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STUDY OBJECTIVES: Drug-induced sleep endoscopy (DISE) using propofol is commonly used to identify the pharyngeal structure involved in collapse among patients with obstructive sleep apnea. DISE has never been compared with zolpidem-induced sleep endoscopy. We hypothesized that propofol at recommended sedation levels does not influence upper airway collapsibility nor the frequency of multilevel pharyngeal collapse as compared with zolpidem-induced sleep. METHODS: Twenty-one patients with obstructive sleep apnea underwent polysomnography and sleep endoscopy during zolpidem-induced sleep and during DISE with propofol. A propofol target-controlled infusion was titrated to achieve a bispectral index between 50 and 70. Airway collapsibility was estimated and compared in both conditions by peak inspiratory flow and the magnitude of negative effort dependence. Respiratory drive was estimated by the difference between end-expiratory and peak-negative inspiratory pharyngeal pressure (driving pressure). Site and configuration of pharyngeal collapse during zolpidem-induced sleep and DISE with propofol were compared. RESULTS: The frequency of multilevel collapse during zolpidem-induced sleep was similar to that observed during DISE with propofol (72% vs 86%, respectively; difference: 14%; 95% confidence interval: -12% to 40%; P = .453). The endoscopic classification of pharyngeal collapse during both conditions were similar. Peak inspiratory flow, respiratory drive (effect size: 0.05 and 0.03, respectively), and negative effort dependence (difference: -6%; 95% confidence interval: -16% to 4%) were also similar in both procedures. CONCLUSIONS: In this pilot study, recommended propofol doses did not significantly increase multilevel pharyngeal collapse or affect upper airway collapsibility and respiratory drive as compared with zolpidem-induced sleep. CLINICAL TRIAL REGISTRATION: Registry: clinicaltrials.gov; Name: Natural and Drug Sleep Endoscopy; URL: https://clinicaltrials.gov/ct2/show/study/NCT03004014; Identifier: NCT03004014.

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Objective: 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...

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Objective 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.

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Introduction A nasolabial cyst is an ectodermal development cyst. It presents as a fullness of canine fossa, nasal ala, or vestibule of the nose. It is rare and usually small. Treatment consists of complete surgical excision or transnasal endoscopic marsupialization. Objective To describe a giant nasolabial cyst case treated using Neumann incision. Case Report A 37-year-old man was referred to the otolaryngology department with nasal obstruction and nasal deformity. Computed tomography showed a nasal cystic lesion 4 × 4.5 × 5 cm wide. Surgical excision using Neumann incision was performed. Discussion Neumann incision provides wide access to the nasal cavity and may be useful in nasolabial cyst treatment.

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A nasolabial cyst is an ectodermal development cyst. It presents as a fullness of canine fossa, nasal ala, or vestibule of the nose. It is rare and usually small. Treatment consists of complete surgical excision or transnasal endoscopic marsupialization. Objective: To describe a giant nasolabial cyst case treated using Neumann incision. Case Report: A 37-year-old man was referred to the otolaryngology department with nasal obstruction and nasal deformity. Computed tomography showed a nasal cystic lesion 4 × 4.5 × 5 cm wide. Surgical excision using Neumann incision was performed. Discussion: Neumann incision provides wide access to the nasal cavity and may be useful in nasolabial cyst treatment...

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OBJECTIVE: To assess the prevalence of allergic rhinitis and the factors associated with the use of emergency care services by children and adolescents with acute asthma submitted to inhaled corticosteroid therapy. METHODS: A cross-sectional study was conducted with 126 patients treated with beclomethasone dipropionate for 3 years. The factors associated with emergency care services in the third year of beclomethasone dipropionate treatment were assessed using logistic regression models. RESULTS: The prevalence of allergic rhinitis amounted to 74.6% (95%CI 65.9-81.7). The presence of allergic rhinitis (OR = 2.98, 95%CI 1.10-8.06) and asthma severity (OR = 2.09, 95%CI 1.05-4.44) were independent factors for emergency care services. CONCLUSION: The prevalence of allergic rhinitis was high and that, combined with asthma severity, constituted the major risk factor for the necessity of emergency care services. Health professionals should attempt to make an early diagnosis of allergic rhinitis in asthmatic patients.

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OBJETIVOS: Avaliar a prevalência da rinite alérgica (RA) e os fatores associados à utilização de serviços de pronto-atendimento por asma aguda em crianças e adolescentes asmáticos tratados com corticóide inalatório. MÉTODOS: Foi realizado um estudo transversal, do qual participaram 126 pacientes que se encontravam em tratamento com o dipropionato de beclometasona por 3 anos. Através de modelos de regressão logística, foram avaliados os fatores associados à consulta de pronto-atendimento no terceiro ano de tratamento com dipropionato de beclometasona. RESULTADOS: A prevalência da rinite alérgica foi de 74,6 por cento (IC95 por cento 65,9-81,7). A presença de rinite alérgica (OR = 2,98, IC95 por cento 1,10-8,06) e a gravidade da asma (OR = 2,09, IC95 por cento 1,05-4,44) foram fatores independentes para consultas em pronto-atendimento. CONCLUSÃO: A rinite alérgica apresentou elevada prevalência no grupo estudado e, aliada à gravidade da asma, foi o principal fator de risco para as consultas de pronto-atendimento. Os serviços de saúde deveriam ficar atentos para o reconhecimento precoce da rinite alérgica nos pacientes com asma.

OBJECTIVE:To assess the prevalence of allergic rhinitis and the factors associated with the use of emergency care services by children and adolescents with acute asthma submitted to inhaled corticosteroid therapy. METHODS: A cross-sectional study was conducted with 126 patients treated with beclomethasone dipropionate for 3 years. The factors associated with emergency care services in the third year of beclomethasone dipropionate treatment were assessed using logistic regression models. RESULTS: The prevalence of allergic rhinitis amounted to 74.6 percent (95 percentCI 65.9-81.7). The presence of allergic rhinitis (OR = 2.98, 95 percentCI 1.10-8.06) and asthma severity (OR = 2.09, 95 percentCI 1.05-4.44) were independent factors for emergency care services. CONCLUSION: The prevalence of allergic rhinitis was high and that, combined with asthma severity, constituted the major risk factor for the necessity of emergency care services. Health professionals should attempt to make an early diagnosis of allergic rhinitis in asthmatic patients.

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