João Ferreira de Mello Júnior

Alterações funcionais do sistema estomatognático em pacientes com rinite alérgica: estudo caso-controle

A respiracao oral pode acarretar alteracoes estruturais e funcionais do sistema estomatognatico. OBJETIVO: Verificar a presenca de alteracoes das funcoes de respiracao, mastigacao, degluticao e fala em pacientes com rinite alergica e relaciona-as com a intensidade dos sintomas da rinite. MATERIAL E METODOS: Para este estudo prospectivo, foram avaliados 170 pacientes com faixa etaria entre 6 e 55 anos de idade. Todos os pacientes passaram por avaliacao otorrinolaringologica e fonoaudiologica. Foram colhidos os dados referentes as funcoes de respiracao, mastigacao, degluticao e fala e dados da consulta medica. Os dados foram comparados e analisados estatisticamente. RESULTADOS: A diferenca dos escores de sinais e sintomas entre GR e GC mostrou-se estatisticamente significante. Quando comparada a presenca de alteracao nas funcoes estudadas entre GR e GC, foi observada diferenca estatisticamente significante no modo respiratorio e nos padroes de mastigacao e degluticao. A correlacao existente entre o escore de obstrucao nasal e a presenca de alteracao funcional foi significante na analise do modo respiratorio e do padrao de mastigacao. CONCLUSAO: O paciente com rinite alergica apresenta alteracoes funcionais do sistema estomatognatico e o aumento do escore de obstrucao nasal pode ser considerado um indicativo destas alteracoes.

Methods for studying mucociliary transport

UNLABELLED Mucociliary transport dysfunctions can impair the quality of life of patients suffering from chronic rhinossinusitis and lead to severe consequences such as alterations in respiratory physiology or even death as in cases of cystic fibrosis and primary ciliary dyskinesia. Therefore, it is crucial to understand the physiology of the mucociliary apparatus and how its components (cilia, mucus-periciliary layer and its interaction) affect the clearance of respiratory secretions. AIMS This paper aims to review and to discuss different techniques for studying mucociliary transport and their clinical and experimental applicability. CONCLUSIONS The methods listed in this revision provide us with valuable information about different aspects of the mucociliary transport. Some of the methods listed are more suitable for clinical practice and present reproducible results. Others, show only applicability in experimental settings due to technical difficulties or financial limitations. However, it is important to emphasize that up to now there is no method that can evaluate ciliary beating frequency (CBF) in vivo and in situ. Such a method would become a valuable tool in the scientific scenario and in the clinical practice, supporting the diagnosis of ciliary dyskinesias and avoiding the use of invasive procedures to corroborate the clinical suspicion.

Métodos de estudo do transporte mucociliar

Mucociliary transport dysfunctions can impair the quality of life of patients suffering from chronic rhinossinusitis and lead to severe consequences such as alterations in respiratory physiology or even death as in cases of cystic fibrosis and primary ciliary dyskinesia. Therefore, it is crucial to understand the physiology of the mucociliary apparatus and how its components (cilia, mucus-periciliary layer and its interaction) affect the clearance of respiratory secretions. AIMS: This paper aims to review and to discuss different techniques for studying mucociliary transport and their clinical and experimental applicability. CONCLUSIONS: The methods listed in this revision provide us with valuable information about different aspects of the mucociliary transport. Some of the methods listed are more suitable for clinical practice and present reproducible results. Others, show only applicability in experimental settings due to technical difficulties or financial limitations. However, it is important to emphasize that up to now there is no method that can evaluate ciliary beating frequency (CBF) in vivo and in situ. Such a method would become a valuable tool in the scientific scenario and in the clinical practice, supporting the diagnosis of ciliary dyskinesias and avoiding the use of invasive procedures to corroborate the clinical suspicion

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.

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.

Futura study: evaluation of efficacy and safety of rupatadine fumarate in the treatment of persistent allergic rhinitis

UNLABELLED Allergic rhinitis affects 10-30% of the population, negatively impacting ones quality of life and productivity. It has been associated with sinusitis, otitis media, sleep disorders, and asthma. Rupatadine is a second generation antihistamine with increased affinity to histamine receptor H1; it is also a potent PAF (platelet-activating factor) antagonist. It starts acting quite quickly, offers long lasting effect, and reduces the chronic effects of rhinitis. AIM this study aims to assess the efficacy and safety of rupatadine in the treatment of persistent allergic rhinitis. MATERIALS AND METHOD this is a multi-centric open prospective study. This study included 241 patients from 13 centers in Brazil and was held between October of 2004 and August of 2005. Signs and symptoms of rhinitis and tolerance to medication were analyzed after one and two weeks of treatment. RESULTS reduction on general scores from 8.65 to 3.21 on week 2 (p<0.001). All signs and symptoms improved significantly in the first day of treatment (p<0.001), except for nasal congestion and secretion, which improved from the second day of treatment (p<0.001). Adverse events occurred in 19.9% of the cases, 27.7% on week 1. CONCLUSION rupatadine effectively controls persistent allergic rhinitis; it is safe and presents low incidence of side effects.

Estudo futura: avaliação da eficácia e segurança do fumarato de rupatadina no tratamento da rinite alérgica persistente

A rinite alergica acomete 10 a 30% da populacao, interferindo na qualidade de vida e na capacidade produtiva. Esta associada a sinusite, otite, roncopatias e asma. A Rupatadina e um anti-histaminico de segunda geracao, com elevada afinidade ao receptor histaminico H1 e potente inibicao do fator ativador plaquetario (PAF). Tem rapido inicio de acao, longa duracao e reduz os efeitos cronicos da rinite. OBJETIVO: Avaliar a eficacia e seguranca da rupatadina no tratamento da rinite alergica persistente. MATERIAL E METODO: Estudo multicentrico, aberto, prospectivo. Foram selecionados 241 pacientes em 13 centros no Brasil durante o periodo de outubro de 2004 a agosto de 2005. Foram analisados os sinais e sintomas da rinite e a tolerabilidade apos 1 e 2 semanas. RESULTADOS: Reducao do escore geral de 8,65 para 3,21 na semana 2 (p<0,001). Todos os sinais e sintomas melhoraram significativamente, e no primeiro dia de tratamento (p<0,001), com excecao da obstrucao e secrecao nasal, a partir do segundo dia (P<0,001). A frequencia de eventos adversos foi 19,9%, sendo 27,7% na 1a semana. CONCLUSOES: A rupatadina e eficaz no controle da rinite alergica persistente, e segura e apresenta baixos indices de efeitos colaterais.

Rhinosinusitis: evidence and experience. A summary

as Mild, Moderate or Severe. Disease severity isclassified through the Visual Analog Scale (VAS) (Fig. 1), from0 to 10cm. The patient is asked to quantify from 0 to 10 thedegree of discomfort caused by the symptoms; zero meaningno discomfort, and 10, the greatest discomfort. Severity isthen classified as follows: Mild: 0---3 cm; moderate: >3---7 cm;Severe: >7---10cm.