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Several studies have shown the importance of quantitative assessment in nasal patency and functional status of the upper airways to provide clinical and diagnostic information in oral breather individuals, which are of great interest to speech therapy. The aim of the study was to evaluate the effect of nasal saline solution irrigation on the upper airways through nasal aeration and active anterior rhinomanometry in oral breathing children. This was an eight case series study, carried out in children aged 7 to 10 years with an otorhinolaryngological clinical diagnosis of mouth breathing. The study consisted of three stages: (I) initial evaluation; (II) intervention; and (III) final evaluation. The questionnaires of the Index for the Identification of Oral Breathing Signs and Symptoms and disease-specific quality of life in pediatric patients with sinonasal complaints were applied, nasal aeration assessments and the anterior active rhinomanometry exam were carried out. The intervention was performed by irrigating nasal saline solution with 10ml. Afterwards, they were re-evaluated by nasal aeration evaluation and rhinomanometry to compare the results. Regarding nasal aeration and rhinomanometry evaluation, from the 16 comparative measurements between pre and post nasal irrigation, we obtained significant changes in nasal aeration and nasal resistance. Nasal irrigation resulted in improvement in nasal aeration measurements while nasal flow measurements from rhinomanometry remained unchanged considering pre and post nasal irrigation.

Cambiamenti strutturali della matrice extracellulare dopo cross-linking del tessuto polipoide nasale.La rinosinusite cronica con poliposi nasale è una malattia caratterizzata da una disfunzione meccanica che facilita la crescita anomala della mucosa nasale, a causa del suo peculiare processo di rimodellamento. Questo studio si propone di valutare gli effetti del cross-linking sulla matrice extracellulare del tessuto del polipo nasale. Sono stati selezionati sei pazienti sottoposti ad intervento chirurgico di polipectomia. È stata applicata la tecnica del cross linking del collagene con riboflavina / UVA alla superficie dei polipi resecati epitelizzati e disepitelizzati del gruppo di pazienti sottoposti ad intervento. I polipi del gruppo di controllo non sono stati sottoposti a procedure di cross linking. Le sezioni ultrasottili (8 μm) di tessuto polipoide sono state analizzate mediante immunofluorescenza con anticorpi anti collagene di tipo I di topo e anticorpi secondari coniugati AlexaFluor 488 con controcolorazione DAPI e analizzate mediante microscopia confocale. L’effetto del cross-linking è risultato visibile al microscopio confocale a fluorescenza. La morfologia quantitativa è stata associata all’analisi di imaging in fluorescenza e sono state valutate la densità e la luminosità dei pixel. La superficie dei polipi trattati mostrava una maggiore densità di fibre di collagene rispetto ai polipi di controllo, come è stato possibile osservare sia visivamente che attraverso misurazioni oggettive delle regioni fluorescenti. L’effetto è stato potenziato sulla superficie dei polipi disepitelizzati. La maggiore densità di fibre di collagene esibita dai polipi trattati disepitelizzati dimostra la fattibilità di questa tecnica per interferire con il processo di rimodellamento e affrontare la disfunzione meccanica riscontrata nella rinosinusite cronica con poliposi nasale.Chronic rhinosinusitis with nasal polyposis is a disease characterised by a mechanical dysfunction that facilitates anomalous growth of the nasal mucosa, due to its unique remodelling process. The development of procedures capable of interfering with this process is thus of the utmost importance. This study deals with the evaluation of the effects of cross-linking upon the nasal polyp tissue extracellular matrix. Six patients undergoing surgery for polypectomy were selected. The riboflavin/UVA collagen cross-linking technique was applied to the surface of epithelialised and de-epithelialised resected polyps of the intervention group. The control group polyps were not submitted to cross-linking procedures. Ultrathin polyp tissue sections (8 μm) were processed for immunofluorescence with mouse anti-type I collagen antibody and AlexaFluor 488 conjugated secondary antibody plus DAPI counterstaining, and analysed by confocal microscopy. The effect of riboflavin/UVA collagen cross-linking was visible on confocal fluorescence microscopy. Quantitative morphology was associated with fluorescence imaging analysis, and pixel density and brightness were evaluated. The surface of treated polyps exhibited a higher density of collagen fibres compared to control polyps, as could be observed both visually and through objective measurements of the fluorescent regions. The effect was enhanced on the surface of the de-epithelialised polyps. The higher density of collagen fibres exhibited by the de-epithelialised treated polyps demonstrates the feasibility of this technique in interfering with the remodelling process and the mechanical dysfunction found in chronic rhinosinusitis with nasal polyposis.

