Elder Yoshimitsu Goto

Antibiotics in septoplasty: is it necessary?

UNLABELLED The use of antibiotics is a common practice among otorhinolaryngogists for surgical procedures. The majority of the American Rhinology Society members uses post-operative antibiotics routinely in septoplasties, which is considered unnecessary by many authors. AIM To study the real necessity of the antibiotic usage in septoplasties, as well as the main post-operative complications described in the literature. STUDY DESIGN clinical prospective with transversal cohort. MATERIAL AND METHOD We studied prospectively 35 patients who were undergone to septoplasty with or without turbinectomy, in the Clinical Hospital of the University of São Paulo. The patients were split in three groups: Group A: without antibiotics; Group B: antibiotics (cefazolin) only during the anesthesic induction; Group C: antibiotics both in the anesthesic induction and post-operatively for seven days. A questionnaire was applied in the immediate post-operatory, in the 7th post-operative day and in the 30th post-operative day asking for bleeding, fever, pain, nausea, vomits and followed by physical and endoscopic evaluation looking for hematoma, septal abscess and purulent secretion which as quantified. RESULT We do not observed significative difference among the groups concerning to pain, fever, nausea, vomits, bleeding and purulent secretion. None of the patients had hematoma or septal abscess. The groups also do not differ in respect to the quantity of purulent secretion. CONCLUSION The nasal surgeries are clean contamined and do not need antibioticprophilaxy because of the low infection risk.

The Role of Rhinitis in Chronic Otitis Media

OBJECTIVE: We investigated the role of allergic rhinitis in chronic otitis media (otitis media with effusion [OME] and chronic perforation of the tympanic membrane) in São Paulo, Brazil and whether there is any association between these diseases. STUDY DESIGN AND SETTING: We studied 51 patients followed in the otologic group of the Otorhinolaryngology Division of the University of São Paulo Hospital. The patients were divided into 3 groups: allergic rhinitis, nonallergic rhinitis with eosinophils syndrome (NARES), and patients with types of rhinitis or without rhinitis. We analyzed the age, gender, intensity of the nasal disease, surgical procedure, and surgical results in each group. RESULTS: We found about 50% of patients presenting with nasal disease and nasal eosinophilia (33.33% of allergic and 15.69% of NARES). CONCLUSION: Nasal disease has an impact on otologic middle ear disease, considering that the normal nasal mucosa do not have eosinophils.

Uso de antibióticos em septoplastias: é necessário?

O uso de antibioticos em cirurgias nasais e pratica rotineira entre os otorrinolaringologistas. A maioria dos membros da Sociedade Americana de Rinologia utiliza rotineiramente antibiotico no pos-operatorio de septoplastias, conduta esta considerada desnecessaria por muitos autores. OBJETIVO: Nosso objetivo e avaliar a necessidade do uso de antibioticos em septoplastias, e as principais complicacoes pos-operatorias descritas na literatura. FORMA DE ESTUDO: clinico prospectivo com coorte transversal. MATERIAL E METODOS: Avaliamos prospectivamente 35 pacientes submetidos a septoplastia e turbinectomia no Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, divididos em 3 grupos: o primeiro grupo nao recebeu antibioticoterapia, o segundo grupo recebeu apenas cefazolina no momento na inducao anestesica, e o terceiro grupo recebeu cefazolina no momento da inducao anestesica e cefalexina durante 7 dias no pos-operatorio. Um protocolo foi aplicado no pos-operatorio imediato, apos uma semana e um mes, pesquisando sangramentos, febre, nauseas, vomitos e dor, associado a endoscopia nasal, avaliando a presenca de hematoma ou abscessos, alem de procurar quantificar secrecao purulenta. RESULTADOS: Nao observamos diferenca significativa com relacao a dor, febre, nauseas, vomitos e sangramentos pos-operatorios entre os grupos. Nenhum paciente desenvolveu hematoma ou abscesso septal. Nao houve tambem diferenca com relacao a quantidade de secrecao purulenta nas fossas nasais atraves da endoscopia nasal. CONCLUSAO: Septoplastias sao consideradas potencialmente contaminadas, e nao necessitam de antibioticoprofilaxia, pelo baixo risco de infeccao pos-operatoria.

Bilateral congenital choanal atresia in a 13-year-old patient

Congenital choanal atresia (CCA) is the developmental failure of the nasal cavity to communicate with the nasopharynx. Surgical repair is recommended in the first weeks of life in bilateral cases, because in newborns this is a life-threatening situation. This is a case report of a 13-year-old patient complaining of long-term bilateral nasal obstruction and rhinorrea, in whom bilateral choanal atresia was diagnosed by endoscopic exploration and CT scan, and who was treated by an endonasal endoscopic surgical technique. Bilateral choanal atresia is a life-threatening disease in newborns; however, it can be diagnosed in adults with bilateral nasal obstruction and rhinorrea.

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.

Nasal contact endoscopy for the in vivo diagnosis of inverted schneiderian papilloma and unilateral inflammatory nasal polyps.

