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BACKGROUND Laryngeal papillomatosis (LP) is a disease that presents in both juvenile (JLP) and adult patients (ALP). This study correlated papillomatosis characteristics with the Derkay score. METHODS Retrospective data and biopsies of 36 patients with JLP and 56 with ALP were collected and separated into groups according to their scores. RESULTS The mean of the Derkay score, in the JLP group was 10.97 and in Group ALP was 8.26. The JLP group presented a more aggressive result than in the adult group (P = .02). In the JLP group, the respiratory difficulty (P = .01) and tracheostomy were correlated to a higher Derkay score (P

Made available in DSpace on 2021-06-25T11:02:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-06-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Human papillomavirus (HPV) types 6 and 11 are the etiological agents of recurrent respiratory papillomatosis (RRP). We examined the prevalence and distribution of HPVs 6 and 11 genetic variants in juvenile onset (JORRP) and adult onset (AORRP) laryngeal papillomas. Cases of JORRP and AORRP were collected, retrospectively. HPV detection and genotyping were accessed by polymerase chain reaction-sequencing in 67 RRP samples. Overall, the most prevalent HPV-6 variants were from B1 (55.8%) and B3 (27.9%) sublineages, whereas among HPV-11 positive samples A2 (62.5%) variants were predominant. A higher prevalence of HPV-6 B1 was observed in JORRP (83.3% B1 and 16.7% B3), compared with AORRP cases (58.3% B1 and 41.7% B3). HPV-11 A2 variants were more prevalent both in JORRP (57.2%) and in AORRP cases (70.0%). Nevertheless, with the exception that HPV-6 B1 were significantly less likely to recur, there was a lack of association between any particular HPVs 6 or 11 variant and clinicopathological features. Our data do not support an association between HPVs 6 and 11 variability and RRP. Center for Translational Research in Oncology Instituto do Cancer do Estado de Sao Paulo Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo Department of Bioscience and Oral Diagnosis São Paulo State University (UNESP) Centro Clínico de Cabeza y Cuello Department of Pathology and Forensic Medicine Ribeirao Preto Medical School Universidade de São Paulo Department of Otorhinolaryngology and Head and Neck Surgery Sao Paulo Federal University Department of Radiology and Oncology Faculdade de Medicina Universidade de São Paulo Department of Bioscience and Oral Diagnosis São Paulo State University (UNESP) FAPESP: 16/24019-0 FAPESP: 17/23211-8 CNPq: 303431/2018-0 CNPq: 306326/2015-9

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.

Objective: To assess the volumetric changes that occur in the nasomaxillary complex of mouth-breathing patients with transverse maxillary deficiency subjected to rapid maxillary expansion (RME). Methods: This was a controlled, prospective intervention study involving 38 mouth-breathing patients presenting with transverse maxillary deficiency, regardless of malocclusion type or race. Twenty-three of them comprised the experimental group, which was composed of 11 (47.8%) boys, and 12 (52.2%) girls, with a mean age of 9.6 years, ranging from 6.4 to 14.2 years and standard deviation of 2.3 years; and 15 of them comprised the control group, composed of 9 (60%) boys and 6 (40%) girls with an mean age of 10.5 years, ranging from 8.0 to 13.6 years, and standard deviation of 1.9 years. All patients were scanned (CT) according to a standard protocol: Initial CT (T1), and CT three months thereafter (T2), and the patients in the experimental group were treated with RME using a Hyrax expander for the correction of maxillary deficiency during the T1-T2 interval. The CT scans were manipulated using Dolphin® Imaging version 11.7 software for total and partial volumetric assessment of the nasomaxillary complex. Results: The results revealed that in the experimental group there was a significant increase in the size of the structures of interest compared to the control group, both in general aspect and in specific regions. Conclusions: Rapid maxillary expansion (RME) provided a significant expansion in all the structures of the nasomaxillary complex (nasal cavity, oropharynx, right and left maxillary sinuses). RESUMO Objetivo: avaliar as alterações volumétricas do complexo nasomaxilar em pacientes respiradores bucais com deficiência transversal da maxila tratados com expansão rápida da maxila (ERM). Métodos: foram selecionados 38 pacientes respiradores bucais, independentemente da má oclusão ou raça, portadores de constrição maxilar, e realizou-se um estudo de intervenção, prospectivo, controlado. Para o grupo experimental, foram selecionados 23 pacientes, sendo 11 (47,8%) meninos e 12 (52,2%) meninas, com média de idade de 9,6 anos (variando de 6,4 a 14,2 anos) e desvio-padrão de 2,3 anos; e 15 pacientes para o grupo controle, sendo 9 (60%) meninos e 6 (40%) meninas, com média de idade de 10,5 anos (variando de 8,0 a 13,6 anos) e desvio-padrão de 1,9 anos. Todos os pacientes realizaram exames de tomografia computadorizada (TC), de acordo com protocolo padronizado: TC inicial (T1) e TC após três meses do período de contenção (T2). Os pacientes do grupo experimental foram tratados com expansão rápida da maxila usando um expansor Hyrax para a correção da deficiência transversal durante o intervalo T1-T2. As imagens tomográficas para avaliação volumétrica total e parcial do complexo nasomaxilar foram manipuladas no programa Dolphin ® versão 11.7. Resultados: os resultados revelaram que no grupo experimental houve um aumento significativo no tamanho das estruturas de interesse em comparação com o grupo controle, tanto no geral quanto nas regiões específicas. Conclusões: a expansão rápida da maxila (ERM) promoveu uma expansão significativa de todas as estruturas do complexo nasomaxilar (cavidade nasal, orofaringe, seios maxilares direito e esquerdo).

