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Abstract Introduction Among the potential diseases that present altered salivary flow and activity is Sjögren syndrome. Sialendoscopy seems to be an important therapeutic option. Objective To compare the results obtained with sialendoscopy for improving salivary flow measured by scintigraphy in patients with primary Sjögren syndrome to those obtained with other intraglandular washing solutions. Methods Patients from our institution's rheumatology clinic diagnosed with primary Sjögren syndrome underwent parotid scintigraphy prior to the sialendoscopy procedure. During the sialendoscopy procedure, one of the parotid glands was randomized to receive a wash with saline while the other was washed with a corticosteroid solution. After 1 month, a new scintigraphy examination of the parotid glands was performed to observe the salivary flow for comparison. Results A total of 13 female patients with mean age of 53.38 years (range, 27-76 years) were included in this study. After sialendoscopy, 10 patients (76.92 %) were observed to have improvement in salivary excretion with radiopharmaceutical during scintigraphy. When analyzing each gland that was treated separately (26 glands), after sialendoscopy, improvement was observed in 18 glands (69.23 %), 8 treated with dexamethasone and 10 with saline solution in the wash. There was no improvement in 8 glands (30.77 %). Conclusion This study demonstrates that sialendoscopy is as an important tool to improve salivary flow measured by scintigraphy in patients with primary Sjogren syndrome, increasing salivary excretion through dilation and consequent unblocking of the ducts. These data suggest that there is no statistically significant difference between intraductal washing solutions using saline or dexamethasone solution.

https://doi.org/10.1055/s-0040-1716574 147 downloads

Incomplete and late recovery of sudden olfactory dysfunction in COVID-19,
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Kosugi, Eduardo Macoto

; Lavinsky, Joel

; Romano, Fabrizio Ricci

; Fornazieri, Marco Aurélio

; Luz-Matsumoto, Gabriela Ricci

; Lessa, Marcus Miranda

; Piltcher, Otávio Bejzman

; Sant'Anna, Geraldo Druck

Brazilian Journal of Otorhinolaryngology

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aug 2020, Volume 86 N. 4 Pages 490 - 496

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Introdução A perda súbita do olfato é um novo sintoma relacionado à COVID-19, porém com poucos dados sobre sua duração ou resolução. Objetivo Caracterizar pacientes que apresentaram perda súbita do olfato durante a pandemia da COVID-19 e em especial a sua recuperação. Método Pesquisa online desenvolvida pela Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial e Academia Brasileira de Rinologia direcionado aos médicos que atenderam pacientes com perda súbita do olfato com início após 1° de fevereiro de 2020. Os participantes foram questionados posteriormente por e-mail, para verificar os dados sobre a recuperação da perda súbita do olfato e teste para COVID-19, no final do período de coleta de dados. Resultados Foram incluídos 253 pacientes com perda súbita de olfato, 59,1% mulheres e idade mediana de 36 anos, acompanhados por 31 dias (mediana). Testagem para COVID-19 foi feita em 183 (72,3%) pacientes, 145 (79,2%) positivos e 38 (20,8%) negativos. COVID-19 positivos apresentaram sintomas inflamatórios inespecíficos mais frequentemente (89,7% vs. 73,7%; p = 0,02); menor taxa de recuperação total da perda súbita do olfato (52,6% vs. 70,3%; p = 0,05) e maior tempo para atingir a recuperação total (15 dias vs. 10 dias; p = 0,0006) comparados aos COVID-19 negativos. Considerando somente COVID-19 positivos, hiposmia súbita apresentou melhoria total mais frequentemente do que anosmia súbita (68,4% vs. 50,0%; p = 0,04). Conclusão A perda súbita do olfato em pacientes COVID-19 positivos apresentou menor taxa de recuperação total e duração mais prolongada do que em Covid-19 negativos. E a hiposmia súbita apresentou recuperação total mais frequentemente do que a anosmia súbita em COVID-19 positivos.

