazilian Academy of Rhinology provides its practical and updated guidelines on the most utilized topical nasal medication, except for the drugs that have topical antibiotics in their formulas.