RESUMO Esse estudo objetivou investigar o efeito da manobra de limpeza e massagem nasal na permeabilidade da via aérea superior de crianças com respiração oral. Trata-se de um relato de caso no qual foram selecionadas oito crianças com idade entre 7 a 10 anos apresentando diagnóstico fonoaudiológico de respiração oral, com avaliação otorrinolaringológica e diagnóstico clínico de rinites. Realizou-se as avaliações da aeração nasal e permeabilidade nasal, utilizando o espelho milimetrado de Altmann e o Peak Nasal Inspiratory Flow (PNIF), respectivamente. Em seguida, executou-se as manobras de limpeza e massagem nasal com soro fisiológico. Ao término, utilizou-se novamente o espelho de Altmann e o PNIF para comparar os resultados. Os resultados obtidos pelas medianas na quantificação da aeração nasal total foram significantes. Os dados da mensuração das cavidades nasais unilateralmente indicaram aumento acentuado na aeração nasal em cada narina, tendo diferenças estatisticamente significante quando comparados com os valores antes e depois das manobras de limpeza e massagem nasal. Os valores obtidos pelas medianas no Fluxo Nasal Máximo Inspiratório Total foram significantes após a limpeza. Concluiu-se que houve aumento da aeração nasal no fluxo nasal máximo inspiratório após manobra de limpeza.

Introduction Severe uncontrolled chronic rhinosinusitis with nasal polyps has a negative impact on an individual’s quality of life. Therefore, new biologics have emerged for use in specific phenotypes of chronic rhinosinusitis, changing the paradigms of its treatment. Objective To review the current status of biologic treatment indications in chronic rhinosinusitis. Methods The Brazilian Academy of Rhinology brought together different specialists to suggest a course of action, considering its particularities and aspects related to the national reality. Results Of particular interest for decision making will be the identification of subgroups of patients refractory to pre-existing treatment options and the construction of a strategy that improves their quality of life, with the best cost-benefit ratio. Conclusion The use of biologics is a valid option for treatment in more severe cases. This strategy must be better understood and improved in the future, with more studies and greater clinical experience. Resumo Introdução A rinossinusite crônica com pólipos nasais grave não controlada impacta negativamente na qualidade de vida do indivíduo. Para esses casos, novos imunobiológicos têm surgido, para uso em fenótipos específicos da rinossinusite crônica, e mudaram os paradigmas de seu tratamento. Objetivo Revisar o estado atual das indicações de imunobiológicos em rinossinusite crônica. Método A Academia Brasileira de Rinologia reuniu diferentes especialistas para sugerir uma conduta que considerasse suas particularidades e seus aspectos relacionados à realidade nacional. Resultados De particular interesse para a tomada de decisão serão a identificação dos subgrupos de pacientes refratários às opções de tratamento pré-existentes e a construção de uma estratégia que realmente melhore a qualidade de vida deles, dentro da melhor relação custo-benefício. Conclusão O uso de imunobiológicos é uma opção válida para tratamento em casos mais graves. Essa estratégia deve ser mais bem compreendida e aprimorada no futuro, com mais estudos e maior experiência clínica.

Socioeconomic status can significantly impact health. To what degree education and other socioeconomic factors influence the chemical sense of olfaction is not clear. Most studies that have assessed such influences come from countries lacking large disparities in education and income and generally view such measures as nuisance variables to be controlled for statistically. In this study, we evaluated the influences of education and income on odor identification in a diverse sample of subjects from Brazil, a society where large disparities in both income and education are present. The 40-item University of Pennsylvania Smell Identification Test (UPSIT) was administered to 1572 healthy Brazilian citizens with no self-reported olfactory or gustatory deficits and for whom detailed socioeconomic and educational status data were obtained. Univariate and multivariate models were employed to examine the influence of socioeconomic status on the test scores. After controlling for age, sex, ethnicity, and smoking behavior, income and educational level were positively and independently related to the olfactory test scores (respective ps 0.0010.01). Both linear and quadratic functions described the relationship between the UPSIT scores and the levels of education and socioeconomic status. Individuals of lower socioeconomic status performed significantly worse than those of higher socioeconomic status on 20 of the 40 odorant items. This study demonstrates socioeconomic status is significantly associated with influence the ability to identify odors. The degree to which this reflects differential exposures to xenobiotic agents, cultural differences, familiarity with odors or their names, cognitive development, or other factors requires further investigation.

