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- ItemSomente MetadadadosAcute impact of continuous positive airway pressure on nasal patency(Wiley, 2017) Balsalobre, Leonardo [UNIFESP]; Pezato, Rogerio [UNIFESP]; Gasparini, Hiran [UNIFESP]; Haddad, Fernanda [UNIFESP]; Gregorio, Luis Carlos [UNIFESP]; Fujita, Reginaldo R. [UNIFESP]Background: Continuous airflow in the upper airway can cause discomfort, leading to nasopharyngeal complaints. The aim of the present study is to evaluate the acute effects of continuous positive upper-airway pressure on nasal patency in awake normal subjects. Methods: Twenty-seven adults (17 men
- ItemSomente MetadadadosAssociation of systematic head and neck physical examination with severity of obstructive sleep apnea-hypopnea syndrome(Lippincott Williams & Wilkins, 2003-06-01) Zonato, A. I.; Bittencourt, L. R.; Martinho, F. L.; Santos, J. F.; Gregorio, L. C.; Tufik, S.; Universidade Federal de São Paulo (UNIFESP)Objectives/Hypothesis: To identify upper airway and craniofacial abnormalities is the principal goal of clinical examination in patients with obstructive sleep apnea-hypopnea syndrome. the aim was to identify anatomical abnormalities that could be seen during a simple physical examination and determine their correlation with apnea-hypopnea index (AHI). Study Design: Consecutive patients with obstructive sleep apnea-hypopnea syndrome who were evaluated in a public otorhinolaryngology center were studied. Methods. Adult patients evaluated previously with polysomnography met the inclusion criteria. All subjects underwent clinical history and otolaryngological examination and filled out a sleepiness scale. Physical examination included evaluation of pharyngeal soft tissue, facial skeletal development, and anterior rhinoscopy. Results. Two hundred twenty-three patients (142 men and 81 women) were included (mean age, 48 +/- 12 y; body mass index, 29 +/- 5 kg/m(2); AHI, 23.8 +/- 24.8 events per hour). Patients were distributed into two groups according to the AHI: snorers (18.4%) and patients with sleep apnea (81.7%). Sleepiness and nasal obstruction were reported by approximately half of patients, but the most common complaint was snoring. There was a statistically significant correlation between AHI and body mass index (P < .000), modified Mallampati classification (P =.002), and ogivale-palate (P < .001). the retrognathia was not correlated to AHI, but the presence of this anatomical alteration was much more frequent in patients with severe apnea when compared with the snorers (P = .05). Other correlations with AHI were performed considering multiple factors divided into two groups of anatomical abnormalities: pharyngeal (three or more) and craniofacial (two or more) abnormalities. There was a statistically significant correlation between pharyngeal landmarks and AHI (correlation coefficient [r] = 0.147, P = .027), but not between craniofacial landmarks and AHL the combination of pharyngeal anatomical abnormalities, modified Mallampati classification, and body mass index were also predictive of apnea severity. Conclusions. Systematic physical examination that was used in the present study indicated that, in combination, body mass index, modified Mallampati classification, and pharyngeal. anatomical abnormalities are related to both presence and severity of obstructive sleep apnea-hypopnea syndrome. Hypertrophied tonsils were observed in only a small portion of the patients. the frequency of symptoms of nasal obstruction was high in sleep apnea patients. Further studies are needed to find the best combination of anatomical and other clinical landmarks that are related to obstructive sleep apnea.
- ItemAcesso aberto (Open Access)Avaliações objetiva e subjetiva da obstrução nasal em crianças e adolescentes com rinite alérgica(Sociedade Brasileira de Pediatria, 2012-10-01) Mendes, Aline Inês [UNIFESP]; Wandalsen, Gustavo Falbo [UNIFESP]; Solé, Dirceu [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To correlate objective assessment of nasal obstruction, as measured by acoustic rhinometry (volume of the first 5 cm of the nasal cavity) and active anterior rhinomanometry (total nasal airway resistance), with its subjective evaluation (obstruction scores). METHOD: Thirty patients, aged 7 to 18 years, with persistent allergic rhinitis and thirty controls were enrolled. The obstruction score was reported for the whole nasal cavity and for each nostril separately. The three variables were measured at baseline and after induction of nasal obstruction. RESULTS: There were significant and negative correlations between resistance and nasal volume in all groups and scenarios, except for the most obstructed nostril, in the control group, post-obstruction. For the whole nasal cavity, there was no significant correlation between objective and subjective variables except between score and total nasal cavity volume in the control group, post-obstruction. Regarding the most obstructed nostril, we found a significant negative correlation between score and resistance and a significant positive correlation between score and volume for the total group at baseline. There were no clear differences in the correlation coefficients found in patients and controls. The correlation coefficients did not change after induction of nasal obstruction. CONCLUSIONS: Objective assessment of nasal obstruction did not correlate significantly with subjective evaluation for the nasal cavity as a whole, but there was a correlation for unilateral assessments. There was correlation between the objective evaluations. Allergic rhinitis and acute induction of nasal obstruction did not affect the correlation between objective and subjective assessments of nasal obstruction. Addition of an objective method for evaluation of nasal obstruction could be useful in the research setting; if no such method can be used, each nostril should be evaluated separately.
