RICHARD LOUIS VOEGELS
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Otorrinolaringologia e Oftalmologia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina - Líder
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article 1776 Citação(ões) na Scopus European Position Paper on Rhinosinusitis and Nasal Polyps 2020(2020) FOKKENS, Wytske J.; LUND, Valerie J.; HOPKINS, Claire; HELLINGS, Peter W.; KERN, Robert; REITSMA, Sietze; TOPPILA-SALMI, Sanna; BERNAL-SPREKELSEN, Manuel; MULLOL, Joaquim; ALOBID, Isam; ANSELMO-LIMA, Wilma Terezinha; BEDOYA, Juan David; BEULE, Achim; BOFARES, Khaled M.; BRAVERMAN, Itzhak; BROZEK-MADRY, Eliza; BYARUHANGA, Richard; CALLEJAS, Claudio; CARRIE, Sean; HAMIZAN, Aneeza W.; MAHDJOUBI, Abdelhak; OZKAN, Muge; CAULLEY, Lisa; CHUSSI, Desderius; CORSO, Eugenio de; COSTE, Andre; HADI, Usama El; ELFAROUK, Ahmed; ELOY, Philippe H.; FARROKHI, Shokrollah; FELISATI, Giovanni; HEINICHEN, Julio V.; PERIC, Aleksandar; FERRARI, Michel D.; MESBAHI, Alireza; FISHCHUK, Roman; GRAYSON, Jessica W.; HUSAIN, Salina; PING, Tang Ing; IVASKA, Justinas; NETKOVSKI, Jane; JAKIMOVSKA, Frodita; KOSAK, Tanja Soklic; PLZAK, Jan; JOVANCEVIC, Ljiljana; KAKANDE, Emily; KAMEL, Reda; KARPISCHENKO, Sergei; KARIYAWASAM, Harsha H.; KAWAUCHI, Hideyuki; KJELDSEN, Anette; KLIMEK, Ludger; KRZESKI, Antoni; TSHIPUKANE, Dieudonne Nyenbue; PROKOPAKIS, Emmanuel; STJARNE, Par; BARSOVA, Gabriela Kopacheva; KIM, Sung Wam; LAL, Devyani; LETORT, Jose J.; OBANDO-VALVERDE, Andres; OKANO, Mitsuhiro; ONERCI, Metin; ONG, Yew Kwang; ORLANDI, Richard; PREPAGERAN, Nerayanan; BACHERT, Claus; SUTIKNO, Budi; OTORI, Nobuyoshi; OUENNOUGHY, Kheir; PSALTIS, Alkis; PUGIN, Benoit; RAFTOPULOS, Marco; STEINSVAG, Sverre; BAROODY, Fuad; JOOS, Guy F.; ROMBAUX, Philippe; RIECHELMANN, Herbert; SAHTOUT, Semia; SARAFOLEANU, Caius-Codrut; SEARYOH, Kafui; RHEE, Chae-Seo; SHI, Jianbo; SHKOUKANI, Mahdi; SHUKURYAN, Arthur K.; TANTILIPIKORN, Pongsakorn; KALOGJERA, Livije; SICAK, Marian; BUCHWALD, Christian von; SMYTH, David; SNIDVONGS, Kornkiat; THANAVIRATANANICH, Sanguansak; Thuy Tran; URBANCIC, Jure; CERVIN, Anders; VALIULIS, Arunas; AHLSTROM-EMANUELSSON, Cecilia; KNILL, Andrew; APARICIO, Carolina Vasquez de; VICHEVA, Dilyana; VIRKKULA, Paula M.; VICENTE, Gil; VOEGELS, Richard; WAGENMANN, Martin; WARDANI, Retno S.; WELGE-LUSSEN, Antje; WITTERICK, Ian; COHEN, Noam; KOCKS, Janwillem H.; ALABRI, Rashid; WRIGHT, Erin; ZABOLOTNIY, Dmytro; ZSOLT, Bella; ZWETSLOOT, Casper P.; CONSTANTINIDIS, Jannis; GABORY, Ludovic De; DESROSIERS, Martin; DIAMANT, Zuzana; DOUGLAS, Richard G.; LANDIS, Basile N.; GEVAERT, Philippe H.; ALBU, Silviu; HAFNER, Anita; HARVEY, Richard J.; LIMPENS, Jacqueline; LEBEER, Sarah; LOURENCO, Olga; ALHABASH, Saied; MATRICARDI, Paolo M.; GONCALVES, Paulo M.; MECO, Cem; O'MAHONY, Liam; PHILPOTT, Carl M.; RYAN, Dermot; SCHLOSSER, Rodney; SENIOR, Brent; SMITH, Timothy L.; TEELING, Thijs; TOMAZIC, Peter Valentin; ALEKSIC, Aleksandra; GRDINIC, Boris; WANG, De Yun; WANG, Dehui; ZHANG, Luo; AGIUS, Adrian M.; ALOULAH, Mohammad; AL-QUDAH, Mohannad; ALSALEH, Saad; BABAN, Muaid Aziz; BAUDOIN, Tomislav; LOPATIN, Andrey; GRGIC, Velimir; BALVERS, Tijmen; BATTAGLIA, PaoloThe European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise. The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included.