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
17 resultados
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- 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.
- 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 LouisIntroduction 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.
- 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.
- Upper Airway Mucociliary Clearance is Impaired in Dyspneic COVID-19 Patients(2023) PEZATO, Rogerio; DAVID, Andrea Goldwasser; BOGGI, Alexandre Coelho; MELO, Bruna; ROSALINO, Claudia Maria Valete; RODRIGUEZ, Athenea Pascual; THAMBOO, Andrew; VOEGELS, Richard LouisCovid-19 is transmitted mainly by respiratory droplets and as the upper airway mucosa is the first innate immune barrier, it is crucial to understand the effects of SARS-CoV-2 on this system. In the current study, we aimed to evaluate the nasal mucociliary clearance in patients with SARS-CoV-2 infection and their symptom development. Observational cross-sectional study. The nasal mucociliary clearance (NMC) time was evaluated by the saccharin test and the results were compared between patients with SARS-CoV-2 infection (group 1) and controls (group 2, asymptomatic patients with a negative polymerase chain reaction test). We also compared the NMC time for each specific symptom suffered by participants in group 1 with the NMC time of the control group as well as with the patients in group 1 who were asymptomatic. There was a significant increase in NMC time in group 1 with dyspnea when compared to the control group (p = 0.032) and also when compared to patients who were infected were not dyspneic (p = 0.04). There were no differences in the clearance times when considering other symptoms. COVID-19 patients with dyspnea present with altered nasal mucociliary clearance.
- 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.
- 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.
- Association between chemosensory impairment with neuropsychiatric morbidity in post-acute COVID-19 syndrome: results from a multidisciplinary cohort study(2023) DAMIANO, Rodolfo Furlan; NETO, Deusdedit Brandao; OLIVEIRA, Joao Vitor Ribeiro; SANTOS, Jonatas Magalhaes; ALVES, Julia Vallin Rodrigues; GUEDES, Bruno F.; NITRINI, Ricardo; ARAUJO, Adriana Ladeira de; OLIVEIRA, Melaine; BRUNONI, Andre R.; VOEGELS, Richard Louis; BENTO, Ricardo Ferreira; BUSATTO, Geraldo; MIGUEL, Euripedes Constantino; FORLENZA, Orestes V.; PINNA, Fabio de RezendePreliminary methodologically limited studies suggested that taste and smell known as chemosensory impairments and neuropsychiatric symptoms are associated in post-COVID-19. The objective of this study is to evaluate whether chemosensory dysfunction and neuropsychiatric impairments in a well-characterized post-COVID-19 sample. This is a cohort study assessing adult patients hospitalized due to moderate or severe forms of COVID-19 between March and August 2020. Baseline information includes several clinical and hospitalization data. Further evaluations were made using several different reliable instruments designed to assess taste and smell functions, parosmia, and neuropsychiatric disorders (using standardized psychiatric and cognitive measures). Out of 1800 eligible individuals, 701 volunteers were assessed on this study. After multivariate analysis, patients reporting parosmia had a worse perception of memory performance (p < 0.001). Moderate/severe hypogeusia was significantly associated with a worse performance on the word list memory task (p = 0.012); Concomitant moderate/severe olfactory and gustatory loss during the acute phase of COVID-19 was also significantly associated with episodic memory impairment (p = 0.006). We found a positive association between reported chemosensory (taste and olfaction) abnormalities and cognition dysfunction in post-COVID-19 patients. These findings may help us identify potential mechanisms linking these two neurobiological functions, and also support the speculation on a possible route through which SARS-CoV-2 may reach the central nervous system.
