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- ItemAcesso aberto (Open Access)Efficacy of syringe-irrigation topical therapy and the influence of the middle turbinate in sinus penetration of solutions(Assoc Brasileira Otorrinolaringologia & Cirurgia Cervicofacial, 2017) Wawginiak, Guilherme Henrique; Balsalobre, Leonardo [UNIFESP]; Kosugi, Eduardo Macoto [UNIFESP]; Mangussi-Gomes, Joao Paulo [UNIFESP]; Samaniego, Raul Ernesto; Stamm, Aldo CassolIntroduction: Topical therapies are the best postoperative treatment option for chronic rhinosinusitis, especially those with high volume and pressure, such as the squeeze bottles. However, they are not an available option in Brazil, where irrigation syringes are used. Objective: To investigate the efficacy of topical sinonasal therapy with syringe and the influence of the middle turbinate on this process Methods: Intervention study in training models (S.I.M.O.N.T.). After standard dissection, three interventions were performed (Nasal Spray 4 puffs, 60-mL syringe and 240-mL Squeeze Bottle) with normal and Sutured Middle Turbinate. Images of each sinus were captured after the interventions, totalizing 144 images. The images were classified by 10 evaluators according to the amount of residual volume from zero to 3, with zero and 1 being considered poor penetration and 2 and 3, good penetration. The 1440 evaluations were used in this study. Results: Considering all middle turbinate situations, the amount of good penetrations were 8.1% for Spray
- ItemEmbargoImpacto da punção do seio esfenoidal no diagnóstico e no tratamento dos pacientes com rinossinusite hospitalar(Universidade Federal de São Paulo (UNIFESP), 2011-06-29) Mendes Neto, José Arruda [UNIFESP]; Gregório, Luiz Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To evaluate the diagnostic and therapeutic effect of the endoscopically-guided sphenoid sinus puncture performed at the bedside of the patients with infective rhinosinusitis hospitalized in an Intensive Care Unit of a high complexity care hospital. Methods: Retrospective study to evaluate patients undergoing mechanical ventilation with fever of unknown origin and computed tomographic signs of rhinosinusitis. They were divided in two groups. On group A, patients were submitted to maxillary sinus puncture (standard diagnosis and treatment), whereas on group B patients were submitted to both maxillary sinus puncture and sphenoid sinus. Results: The total study sample consisted of 54 patients (72,2% male, mean age 42 years), distributed in 27 per group. The most common Intensive Care Unit admission diagnosis was head trauma and stroke. On computed tomographic scans, the paranasal sinuses most affected were the sphenoid sinus (82,4%) and the maxillary sinus (75,9%). Purulent drainage was seen in the middle meatus (27,5%) and in the sphenoethmoid recess (37,5%). In group A and B there was fever reduction in 70,4% of the patients after the punctures (p<0,001). Comparing the two groups in relation to this same variable, no statistically significant difference was found (p = 1.000). Most commonly found organisms in sinus aspirates were Pseudomonas aeruginosa and Acinetobacter baumannii. The average number of organisms recovered from the punctures of the patients of group B was significantly higher than in group A. In group B there was a higher occurrence of Enterobacteria. On patients in group B 57,1% of the punctured sides showed no endoscopic signs of rhinosinusitis, despite the positive culture. Conclusion: The endoscopically-guided sphenoid sinus puncture performed at the bedside of the patients has shown to be an important diagnostic tool. It didn’t contribute to increase the success rate of fever control in critically ill patients.