- Fire simulator exposure alters the innate epithelial response and inflammatory status in the airways of firefighters(2021) CORDEIRO, Telma Gomes; AMARAL, Jonatas Bussador do; PAVAO, Valdir; CARDOSO, Ricardo Galesso; VOEGELS, Richard Louis; PEZATO, Pedro Michaluat; PAIXAO, Vitoria; ALMEIDA, Ewin Barbosa de; BACHI, Andre Luis Lacerda; PEZATO, RogerioBackground: Firefighters are often exposed to high temperatures and by-products of combustion, which can compromise their health. We aimed to evaluate the effect of fire exposure in fire simulators on the airways of firefighters at different time-points. Methodology: Thirty-seven male firefighters exposed to fire simulators were evaluated in three phases: pre-exposure, at the end of the first week, and 4 weeks after. Pulmonary function by spirometry, nasal mucociliary clearance; peripheral oxygen saturation, inflammatory markers in the nasal lavage and CC16 in the sputum, nasal obstruction, and quality of life (using the questionnaires NOSE and SNOT-22) were assessed. Results: Higher levels of IL-8, IL-10, and exhaled carbon monoxide were found more in phase 2 than in phase 1. Higher CC16 levels and lower peripheral oxygen saturation were observed in phase 3 as compared to phase 1. Lower levels of IL-2 and peripheral oxygen saturation were found in phase 3 than in phase 2. Higher nasal mucociliary clearance, as well as the worst quality of life and nasal obstruction, were observed in phases 2 and 3 as compared to phase 1. Conclusions: The firefighters' exposures to high temperatures and by-products of combustion in the fire simulators elicit an inflammatory process in the airways with impairment in the innate epithelial response of the upper airway lining. Furthermore, changes in O2 transport affected the professionals' quality of life negatively.
- Endoscopic Study of Ethmoidal Canals in Cadavers, Including a Histological Analysis of Their Contents(2024) FELIPPU, Alexandre Wady Debes; MORSCH, Thiago Picolli; FELIPPU, Andre Wady Debes; CASCIO, Filippo; OLIVEIRA, Claudia Regina Gomes Cardim Mendes de; FELIPPU, Alexandre; VOEGELS, Richard LouisIntroduction The advent of the endoscope has enabled the use of the endonasal approach for a variety of diseases. Studying the ethmoidal canals is important for surgeries of the paranasal sinuses and the anterior base of the skull.Objective To investigate the ethmoidal canals and evaluate their structure, the presence of vessels and nerves, their location, and to perform an anatomopathological study of their contents.Methods We evaluated 20 cadavers (20 left and 20 right nasal cavities) through endoscopic dissection of the anterior base of the skull and exposure of the medial periorbita and dura mater; then, the ethmoidal canals were located and measured in relation to the anterior wall of the sphenoid sinus and between the ethmoidal canals, followed by removal of their content for histological analysis.Results Vessels were present in 75% of the left anterior ethmoidal canals, 70% of the left posterior ethmoidal canals, 75% of the left middle ethmoidal canals, 85% of the right anterior ethmoid canals, and 64.5% of the right posterior ethmoid canals; 50% of the right middle ethmoidal canals contained one vessel.Conclusion The ethmoidal canal does not necessarily contain an ethmoidal artery. Studies with a larger sample should be performed to quantify the correct proportion of arteries and ethmoidal canals.