Abstract Introduction Sudden olfactory dysfunction is a new symptom related to COVID-19, with little data on its duration or recovery rate. Objective To characterize patients with sudden olfactory dysfunction during the COVID-19 pandemic, especially their recovery data. Methods An online survey was conducted by the Brazilian Society of Otorhinolaryngology and Cervico-Facial Surgery, and Brazilian Academy of Rhinology, including doctors who assessed sudden olfactory dysfunction patients starting after February 1st, 2020. Participants were posteriorly asked by e-mail to verify data on the recovery of sudden olfactory loss and test for COVID-19 at the end of the data collection period. Results 253 sudden olfactory dysfunction patients were included, of which 59.1% were females with median age of 36 years, with a median follow-up period of 31 days. 183 patients (72.3%) had been tested for COVID-19, and of those 145 (79.2%) tested positive. Patients that tested positive for COVID-19 more frequently showed non-specific inflammatory symptoms (89.7% vs. 73.7%; p = 0.02), a lower rate of total recovery of sudden olfactory dysfunction (52.6% vs. 70.3%; p = 0.05) and a longer duration to achieve total recovery (15 days vs. 10 days; p = 0.0006) than the ones who tested negative for COVID-19. Considering only positive-COVID-19 patients, individuals with sudden hyposmia completely recovered more often than the ones with sudden anosmia (68.4% vs. 50.0%; p = 0.04). Conclusion Positive-COVID-19 patients with sudden olfactory dysfunction showed lower total recovery rate and longer duration than negative-COVID-19 patients. Additionally, total recovery was seen more frequently in positive-COVID-19 patients with sudden hyposmia than the ones with sudden anosmia.

https://doi.org/10.1016/j.bjorl.2020.05.001 10700 downloads

How to avoid the inappropriate use of antibiotics in upper respiratory tract infections? A position statement from an expert panel
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Piltcher, Otávio Bejzman

; Kosugi, Eduardo Macoto

; Sakano, Eulalia

; Mion, Olavo

; Testa, José Ricardo Gurgel

; Romano, Fabrizio Ricci

; Santos, Marco Cesar Jorge

; Di Francesco, Renata Cantisani

; Mitre, Edson Ibrahim

; Bezerra, Thiago Freire Pinto

; Roithmann, Renato

; Padua, Francini Greco

; Valera, Fabiana Cardoso Pereira

; Lubianca Neto, José Faibes

; Sá, Leonardo Conrado Barbosa

; Pignatari, Shirley Shizue Nagata

; Avelino, Melissa Ameloti Gomes

; Caixeta, Juliana Alves de Souza

; Anselmo-Lima, Wilma Terezinha

; Tamashiro, Edwin

Brazilian Journal of Otorhinolaryngology

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jun 2018, Volume 84 N. 3 Pages 265 - 279

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Introdução: A resistência bacteriana a antibióticos nos processos infecciosos é um fato crescente nos últimos anos, especialmente devido ao seu uso inapropriado. Ao longo dos anos vem se tornando um grave problema de saúde pública devido ao prolongamento do tempo de internação, elevação dos custos de tratamento e aumento da mortalidade relacionada às doenças infecciosas. Quase a metade das prescrições de antibióticos em unidades de pronto atendimento é destinada ao tratamento de alguma infecção de vias aéreas superiores, especialmente rinossinusites, otite média aguda supurada e faringotonsilites agudas, sendo que uma significativa parcela dessas prescrições é inapropriada. Nesse contexto, os otorrinolaringologistas têm um papel fundamental na orientação de pacientes e colegas não especialistas, para o uso adequado e racional de antibióticos frente a essas situações clínicas. Objetivos: Realizar uma revisão das atuais recomendações de utilização de antibióticos nas otites médias, rinossinusites e faringotonsilites agudas adaptadas à realidade nacional. Método: Revisão na base PubMed das principais recomendações internacionais de tratamentos das infecções de vias aéreas superiores, seguido de discussão com um painel de especialistas. Resultados: Os antibióticos devem ser utilizados de maneira criteriosa nas infecções agudas de vias aéreas superiores não complicadas, a depender da gravidade da apresentação clínica e dos potenciais riscos associados de complicações supurativas e não supurativas. Conclusões: Constantes revisões a respeito do tratamento das principais infecções agudas são necessárias para que sejam tomadas medidas coletivas no uso racional e apropriado de antibióticos. Somente com orientação e transformações no comportamento de médicos e pacientes é que haverá mudanças do paradigma de que toda infecção de vias aéreas superiores deva ser tratada com antibióticos, minimizando por consequência os efeitos de seu uso inadequado.