Objective To describe the external and middle ear of goats, using computed tomography and endoscopic dissection, comparing them with the anatomy of the human ear, aiming to evaluate the viability of this animal model for training in otological endoscopic surgery. Methods Images of the external and middle ear of goats were produced by computed tomography in the coronal and axial planes and analyzed. The radiological anatomy of the external and middle goat and human ear are described. Some measures of surgical interest were described, such as the length of the external auditory canal, external and internal cross-sectional area of the external auditory canal, middle ear depth, vertical angle of the external auditory canal, length of malleus and incus. After the tomographic study, we analyzed the importance of evaluations through the endoscopic dissection of the goat ear. Results The bony canal is extremely tortuous and shows a bony prominence with significant elevation near the lower edge of the tympanic membrane. The middle ear has a large tympanic bulla in the hypotympanum region. The malleus is shaped similarly to that of the human, but its handle is located anterior to its head. The mastoid is not pneumatized. Compared to the human mastoid, there was a statistically significant difference in the external and internal cross-sectional area, at the depth of the middle ear, in the vertical angle of the canal and in the length of the incus. Conclusion Goat morphometric anatomy showed that this model is suitable for surgical simulation in the initial training for endoscopic otological surgery. It is an important contribution to the development of skills to accelerate the subsequent endoscopic otological surgical training in humans, despite some differences found.

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.

BACKGROUND: This study aimed to assess clinical outcomes of long-term low-dose oral doxycycline therapy in difficult-to-treat chronic rhinosinusitis with polyps (CRSwNP). METHODS: This was a prospective, open-label study of 60 patients with difficult-to-treat CRSwNP who had undergone endoscopic sinus surgery. Patients were divided into two groups: 28 received nasal steroids, saline irrigation, and doxycycline (200 mg on the first day, followed by 100 mg once daily) for 12 weeks, while 30 received only nasal steroids and saline irrigation. The main outcome measure was an adequate effect size of doxycycline treatment on clinically meaningful significant improvement of SNOT-20. Other outcome measures were the SNOT-20, NOSE, and Lund-Kennedy scores. The following parameters were also analyzed: asthma, rhinitis, non-steroidal-exacerbated respiratory disease (NERD), and baseline serum IgG, IgA, IgE, IgM, ANCA, and eosinophil count. RESULTS: There was an adequate effect size of doxycycline treatment on clinically meaningful significant improvement of SNOT-20. Patients who received doxycycline also had significantly better outcomes regarding SNOT-20, NOSE, and Lund-Kennedy scores. There was a negative association among a clinically significant improvement of SNOT-20 and presence of asthma, NERD, and elevated serum IgE levels before treatment. CONCLUSION: These findings suggest that doxycycline may have a beneficial role for CRSwNP patients, especially for patients without asthma, NERD or high levels of serum IgE before treatment.

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.

Objectives/Hypothesis To describe anatomical landmarks for endoscopic endonasal approaches to the orbital apex and to measure the distances between those landmarks. Methods In this anatomic study, the nasal fossae of 30 adult fresh cadavers were dissected (n = 60 half-skulls). One double-injected orbit was carefully dissected, mainly focusing on the neurovascular structures. The orbital apex was dissected under endoscopic endonasal visualization in all cases. The distances between the ethmoidal crest and choanal arch to the optic canal (OC) and superior orbital fissure (SOF) were measured and recorded. Results The sample was predominantly male (63.3%, 19/30 cadavers). The following correlations between measurements according to side were observed: ethmoidal crest to OC, r = 0.748 (P = 0.0001); ethmoidal crest to SOF, r = 0.785 (P = 0.0001); choanal arch to OC, r = 0.835 (P = 0.0001); choanal arch to SOF, r = 0.820 (P = 0.0001). Conclusions In the cadavers studied in this sample, the ethmoidal crest and choanal arch were relevant structures and exhibited consistent measurements. Spearman correlation coefficients were greater than 0.7, which is indicative of good correlation between measurements obtained in the skull halves of each cadaver. Comparison of the measurements obtained in different sides showed similar values, with no statistically significant differences in the distances between any of the proposed anatomic landmarks. Level of Evidence N/A. Laryngoscope, 2015

