Inflammatory pseudotumors of the paranasal sinuses

Pseudotumor inflamatório pode ser definido como uma lesão que simula neoplasia clínica e radiologicamente. Não se trata de uma entidade clínico-patológica única, mas um termo genérico para qualquer lesão expansiva inflamatória crônica inespecífica. Há poucos relatos de pseudotumor inflamatório em cavidade nasal e seios paranasais. RELATO DE CASOS: Apresentamos três casos de pseudotumor inflamatório em nariz e seios paranasais atendidos na Divisão de Clínica Otorrinolaringológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. DISCUSSÃO: Pseudotumor inflamatório de seios paranasais apresenta sintomatologia variável conforme o local de origem. Geralmente, segue curso benigno, porém pode ser localmente agressivo.Inflammatory pseudotumors may be defined as lesions that clinically and radiologically simulate neoplasms. These tumor are not a single clinical-pathological entity, but rather a generic term applied to any nonspecific, chronic, inflammatory expanding lesion. There are few reports of inflammatory pseudotumors in the nasal cavity and paranasal sinuses. CASE REPORT: We report three cases of inflammatory pseudotumors of the nose and paranasal sinuses seen at the Division of Otolaryngology of the Medical School University Hospital, Sao Paulo University. DISCUSSION: Inflammatory pseudotumors of the paranasal sinuses present a variety of symptoms according to the site

Applicability of the University of Pennsylvania Smell Identification Test (SIT) in Brazilians: pilot study

O teste de identificação do olfato da Universidade da Pensilvânia (SIT) é o exame olfatório mais citado na literatura devido a sua fácil aplicação e alta confiabilidade teste-reteste. Ainda não foram normatizados seus valores de olfação normal para a população brasileira. OBJETIVO: Verificar o escore no SIT alcançado por um grupo de brasileiros e o nível de dificuldade encontrado para a execução do teste. FORMA DE ESTUDO: Transversal. MATERIAL E MÉTODO: O SIT foi aplicado a 25 voluntários brasileiros de diversas classes econômicas, sem queixas olfatórias prévias. Após a aplicação do teste, todos preencheram um questionário com uma escala visual analógica (VAS) referente ao nível de dificuldade encontrado na realização do teste. RESULTADOS: O escore médio da amostra de brasileiros foi 32,5 (desvio-padrão:3,48) de 40, abaixo do considerado normal para a população americana. O nível de dificuldade médio encontrado foi 26mm (desvio padrão: 24,68) segundo a VAS, tendendo a facilidade, e 4(16%) participantes não conheciam algum dos odores escritos nas alternativas. CONCLUSÃO: Nesse estudo piloto, houve indícios de boa aplicabilidade do teste, com o escore dos brasileiros pouco abaixo da normosmia. São necessários estudos futuros para confirmar a existência de diferença de pontuação entre pessoas de diferente classe econômica.The University of Pennsylvania Smell Identification Test (SIT) is the most cited olfactory test in the literature because it is easy to perform and there is high test-retest reliability. There were no standardized olfaction values in a normal Brazilian population. AIM: To measure the SIT score in a group of Brazilians, and to assess the level of difficulty when implementing the test. STUDY DESIGN: A cross-sectional study. MATERIALS AND METHODS: The SIT was applied in 25 Brazilian volunteers of various income levels who presented no olfactory complaints. Following the test, subjects answered a questionnaire with a visual analog scale (VAS) for the level of difficulty. RESULTS: The mean in the sample of Brazilians was 32.5 (SD: 3.48) our of 40; this is below what is considered normal for US citizens. The level of difficulty was on average 26 mm (SD: 24.68) in the VAS, but it trended towards easy; 4(16%) participants did not recognize some of the odors under 'alternatives'. CONCLUSION: In this pilot study, there was evidence of good test applicability; the score of the sample of Brazilians was just below normosmia. Further studies are needed to confirm the existence of differences between people of different income levels

