RESUMO
Idiopathic ulcerative laryngitis (IUL) is characterized by bilateral ulceration of vocal cords which is followed by a protracted course of healing. It is rarely diagnosed, with a paucity of published data in English literature. There is no published data on this topic in the Indian population. Twenty-one patients from 3 centres were prospectively evaluated for clinical presentation, diagnosis, treatment, and follow-up. All patients underwent fibreoptic laryngoscopic evaluation and stroboscopic assessment. They were treated with supportive care and stringent follow-up. 21 patients with a median age of 39 years were included. This condition was commonly seen in males. All patients were treated conservatively except two who underwent a biopsy. The average time for full recovery in 14 of our patients who had compliant follow-ups was 9.24 weeks. GRBAS score improved from 9 to 5.93(p < 0.0001). Self-reported voice outcomes improved in all patients except for one patient who had a biopsy. IUL is uncommon but not rare in the Indian population. It shows full recovery with conservative management that involves at least more than 3-4 weeks.
RESUMO
Tumor induced osteomalacia is a rare paraneoplastic syndrome caused by usually small mesenchymal tumors. The tumors are commonly located in the extremities whereas occurrence in the nasal cavity is quite rare. An 18 year old male presented with asymmetric weakness of both lower limbs and difficulty in walking since one year. On evaluation he was found to have open femur head physes and iliac apophyses, low serum Phosphorus, low vitamin D, normal serum calcium, elevated PTH & alkaline phosphatase levels. FGF-23 levels in serum were elevated. DOTA NOC PET CT revealed tumor in the left nasal cavity abutting the nasal septum. Surgical excision of the tumor resulted in normalisation of the serum levels of phosphorus, vitamin D and FGF-23. This case report indicates the importance of maintaining high clinical suspicion and early detection of causative tumor using appropriate imaging techniques.
RESUMO
Outcomes of cochlear implantation (CI) are generically assessed using standard validated measures like CAP, SIR, MAIS and MUSS scales. Although this reflects the improvement in auditory verbal skills among the implantees with habilitation over one year, the overall perception of their skill development may vary between the parents of these children and the clinicians who provide the habilitation. This study aimed to compare the CAP and SIR scores sequentially over habilitation and further analyzes the correlation between clinician assessment (with CAP/SIR scores) and parental perspective (with MAIS/MUSS scores), at the end of one year of habilitation. 388 children aged 1-6 years who underwent unilateral CI were included in the study. Their baseline CAP and SIR scores were recorded post implantation. All children received 1 year of intensive auditory verbal therapy and their 12 month CAP, SIR, MAIS and MUSS scores were then recorded. The baseline CAP/SIR scores were compared with 12 month CAP/SIR scores and then their 12 month CAP/SIR scores were correlated with 12 month MAIS/MUSS scores respectively. There was significant difference between baseline and the 12 month CAP/SIR scores (p < 0.001). There was strong positive correlation between CAP and SIR scores after 12 months of habilitation (r = 0.7), while there was moderate positive correlation between CAP and MAIS scores (r = 0.59) and between SIR and MUSS scores (r = 0.49) respectively. Though the parents note significant improvement in child's communication abilities, the parental perspective of final outcomes does not always match with the clinician's assessments at the end of habilitation, as highlighted by the moderate correlations. A more precise method of holistic assessment is lacking currently and stands warranted.