It is well established that olfactory dysfunction has significant implications for safety, nutrition, and quality of life. The more reliable standardized tests of olfactory function, such as the University of Pennsylvania Smell Identification Test (UPSIT), assess odor identification ability. Unfortunately, cultural factors can influence such tests, as a number of odors are not universally recognized. In this study, a Portuguese language version of the UPSIT was administered to an age- and sex-stratified prospective sample of 1820 Brazilian subjects. Normative data were developed for a subset of 1578 subjects who reported having no difficulties smelling or tasting. Individuals with a history of head trauma or, in the case of those over the age of 64 years, Mini-Mental State Examination Scores

INTRODUCTION: Establishing a diagnosis in patients with olfactory disturbances has always been challenging for physicians.One reason for this is the rarity of some of the diseases that affect this sense, such as Kallmann's syndrome and post-viral olfactory loss. OBJECTIVE: To identify the major causes of olfactory disturbances and to describe the diagnostic evaluation in outpatients attended to at an ambulatory clinic specialized in olfaction disorders. METHODS: A retrospective analysis was performed in outpatients with primary olfactory complaint attended to between June 1, 2011 and September 30, 2013 in a center specialized in olfactory disorders. Patient history, nasofibroscopy, and the University of Pennsylvania Smell Identification Test (UPSIT) comprised the examination. RESULTS: Sixty-two patients were evaluated. The major causes were chronic rhinosinusitis (31%); rhinitis, primarily the allergic type (19%); post-viral olfactory loss (13%); and post-traumatic loss (8%). UPSIT scores were statistically different among different etiologies (p = 0.01). CONCLUSIONS: The major diagnoses that should be part of the physician assessment when a patient complains of olfactory disturbance are chronic rhinosinusitis with and without polyps, allergic rhinitis, post-viral olfactory loss, and post-traumatic loss.

IntroductionAlthough it is a rare neoplasm, juvenile nasopharyngeal angiofibroma (JNA) is associated with high rates of morbidity and mortality, with the potential for intracranial extension. Surgical excision is the main treatment. The external approach has largely been replaced by the endoscopic approach in small lesions, and it can be used as a complement in more advanced cases. However, there is no consensus in the literature regarding the complications of surgical treatment of JNAs with intracranial extension.AimTo assess the prevalence of complications in endoscopic or endoscopic-assisted surgical treatment of JNA with minimal intracranial invasion.MethodsThis was a retrospective cohort study of all patients with JNA with intracranial extension (Radkowski grade IIIa) treated with endoscopic, endoscopic-assisted, and external surgery from January of 1996 to May of 2010.ResultsThirteen patients underwent surgery. Endoscopic surgery was performed in three patients, without postoperative complications; endoscopic-assisted surgery in three others, with two instances of complications, and external surgery in seven.ConclusionsOperative treatment of nasopharyngeal angiofibroma with intracranial extension is one of the major challenges of ENT and neurosurgical practice. The success rates and low intra- and postoperative complication rates of endoscopic surgery suggest that this route has been gaining ground in the management of Radkowski grade IIIa JNAs.© 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Introduction: The concept of quality of life is subjective and variable definition, which depends on the individual's perception of their state of health. Quality of life questionnaires are instruments designed to measure quality of life, but most are developed in a language other than Portuguese. Questionnaires can identify the most important symptoms, focus on consultation, and assist in defining the goals of treatment. Some of these have been validated for the Portuguese language, but none in children. Objective: To validate the translation with cross-cultural adaptation and validation of the Sinus and Nasal Quality of Life Survey (SN-5) into Portuguese. Methods: Prospective study of children aged 2-12 years with sinonasal symptoms of over 30 days. The study comprised two stages: (I) translation and cross-cultural adaptation of the SN-5 into Portuguese (SN-5p); and (II) validation of the SN5-p. Statistical analysis was performed to assess internal consistency, test-retest reliability, and sensitivity, as well as construct and discriminant validity and standardization. Results: The SN-5 was translated and adapted into Portuguese (SN-5p) and the author of the original version approved the process. Validation was carried out by administration of the SN-5p to 51 pediatric patients with sinonasal complaints (mean age, 5.8 ± 2.5 years; range, 2-12 years). The questionnaire exhibited adequate construct validity (0.62, p < 0.01), internal consistency (Cronbach's alpha = 0.73), and discriminant validity (p < 0.01), as well as good test-retest reproducibility (Goodman-Kruskal gamma = 0.957, p < 0.001), good correlation with a visual analog scale (r = 0.62, p < 0.01), and sensitivity to change. Conclusion: This study reports the successful translation and cross-cultural adaptation of the SN-5 instrument into Brazilian Portuguese. The translated version exhibited adequate psychometric properties for assessment of disease-specific quality of life in pediatric patients with sinonasal complaints. Resumo Introdução: O conceito de qualidade de vida é subjetivo e de definição variável; depende da percepção do indivíduo quanto ao seu estado de saúde. Os questionários para qualidade de vida são instrumentos planejados para medir a qualidade de vida, mas a maioria foi desenvolvida em línguas diferentes do português. Os questionários podem identificar os sintomas mais importantes, serem focadas na consulta e ajudar na definição das metas terapêuticas. Alguns desses instrumentos foram validados para o idioma português, mas nenhum em crianças. Objetivo: Validar a tradução com adaptação transcultural e validação do questionário SN-5 para o idioma português. Método: Estudo prospectivo de crianças com idades entre 2 e 12 anos com sintomas sinonasais com mais de 30 dias de duração. O estudo consistiu em dois estágios: (I) tradução e adaptação transcultural do SN-5 para o idioma português (SN-5p); e (II) validação do SN5-p. Foi realizada análise estatística para avaliação da consistência interna, confiabilidade de reteste e sensibilidade, bem como construto e validade discriminante e de padronização. Resultados: O questionário SN-5 foi traduzido e adaptado para o idioma português (SN-5p) e o autor da versão original aprovou o processo. A validação foi realizada pela administração do SN-5p a 51 pacientes pediátricos com queixas sinonasais (media de idade, 5,8 ± 2,5 anos; variação de 2-12 anos). O questionário exibiu validade de construto adequada (0,62, p < 0,01), consistência interna (alfa de Cronbach = 0,73) e validade discriminante (p < 0,01), além de boa reprodutibilidade de teste-reteste (gama de Goodman-Kruskal = 0,957, p < 0,001), boa correlação com uma escala analógica visual (r = 0,62, p < 0,01) e sensibilidade à mudança. Conclusão: O presente estudo relata uma bem-sucedida tradução e adaptação transcultural do questionário SN-5 para o idioma português brasileiro. A versão traduzida exibiu propriedades psicométricas adequadas para avaliação da qualidade de vida específica para doenças em pacientes pediátricos com queixas sinonasais.

