Avaliação radiográfica da adenoide - sugestão de parâmetros de referência

OBJECTIVE:this study aimed to evaluate the usefulness of current radiographic measurements, which were originally conceived to evaluate adenoid hypertrophy, as potential referral parameters.METHODS:children aged from 4 to 14 years, of both genders, who presented nasal obstruction complaints, were subjected to cavum radiography. Radiographic examinations (n = 120) were evaluated according to categorical and quantitative parameters, and data were compared to gold-standard videonasopharyngoscopic examination, regarding accuracy (sensitivity, negative predictive value, specificity, and positive predictive value).RESULTS:radiographic grading systems presented low sensitivity for the identification of patients with two-thirds choanal space obstruction. However, some of these parameters presented relatively high specificity rates when three-quarters adenoid obstruction was the threshold of interest. Amongst the quantitative variables, a mathematical model was found to be more suitable for identifying patients with more than two-thirds obstruction.CONCLUSION:this model was shown to be potentially useful as a screening tool to include patients with, at least, two-thirds adenoid obstruction. Moreover, one of the categorical parameters was demonstrated to be relatively more useful, as well as a potentially safer assessment tool to exclude patients with less than three-quarters obstruction, to be indicated for adenoidectomy.OBJETIVO:o objetivo deste estudo foi de investigar a utilidade de medidas radiográficas destinadas à avaliação da tonsila faríngea a serem utilizadas como potenciais parâmetros de encaminhamento.MÉTODOS:crianças de quatro a 14 anos, de ambos os gêneros, que apresentavam queixas referentes à obstrução nasal foram submetidas à radiografia do cavum. Os registros radiográficos (n = 120) foram avaliados de acordo com parâmetros categóricos e quantitativos, e dados resultantes foram comparados ao exame padrão-ouro de videonasofaringoscopia, em relação às suas taxas de acurácia (sensibilidade, valor preditivo negativo, especificidade e valor preditivo positivo).RESULTADOS:os parâmetros radiográficos categóricos apresentaram baixa sensibilidade para a identificação de pacientes portadores de 2/3 de obstrução do espaço coanal. No entanto, alguns destes parâmetros apresentaram especificidades relativamente altas quando 3/4 de obstrução coanal era o ponto de corte de interesse. Dentre as variáveis quantitativas, um modelo matemático se mostrou mais adequado para identificar pacientes com mais de 2/3 de obstrução coanal.CONCLUSÃO:este modelo demonstrou, assim, ser potencialmente útil como método de rastreamento para identificação de pacientes com pelo menos 2/3 de obstrução adenoidiana. Além disso, um dos parâmetros categóricos analisados demonstrou ser relativamente mais útil e potencialmente seguro para eliminar pacientes queixosos com menos de 3/4 de obstrução a serem indicados à adenoidectomia.Universidade São Francisco Faculdade de OdontologiaUniversidade Federal de São Paulo (UNIFESP) Department of Otorhinolaryngology, Head and Neck SurgeryUNIFESP, Department of Otorhinolaryngology, Head and Neck SurgerySciEL

Laryngeal sequelae of recurrent respiratory papillomatosis surgery in children

OBJECTIVE: To evaluate laryngeal sequelae from surgical treatment of recurrent respiratory papillomatosis in children, as well as associated risk factors. METHODS: Case-control study. Medical record data analysis of 50 children with recurrent respiratory papillomatosis, divided into two groups: with and without laryngeal sequelae. The group of patients with laryngeal sequelae was compared to those without sequelae in regard to the onset of disease, age at first surgery, number and frequency of surgeries, disease stage, and type of surgery (CO2 laser, cold forceps). RESULTS: 23 patients (46%) sustained laryngeal sequelae. The most frequent sequela was anterior commissure synechia (17 patients [34%]), followed by glottic stenosis (six patients [12%]). There was no statistically significant difference between groups with and without laryngeal sequelae regarding the disease onset (p = 0.93), age at first surgery (p = 0.68), number of surgeries (p = 0.22), annual frequency of surgery (p = 0.93), presence of papilloma in anterior (p = 0.430) or posterior commissure (p = 0.39), and type of surgery (p = 0.27). The Derkay anatomical score (a staging system that assesses the extent of the disease in the aerodigestive tract) was significantly higher in the laryngeal sequelae group (p = 0.04). CONCLUSION: Laryngeal sequelae are a frequent complication of recurrent respiratory papillomatosis surgical treatment in children, particularly anterior commissure synechiae and glottic stenosis. Advanced stages are associated with increased risk of laryngeal sequelae after surgery.Universidade Federal de São Paulo (UNIFESP) Department of Otorhinolaryngology and Head and Neck SurgeryUniversidade Federal de São Paulo (UNIFESP) Department of Otorhinolaryngology and Head and Neck Surgery Internal Clinic of the Pediatric Otorhinolaryngology DisciplineUNIFESPUNIFESP Pediatric Otorhinolaryngology DisciplineUNIFESP, Department of Otorhinolaryngology and Head and Neck SurgeryUNIFESP, Department of Otorhinolaryngology and Head and Neck Surgery Internal Clinic of the Pediatric Otorhinolaryngology DisciplineUNIFESP, Pediatric Otorhinolaryngology DisciplineSciEL

