ABSTRACT
Abstract Objective: To assess the diagnostic agreement between smartphone-enabled otoscopy and rigid otoendoscopy in tympanic membrane and middle ear diseases. Methods: A cross-sectional study was carried out to analyze otoscopies in patients seen at a general otorhinolaryngology (ORL) outpatient clinic, from June to December 2019. Eighty-three images of patients obtained from otoscopies performed through a smartphone device and a rigid endoscope were included, recorded, and stored for further analysis. The images were first analyzed by an experienced otologist, who assigned his diagnostic impression (defined as the gold standard) on each of the images. After this analysis, the images were displayed to a group of secondary raters (an experienced otorhinolaryngologist, a second-year resident in ORL, and a general practitioner). A questionnaire was applied related to each image. Results: There was high agreement between the smartphone device and the otoendoscopy images for all professionals, with a Kappa coefficient of 0.97 (p < 0.001). The smartphone device showed a diagnostic sensitivity of 81.1% and a specificity of 71.1%. As for the otoendoscopy, it showed a sensitivity of 84.7% and a specificity of 72.4%. The image classification as "2 = Good" was the most frequent one, with 34.9% for otoendoscopy and 31.6% for the smartphone device. Conclusion: There was a high diagnostic agreement between smartphone device-guided otoscopy and the rigid otoendoscopy, demonstrating the feasibility of using this device in clinical practice. Level of Evidence: 3
ABSTRACT
A tomografia computadorizada e ressonância magnética (RM) com seqüências convencionais têm baixa especificidade para a diferenciação entre tecido de granulação e recidiva de colesteatoma. OBJETIVO: Avaliar a aplicação da RM com sequência de difusão e pós-contraste T1 tardio na detecção de recidiva de colesteatoma. MATERIAL E MÉTODO: Realizado estudo transversal prospectivo de dezessete pacientes estudados no pós-operatório de colesteatoma utilizando RM de 1.5 T com seqüência difusão, T1, T2 e pós-contraste T1 tardio nos planos coronal e axial. Dois radiologistas avaliaram e decidiram em consenso a presença de foco de hipersinal na difusão e T2, iso/hipossinal em T1 e ausência de impregnação pelo contraste como suspeitos de recidiva de colesteatoma. Os achados da revisão cirúrgica foram comparados com o resultado da RM. RESULTADOS: Onze dos doze casos de recidiva de colesteatoma apresentaram hipersinal na difusão. Todos os pacientes com tecido de granulação na cavidade cirúrgica não apresentaram alteração de sinal na difusão. Um paciente com abscesso no conduto auditivo interno também apresentou hipersinal na difusão. A sensibilidade, especificidade, valor preditivo positivo e negativo foram respectivamente 91,6 por cento, 60 por cento, 84,6 por cento e 75 por cento. CONCLUSÃO: A seqüência de difusão combinada com pós-contraste tardio pode ser útil na diferenciação entre tecido de granulação e recidiva de colesteatoma.
Conventional CT and MRI scans have low specificity when it comes to differentiating granulation tissue from relapsing cholesteatoma. AIM: this paper aims to analyze the use of DWI and delayed post-contrast T1-weighed imaging in the detection of recurring cholesteatomas. MATERIALS AND METHOD: this is a cross-sectional prospective study that looked at 17 cholesteatoma patients postoperatively. All patients underwent diffusion magnetic resonance imaging at 1.5T, T1, T2, and delayed post-contrast T1 and images were produced from both coronal and axial planes. Two radiologists assessed the images and decided consensually that the presence of hyperintensive signal in DWI on T2, iso/hypointensive signal on T1, and absence of contrast uptake were indicative of relapsing cholesteatoma. Surgical review findings were compared to DWI scans. RESULTS: eleven of the twelve cases of recurring cholesteatoma presented hyperintensive signal in the DWI scans. None of the patients with granulation tissue in the surgical wound presented hyperintensive signal in the DWI scans. A patient with an abscess in the internal acoustic meatus also presented a hyperintensive signal in the DWI scans. Sensibility, specificity, positive predictive value and negative predictive value were 91.6 percent, 60.0 percent, 84.6 percent, and 75.0 percent, respectively. CONCLUSION: DWI combined with delayed post-contrast T1 SE sequence proved to be useful in the differential diagnosis of granulation tissue and recurring cholesteatoma.