- ItemAcesso aberto (Open Access)Correlação entre a resistência nasal e diferentes parâmetros da rinometria acústica em crianças e adolescentes com e sem rinite alérgica(Associação Brasileira de Otorrinolaringologia e Cirurgia Cervicofacial, 2012-12-01) Wandalsen, Gustavo Falbo [UNIFESP]; Mendes, Aline Inês [UNIFESP]; Solé, Dirceu [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Acoustic rhinometry and rhinomanometry are important tests used to assess nasal function. The degree to which the parameters of these tests are correlated is yet to be established. OBJECTIVE: This paper aimed to study the correlations between nasal resistance (NR) and acoustic rhinometry parameters in children and adolescents with allergic rhinitis and controls. METHOD: Twenty patients with allergic rhinitis and 20 controls were enrolled. NR, volumes (V4, V5, V2-5), and minimal cross-sectional areas (MC1, MC2) were measured in three moments: baseline, after induction of nasal obstruction and after topical decongestant administration. RESULTS: Patients with allergic rhinitis had significant correlation between NR and all volumes (V5: r = -0.60) and with MC2. Among controls, MC1 was the parameter with the strongest correlation with NR at baseline (r = -0.53) and after decongestant administration. In the combined analysis, V5 had the highest correlation coefficients at baseline (r = -0.53), after obstruction (r = -0.58) and after decongestant (r = -0.46). CONCLUSIONS: Our data showed that NR and acoustic rhinometry parameters have negative and significant correlations. Nasal volumes are, in general, better correlated than minimal cross-sectional areas. V5 was the parameter with the highest correlation in the rhinitis group and in the combined analysis.
- ItemSomente MetadadadosHead and neck physical examination: Comparison between nonapneic and obstructive sleep apnea patients(Lippincott Williams & Wilkins, 2005-06-01) Zonato, A. I.; Martinho, F. L.; Bittencourt, L. R.; Brasil, ODC do; Gregorio, L. C.; Tufik, S.; Universidade Federal de São Paulo (UNIFESP)Study Objectives: the purpose of this study was to apply a systematic physical examination, used to evaluate obstructive sleep apnea (OSA) patients, in nonapneic patients. Design: Study was prospective. Setting: Patients were seen in the sleep laboratory and department of otorhinolaryngology. Patients or Participants: Nonapneic patients (n = 100) were involved in the study. Interventions. Physical examination to evaluate facial skeleton, pharyngeal soft tissue, rhinoscopy, and body mass index. Data were compared with a previously published study (2003) on a group of OSA patients (n = 223). Measurements and Results: Skeletal examination detected retrognathism in 6%, class II occlusion in 12%, and high-arched hard palate in 11%. the modified Mallampati classification showed 54% in class I to II and 46% in class III to IV. Only 1% of nonapneic patients had tonsils of degree III to IV. Oropharynx evaluation showed web palate in 38%, posterior palate in 19%, thick palate in 10%, thick uvula in 10%, long uvula 15%, voluminous lateral wall in 11%, and tongue edge crenations in 28%. Anterior rhinoscopy detected significant septal deviation in 1% and turbinate hypertrophy in 31% of patients. Conclusions: the head and neck physical examination, considering both skeletal and soft tissue alterations, illustrated significant differences between nonapneic and OSA patients. Body mass index, modified Mallampati classification, tonsils hypertrophy, and high-arched hard palate previously related to the presence of sleep apnea in the literature showed different outcomes in nonapneic patients. Nonapneic patients had less alterations in nasal anatomy (severe septal deviation and enlarged turbinate). Skeletal parameters, such as retropositioned, mandible and angle class II occlusion, were less frequent in nonapneic patients.
- ItemAcesso aberto (Open Access)Mouth breathing in children with learning disorders(Assoc Brasileira Otorrinolaringologia & Cirurgia Cervicofacial, 2013-09-01) Fensterseifer, Giovana Serrao; Carpes, Oswaldo; Weckx, Luc Louis Maurice [UNIFESP]; Martha, Viviane Feller; Pontifical Catholic Univ Rio Grande do Sul PUCRS; Pontificia Univ Catolica Rio Grande do Sul; Universidade Federal de São Paulo (UNIFESP); Univ Fed Rio Grande do SulGiven the importance of studying the causes of learning disorders, we designed this case-control study to assess the nasal cavity volume, pharyngeal and palatine tonsils in children with and without learning disabilities.Method: A total of forty-eight children were enrolled in the study: twenty-four coming from the Center for Evaluation and Early Stimulation (CADEP), in which the criterion is the school failure of at least two consecutive years; and twenty-four students with normal learning - which made up the control group. the children were submitted to ENT examination (history, physical examination) and specific tests (acoustic rhinometry, cavum radiography).Results: the results showed that students with learning disabilities have a higher prevalence of pharyngeal tonsil hypertrophy: p < 0.001, and palatine tonsil hypertrophy: p < 0.001. the average volume of the nasal cavities showed no statistically significant association with learning difficulties (P = 0.75).Conclusion: Based on this study, we concluded that children with adenotonsillar hypertrophy have more learning difficulties when compared to children without such hypertrophy.