Made available in DSpace on 2020-12-12T01:51:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-01-01 Objective: The objective was to investigate the prevalence of the Epstein-Barr virus (EBV) and its association with human papilloma virus (HPV) detection, clinicopathological features, and the severity of recurrent respiratory papillomatosis (RRP). Methods: Cases of juvenile recurrent respiratory papillomatosis (JRRP) (n = 36) and adult recurrent respiratory papillomatosis (ARRP) (n = 44) were collected retrospectively and subdivided into low- and high-risk severity groups based on the Derkay score. We performed HPV detection and genotyping using a reverse hybridization protocol and investigated the presence of EBV by polymerase chain reaction (PCR) and in situ hybridization. CD21 levels were accessed by immunohistochemistry. Results: All samples were HPV-positive, including 49 cases of HPV 6, 26 cases of HPV 11, four cases of HPV 6 and 11 coinfections, and one case of HPV 16. EBV-DNA was detected in nine samples by PCR, although none of the cases were positive by means of in situ hybridization. CD21 immunoexpression was not statistically associated with any of the variables analyzed. HPV 6 detection was significantly higher in ARRP cases (P = 0.03), whereas HPV 11 was more prevalent in JRRP cases (P = 0.02) and was even more prevalent in JRRP cases of greater severity (Derkay laryngoscopic scale ≥20) (P = 0.04). Conclusion: The presence of EBV does not seem to play an important role in the progression/severity of RRP. Level of Evidence: 4 Laryngoscope, 2019. Department of Biosciences and Oral Diagnosis Institute of Science and Technology São Paulo State University (Unesp), São José dos Campos Department of Stomatology Collective Health and Legal Dentistry Ribeirão Preto School of Dentistry Department of Pathology and Forensic Medicine Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Department of Otolaryngology and Head and Neck Surgery Federal University of Sao Paulo Center for Translational Investigation in Oncology Instituto do Cancer do Estado de Sao Paulo Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo Department of Radiology and Oncology Faculdade de Medicina Universidade de São Paulo Centro Clínico de Cabeza y Cuello Department of Biosciences and Oral Diagnosis Institute of Science and Technology São Paulo State University (Unesp), São José dos Campos

Introduction The importance of our study lies in the fact that we have demonstrated the occurrence of mechanical 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.

Choanal atresia surgery is still a challenge, particularly due to the small dimensions of the surgical field and the possibility of restenosis. The authors present an easy and effective endoscopic surgical technique based on the removal of the posterior third of the bony/cartilaginous nasal septum and the atretic plate, keeping their covering mucosa. At the end of the procedure, the neochoana is covered with the mucosal flaps previously kept from the removed septum. This technique has been used by the authors in over 25 children with 2–16 years follow-up, and no complications or cases of restenosis have been observed. The authors concluded that the cross-over flap surgical technique for choanal atresia repair is a safe, easy, and effective procedure.

Made available in DSpace on 2020-12-12T01:07:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-03-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Objective: To characterize inflammatory cells in Recurrent Respiratory Papillomatosis (RRP) and to correlate it with severity using the Derkay laryngoscopic scale. Materials and methods: The data and biopsies from 36 patients with Juvenile (JRRP) and 56 patients with Adult (ARRP) were collected and analyzed under light microscopy. The patients were separated into groups according to the Derkay index: ≥20 for the most severe and < 20 for the less severe cases. Immunohistochemical analysis using CD3, CD4, CD8, CD15, CD20, CD68, FoxP3 and MUM-1 antibodies was performed, and the inflammatory cells were quantified. All the clinicopathological characteristics and the results of the immunohistochemical analysis were compared among the groups proposed using the Chi-Square test and correlated through the Spearman correlation test. Results: The ARRP showed significantly higher quantities of CD3+, CD8+ and MUM1+ cells (p < .05) than the JRRP samples. The presence of CD15+ cells showed positive correlation with the Derkay index (p < .05), while the MUM-1+ cells showed an inverse correlation (p = .01). Conclusion: There are differences between the inflammatory cells population in the juvenile and adult groups and it can be related to disease severity. Department of Bioscience and Oral Diagnosis Institute of Science and Technology São Paulo State University - UNESP Department of Pathology Ribeirão Preto School of Medicine University of São Paulo Pathology Department Hospital Herrera-Llerandi Oral Pathology Department of Stomatology Public Oral Health and Forensic Dentistry School of Dentistry of Ribeirão Preto University of São Paulo Department of Pathology and Legal Medicine Ribeirão Preto School of Medicine University of São Paulo Department of Otorhinolaryngology and Head and Neck Surgery São Paulo Federal University Department of Bioscience and Oral Diagnosis Institute of Science and Technology São Paulo State University - UNESP FAPESP: 16/24019-0