article 1575 Citação(ões) na Scopus European position paper on rhinosinusitis and nasal polyps 2012(2012) FOKKENS, W. J.; LUND, V. J.; MULLOL, J.; BACHERT, C.; ALOBID, I.; BAROODY, F.; COHEN, N.; CERVIN, A.; DOUGLAS, R.; GEVAERT, Ph.; GEORGALAS, Ch.; GOOSSENS, H.; HARVEY, R.; HELLINGS, P.; HOPKINS, C.; JONES, N.; JOOS, G.; KALOGJERA, L.; KERN, B.; KOWALSKI, M.; PRICE, D.; RIECHELMANN, H.; SCHLOSSER, R.; SENIOR, B.; THOMAS, M.; TOSKALA, E.; VOEGELS, R.; WANG, D. -Y.; WORMALD, P. J.- Outcomes of Endoscopic Sinus Surgery for Chronic Rhinosinusitis in Adults with Primary Ciliary Dyskinesia(2023) PLANTIER, Diogo Barreto; PINNA, Fabio de Rezende; OLM, Mary Anne Kowal; ATHANAZIO, Rodrigo; PILAN, Renata Ribeiro de Mendonca; VOEGELS, Richard LouisIntroduction Primary ciliary dyskinesia (PCD) is a rare inherited disease associated with impairment of mucociliary transport and, consequently, with a high incidence of chronic rhinosinusitis. For patients with chronic rhinosinusitis who remain symptomatic despite medical treatment, endoscopic sinus surgery is a safe and effective therapeutic option. However, to date, no studies have been found evaluating the effect of surgery on the quality of life associated with the effect on olfaction and nasal endoscopy findings of patients with primary ciliary dyskinesia and chronic rhinosinusitis.Objective To describe the effect of endoscopic sinus surgery on the quality of life, on olfaction, and on nasal endoscopy findings of adults with PCD and chronic rhinosinusitis.Methods Four patients who underwent endoscopic sinus surgery were included. The Sinonasal Outcome Test-22 (SNOT-22) score, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and the Lund-Kennedy score were collected preoperatively and at 3 and 6 months postoperatively. The olfaction as assessed with the University of Pennsylvania Smell Identification Test (UPSIT), which was administered preoperatively and 3 months postoperatively.Results A total of 4 patients with a mean age of 39.3 years old (3 men and 1 woman) completed the study. All patients showed clinically significant improvement in the SNOT-22, NOSE, and Lund-Kennedy scores at 3 months postoperatively, and this improvement was sustained throughout the follow-up period. However, olfaction did not improve after surgery.Conclusion The endoscopic sinus surgery treatment of chronic rhinosinusitis in adults with PCD was associated with improvement in quality of life and endoscopic findings. However, no improvement in olfaction was demonstrated. Studies with a larger number of patients and control groups should help confirm these findings.
- Computational fluid dynamics and NOSE scale to assess nasal respiratory function, and correlation with linear maxillary measurements after surgically assisted rapid maxillary expansion(2023) ZAMBON, C. E.; CHEROBIN, G. B.; UTUMI, E. R.; MACHADO, G. G.; VASCONCELLOS, F. A. F. de; PERES, M. P. S. M.; PILAN, R. R. M.; VOEGELS, R. L.; PINNA, F. R.Nasal obstruction is common in patients with a transverse maxillary deficiency. The aim of this study was to determine the variation in nasal airway resistance in adult patients with a transverse maxillary deficiency before and after surgically assisted rapid maxillary expansion (SARME) by computational fluid dynamics (CFD) using computed tomography scans, and to correlate this variation with maxillary linear measurements obtained by means of plaster models. The subjective symptoms of nasal obstruction were also analysed using a visual analogue scale (VAS) for nasal breathing and the Nasal Obstruction Symptom Evaluation (NOSE) scale. There was a median reduction of 21% in nasal airway resistance post SARME (P = 0.002). The NOSE scale score decreased (P < 0.001) and nasal breathing quality VAS scores increased in both nostrils (P < 0.001). Transverse measurements between the upper canines (C-C), premolars (PM-PM), and molars (M-M), and maxillary perimeter showed significant increases (P < 0.001), while the anteroposterior maxillary arch length showed a significant decrease (P = 0.016). An inverse proportional correlation was found between PM-PM and nasal airway resistance (r = -0.395; P = 0.034) and between M-M and nasal airway resistance (r = -0.383; P = 0.040). These results demonstrate that surgically expanding the posterior region of the maxilla results in decreased nasal airway resistance, decreased obstructive symptoms, and improved patient respiratory quality.