Diagnóstico de rinossinusite crônica em pacientes com fibrose cística: correlação entre anamnese, nasofibroscopia e tomografia computadorizada

Abstract

The sinonasal involvement is one of the most common manifestations in cystic fibrosis. Data show a high incidence of chronic rhinosinusitis in these patients. Although it has been found radiographic opacification of the sinus in more than 90% of cases, few are symptomatic. So that, it is difficult to recognize nasossinusal disease in patients with cystic fibrosis. Questionnaire, nasal endoscopy and CT-scan are very important methods in this approach. Aim: To evaluate the diagnosis of chronic rhinosinusitis in patients with cystic fibrosis by anamnesis, nasal endoscopy and CT-scan and compare those results. Study Design: Clinical prospective. Material and Method: Evaluation of 34 patients -older than 6 years and with a confirmed diagnoses of cystic fibrosis -by anamnesis (questionnaire), nasal endoscopy (score Lund-Kennedy) and CT-scan (score Lund-Mackay). Results: chronic rhinosinusitis was confirmed in: 20,58% of cases by the questionnaire, 73,52% of the cases by the nasal endoscopy and in 93,54% of the cases by the CT-scan. The results showed significant differences. The correlation between nasal endoscopy score (Lund-Kennedy score) and CT-scan score (Lund-Mackay score) was statistically significant. Conclusion: The diagnosis of chronic rhinosinusitis was statistically different between the three methods. It was higher in imaging analysis and lower in questionnaire. The nasal endoscopy is an excellent method to evaluate nasossinusal disease in cystic fibrosis

Avaliação endoscópica nasal de crianças e adolescentes com fibrose cística

“…The reported frequency of these symptoms in CF patients is very variable in the literature, although generally higher than the frequency in our study. Recent European and North American studies have shown that the symptoms most frequently associated with CF are coughing (in about 60%), 29 nasal block (in 60 to 90.5%), 3,29,45,46 rhinorrhea (in 20 to 85.7%), 3,29,36,45,46 headaches (in 22.6 to 71.4%), 3,29,46 facial pain (in 15 to 57.1%),45,46 and sleep disorders with agitation, snoring and daytime drowsiness (in 37%), especially in patients with severe nasal block.15 In Brazil, Boari and Castro Jr. 42 found that except for coughing, symptoms of rhinosinusitis occurred infrequently. These variations probably reflect the small samples and different age groups in these studies.…”

“…From 1961 to 2005, the prevalence of nasal polyps increased from 5 to 57%. 26,29,[31][32][33][34][35][36][37][38][40][41][42] Explanations include increased survival rates of CF patients in developed countries, the selection of patients, sample sizes, different age groups in these studies, and especially the more recent routine use of nasal endoscopy as a diagnostic tool. 3,19,48 Brihaye et al 29 showed that over 25% of polyps were not diagnosed in the clinical examination with anterior rhinoscopy without nasal endoscopy in CF patients.…”

“…Only nasal endoscopy can provide an adequate view of the middle meatus and the posterior half of the nose. 4,21,49 Boari and Castro Jr 42 compared clinical, tomographic and endoscopic findings and found that nasal endoscopy helped significantly in evaluating chronic rhinosinusitis and nasal polyps in CF patients; endoscopy accurately characterized the nasosinusal status.…”

“…Weber and Ferrari 40 found nasal polyps in 39.1% of CF patients in a sample of 23 patients aged from one year and nine months to 22 years and 8 months. Boari and Castro Jr. 42 used nasal endoscopy and found polyps in only three (8.82%) of 34 CF patients aged from six to 22 years. Sakano et al 26 used rigid endoscopy under general anesthesia and found nasal polyps in 36% of 50 patients aged over 2 years; this method may have increased the diagnostic accuracy for polyps, including very small ones.…”

“…[28][29][30] The frequency of nasal polyposis varies in different populations, and depends on the evaluation technique. 26,29,[31][32][33][34][35][36][37][38][39][40][41][42] It is thought that nasosinusal involvement may worsen pulmonary manifestations; 20 thus, otorhinolaryngologists have become more involved in evaluating these patients. Recent studies in Brazil 26,40,41 have shown a growing concern with characterizing in more detail the nasosinusal findings of CF patients, because this disorder is genetically very heterogeneous, with many types of mutations and a wide variety of clinical presentations, 28 which may be explained by specific phenotypic features of the Brazilian population and even within populations of any given region in this country.…”