The role of endoscopic surgery in the treatment of nasal inverted papilloma

SummaryThe inverted papilloma is a benign neoplasm, prone to malignancy, and bearing a high rate of post-op recurrence. There is much debate in the literature concerning the issue that an endoscopic approach may offer a benefit over an external approach.AimDemonstrate the efficacy of an endonasal endoscopic approach in the treatment of inverted papilloma.Study designRetrospective.Materials and MethodsRetrospective analysis of patients with inverted papilloma operated at the University Hospital - FMUSP from 1994 to 2004.ResultsTwenty-eight patients' records were studied. Nine patients (32.1%) had tumor recurrence, one being operated via the endoscopic method and eight by external approach.DiscussionKrouse's staging system for inverted papillomas can facilitate both treatment planning and comparison of surgical outcomes. The use of the endoscopic approach resulted in fewer relapses than when the external one was used in cases with the same tumor staging.ConclusionThe use of the endoscope in this type of surgical treatment is an important success factor in the treatment of inverted papilloma

A new cultural adaptation of the University of Pennsylvania Smell Identification Test

OBJECTIVES: The University of Pennsylvania Smell Identification Test, a test of olfactory function that is widely used by otolaryngologists, geriatricians, and neurologists, has been translated into more than a dozen languages. In some instances, cultural and socioeconomic factors have necessitated changes in the odorant items or the response alternatives to make the test scores congruent with North American norms. The objective of this study was to compare the performance of Brazilian subjects on a new Portuguese language version of the University of Pennsylvania Smell Identification Test with their performance on an earlier Portuguese language version of the test, as well as to assess the influences of gender, age, ethnicity, and economic status on the test scores. METHODS: Based on pilot data, several response alternatives of the earlier Portuguese language version of the test were altered in an effort to improve test performance. Forty-nine healthy Brazilian volunteers, who represented several economic classes, were tested. The test scores of the study cohort who received the newer version of the test were compared with those of a group of 25 subjects who received the earlier version of the test. RESULTS: The mean score for the new version [35 (2.1)] was significantly (p = 0.002) higher than that for the earlier version [32.5 (3.5)]. Although no apparent influence of socioeconomic status was observed, the female participants outperformed the male participants in the current subject cohort. CONCLUSION: The changes made in the new cultural adaptation of the Portuguese version of the University of Pennsylvania Smell Identification Test were effective in increasing the average test scores of the participants. Overall, the female subjects outperformed the male subjects on the test

Bone: the final frontier for Staphylococcus aureus penetration in chronic rhinosinusitis

The superantigenic properties of Staphylococcus aureus have been implicated in increasing the inflammatory process in airway diseases. Local formation of IgE antibodies against staphylococcal enterotoxins by secondary lymphoid tissue in nasal polyps has been demonstrated. Staphylococcus aureus is known to colonize the nasal mucosa, and has been found invading the nasal submucosa and intracellularly.Objective: To evaluate the limits of Staphylococcus aureus invasion in the upper airway.Material and methods: Inferior turbinate samples from 3 patients without sinus disease, 6 ethmoid samples from patients with chronic rhinosinusitis with nasal polyposis, and 6 ethmoid samples from patients with chronic rhinosinusitis without nasal polyposis were studied. A fluorescein-labeled PNA probe against Staphylococcus aureus was used to test for the presence of the bacterium in bone (after decalcification) and mucosa.Results: We found Staphylococcus aureus invading the nasal submucosa in patients with nasal polyposis, but no cases of Staphylococcus aureus positivity in bone. in conclusion, we cannot support the hypothesis of nasal bone as a reservoir for Staphylococcus aureus, releasing massive amounts of staphylococcal enterotoxins and eliciting an inflammatory reaction, as occurs with the nasal mucosa.Univ São Paulo, Dept Otorhinolaryngol, São Paulo, BrazilSão Paulo State Mil Police, Mil Police Hosp, São Paulo, BrazilFed Univ São Paulo Unifesp, Dept Otorhinolaryngol, São Paulo, BrazilFed Univ São Paulo Unifesp, Dept Immunol, São Paulo, BrazilFed Univ São Paulo Unifesp, Dept Otorhinolaryngol, São Paulo, BrazilFed Univ São Paulo Unifesp, Dept Immunol, São Paulo, BrazilWeb of Scienc