Objetivo: Hipomineralização incisivo-molar (HIM) é um distúrbio de desenvolvimento dentário altamente prevalente devi­do à maturação interrompida do ameloblasto. Esta condição afeta até 44% das crianças ao redor do mundo e várias condições sistêmicas têm sido associadas à HIM, incluindo a respiração oral. E importante mostrar que HIM tem etiologia multifatorial e está associada com crianças alérgicas com respiração bucal. Métodos: Para avaliar a prevalência da HIM em crianças com SRBI com resposta alérgica positiva e negativa para testes de escarificação, uma avaliação transversal quantitativa e qualitativa foi realizada em 23 crianças com respiração oral e 25 irmãos com idade/sexo correspondentes. Defeitos de esmalte foram classificados de acordo com o índice de defeitos de esmalte da FDI. Teste t de Student foi aplicado para verificar a relevância dos dados. Resultados: A prevalência de HIM mostrou diferenças estatísticas significativas na comparação entre molares, independentemente de idade individual (p = 0,01513474). Crianças com SRBI menores de 5 anos apresentaram maior prevalência estatística de HIM (p = 0,00594). Crianças com SRBI que obtiveram reações positivas para os testes de escarificação apresentaram maior prevalência de HIM (p = 0,023). Crianças com SRBI apresentaram maior prevalência estatística de opacidade demarcada (p = 0,00012). Conclusões: Crianças com SRBI que obtiveram reações positivas para os testes de escarificação apresentaram maior prevalência de HIM (p = 0,023), indicando que crianças alérgicas com respiração oral tiveram maior prevalência de HIM. Nossos resultados corroboram nossa hipótese anterior que crianças com SRBI demonstram maior prevalência de HIM em comparação com seus irmãos, com significância estatística (p = 0,01513474). Investigações com amostras popu­lacionais maiores podem reforçar e confirmar a exatidão dos nossos resultados. Objective: Molar-incisor hypomineralization (MIH) is a highly prevalent dental development disturbance caused by dis­rupted ameloblast maturation. This condition affects up to 44% of children around the world and several systemic con­ditions have been associated with MIH, including Mouth-Breathing. It is important to show that MIH has multifacto­rial etiology and is associated with allergic mouth-breathing children. Methods: To evaluate MIH prevalence in MBCS children with positive and negative allergic response to the skin prick test, a cross-sectional quantitative and qualitative comparative assessment was conducted in 23 mouth-breathing children and 25 sex/age-matched siblings. Enamel defects were classified by the modified rate of FDI Development Defects of Enamel. Statistical Student’s t tests were applied to ve­rify the relevance of the data. Results: MIH prevalence showed significant statistical differences in the comparison betwe­en molars, independently of individual age (p = 0.01513474). MBCS children under 5 years old had higher statistical preva­lence of MIH (p = 0.00594). MBCS children with positive skin reactions to the prick test had higher prevalence of MIH (p = 0,023). MBCS children had statistically significant higher prevalence of demarcated opacity (p = 0.00012). Conclusions: Finally, MBCS children with positive skin reactions to the prick test had higher prevalence of MIH (p = 0,023), indicating that mouth-breathing allergy-responsive children had higher MIH prevalence. Our results corroborate our previous hypo­thesis that MBCS children have increased MIH prevalence in comparison to their siblings, with statistical significance (p = 0.01513474). Further investigations with larger samples may enhance and confirm the accuracy of our results.

Introduction The guidelines on allergic rhinitis aim to update knowledge about the disease and care for affected patients. The initiative called "Allergic Rhinitis and its Impact on Asthma", initially published in 2001 and updated in 2008 and 2010, has been very successful in disseminating information and evidence, as well as providing a classification of severity and proposing a systemized treatment protocol. In order to include the participation of other medical professionals in the treatment of allergic rhinitis, it is important to develop algorithms that accurately indicate what should and can be done regionally. Objective To update the III Brazilian Consensus on Rhinitis - 2012, with the creation of an algorithm for allergic rhinitis management. Methods We invited 24 experts nominated by the Brazilian Association of Allergy and Immunology, Brazilian Association of Otorhinolaryngology and Head and Neck Surgery and Brazilian Society of Pediatrics to update the 2012 document. Results The update of the last Brazilian Consensus on Rhinitis incorporated and adapted the relevant information published in all "Allergic Rhinitis and its Impact on Asthma" Initiative documents to the Brazilian scenario, bringing new concepts such as local allergic rhinitis, new drugs and treatment evaluation methods. Conclusion A flowchart for allergic rhinitis treatment has been proposed. Resumo Introdução As diretrizes sobre rinite alergica visam atualizar os conhecimentos sobre a doença e os cuidados para com esses pacientes. A iniciativa designada "Rinite Alergica e seu Impacto na Asma", cujo relatorio inicial foi publicado em 2001 e atualizada em 2008 e 2010, tem sido muito bem sucedida na disseminaçao de informaçoes e evidencias, bem como na formulaçao da classificaçao de gravidade e proposta de sistematizaçao do tratamento. Entretanto, visando a participaçao de outros profissionais medicos no atendimento da rinite alergica, e importante o desenvolvimento de algoritmos que indiquem com precisao o que deve e pode ser feito regionalmente. Objetivo Atualizar o III Consenso Brasileiro sobre Rinites-2012, com elaboraçao de algoritmo para conduta da rinite alergica. Método Foram convidados 24 especialistas indicados pelas Associaçao Brasileira de Alergia e Imunologia, Associaçao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial e Sociedade Brasileira de Pediatria para atualizaçao do documento de 2012. Resultados A atualizaçao do ultimo Consenso Brasileiro sobre Rinites, incorporou e adaptou para a realidade brasileira as informaçoes relevantes publicadas em todos os documentos da Iniciativa "Rinite Alergica e seu Impacto na Asma", trazendo novos conceitos como a rinite alergica local, novos medicamentos e metodos de avaliaçao de tratamento. Conclusão Proposto um fluxograma de tratamento para a rinite alergica.

OBJECTIVE: The aim of this study was to compare the cephalometric pattern of children with and without adenoid obstruction.METHODS: The sample comprised 100 children aged between four and 14 years old, both males and females, subjected to cephalometric examination for sagittal and vertical skeletal analysis. The sample also underwent nasofiberendoscopic examination intended to objectively assess the degree of adenoid obstruction.RESULTS: The individuals presented tendencies towards vertical craniofacial growth, convex profile and mandibular retrusion. However, there were no differences between obstructive and non-obstructive patients concerning all cephalometric variables. Correlations between skeletal parameters and the percentage of adenoid obstruction were either low or not significant.CONCLUSIONS: Results suggest that specific craniofacial patterns, such as Class II and hyperdivergency, might not be associated with adenoid hypertrophy. OBJETIVO: a presente pesquisa teve como objetivo comparar o padrão cefalométrico de crianças com e sem obstrução adenoidiana.MÉTODOS: a amostra consistiu de 100 crianças, com idades entre 4 e 14 anos, de ambos os sexos, submetidas a exames cefalométricos para a avaliação de variáveis cefalométricas horizontais e verticais. A amostra também foi submetida à nasofibroendoscopia, por meio da qual o grau de obstrução adenoidiana foi objetivamente aferido.RESULTADOS: os pacientes avaliados demonstraram tendência ao crescimento vertical acentuado, ao perfil convexo e à retrusão mandibular. No entanto, não houve diferenças entre pacientes portadores e não portadores de obstrução, em relação a todas as variáveis cefalométricas. As correlações estabelecidas entre os parâmetros esqueléticos e os percentuais de hipertrofia foram baixas ou não significativas.CONCLUSÕES: os resultados sugerem que padrões faciais específicos, tais como Classe II e hiperdivergência, parecem não estar associados à hipertrofia adenoideana.