Objective To describe a case of dermoid cyst arising from the pterygopalatine fossa and review the literature. Methods We report a case of a 23-year-old man who suffered a car accident 2 years before otolaryngologic attendance. He had one episode of generalized tonic-clonic seizure and developed a reduction of visual acuity of the left side after the accident. Neurologic investigation was performed and magnetic resonance imaging revealed an incidental finding of a heterogeneous ovoid lesion in the pterygopalatine fossa, hyperintense on T2-weighted imaging. Results Endoscopic sinus surgery with transpterygoid approach was performed. The ovoid lesion was noted in the pterygopalatine fossa. Puncture for intraoperative evaluation showed a transparent thick fluid. Surprisingly, hair and sebaceous glands were found inside the cyst capsule. The cyst was excised completely. Histologic examination revealed a dermoid cyst. The patient currently has no evidence of recurrence at 1 year postoperatively. Conclusion This unique case is a rare report of a dermoid cyst incidentally diagnosed. An endoscopic transnasal transpterygoid approach may be performed to treat successfully this kind of lesion. Although rare, it should be considered in the differential diagnosis of expansive lesions in the pterygopalatine fossa, including schwannoma, angiofibroma, esthesioneuroblastoma, osteochondroma, cholesterol granuloma, hemangioma, lymphoma, and osteoma.

