LIM/32 - Laboratório de Otorrinolaringologia
URI Permanente desta comunidade
O Laboratório de Otorrinolaringologia é ligado ao Departamento de Oftalmologia e otorrinolaringologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP).
Linhas de pesquisa: pesquisa experimental e análise crítica das técnicas cirúrgicas sobre osso temporal; pesquisa em próteses eletrônicas cirurgicamente implantáveis para deficiência auditiva profunda; bases clínicas e experimentais da fisiopatologia e tratamento do zumbido e da hiperacusia; mecanismos fisiopatológicos dos distúrbios vestibulares periféricos; pesquisa anatômica e experimental das propriedades biomecânicas da laringe no desempenho das funções respiratória, fonatória e esfinctérica; distúrbios do anel linfático de Waldeyer e sua influência no desenvolvimento craniofacial e no sistema estomagotognático; correlação de fatores estruturais e microbiológicos na fisiopatogenia das rinossinusites; estudo da patogênese de nasoangiofibroma juvenil; alterações funcionais na mucosa nasal exposta a poluentes ambientais alérgenos.
Site oficial: http://limhc.fm.usp.br/portal/lim32-laboratorio-de-otorrinolaringologia/
Linhas de pesquisa: pesquisa experimental e análise crítica das técnicas cirúrgicas sobre osso temporal; pesquisa em próteses eletrônicas cirurgicamente implantáveis para deficiência auditiva profunda; bases clínicas e experimentais da fisiopatologia e tratamento do zumbido e da hiperacusia; mecanismos fisiopatológicos dos distúrbios vestibulares periféricos; pesquisa anatômica e experimental das propriedades biomecânicas da laringe no desempenho das funções respiratória, fonatória e esfinctérica; distúrbios do anel linfático de Waldeyer e sua influência no desenvolvimento craniofacial e no sistema estomagotognático; correlação de fatores estruturais e microbiológicos na fisiopatogenia das rinossinusites; estudo da patogênese de nasoangiofibroma juvenil; alterações funcionais na mucosa nasal exposta a poluentes ambientais alérgenos.
Site oficial: http://limhc.fm.usp.br/portal/lim32-laboratorio-de-otorrinolaringologia/
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Submissões Recentes
“Benefits of the pedicled osteoplastic flap as a surgical approach of mastoidectomy in cochlear implant surgery”
(2022) LOPES, P. T.; BENTO, R. F.; GEBRIM, E. M. Mello Santiago; BECK, R. M. de Oliveira; CARVALLO, R. Mota Memede; SANCHES, S. G. Gandolfi; LESSER, J. C. Cisneros
Objective: To evaluate the esthetic and functional results of an osteoplastic flap for mastoid cavity closure in cochlear implant surgery. Study design: Double-blind, prospective, randomized clinical trial. Setting: tertiary referral center. Intervention(s): On hundred and twenty-six patients were randomized in 2 groups for cochlear implant surgery. Cases (n: 63) underwent simple mastoidectomy using an anteriorly pedicled osteoplastic flap for mastoid closure. In controls (n: 63), a traditional periosteal flap was used. Evaluation with the POSAS questionnaire was performed 1 year after surgery to assess surgical wound esthetics. Sixteen patients from each group had postoperative CT-scans and wideband tympanometry to assess mastoid aeration and middle ear absorbance. Gender and time after surgery were correlated. Main outcome measure(s): Evaluation of the quality of the surgical wound with the application of a questionnaire validated in the medical literature and translated into Portuguese language called POSAS, considering the perception of the blinded patient and doctor regarding the surgical technique proceeded. A lower POSAS score suggests better esthetics of the surgical wound. Secondary outcomes are volumetric measurement of aeration inside mastoid cavity using 3D computer tomography exam, which aims to analyze the influence of fibrocicatricial retraction in the surgical wound into the mastoid and the interference of its aeration volume in the absorption of sound in the middle ear, using the wideband tympanometry exam. Results: The POSAS questionnaire in the Case group showed a lower level of local pain and itchiness, a skin color and thickness more similar to the surrounding skin and less irregularity and stiffness, with no influence from time after surgery and gender compared to the Control group. The median tomographic volume was 6.37 cc in the cases and 4.60 cc in controls. Wideband tympanometry showed general smaller sound absorbance in the Case group results, specially, at 1000 Hz frequency. No intraoperative or postoperative complications were observed with the osteoplastic flap. Conclusions: This technique is an effective and safe alternative to alleviate common problems of mastoid surgery for cochlear implantation. In addition to esthetic benefits, it has less interference in middle ear physiology of sound absorbance and less fibrous tissue into the mastoid cavity during the follow-up of more than 1 year.