Abstract Introduction: Bacterial resistance burden has increased in the past years, mainly due to inappropriate antibiotic use. Recently it has become an urgent public health concern due to its impact on the prolongation of hospitalization, an increase of total cost of treatment and mortality associated with infectious disease. Almost half of the antimicrobial prescriptions in outpatient care visits are prescribed for acute upper respiratory infections, especially rhinosinusitis, otitis media, and pharyngotonsillitis. In this context, otorhinolaryngologists play an important role in orienting patients and non-specialists in the utilization of antibiotics rationally and properly in these infections. Objectives: To review the most recent recommendations and guidelines for the use of antibiotics in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, adapted to our national reality. Methods: A literature review on PubMed database including the medical management in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, followed by a discussion with a panel of specialists. Results: Antibiotics must be judiciously prescribed in uncomplicated acute upper respiratory tract infections. The severity of clinical presentation and the potential risks for evolution to suppurative and non-suppurative complications must be taken into ‘consideration'. Conclusions: Periodic revisions on guidelines and recommendations for treatment of the main acute infections are necessary to orient rationale and appropriate use of antibiotics. Continuous medical education and changes in physicians' and patients' behavior are required to modify the paradigm that all upper respiratory infection needs antibiotic therapy, minimizing the consequences of its inadequate and inappropriate use.

https://doi.org/10.1016/j.bjorl.2018.02.001 22744 downloads

Sleep-disordered breathing in patients with cystic fibrosis
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Veronezi, Jefferson

; Carvalho, Ana Paula

; Ricachinewsky, Claudio

; Hoffmann, Anneliese

; Kobayashi, Danielle Yuka

; Piltcher, Otavio Bejzman

; Silva, Fernando Antonio Abreu e

; Martinez, Denis

Jornal Brasileiro de Pneumologia

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aug 2015, Volume 41 N. 4 Pages 351 - 357

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

ResumoObjetivo: Testar a hipótese de que a gravidade da doença em pacientes com fibrose cística (FC) correlaciona-se com maior risco de apneia do sono.Métodos: Um total de 34 pacientes com FC foram submetidos a avaliação clínica e funcional, polissonografia portátil, espirometria e dosagem de IL-1β.Resultados: As médias do índice de apneia e hipopneia (IAH), da SpO2 em ar ambiente e da pontuação na Escala de Sonolência de Epworth foram de 4,8 ± 2,6, 95,9 ± 1,9% e 7,6 ± 3,8, respectivamente. Dos 34 pacientes, 19 eram eutróficos, 6 apresentavam risco nutricional e 9 apresentavam desnutrição. No modelo multivariado para prever o IAH, permaneceram significativos o estado nutricional (β = −0,386; p = 0,014), a SpO2 (β = −0,453; p = 0,005) e a pontuação na Escala de Sonolência de Epworth (β = 0,429; p = 0,006). O modelo explicou 51% da variação do IAH.Conclusões: Os maiores determinantes de apneia do sono foram o estado nutricional, a SpO2 e a sonolência diurna. Esse conhecimento representa não somente uma oportunidade de definir o risco clínico de apresentar apneia do sono, mas também de atuar na prevenção e tratamento da doença.

AbstractObjective: To test the hypothesis that disease severity in patients with cystic fibrosis (CF) is correlated with an increased risk of sleep apnea.Methods: A total of 34 CF patients underwent clinical and functional evaluation, as well as portable polysomnography, spirometry, and determination of IL-1β levels.Results: Mean apnea-hypopnea index (AHI), SpO2 on room air, and Epworth Sleepiness Scale score were 4.8 ± 2.6, 95.9 ± 1.9%, and 7.6 ± 3.8 points, respectively. Of the 34 patients, 19 were well-nourished, 6 were at nutritional risk, and 9 were malnourished. In the multivariate model to predict the AHI, the following variables remained significant: nutritional status (β = −0.386; p = 0.014); SpO2 (β = −0.453; p = 0.005), and the Epworth Sleepiness Scale score (β = 0.429; p = 0.006). The model explained 51% of the variation in the AHI.Conclusions: The major determinants of sleep apnea were nutritional status, SpO2, and daytime sleepiness. This knowledge not only provides an opportunity to define the clinical risk of having sleep apnea but also creates an avenue for the treatment and prevention of the disease.