Subject(s)
Female , Humans , Male , Middle Aged , Cholesteatoma, Middle Ear/pathology , Cholesteatoma, Middle Ear/prevention & control , Diffusion Magnetic Resonance Imaging , Mastoid/surgery , Postoperative Complications/diagnosis , Contrast Media , Cross-Sectional Studies , Cholesteatoma, Middle Ear/surgery , Mastoid/pathology , Postoperative Period , Prospective Studies , Recurrence , Tomography, X-Ray ComputedABSTRACT
A anatomia do osso temporal humano é considerado uma das mais complexas do organismo. Estruturas nervosas, vasculares e outras estão em relação íntima, às vezes separadas apenas por alguns milímetros. Longos períodos de treinamento através de dissecções de ossos temporais e observações cirúrgicas têm tradicionalmente formado a base da educação...
The anatomy considered to be among the most complex structures in the body. Critical nervous, vascular and other structures are closely related to each other, often by only a few milimeters. Long training periods, exhaustive temporal bone dissection and surgical observation have traditionally formed the basis for education...
Subject(s)
Imaging, Three-Dimensional/methods , Temporal Bone/anatomy & histology , Otolaryngology/educationABSTRACT
O nariz, a garganta e o ouvido intrigam a humanidade desde os períodos mais remotos. Tratamentos laringológicos, rinológicos e otológicos, além de cirurgias, já eram praticados por médicos gregos, hindus e bizantinos. No século XX inovações clínicas e cirúrgicas foram incorporadas graças às novas técnicas anestésicas, aos antibióticos, à radiologia e às novas tecnologias. OBJETIVO E MÉTODO: Mostrar a evolução desta ciência ao longo dos tempos, reconhecendo figuras importantes da otologia, rinologia e laringologia por revisão em literatura. RESULTADO E CONCLUSÃO: O conhecimento das evoluções em anatomia, fisiologia, tratamentos clínicos e cirúrgicos, além das personalidades que conduziram a estes avanços é de grande importância para que a ciência médica evolua cada vez mais. A Otorrinolaringologia tem história muito rica, com importantes colaboradores e figuras de renome para a história da medicina. A especialidade foi uma das primeiras a utilizar anestesia local para realização de procedimentos, pioneira em tratamentos com próteses que recuperavam a audição e teve a primazia na utilização de microscópios em cirurgias. Poucas especialidades médicas sofreram tantas mudanças e desenvolvimentos científicos nestas últimas décadas quanto a Otorrinolaringologia que teve a vantagem de incorporar tecnologias na endoscopia, radiologia, microcirurgia e uso da informática.
Ears, nose and throat have intrigued humanity since immemorial times. Treatments for the larynx, the nose and the ear and also surgeries were practiced by Greek, Hindu and Byzantine doctors. In the 20th century clinical and surgical innovations were incorporated, thanks to new anesthesia techniques, antibiotics, radiology and new technologies. AIM AND METHOD: show the evolution of this science throughout the times, recognizing important persons in otology, rhinology and laryngology. RESULTS AND CONCLUSION: Understanding the evolutions in clinical and surgical anatomy, physiology, treatment modalities, and the personalities that lead to these advances is of great importance for the evolution of medical science. Otorhinolaryngology has a very rich history, with important collaborators and personalities in the history of medicine. The specialty was one of the first to use local anesthesia for procedures, pioneer in treatments with devices that recouped hearing and the use of microscopes in surgeries. Few medical specialties had suffered as many changes and scientific developments in these last decades as Otorhinolaryngology had, with the advantage of incorporating technologies such as endoscopy, radiology, microsurgery and information technology.