Efeito da vacina contra papilomavírus humano (tipos 6, 11, 16 e 18) no tratamento de crianças com papilomatose respiratória recorrente

Purpose: To evaluate whether the tetravalent vaccine against human papilomavírus (HPV) (types 6, 11, 16 and 18), when administered in a group of patients with juvenile-onset recurrent respiratory papillomatosis (RRP), influences the clinical course of the disease. Method: Uncontrolled intervention study of patients with juvenile-onset RRP of the Clinic of Pediatric Otorhinolaryngology, Federal University of São Paulo, where nine patients aged between 9-17 years received three doses of prophylactic quadrivalent vaccine against HVP (Gardasil®) and were followed for one year. The staging of disease, the intervals between relapses, the intervals between surgeries and their number during the year prior to vaccination and the first year of follow-up after vaccination were compared. Results: Eight patients had disease due to HPV-6 and one per HPV-11. There was no statistically significant change between the previous and subsequent years of vaccination in relation to clinical score (p = 0,083), anatomical score (p = 0,257), interval between relapses (p = 0,062), interval between surgery (p = 0,357) and the number of surgeries (p = 0,180). All patients had relapsed following vaccination. Conclusion: Vaccination with Gardasil® did not affect the clinical course of patients with juvenile-onset RRP during the study period.Objetivo: Avaliar se a vacina quadrivalente contra papilomavírus humano (HPV) (tipos 6, 11, 16 e 18), quando administrada em um grupo de pacientes com papilomatose respiratória recorrente (PRR) juvenil, influencia o curso clínico da doença. Método: Estudo de intervenção não controlado de pacientes com PRR juvenil, acompanhados no Ambulatório de Otorrinolaringologia Pediátrica da Universidade Federal de São Paulo, onde nove pacientes com idades variando entre 9 a 17 anos receberam três doses de vacina quadrivalente profilática contra HPV (Gardasil®) e foram seguidos durante um ano. O estadiamento da doença, os intervalos entre as recidivas, os intervalos entre as cirurgias realizadas e o seu número durante o ano anterior à vacinação e o primeiro ano de seguimento após a vacinação foram comparados. Resultados: Oito apresentava doença por HPV-6 e um por HPV-11. Não houve mudança estatisticamente significante entre os anos anterior e posterior à vacinação em relação ao escore clínico (p = 0,083), escore anatômico (p = 0,257), intervalo entre recidivas (p = 0,062), intervalo entre cirurgias (p = 0,357) e o número de cirurgias (p = 0,180). Todos os pacientes apresentaram recidiva após a vacinação. Conclusão: A vacinação com Gardasil® não interferiu no curso clínico de pacientes com PRR juvenil durante o período avaliado.Dados abertos - Sucupira - Teses e dissertações (2013 a 2016

Lateral X-ray view of the skull for the diagnosis of adenoid hypertrophy: A systematic review