- 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, ClausPurpose 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.
- Convergence of two major pathophysiologic mechanisms in nasal polyposis: immune response to Staphylococcus aureus and airway remodeling(2013) PEZATO, Rogerio; BALSALOBRE, Leonardo; LIMA, Milena; BEZERRA, Thiago F. P.; VOEGELS, Richard L.; GREGORIO, Luis Carlos; STAMM, Aldo Cassol; ZELE, Thibaut vanThis review is addressed two pathophysiologic mechanisms implicated in the pathogenesis of nasal polyposis: the unique remodeling process found in nasal polyp tissue and the immune response of patients with nasal polyposis to Staphylococcus aureus. These two theories converge to the same direction in different aspects, including decreased extracellular matrix production, impaired T regulation and favoring of a Th2 immune response. In patients with nasal polyposis, an exaggerated immune response to Staphylococcus aureus may aggravate the airway remodeling process.
bookPart Infecções Agudas de Orelha (e Complicações)(2013) NEVES, Maura Catafesta; VOEGELS, Richard Louis; GODOY, Maria Dantas Costa Lima- Endonasal Identification of the Orbital Apex(2016) TEPEDINO, Miguel S.; PINHEIRO-NETO, Carlos D.; BEZERRA, Thiago F. P.; GARDNER, Paul A.; SNYDERMAN, Carl H.; VOEGELS, Richard L.Objectives/Hypothesis: To describe anatomical landmarks for endoscopic endonasal approaches to the orbital apex and to measure the distances between those landmarks. Methods: In this anatomic study, the nasal fossae of 30 adult fresh cadavers were dissected (n=60 half-skulls). One double-injected orbit was carefully dissected, mainly focusing on the neurovascular structures. The orbital apex was dissected under endoscopic endonasal visualization in all cases. The distances between the ethmoidal crest and choanal arch to the optic canal (OC) and superior orbital fissure (SOF) were measured and recorded. Results: The sample was predominantly male (63.3%, 19/30 cadavers). The following correlations between measurements according to side were observed: ethmoidal crest to OC, r=0.748 (P=0.0001); ethmoidal crest to SOF, r=0.785 (P=0.0001); choanal arch to OC, r=0.835 (P=0.0001); choanal arch to SOF, r=0.820 (P=0.0001). Conclusions: In the cadavers studied in this sample, the ethmoidal crest and choanal arch were relevant structures and exhibited consistent measurements. Spearman correlation coefficients were greater than 0.7, which is indicative of good correlation between measurements obtained in the skull halves of each cadaver. Comparison of the measurements obtained in different sides showed similar values, with no statistically significant differences in the distances between any of the proposed anatomic landmarks.
- The digital scent device as a new concept for olfactory assessment(2022) NAKANISHI, Marcio; FORNAZIERI, Marco Aurelio; GOMES, Pedro Lanca; DIAS, Luis Augusto de Miranda; FREIRE, Gustavo Subtil Magalhaes; VINHA, Luis Gustavo do Amaral; SA, Leonardo Conrado Barbosa de; VOEGELS, Richard Louis; ENG, Claudia Galvao; LIMA, Wilma Terezinha AnselmoBackground There are major challenges in olfactory measurements in clinical practice; therefore, a handheld digital scent device (DSD; Noar MultiScent 20) was developed as a tablet with an integrated storage system for odors. The DSD is a self-administered, handheld device that controls the duration of odor release to the nasal cavity through a touchscreen digital interface with automatic database generation. In this study we aimed to determine the feasibility of this DSD as an olfactory assessment test. Methods We recruited 180 participants (age [mean +/- standard deviation], 34.58 +/- 9.71 years; 114 women and 66 men) to participate in smell tests using both the DSD and the 40-item Smell Identification Test (SIT-40), which contained the same type and order of odors and the same multiple-choice answers. The scores were compared and evaluated for correlation between the tests, and test-retest reliability was calculated. Results The DSD test scores were higher than the SIT-40 scores (median [interquartile range], 32 [5.0] vs 31 [7.0]; p = 0.005). The completion time was less for the DSD test than for the SIT-40 (12.5 [5.0] vs 16 [6.0] minutes; p < 0.001). The tests were strongly correlated (Spearman rho = 0.74; p < 0.001) and exhibited a high level of agreement (Bland-Altman regression coefficient = 0.672; p = 0.003). The DSD test-retest reliability coefficient was 0.820. Conclusion The DSD is feasible as an olfactory assessment test. The digitalization of olfactory assessment combined with data science may enable new research perspectives in the field of olfaction.