OBJECTIVE: To assess short-term tomographic changes in the upper airway dimensions and quality of life of mouth breathers after rapid maxillary expansion (RME). METHODS: A total of 25 mouth breathers with maxillary atresia and a mean age of 10.5 years old were assessed by means of cone-beam computed tomography (CBCT) and a standardized quality of life questionnaire answered by patients' parents/legal guardians before and immediately after rapid maxillary expansion. RESULTS: Rapid maxillary expansion resulted in similar and significant expansion in the width of anterior (2.8 mm, p < 0.001) and posterior nasal floor (2.8 mm, p < 0.001). Although nasopharynx and nasal cavities airway volumes significantly increased (+1646.1 mm3, p < 0.001), oropharynx volume increase was not statistically significant (+1450.6 mm3, p = 0.066). The results of the quality of life questionnaire indicated that soon after rapid maxillary expansion, patients' respiratory symptoms significantly decreased in relation to their initial respiratory conditions. CONCLUSIONS: It is suggested that RME produces significant dimensional increase in the nasal cavity and nasopharynx. Additionally, it also positively impacts the quality of life of mouth-breathing patients with maxillary atresia. OBJETIVO: avaliar, por meio de tomografias, as mudanças em curto prazo nas vias aéreas superiores e na qualidade de vida em pacientes respiradores bucais, após expansão rápida da maxila (ERM). MÉTODOS: foram avaliados 25 pacientes respiradores bucais com atresia maxilar, com idade média de 10,5 anos, por meio de tomografia computadorizada de feixe cônico (TCFC) e questionário padronizado de qualidade de vida submetido aos pais/responsáveis, antes e imediatamente após a ERM. RESULTADOS: a ERM promoveu uma expansão, de forma semelhante e significativa, tanto na largura do soalho nasal anterior (2,8mm, p < 0,001) quanto na largura do soalho nasal posterior (2,8mm, p < 0,001). No volume aéreo da nasofaringe e fossas nasais, houve aumento significativo (+1646,1mm3 p < 0,001); entretanto, no volume aéreo da orofaringe, houve aumento não significativo (+1450,6 mm3 p = 0,066). Os resultados do questionário de qualidade de vida indicaram melhora significativa na qualidade de vida dos pacientes após a ERM, em comparação ao questionário inicial. CONCLUSÕES: a ERM promoveu aumento dimensional significativo nas fossas nasais e na nasofaringe, bem como melhorou significativamente a qualidade de vida dos pacientes.

Introduction: Maxillary constriction is a dentoskeletal deformity characterized by discrepancy in maxilla/mandible relationship in the transverse plane, which may be associated with respiratory dysfunction. Objective: The objective of this study was to evaluate the skeletal effects of RME on maxillary and nasal transverse dimensions and compare the differences between males and females. Methods: Sixty-one mouth-breathers patients with skeletal maxillary constriction (35 males and 26 females, mean age 9.6 years) were included in the study. Posteroanterior (PA) radiographs were taken before expansion (T1) and 3 months after expansion (T2). Data obtained from the evaluation of T1 and T2 cephalograms were tested for normality with the Kolmogorov-Smirnov method. The Student’s t-test was performed for each measurement to determine sex differences. Results: RME produced a significant increase in all linear measurements of maxillary and nasal transverse dimensions. Conclusions: No significant differences were associated regarding sex. The RME produced significant width increases in the maxilla and nasal cavity, which are important for treatment stability, improving respiratory function and craniofacial development. RESUMO Introdução: a constrição maxilar é uma alteração dentoesquelética relacionada à diminuição transversal da arcada superior, que pode correlacionar-se com problemas respiratórios. O tratamento nos pacientes em crescimento inclui a expansão rápida da maxila (ERM). A correção precoce resulta em maiores alterações esqueléticas e estabilidade dos resultados, podendo evitar desvios de crescimento facial. Objetivo: avaliar comparativamente, por meio de telerradiografias posteroanteriores (PA), as alterações dimensionais da cavidade nasal pré- e pós-ERM em pacientes respiradores bucais dos sexos masculino e feminino. Métodos: realizou-se o estudo de medidas lineares em telerradiografias PA pré- e pós-ERM de uma amostra composta por 61 pacientes (35 do sexo masculino e 26 do feminino), com média de idade de 9,6 anos. Todos os pacientes eram respiradores bucais com constrição maxilar esquelética, e foram tomadas radiografias PA pré- e pós-ERM (3 meses). Os dados obtidos foram avaliados nos tempos T1 e T2 a normalidade dos dados foi confirmada por meio do teste de Kolmogorov-Smirnov. O teste t de Student foi aplicado para cada mensuração, para determinar diferenças entre os sexos. Resultados: a ERM promoveu aumento significativo em todas as medidas lineares maxilares e das dimensões da cavidade nasal. Conclusão: nenhuma diferença significativa foi associada ao sexo. A ERM produziu aumentos significativos na largura maxilar e volume da cavidade nasal, que são importantes na estabilidade do tratamento Nos pacientes em crescimento e respiradores bucais com constrição maxilar esquelética da maxila, a ERM promoveu aumento do volume da cavidade nasal que melhorou o fluxo aéreo e possibilitou reconduzir o crescimento facial. As alterações transversais não foram significativas quando relacionadas ao sexo.