https://doi.org/10.1590/S1806-37132015000004468 2982 downloads

Chronic rhinosinusitis and nasal polyposis in cystic fibrosis: update on diagnosis and treatment
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Kang, Suzie Hyeona

; Dalcin, Paulo de Tarso Roth

; Piltcher, Otavio Bejzman

; Migliavacca, Raphaella de Oliveira

Jornal Brasileiro de Pneumologia

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feb 2015, Volume 41 N. 1 Pages 65 - 76

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

A fibrose cística (FC) é uma doença genética irreversível, mas os avanços no tratamento têm aumentado a expectativa de vida dos pacientes. O acometimento das vias aéreas superiores, principalmente por alterações patológicas dos seios paranasais, é prevalente nesses pacientes, embora muitos apresentem poucos sintomas. O objetivo desta revisão é discutir a fisiopatologia e o manejo terapêutico atual da rinossinusite crônica (RSC) na FC. A revisão fundamentou-se nas evidências mais recentes, classificadas em conformidade com os critérios do Oxford Centre for Evidence-Based Medicine. Quando sintomática, a RSC com pólipos nasais pode afetar a qualidade de vida e as exacerbações pulmonares, já que os seios paranasais podem ser colonizados por bactérias patogênicas, principalmente a Pseudomonas aeruginosa. Essa bactéria tem papel crucial na morbidade e mortalidade após o transplante pulmonar em pacientes com FC. Embora o tratamento clínico das vias aéreas superiores seja indicado no manejo inicial, a indicação é muitas vezes extrapolada de estudos sobre RSC na população geral. A cirurgia é a alternativa quando o quadro nasossinusal é refratário à terapia não invasiva. Mais estudos são necessários para compreender melhor o acometimento das vias aéreas superiores e melhorar o manejo da RSC na FC, a fim de preservar a função pulmonar e evitar procedimentos invasivos desnecessários.

Although cystic fibrosis (CF) is an irreversible genetic disease, advances in treatment have increased the life expectancy of CF patients. Upper airway involvement, which is mainly due to pathological changes in the paranasal sinuses, is prevalent in CF patients, although many are only mildly symptomatic (with few symptoms). The objective of this literature review was to discuss the pathophysiology and current therapeutic management of chronic rhinosinusitis (CRS) in CF patients. The review was based on current evidence, which was classified in accordance with the Oxford Centre for Evidence-Based Medicine criteria. When symptomatic, CRS with nasal polyps can affect quality of life and can lead to pulmonary exacerbations, given that the paranasal sinuses can be colonized with pathogenic bacteria, especially Pseudomonas aeruginosa. Infection with P. aeruginosa plays a crucial role in morbidity and mortality after lung transplantation in CF patients. Although clinical treatment of the upper airways is recommended as initial management, this recommendation is often extrapolated from studies of CRS in the general population. When sinonasal disease is refractory to noninvasive therapy, surgery is indicated. Further studies are needed in order to gain a better understanding of upper airway involvement and improve the management of CRS in CF patients, with the objective of preserving lung function and avoiding unnecessary invasive procedures.

https://doi.org/10.1590/s1806-37132015000100009 8594 downloads

Rhinosinusitis: evidence and experience. A summary
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Anselmo-Lima, Wilma T.