OBJECTIVES: The University of Pennsylvania Smell Identification Test, a test of olfactory function that is widely used by otolaryngologists, geriatricians, and neurologists, has been translated into more than a dozen languages. In some instances, cultural and socioeconomic factors have necessitated changes in the odorant items or the response alternatives to make the test scores congruent with North American norms. The objective of this study was to compare the performance of Brazilian subjects on a new Portuguese language version of the University of Pennsylvania Smell Identification Test with their performance on an earlier Portuguese language version of the test, as well as to assess the influences of gender, age, ethnicity, and economic status on the test scores. METHODS: Based on pilot data, several response alternatives of the earlier Portuguese language version of the test were altered in an effort to improve test performance. Forty-nine healthy Brazilian volunteers, who represented several economic classes, were tested. The test scores of the study cohort who received the newer version of the test were compared with those of a group of 25 subjects who received the earlier version of the test. RESULTS: The mean score for the new version [35 (2.1)] was significantly (p = 0.002) higher than that for the earlier version [32.5 (3.5)]. Although no apparent influence of socioeconomic status was observed, the female participants outperformed the male participants in the current subject cohort. CONCLUSION: The changes made in the new cultural adaptation of the Portuguese version of the University of Pennsylvania Smell Identification Test were effective in increasing the average test scores of the participants. Overall, the female subjects outperformed the male subjects on the test.

Obstrução nasal é uma queixa frequente. Quando causada por um desvio de septo nasal, a septoplastia é cirurgia de escolha para tratamento destes pacientes. O questionário NOSE é um instrumento para avaliar a qualidade de vida doença-específica dos pacientes após intervenções para tratamento da obstrução nasal. OBJETIVO: Avaliar o impacto da septoplastia na qualidade de vida doença-específica dos pacientes com obstrução nasal secundária a desvio de septo. Desenho: Prospectivo. PACIENTES E MÉTODOS: Pacientes submetidos à septoplastia com/sem turbinectomia após ausência de melhora clínica ao tratamento medicamentoso foram avaliados através do NOSE antes e 3 meses após cirurgia. Avaliou-se a melhora na pontuação total, a magnitude do efeito da cirurgia na qualidade de vida doença-específica e a correlação entre a pontuação pré-operatória e a melhora pós-operatória. RESULTADOS: Quarenta e seis pacientes foram incluídos no estudo. Observou-se melhora estatisticamente significativa entre a pontuação do questionário NOSE pré-opera¬tória (md = 75, IIQ = 26) e após três meses (md = 10,IIQ = 20, p < 0,001.T-Wilcoxon). A cirurgia resultou numa magnitude de efeito padronizada de 3,07. Mostrou-se uma forte correlação entre a pontuação pré-operatória no questionário NOSE e a melhora da pontuação no pós-operatório (r = -0,789, p < 0,001, Spearman). Não se encontrou diferença entre a melhora na pontuação segundo sexo. (p = 0,668, U-Mann-Whitney). CONCLUSÃO: A septoplastia resultou numa melhora da QV doença-específica estatisticamente significativa. Nasal obstruction is a common complaint in the population. When caused by a deviated nasal septum, septoplasty is the procedure of choice for treating these patients. NOSE is a tool for assessing the disease-specific quality of life related to nasal obstruction. AIM: To assess the impact of septoplasty on patients with nasal obstruction secondary to deviated nasal septum based on the disease-specific quality-of-life questionnaire. Design: Prospective. METHODS: Patients undergoing septoplasty with/without turbinectomy after no clinical improvement with medical treatment were assessed by the NOSE questionnaire before and 3 months after surgery. We evaluated the surgical improvement based on total score, the magnitude of the surgery in the disease-specific quality of life and the correlation between the preoperative score and postoperatively improvement. RESULTS: Fourty-six patients were included in the study. There was a statistically significant improvement in the preoperative NOSE score (md = 75, IQR = 26) and after three months (md = 10, IQR = 20) (p < 0.001.T-Wilcoxon). The standardized response mean was 3.07. We found a strong correlation between the preoperative score in the NOSE questionnaire and improvements in the postoperative period (r = -0.789, p < 0.001, Spearman). No difference was found in improvement scores by gender. (p = 0.668, U-Mann-Whitney). CONCLUSION: Septoplasty resulted in a statistically significant improvement in the disease-specific QOL questionnaire.

BACKGROUND: Glucocorticoids (GCs) are considered drugs of choice for treating nasal polyps (NPs). However, a subset of patients shows a limited clinical response even to high doses of GCs. Altered expression of glucocorticoid receptors (GRs), namely GR-alpha; and GR-beta;, is a potential mechanism underlying GC insensitivity. GCs modulate the expression of several cytokines, including transforming growth factor-beta (TGF-beta), which may contribute to cellular proliferation in NPs. The study investigates some biomolecular features of GC-resistant NPs, and examines possible differences from normal mucosa (NM). METHODOLOGY: Radioligand binding assay (binding) was used to determine GR-alpha; binding capacity; Western blotting was used to evaluate GR-alpha;, GR-beta;, and TGF-beta; expression and GR-alpha; subcellular distribution. NPs were sampled in 32 patients during ethmoidectomy; NM was taken from 15 healthy patients during rhinoplasty. RESULTS: GR-alpha; was present in NPs and NM, with lower affinity for the ligand in NPs. GR-alpha; was prevalent in the cytosol of NPs that were GR-alpha-negative to the binding assay. GR-beta was expressed in NPs and absent in the majority of NM. TGF-beta1 expression was higher in NPs than in NM. CONCLUSIONS: GR-beta and TGF-beta1 might be involved in NP pathogenesis, but their role in modulating GC sensitivity is still unclear.

