Francini Grecco de Melo Padua

Prevalence of chronic rhinosinusitis in Sao Paulo

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.INTRODUCTION Studies designed to investigate chronic rhinosinusitis (CRS) epidemiology play an important role to assess population`s distribution and risk factors to result in the development and promotion of public health policies. METHOD This study design is a survey carried out with a complex two-stage cluster sampling plan. Personal interviews were carried out with 2,003 individuals. The questionnaire included the epidemiological criteria for CRS. Demographic data, history of physician-diagnosed respiratory diseases (asthma, sinusitis, rhinitis), smoking, family income, educational attainment, and household characteristics were also evaluated. RESULTS The overall response rate was 93.9% of the households. Mean age was 39.8 +- 21 years; 45.33% were male. The overall prevalence of CRS in the city of Sao Paulo was 5.51%. We found a significant association between diagnosis of CRS and diagnosis of asthma and CRS and diagnosis of rhinitis and a significant association between presence of CRS and belonging to the low-income subgroup. CONCLUSION The municipality of Sao Paulo has an urban population of 11 million. According to the present study, the prevalence of CRS is 5.51%, which represents more than 500,000 individuals affected by this condition in the city.

Severe Posterior Epistaxis–Endoscopic Surgical Anatomy

Objective: To describe the anatomy of the sphenopalatine foramen (SPF) region and possible anatomical variations.

Biofilms in Chronic Rhinosinusitis with Nasal Polyps

Objective. (1) Evaluate the presence of biofilms in patients with chronic sinusitis with nasal polyps (CRSwNP) and (2) investigate the association of biofilm presence and CRSwNP. Study Design. Cross-sectional study. Setting. University-based tertiary care center. Subjects and Methods. The study group consisted of 33 consecutive patients undergoing functional endoscopic sinus surgery for CRSwNP. The control group consisted of 27 control patients undergoing septoplasty for nasal obstruction without diagnosis of chronic sinusitis. Mucosal samples were harvested intraoperatively for scanning electron microscopic examination to determine biofilm presence. Statistical analysis was performed. For all statistical tests, P = .05 was considered significant. Results. Biofilms were found in 24 (72.7%) of the 33 patients with CRSwNP and in 13 (48.1%) of the 27 septoplasty patients (odds ratio = 2.87; 95% confidence interval, 0.98-8.42; P = .051). Conclusion. (1) Biofilms were present in patients undergoing functional endoscopic sinus surgery for CRSwNP and also in controls without chronic sinusitis. This suggests that biofilms may not be sufficient to cause chronic sinusitis without other cofactors. Host factors could be the responsible for the pathogenesis of biofilms. (2) Although the prevalence of biofilms in patients with CRSwNP was not significantly different from that in the controls, the extremely wide 95% confidence interval, which is just below unity, suggests that a meaningful clinical difference may have been missed because of low statistical power. Further studies are necessary.

Cross-cultural adaptation and validation of a quality of life questionnaire: the Nasal Obstruction Symptom Evaluation questionnaire.

BACKGROUND The Nasal Obstruction Symptom Evaluation (NOSE) instrument is a disease-specific questionnaire for assessing the outcome of an intervention in nasal obstruction in trials. This instrument is only available in the English language and cross-culturally valid questionnaires are very important for all research, including nasal obstruction. The aim of the current study was to reproduce the cross-cultural adaptation process for the NOSE questionnaire in the Portuguese language (NOSE-p). METHODOLOGY/PRINCIPAL Cross-cultural adaptation and validation of the instrument were divided into two stages. Stage 1 involved four bilingual professionals, an expert committee and the author of the original instrument. In Stage 2, the NOSE-p was tested on 33 patients undergoing septoplasty for internal consistency, test-retest reliability, construct validity, discriminant validity, criterion validity, and response sensitivity. RESULTS The cross-cultural adaptation process was completed and the NOSE-p was demonstrated to be a valid instrument with satisfactory construct validity. It showed an adequate internal consistency reliability and adequate test-retest reliability. It could discriminate between patients with and without nasal obstruction and it has a high response sensitivity to change. CONCLUSIONS The cross-cultural adaptation and validation process demonstrated to be valid and the NOSE-p proved to be applicable in Brazil.

Avaliação da qualidade de vida após septoplastia em pacientes com obstrução nasal

UNLABELLED 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.

Expression of interleukins in patients with nasal polyposis.

OBJECTIVE: To correlate the levels of interleukins 1 β, 3, 4, and 5 before and after surgery and compare the levels between patients with and without recurrence of nasal polyposis. STUDY DESIGN AND SETTING: Thirty-nine patients with NP were selected, 13 of them allergic and 26 nonallergic. A control group of 11 individuals was also studied. The concentrations of interleukins were measured by enzyme-linked immunosorbent assay. RESULTS: There was a higher incidence of NP after the fourth decade of life and among men. The clinical symptoms were similar in both groups of patients with nasal polyposis and characterized by nasal obstruction and anosmia. A significant reduction of all interleukins studied was observed after surgical treatment. CONCLUSION: Levels of interleukins 1β, 3, 4, and 5 were significantly reduced after surgery and the levels of interleukins 1β and 5 were significantly lower in patients without recurrence of nasal polyposis after surgery when compared to those with recurrence.