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

INTRODUCTION: Sinonasal polyposis (NP) is a chronic inflammatory pathology of the nasal/paranasal cavities which affects from 1%-4% of the population. Although polyps seem to be a manifestation of chronic inflammation in both allergic and non-allergic subjects, the pathogenesis of nasal polyposis remains unknown. HLA-G molecules are a kind of no classic class I antigen with anti-inflammatory and tolerogenic properties. Little attention has been paid to the role of HLA-G chronic inflammatory disorders. OBJECTIVE: The aim of this study is to investigate the expression of HLA-G in the NP. MATERIALS AND METHODS: Prospective study involving samples of patients presenting with nasal polyposis that were subjected to the immunohistochemistry technique. After a skin prick test, all patients were divided into atopic and nonatopic groups and classified as asthmatic or non-asthmatic. RESULTS: Immunohistochemical staining demonstrated a higher expression of the HLA-G molecule in samples from nonatopic than in those from atopic patients, and was significantly lower in the non-asthmatic patients. CONCLUSION: These results indicate that HLA-G may play an important role in the pathology of nasal polyposis. Considering the anti-inflammatory properties of HLA-G, this study suggests that it could reduce susceptibility to atopy and asthma. INTRODUÇÃO: Polipose nasossinusal (PNS) é uma patologia inflamatória crônica das cavidades nasais/paranasais que afeta 1%-4% da população. Embora os pólipos pareçam ser uma manifestação de inflamação crônica em ambos os indivíduos alérgicos e não alérgicos, a patogênese da polipose nasal permanece desconhecida. Moléculas HLA-G são antígenos não clássicos da classe I com propriedades anti-inflamatórias e tolerogênicas. Pouca atenção tem sido dada ao papel do HLA-G em doenças inflamatórias crônicas. OBJETIVO: Investigar a expressão de HLA-G na PNS. MATERIAIS E MÉTODOS: Estudo prospectivo de pacientes com polipose nasal que foram submetidas à técnica de imuno-histoquímica. Após realizarem teste cutâneo, os pacientes foram divididos em grupos atópicos e não atópicos e classificados como asmáticos ou não asmáticos. RESULTADO: A coloração imuno-histoquímica mostrou uma maior expressão da molécula HLA-G em pacientes não atópicos do que naqueles atópicos e foi significativamente inferior nos pacientes não asmáticos. CONCLUSÃO: Os resultados indicam que o HLA-G pode ter um papel importante na patologia da polipose nasal. Considerando as propriedades anti-inflamatórias do HLA-G, este estudo sugere que ele poderia reduzir a susceptibilidade a atopia e asma.

Objective The objective of the present study was to evaluate current radiographic parameters designed to investigate adenoid hypertrophy and nasopharyngeal obstruction, and to present an alternative radiographic assessment method. Materials and Methods In order to do so, children (4 to14 years old) who presented with nasal obstruction or oral breathing complaints were submitted to cavum radiographic examination. One hundred and twenty records were evaluated according to quantitative radiographic parameters, and data were correlated with a gold-standard videonasopharyngoscopic study, in relation to the percentage of choanal obstruction. Subsequently, a regression analysis was performed in order to create an original model so the percentage of the choanal obstruction could be predicted. Results The quantitative parameters demonstrated moderate, if not weak correlation with the real percentage of choanal obstruction. The regression model (110.119*A/N) demonstrated a satisfactory ability to “predict” the actual percentage of choanal obstruction. Conclusion Since current adenoid quantitative radiographic parameters present limitations, the model presented by the present study might be considered as an alternative assessment method in cases where videonasopharyngoscopic evaluation is unavailable. Objetivo O objetivo deste estudo foi avaliar parâmetros radiográficos atuais destinados à verificação da adenoide e obstrução nasofaríngea e apresentar um método de avaliação alternativo. Materiais e Métodos Crianças (4 a 14 anos) que apresentavam queixas de obstrução nasal e/ou respiração oral foram submetidas ao exame radiográfico de cavum faríngeo. Cento e vinte registros foram avaliados por parâmetros radiográficos quantitativos, e estes dados foram correlacionados ao exame de videonasofaringoscopia, aqui considerado como padrão ouro, em relação à porcentagem de obstrução coanal. Posteriormente, uma análise de regressão foi realizada com os mesmos parâmetros quantitativos, de modo que um modelo original fosse criado com o objetivo de predição do percentual de obstrução coanal. Resultados Os parâmetros quantitativos atuais demonstraram correlações moderadas, quando não fracas, ao percentual de obstrução. O modelo de regressão desenvolvido (110.119*A/N) demonstrou capacidade satisfatória de “prever” o real percentual de obstrução adenóidea. Conclusão Uma vez que os parâmetros radiográficos atuais apresentam limitações, o modelo original aqui apresentado deve ser considerado como um método de avaliação adenóidea alternativo, a ser utilizado quando a videonasofaringoscopia estiver indisponível.

Polipose nasossinusal (PNS) é uma afecção inflamatória crônica das cavidades nasais/paranasais que afeta 1%-4% da população. Pólipos parecem ser uma manifestação inflamatória crônica da mucosa do seio nasal/paranasal em indivíduos alérgicos e não alérgicos; porém, a patogênese da PNS permanece desconhecida. A interleucina-17A (IL-17A) é uma citocina chave em muitas doenças inflamatórias. Pouca atenção tem sido dada ao papel da IL-17A em distúrbios inflamatórios crônicos. OBJETIVO: Investigar a expressão da IL-17A na PNS e verificar se ela é um marcador de bom ou mau prognóstico. MÉTODO: Estudo prospectivo de 25 pacientes com PNS foram submetidas à técnica de imuno-histoquímica. Após realizarem teste cutâneo, todos os pacientes foram divididos em grupos atópicos e não atópicos e classificados em asmáticos ou não asmáticos. RESULTADOS: A expressão de IL-17A foi observada nos pacientes atópicos e não atópicos; porém, o número de células positivas com IL-17A foi maior nos pólipos nasais de pacientes atópicos que nos não atópicos (p = 0,0128). CONCLUSÃO: Os resultados indicam que a IL-17A pode desempenhar papel importante na patologia da PNS. Considerando as propriedades inflamatórias da IL-17A, este estudo sugere que a IL-17A pode aumentar a susceptibilidade a atopia e asma. Sinonasal polyposis (SNP) is a chronic inflammatory pathology of the nasal/paranasal cavities which affects from 1%-4% of the population. Although polyps seem to be a manifestation of chronic inflammation of nasal/paranasal sinus mucosa in both allergic and non-allergic subjects, the pathogenesis of nasal polyposis remains unknown. Interleukin-17A (IL-17A) is a key inflammatory cytokine in many disorders. Little attention has been paid to the role of IL-17A in chronic inflammatory disorders. OBJECTIVE: To investigate the expression of IL-17A in the SNP and verify if this expression is a marker of good or bad prognosis. METHOD: Prospective study with 25 patients presenting with SNP were subjected to the immunohistochemistry technique. After a skin prick test, all patients were divided into atopic and nonatopic groups, and asthmatic or non-asthmatic. RESULTS: The IL-17A expression was observed in both atopic and nonatopic patients. The numbers of IL-17A positive cells were greater in nasal polyps of atopic patients than nonatopic (p = 0.0128). CONCLUSION: These results indicate that IL-17A may play an important role in the pathology of SNP. Considering the inflammatory properties of IL-17A, this study suggests that it could increase susceptibility to atopy and asthma.