A rinossinusite crônica é uma doença de etiologia não definida que impacta significativamente a qualidade de vida dos pacientes. A sinusectomia endoscópica foi demonstrada como um tratamento eficaz em melhorar a qualidade de vida dos pacientes em outros países; contudo, não existem estudos nacionais. OBJETIVO: Avaliar a associação cirurgia endoscópica nasossinusal com a qualidade de vida doença-específica dos pacientes com rinossinusite crônica com e sem polipose nasossinusal pelo SNOT-20. Desenho: Estudo prospectivo. PACIENTES E MÉTODOS: Pacientes submetidos à sinusectomia endoscópica após ausência de melhora ao tratamento medicamentoso foram avaliados pelo questionário SNOT-20p antes e 12 meses após a cirurgia. Avaliou-se a melhora na pontuação total e nos cinco itens considerados mais importantes por cada paciente. Avaliamos também a presença de correlação entre a pontuação pré-operatória e a melhora pós-operatória e se havia diferença entre a melhora segundo sexo. RESULTADOS: Incluímos 43 pacientes com idade de 44 (19), md (IIQ); e 60,5% (26/43) do sexo masculino. Os pacientes apresentaram melhora estatisticamente significativa no SNOT-20 e SNOT-20 (5+), e correlação entre a pontuação pré-operatória e a melhora da pontuação (p

INTRODUÇÃO: síndrome de Frey é uma seqüela observada após parotidectomia com incidência que varia muito na literatura. O diagnóstico é avaliado pela presença da tríade clássica - sudorese, calor e hiperemia na face, durante a alimentação - e documentado pelo teste com amido e iodo de Minor. OBJETIVO: Avaliar a incidência desta síndrome nos pacientes submetidos à parotidectomia parcial, no Centro de Otorrinolaringologia de Limeira, no período de 1994-2004 e correlacioná-la com os achados clínicos e com a técnica cirúrgica utilizada. MATERIAL E MÉTODO: Quatorze pacientes foram submetidos à parotidectomia parcial com rotação de retalho pediculado do músculo esternocleidomastóideo e responderam a questionário e a seguir foi realizado o teste do iodo, classificando-se os pacientes em positivos e negativos para o teste em um estudo clínico retrospectivo. RESULTADO: Nesta casuística, observamos que 21% dos pacientes após parotidectomia parcial apresentaram positividade para o teste, sendo os mesmos pacientes que apresentaram queixas clínicas ao responderem o questionário. CONCLUSÃO: Somente os pacientes que apresentaram sintomatologia clínica tiveram positividade no teste do iodo, e a técnica cirúrgica empregada foi eficiente no tratamento da patologia da glândula, pois apresentou baixa incidência de acordo com a literatura pesquisada.INTRODUCTION: Frey syndrome is a sequela observed after parotidectomy and the reported incidence varies enormously in the literature. Diagnosis is evaluated by presence of the classic triad of gustatory sweating, heating and flushing while feeding and documented by Minor starch-iodine test. AIM: to evaluate the incidence of this syndrome in patients submitted to partial parotidectomy at Centro Otorrinolaringológico de Limeira, from 1994 to 2004, including presence of signs and symptoms and the surgical technique. MATERIAL AND METHOD: fourteen patients undergoing partial parotidectomy with sternocleidomastoid muscle flap answered a questionnaire and were classified as positive or negative by Minor starch-iodine test in a clinical retrospective study. RESULTS: 21% of the patients presented symptoms and positive iodine test. CONCLUSION: only the patients presenting clinical symptoms had a positive test and the adopted surgical technique was efficient due to low incidence of the syndrome.

