Flávio Barbosa Nunes

Prevalence and impact of chronic otitis media in school age children in Brazil. First epidemiologic study concerning chronic otitis media in Latin America

OBJECTIVE The first epidemiological study carried out in Latin America to investigate the prevalence of otological disease and its impact in a representative random sample of the school children population. METHODS A cross sectional epidemiological survey to investigate the epidemiology of otitis in a representative random sample of 1119 children and adolescents from a total of 486166 elementary and high-school students, aged 6-18 years, regularly registered in one of the 521 public and private schools of the city of Belo Horizonte, in the state of Minas Gerais, southern Brazil. The interviews were conducted individually, in the school, by an otolaryngologist or a pediatrician. The interview included all of the personal data and also detailed questions regarding otological disorders and hearing. The otological examination was carried out with Mini-Heine otoscopes and the audiometric evaluation with the AudioScope 3 with 25dB intensity. The questionnaire and basic procedures for medical examination had been previously tested through a pilot test in two schools. RESULTS The prevalence of chronic otitis media was 0.94%. Impacted wax was found in 12.3% of the students. The prevalence of abnormalities (excluding wax) in the otoscopy examination was 10.5%. It was found that 8.3% of students had a past history of otitis and 7.7% had a past history of otorrhea. These two special groups presented statistically significant associations with chronic otitis media, hearing loss and otolaryngological surgeries (when compared with the other school children). Parents and school children seemed significantly able to identify a special group of children with past history of otitis during childhood.

Avaliação do processamento auditivo em idosos que relatam ouvir bem

Em idosos, os resultados da avaliacao comportamental das vias auditivas centrais sao considerados de dificil interpretacao devido a possivel interferencia do comprometimento das vias auditivas perifericas. OBJETIVO: Avaliar a eficiencia das funcoes auditivas centrais de idosos que relatam ouvir bem. MATERIAL E METODO: Estudo de casos que incluiu 40 individuos na faixa etaria de 60 a 75 anos. Os pacientes foram submetidos a avaliacao do processamento auditivo que constou de anamnese, exame otorrinolaringologico, audiometria tonal liminar, limiar de reconhecimento de fala, indice de reconhecimento de fala, imitanciometria, pesquisa de reflexos estapedianos, teste de identificacao de sentencas sinteticas com mensagem competitiva ipsilateral, teste de padroes de frequencia e teste de dissilabos alternados por meio de tarefa dicotica. RESULTADOS: Genero, faixa etaria e perda auditiva nao influenciaram os resultados dos testes de padroes de frequencia e dissilabos alternados por meio de tarefa dicotica; faixa etaria e perda auditiva influenciaram os resultados do teste de identificacao de sentencas com mensagem competitiva ipsilateral. Porcentagens de acertos abaixo dos padroes da normalidade de adultos foram observadas nos tres testes que acessam as funcoes auditivas centrais. CONCLUSAO: Individuos idosos que relatam ouvir bem apresentam prevalencia relevante de sinais de ineficiencia das funcoes auditivas centrais.

Auditory processing assessment in older people with no report of hearing disability

UNLABELLED In the elderly, the results of central auditory pathways behavioral assessments are considered to be difficult to read because of the possible interference of peripheral auditory pathway involvement. AIM Assess the efficacy of the central auditory function in elderly patients who do not complain of hearing. MATERIALS AND METHODS Case study involving 40 individuals within the age range of 60 to 75 years. The patients underwent auditory processing evaluation based on anamnesis, otorhinolaryngological exam, threshold tonal audiometry, speech recognition threshold, speech recognition index, immittance measures, stapes reflex study, synthetic phrases identification test with ipsilateral competitive message, frequency pattern test and alternate twin-syllable test through dichotic task; age range and hearing loss influenced results from the phrases identification with ipsilateral competitive message. Percentages of right answers below normal standards were seen in the three tests that assessed the central auditory functions. CONCLUSION Elderly individuals who did not complain of hearing presented relevant prevalence of signs of central auditory function inefficiencies.

Effect of mitomocin C in eosinophilic nasal polyposis, in vivo: concentration of IL5 and GM-CSF, RT-PCR

UNLABELLED Eosinophilic nasosinusal polyposis is a chronic inflammatory infection with elevated infiltration of eosinophils, which presents high rate of recurrence after surgical treatment. The continuous inflammatory process that leads to the formation of polyps requires constant clinical treatment. Contributing to the maintenance of eosinophilia are cytokines IL5 (interleukin-5) and GM-CSF (granulocyte macrophages colony-stimulating factor), which show up in elevated concentrations. These oligoproteins diminish the rate of apoptosis and prolong the survival of eosinophils. AIM By diminishing these cytokines, the action of Mitomycin C (MMC), an antineoplastic drug which inhibits the synthesis of DNA, was studied. In a recent study the power of this drug to cause apoptosis in eosinophils, in vitro, of nasal polyps was verified. METHODOLOGY A biopsy of the nasal polyps was undertaken in 15 patients carriers of eosinophilic nasosinusal polyposis 24 hours after applying 0.5 mg/ml of MMC during five minutes. RT-PCR (reverse transcription of polymerase chain reaction) for IL5 and GM-CSF was the method used to obtain the results. RESULTS The comparison of the results of GM-CSF pre- and post-application of MMC, when the paired T-test was used, showed p=0.041 and for IL5 we found p<0.001. CONCLUSION Topic use of MMC in patients with eosinophilic nasosinusal polyposis shows statistically significant reduction for GM-CSF and significant and important reduction for IL5.