Impact of Chronic Rhinosinusitis with Nasal Polyposis on IL-12 and IL-8
(2023) AMARAL, J. B. do; DAVID, A. G.; MELLO, L.; BACHI, A. L. L.; VOEGELS, R. L.; THAMBOO, A.; PEZATO, R.
Introduction: The pathophysiology of Chronic Rhinosinusitis is coordinated by distinct inflammatory reactions in different individuals. Inflammatory environments with a predominance of Th2 lymphocytes tend also to be rich in eosinophils. These environments are common during the formation of nasal polyps associated with aspirin intolerance, which is also marked by an increase in inflammatory mediators, especially IL-4, IL-5, and IL-13. Despite the significance of these inflammatory mediators, the relevance of IL-12 subunits' presence within eosinophilic nasal polyps, however, has been less studied. The current study aims to evaluate the presence of IL-12 subunits, IL-12p40 and IL-12p70, in eosinophilic nasal polyps and their correlations with IL-8 presence. Materials and Methods: We compared the concentrations of IL-8, IL12p40, and IL12p70 among samples of eosinophilic nasal polypoid tissue, eosinophilic nasal polypoid tissue associated with aspirin intolerance, and healthy nasal mucosa, using an indirect immunoassay (ELISA) kit. Results: When compared to healthy nasal mucosa, there was a lower concentration of IL-8 in Chronic Rhinosinusitis with Nasal Polyp (CRSwNP) tissue. Aspirin Intolerant polypoid tissue also presented a lower concentration of IL-12 subunits compared to healthy nasal mucosa. There was no significant correlation between IL-8 and IL-12 in the eosinophilic polypoid conditions. Conclusion: In CRSwNP, there is a reduction in IL-8 and IL-12 subunits compared to control, with a lack of correlation between IL-12 and IL-8. The lack of correlation can be justified by a type two inflammatory storm environment.
EVALUATION OF THE IMPACT OF EXPOSURE TO HEAT AND TO BY-PRODUCTS OF COMBUSTION ON THE HEALTH OF FIREFIGHTERS
(2023) BOGGI, A. C.; AMARAL, J. B. Do; BACCHI, A. L. L.; NASCIMENTO, V. M.; VOEGELS, R. L.; SANTOS, J. M. B. Dos; GRIMALDI, G.; ARAúJO, K. Basseto de Oliveira; PAVãO, V.; PASSARETTI, D. A.; ALDRED, A.; GOMES, G.; PEZATO, R.
Firefighters are often exposed to high temperatures and by-products of combustion, which can affect their health. In this study, we assessed the impact of acute exposure of firefighters in fire simulators. Twenty male firefighters were exposed to fire simulators, and observed in four phases: pre-exposure (group 0, control) and after the end of the first (group 1), second (group 2), and fourth (group 3) weeks of training. Blood samples were collected and dosed to evaluate the response of the immune, inflammatory (C-reactive protein, IL6, and IL10), and endocrine systems (cortisone, total testosterone, free testosterone, SHBG, bioavailable testosterone, TSH, and free T4). In groups 0, 1, and 3, a thermographic evaluation was also carried out to study the temperature and body heat flow of the participants. Regarding the inflammatory process, an increase in C-reactive protein and a reduction in IL-10 were observed. With respect to hormonal markers, an increase in cortisol and reduced levels of free T4 and bioa-vailable testosterone were found after exposure, with recovery of testosterone levels in the final week of training. Thermoregulatory adaptation of the organism has been associated with changes in heat flow in the organism in people subjected to extreme temperatures, with emphasis on the performance of the lower limbs. Our findings de-monstrate an inflammatory response with hormonal changes after exposure to fire and an adaptive response of thermal balance, which could aid understanding of the physiology of the human body in extreme situations.
Individualized Vibrotactile Neurofeedback Training in Patients with Chronic Bilateral Vestibulopathy
(2023) BASTA, Dietmar; ROSSI-IZQUIERDO, Marcos; WONNEBERGER, Kai; BRUGNERA, Cibele; BITTAR, Roseli Saraiva Moreira; GRETERS, Mario Edvin; ERNST, Arne; SOTO-VARELA, Andres
Patients with bilateral vestibulopathy (BVP) suffer from postural imbalance during daily life conditions, which in turn leads to a high frequency of falls. Unfortunately, vestibular rehabilitation has only modest and somewhat inconsistent effects in this patient group. Approximately 50% of BVP patients show an improved postural control after conventional vestibular rehabilitation training. New and more promising approaches are required. The individualized vibrotactile neurofeedback training (IVNT) in stance and gait conditions has already been described as highly effective in patients with various vestibular disorders. The purpose of the present multicenter study was to determine the efficacy of the IVNT in improving balance, reducing self-perceived disability, and improving gait in patients with confirmed BVP. In total, 22 patients performed the IVNT with the Vertiguard (R) system for 10 daily sessions. The dizziness handicap inventory (DHI), the stance stability score of the sensory organization test (SOT) and the score for everyday life mobility in stance and gait tasks (SBDT) were obtained immediately before and after the rehabilitation training period, as well as 3 and 12 months later. All measures improved significantly after the IVNT. Between 77.3% and 94.4% of patients showed an individual benefit (depending on outcome measure). The effect was not significantly reduced within the follow-up period of 12 months. The results demonstrate a high efficacy of the IVNT for vestibular rehabilitation in BVP patients.
