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
28 resultados
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- 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.
- Juvenile angiofibroma: major and minor complications of preoperative embolization(2012) OGAWA, Alex Itar; FORNAZIERI, Marco Aurelio; SILVA, Leonardo Victor Espana Rueda da; PINNA, Fabio de Rezende; VOEGELS, Richard Louis; SENNES, Luis Ubirajara; PUGLIA JUNIOR, Paulo; CALDAS, Jose Guilherme Mendes PereiraIntroduction: Juvenile angiofibromas (JA) are highly vascular, benign tumours for which surgery is the treatment of choice. In most services, embolisation is performed prior to resection. Nevertheless, there are few data on the complications of preoperative embolisation for JA. Aim: To describe major and minor complications of preoperative embolisation in a 32-year experience of patients undergoing surgical resection of JA at a tertiary hospital. Methods: Retrospective chart review study of 170 patients who underwent surgical resection of JA at a tertiary hospital between September 1976 and July 2008. Results: All patients were male. Age ranged from 9 to 26 years. Ninety-one patients had no complications after embolisation. Overall, 105 complication events occurred of which four major and 101 minor. Conclusion: In our series, preoperative embolisation for JA produced no irreversible complications and no aesthetic or functional sequelae. The vast majority of complications were transient and amenable to clinical management.
- Is Olfactory Epithelium Biopsy Useful for Confirming Alzheimer's Disease?(2019) GODOY, Maria Dantas Costa Lima; FORNAZIERI, Marco Aurelio; DOTY, Richard L.; PINNA, Fabio de Rezende; FARFEL, Jose Marcelo; SANTOS, Glaucia Bento dos; MOLINA, Mariana; FERRETTI-REBUSTINI, Renata E. L.; LEITE, Renata E. P.; SUEMOTO, Claudia K.; GRINBERG, Lea T.; PASCRALUCCI, Carlos A. G.; VOEGELS, Richard Louis; NITRINI, Ricardo; JACOB FILHO, WilsonObjectives: The clinical symptoms of Alzheimer's disease (AD) are preceded by a long asymptomatic period associated with ""silent"" deposition of aberrant paired helical filament (PHF)-tau and amyloid-beta proteins in brain tissue. Similar depositions have been reported within the olfactory epithelium (OE), a tissue that can be biopsied in vivo. The degree to which such biopsies are useful in identifying AD is controversial. This postmortem study had 3 main goals: first, to quantify the relative densities of AD-related proteins in 3 regions of the olfactory neuroepithelium, namely, the nasal septum, middle turbinate, and superior turbinate; second, to establish whether such densities are correlated among these epithelial regions as well as with semi-quantitative ratings of general brain cortex pathology; and third, to evaluate correlations between the protein densities and measures of antemortem cognitive function. Methods: Postmortem blocks of olfactory mucosa were obtained from 12 AD cadavers and 24 controls and subjected to amyloid-beta and PHF-tau immunohistochemistry. Results: We observed marked heterogeneity in the presence of the biomarkers of tau and amyloid-beta among the targeted olfactory epithelial regions. No significant difference was observed between the cadavers with AD and the controls regarding the concentration of these proteins in any of these epithelial regions. Only one correlation significant was evident, namely, that between the tau protein densities of the middle and the upper turbinate (r = .58, P = .002). Conclusion: AD-related biomarker heterogeneity, which has not been previously demonstrated, makes comparisons across studies difficult and throws into question the usefulness of OE amyloid-beta and PHF-tau biopsies in detecting AD.
- Safety and efficacy of superior turbinate biopsies as a source of olfactory epithelium appropriate for morphological analysis(2020) GARCIA, Ellen Cristine Duarte; ROSSANEIS, Ana Carolina; PIPINO, Alexandre Salvatore; GOMES, Gustavo Vasconcelos; PINNA, Fabio De Rezende; VOEGELS, Richard Louis; DOTY, Richard L.; VERRI, Waldiceu Aparecido; FORNAZIERI, Marco AurelioPurpose There is no standardized approach for preserving olfactory function in the side of the nose where biopsy of the olfactory epithelium (OE) is performed. Moreover, a gold standard technique for obtaining human OE in vivo is still lacking. We determined the efficacy of obtaining good-quality OE specimens suitable for pathological analysis from the lower half of the superior turbinate and verified the safety of this procedure in maintaining bilateral and unilateral olfactory function. Methods In 21 individuals without olfactory complaints and who had undergone septoplasty and inferior turbinectomy OE biopsy was made during septoplasty. Olfactory function, both unilateral and bilateral, was assessed using the University of Pennsylvania Smell Identification Test (UPSIT) before and 1 month after the procedure. Specimens were marked with the olfactory marker protein for confirmation of OE presence. Results Ninety percent of the samples contained OE, although clear histological characterization was possible from only 62%. There was no deterioration of UPSIT scores either bilaterally or unilaterally on the side of the biopsy. Patients also maintained the ability to identify individual odorants. Conclusion Biopsies of the lower half of the superior turbinate do not affect olfactory function and show strong efficacy in yielding OE tissue and moderate efficacy for yielding tissue appropriate for morphological analysis. Future studies are needed to assess the safety of this procedure in other OE regions.
