Comparação entre as avaliações objetiva e subjetiva da obstrução nasal em crianças e adolescentes com e sem rinite alérgica
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Data
2011-03-30
Autores
Mendes, Aline Inês [UNIFESP]
Orientadores
Solé, Dirceu [UNIFESP]
Tipo
Dissertação de mestrado
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Objetivos: Comparar a avaliação objetiva da obstrução nasal, mensurada por rinometria acústica (RnA) (volume dos cinco primeiros centímetros da cavidade nasal, V5) e rinomanometria anterior ativa (RMAA) (resistência nasal total, RNT), com a avaliação subjetiva dada pelo escore de obstrução (EO, escala de 0 a 10) em crianças e adolescentes com rinite alérgica e controles. Método: Trinta pacientes, entre sete e 18 anos, com rinite alérgica persistente e trinta controles participaram do estudo. As variáveis objetivas foram mensuradas em triplicata e de acordo com recomendações mais utilizadas. O EO foi referido para a cavidade nasal total e para as narinas em separado. RNT, V5 e EO foram mensurados nos momentos basal e após indução de obstrução nasal (100% aumento RNT após provocação nasal com histamina). Os pacientes com rinite alérgica foram tratados com corticosteroide tópico nasal (mometasona 100 mcg/dia por 15 dias) e avaliados 21 (±5) dias após. Resultados: Houve correlações significantes e negativas entre RNT e V5 em todos os grupos e situações de avaliação. Os valores de r encontrados variaram de -0,73 a -0,32, sendo a correlação encontrada no grupo rinite, no momento basal, na avaliação da narina mais obstruída a mais forte (r= -0,727). Para a cavidade nasal total não houve correlação significante entre EO e RNT e entre EO e V5 em todos os momentos estudados. Em relação à narina mais obstruída, verificamos correlação significante e negativa para EO e RNT (r= -0,51) e significante e positiva para EO e V5 (r= 0,29), avaliando-se o grupo total no momento basal. Não houve diferenças nítidas nos coeficientes de correlação encontrados nos paciente e nos controles. Os coeficientes de correlação não se alteraram após a indução de obstrução nasal e após tratamento com corticosteroide nasal. De forma semelhante, as crianças mais novas apresentaram coeficientes de correlação semelhantes aos dos adolescentes mais velhos. Conclusões: Assim como já fora descrito para adultos, a avaliação objetiva da obstrução nasal por RnA (V5) e RMAA (RNT) não apresentou correlação significativa em relação à avaliação subjetiva (escore de obstrução), em crianças e adolescentes, ao avaliar-se a cavidade nasal como um todo, fato que ocorreu na avaliação unilateral da cavidade nasal. Houve forte correlação entre as avaliações objetivas. A presença de doença nasal crônica (rinite alérgica) não interferiu na correlação entre as avaliações objetivas e subjetivas da obstrução nasal. A indução aguda de obstrução nasal, o tratamento com corticosteroide nasal e a idade também parecem não induzir alterações nessa correlação. Sugere-se, portanto, utilidade no acréscimo de um método objetivo para avaliação da obstrução nasal nas pesquisas em rinologia e, na sua impossibilidade, a avaliação das narinas em separado.
