Navegando por Palavras-chave "Rinossinusite crônica"

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    Efeito da pressão positiva aguda na cavidade nasal
    (Universidade Federal de São Paulo (UNIFESP), 2018-10-25) Balsalobre Filho, Leonardo Lopes [UNIFESP]; Fujita, Reginaldo Raimundo [UNIFESP]; Gregório, Luís Carlos [UNIFESP]; http://lattes.cnpq.br/3121718741179338; http://lattes.cnpq.br/3164472905601886; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Many studies have shown the influence of nasal obstruction on sleep disorders and adaptation to continuous positive airway pressure (CPAP). However, data are lacking on the impact of continuous positive pressure on the nasal cavity – whether in healthy individuals or patients with allergic rhinitis – and on the effect, if any, of topical corticosteroids on nasal patency after exposure to CPAP. In addition, it has been hypothesized that increasing interstitial hydrostatic pressure within the sinonasal mucosa of patients with nasal polyposis may decrease polyp size. Objective: The overarching goal of this series of studies was to evaluate the effect of continuous positive pressure on the nasal cavity of healthy individuals, subjects with allergic rhinitis, and subjects with nasal polyposis by objective and subjective methods. Methods: Three studies were carried out. The first included 27 subjects who were exposed to 2 hours of positive nasal pressure by CPAP via nasal mask with a pressure of 20 cm/H2O. A questionnaire on nasal allergic symptoms was applied, and participants were subsequently divided into two groups: with and without nasal allergic symptoms. Four methods were applied immediately before and after exposure to positive pressure: a visual analogue scale (VAS) of nasal obstruction; the Nasal Obstruction Symptom Evaluation (NOSE) scale; peak nasal inspiratory flow (PNIF) measurement; and acoustic rhinometry (AcRh). For the second study, 10 patients with nasal allergic rhinitis were exposed to 1 hour of positive nasal pressure by CPAP via nasal mask with a pressure of 15 cm/H2O. VAS, NOSE, PNIF, and AcRh measurements were obtained immediately before exposure to positive pressure. Topical intranasal budesonide therapy (400 mcg/day) was administered for 4 weeks, and the aforementioned tests were performed again, now before and after exposure to positive pressure. For the third study, 12 patients with nasal polyposis and 27 controls without polyposis were exposed to CPAP (20 cm/H2O) for 2 hours. VAS, NOSE, PNIF, AcRh, and nasal endoscopy (for polyp grading with the Meltzer Clinical Scoring System) were performed before and after the intervention. Results: In the first study, an increase in nasal obstruction was observed both on subjective parameters (VAS and NOSE) and on objective evaluation (reduction of nasal cavity volume on AcRh and lower PNIF). Deterioration of indicators of nasal patency was worse in subjects with nasal allergic complaints. In the second study, comparison of VAS, NOSE, PNIF, and AcRh findings after and before topical budesonide therapy and after exposure to positive pressure showed a statistically significant improvement in nasal obstruction scores and indicators of nasal patency. In the third study, for the polyposis group, VAS, NOSE and AcRh findings did not differ significantly (p=0.72, p=0.73, and p=0.17, respectively), but PNIF worsened (p=0.04) after exposure to CPAP. There was a statistically significant reduction in nasal polyp volume (p=0.04). The control group experienced deterioration of all measured parameters of nasal obstruction. Conclusion: Acute exposure to positive pressure via CPAP impairs nasal patency. This effect is even more pronounced in individuals with nasal allergic symptoms. Topical corticosteroid therapy was able to mitigate the irritant effects of CPAP on the nasal mucosa, leading to improvement of nasal patency parameters. In patients with nasal polyposis, CPAP exposure reduced the size of nasal polyps, but also reduced nasal patency as measured by PNIF. However, it had no significant effects on acoustic rhinometry findings or clinical symptoms of nasal obstruction.
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    A fibrose e a remodelação na rinossinusite crônica
    (Universidade Federal de São Paulo (UNIFESP), 2018-05-24) Gregorio, Luciano Lobato [UNIFESP]; Kosugi, Eduardo Macoto [UNIFESP]; Pezato, Rogério; http://lattes.cnpq.br/8850675385685321; http://lattes.cnpq.br/9771826548166046; http://lattes.cnpq.br/5139361443351453; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Tissue remodeling is considered a key aspect in distinguishing between chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP), due to its purported central role in polyp formation. Objective: To evaluate the role of fibrosis and remodeling of the nasal mucosa, whether through biomechanical or molecular mechanisms, in CRS. Methods: Three studies were carried out. The first evaluated biomechanical mechanisms in the nasal mucosa. The behavior of interstitial hydrostatic pressure (IHP) was analyzed by recording a continuous infusion of saline solution into the nasal mucosa of patients with CRS, in nasal synechiae, and in control mucosa of individuals without sinonasal disease. Twenty participants (N=20) were examined, at different sites in the nasal cavity. Analysis of the infusion produced a plot of tissue pressure vs. volume infused, which would correspond to IHP, or, in a simplified manner, to mucosal compliance. For the second study, considering the essential role of TGF-β in mucosal remodeling, the existence of a subgroup of patients with CRSwNP who exhibit an exacerbated systemic inflammatory response, and in vitro studies demonstrating a potential relationship between pro- and anti-inflammatory factors, we decided to evaluate the direct influence of administration of a leukotriene receptor antagonist (montelukast) on the systemic production of TGF-β1 in CRS. Serum levels of TGF-β1 were measured in patients with CRSwNP (from different subgroups) and in controls, before and after administration of montelukast. Finally, the third study evaluated the possible variation of tissue levels of TGF-β1 in different regions of the nasal cavity and its relationship with serum levels in healthy controls and in individuals with sinonasal disease. Results: The experimental model of continuous saline injection in the nasal mucosa revealed mechanical dysfunction. IHP increased less in tissue from individuals with CRSwNP when compared to fibrotic tissue (nasal synechiae) and to control tissue. There was no significant difference between the latter two groups. In the control group, a statistically significant difference was found in the IHP reached in the middle and inferior turbinate sites. Regarding analysis of TGF-β1 levels before and after administration of an antileukotriene agent, no statistically significant differences were found, whether in the control group or in subgroups of patients with CRSwNP. Controls showed a trend toward lower serum levels of TGF-β1 in relation to the CRSwNP group. Comparison of tissue levels of TGF-β1 between different nasal sites did not reveal statistically significant differences. Samples taken from the middle meatus of patients with CRSwNP exhibited a numerically lower cytokine concentration in relation to the control and CRSsNP groups. A possible inverse pattern of TGF-β1 levels in the middle meatus/inferior turbinate of the CRSwNP group was found in comparison to the control and CRSsNP groups. Conclusion: These studies confirmed biomechanical involvement of the mucosa in patients with CRSwNP, with evidence of increased mucosal compliance, which might facilitate polyp formation. Montelukast administration had no appreciable impact on systemic TGF-β1 production in patients with CRSwNP, suggesting that use of this agent with a view to altering the remodeling process is a questionable practice. There was no significant difference in tissue levels of TGF-β1 at different sites of the nasal cavity in patients with CRS.