Efeito da mitomicina C em cultura de estroma de pólipos nasais eosinofílicos: indução de apoptose em eosinófilos

The eosinophilic nasal polyposis occurs as a manifestation of several diseases. It affects multiple nasal sinuses and presents with high relapsing rates after current treatment. The eosinophils play an essencial role in the pathogenesis through their low apoptosis rates and the long periods of remaining in the tissues in an active form. AIM: During the present study the effect of C-mitomycin was observed in the apoptosis induction of stromal eosinophils in eosinophilic nasal polyps. STUDY DESIGN: Case control. MATERIALS AND METHOD: During this auto-matched study, 9 samples of eosinophilic nasal polyps were cultivated in RPMI 1640 medium and then evaluated at the beginning, and after 12 and 24 hours of incubation. The study group was submitted to C-mitomycin in a 400 µg/ml concentration during 5 minutes. Both control and study group cultures were evaluated histopathologically and their apoptotic rates were determined. They were stained using hematoxilin-eosin and observed through microscopic enhancement of 1000 times. RESULTS: The analysis of 674 digitalized fields showed that those cultures treated with C-mitomycin achieved significantly higher apoptotic rate after 12 hours of incubation when compared to control group rate (p<0,001). CONCLUSION: This study supports that C-mitomycin is efficacious in the induction of the apoptosis of stromal eosinophils in eosinophilic nasal polyps.

Efeito da mitomicina C em polipose nasossinusal eosinofílica, in vivo: dosagem de IL5 e GM-CSF, RT-PCR

Eosinophilic nasosinusal polyposis is a chronic inflammatory infection with elevated infiltration of eosinophils, which presents high rate of recurrence after surgical treatment. The continuous inflammatory process that leads to the formation of polyps requires constant clinical treatment. Contributing to the maintenance of eosinophilia are cytokines IL5 (interleukin-5) and GM-CSF (granulocyte macrophages colony-stimulating factor), which show up in elevated concentrations. These oligoproteins diminish the rate of apoptosis and prolong the survival of eosinophils. AIM: By diminishing these cytokines, the action of Mitomycin C (MMC), an antineoplasic drug which inhibits the synthesis of DNA, was studied. In a recent study the power of this drug to cause apoptosis in eosinophils, in vitro, of nasal polyps was verified. METHODOLOGY: A biopsy of the nasal polyps was undertaken in 15 patients carriers of eosinophilic nasosinusal polyposis 24 hours after applying 0.5 mg/ml of MMC during five minutes. RT-PCR (reverse transcription of polymerase chain reaction) for IL5 and GM-CSF was the method used to obtain the results. RESULTS: The comparison of the results of GM-CSF pre- and post-application of MMC, when the paired T-test was used, showed p=0.041 and for IL5 we found p<0.001. CONCLUSION: Topic use of MMC in patients with eosinophilic nasosinusal polyposis shows statistically significant reduction for GM-CSF and significant and important reduction for IL5.

Cytokine profile in subjects with Cystic Fibrosis and nasal polyposis compared to patients with no nasal disorders

UNLABELLED Although the cytokine profile in nasal polyposis is well documented, little is known about cytokines associated to cystic fibrosis. AIM Assess the expression of cytokines IL not4, IL not5, IL not6, IL not8, GM not-CSF and IFN not-y, analyzed through RT-PCR, in the polyps of patients with cystic fibrosis. MATERIALS AND METHODS A cross-sectional, prospective study was carried out with 24 patients, 13 of whom had cystic fibrosis and nasal polyposis (Cystic Fibrosis Group) and 11 had normal otorhinolaryngological exams (Control Group). The average age was 21 years (3 not57); 12 participants were males and 12 were females. The cytokine profile was studied in mucosal fragments (Control Group) or nasal polyps (Cystic Fibrosis Group) through RT notPCR. Transcriptions were studied for cytokines IL not4, IL not5, IL not6, IL not8, IFN noty and GM notCSF, adjusted for the beta not-actin value. RESULTS Interleukins 5, 6, 8 and GM notCSF were similar in both groups (p>0.05). There were lower values of IFN-y not (p=0.03) and a strong tendency toward an increase in IL not4 (p=0.06) in the Cystic Fibrosis Group. CONCLUSION Inflammatory and structural cells may produce messenger RNA for IL not4, blocking the production of other cytokines such as IFN-y, suggesting the participation of this mechanism in the formation of polyps in cystic fibrosis.

