José Arruda Mendes Neto

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.

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.

Pilomatrixoma in the head and neck.

Universidade Federal de Sao Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Department of Otorhinolaryngology - Head and Neck Surgery

Plug cartilage tympanoplasty in children

UNLABELLED The treatment of tympanic membrane perforations in the pediatric population with sequelae of chronic otitis media represents a challenge to otolaryngologists. AIM To assess the clinical and audiometric results of the inlay technique with a tragus cartilage plug. MATERIALS AND METHODS We assessed 23 patients (ages between 1 and 15 years) who underwent plug tympanoplasty. STUDY DESIGN clinical retrospective. RESULTS Repair success rate was of 82.6%, with audiometric parameters improvement in 87.5% of the patients. Complications were minimum. CONCLUSION Considering the results attained, this method of tympanoplasty should be considered a good treatment option for tympanic membrane perforation in children.

Comparison between telelaryngoscopy and suspension laryngoscopy in the diagnosis of benign vocal fold lesions

UNLABELLED Proper diagnosis of laryngeal benign lesions still brings doubts among experienced laryngologists, despite current diagnostic progress. AIM The goal of this study was to compare telelaryngoscopy (preoperative) with suspension laryngoscopy (intraoperative) on the diagnosis of vocal fold benign lesions. MATERIALS AND METHODS We carried out a restrospective study analyzing 79 charts from patients followed up in a University Hospital. In all the charts there was at least diagnostic hypothesis suggested by telelaryngoscopy, which was later on compared to intraoperative findings of suspension laryngoscopy. RESULTS Almost two-thirds of the patients were females, with ages varying between 12 and 66 years (mean of 37 years). Of the 79 patients studied, we diagnosed 95 lesions with telelaryngoscopy and 124 with suspension laryngoscopy. The most frequently found benign lesion was the vocal polyp in both methods. In 64.5% of the cases the diagnosis of the lesions in the outpatient ward was the same as those in the surgical findings. CONCLUSION Laryngologists must be prepared to alter their surgical planning and treatment approaches because of diagnostic changes that may happen during surgery.

The role of maxillary sinus puncture on the diagnosis and treatment of patients with hospital-acquired rhinosinusitis

UNLABELLED Rhinosinusitis is one of the most common causes of fever of unknown origin in critically ill patients and should be systematically searched. OBJECTIVE This study aims to evaluate the diagnostic and therapeutic effect of maxillary sinus puncture performed at the bedside in patients with infective rhinosinusitis hospitalized in an Intensive Care Unit of a high complexity care hospital. MATERIALS AND METHODS This retrospective study looks into patients on mechanical ventilation with fever of unknown origin and signs of rhinosinusitis on CT images who were submitted to inferior meatus maxillary sinus puncture. RESULTS The total study sample consisted of 27 patients (70.3% male; mean age 45.3 years). The most common Intensive Care Unit admission diagnoses were head trauma and stroke. CT scans revealed the maxillary (85.2%) and sphenoid (74.1%) sinuses were the most involved paranasal sinuses. Middle meatus purulent drainage was seen in 30.7% of the nasal cavities. Fever was reduced in 70.4% of the patients after puncture (p < 0.001). The most commonly found organisms in sinus aspirates were Pseudomonas aeruginosa and Acinetobacter baumannii. CONCLUSION Maxillary sinus puncture performed at the bedside of the patients is an important diagnostic and therapeutic tool for critically ill patients.

Comparação entre a telelaringoscopia e a laringoscopia de suspensão no diagnóstico das lesões benignas das pregas vocais

O correto diagnostico das lesoes benignas da laringe ainda causa duvida em laringologistas experientes, apesar dos avancos diagnosticos. OBJETIVO: O objetivo desse estudo foi comparar a telelaringoscopia (pre-operatoria) com a laringoscopia de suspensao (intra-operatoria) no diagnostico das lesoes benignas das pregas vocais. MATERIAL E METODO: Foi realizado um estudo retrospectivo atraves da analise de 79 prontuarios de pacientes acompanhados em um hospital universitario. Em todos os prontuarios havia pelo menos uma hipotese diagnostica ambulatorial sugerida pela telelaringoscopia, que posteriormente foi comparada aos achados intra-operatorios da laringoscopia de suspensao. RESULTADOS: Quase dois tercos dos pacientes eram do genero feminino, com idade variando de 12 aos 66 anos (media de 37 anos). Dos 79 pacientes estudados, foram diagnosticadas 95 lesoes com a telelaringoscopia e 124 com a laringoscopia de suspensao. A lesao benigna mais frequente foi polipo vocal em ambos os metodos. Em 64,5% dos casos, o diagnostico das lesoes feito no ambulatorio foi o mesmo dos achados cirurgicos. CONCLUSAO: O laringologista deve estar preparado para alterar seu planejamento cirurgico e abordagens terapeuticas devido as mudancas diagnosticas que ocorrem no intra-operatorio.