HYPOTHESIS: Hypercalcemia is thought to perform an important role in the etiopathogenesis of tympanosclerosis. The purpose of the present study was to assess the influence of hypercalcemia in the development of tympanosclerosis in rats with or without acute otitis media. BACKGROUND: The pathogenesis of tympanosclerosis is still unclear. Histologically, it is characterized by a hyaline degeneration in the lamina propria of the middle ear and mastoid mucosa and may lead to a calcification process. The process of calcification is similar to that of other pathologically calcified tissues, such as vessels, heart valves, cornea, and others, which depend on calcium serum levels. METHODS: Twenty-four Wistar rats were divided into two different groups, with one group submitted to hypercalcemia status through calcium diet supplementation and the other used as a control group (normal calcium content diet). Both were submitted to induction of tympanosclerosis by inoculation of Streptococcus pneumoniae on the right middle ear only. Otomicroscopy was conducted every 15 days, and after 7 weeks of inoculation, the animals were killed and the tympanic bullae were resected to be analyzed through light and electron microscopy. RESULTS: The group submitted to hypercalcemia presented a prevalence of tympanosclerosis of 25% against 16.7% in the control group, presenting a relative risk of 1.27 (p=0.72). CONCLUSION: The results suggest that hypercalcemia can have an influence in the development of tympanosclerosis.

Summary Introduction Frey syndrome is a sequela observed after parotidectomy and the reported incidence varies enormously in the literature. Diagnosis is evaluated by presence of the classic triad of gustatory sweating, heating and flushing while feeding and documented by Minor starch-iodine test. Aim to evaluate the incidence of this syndrome in patients submitted to partial parotidectomy at Centro Otorrinolaringologico de Limeira, from 1994 to 2004, including presence of signs and symptoms and the surgical technique. Material and method fourteen patients undergoing partial parotidectomy with sternocleidomastoid muscle flap answered a questionnaire and were classified as positive or negative by Minor starch-iodine test in a clinical retrospective study. Results 21% of the patients presented symptoms and positive iodine test. Conclusion only the patients presenting clinical symptoms had a positive test and the adopted surgical technique was efficient due to low incidence of the syndrome.

Objectives:Assess the clinical outcome of long-term low-dose oral doxycycline in difficult-to-treat chronic rhinosinusitis with polyps.Methods:We conducted an open label prospective study in a university-based tertiary care center from 2013 to 2014 with 60 patients with difficult-to-treat chronic rhinosinusitis with nasal polyps uncontrolled after 6 or more months of endoscopic sinus surgery. They were divided into 2 groups: 28 patients received nasal steroids plus doxycycline (200 mg on the first day, followed by 100 mg once daily) for 12 weeks while 32 patients received only nasal steroids. The main outcome measure was a meaningful improvement in SNOT-20 (>0.80). Other outcome measures were the SNOT-20, NOSE, and Lund-Kennedy scores. The following parameters were also analyzed: asthma, rhinitis, DREA and blood testing before treatment for IgG, IgA, IgE, IgM, antineutrophil cytoplasmic antibodies, and blood eosinophil count.Results:There was a statistically significant association among meaningful improv...

Nasal polyposis is a severe, chronic inflammatory condition of the paranasal sinuses and is frequently associated with asthma and aspirin sensitivity. Mesenchymal stem cells exhibit a potent immunosuppressive effect in several inflammatory conditions, and their role in nasal polyposis remains little explored. Hence, we investigated whether bone marrow-derived mesenchymal stem cells could modulate cell phenotype in the nasal polyp milieu. After coculture with mesenchymal stem cells, the frequency of these inflammatory cells was found to decrease. Furthermore, mesenchymal stem cells promoted strong inhibition of CD4+ and CD8+ T cell proliferation, increased the frequency of CD4+CD25+Foxp3 T cells, and changed the global cytokine profile from an inflammatory to an anti-inflammatory response. We believe that mesenchymal stem cells may be a very useful adjunct for investigation of the inflammatory process in nasal polyposis, contributing to better understanding of the inflammatory course of this condition.

This review is addressed two pathophysiologic mechanisms implicated in the pathogenesis of nasal polyposis: the unique remodeling process found in nasal polyp tissue and the immune response of patients with nasal polyposis to Staphylococcus aureus. These two theories converge to the same direction in different aspects, including decreased extracellular matrix production, impaired T regulation and favoring of a Th2 immune response. In patients with nasal polyposis, an exaggerated immune response to Staphylococcus aureus may aggravate the airway remodeling process.