Endoscopic ligation of the anterior ethmoidal artery: a cadaver dissection study

Ligadura da artéria etmoidal anterior (AEA) pode ser necessária em casos de epistaxe grave refratária ao tratamento tradicional. O uso da ligadura endoscópica endonasal da AEA ainda é bastante limitado. Existem poucos estudos na literatura sobre a técnica de abordagem endoscópica desta artéria. OBJETIVOS: Demonstrar a aplicabilidade técnica da ligadura periorbitária da AEA por via endoscópica transetmoidal. MATERIAL E MÉTODOS: Estudo prospectivo. 50 fossas nasais de cadáveres foram dissecadas. Após a realização de uma etmoidectomia anterior e remoção parcial da lâmina papirácea, a periórbita foi cuidadosamente dissecada até a identificação da AEA. Após sua identificação, a artéria foi exposta e ligada dentro da órbita. RESULTADOS: Todas as dificuldades inerentes ao procedimento, as complicações associadas, a curva de aprendizado e variações anatômicas foram coletados. CONCLUSÕES: A abordagem endoscópica da AEA na órbita de cadáveres mostrou-se factível. A identificação da artéria é fácil e a técnica evita incisões externas. Este acesso parece ser uma excelente alternativa para a abordagem da AEA. Estudos clínicos futuros são necessários para comprovar os benefícios desta técnica.Anterior ethmoidal artery (AEA) ligation may be necessary in cases of severe epistaxis not controllable with traditional therapy. Endoscopic endonasal ligation of the AEA is not used frequently; there are few studies in the literature for standardization of the endoscopic technique for this vessel. AIM: To demonstrate the feasibility of periorbital AEA ligation in a transethmoidal endoscopic approach. METHODS: A prospective study where 50 nasal cavities were dissected. After anterior ethmoidectomy and partial removal of lamina papyracea, the periorbital area was carefully dissected along a subperiosteal plane to identify the AEA. The vessel was exposed within the orbit and dissected. RESULTS: Data on technical difficulties, complications, the learning curve and anatomical variations were gathered. CONCLUSION: An endonasal endoscopic approach to the AEA within the orbit was shown to be feasible. Identifying the artery is not difficult, and this technique avoids external incisions. This approach appears to be an excellent alternative for approaching the AEA. Further clinical studies are needed to demonstarte the benefits of this technique

Tumor neuroectodérmico de seios paranasais: diagnóstico e tratamento

Tumores neuroectodérmicos primitivos (PNET) são neoplasias raras e extremamente agressivas encontradasprincipalmente em crianças e adultos jovens. São classificados em periféricos ou centrais, de acordo com sua origem. O diagnóstico baseia-se na história clínica, sendo essenciais exames de imagem, como tomografia computadorizada e ressonância magnética, e, para a confirmação, estudo anatomopatológico. É importante distingui-los de outros tumores de células redondas pequenas,como linfoma, sarcoma de Ewing extraósseo e rabdomiossarcoma,exigindo diferenciação imunoistoquímica através de marcadores específicos. O tratamento envolve cirurgia, quimioterapia e radioterapia, sendo o prognóstico pobre e a sobrevida bastante reservada. O objetivo deste artigo é discutir as características clínicas, radiográficas e histológicas dos tumores neuroectodérmicos primitivos e seu tratamento.Primitive neuroectodermal tumours (PNET) are rare and highly aggressive neoplasms found mainly in children and young adults. They are classified in peripheral or central according to their origin. The diagnosis is based on clinical history, computed tomography and magnetic resonance imaging, but the pathological study is the only way to confirm it. It´s very important to distinguish the PNET from other small cell round cell tumors - such as lymphoma, Ewing´s sarcoma and rhabdomyosarcoma – through immunohistochemical specific markers. The treatment includes surgical resection, chemotherapy and irradiation. The prognosis is poor and the survival rate is variable. This article aims to discuss the clinical, imaging and histological features of the primitive neuroectodermal tumors and their treatment