Olfaction in nasal polyp patients after Reboot surgery: an endotype-based prospective study
(2023) GOMES, Sara Costa; DELEMARRE, Tim; HOLTAPPELS, Gabriele; ZELE, Thibaut Van; DERYCKE, Lara; BONNE, Ellen; EECKELS, Anne-Sophie; ZHANG, Nan; VOEGELS, Richard Louis; BACHERT, Claus
Purpose To report biomarkers present in the olfactory mucosa in chronic rhinosinusitis with nasal polyps (CRSwNP) in comparison with nasal polyps and to nasal mucosal tissues from control patients. To evaluate the kinetics of smell over 6 months in patients who underwent Reboot surgery. Methods Cohort study from May 2021 to May 2022. We collected samples of olfactory mucosa and nasal polyps from 16 CRSwNP patients and inferior turbinate samples from 20 control subjects. The study was not randomized for surgical and/or medical treatment. Samples were analyzed by Luminex and Unicap 100 to measure biomarkers of inflammation (IL1-beta, IL4, IL5, IL6, IL17, CCL3, CCL4, G-CSF, SE-IgE, total IgE and ECP). 12 of the CRSwNP patients underwent Extended Sniffin'tests at timepoints 1-4 days pre-surgery, and 1, 3 and 6 months after Reboot surgery. Results Type-2 markers were significantly elevated in OM and polyp tissue in CRSwNP (n = 16) vs. controls (n = 20), P < 0.05. TDI scores improved already 1 month (P < 0.05) after surgery and remained stable for 6 months. Type-2 inflammation in nasal polyps was associated with decreased sense of smell and taste before surgery, but improved after surgery (P = 0.048). Type-3 inflammation was present in the olfactory mucosa and was associated with a better sense of smell before surgery, but a smaller improvement of smell afterward. Conclusions Type-2 inflammation is present in the olfactory mucosa in CRSwNP patients and is associated with smell loss. Reboot surgery, aiming to completely remove inflamed sinus mucosa, significantly improves the smell in this group of patients.
Predicting emotion perception abilities for cochlear implant users
(2023) PAQUETTE, S.; DEROCHE, M. L. D.; V, M. Goffi-Gomez; HOSHINO, A. C. H.; LEHMANN, A.
Objective In daily life, failure to perceive emotional expressions can result in maladjusted behaviour. For cochlear implant users, perceiving emotional cues in sounds remains challenging, and the factors explaining the variability in patients' sensitivity to emotions are currently poorly understood. Understanding how these factors relate to auditory proficiency is a major challenge of cochlear implant research and is critical in addressing patients' limitations. Design To fill this gap, we evaluated different auditory perception aspects in implant users (pitch discrimination, music processing and speech intelligibility) and correlated them to their performance in an emotion recognition task. Study sample Eighty-four adults (18-76 years old) participated in our investigation; 42 cochlear implant users and 42 controls. Cochlear implant users performed worse than their controls on all tasks, and emotion perception abilities were correlated to their age and their clinical outcome as measured in the speech intelligibility task. Results As previously observed, emotion perception abilities declined with age (here by about 2-3% in a decade). Interestingly, even when emotional stimuli were musical, CI users' skills relied more on processes underlying speech intelligibility. Conclusions These results suggest that speech processing remains a clinical priority even when one is interested in affective skills.
White noise effect on listening effort among patients with chronic tinnitus and normal hearing thresholds
(2024) OITICICA, Jeanne; VASCONCELOS, Laura G. E.; HORIUTI, Mirella B.
Objective: This study investigated the effects of WN on LE in subjects with chronic tinnitus and normal hearing thresholds. The study was a prospective, non-randomized, before-and-after, intra-participant intervention. Methods: Twenty-five subjects performed the following tests: conventional and high-frequency audiometry, acuphenometry, screening questionnaires for depression and anxiety symptoms, Tinnitus Handicap Inventory (THI), Montreal Cognitive Assessment, and high WM test from the Working Memory Assessment Battery, Federal University of Minas Gerais (WMAB) as the LE measure in two conditions: No Added Noise (NAN) and with Added Noise (AN). Results: Seventeen participants (68%) performed better on AN condition. Data analysis revealed a 45% improvement in the WMAB total span count on AN setting, with a significant p value (p = 0.001). Conclusion: The subgroup of participants without traces of anxiety symptoms, up to mild traces of depressive symptoms, having unilateral tinnitus, and a THI level up to grade 2, had improved WM performance in the presence of WN, which suggests a release of cognitive resources and less auditory effort under these combined conditions. Evidence level: 4. (c) 2023 Associac,ao Brasileira de Otorrinolaringologia e Cirurgia C ' ervico-Facial.
