Viviane Carvalho da Silva

Quality of life in children with sleep-disordered breathing: evaluation by OSA-18

UNLABELLED Sleep-disordered breathing (SDB) is prevalent. There is evidence of their effect on quality of life. AIM To assess the quality of life in children with SDB before and after adenoidectomy or adenotonsillectomy. METHODS A prospective before and after interventional study, with a component for assessment. A consecutive sample of children referred to adenoidectomy or adenotonsillectomy was recruited from the otolaryngology clinic; guardians answered a specific survey for the evaluation of quality of life in children with SDB, the OSA-18, before and at least 30 days after surgery. Nasofibroscopic and otolaryngological exams and a semi-structured survey on the childs social and clinical profile were done on both appointments. RESULTS 48 children with a mean age of 5.93 years (SD=2.43) were evaluated. The mean number of schooling years for guardians was 8.29 years (SD=3.14). The most frequent symptoms were: agitated sleep, apnea and snoring. The total mean score of the initial OSA-18 was 82.83 (major impact); following surgery, the total mean score was 34.15. The differences in the total scores and in the domains between the initial OSA-18 and post-surgery scores were all significant (p<0.00). CONCLUSION SDB has a relevant impact on quality of life, and patients show dramatic improvements after surgical treatment.

Resultados na qualidade de vida em longo prazo de crianças submetidas à adenoidectomia/adenotonsilectomia por distúrbios obstrutivos do sono

Os Disturbios Obstrutivos do Sono (DOS) afetam significativamente a populacao pediatrica. Neste grupo, sua principal etiologia e a hiperplasia adenotonsilar, sendo adenoidectomia ou adenotonsilectomia indicadas para tratamento, reversao de sequelas e melhora na qualidade de vida. OBJETIVO: Avaliar qualidade de vida de criancas com DOS apos adenoidectomia/adenotonsilectomia. CASUISTICA E METODO: Realizou-se estudo tipo prospectivo com 48 criancas, entre 2 e 11 anos, apresentando DOS e hiperplasia adenotonsilar obstrutiva com indicacao cirurgica. Aplicou-se o questionario OSA18 sobre qualidade de vida aos cuidadores destas criancas antes da cirurgia, cerca de trinta dias e com pelo menos onze meses apos o procedimento. Pontuacoes elevadas no escore significam pior qualidade de vida. RESULTADOS: No pre-operatorio, o escore OSA18 medio foi 82,83 (DP=12,57), com nota global media para a qualidade de vida de 6,04 (DP=1,66). Na avaliacao pos-operatoria inicial, obteve-se escore OSA18 de 34,3(DP=9,95) e nota global de 9,6 (DP=0,81), ambos tendo reducao significativa (p<0,001). Na avaliacao pos-operatoria tardia, entre 11 e 30 meses (media=16,85,DP=5,16), trinta e quatro (70,83%) criancas foram reavaliadas, obtendo-se escore OSA18 de 35,44(DP=19,95) e nota global de 9,28 (DP=1,78). Nao houve diferenca significativa entre as avaliacoes pos-operatorias. CONCLUSAO: A cirurgia promoveu melhora na qualidade de vida das criancas com DOS, mantendo-se esta em longo prazo.

Antrochoanal polyp: a review of sixteen cases

INTRODUCTION An Antrochoanal polyp, or Killians polyp is a benign solitary polypoid lesion that affects mainly children and young adults. Studies demonstrate that Killians polyp generally represents 4-6% of all nasal polyps. However, in the pediatric population this percentage reaches 33%. It originates from a hypertrophy of the mucous membrane on the maxillary sinus antrum, and it grows for unknown reasons, through the maxillary sinus ostium towards the nasal cavity and the choana--the posterior portion of the pharynx. AIM To evaluate the result of the surgical treatment on patients assisted in the Department of Otorhinolaryngology of the Walter Cantídio University Hospital-Medical School of the Federal University of Ceará, mainly on the surgical technique employed and the efficacy of each technique in controlling the disease. MATERIALS AND METHODS Retrospective study, accomplished through a chart analysis from the patients submitted to polypectomy because of Killians polyps or other nasal polyps, operated from March 1st, 1991 to April 30th of 2001, in the Department of Otorhinolaryngology of the Medical School of the Walter Cantídio University Hospital of the Federal University of Ceará. RESULTS Nine patient (56.6%) were males and 7 (43.8%) were females. Eleven (68.75%) patients were between 8 and 20 years of age. Predominant symptoms were unilateral nasal obstruction (81.3%) and purulent rhinorrhoea (43.8%). The most common procedure employed was the combined approach: external and endonasal, in 87.5% of the cases. Antrochoanal polyp removal procedure accounted for 21.6% of all the surgical procedures accomplished in the same period for the removal of nasal polyps. Postoperative recurrence was of 12.5%. CONCLUSIONS Antrochoanal polyp was an affection that prevailed among children and young adults. The combined external and endonasal approach was the one most used. Despite maxillary sinus approach to the polyp origin, postoperative recurrence is a possibility.

