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
19 resultados
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- Nasal Polyposis: More than a Chronic Inflammatory Disorder-A Disease of Mechanical Dysfunction -The Sao Paulo Position(2019) PEZATO, Rogerio; VOEGELS, Richard Louis; PIGNATARI, Shirley; GREGORIO, Luiz Carlos; BEZERRA, Thiago Freire Pinto; GREGORIO, Luciano; BALSALOBRE, Leonardo; TEPEDINO, Miguel Soares; CORONEL, Nathalia; PINNA, Fabio de Rezende; NETO, Jose Mendes; OLIVEIRA, Pedro; MACOTO, Eduardo; STEFANINI, Renato; FIGUEIREDO, Claudia; HADDAD, Fernanda; PILAN, Renata; SOTER, Ana Bezerra; MELO, Nelson Almeida; CANDIDO, Danilo Almeida; AMARAL, Jonatas do; SANTOS, Rodrigo de Paula; ZELE, Thibaut Van; FUJITA, Reginaldo; DREYFUSS, Juliana L.; CHAMON, Wallace; ALENCAR, Adriano Mesquita; PEREZ-NOVO, Claudina; STAMM, Aldo CassolIntroduction The importance of our study lies in the fact that we have demonstrated the occurrence of mechanical dysfunction within polypoid tissues, which promotes the development of polyps in the nasal cavity. Objective To change the paradigm of nasal polyposis (NP). In this new conception, the chronic nasal inflammatory process that occurs in response to allergies, to pollution, to changes in the epithelial barrier, or to other factors is merely the trigger of the development of the disease in individuals with a genetic predisposition to an abnormal tissue remodeling process, which leads to a derangement of the mechanical properties of the nasal mucosa and, consequently, allows it to grow unchecked. Data Synthesis We propose a fundamentally new approach to intervening in the pathological process of NP, addressing biomechanical properties, fluid dynamics, and the concept of surface tension. Conclusion The incorporation of biomechanical knowledge into our understanding of NP provides a new perspective to help elucidate the physiology and the pathology of nasal polyps, and new avenues for the treatment and cure of NP.
- Assessment of quality of life after endoscopic sinus surgery for chronic rhinosinusitis(2012) BEZERRA, Thiago Freire Pinto; PICCIRILLO, Jay F.; FORNAZIERI, Marco Aurelio; PILAN, Renata Ribeiro de Mendonca; PINNA, Fabio de Rezende; PADUA, Francini Grecco de Melo; VOEGELS, Richard LouisChronic rhinosinusitis is a disease of undefined etiology that significantly impacts the quality of life of its patients. Various studies carried out in countries other than Brazil have shown endoscopic sinus surgery as an effective means of treating this condition. Objective: This study aims to analyze, with the aid of SNOT-20, the association between endoscopic sinus surgery and disease-specific quality of life of Brazilian patients treated for chronic rhinosinusitis accompanied or not by nasal polyps. Materials and Methods: This prospective study enrolled patients submitted to endoscopic sinus surgery after drug therapy failed to improve their symptoms. They were assessed based on questionnaire SNOT-20p before and 12 months after surgery. Improvement on total scores and on the five items deemed more important by each patient were assessed. The study also looked into the correlation between preoperative scores and postoperative improvement and if there were any gender-related improvement differences. Results: Forty-three patients aged 44 (19), md (IQR), 65% of whom (26/43) were males. Statistically significant improvement was seen on SNOT-20 and SNOT-20(5+) and a correlation was established between preoperative scores and postoperative improved scores (p<0.001). No gender-related differences were observed in quality of life. Conclusion: Endoscopic sinus surgery in patients with chronic rhinosinusitis is associated with statistically significant improvements in disease-specific quality of life.
- Transpterygoid Approach to a Dermoid Cyst in Pterygopalatine Fossa(2014) ORDONES, Alexandre Beraldo; FORNAZIERI, Marco Aurélio; PINNA, Fábio de Rezende; BEZERRA, Thiago Freire Pinto; VOEGELS, Richard Louis; SENNES, Luiz UbirajaraObjective To describe a case of dermoid cyst arising from the pterygopalatine fossa and review the literature. Methods We report a case of a 23-year-old man who suffered a car accident 2 years before otolaryngologic attendance. He had one episode of generalized tonic-clonic seizure and developed a reduction of visual acuity of the left side after the accident. Neurologic investigation was performed and magnetic resonance imaging revealed an incidental finding of a heterogeneous ovoid lesion in the pterygopalatine fossa, hyperintense on T2-weighted imaging. Results Endoscopic sinus surgery with transpterygoid approach was performed. The ovoid lesion was noted in the pterygopalatine fossa. Puncture for intraoperative evaluation showed a transparent thick fluid. Surprisingly, hair and sebaceous glands were found inside the cyst capsule. The cyst was excised completely. Histologic examination revealed a dermoid cyst. The patient currently has no evidence of recurrence at 1 year postoperatively. Conclusion This unique case is a rare report of a dermoid cyst incidentally diagnosed. An endoscopic transnasal transpterygoid approach may be performed to treat successfully this kind of lesion. Although rare, it should be considered in the differential diagnosis of expansive lesions in the pterygopalatine fossa, including schwannoma, angiofibroma, esthesioneuroblastoma, osteochondroma, cholesterol granuloma, hemangioma, lymphoma, and osteoma.
