Retrospective study of a series of choanal atresia patients

Introduction Although it has been more than 250 years since the first description of choanal atresia (CA), there are still doubts about this abnormality. The differences between unilateral and bilateral forms are seldom discussed. Objectives Aggregate data from patients diagnosed with CA, grouping patients with unilateral and bilateral forms. Methods Retrospective study. Results Eighteen patients were included: 12 (66.6%) presented bilateral atresia, of which 77.8% were mixed bony-membranous type and 22.2% were pure bony type. From the 12 patients with bilateral atresia, 10 presented related malformations, 3 of whom had CHARGE syndrome (coloboma, heart defects, choanal atresia, retardation of growth and development, genitourinary problems, ear abnormalities). From the remaining 6 patients with unilateral atresia, only 2 showed malformations, 1 renal and 1 cardiac. All patients with unilateral atresia needed only 1 surgical procedure, and patients with the bilateral form needed amedian of 2.85 interventions (p ¼ 0.003). The median age of surgical procedure in the unilateral group was 6 years, ranging from 6 months to 18 years, and in the bilateral group was 25 days, ranging from 6 days to 6 years (p ¼ 0.003). The median interval between diagnosis and surgery was 9 months in the unilateral group, ranging from 1 month to 18 years, and in the bilateral group was 1 day, ranging from 1 day to 2 months (p ¼ 0.001). Discussion and Conclusions Success rates with the endoscopic approach vary from 62 to 100%. Nonetheless, most of these reports present results without considering the number of compromised sides. In our opinion, unilateral and bilateral cases involve distinct patients (taking into account the related malformations), have diverging clinical presentations, and show discrepant restenosis rates and therefore could be considered in different groups of analysis

Sinusite e asma

The association between sinusitis and asthma has been studied for many years. It is well known that sinusitis and asthma coexist in many patients. Moreover, sinus disease seems to be an aggravating factor for asthma, and several authors relate control of asthma with the effective treatment of concomitant sinusitis. However, thus far, the cause-and-effect relationship remains unclear. Many theories have been proposed to explain this association, mainly the nasal-sinusbronchial reflex, the pharyngeal aspiration, and the activation of inflammatory mediators. The objective of this article is to review the most important theories that correlate sinus disease and asthma, and to analyze the existence of a link between these entities.A associação entre sinusite e asma tem sido estudada por muitos anos. Sabe-se que a sinusite e a asma coexistem em muitos pacientes. Além disso, a afecção dosseios da face parece ser um fator agravante para a asma e diversos autores relataram um melhor controle das crises de asma quando uma sinusite concomitante foiefetivamente tratada. Entretanto, até o momento, a relação causa-efeito permanece incerta. Muitas teorias têm sido propostas para explicar esta associação,principalmente o reflexo naso-sinuoso-brônquico, a aspiração faríngea e a ativação de mediadores inflamatórios. O objetivo deste artigo é revisar as principais teorias que correlacionam as doenças dos seios paranasais à asma, analisando a existência de um vínculo entre estas duas entidades

Sinusitis and asthma

A associação entre sinusite e asma tem sido estudada por muitos anos. Sabe-se que a sinusite e a asma coexistem em muitos pacientes. Além disso, a afecção dos seios da face parece ser um fator agravante para a asma e diversos autores relataram um melhor controle das crises de asma quando uma sinusite concomitante foi efetivamente tratada. Entretanto, até o momento, a relação causa-efeito permanece incerta. Muitas teorias têm sido propostas para explicar esta associação, principalmente o reflexo naso-sinuoso-brônquico, a aspiração faríngea e a ativação de mediadores inflamatórios. O objetivo deste artigo é revisar as principais teorias que correlacionam as doenças dos seios paranasais à asma, analisando a existência de um vínculo entre estas duas entidades.The association between sinusitis and asthma has been studied for many years. It is well known that sinusitis and asthma coexist in many patients. Moreover, sinus disease seems to be an aggravating factor for asthma, and several authors relate control of asthma with the effective treatment of concomitant sinusitis. However, thus far, the cause-and-effect relationship remains unclear. Many theories have been proposed to explain this association, mainly the nasal-sinusbronchial reflex, the pharyngeal aspiration, and the activation of inflammatory mediators. The objective of this article is to review the most important theories that correlate sinus disease and asthma, and to analyze the existence of a link between these entities

Subsedação é um fato de risco para o desenvolvimento de estenose subglóticaem crianças intubadas

Objective: To analyze the level of sedation in intubated children as a risk factor for the development of subglottic stenosis (SGS). Methods: All patients between 30 days and 5 years of age who required endotracheal intubation in the pediatric intensive care unit between 2013 and 2014 were included in this prospective study. They were monitored daily and COMFORT-B scores were obtained. Flexible fiber-optic laryngoscopy was performed within eight hours of extubation, and repeated seven to ten days later if the first examination showed moderate to severe laryngeal injuries. If these lesions persisted and/or if the child developed symptoms in the follow-up period, microlaryngoscopy under general anesthesia was performed to evaluate for SGS. Results: The study included 36 children. Incidence of SGS was 11.1%. Children with SGS had a higher percentage of COMFORT-B scores between 23 and 30 (undersedated) than those who did not develop SGS (15.8% vs. 3.65%, p = 0.004). Conclusion: Children who developed SGS were less sedated than children who did notdevelop SGS.Objetivo: Analisar o nível de sedac¸ão em crianc¸as intubadas como um fator de risco para odesenvolvimento de estenose subglótica (ES).Métodos: Todos os pacientes entre 30 dias e cinco anos que necessitaram de intubac¸ão endo-traqueal na Unidade de Terapia Intensiva Pediátrica entre 2013 e 2014 foram incluídos nesteestudo prospectivo. Eles foram monitorados diariamente e foram obtidos os escores da escalaComfort-B. Foi feita laringoscopia com tubo flexível de fibra óptica em oito horas da extubac¸ãoe repetida 7-10 dias depois, caso o primeiro exame tivesse mostrado lesões laríngeas mode-radas a graves. Caso essas lesões tivessem persistido e/ou caso a crianc¸a tivesse desenvolvidosintomas no período de acompanhamento, foi feita microlaringoscopia sob anestesia geral paraavaliar a ES.Resultados: Incluímos 36 crianc¸as. A incidência da ES foi de 11,1%. As crianc¸as com ES apre-sentaram um maior percentual de escores da escala Comfort-B entre 23 e 30 (subsedados) queos que não desenvolveram ES (15,8% em comparac¸ão com 3,65%, p = 0,004).Conclusão: As crianc¸as que desenvolveram ES foram menos sedadas do que as que não desen-volveram