Long term results in the life quality of children with obstructive sleep disorders

Summary Obstructive Sleep Disorders (OSD) affect mostly the pediatric population. Within this group, its main etiology is adenotonsillar hyperplasia, being adenoidectomy or adenotonsillectomy the best treatment option for quality of life improvement. Aim To asses quality of life of children with OSD after adenoidectomy/adenotonsillectomy. Method A prospective study was carried out with 48 children, between 2 and 11 years, with clinical manifestations of OSD and obstructive adenotonsillar hyperplasia. The OSA18 questionnaire was answered by the parents to evaluate their children’s quality of life before surgery; at about thirty days and at least eleven months after the procedure. A higher score meant a worse quality of life. Results Before surgery, the average OSA18 score was 82.83(SD=12.57), with an average global score for quality of life of 6.04(SD=1.66). Within thirty days after surgery, the average OSA18 score was 34.3 (SD=9.95) with an average global score of 9.6(SD=0.81), both showing significant reduction (p Conclusion surgery improves the quality of life of children with OSD, and such improvement maintains for the long run.

Bilateral antrochoanal polyps in an adult

Medical doctor, Ceara Fedral University. Medical resident in the Otorhinolaryngology Unit of the Walter Cantidio University Hospital, Medical School, Ceara Federal University.Send correspondence to: David Weber Sampaio Sousa - Rua Senador Paula Pessoa, 725, Bairro Cambeba, Fortaleza - CE, Brazil. CEP: 60822-200.Paper submitted to the BJORL-SGP (Publishing Management System – Brazilian Journal of Otorhinolaryngology) on May 4, 2010; and accepted on August 25, 2010. cod. 7066

34 self-inflicted foreign bodies in the maxillary sinus

Foreign bodies (FB) are a common occurrence in the realm of ENT practice. The most commonly involved sites are nasal cavities, ears, and pharynx. Foreign bodies are accompanied by site-related symptoms and do not pose much of a challenge to well-trained physicians. Foreign bodies may be introduced willingly by the patient or by accident. Paranasal sinus foreign bodies are rarely seen, and most of them are introduced accidentally (25%) or iatrogenically (60%). The latter may occur as a consequence of dental, ophthalmic, and otorhinolaryngological procedures. The maxillary sinus is more frequently involved (75%), followed by the frontal sinus (18%). Only a few cases of self-inoculated paranasal sinus foreign body have been reported in the literature. This paper reports a case of chronic sinusitis secondary to the inoculation of multiple foreign bodies in the maxillary sinus.

Avaliação da sensibilidade das emissões otoacústicas produtos de distorção e dos potenciais auditivos evocados de tronco encefálico na ototoxicidade por cisplatina em ratos

Cisplatin (cis-diamminedicloroplatinum) is an antineoplastic drug used in the treatment of a variety of cancers, especially head-and-neck cancer. Its ototoxi...

34 corpos estranhos auto-inoculados em seio maxilar

Corpos estranhos (CE) sao motivos frequentes de consultas em Otorrinolaringologia. Os sitios mais comumente acometidos sao cavidade nasal, orelhas e faringe. Nestes locais os corpos estranhos apresentam sintomas caracteristicos e a remocao destes nao representa grande dificuldade para o especialista. A forma de inoculacao pode ser voluntaria ou acidental1,2. A ocorrencia de corpos estranhos em seios paranasais e rara, sendo mais usualmente introduzidos de forma acidental (25%) ou iatrogenica (60%). Esta ultima decorre de procedimentos dentarios, oftalmologicos e otorrinolaringologicos. O seio mais acometido e o maxilar (75%), seguido pelo frontal (18%)3,4. Na literatura medica, poucos casos de corpos estranhos auto-inoculados em seios paranasais foram descritos. O objetivo deste trabalho e relatar um caso de rinossinusite cronica secundaria a multiplos corpos estranhos auto-inoculados em seio maxilar.

Role of the route of leukotrienes in an experimental model of oral mucositis induced by 5-fluorouracil

PURPOSE To investigate the participation of cysteinyl leukotrienes in the pathophysiology of oral mucositis. METHODS Oral mucositis was induced in hamsters using 5-fluorouracil (5-FU; 60 and 40 mg/kg; i.p., on days 1 and 2, respectively, and with excoriations in jugal mucosa on day 4). Montelukast (10, 20, or 40 mg/kg/d; gavage), MK886 (3 mg/kg/d, i.p.), or saline or celecoxib (7.5 mg/kg/d; i.p.) was administered 1 h prior to 5-FU and daily, until the fourth (MK886) or tenth day, when the animals were euthanized and their jugal mucosa was collected for macroscopic, histopathological, and immunohistochemical evaluation. RESULTS Neither montelukast nor MK-886 prevented the oral mucositis induced by 5-FU, as observed by histopathological evaluation. In addition, we did not find significant differences in the expression of inducible nitric oxide synthase-2, cyclooxygenase-2, or interleukin (IL)-1β between the experimental and control groups. However, we did observe a significant decrease in tumor necrosis factor (TNF)-α expression for all doses of montelukast; we also observed a significant decrease in IL-10 with 40 mg/kg/d and MK 886. CONCLUSIONS Cysteinyl leukotrienes do not play an important role in experimental oral mucositis induced by 5-FU. There is a modulating action specifically on TNF-α.