Palatine and pharyngeal tonsils are immune reactive lymphoid organs that manifest specific antibodies and B/T-cell activity to respond to a variety of antigens. They perform humoral and cellular immune functions. The possible effects of adenotonsillectomy upon the immune system remain controversial. Objective: To study the short and long-term impacts of tonsillectomy upon the cellular and humoral immunity of children. Method: This longitudinal prospective study included 29 children referred to adenotonsillectomy for adenotonsillar hypertrophy. Serum IgA, IgM, and IgG and lymphocyte counts were analyzed at three points in time: before surgery, 1-2 months after surgery (short term), and 12-14 months after surgery (long term). Results: TCD4+ cell counts were significantly increased shortly after surgery. IgA and IgG values were significantly reduced in the long run, but were within normal ranges for this age group. Conclusion: This study indicated that adenotonsillectomy does not pose negative short or long term impacts upon the cellular and humoral immunity of children submitted to the procedure.

INTRODUCTION: Adenotonsillectomy is the most common surgery performed by otolaryngologists in pediatric age, and one of the most frequently asked questions about the postoperative period is whether there is a potential for change in vocal pattern of these children. OBJECTIVE: To evaluate the impact of adenotonsillectomy in the voice emission pattern of children with hypertrophy of palatine and pharyngeal tonsils. METHODS: This is a prospective study in which we carried out perceptual auditory assessments and acoustic analysis of 26 children with adenotonsillar hypertrophy at three time points: before surgery, one month and three months after surgery. The following acoustic parameters were estimated using the Praat software: fundamental frequency, jitter, shimmer, and harmonic-noise ratio. RESULTS: A statistically significant change was found between shimmer and harmonic-noise ratio during vowel /u/ production between the preoperative and 1st month postoperative time points. No significant differences were detected for acoustic parameters between preoperative analysis and that of the 3rd month post-operation. CONCLUSION: Transient changes in acoustic parameters occur in children with adenotonsillar hypertrophy submitted to adenotonsillectomy, progressing to normalization in the 3rd postoperative month. RESUMO INTRODUÇÃO: Adenotonsilectomia é o procedimento cirúrgico mais realizado pelos otorrinolaringologistas em pacientes pediátricos, e entre as dúvidas mais frequentes a respeito do pós-operatório, inclui-se a possibilidade de modificações no padrão vocal dessas crianças. OBJETIVO: Avaliar o impacto da adenotonsilectomia no padrão de emissão vocal de crianças com hipertrofia de tonsilas palatinas e faríngea. MÉTODO: Trata-se de estudo prospectivo, em que foram realizadas a avaliação perceptiva-auditiva e a análise acústica da voz de 26 crianças com hipertrofia adenotonsilar em três oportunidades: no pré-operatório e no 1° e 3° meses após o procedimento cirúrgico. Os parâmetros acústicos frequência fundamental, jitter, shimmer e proporção harmônico-ruído foram avaliados por meio do programa Praat. RESULTADOS: Houve uma alteração estatisticamente significante entre o shimmer e a proporção harmônico-ruído da emissão da vogal/u/entre o período pré-operatório e o 1° mês do pós-operatório. Não houve diferenças significantes dos parâmetros acústicos entre a análise pré-operatória e aquela realizada no 3° mês do pós-operatório. CONCLUSÃO: Crianças com hipertrofia adenotonsilar submetidas à adenotonsilectomia cursam com alterações transitórias dos parâmetros acústicos, evoluindo com a normalização dos mesmos no 3° mês do pós-operatório.

Few studies in the literature have looked into the cardiovascular and metabolic effects of Obstructive Sleep Apnea Syndrome (OSAS) in children. OBJECTIVE: This study aims to evaluate the metabolic profile of non-obese children with OSAS. METHODS: Fifty-two children were enrolled in this study, 21 girls and 31 boys. Patients were divided into two groups: OSAS (28 children) and Snore (22 children) according to polysomnographic evaluation. All children were submitted to ENT examination, measurements of weight, height and blood pressure. Blood samples were tested for hemoglobin, hematocrit, fasting glucose, fasting insulin, triglycerides, total cholesterol, HDL, LDL, VLDL, TSH and T4. The gathered data sets were compared between groups and also within the OSAS group according to the severity of the syndrome. RESULTS: The children from both groups had no alterations in blood pressure levels. The results of the blood tests were normal for both groups. Results of hemoglobin, hematocrit, and HDL were all significantly higher in the Snore group when compared to the OSAS group; by their turn, VLDL levels were higher in the OSAS group. There was no statistical difference between the groups based on OSAS severity. CONCLUSION: Non-obese children with OSAS present no significant alterations in metabolic tests or blood pressure levels.