Papilomatose de laringe

Laryngeal papillomatosis is the most frequent benign neoplasm of the larynx, occurring in children and adults. It is caused by the human papilloma virus, especially types 6 and 11. The clinical course is unpredictable and recurrence is frequent in children. There have been reports of association between this disease and tracheobronchial tree and squamous cell carcinoma of the larynx. Papillomatosis is probably one of thefactors that can predispose a patient to the development of cancer, similarly to alcohol, tobacco, and radiation exposure.Treatment aims at maintaining airway patency and speech. Surgery with carbon dioxide laser is able to achieve this objective, however, without preventing recidivation. The low rates of surgical cure have been stimulating new research with chemotherapics. Unfortunately these have not been successful. Their main purpose is to reduce the extension of the disease and rates of recidivation, slowing down papilloma growth.The present study reviews pathophysiology, the clinical presentation and treatment aspects .A papilomatose de laringe é a neoplasia benigna que mais freqüentemente acomete a laringe, tanto em crianças quanto em adultos. É causada pelo papiloma vírus humano, em especial pelos tipos 6 e 11. A apresentação clínica é variável e a evolução praticamente imprevisível, devido especialmente ao alto grau de recorrência típico desta entidade. Existem diversos relatos que demonstram associação entre estadoença e o carcinoma de células escamosas de laringe e de árvore traqueobrônquica. Acredita-se que a papilomatose seja um dos fatores que predisponham o paciente ao câncer, assim como o são o álcool, o fumo e a exposição à radiação ionizante. O objetivo do tratamento é a manutenção da via aérea e da função vocal. Para tanto, a microcirurgia com laser tem demonstrado os melhores resultados, apesar de nãoimpedir as recorrências. Assim, os pobres índices de cura cirúrgica têm estimulado o desenvolvimento de estudos com quimioterápicos. A proposta do uso destes é reduzir a extensão da doença e a freqüência das recidivas, lentificando o crescimento do papiloma. Essas terapias adjuvantes, entretanto, ainda apresentam pouco sucesso a longo prazo. Realizamos aqui uma revisão da literatura a respeito do assunto, com ênfase nos aspectos de fisiopatologia, apresentação clínica e tratamento

Voice challenge in transgender women : trans women self-perception of voice handicap as compared to gender perception of naïve listeners

Objetivo: analisar a autopercepção de desvantagem vocal de mulheres transgêneros em comparação à percepção de gênero das vozes por ouvintes leigos. Métodos: foram eleitas para o estudo 31 mulheres transgêneros. Todas foram submetidas à análise acústica vocal para mensuração da frequência fundamental e desvio padrão. Após, responderam ao protocolo Índice em Desvantagem Vocal, do qual, ao final da coleta de todos os dados, foram selecionadas as questões consideradas mais afeitas às demandas diárias desta população. Subsequentemente, 50 ouvintes leigos foram cegamente expostos às vozes e tiveram de identificar as vozes como sendo masculinas, femininas ou indefinidas. Estatística descritiva foi aplicada para as características das transgêneros e correlação de Spearman para as pontuações do protocolo e a identificação de gênero pelos ouvintes leigos. Resultados: a frequência fundamental média encontrada foi de 172,40 Hz (DP=4,8 Hz) e um terço das transgêneros relatou satisfação com a própria voz. Foi encontrada correlação moderadamente significante e positiva nas vozes consideradas masculinas (rs=0,584; p=0,001) e fortemente significante e negativa nas femininas (rs= -0,605; p<0,001). Não houve correlação significativa com o IDV para as vozes consideradas indefinidas (rs=0,320; p=0,079). Conclusão: a autopercepção de desvantagem vocal em mulheres trans está diretamente relacionada à percepção de gênero por ouvintes leigos.Purpose: to analyze the self-perception of transgender women’s voice handicap in comparison to the voices’ gender perception by naïve listeners. Methods: 31 transgender women, who were first submitted to vocal acoustic assessment and had their voices recorded to measure fundamental frequency and standard deviations, were eligible to the study. Next, they answered to the Voice Handicap Index protocol, from which, at the end of data collection, the most suited questions to the daily demands of this population were selected. Subsequently, 50 naïve blindfolded listeners were exposed to the recordings and had to identify the voices as males, females or undefined. Descriptive statistics were applied to speakers’ characteristics and the Spearman’s correlation coefficient was applied to the protocol scores and the speaker’s voice identifications. Results: the mean fundamental frequency found was 172.40 Hz (SD=4.8Hz) and one third of the transgender women reported being satisfied with their voices. A moderate positive significant correlation was found in voices considered as males, and strongly significant and negative in voices considered as females. For the voices considered undefined, however, no significant correlation was found. Conclusion: transgender women’s self-perception of voice handicap is directly related to naïve listeners’ perception of their voice gender