Convergence of two major pathophysiologic mechanisms in nasal polyposis : immune response to Staphylococcus aureus and airway remodeling

This review is addressed two pathophysiologic mechanisms implicated in the pathogenesis of nasal polyposis: the unique remodeling process found in nasal polyp tissue and the immune response of patients with nasal polyposis to Staphylococcus aureus. These two theories converge to the same direction in different aspects, including decreased extracellular matrix production, impaired T regulation and favoring of a Th2 immune response. In patients with nasal polyposis, an exaggerated immune response to Staphylococcus aureus may aggravate the airway remodeling process

Biofilm in chronic sinusitis with nasal polyps: pilot study

Apatogenia da rinossinusite crônica não está completamente estabelecida e existem algumas explicações para essa doença, como a osteíte, os superantígenos, a hipersensibilidade mediada por fungos e, mais recentemente, o biofilme. Não existem publicações na língua portuguesa sobre biofilmes na rinossinusite crônica. OBJETIVO: Reproduzir um método para evidenciar a presença de biofilmes em pacientes com rinossinusite crônica com polipose nasossinusal. MATERIAL E MÉTODO: Amostras de bula etmoidal de nove pacientes com rinossinusite crônica com polipose nasossinusal sem resposta ao tratamento clínico submetidos à cirurgia foram analisadas com microscopia eletrônica de varredura para evidenciar o biofilme. DESENHO DO ESTUDO: Estudo de coorte contemporânea com corte transversal. RESULTADOS: Observamos o biofilme em 55,56% (5/9) dos pacientes, através da visualização da estrutura tridimensional, de estruturas esféricas envolvidas por uma matriz amorfa e dos canais de água. CONCLUSÃO: Reproduzimos um método de visualização de biofilme bacteriano através da microscopia eletrônica de varredura e evidenciamos a sua presença nos pacientes com rinossinusite crônica com polipose nasossinusal.Chronic rhinosinusitis' pathogenesis is not completely established and there are some explanations for this disease, such as osteitis, superantigens, fungal-mediated hypersensitivity and, more recently, biofilms. There are no reports in Portuguese about biofilms in chronic rhinosinusitis. AIM: To reproduce a method for visualization of biofilms in patients with chronic rhinosinusitis and nasal polyps. PATIENTS AND METHODS: Samples of ethmoid bulla of nine patients with chronic rhinosinusitis with nasal polyps without response to clinical treatment who underwent surgery were analyzed with scanning electron microscopy to evidence bacterial biofilms. STUDY DESIGN: A contemporary cross-sectional cohort study RESULTS: In 55.56% (5/9) of the patients we observed biofilms by seeing three-dimensional structures, spherical structures surrounded by an amorphous matrix and water-channels. CONCLUSION: We reproduced a method for visualization of bacterial biofilms by scanning electron microscopy and evidenced its presence in chronic rhinosinusitis with nasal polyps

Cross-Cultural Adaptation and Validation of SNOT-20 in Portuguese

Introduction. Chronic rhinosinusitis is a highly prevalent disease, so it is necessary to create valid instruments to assess the quality of life of these patients. The SNOT-20 questionnaire was developed for this purpose as a specific test to evaluate the quality of life related to chronic rhinosinusitis. It was validated in the English language, and it has been used in most studies on this subject. Currently, there is no validated instrument for assessing this disease in Portuguese. Objective. Cross-cultural adaptation and validation of SNOT-20 in Portuguese. Patients and Methods. The SNOT-20 questionnaire underwent a meticulous process of cross-cultural adaptation and was evaluated by assessing its sensitivity, reliability, and validity. Results. The process resulted in an intelligible version of the questionnaire, the SNOT-20p. Internal consistency (Cronbach's alpha = 0.91, P < .001), reliability testing-retesting (r = 0.994, P < .001), content validity, validity of discrimination of patients without chronic rhinosinusitis (U = 44, P < .0001) and assessment of sensitivity to change (SRM = 1.53 and 1.09) were evaluated. Conclusion. We conducted a successful process of cross-cultural adaptation and validation of the SNOT-20 questionnaire into Portuguese