; Sakano, Eulália

; Tamashiro, Edwin

; Nunes, André Alencar Araripe

; Fernandes, Atílio Maximino

; Pereira, Elizabeth Araújo

; Ortiz, Érica

; Pinna, Fábio de Rezende

; Romano, Fabrizio Ricci

; Padua, Francini Grecco de Melo

; Mello Junior, João Ferreira de

; Teles Junior, João

; Dolci, José Eduardo Lutaif

; Balsalobre Filho, Leonardo Lopes

; Kosugi, Eduardo Macoto

; Sampaio, Marcelo Hamilton

; Nakanishi, Márcio

; Santos, Marco César Jorge dos

; Andrade, Nilvano Alves de

; Mion, Olavo de Godoy

; Piltcher, Otávio Bejzman

; Fujita, Reginaldo Raimundo

; Roithmann, Renato

; Voegels, Richard Louis

; Guimarães, Roberto Eustaquio Santos

; Meirelles, Roberto Campos

; Santos, Rodrigo de Paula

; Nakajima, Victor

; Valera, Fabiana Cardoso Pereira

; Pignatari, Shirley Shizue Nagata

Brazilian Journal of Otorhinolaryngology

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feb 2015, Volume 81 N. 1 Pages 8 - 18

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1016/j.bjorl.2014.11.005 7696 downloads

An experimental model of chronic rhinosinusitis in rabbits without bacterial inoculation
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Migliavacca, Raphaella de Oliveira

; Piltcher, Otávio Bejzman

; Kliemann, Lúcia Maria

; Cerski, Marcelle Reesink

; Meyer, Fabíola

; Oppermann, Paula de Oliveira

; Machado Filho, Geraldo

; Kang, Suzie Hyeona

; Costa, Sady Selaimen da

Acta Cirúrgica Brasileira

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may 2014, Volume 29 N. 5 Pages 313 - 319

Abstract: En | Text: En | PDF: En

PURPOSE: Evaluate and compare two different experimental techniques of maxillary sinus ostium occlusion using N-butyl cyanoacrylate in developing chronic histological findings without the inoculation of pathogenic bacteria among rabbits.METHODS: In a randomized study, sixteen New Zealand rabbits were assigned for occlusion of the right maxillary sinus through a transmaxillary approach or through the roof of the nasal cavity. The contralateral sinus served as a control. After 12 weeks, the animals were sacrificed for blinded histopathological analysis of the maxillary sinus mucosa.RESULTS: Histopathological changes consistent with CRS were found in eight (100%) of the maxillary sinuses approached transmaxillary and three of those through the roof of the nasal cavity (37.5%), p 0.008 and 0.250, respectively, comparing with the control side. Chronic mucosal changes were significantly better induced using the transmaxillary approach (p 0.026).CONCLUSION:It is possible to induce a model of chronic sinusitis among rabbits with transmaxillary sinus occlusion without bacterial inoculation. This model can be replicated for future cellular studies.

https://doi.org/10.1590/S0102-86502014000500005 2729 downloads

10.

A Trefinação do Seio Frontal deve ser sempre realizada a 1cm da linha média? Um estudo tomográfico
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Piltcher, Otavio Bejzman

; Antunes, Marcelo

; Monteiro, Fernanda

; Schweiger, Cláudia

; Schatkin, Barry

Revista Brasileira de Otorrinolaringologia

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aug 2006, Volume 72 N. 4 Pages 505 - 508

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

A complexa anatomia do recesso frontoetmoidal, bem como sua relação anatômica com estruturas vitais, explicam a razão do considerável cuidado que se tem durante a cirurgia para preservar estas estruturas e minimizar complicações relacionadas ao processo de cicatrização. A trefinação é um procedimento amplamente aceito para acesso ao seio frontal. OBJETIVO: Avaliar o melhor ponto para se realizar a trefinação do seio frontal. MÉTODOS: Mensuração da profundidade do seio frontal em 3 pontos eqüidistantes da linha média (crista galli) em cortes tomográficos axiais. RESULTADOS: Foram medidos 138 seios frontais (69 pacientes). A profundidade do seio frontal medida a 0,5cm da linha média foi significativamente maior do que a 1,0 e 1,5cm, assim como a medida a 1,0cm foi significativamente maior do que a 1,5cm (12,22±4,25 vs 11,78±4,65 p<0,05; 12,22±4,25 vs 10,78±5,98 p<0,001; 11,78±4,65 vs 10,78±5,98 p<0,05). O trefinador usado (penetração máxima de 0,7cm) é seguro de ser usado em cerca de 80% dos pacientes. CONCLUSÃO: A trefinação pode ser realizada em pontos variáveis do seio frontal, mas a distância de 1cm da linha média parece ser mais segura e apresentar resultados estéticos melhores.