Objectives: Many studies have been developed aiming to reveal the usefulness of cavum X-rays and telerradiographies as diagnostic tools for the detection of upper airway obstruction due to adenoid hypertrophy. However, the scientific literature is diverse and controversial. Therefore, a systematic review is proposed; with the objective to determine the diagnosis value of lateral X-ray view of the skull regarding adenoid hypertrophy.Methods: Searching was conducted on Pubmed, Lilacs, Cochrane Library, Embase, and Web of Knowledge databases; and was restricted to studies published in English, Portuguese or Spanish languages, carried out on humans under 18 years of age. All the obtained publications were first submitted to a pre-selection, and then, full-texts (n = 66) were analyzed and selected by independent examiners. the resultant studies (n = 11) were systematically and critically analyzed, and qualified according to QUADAS (Quality Assessment of Diagnostic Accuracy Studies) questionnaire, an assessment tool designed to qualify diagnostic tests accuracy studies.Results: Searching and selection procedures generated 11 studies which were considered adequate to be systematically analyzed. Accordingly, large variation was observed concerning the evaluation methods of radiographic and fibronasoendoscopic exams, and the sample characteristics. Additionally, little amount of scientific evidences could be provided, since few radiographic variables were analyzed simultaneously. Moreover, assessment methods were, at most, subjective or poorly described. QUADAS application revealed other significant limitations related to the sampling, such as inadequate spectrum of the investigated disease (adenoid hypertrophy), and poor report of the subjects' enrollment and participation process. Further, QUADAS revealed inadequacies regarding methodological features, including poor description of the radiographic exams and assessment methods. in addition, it was also shown that most of the studies did not specify the moment in clinical time when both exams were performed; neither reported a strategy of blindness by the examiners.Conclusions: Despite such limitations, the majority of the resultant data indicates that lateral X-rays might be considered somewhat useful, even though it could not be clearly demonstrated. Future research should then adhere to greater methodological rigor, in order to investigate the significance of radiographies as a screening test. (C) 2010 Elsevier Ireland Ltd. All rights reserved.Universidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, BR-18040710 Sorocaba, SP, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol, Div Pediat Otolaryngol, BR-04025002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, BR-02016001 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, BR-04101300 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, BR-18040710 Sorocaba, SP, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol, Div Pediat Otolaryngol, BR-04025002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, BR-02016001 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, BR-04101300 São Paulo, BrazilWeb of Scienc

Cephalometric evaluation of adenoids: An analysis of current methods and a proposal of a new assessment tool

Introduction: Although the scientific literature recognizes that lateral cephalometric radiographs might be clinically useful, there is no consensus in relation to the best parameter available. Therefore, this research was aimed at evaluating current radiographic assessment methods designed to investigate adenoid hypertrophy and nasopharyngeal obstruction. Methods: Children from 4 to 14 years old with nasal obstruction or oral breathing complaints, suspected to be caused by adenoid hypertrophy, received cephalometric examinations. One hundred twenty radiographic records were evaluated according to several current methods, and data were compared with respective gold-standard videonasopharyngoscopic examinations, in relation to the percentage of choanal obstruction. Results: Groups derived from a grading system had significantly different percentages of choanal obstruction. However, this parameter showed low sensitivity. Significant but moderate correlations were observed between most of the quantitative radiographic parameters and the percentage of choanal obstruction. Alternatively, a regression model was introduced; it demonstrated satisfactory ability to predict choanal obstruction percentage. Despite limitations, this model could also distinguish patients who might benefit from referral to otolaryngologic care. Conclusions: Current adenoid assessment methods have significant limitations. A novel assessment method introduced here might be clinically useful. (Am J Orthod Dentofacial Orthop 2012; 142: 671-8)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, São Paulo, BrazilFAPESP: 08/53538-0Web of Scienc

Trombose de seio sigmoide secundária a fístula liquórica espontânea para osso temporal: um relato de caso