- 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.
- Biopsy of the olfactory epithelium from the superior nasal septum: is it possible to obtain neurons without damaging olfaction?(2022) GARCIA, Ellen Cristine Duarte; LUZ, Lucas de Almeida; ANZOLIN, Lucas Kanieski; SILVA, Jose Lucas Barbosa da; DOTY, Richard L.; PINNA, Fabio de Rezende; VOEGELS, Richard Louis; FORNAZIERI, Marco AurelioIntroduction: Olfactory epithelium biopsy has been useful for studying diverse otorhinolaryngological and neurological diseases, including the potential to better understand the pathophysiology behind COVID-19 olfactory manifestations. However, the safety and efficacy of the technique for obtaining human olfactory epithelium are still not fully established. Objective: This study aimed to determine the safety and efficacy of harvesting olfactory epithelium cells, nerve bundles, and olfactory epithelium proper for morphological analysis from the superior nasal septum. Methods: During nasal surgery, 22 individuals without olfactory complaints underwent olfactory epithelium biopsies from the superior nasal septum. The efficacy of obtaining olfactory epithelium, verification of intact olfactory epithelium and the presence of nerve bundles in biopsies were assessed using immunofluorescence. Safety for the olfactory function was tested psychophysically using both unilateral and bilateral tests before and 1 month after the operative procedure. Results: Olfactory epithelium was found in 59.1% of the subjects. Of the samples, 50% were of the quality necessary for morphological characterization and 90.9% had nerve bundles. There was no difference in the psychophysical scores obtained in the bilateral olfactory test (University of Pennsylvania Smell Identification Test [UPSIT (R)]) between means before biopsy: 32.3 vs. postoperative: 32.5, p = 0.81. Also, no significant decrease occurred in unilateral testing (mean unilateral test scores 6 vs. 6.2, p = 0.46). None out of the 56 different odorant identification significantly diminished (p > 0.05). Conclusion: The technique depicted for olfactory epithelium biopsy is highly effective in obtaining neuronal olfactory tissue, but it has moderate efficacy in achieving samples useful for morphological analysis. Olfactory sensitivity remained intact. (c) 2021 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial.
- Chemosensory Dysfunction 3-Months After COVID-19, Medications and Factors Associated with Complete Recovery(2023) FORNAZIERI, Marco Aurelio; SILVA, Jose Lucas Barbosa da; GAMEIRO, Juliana Gutschow; SCUSSIATO, Henrique Ochoa; RAMOS, Rafael Antonio Matias Ribeiro; CUNHA, Bruno Machado; FIGUEIREDO, Alan Felipe; TAKAHASHI, Eduardo Hideki; MARIN, Gabrielli Algazal; CAETANO, Igor Ruan de Araujo; MELI, Tainara Kawane; HIGUCHI, Diego Issamu; SANTOS, Rafael Rodrigues Pinheiro dos; RAMPAZZO, Ana Carla Mondek; PINNA, Fabio de Rezende; VOEGELS, Richard Louis; DOTY, Richard L.Objectives: To examine the longitudinal prevalence and recovery of olfactory, gustatory, and oral chemesthetic deficits in a sizable cohort of SARS-CoV-2 infected persons using quantitative testing. To determine whether demographic and clinical factors, mainly the medications used after the COVID-19 diagnosis, influence the test measures. Methods: Prospective cohort in a hospital with primary, secondary, tertiary, and quaternary care. Patients with confirmed COVID-19 were tested during the acute infection phase (within 15 days of initial symptom, n = 187) and one (n = 113) and 3 months later (n = 73). The University of Pennsylvania Smell Identification Test, the Global Gustatory Test, and a novel test for chemesthesis were administered at all visits. Results: During the acute phase, 93% were anosmic or microsmic and 29.4% were hypogeusic. No one was ageusic. A deficit in oral chemesthesis was present in 13.4%. By 3 months, taste and chemesthesis had largely recovered, however, some degree of olfactory dysfunction remained in 54.8%. Remarkably, patients who had been treated with anticoagulants tended to have more olfactory improvement. Recovery was greater in men than in women, but was unrelated to disease severity, smoking behavior, or the use of various medications prior to, or during, COVID-19 infection. Conclusions: When using quantitative testing, olfactory disturbances were found in nearly all SARS-CoV-2 infected patients during the acute infection phase. Taste or chemesthetic deficits were low. Olfactory impairment persisted to some degree in over half of the patients at the 3-month follow-up evaluation, being more common in women and less common in those who had been treated earlier with anticoagulants.