Objectives: Compare the objective assessment of nasal obstruction, measured by acoustic rhinometry (ARM) (volume of the first five centimeters of the nasal cavity, V5) and active anterior rhinomanometry (AARMM) (total nasal resistance, TNR), with the subjective evaluation given by obstruction scores (OS, scale from 0 to 10) in children and adolescents with allergic rhinitis and controls. Method: Thirty patients, aged 7 to 18 years, with persistent allergic rhinitis and thirty controls were enrolled. The objective variables were measured in triplicate and according to existing recommendations. The OS was reported for the total nasal cavity and nostrils separately. TNR, V5 and EO were measured at baseline and in the moments after the induction of nasal obstruction (100% increase in NTS after nasal challenge with histamine). Patients with allergic rhinitis were treated with topical nasal corticosteroids, mometasone 100mcg/day for 15 days and assessed 21 (± 5) days later. Results: There were significant and negative correlations between TNR and V5 in all groups and evaluation situations. The r values ranged from -0.73 to -0.32, and the association found in rhinitis group, at baseline, to evaluate the strongest and most obstructed nostril (r = -0.727). For the nasal cavity, of no significant correlation between OS and TNR and between OS and V5 at all studied times. Regarding the most obstructed nostril, we found significant negative correlation for OS and TNR (r = -0.51) and significant and positive for OS and V5 (r = 0.29), evaluating the total group at baseline. There were no clear differences in the coefficients of correlation found in patients and controls. The correlation coefficients were not changed after the induction of nasal obstruction and after treatment with nasal corticosteroids. Similarly, younger children showed a correlation coefficient similar to those of older adolescents. Conclusions: As has been described for adults, the objective assessment of nasal obstruction ARM (V5) and RMAA (TNR) showed no significant correlation in relation to the subjective evaluation (obstruction score) in children and adolescents, when assessing the nasal cavity as a whole, which has been seen in the assessment of unilateral nasal cavity. There was strong correlation between the objective evaluations. The presence of chronic nasal disease (allergic rhinitis) did not affect the correlation between objective and subjective assessments of nasal obstruction. The acute induction of nasal obstruction, nasal corticosteroid treatment and age also seem to induce changes in this correlation. It is suggested, therefore, usefulness in adding an objective method for evaluating nasal obstruction in the polls in rhinology and, failing which, the evaluation of the nostrils separately.
Objectives: Compare the objective assessment of nasal obstruction, measured by acoustic rhinometry (ARM) (volume of the first five centimeters of the nasal cavity, V5) and active anterior rhinomanometry (AARMM) (total nasal resistance, TNR), with the subjective evaluation given by obstruction scores (OS, scale from 0 to 10) in children and adolescents with allergic rhinitis and controls. Method: Thirty patients, aged 7 to 18 years, with persistent allergic rhinitis and thirty controls were enrolled. The objective variables were measured in triplicate and according to existing recommendations. The OS was reported for the total nasal cavity and nostrils separately. TNR, V5 and EO were measured at baseline and in the moments after the induction of nasal obstruction (100% increase in NTS after nasal challenge with histamine). Patients with allergic rhinitis were treated with topical nasal corticosteroids, mometasone 100mcg/day for 15 days and assessed 21 (± 5) days later. Results: There were significant and negative correlations between TNR and V5 in all groups and evaluation situations. The r values ranged from -0.73 to -0.32, and the association found in rhinitis group, at baseline, to evaluate the strongest and most obstructed nostril (r = -0.727). For the nasal cavity, of no significant correlation between OS and TNR and between OS and V5 at all studied times. Regarding the most obstructed nostril, we found significant negative correlation for OS and TNR (r = -0.51) and significant and positive for OS and V5 (r = 0.29), evaluating the total group at baseline. There were no clear differences in the coefficients of correlation found in patients and controls. The correlation coefficients were not changed after the induction of nasal obstruction and after treatment with nasal corticosteroids. Similarly, younger children showed a correlation coefficient similar to those of older adolescents. Conclusions: As has been described for adults, the objective assessment of nasal obstruction ARM (V5) and RMAA (TNR) showed no significant correlation in relation to the subjective evaluation (obstruction score) in children and adolescents, when assessing the nasal cavity as a whole, which has been seen in the assessment of unilateral nasal cavity. There was strong correlation between the objective evaluations. The presence of chronic nasal disease (allergic rhinitis) did not affect the correlation between objective and subjective assessments of nasal obstruction. The acute induction of nasal obstruction, nasal corticosteroid treatment and age also seem to induce changes in this correlation. It is suggested, therefore, usefulness in adding an objective method for evaluating nasal obstruction in the polls in rhinology and, failing which, the evaluation of the nostrils separately.
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Citação
MENDES, Aline Inês dos Santos. Comparação entre as avaliações objetiva e subjetiva da obstrução nasal em crianças e adolescentes com e sem rinite alérgica. 2011. 83 f. Dissertação (Mestrado) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2011.