Carlos Eduardo Nazareth Nigro

Nasal valve: anatomy and physiology

UNLABELLED The anterior portion of the nasal cavities, from the nostril to the nasal valve (NV), is the place of highest nasal resistance to airflow, paramount to nasal physiology. There are different terminologies for the same anatomic structures in the literature. AIM The aim of this paper was to study the NV function and define clearly the structures of the anterior portion of the nasal cavities, mainly the region of the NV. CONCLUSION Internum ostium is the anterior segment and isthmus nasi is the posterior segment of the NV region.

Rinometria acústica: correlacão anatômica dos dois primeiros entalhes encontrados no rinograma

The graphic obtained by acoustic rhinometry in Caucasian adult individuals with no nasal affections clearly shows two notches at the beginning of the nasal echogram. However, there are controversies in the literature concerning their anatomic correlation. AIM: The aim of this study was to obtain data that would contribute to the anatomic correlation of these two notches. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: We analyzed the nasal echogram of 35 volunteers in basal conditions, after decongestion and after obstruction of the nasal valve by using cotton impregnated with Vaseline. RESULTS: We identified statistically significant reduction and increase of the cross-sectional area only for the second notch after obstruction of the nasal valve and after decongestion, respectively. CONCLUSION: The analysis of the results suggested that the first notch of the nasal echogram refers to the nostril and the second notch refers to the nasal valve as a whole.

Avaliação da cavidade nasal e nasofaringe através da rinometria acústica antes e após adenoidectomia

INTRODUCAO: A hipertrofia adenoideana e vista com frequencia na pratica otorrinolaringologica e e importante avaliar a patencia nasal antes do inicio do tratamento. Neste trabalho, os autores buscam avaliar as mudancas na geometria nasal e nasofaringe antes e apos adenoidectomia atraves de um metodo objetivo de mensuracao da patencia nasal, a rinometria acustica. FORMA DE ESTUDO: Clinico prospectivo. OBJETIVO: Os autores avaliam a area de seccao transversal minima (ASTM) e o volume das cavidades nasais e nasofaringe atraves da rinometria acustica (RA) antes e apos a cirurgia de adenoidectomia. MATERIAL E METODO: Vinte e tres criancas que tinham indicacao cirurgica para adenoidectomia com ou sem tonsilectomia foram submetidas ao exame de RA antes e 15 dias apos a cirurgia. RESULTADOS: A ASTM das fossas nasais variou, antes do uso de vasoconstritor (VC), de 0,73 cm2 antes da cirurgia para 0,79 cm2 apos a cirurgia; apos o uso de VC variou de 0,87 cm2 para 0,93 cm2. O volume das fossas nasais variou, antes do uso de VC, de 6,18 cm3 antes da cirurgia para 6,47 cm3 apos a cirurgia; apos o uso de VC variou de 8,31 cm3 para 8,65 cm3. Na nasofaringe a ASTM variou, antes do uso de VC, de 2,43 cm2 antes da cirurgia para 2,69 cm2 apos a cirurgia; apos o uso de VC variou de 2,76 cm2 para 3,79 cm2. Na nasofaringe o volume variou, antes do uso de VC, de 5,57 cm3 antes da cirurgia para 6,14 cm3 apos a cirurgia; apos o uso de VC variou de 6,51 cm3 para 8,78 cm3. CCINCLUSAO: O aumento de ASTM e volume da nasofaringe, indicando melhora da permeabilidade nasal, concorda com a melhora dos sintomas obstrutivos referidos pelo paciente e familiares apos a cirurgia de adenoidectomia.

Acoustic rhinometry: anatomic correlation of the first two notches found in the nasal echogram

UNLABELLED The graphic obtained by acoustic rhinometry in Caucasian adult individuals with no nasal affections clearly shows two notches at the beginning of the nasal echogram. However, there are controversies in the literature concerning their anatomic correlation. AIM The aim of this study was to obtain data that would contribute to the anatomic correlation of these two notches. STUDY DESIGN Clinical prospective. MATERIAL AND METHOD We analyzed the nasal echogram of 35 volunteers in basal conditions, after decongestion and after obstruction of the nasal valve by using cotton impregnated with Vaseline. RESULTS We identified statistically significant reduction and increase of the cross-sectional area only for the second notch after obstruction of the nasal valve and after decongestion, respectively. CONCLUSION The analysis of the results suggested that the first notch of the nasal echogram refers to the nostril and the second notch refers to the nasal valve as a whole.