- ItemAcesso aberto (Open Access)Rinolitíase como causa de fístula oronasal(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2005-02-01) Dib, Gabriel Cesar [UNIFESP]; Tangerina, Rodrigo P. [UNIFESP]; Abreu, Carlos E.c. [UNIFESP]; Santos, Rodrigo de Paula [UNIFESP]; Gregório, Luiz Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Rhinolithiasis is a disease caused by deposition of organic and inorganic compounds in the nasal cavity, leading to unilateral nasal obstruction, fetid rhinorrhea, epistaxis, and it may cause complications. The authors present a case of rhinolithiasis with oronasal fistula and literature review.
- ItemSomente MetadadadosSystematic Evaluation of the Upper Airway in the Adult Population of São Paulo, Brazil(Sage Publications Ltd, 2012-05-01) Stefanini, Renato [UNIFESP]; Tufik, Sergio [UNIFESP]; Mattos Soares, Maria Claudia [UNIFESP]; Martinho Haddad, Fernanda Louise [UNIFESP]; Azeredo Bittencourt, Lia Rita [UNIFESP]; Santos-Silva, Rogerio [UNIFESP]; Gregório, Luiz Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives. To study the prevalence of otorhinolaryngologic symptoms and findings of physical examination of the upper airway (UA) of a representative sample of the adult population of São Paulo, Brazil, and the association between these findings.Study Design. Cross-sectional survey.Setting. Population sample.Methods. A total of 1101 randomly selected volunteers representing the adult population of São Paulo according to sex, age, and socioeconomic class were included in this study. Otorhinolaryngological evaluation included investigation of nasal complaints, physical examination of the UA, and a facial inspection.Results. A total of 993 volunteers (53.9% women), with a mean age of 41.8 +/- 0.89 years, underwent otorhinolaryngologic examination. the most prevalent symptoms were the following: symptoms suggestive of rhinitis (44.9%), snoring (42.8%), mouth breathing (39.3%), and nasal obstruction (33.3%). in physical examination, the most common findings were a web palate (redundant posterior pillar; 62.9%), septum deviation (56.9%), and inferior turbinate hypertrophy (37.7%). Significant associations were found between nasal obstruction and septum deviations, inferior turbinate hypertrophy, high-arched palate, and class II dental occlusion; between symptoms of rhinitis and inferior turbinate hypertrophy; and between snoring and obstructive deviated septum, modified Mallampatti grades III and IV, increased neck circumference, and age greater than or equal to 50 years.Conclusions. the prevalence of otorhinolaryngologic symptoms and alterations in physical examination of the UA were high in the adult population of São Paulo, Brazil. the snoring and nasal symptoms were significantly associated with findings from UA physical examination and inspection of the facial skeleton.
- ItemSomente MetadadadosUpper airway surgery: the effect on nasal continuous positive airway pressure titration on obstructive sleep apnea patients(Springer, 2006-05-01) Zonato, A. I.; Bittencourt, LRA; Martinho, F. L.; Gregorio, L. C.; Tufik, S.; Universidade Federal de São Paulo (UNIFESP)The objective of this study was to observe the change in CPAP pressure after nasal and/or tonsil surgery in a retrospective study involving 17 patients unable to tolerate CPAP titration. All patients had two polysomnography studies for titration: one before and another subsequent to upper airway surgical treatment. the results showed a mean age of 49 +/- 9 years, a body mass index of 30 +/- 4 kg/m(2) and an apnea-hypopnea index of 38 +/- 19. Surgical procedures were radiofrequency reduction of the inferior turbinate (eight patients), septoplasty (one patient), septoplasty with inferior turbinectomy (two patients), septoplasty with inferior turbinate submucosal diathermy (two patients), septoplasty with tonsillectomy (two patients), septoplasty with inferior turbinate submucosal diathermy and tonsillectomy (one patient) and tonsillectomy (one patient). CPAP titration before and after surgery had respectively a mean pressure of 12.4 +/- 2.5 and 10.2 +/- 2.2 cmH(2)O (P = 0.001). Maximum CPAP pressure was 16.4 cmH(2)O before and 13 cmH(2)O after surgery. A pressure reduction >= 1 cmH(2)O occurred in 76.5% of the patients and >= 3 cmH(2)O in 41.1%. Upper airway surgical treatment appears to have some benefit by reducing nasal CPAP pressure levels. the effect seems to be greater when the prior pressure was >= 14 cmH(2)O.