- Effect of Water Precautions on Otorrhea Incidence after Pediatric Tympanostomy Tube: Randomized Controlled Trial Evidence(2019) SUBTIL, Joao; JARDIM, Ana; ARAUJO, Joao; MOREIRA, Carla; ECA, Tiago; MCMILLAN, Merlin; DIAS, Sara Simoes; CRUZ, Paulo Vera; VOEGELS, Richard; PACO, Joao; ROSENFELD, RichardObjectives Tympanostomy with ventilation tube insertion is the most common otologic surgery. Many surgeons recommend water precautions, although its utility is questioned. We aimed to investigate if water precautions reduce the rate of otorrhea after transtympanic tube insertion. Study Design Multicenter randomized controlled trial. Subjects and Methods A total of 244 children aged 2 to 10 years undergoing their first set of Shepard tubes for otitis media with effusion and concomitant adenoidectomy were randomized to 2 groups: 1 with ear protection during water exposure (ear plugs and headbands, n = 130) and 1 without (n = 114). Bathing or swimming with unprotected ears was considered the exposure event and incidence of otorrhea, the primary outcome. Outcomes were assessed during the 6-month follow-up period. Results In the water precaution group, 32% had at least 1 episode of otorrhea as compared with 22% in the unprotected group, which was not statistically significant (P = .09). Only 37% of the episodes of otorrhea in the protected group and 36% in the unprotected group had a temporal relation to water exposure (no difference, P = .81). Respectively, 56% and 52% of the episodes of otorrhea were in the context of upper respiratory tract infection. Global quality of life improved significantly, irrespective of whether water protection was prescribed. Conclusion The incidence of otorrhea was not different with or without prescription of ear protection during water exposure among children with tympanostomy tubes, which supports current guideline recommendations that routine water precautions are unnecessary in this population.
- Orthodontic measurements and nasal respiratory function after surgically assisted rapid maxillary expansion: an acoustic rhinometry and rhinomanometry study(2012) ZAMBON, C. E.; CECCHETI, M. M.; UTUMI, E. R.; PINNA, F. R.; MACHADO, G. G.; PERES, M. P. S. M.; VOEGELS, R. L.The present study sought to assess nasal respiratory function in adult patients with maxillary constriction who underwent surgically assisted rapid maxillary expansion (SARME) and to determine correlations between orthodontic measurements and changes in nasal area, volume, resistance, and airflow. Twenty-seven patients were assessed by acoustic rhinometry, rhinomanometry, orthodontic measurements, and use of a visual analogue scale at three time points: before surgery; after activation of a preoperatively applied palatal expander; and 4 months post-SARME. Results showed a statistically significant increase (p < 0.001) in all orthodontic measurements. The overall area of the nasal cavity increased after surgery (p < 0.036). The mean volume increased between assessments, but not significantly. Expiratory and inspiratory flow increased over time (p < 0.001). Airway resistance decreased between assessments (p < 0.004). Subjective analysis of the feeling of breathing exclusively through the nose increased significantly from one point in time to the next (p < 0.05). There was a statistical correlation between increased arch perimeter and decreased airway resistance. Respiratory flow was the only variable to behave differently between sides. The authors conclude that the SARME procedure produces major changes in the oral and nasal cavity; when combined, these changes improve patients' quality of breathing.