Eduardo Macoto Kosugi

Translation, cross-cultural adaptation and validation of SinoNasal Outcome Test (SNOT): 22 to Brazilian Portuguese

UNLABELLED Quality of life questionnaires have been increasingly used in clinical trials to help establish the impact of medical intervention or to assess the outcome of health care services. Among disease-specific outcome measures, SNOT-22 was considered the most suitable tool for assessing chronic rhinosinusitis and patients with nasal polyps. AIMS To perform translation, cross-cultural adaptation and validation of the SNOT-22 to Brazilian Portuguese. METHODS Prospective study involving eighty-nine patients with chronic rhinosinusitis or nasal polyps submitted to functional endoscopic sinus surgery, who answered the questionnaire before and after surgery. Furthermore, 113 volunteers without sinonasal disease also answered the questionnaire. Internal consistency, test-retest reliability, measure validity, responsiveness and clinical interpretability were assessed. RESULTS Mean preoperative, postoperative and no sinonasal disease scores were 62.39, 23.09 and 11.42, respectively (p<0.0001); showing validity and responsiveness. Internal consistency was high (Cronbachs alpha = 0.9276). Reliability was sufficiently good, considering inter-interviewers (r=0.81) and intra-interviewers within a 10 to 14 day-interval (r=0.72). Surgery effect size was 1.55. Minimally important difference was 14 points; and scores up to 10 points were considered normal. CONCLUSION The Brazilian Portuguese SNOT-22 version is a valid instrument to assess patients with chronic rhinosinusitis and nasal polyps.

Long-term outcomes of endoscopic sinus surgery for chronic rhinosinusitis with and without nasal polyps

UNLABELLED Chronic rhinosinusitis (CRS) significantly affects patient quality of life. Medical and surgical treatments aim to clinically manage the condition. OBJECTIVE To assess the long-term quality of life and clinical management of CRS in patients submitted to endoscopic sinus surgery. METHOD This prospective cross-sectional cohort study enrolled 38 patients and looked into the follow-up data of subjects diagnosed with CRS before surgery, three months after surgery, and at least two years after surgery. The Sinonasal Outcome Test 22 (SNOT-22) was used to assess response to treatment and long-term clinical management of the disease. RESULTS Significant improvements in the SNOT-22 scores were seen between the preoperative (61.3) and postoperative assessments with three (16.9) and 24 (32.3) months. No statistically significant differences were seen when patients with polyps were compared to polyp-free subjects. Few patients were controlled in both groups, and 7.89% of the subjects had revision surgery during the study. CONCLUSION Endoscopic sinus surgery significantly improved the quality of life of patients with chronic rhinosinusitis. Clinical control of the condition was acceptable, with few patients requiring re-operation within two years of the first surgery.

Laryngeal assessment in reumatic disease patients

Summary Rheumatic diseases usually promote several systemic disorders, which can affect blood vessels, mucosa and serosa of the aerodigestive tract. Scarce laryngeal involvement has been described in these patients and this study aims at investigating laryngeal alterations found in patients with rheumatic diseases. Study design: transversal cohort. Material and method: A transversal study was developed with systemic lupus erythematous, systemic sclerosis and mixed connective tissue disease’s patients. They were evaluated by means of clinical examinations and videolaryngoestroboscopy. Results: Twenty-seven patients were included in the study, 26 succeeded in completing the videolaryngoestroboscopy. Laryngeal abnormalities were seen in 11 of 12 patients with lupus, in all 11 patients with sclerodermia and in 3 patients with mixed connective tissue disease. Vocal fold bamboo node was observed in 5 patients and 92.3% of all patients presented laryngeal signs of gastroesophageal reflux disease. Conclusion: We noticed 5 vocal fold bamboo nodes and gastroesophageal reflux disease in almost all patients.

Topical therapy with high-volume budesonide nasal irrigations in difficult-to-treat chronic rhinosinusitis

INTRODUCTION Chronic rhinosinusitis (CRS) is termed difficult-to-treat when patients do not reach acceptable level of control despite adequate surgery, intranasal corticosteroid treatment and up to 2 short courses of systemic antibiotics or corticosteroids in the preceding year. Recently, high-volume corticosteroid nasal irrigations have been recommended for CRS treatment. OBJECTIVE To assess high-volume budesonide nasal irrigations for difficult-to-treat CRS. METHODS Prospective uncontrolled intervention trial. Participants were assessed before- and 3 months after nasal irrigation with 1mg of budesonide in 500 mL of saline solution daily for 2 days. Subjective (satisfactory clinical improvement) and objective (SNOT-22 questionnaire and Lund-Kennedy endoscopic scores) assessments were performed. RESULTS Sixteen patients were included, and 13 (81.3%) described satisfactory clinical improvement. SNOT-22 mean scores (50.2-29.6; p=0.006) and Lund-Kennedy mean scores (8.8-5.1; p=0.01) improved significantly. Individually, 75% of patients improved SNOT-22 scores, and 75% improved Lund-Kennedy scores after high volume budesonide nasal irrigations. CONCLUSION High-volume corticosteroid nasal irrigations are a good option in difficult-to-treat CRS control of disease, reaching 81.3% success control and significant improvement of SNOT-22 and Lund-Kennedy scores.