Background Inverted schneiderian papilloma is an entity surrounded by controversies ranging from its etiology to the indication of treatment. Any method that permits histopathological analysis without damage to the tissue studied deserves to be investigated. In this study, we tested a new noninvasive method, i.e., nasal contact endoscopy. Methods The main alterations visible on nasal contact endoscopy were described in 11 patients with inverted papilloma and in 8 patients with unilateral inflammatory nasal polyps. The characteristics showing the differentiation between the two entities were defined and these findings were presented to inexperienced examiners. Results The significant characteristics for differentiation between the two diseases were the presence of vacuolized cells, cellular heterogeneity, cell clusters, a ciliated respiratory epithelium, and vascular patterns. Two of the three examiners showed a statistically significant high rate of correct diagnosis. Conclusion Nasal contact endoscopy may be an effective method for the differential diagnosis between inverted schneiderian papilloma and inflammatory polyps even when the examiner is inexperienced.

Agenesia do nariz: relato de caso

Agenesis of the nose (arhinia, congenital nasal atresia) is a rare anomaly with about 20 surviving cases reported in the English literature in the last century. The embryological origin of the defect is thought to be maldevelopment of the paired nasal placodes. The respiratory distress is evident after the birth and requires immediate orotracheal intubation and mechanical ventilation. Herein we report a case of congenital absence of the nose in a male child. Immediately after birth, the baby had difficulty in breathing and developed cyanosis, for which he required orotracheal intubation and tracheotomy, posteriorly. On examination a, a flat bony area replaced the nose, the hard palate was highly arched, and bilateral microphthalmia. The child was also was evaluated by CT (computed tomography) and MRI (magnetic resonance imaging) studies. The CT scan revealed absence of the nose, anterior bony stenosis, absence of the nasal chamber and paranasal sinuses, a high-arched palate, bilateral microphtalmia, and bilateral mucocele of the lachrymal sac. The MRI demonstrated normal configuration and density of the brain.

Pseudomucocele bilateral associada à fibrose cística: relato de caso

Cystic fibrosis, also known as mucoviscidosis, is a monogenetic disorder that is presented as a multisystemic disease. The incidence is approximately 1: 2500 live births. The pathophysiologic mechanism is a qualitative change in all exocrine secretions of the body. An increased viscosity of those secretions leads to stasis and mechanical obstruction, resulting in an impaired function of secretory and target organs. Nose and sinuses are involved due to abnormal mucociliary clearance, responsible for chronic rhinosinusitis, nasal polyps and sinus pseudomucocele. OBJECTIVE: show a rare case of bilateral pseudomucocele in a child with cystic fibrosis. CASE DESCRIPTION: M.F.B.R., 2 years old, male, with nasal obstruction and recurrent pulmonary infections. Clinical findings were copious nasal secretion and posterior nasal drip. The CT scan of the paranasal sinuses showed an image that was suggestive of pseudomucocele, with opacification of maxillary and ethmoid sinuses. The sweat test presented meaningful results. We preferred surgical treatment, after patient hospitalization, to control the pulmonary manifestations. The child presented improvement of nasal obstructive symptoms. CONCLUSIONS: Pseudomucocele is a disease that has been increasingly included in the routine of the differential diagnoses since CT scans became part of sinus disease semiology. Patients with pseudomucoceles have enjoyed relevant increases in their survival, thanks to current treatment modalities.

Cystic Fibrosis-Associated Bilateral Pseudomucocele: case Report

UNLABELLED Cystic fibrosis, also known as mucoviscidosis, is a monogenetic disorder that is presented as a multisystemic disease. The incidence is approximately 1: 2500 live births. The pathophysiologic mechanism is a qualitative change in all exocrine secretions of the body. An increased viscosity of those secretions leads to stasis and mechanical obstruction, resulting in an impaired function of secretory and target organs. Nose and sinuses are involved due to abnormal mucociliary clearance, responsible for chronic rhinosinusitis, nasal polyps and sinus pseudomucocele. OBJECTIVE show a rare case of bilateral pseudomucocele in a child with cystic fibrosis. CASE DESCRIPTION M.F.B.R., 2 years old, male, with nasal obstruction and recurrent pulmonary infections. Clinical findings were copious nasal secretion and posterior nasal drip. The CT scan of the paranasal sinuses showed an image that was suggestive of pseudomucocele, with opacification of maxillary and ethmoid sinuses. The sweat test presented meaningful results. We preferred surgical treatment, after patient hospitalization, to control the pulmonary manifestations. The child presented improvement of nasal obstructive symptoms. CONCLUSIONS Pseudomucocele is a disease that has been increasingly included in the routine of the differential diagnoses since CT scans became part of sinus disease semiology. Patients with pseudomucoceles have enjoyed relevant increases in their survival, thanks to current treatment modalities.

Glioma nasal: relato de três casos e revisão de literatura

Nasal glioma is a rare and benign congenital defect. This condition is diagnosed usually at birth time and requires early treatment to prevent facial deformations. We report three patients with nasal glioma that were diagnosed and treated at Otorhinolaryngology Department of Clinics Hospital of Sao Paulo University, and discuss clinical aspects, complementary exams, treatment and follow-up for each case. The first case was female, who presented a solid mass getting off left nasal fossae. The second case was male and presented cleft palate with a solid mass occupying the oral cavity. The third patient was male and had a solid mass over nasal pyramid. After surgical resection, all cases showed nasal glioma. Nasal congenital midline mass may be difficult to diagnose before histopathology, but is necessary to make an effort to do the correct diagnosis, letting an accuracy prognosis and appropriate surgical treatment.