RESUMEN
UNLABELLED: Laryngomalacia is the most common cause of stridor in infancy. Diagnosis is established by associating the clinical manifestations with laryngoscopic findings in a dynamic form. AIM: To analyze diagnostic accuracy of laryngomalacia through flexible nasolaryngoscopy performed by four different examiners. Form of studying: Comparison of diagnostic tests (clinical study). MATERIAL AND METHOD: A protocol of videolaryngoscopic evaluation for patients with laryngomalacia was created encompassing the following items: anterior displacement of the arytenoids; omega-shaped epiglottis; short aryepiglottic folds; posterior displacement of epiglottis; vocal folds being visible or not; edema of the posterior larynx. Four different examiners analyzed the videolaryngoscopic examinations of 18 patients with established diagnosis of laryngomalacia previously established by clinical data, epidemiology and anatomical traits. The four observers knew previously that the patients had laryngomalacia and which criteria should be analyzed in the evaluation protocol. Observers were unaware of the results each one found. RESULTS: diagnostic agreement average considering all parameters evaluated was of 88.2%. DISCUSSION/CONCLUSION: Dynamic flexible nasolaryngoscopy is a proven diagnostic method, regardless of physician experience.
Asunto(s)
Enfermedades de la Laringe/diagnóstico , Laringoscopía/métodos , Competencia Clínica , Humanos , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
A laringomalácia é a causa mais comum de estridor na infância. O diagnóstico é estabelecido através do quadro clínico associado aos achados laringoscópicos analisados de forma dinâmica. OBJETIVO: Avaliar a confiabilidade no diagnóstico da laringomalácia através da nasofibrolaringoscopia. Forma de Estudo: Concordância para avaliar a confiabilidade de um teste diagnóstico (clínico). MATERIAL E MÉTODO: Dezoito pacientes com diagnóstico prévio de laringomalácia a partir dos dados clínicos, epidemiológicos e anatômicos foram avaliados. O exame videolaringoscópico desses pacientes foi comparado com relação ao índice de concordância de quatro diferentes examinadores, através da análise cega de um em relação ao exame do outro observador. No protocolo de avaliação, os critérios considerados para o diagnóstico foram: basculamento anterior das aritenóides; epiglote em ômega; pregas ariepiglóticas curtas; basculamento posterior da epiglote; visão ou não da prega vocal; edema da laringe posterior. Os observadores variavam em relação à experiência profissional. Comparou-se a média de concordância de todos os parâmetros considerados. O padrão ouro foi o consenso no exame dos quatro observadores. RESULTADOS: A média de concordância foi de 88,2 por cento. DISCUSSÃO E CONCLUSÃO: A nasofibrolaringoscopia é um método diagnóstico de boa acuidade, uma vez que a experiência do profissional não interferiu no resultado do exame.
Laryngomalacia is the most common cause of stridor in infancy. Diagnosis is established by associating the clinical manifestations with laryngoscopic findings in a dynamic form. AIM: To analyze diagnostic accuracy of laryngomalacia through flexible nasolaryngoscopy performed by four different examiners. Form of studying: Comparison of diagnostic tests (clinical study). MATERIAL AND METHOD: A protocol of videolaryngoscopic evaluation for patients with laryngomalacia was created encompassing the following items: anterior displacement of the arytenoids; omega-shaped epiglottis; short aryepiglottic folds; posterior displacement of epiglottis; vocal folds being visible or not; edema of the posterior larynx. Four different examiners analyzed the videolaryngoscopic examinations of 18 patients with established diagnosis of laryngomalacia previously established by clinical data, epidemiology and anatomical traits. The four observers knew previously that the patients had laryngomalacia and which criteria should be analyzed in the evaluation protocol. Observers were unaware of the results each one found. RESULTS: diagnostic agreement average considering all parameters evaluated was of 88.2 percent. DISCUSSION/CONCLUSION: Dynamic flexible nasolaryngoscopy is a proven diagnostic method, regardless of physician experience.
Asunto(s)
Humanos , Enfermedades de la Laringe/diagnóstico , Laringoscopía/métodos , Competencia Clínica , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Relata-se o caso de uma criança de seis meses de Idade que apresentou granuloma umbilical a partir dos cinco meses de Idade, diagnóstico confirmado aos sete meses por completa remissão da lesão após aplicação de nitrato de prata. A ocorrência de granuloma umbilical nessa idade trata-se de caso raro.
The authors related a case of an umbilical granuloma in a child fiye-month-old, which diagnosis was confirmed when he was seyen-month-old. There was a complete remission of the lesion after the use of silyer nitrate. It's a rare case at this age.