Microbiologia dos seios maxilar e etmoidal em pacientes com rinossinusite crônica submetidos à cirurgia funcional endoscópica dos seios paranasais

Estudos da microbiologia da rinossinusite cronica mostram a presenca de microorganismos aerobicos, anaerobicos, fungos e virus e sua incidencia varia de acordo com cada estudo. Estes estudos nos guiam para a escolha do antimicrobiano mais adequado para eliminar o processo infeccioso, ajudando a restaurar a mucosa nasossinusal. FORMA DE ESTUDO: Clinico prospectivo. OBJETIVO: O objetivo deste trabalho foi estudar a microbiologia dos seios maxilar e/ou etmoidal de pacientes com rinossinusite cronica e com indicacao de cirurgia funcional endoscopica dos seios paranasais. MATERIAIS E METODOS: Durante a cirurgia coletamos, em 41 pacientes, secrecao e/ou fragmento de mucosa dos seios maxilar e/ou etmoidal para realizacao de bacterioscopia, pesquisa direta de fungos, cultura para microorganismos aerobios, anaerobios e fungos. RESULTADOS: Identificou-se a presenca de microorganismos aerobios em 21 pacientes (51,2%), anaerobios em 16 (39%) e fungos em 1 (2,4%). Na populacao estudada, apenas em 12 (29,2%) o microorganismo isolado foi considerado patogenico quando analisado junto a contagem semiquantitativa de leucocitos. O Staphylococcus coagulase-negativo e o Staphylococcus aureus foram os microorganismos mais frequentes, em 5 (12,1%) e em 4 pacientes (9,75%) respectivamente. CONCLUSAO: Este estudo revela que o Staphylococcus coagulase-negative e o Staphylococcus aureus foram os microorganismos mais frequentes isolados nos pacientes com rinossinusite cronica.

Microbiology of the maxillary and ethmoid sinuses in patients with chronic rhinosinusitis submitted to functional endoscopic sinus surgery

UNLABELLED Chronic rhinosinusitis microbiology studies show the presence of aerobe and anaerobe microorganisms, fungus and virus and their incidence vary according to each study. These studies guide us on choosing the most adequate antimicrobial agent to eliminate the infectious process, thus, helping in restoring rhinosinusal mucosa. STUDY DESIGN Clinical prospective. AIM This work aimed at studying the microbiology of the maxillary and/or ethmoid sinuses of patients with chronic rhinosinusitis and with indication of functional endoscopic sinus surgery. MATERIALS AND METHODS During surgery, we collected secretion and/or fragments of maxillary and/or ethmoid sinus mucosa from 41 patients to perform Gram stain, fungus direct research, aerobe and anaerobe microorganism culture and fungus culture. RESULTS We identified the presence of aerobe microorganisms in 21 patients (51.2%), anaerobe microorganisms in 16 (39%) and fungus in 1 (2.4%). In the studied population, only 12 patients (29.2%) presented microorganisms considered pathogenic when analyzed together with the semi-quantitative leukocyte count. Staphylococcus coagulase-negative and Staphylococcus aureus were the most frequent microorganisms found, in 5 (12.18%) and in 4 (9.75%) patients respectively. CONCLUSION This study reveals that Staphylococcus coagulase-negative and Staphylococcus aureus were the most frequent microorganisms isolated from patients with chronic rhinosinusitis.

Acoustic rhinometry: impact of external nasal dilator on the two first notches of the rhinogram.

Background Acoustic rhinometry is more accurate in the anterior portion of the nasal cavities, from the nostril to the nasal valve (NV), the most important site of nasal obstruction. Literature presents different opinions regarding the anatomical correlation of the two notches at the beginning of the rhinogram curve in normal adult white individuals. The aim of this study was to present new data for a better understanding of the anatomic correlation of these two notches. Methods This prospective study included 32 nasal cavities under the following conditions: (1) basal condition, (2) with external nasal dilator strip (ENDS), (3) after decongestion (0.05% oxymetazoline chloride applied as an aerosol spray), and (4) after decongestion with ENDS. Results No statistically significant variation was observed in the cross-sectional area of the first notch (CSA1) after decongestion. However, there was a statistically significant increase in the CSA2 after ENDS. Conclusion Analysis of the results suggested that the first notch of the rhinogram refers to the nostril and the second notch refers to the NV as a whole. This study was part of the clinical trial NCT01411969 registered at www.clinicaltrials.gov.