Avaliação laríngea em pacientes reumatológicos

Rheumatic diseases usually promote several systemic disorders, which can affect blood vessels, mucosa and serosa of the aerodigestive tract. Scarce laryngeal involvement has been described in these patients and this study aims at investigating laryngeal alterations found in patients with rheumatic diseases. STUDY DESIGN: transversal cohort. MATERIAL AND METHOD: A transversal study was developed with systemic lupus erythematous, systemic sclerosis and mixed connective tissue diseases patients. They were evaluated by means of clinical examinations and videolaryngoestroboscopy. RESULTS: Twenty-seven patients were included in the study, 26 succeeded in completing the videolaryngoestroboscopy. Laryngeal abnormalities were seen in 11 of 12 patients with lupus, in all 11 patients with sclerodermia and in 3 patients with mixed connective tissue disease. Vocal fold bamboo node was observed in 5 patients and 92.3% of all patients presented laryngeal signs of gastroesophageal reflux disease. CONCLUSION: We noticed 5 vocal fold bamboo nodes and gastroesophageal reflux disease in almost all patients.

Interleukin-6-174 G/C promoter gene polymorphism in nasal polyposis and asthma

BACKGROUND Interleukin-6 (IL-6) is an inflammatory mediator linked to nasal polyposis and asthma, with a single nucleotide poly- morphism -174 G/C that seems to promote an inflammatory status. We aimed to analyze the relationship between this poly-morhism and asthmatic nasal polyposis patients. METHODOLOGY Cross-sectional study to investigate IL-6 - 174 G/C genotypes of 45 nasal polyposis with asthma patients, 63 nasal polyposis-only patients, 45 asthma-only patients and 81 subjects without both diseases. Aspirin intolerance and atopy were main exclusion criteria. IL-6 genotyping was performed using the PCR method with specific primers followed by restriction enzyme analysis, classifying patients in GG, GC or CC genotype. RESULTS The GG genotype was the most frequent in all inflammatory groups. Less than 40% of controls presented with the GG ge- notype. There were significant differences between inflammatory groups and control group. No significant differences were seen when comparing inflammatory groups to each other, other than between nasal polyposis-only group and asthma-only group. CONCLUSION The IL-6 74 GG genotype was found more frequently in all inflammatory groups than in controls. This genotype could influence nasal polyposis and asthma, and seems to be more important in the latter.

Corpo estranho em Otorrinolaringologia: perfil dos atendimentos em um pronto-socorro de referência

UNLABELLED Individuals often seek help with foreign bodies (FB) in their ears, noses, and throats. Proper recognition, study, and management of foreign bodies is required to prevent complications. OBJECTIVE To analyze the profile of the patients seen for FB at a reference otorhinolaryngology emergency care unit between February of 2010 and January of 2011. METHOD Cross-sectional retrospective historical cohort study based on digitized patient charts. RESULTS FB accounted for 827 cases and 5.3% of all patients seen in the ENT emergency unit. Children were affected more frequently, particularly when aged 8 and under. No statistically significant differences were seen between genders. Foreign bodies were mostly located in the ears (64.4%), followed by the nasal fossae (19.5%), and the oropharynx (8.9%). Complications were seen in 4.5% of the cases, and 4.4% required general anesthesia to have the FB removed. CONCLUSION In our ENT practice, foreign bodies were more commonly seen in children; the ears were the preferential site of occurrence. Complication rates and use of general anesthesia were low in our practice. It should be stressed that ENT foreign bodies need to be properly managed so as to avoid complications.

Influence of age and gender in the normal values of Sino Nasal Outcome Test–22

Sino Nasal Outcome Test (SNOT)‐22 is a disease‐specific outcomes measure questionnaire that combines rhinologic issues with general health issues. These issues may have variable weight on quality of life perception, and the influence of several factors such as gender, ethnicity, age, socio‐cultural status and co‐morbidities is unknown. The aim of this study was to evaluate the influence of gender and age on normal values of SNOT‐22.

Vestibular Schwannoma: spontaneous tumor involution

The natural history of Vestibular Schwannomas (VS) is yet not totally known, but most of them have the tendency to slow growth, sometimes without any kind of symptoms during the individuals entire time. About 69% of diagnosed VS do not grow at all and 16% of these can even regress. Considering tumors that grow, about 70% have grown less than 2mm an year. Advanced radiological diagnosis, especially magnetic resonance imaging with gadolinium helps us diagnose small and less symptomatic tumors. Treatment of choice still is complete tumor resection. Surgical approaches have improved considerably and have helped preserve facial nerve function and hearing. Considering VSs natural history, there is a possibility for conservative treatment for these tumors, because their growth in the first year after diagnosis predicts tumor growth behavior in the next years. Surgery should be done in cases of tumor growth, patients desire or symptoms worsening. Moreover, in terms of postoperative sequelae, there is no difference between patients who underwent surgery immediately after diagnosis and those who underwent initial conservative treatment for these tumors.

Surgical treatment of severe epistaxis: an eleven-year experience

UNLABELLED Epistaxis is one of the most prevalent emergencies in ENT practice, and its surgical treatment is part of the routine at services for emergency care, especially in cases refractory to clinical procedures. OBJECTIVE To analyze the profile of patients and the results this service has had in the surgical treatment of epistaxis for the last 11 years. METHOD Data from 98 patients submitted to surgery for epistaxis between 2000 and 2011 were analyzed retrospectively. RESULTS Most in the sample were males, and mean age was around 46 years. Hypertension was identified in 58% of patients, and most events occurred during fall and winter. The re-bleeding rate was 13.27%. CONCLUSION This study concluded that the surgical treatment for epistaxis, when indicated, had good success rates and low incidence of complications. In our service, it remains as the gold-standard procedure for nosebleeds refractory to initial management measures.