- Prospective evaluation of clarithromycin in recurrent chronic rhinosinusitis with nasal polyps(2021) BEZERRA, Thiago Freire Pinto; PEZATO, Rogerio; BARROS, Pamella Marletti de; COUTINHO, Larissa Leal; COSTA, Leidianny Firmino; PINNA, Fabio; VOEGELS, RichardIntroduction: The antiinflammatory effects of macrolides, especially clarithromycin, have been described in patients with chronic rhinosinusitis without polyps and also other chronic inflammatory airway diseases. There is no consensus in the literature regarding the effectiveness of clarithromycin in patients with chronic rhinosinusitis with sinonasal polyposis and the national literature does not report any prospective studies on the efficacy of clarithromycin in chronic rhinosinusitis in our population. Objective: To evaluate the effect of clarithromycin in the adjunctive treatment of recurrent chronic rhinosinusitis with sinonasal polyposis refractory to clinical and surgical treatment. Methods: Open prospective study with 52 patients with chronic rhinosinusitis and recurrent sinonasal polyposis. All subjects received nasal lavage with 20 mL 0.9% SS and fluticasone nasal spray, 200 mcg / day, 12/12 h for 12 weeks; and clarithromycin 250 mg 8/8 h for 2 weeks and, thereafter, 12/12 h for 10 weeks. The patients were assessed by SNOT 20, NOSE and Lund-Kennedy scales before, immediately after treatment and 12 weeks after treatment. The patients were also evaluated before treatment with paranasal cavity computed tomography (Lund-Mackay) and serum IgG, IgM, IgA, IgE and eosinophil levels. The outcomes evaluated were: SNOT-20, NOSE and Lund-Kennedy. Results: Most patients were women, aged 47 (15) years (median / interquartile range), and 61.5% (32/52) had asthma. All patients completed the follow-up after 12 weeks and 42.3% (22/52) after 24 weeks. Treatment resulted in a quantitative decrease in the SNOT-20 [2.3 (1.6) vs. 1.4 (1.6); Delta = -0.9 (1.1); p < 0.01]; NOSE [65 (64) vs. 20 (63); Delta = -28 (38), p < 0.01] and Lund-Kennedy [11 (05) vs. 07 (05); Delta = -2 (05); p < 0.01] scores. SNOT-20 showed a qualitative improvement (>0.8) in 54% (28/52, p < 0.04) of patients, a group that showed lower IgE level [108 (147) vs. 289 (355), p < 0.01]. The group of patients who completed follow-up 12 weeks after the end of treatment (n = 22) showed no worsening of outcomes. Conclusion: Long-term adjuvant use of low-dose clarithromycin for chronic rhinosinusitis patients with recurrent sinonasal polyposis refractory to clinical and surgical treatment has resulted in improved quality of life and nasal endoscopy findings, especially in patients with normal IgE levels. This improvement persisted in the patient group evaluated 12 weeks after the end of the treatment. (C) 2021 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial.
- Biofilms in Chronic Rhinosinusitis with Nasal Polyps(2011) BEZERRA, Thiago Freire Pinto; PADUA, Francini Grecco de Melo; GEBRIM, Eloisa Maria Mello Santiago; SALDIVA, Paulo Hilario Nascimento; VOEGELS, Richard LouisObjective. (1) Evaluate the presence of biofilms in patients with chronic sinusitis with nasal polyps (CRSwNP) and (2) investigate the association of biofilm presence and CRSwNP. Study Design. Cross-sectional study. Setting. University-based tertiary care center. Subjects and Methods. The study group consisted of 33 consecutive patients undergoing functional endoscopic sinus surgery for CRSwNP. The control group consisted of 27 control patients undergoing septoplasty for nasal obstruction without diagnosis of chronic sinusitis. Mucosal samples were harvested intraoperatively for scanning electron microscopic examination to determine biofilm presence. Statistical analysis was performed. For all statistical tests, P = .05 was considered significant. Results. Biofilms were found in 24 (72.7%) of the 33 patients with CRSwNP and in 13 (48.1%) of the 27 septoplasty patients (odds ratio = 2.87; 95% confidence interval, 0.98-8.42; P = .051). Conclusion. (1) Biofilms were present in patients undergoing functional endoscopic sinus surgery for CRSwNP and also in controls without chronic sinusitis. This suggests that biofilms may not be sufficient to cause chronic sinusitis without other cofactors. Host factors could be the responsible for the pathogenesis of biofilms. (2) Although the prevalence of biofilms in patients with CRSwNP was not significantly different from that in the controls, the extremely wide 95% confidence interval, which is just below unity, suggests that a meaningful clinical difference may have been missed because of low statistical power. Further studies are necessary.