RT-PCR cytokine study in patients with allergic rhinitis

UNLABELLED Allergic rhinitis is an inflammatory reaction of the nasal mucosa, in consequence of an IgE mediated hypersensitive reaction to inhaling allergens, involving different mediators and cytokine cells. AIM The purpose of this study was to evaluate the transcriptions for IL-4, IL-5, IL-8 and IFN-gama, particularly important in the nasal allergy process, especially IL-4 and IL-5. For this study we decided to evaluate atopic patients who were free from allergic crises, with the purpose of knowing the cytokine expressions during this period. MATERIALS AND METHODS Another prospective and transversal study was carried out, selecting 30 patients, 13 of these patients were pauci-symptomatic and 17 were non atopic. The groups were selected by means of a medical interview, an otolaryngologic clinical exam and allergy skin tests - Prick Test. The cytokines were investigated in fragments of the nasal mucosa, using RT-PCR - chosen because it has good reproducibility and specificity. RESULTS IL-5, IL-8, IFN-gama cytokine values were kept homogeneous in relation to the control group. Only IL-4 presented significant statistic differences. CONCLUSION Asymptomatic patients with allergic rhinitis presented with normalization of cytokine expression in the nasal mucosa, with exception of IL-4.

Análise de citocinas pela RT-PCR em pacientes com rinite alérgica

Rinite alergica e uma doenca que decorre de um processo inflamatorio da mucosa nasal consequente a reacao de hipersensibilidade a alergenos inalatorios e, eventualmente, alimentares. E mediada por IgE, envolvendo diferentes celulas, mediadores e citocinas. OBJETIVO: Avaliar as transcricoes para as seguintes citocinas: IL-4, IL-5, IL-8 e IFN-gama, particularmente importantes no processo alergico nasal, principalmente IL-4 e IL-5. Neste estudo, optou-se por avaliar os pacientes atopicos fora das crises alergicas, com a finalidade de se conhecer as expressoes das citocinas neste periodo. MATERIAL E METODO: Realizou-se um estudo transversal e prospectivo, selecionando-se 30 pacientes, sendo 13 pacientes portadores de rinite alergica paucissintomaticos e 17 pacientes nao-atopicos. Os grupos foram selecionados atraves da historia, do exame clinico otorrinolaringologico e do teste alergico cutâneo - Prick Test. O perfil das citocinas foi pesquisado nos fragmentos de mucosa nasal, atraves da RT-PCR semiquantitativa, escolhida por apresentar boa reprodutibilidade e especificidade, utilizando-se como referencia o gene da Beta-actina. RESULTADOS: Os valores de IL-5, IL-8, IFN-gama mantiveram-se homogeneos em relacao ao grupo controle. A IL-4 apresentou diferenca com significância estatistica. CONCLUSAO: Os pacientes alergicos paucissintomaticos apresentaram normalizacao da expressao das citocinas na mucosa nasal a excecao de IL-4.

Evaluation of the improvement of quality of life with Azithromycin in the treatment of eosinophilic nasal polyposis

INTRODUCTION The Sino-Nasal Outcome Test 22 (SNOT-22) is an important tool in assessing the quality of life (QoL) of patients with chronic rhinosinusitis with a validated version in Brazil. The eosinophilic nasal polyposis (ENP) represents most of the cases of nasal polyposis (85-90%) and belongs to the group of chronic rhinosinusitis. It is a chronic inflammatory disease that impacts the QoL of patients, not only causing localized symptoms, but also resulting in a general malaise. The standard treatments (corticosteroids and nasal endoscopic surgery) lead to partial control of symptoms, but relapses are frequent. Macrolide acting as an immunomodulator is a promising tool for more effective control of this disease. Studies are still lacking to assess the real impact on the QoL in patients treated with macrolides. OBJECTIVE To evaluate the improvement of QL, evaluated using SNOT-22, in patients with PNSE treated with immunomodulatory dose azithromycin. METHODS This is a paired experimental study in patients with ENP. Comparison of pre-treatment and post-treatment with azithromycin was performed. Patients completed the SNOT-22 questionnaire before the start of treatment and returned for evaluation after eight weeks of treatment. Azithromycin was prescribed at a dose of 500 mg, orally, three times a week, for 8 weeks. RESULTS SNOT-22 score decreased 20.3 points on average. There was a significant decrease in the SNOT-22 (difference greater than 14 points) in 19 patients (57.6%). There was no significant difference in improvement in SNOT in subgroups with or without asthma/aspirin intolerance. CONCLUSION Azithromycin resulted in significant improvement of QoL, assessed by SNOT-22, in the studied population.