- Chemosensory Dysfunction in COVID-19: Prevalences, Recovery Rates, and Clinical Associations on a Large Brazilian Sample(2021) BRANDAO NETO, Deusdedit; FORNAZIERI, Marco Aurelio; DIB, Caroline; FRANCESCO, Renata Cantisani Di; DOTY, Richard L.; VOEGELS, Richard Louis; PINNA, Fabio de RezendeObjective. Our study aimed to measure the percentage of reported olfactory or taste losses and their severity, recovery time, and association with other features in a large cohort of patients with COVID-19. Study Design. Prospective survey. Setting. Quaternary medical center and online survey. Methods. The perceived chemosensory capacities of 655 patients with confirmed COVID-19 were assessed with 11-point category rating scales (0, no function; 10, normal function). Patients were contacted in hospital, by phone calls, or by internet regarding their ability to smell or taste, and 143 were interviewed by phone 1 to 4 months later to assess the recovery of their chemosensory abilities. Results. The prevalence of self-reported olfactory, general taste, and taste quality-specific disturbances (sweet, sour, bitter, and salty) in the patients with COVID-19 were 82.4% (95% CI, 79.5%-85.3%), 76.2% (95% CI, 72.9%-79.4%), and 52.2% (95% CI, 48.3%-56.1%), respectively. The majority reported anosmia (42.9%). The presence of chemosensory symptoms was not associated with COVID-19 severity. At a median time >2 months after the onset of symptoms, rates of total and partial olfaction recovery were 53.8% and 44.7%, while complete or partial return to previous taste function was 68.3% and 27.6%. Less than 5% of the patients reported no chemosensory function improvement at all. Conclusion. The prevalence of self-reported chemosensory dysfunction is high among patients with COVID-19. Almost all patients seem to recover a significant part of their smell and taste abilities in the first 4 months after the onset of symptoms.
- Association of air pollution with olfactory identification performance of Sao Paulo residents: a cross-sectional study(2023) SCUSSIATTO, Henrique Ochoa; SILVA, Jose Lucas Barbosa Da; FIGUEIREDO, Alan Felipe; RAMOS, Rafael Antonio Matias Ribeiro; PINNA, Fabio De Rezende; VOEGELS, Richard Louis; PINTO, Jayant M. M.; FORNAZIERI, Marco AurelioObjectiveExposure to particulate matter of 10 mu m or less in diameter (PM10) has been implicated in pulmonary and cardiovascular diseases. However, the effect of PM10 on olfaction has not been well established. We estimated individual acute and chronic PM10 exposure levels in a large Brazilian cohort and related them to the ability to identify odors.MethodsAdults from Sao Paulo (n = 1358) were recruited from areas with different levels of air pollution. To verify individual exposure to air pollution, the averages of 30, 60, 90, 180 and 364 days of PM10 were interpolated to subjects' zip codes using the kriging method. Olfactory identification performance was tested using the University of Pennsylvania Smell Identification Test (UPSIT (R)). Multiple linear regressions were used to calculate the effect of air pollution on olfactory identification performance, controlling for demographic and other variables that affect the sense of smell.ResultsAcute exposures to PM10 were related to worse UPSIT (R) scores, including 30- (beta = - 0.94, 95% Confidence Interval [CI] - 0.98, - 0.89), 60- (beta = - 1.09, 95% CI = - 1.13, - 1.04) and 90-day intervals (beta = - 1.06, 95% CI - 1.10, - 1.02) (reference for beta: 1 mu m/m(3) increase in PM10 exposure per point decrease in UPSIT (R) score). Chronic exposures were also associated with worse olfaction for both 180- (beta = - 1.06, 95% CI - 1.10, - 1.03) and 364-day (beta = - 0.87, 95% CI - 0.90, - 0.84) intervals. As in prior work, men, older, low-income, and low-schooling people demonstrated worse olfactory performance.ConclusionAcute and chronic exposure to PM10 is strongly associated with olfactory identification performance in Brazilian adults. Understanding the mechanisms which underlie these relationships could help to improve chemosensory function with a large public health impact.
- Olfaction During Pregnancy and Postpartum Period(2019) FORNAZIERI, Marco Aurelio; PRINA, Douglas Manuel Carrapeiro; FAVORETO, Joao Paulo Maximiano; SILVA, Kleber Rodrigues e; UEDA, Denis Massatsugu; PINNA, Fabio de Rezende; VOEGELS, Richard Louis; CAMERON, Leslie; DOTY, Richard L.Introduction Studies of the effect of pregnancy on olfactory function are contradictory-some report reduced function, others hypersensitivity, and still others no change at all. Our objectives were to quantify olfactory function in women during gestational and puerperal periods, to compare the olfactory test scores to those of non-pregnant women, and to explore the potential influence of rhinitis on olfactory function during these periods. Methods We evaluated olfactory function in 206 women with and without rhinitis-47 in the first trimester of pregnancy, 33 in the second, 44 in the third, 32 in the postpartum period, and 50 who were non-pregnant. Olfactory assessment was performed using the University of Pennsylvania Smell Identification Test (UPSIT) and ratings of the pleasantness and intensity of four common odors. Results Although total UPSIT scores did not differ among the study groups, pregnant and postpartum women identified some odors less well than did the controls. Pregnant women, especially in the first trimester, tended to consider some smells less pleasant. Rhinitis was adversely associated with the olfactory test scores of the pregnant and postpartum women. Conclusions The overall olfactory function of postpartum and pregnant women did not differ compared to controls; however, detection of some individual UPSIT items was adversely impacted (e.g., menthol, gingerbread, gasoline). Rhinitis was associated with reduced olfaction during pregnancy and puerperium.
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