bookPart Rinossinusite crônica com e sem polipose nasal(2018) BEZERRA, Thiago Freire Pinto; VOEGELS, Richard Louis- Quality of life assessment septoplasty in patients with nasal obstruction(2012) BEZERRA, Thiago Freire Pinto; STEWART, Michael G.; FORNAZIERI, Marco Aurelio; PILAN, Renata Ribeiro de Mendonca; PINNA, Fabio de Rezende; PADUA, Francini Grecco de Melo; VOEGELS, Richard LouisNaasal obstruction is a common complaint in the population. When caused by a deviated nasal septum, septoplasty is the procedure of choice for treating these patients. NOSE is a tool for assessing the disease-specific quality of life related to nasal obstruction. Aim: To assess the impact of septoplasty on patients with nasal obstruction secondary to deviated nasal septum based on the disease-specific quality-of-life questionnaire. Design: Prospective. Methods: Patients undergoing septoplasty with/without turbinectomy after no clinical improvement with medical treatment were assessed by the NOSE questionnaire before and 3 months after surgery. We evaluated the surgical improvement based on total score, the magnitude of the surgery in the disease-specific quality of life and the correlation between the preoperative score and postoperatively improvement. Results: Fourty-six patients were included in the study. There was a statistically significant improvement in the preoperative NOSE score (md = 75, IQR = 26) and after three months (md = 10, IQR = 20) (p < 0.001.T-Wilcoxon). The standardized response mean was 3.07. We found a strong correlation between the preoperative score in the NOSE questionnaire and improvements in the postoperative period (r = -0.789, p < 0.001, Spearman). No difference was found in improvement scores by gender. (p = 0.668, U-Mann-Whitney). Conclusion: Septoplasty resulted in a statistically significant improvement in the disease-specific QOL questionnaire.
- Anatomical terminology of the internal nose and paranasal sinuses: cross-cultural adaptation to Portuguese(2018) BEZERRA, Thiago Freire Pinto; STAMM, Aldo; ANSELMO-LIMA, Wilma Teresinha; FORNAZIERI, Marco Aurelio; MELO, Nelson D'Avila; BALSALOBRE, Leonardo; JOTZ, Geraldo Pereira; LEAO, Henrique Zaquia; NUNES, Andre Alencar Araripe; FELIPPU, Alexandre; CEDIN, Antonio Carlos; PINHEIRO-NETO, Carlos D.; OLIVEIRA, Diego Lima; SAKANO, Eulalia; KOSUGI, Eduardo Macoto; ARAUJO, Elizabeth; VALERA, Fabiana Cardoso Pereira; PINNA, Fabio de Rezende; ROMANO, Fabrizio Ricci; PADUA, Francine Grecco de Melo; RAMOS, Henrique Faria; TELLES JR., Joao; SA, Leonardo Conrado Barbosa de; D'ASSUNCAO FILHO, Leopoldo Marques; SENNES, Luiz Ubirajara; GREGORIO, Luis Carlos; SAMPAIO, Marcelo H.; SANTOS, Marco Cesar Jorge dos; FRANCA, Marco; MOCELLIN, Marcos; LESSA, Marcus Miranda; AVELINO, Melissa Ameloti G.; TEPEDINO, Miguel; ANDRADE, Nilvano Alves de; PILTCHER, Otavio B.; ROITHMANN, Renato; PILAN, Renata Mendonca; MEIRELES, Roberto Campos; GUIMARAES, Roberto Eustaquio; SANTOS, Rodrigo de Paula; PEZATO, Rogerio; PIGNATARI, Shirley; ABDO, Tatiana Telles; NAKAJIMA, Victor; ALMEIDA, Washington; VOEGELS, Richard L.Introduction: Functional endonasal endoscopic surgery is a frequent surgical procedure among otorhinolaryngologists. In 2014, the European Society of Rhinology published the ""European Position Paper on the Anatomical Terminology of the Internal Nose and Paranasal Sinuses"", aiming to unify the terms in the English language. We do not yet have a unified terminology in the Portuguese language. Objective: Transcultural adaptation of the anatomical terms of the nose and paranasal cavities of the ""European Anatomical Terminology of the Internal Nose and Paranasal Sinuses"" to Portuguese. Methods: A group of rhinologists from diverse parts of Brazil, all experienced in endoscopic endonasal surgery, was invited to participate in the creation of this position paper on the anatomical terms of the nose and paranasal sinuses in the Portuguese language according to the methodology adapted from that previously described by Rudmik and Smith. Results: The results of this document were generated based on the agreement of the majority of the participants according to the most popular suggestions among the rhinologists. A cross-cultural adaptation of the sinonasal anatomical terminology was consolidated. We suggest the terms ""inferior turbinate"", ""nasal septum"", ""(bone/cartilaginous) part of the nasal septum"", ""(middle/inferior) nasal meatus"", ""frontal sinus drainage pathway"", ""frontal recess"" and ""uncinate process"" be standardized. Conclusion: We have consolidated a Portuguese version of the European Anatomical Terminology of the Internal Nose and Paranasal Sinuses, which will help in the publication of technical announcements, scientific publications and the teaching of the internal anatomical terms of the nose and paranasal sinuses in Brazil. (C) 2018 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial.