Objectives Many studies have been developed aiming to reveal the usefulness of cavum X-rays and telerradiographies as diagnostic tools for the detection of upper airway obstruction due to adenoid hypertrophy. However, the scientific literature is diverse and controversial. Therefore, a systematic review is proposed; with the objective to determine the diagnosis value of lateral X-ray view of the skull regarding adenoid hypertrophy. Methods Searching was conducted on Pubmed, Lilacs, Cochrane Library, Embase, and Web of Knowledge databases; and was restricted to studies published in English, Portuguese or Spanish languages, carried out on humans under 18 years of age. All the obtained publications were first submitted to a pre-selection, and then, full-texts (n = 66) were analyzed and selected by independent examiners. The resultant studies (n = 11) were systematically and critically analyzed, and qualified according to QUADAS (Quality Assessment of Diagnostic Accuracy Studies) questionnaire, an assessment tool designed to qualify diagnostic tests accuracy studies. Results Searching and selection procedures generated 11 studies which were considered adequate to be systematically analyzed. Accordingly, large variation was observed concerning the evaluation methods of radiographic and fibronasoendoscopic exams, and the sample characteristics. Additionally, little amount of scientific evidences could be provided, since few radiographic variables were analyzed simultaneously. Moreover, assessment methods were, at most, subjective or poorly described. QUADAS application revealed other significant limitations related to the sampling, such as inadequate spectrum of the investigated “disease” (adenoid hypertrophy), and poor report of the subjects’ enrollment and participation process. Further, QUADAS revealed inadequacies regarding methodological features, including poor description of the radiographic exams and assessment methods. In addition, it was also shown that most of the studies did not specify the moment in clinical time when both exams were performed; neither reported a strategy of “blindness” by the examiners. Conclusions Despite such limitations, the majority of the resultant data indicates that lateral X-rays might be considered somewhat useful, even though it could not be clearly demonstrated. Future research should then adhere to greater methodological rigor, in order to investigate the significance of radiographies as a screening test.

Universidade Federal de Sao Paulo (UNIFESP) Departamento de Otorrinolaringologia e Cirurgia de Cabeca e Pescoco

Os distúrbios obstrutivos do sono são relativamente freqüentes na população pediátrica, porém o impacto da perda do sono na aprendizagem e função cognitiva não está bem estabelecido. OBJETIVO: Avaliar se pacientes com distúrbios obstrutivos do sono apresentam alteração de aprendizagem, memória e atenção. CASUÍSTICA E MÉTODO: Foram avaliadas 81 crianças de 6 a 12 anos de idade, divididas em 3 grupos: grupo SAHOS (n=24), grupo Ronco Primário (n=37) e grupo Controle (n=20), através de testes de aprendizagem (Teste de Rey) e cognitivos (Dígito, Código, Cancelamento de Letras e Símbolos). Todas as crianças realizaram polissonografia. RESULTADOS: O grupo SAHOS (n=24) e o grupo Ronco Primário (n=37) apresentaram diferença estatisticamente significante nas variáveis A1 (p=0,001) do Teste de Rey quando comparados ao grupo controle. O grupo Ronco Primário apresentou ainda diferenças nas variáveis A2, A4, AT e A6 do Teste de Rey (p=0,020; p=0,05; p=0,004; p=0,05, respectivamente) em relação ao grupo controle (n=20). CONCLUSÃO: Crianças com distúrbios obstrutivos do sono apresentam piores resultados no teste de aprendizagem e memória (Teste de Rey), principalmente o grupo RP, quando este é comparado ao grupo SAHOS. Os testes de atenção apresentam resultados semelhantes entre os grupos.Sleep obstructive breathing disorders are frequent in children but the impact of sleep deprivation on the cognitive learning function is unclear. AIM: To establish whether patients with sleep obstructive breathing disorders show any functional change in learning, memory and attention. MATERIAL AND METHODS: Eighty-one children aged from 6 to 12 years were divided into 3 groups: obstructive sleep apnea syndrome (OSAS), n=24; primary snoring (PS), n=37; and control, n=20. The groups were assessed using learning (Rey) and psychological (Digit, Code, Letter Concealing, and Symbol) tests. RESULTS: OSAS and PS children showed statistically significant worse performance on the variable A1 in Rey test (learning and memory) when compared with controls (p=0.011). PS children had an even worse performance on the variables A2, A4, AT and A6 compared to OSAS participants and controls (p=0.020;p=0.050;p=0.004,p=0.05). Conclusion: Children with obstructive sleep breathing disorders, in particular PS, show worse Rey test scores. PS and OSAS children performed similarly in attention tests.

A cada ano aumentam as evidências de que o refluxo gastroesofágico seja um fator que contribui para as desordens de vias aéreas, principalmente na população pediátrica, podendo gerar sintomas respiratórios como estridor, tosse crônica, pneumonias de repetição e bronquite crônica. Estudos recentes têm sugerido que a associação entre papilomatose laríngea recorrente e refluxo gastroesofágico possa ser um fator determinante na recorrência e crescimento dos papilomas. OBJETIVO: O objetivo deste estudo foi verificar a freqüência e a intensidade do refluxo gastroesofágico em crianças portadoras de Papilomatose Laríngea Recorrente (PLR). MATERIAL E MÉTODOS: Foram selecionadas 10 crianças portadoras de papilomatose laríngea recorrente, de ambos os sexos, com idade entre 3 e 12 anos. Todas foram submetidas a pH-metria de 24 horas com duplo canal para avaliação da presença e intensidade de refluxo gastroesofágico. RESULTADOS: Cinqüenta por cento dos pacientes apresentaram evidências de refluxo gastroesofágico patológico em nível do esfíncter distal, e 90% apresentou refluxo proximal patológico. CONCLUSÃO: A freqüência da associação entre refluxo gastroesofágico proximal em pacientes portadores de papilomatose recorrente de laringe é extremamente alta.Evidence of a relation between gastroesophaeal reflux and pediatric respiratory disorders increases every year. Many respiratory symptoms and clinical conditions such as stridor, chronic cough, and recurrent pneumonia and bronchitis appear to be related to gastroesophageal reflux. Some studies have also suggested that gastroesophageal reflux may be associated with recurrent laryngeal papillomatosis, contributing to its recurrence and severity. AIM: the aim of this study was to verify the frequency and intensity of gastroesophageal reflux in children with recurrent laryngeal papillomatosis. MATERIAL AND METHODS: ten children of both genders, aged between 3 and 12 years, presenting laryngeal papillomatosis, were included in this study. The children underwent 24-hour double-probe pH-metry. RESULTS: fifty percent of the patients had evidence of gastroesophageal reflux at the distal sphincter; 90% presented reflux at the proximal sphincter. CONCLUSION: the frequency of proximal gastroesophageal reflux is significantly increased in patients with recurrent laryngeal papillomatosis.