Cross-Cultural Adaptation and Validation of SNOT-20 in Portuguese

Introduction. Chronic rhinosinusitis is a highly prevalent disease, so it is necessary to create valid instruments to assess the quality of life of these patients. The SNOT-20 questionnaire was developed for this purpose as a specific test to evaluate the quality of life related to chronic rhinosinusitis. It was validated in the English language, and it has been used in most studies on this subject. Currently, there is no validated instrument for assessing this disease in Portuguese. Objective. Cross-cultural adaptation and validation of SNOT-20 in Portuguese. Patients and Methods. The SNOT-20 questionnaire underwent a meticulous process of cross-cultural adaptation and was evaluated by assessing its sensitivity, reliability, and validity. Results. The process resulted in an intelligible version of the questionnaire, the SNOT-20p. Internal consistency (Cronbachs alpha = 0.91, P < .001), reliability testing-retesting (r = 0.994, P < .001), content validity, validity of discrimination of patients without chronic rhinosinusitis (U = 44, P < .0001) and assessment of sensitivity to change (SRM = 1.53 and 1.09) were evaluated. Conclusion. We conducted a successful process of cross-cultural adaptation and validation of the SNOT-20 questionnaire into Portuguese.

Assessment of quality of life after endoscopic sinus surgery for chronic rhinosinusitis

UNLABELLED Chronic rhinosinusitis is a disease of undefined etiology that significantly impacts the quality of life of its patients. Various studies carried out in countries other than Brazil have shown endoscopic sinus surgery as an effective means of treating this condition. OBJECTIVE This study aims to analyze, with the aid of SNOT-20, the association between endoscopic sinus surgery and disease-specific quality of life of Brazilian patients treated for chronic rhinosinusitis accompanied or not by nasal polyps. MATERIALS AND METHODS This prospective study enrolled patients submitted to endoscopic sinus surgery after drug therapy failed to improve their symptoms. They were assessed based on questionnaire SNOT-20p before and 12 months after surgery. Improvement on total scores and on the five items deemed more important by each patient were assessed. The study also looked into the correlation between preoperative scores and postoperative improvement and if there were any gender-related improvement differences. RESULTS Forty-three patients aged 44 (19), md (IQR), 65% of whom (26/43) were males. Statistically significant improvement was seen on SNOT-20 and SNOT-20(5+) and a correlation was established between preoperative scores and postoperative improved scores (p<0.001). No gender-related differences were observed in quality of life. CONCLUSION Endoscopic sinus surgery in patients with chronic rhinosinusitis is associated with statistically significant improvements in disease-specific quality of life.

Tegmen tympani cerebrospinal fluid leak repair.

Objective To describe the transmastoid approach for closing cerebrospinal fluid leaks in the tegmen tympani using autologous materials (temporal muscle fascia and abdominal fat) and heterologous materials (bovine collagen), together with its advantages and disadvantages. Material and Methods We present the cases of three patients who underwent closure of spontaneous cerebrospinal fluid leaks in the tegmen tympani in which we used the transmastoid approach and autologous and heterologous materials. The three patients underwent canal wall-up mastoidectomy, posterior tympanotomy, removal of the malleus head and incus and, consequently, exposure of the tegmen tympani and the cerebrospinal fluid leak. Closure was performed using temporal muscle fascia, abdominal fat and bovine collagen, fixed in place with fibrin glue. A lumbar shunt was established, as is routine. Results The cerebrospinal fluid leak was closed in all patients using the technique described, with a minimum follow-up of 14 months. Conclusion The technique presented herein is an excellent option in cases of cerebrospinal fluid leakage in the tegmen tympani; it is easy to perform and results in minimal risk to patients.OBJECTIVE To describe the transmastoid approach for closing cerebrospinal fluid leaks in the tegmen tympani using autologous materials (temporal muscle fascia and abdominal fat) and heterologous materials (bovine collagen), together with its advantages and disadvantages. MATERIAL AND METHODS We present the cases of three patients who underwent closure of spontaneous cerebrospinal fluid leaks in the tegmen tympani in which we used the transmastoid approach and autologous and heterologous materials. The three patients underwent canal wall-up mastoidectomy, posterior tympanotomy, removal of the malleus head and incus and, consequently, exposure of the tegmen tympani and the cerebrospinal fluid leak. Closure was performed using temporal muscle fascia, abdominal fat and bovine collagen, fixed in place with fibrin glue. A lumbar shunt was established, as is routine. RESULTS The cerebrospinal fluid leak was closed in all patients using the technique described, with a minimum follow-up of 14 months. CONCLUSION The technique presented herein is an excellent option in cases of cerebrospinal fluid leakage in the tegmen tympani; it is easy to perform and results in minimal risk to patients.

Brazilian Academy of Rhinology position paper on topical intranasal therapy

This documents aims at educating those who treat sinonasal diseases - both general practitioners and specialists - about topical nasal treatments. By means of scientific evidence reviews, the Brazilian Academy of Rhinology provides its practical and updated guidelines on the most utilized topical nasal medication, except for the drugs that have topical antibiotics in their formulas.