- Anatomical terminology of the internal nose and paranasal sinuses: cross-cultural adaptation to Portuguese (vol 85, pg 130, 2019)(2019) BEZERRA, Thiago Freire Pinto; STAMM, Aldo; ANSELMO-LIMA, Wilma Teresinha; FORNAZIERI, Marco Aurelio; MELO, Nelson D'Avila; BALSALOBRE, Leonardo; JOTZ, Geraldo Pereira; LEAO, Henrique Zaquia; NUNES, Andre Alencar Araripe; FELIPPU, Alexandre; CEDIN, Antonio Carlos; PINHEIRO-NETO, Carlos D.; OLIVEIRA, Diego Lima; SAKANO, Eulalia; KOSUGI, Eduardo Macoto; ARAUJO, Elizabeth; VALERA, Fabiana Cardoso Pereira; PINNA, Fabio de Rezende; ROMANO, Fabrizio Ricci; PADUA, Francine Grecco de Melo; RAMOS, Henrique Faria; TELLES JR., Joao; SA, Leonardo Conrado Barbosa de; D'ASSUNCAO FILHO, Leopoldo Marques; SENNES, Luiz Ubirajara; GREGORIO, Luis Carlos; SAMPAIO, Marcelo H.; SANTOS, Marco Cesar Jorge dos; FRANCA, Marco; MOCELLIN, Marcos; LESSA, Marcus Miranda; AVELINO, Melissa Ameloti G.; TEPEDINO, Miguel; ANDRADE, Nilvano Alves de; PILTCHER, Otavio B.; ROITHMANN, Renato; PILAN, Renata Mendonca; MEIRELES, Roberto Campos; GUIMARAES, Roberto Eustaquio; SANTOS, Rodrigo de Paula; PEZATO, Rogerio; PIGNATARI, Shirley; ABDO, Tatiana Telles; NAKAJIMA, Victor; ALMEIDA, Washington; NAKANISHI, Marcio; VOEGELS, Richard L.
- Prospective open-label evaluation of long-term low-dose doxycycline for difficult-to-treat chronic rhinosinusitis with nasal polyps(2017) SOTER, Ana Carolina Pinto Bezerra; BEZERRA, Thiago Freire Pinto; PEZATO, Rogerio; ABDO, Tatiana Regina Teles; PILAN, Renata Mendonca; PINNA, Fabio de Rezende; GEVAERT, Philippe; ZELE, Thibaut van; BACHERT, Claus; VOEGELS, Richard LouisBackground: This study aimed to assess clinical outcomes of long-term low-dose oral doxycycline therapy in difficult-to-treat chronic rhinosinusitis with polyps (CRSwNP). Methods: This was a prospective, open-label study of 60 patients with difficult-to-treat CRSwNP who had undergone endoscopic sinus surgery. Patients were divided into two groups: 28 received nasal steroids, saline irrigation, and doxycycline (200 mg on the first day, followed by 100 mg once daily) for 12 weeks, while 30 received only nasal steroids and saline irrigation. The main outcome measure was an adequate effect size of doxycycline treatment on clinically meaningful significant improvement of SNOT-20. Other outcome measures were the SNOT-20, NOSE, and Lund-Kennedy scores. The following parameters were also analyzed: asthma, rhinitis, non-steroidal-exacerbated respiratory disease (NERD), and baseline serum IgG, IgA, IgE, IgM, ANCA, and eosinophil count. Results:There was an adequate effect size of doxycycline treatment on clinically meaningful significant improvement of SNOT-20. Patients who received doxycycline also had significantly better outcomes regarding SNOT-20, NOSE, and Lund-Kennedy scores. There was a negative association among a clinically significant improvement of SNOT-20 and presence of asthma, NERD, and elevated serum IgE levels before treatment. Conclusion:These findings suggest that doxycycline may have a beneficial role for CRSwNP patients, especially for patients without asthma, NERD or high levels of serum IgE before treatment.