The complex anatomy of the frontoethmoidal recess, as well as its anatomical relationship with the vital adjacent structures in the region explain the reason for considerable surgical care to protect these structures and minimize complications related to healing. Trephination is an accepted procedure to access the frontal sinus. AIM: Discuss the best location for performing frontal sinus trephination. METHODS: Measuring sinus frontal depth at 3 points equidistant to the midline (crista galli) through the axial tomographic sections. RESULTS: We measured 138 frontal sinus (69 patients). Frontal sinus depth at 0,5 cm was statistically larger than 1 cm and 1,5 cm, as well as the 1 cm trephine point was significantly larger than 1,5 cm (12,22±4,25 vs 11,78±4,65 p<0,05; 12,22±4,25 vs 10,78±5,98 p<0,001; 11,78±4,65 vs 10,78±5,98 p<0,05). The trephine set used (maximum depth of penetration of 0,7 cm) is safe to be applied in approximately 80% of the patients. CONCLUSION: Analizing the results, the trephination may be performed at variable points of the frontalsinus, but the distance of 1 cm from midline appears to be safer and shows better aestethic results.

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11.

Antibióticos em tonsilectomias: terapêutico ou profilático? Necessário ou abusivo?
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Piltcher, Otávio Bejzman

; Scarton, Fabiana Bortoncello

Revista Brasileira de Otorrinolaringologia

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oct 2005, Volume 71 N. 5 Pages 686 - 690

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

A adenotonsilectomia é uma das cirurgias mais comumente realizadas na população pediátrica e adulta jovem. A morbidade pós-operatória de tal procedimento cirúrgico é importante incluindo odinofagia, disfagia, otalgia, febre, halitose, perda ponderal e redução da aceitação por via oral. Após a tonsilectomia, com ou sem adenoidectomia, a colonização da loja tonsilar aberta pela flora bacteriana oral causaria uma exacerbação da reação inflamatória local, piorando a dor pós-operatória. A hipótese de que a redução da população bacteriana na ferida cirúrgica aberta possa diminuir a inflamação local, promover o processo cicatricial e acelerar a recuperação pós-operatória determinou inúmeros estudos que abordaram a relação entre o uso perioperatório de antibióticos e a morbidade pós-operatória da adenotonsilectomia. Apesar desses estudos se definirem como avaliadores do uso profilático cirúrgico de antibióticos nessas cirurgias, não houve seguimento das normas de antibioticoprofilaxia cirúrgica internacionalmente aceitas, sendo que a maioria utiliza antibióticos por sete dias pós-operatórios. Através de uma revisão crítica da literatura, os autores discutem os prós e contras do uso de antibiótico nas tonsilectomias ou adenotonsilectomias, assim como a correta definição para sua utilização.

Adenotonsillectomy is one of the most commonly performed surgeries in the pediatric and young adult populations. The postoperative morbidity of this surgical procedure is often significant, including odynophagia, dysphagia, fever, halitosis, loss of weight and reduced oral intake. After tonsillectomy, with or without adenoidectomy, the colonization of the open tonsillar fossae by the bacterial population of the oral cavity would cause an exacerbation of the local inflammatory response worsening postoperative pain. The hypothesis that a reduction of the bacterial population of an open surgical wound could minimize the local inflammation, stimulate the healing process and hasten recovery triggered a considerable number of studies addressing the relation between the use of perioperative antibiotics and postoperative morbidity of adenotonsillectomy. In spite of the fact that those studies claim to perform an assessment of the surgical prophylactic use of antibiotics, their outline is not in compliance with the worldwide-accepted principles of surgical antibiotic prophylaxis. By performing a critical review of the literature, the authors discuss the advantages and disadvantages of using antibiotics in tonsillectomies or adenotonsillectomies, as well as the most appropriate definition for its utilization.

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