Perivascular Innervation in the Nasal Mucosa and Clinical Findings in Patients with Allergic Rhinitis and Idiopathic Rhinitis
(2023) CARVALHO, Thiago; JR, Joao Ferreira de Mello; CALDINI, Elia Tamaso Espin Garcia; SALGADO, Daniel Calduro; CARVALHO, Nicole Mary Garcia de; DAMACENO-RODRIGUES, Nilsa Regina; VOEGELS, Richard Louis
Introduction The nonspecific hyperreactivity of rhinitis has been attributed to neurotrophins activating sensory nerves and inflammatory cells. The relationship between these markers and the intensity of the symptoms is not well established and few studies have evaluated individuals with idiopathic rhinitis.Objective The present study aims to evaluate whether perivascular innervation and nerve growth factor (NGF) are related to the intensity of the clinical conditions in allergic rhinitis (AR) and idiopathic rhinitis (IR).Methods A total of 15 patients with AR and 15 patients with IR with the indication for inferior turbinectomy (associated or not with septoplasty) were selected. The patients received a score according to their signs and symptoms. After the surgery, we quantified eosinophils, mast cells, NGF, and nerve fibers in the nasal turbinate.Results The score of the signs and symptoms was higher in the AR group. Nerve growth factor was found in the cytoplasm of inflammatory cells in the submucosa in greater quantity in the AR group. The nerve fibers were distributed throughout the tissue, mainly in the subepithelial, glandular, and vascular regions, and there was no difference between the groups. Greater perivascular innervation was associated with a higher signs and symptoms score.Conclusions We concluded that these findings suggest that the NGF produced by submucosal inflammatory cells stimulates increased perivascular innervation in rhinitis, thus directly reflecting in more intense clinical conditions, especially in AR.
Communicative and Hearing Performance in Individuals with Cochlear Implants and Delayed Neuropsychomotor Development: A Longitudinal Analysis
(2023) ROCHA, Larissa Veloso; ZABEU-FERNANDES, Julia Speranza; NETO, Rubens Vuono de Brito; MORETTIN-ZUPELARI, Marina; LOURENCONE, Luiz Fernando Manzoni
Introduction Between 15% to 30% of individuals with bilateral prelingual sensorineural hearing loss present with associated disabilities. Cochlear implant (CI) is an alternative treatment that provides consistent access to environmental and speech sounds, which results in significant benefits regarding quality of life and auditory and language development.Objectives To study the auditory and communicative performance of individuals with CI and delayed neuropsychomotor development after a minimum of five years using the device.Methods A total of eight patients were included in the study. We collected the multidisciplinary clinical records of participants, as well as the answers for the questionnaires applied remotely, which included the Children with Cochlear Implants: Parental Perspectives (CCIPP), International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY), and the Gross Motor Function Classification System (GMFCS).Results We found that throughout the years of CI use, the auditory threshold means improved significantly in all tested frequencies, as did the speech detection threshold and the language and hearing results. Regarding parental perception, parents evaluated aspects related to their children's social relations to be positive, and had worse perceptions regarding aspects related to their education.Conclusion We observed a progression in the participants' auditory and language skills throughout the years of CI use; even in the presence of other associated disabilities. Future multicentric studies with larger samples are needed to further the advancement of rehabilitation in patients with other associated disabilities.
Brazilian Society of Otology task force -- Vestibular Schwannoma -- evaluation and treatment
(2023) SILVA, Vagner Antonio Rodrigues; LAVINSKY, Joel; PAUNA, Henrique Furlan; VIANNA, Melissa Ferreira; SANTOS, Vanessa Mazanek; IKINO, Claudio Marcio Yudi; SAMPAIO, Andre Luiz Lopes; LOPES, Paula Tardim; LAMOUNIER, Pauliana; MARANHAO, Andre Souza de Albuquerque; SOARES, Vitor Yamashiro Rocha; POLANSKI, Jose Fernando; DENARO, Mariana Moreira de Castro; CHONE, Carlos Takahiro; BENTO, Ricardo Ferreira; CASTILHO, Arthur Menino
Objective: To review the literature on the diagnosis and treatment of vestibular schwannoma. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: (1) Diagnosis audiologic, electrophysiologic tests, and imaging; (2) Treatment wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. Conclusions: Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.(c) 2023 Associacao Brasileira de Otorrinolaringologia e Cirurgia C ' ervico-Facial.