Das complicações da sinusite, as que envolvem a região orbitária são mais freqüentes. OBJETIVO: Este trabalho tem por objetivo mostrar a incidência de celulite orbitária (CO) como complicação de sinusite aguda em crianças. Forma de Estudo: Retrospectivo. MÉTODO: Após autorização específica, foram avaliados todos os prontuários de pacientes pediátricos, com idade até 12 anos, com diagnóstico de complicação orbitária por sinusite, admitidos na Clínica de ORL e Pediátrica do HPEV no período de 1985 a 2004. Os casos foram analisados segundo o sexo, idade, quadro clínico, seio paranasal acometido, período médio de internação, exames de imagem realizados e tratamento instituído. RESULTADO: No período de 1985 a 2004, foram diagnosticados 25 pacientes portadores de CO, apresentando uma incidência de 6%, predomínio do sexo masculino, com média de idade de 6,5 anos. O seio paranasal mais acometido foi o maxilar. 24 pacientes apresentavam edema periorbitário. Todos os 25 pacientes apresentavam velamento sinusal ao Rx. Um paciente apresentava deslocamento do globo ocular e proptose e a TC mostrava abscesso subperiosteal. O período médio de internação foi de 4 dias. 25 pacientes receberam tratamento antibiótico endovenoso e 2 foram submetidos a tratamento cirúrgico associado. CONCLUSÃO: A incidência de complicações orbitárias pós-sinusite são infreqüentes, com diagnóstico precoce evoluem bem com tratamento clínico. A cirurgia pode ser necessária em alguns casos. Among the complications of sinusitis, those that involve the orbital region are the most frequent. AIM: the objective of this paper is to show an incidence of orbital cellulites (OC) secondary to acute sinusitis in children. Study design: retrospective. METHODS: After board approval, the charts of all pediatric patients diagnosed with orbital complications secondary to sinusitis, seen at the Pediatric and at the ENT clinics of the HPEV, between 1985 and 2004, were evaluated. The data was analyzed considering gender, age, clinical presentation, period of hospitalization, image study, and treatment. RESULTS: from 1985 to 2004, 25 patients were diagnosed with OC secondary to sinusitis, presenting an incidence of 6% . Males predominated, the median age was 6.5 years, and the maxillary was the most frequently involved sinus. Twenty-four patients presented mild peri-orbital swallowing. All 25 patients presented X-Ray alterations. One patient with proptosis had a subperiosteal abcess seen on the CT-scan. The average time of hospitalization was 4 days. All 25 patients received IV antibiotics, 2 required surgery. CONCLUSION: The incidence of orbital complications secondary to sinusitis is low, and although the majority of cases are early diagnosed and respond well to medication treatment, a surgical intervention may be required. Hospital Heliópolis UNIFESP Hospital Prof. Edmundo Vasconcelos UNIFESP SciELO

Objective To evaluate whether the quadrivalent human papillomavirus (HPV) (types 6, 11, 16, and 18) vaccine influences the clinical course of juvenile-onset recurrent respiratory papillomatosis (RRP) when administered to a group of patients with this condition. Methods Uncontrolled intervention study of patients with juvenile-onset RRP examined at the Pediatric Otorhinolaryngology Clinic, Federal University of Sao Paulo, where nine patients between the ages of nine and 17 received three doses of the prophylactic quadrivalent HPV vaccine (Gardasil ® ) and were followed for one year. Disease staging, intervals between relapses, intervals between surgeries, and the number of surgeries during the year prior to vaccination and during the first year after vaccination were compared. Results Eight patients were infected with HPV-6 and one with HPV-11. There were no statistically significant differences in the clinical scores ( p = 0.083), anatomical scores ( p = 0.257), intervals between relapses ( p = 0.062), intervals between surgeries ( p = 0.357), or the numbers of surgeries ( p = 0.180) when the years before and after vaccination were compared. All patients had relapses following vaccination. Conclusion Patients with juvenile-onset RRP experienced a similar clinical course in the year after versus the year before vaccination with Gardasil ® .

This study aimed to investigate the dental and skeletal variables associated with disturbances of craniofacial development in oral-breathing (OB) individuals and the probability that these variables are related to this condition. This is an observational retrospective case–control study of 1596 patients divided into three groups of age n1 5–12, n2 13–18, and n3 19–57 years. Radiographic, clinical, and models data were analyzed. The control group was consisted of nasal breathing (NB) individuals. Statistical analyses of the qualitative data were performed with x 2 test to identify associations, and odds ratio (OR) tests were performed for the variables that the chi-square test (x 2) identified an association. In the descriptive analysis of the data, we observed that the class II malocclusion was the most frequent in the total sample, but when divided by age group and mode of breathing, there is a random division of these variables. In n1 group, class II, (OR = 2.02) short and retruded mandible (SM and RM) (OR = 1.65 and1.89) were associated with OB and it was considered a risk factor. In n2 group, class II (OR = 1.73), SM (OR = 1.87) and increased lower anterior height (ILAFH) (OR = 1.84) seemed to be associated and to be risk factors for OB. In the n1 group, decreased lower anterior facial height (DLAFH) and brachycephalic facial pattern (BP) seemed to be associated with NB and a protective factor against oral breathing. This study showed that dental and skeletal factors are associated with OB in children, and it seems that it becomes more severe until adolescence. But adults showed no associations between OB and skeletal factors, only in dental variables, indicating that there is no cause–effect relationship between the dental and skeletal factors and OB. The treatment of nose breathing patient should be multidisciplinary, since OB remains even when dental and skeletal factors slow down.