Temporal bone cerebrospinal fluid fistula is a rare event that results from abnormal communication between the subarachnoid space and the mastoid cells, allowingthe cerebrospinal fluid to flow into the pneumatized portions of the temporal bone. It leads to spontaneous intracranial hypotension, characterized by loss of cerebrospinal fluid and orthostatic headache as a clinical manifestation. Spontaneous intracranial hypotension is believed to create favorable hemodynamic conditions to the occurrence of cerebral venous thrombosis, a potentially fatal disorder of difficult diagnosis giventhe nonspecific clinical signs and symptoms. Therefore, it is pertinent to consider the possibility of cerebral venous thrombosis in patients with cerebrospinal fluid fistulas,especially when there is a modification in the headache pattern from orthostatic to intense and continuous pain.A fístula liquórica para o osso temporal constitui um evento raro que decorre da comunicação anormal entre o espaço subaracnóideo e as células da mastoide,permitindo que o líquido cefalorraquidiano flua para as porções pneumatizadas do osso temporal. Tem como consequência a hipotensão intracraniana espontânea,caracterizada por perda de líquor e pela manifestação clínica de cefaleia ortostática. Acredita-se que a hipotensão intracraniana espontânea crie condições hemodinâmicas favoráveis à ocorrência de trombose venosa cerebral, uma desordem potencialmentefatal e de difícil diagnóstico, visto a inespecificidade de sinais clínicos e sintomas. Dessa forma, é pertinente atentar para a possibilidade de trombose venosa cerebral em pacientes com fístulas liquóricas, especialmente quando houver mudança do padrão da cefaleia, que passa de ortostática a intensa e contínua

Effectiveness of the human papillomavirus (types 6, 11, 16, and 18) vaccine in the treatment of children with recurrent respiratory papillomatosis

Objective: To evaluate whether the quadrivalent human papillomavirus (HPV) (types 6, 11, 16, and 18) vaccine influences the clinical course of juvenile-onset recurrent respiratory papillomatosis (RRP) when administered to a group of patients with this condition. Methods: Uncontrolled intervention study of patients with juvenile-onset RRP examined at the Pediatric Otorhinolaryngology Clinic, Federal University of Sao Paulo, where nine patients between the ages of nine and 17 received three doses of the prophylactic quadrivalent HPV vaccine (Gardasil) and were followed for one year. Disease staging, intervals between relapses, intervals between surgeries, and the number of surgeries during the year prior to vaccination and during the first year after vaccination were compared. Results: Eight patients were infected with HPV-6 and one with HPV-11. There were no statistically significant differences in the clinical scores (p = 0.083), anatomical scores (p = 0.257), intervals between relapses (p = 0.062), intervals between surgeries (p = 0.357), or the numbers of surgeries (p = 0.180) when the years before and after vaccination were compared. All patients had relapses following vaccination. Conclusion: Patients with juvenile-onset RRP experienced a similar clinical course in the year after versus the year before vaccination with Gardasil. (C) 2016 Elsevier Ireland Ltd. All rights reserved.Univ Fed Sao Paulo, Discipline Pediat Otorhinolaryngol, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Pediat, Sao Paulo, BrazilRes Incent Fund Assoc, Sao Paulo, BrazilUniv Fed Sao Paulo, Discipline Infect Dis, Sao Paulo, BrazilUniv Fed Sao Paulo, Discipline Pediat Otorhinolaryngol, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Pediat, Sao Paulo, BrazilUniv Fed Sao Paulo, Discipline Infect Dis, Sao Paulo, BrazilWeb of Scienc

A geometrically exact finite beam element formulation for thin film adhesion and debonding

Objectives. TO investigate intra- and interexaminers' reproducibility of usual adenoid hypertrophy assessment methods, according to nasofiberendoscopic eXamination.Methods. Forty children of both sexes, ages ranging between 4 and 14 years, presenting with nasal obstruction and oral breathing suspected to be caused by adenoid hypertrophy, were enrolled in this study, Patients were evaluated by nasofiberendoscopy, and records were referred to and evaluated by two experienced otolaryngologists. Examiners analysed the records according to different evaluation methods; i.e., estimated, and measured percentage of choanal occlusion; as well as Subjective and objective classificatory systems of adenoid hypertrophy.Results. Data disclosed excellent intraexarniner reproducibility for both estimated and measured choanal occlusion. Interexaminers analysis revealed lower reproducibility rates of estimated in relation to measured choanal occlusion. Measured choanal occlusion also demonstrated less agreement among evaluations made through the right and left sides of the nasal cavity. Alternatively, intra- and interexaminers reliability analysis revealed higher agreement for subjective than objective classificatory system. Besides, subjective method demonstrated higher agreement than the objective classificatory system, when opposite sides were compared.Conclusion. Our results suggest that Measured is superior to estimated percentage of choanal occlusion, particularly if employed bilaterally, diminishing the lack of agreement between sides. When adenoid categorization is used instead, the authors recommend Subjective rather than objective classificatory system of adenoid hypertrophy