FABIO DE REZENDE PINNA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina
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- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Reducing the exposure of the tonsillar fossa does not impact postoperative pain levels in children undergoing tonsillectomy: A double-blind randomized controlled trial(2018) FORNAZIERI, Marco Aurelio; MIYAZATO, Edson Satoshi; YAMAMOTO, Henrique Massamiti; NAVARRO, Paulo de Lima; PINNA, Fabio de Rezende; VOEGELS, Richard LouisBackground: It is not established whether reducing the exposure of the tonsillar fossa would be an effective strategy for postoperative pain relief among the pediatric population submitted to tonsillectomy. We assessed the impact of closing this region using absorbable sutures on pain, on the resumption of normal diet and on the healing process until seven days after surgery. Methods: Randomized, double-blind, controlled trial comparing postoperative pain in 132 children between the ages of 5 and 12 years undergoing tonsillectomy having bilateral closure, unilateral closure or non-closure of the tonsillar fossa. Results: No differences in pain levels were reported both at discharge and on postoperative day 7. The day of resumption of normal diet was similar in all patients. Less granuloma and edema of the uvula were noted in patients with non-closure of the tonsillar fossa. Conclusion: These results showed that reducing the exposure of the tonsillar fossa after the removal of the palatine tonsils was not an effective method for postoperative pain relief in children. Moreover, its closure was associated with slower healing.
- The effects of adenoidectomy on the smell perception of children(2019) FORNAZIERI, Marco Aurelio; ARAUJO, Rafael Goulart; LIMA, Joao Vitor Fernandes; FAVARETO, Felipe Bays; PINNA, Fabio de Rezende; VOEGELS, Richard Louis; DOTY, Richard L.Background In this study, we employed a novel children's olfactory test in order to more accurately assess the relationship between nasopharyngeal obstruction and odor identification ability. We quantified the impact of adenoidectomy on olfactory function, established whether the influences of the operation were related to the preoperative amount of nasopharyngeal obstruction, and determined whether sex influenced the olfactory measures. Methods Fifty-three boys and 23 girls were administered a standardized children's olfactory test, the Pediatric Smell Wheel (TM), before and 45 days after adenoidectomy. They ranged in age from 5 to 12 years and exhibited varying degrees of adenotonsillar hypertrophy and histories of recurrent adenotonsillitis. Radiographs of the nasopharynx were used to grade the degree of nasopharyngeal obstruction. Results Significant postoperative improvement in smell function occurred more frequently in children with >50% preoperative obstruction of the nasopharynx. In this group, average function improved 50.8% after surgery (95% confidence interval [CI], 39.1% to 64%). Improvement on 9 of the 11 odors was present, with significant differences occurring for the odors of bubble gum, baby powder, mint, and cinnamon. No sex differences were evident. Conclusion Olfactory dysfunction occurs primarily in children whose nasopharyngeal obstruction is >50%. Removal of the hypertrophied adenoids returned smell function back to normal in these cases. This study suggests that smell loss may be of value in decisions regarding whether or not to perform adenoidectomy in children with nasopharyngeal obstruction.