Smartphone-enabled otoscopy: method evaluation in clinical practice.

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.

Smartphone-enabled otoscopy: method evaluation in clinical practice

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

Spontaneous Regression of a Clival Chordoma: An Unusual Case Report.

INTRODUCTION: Chordoma is a malignant and aggressive tumor originating from remnants of the primitive notochord and usually involving the axial skeleton. Spontaneous regression of clival chordomas was described recently. We present the third case report of spontaneous regression of a clival chordoma and discuss similarities of cases and implications for clinical practice. CASE DESCRIPTION: We present the case of a previously healthy 21-year-old Caucasian woman who presented with progressive holocranial headache for 3 months, which encouraged image investigation. Magnetic resonance imaging (MRI) revealed an osteolytic clival lesion hyperintense in T2 and hypointense in T1 images. After 2 months of initial evaluation and surgical proposal, she repeated MRI to allow use for intraoperative neuronavigation. Surprisingly, there was tumor regression. DISCUSSION: The present reported case is somehow different from previous ones and does not share an underlying inflammatory/immunological recognizable fact, being interpreted by us as a spontaneous partial regression of the tumor. We highlight the need for continuous investigation of chordoma regression to uncover the underlying mechanisms.

Endoscopic resection of sellar and suprasellar epidermoid cyst: report of two cases and review of literature.

INTRODUCTION: Epidermoid cysts (EC) are lesions developing from neuroectodermal epithelial cells. They represent 1-2% of all intracranial tumors and are usually found in cerebellopontine angle and parasellar regions. To the best of our knowledge, only 27 cases have been reported of EC in sellar and suprasellar region. In 12 cases out of the 27, surgery was done by craniotomy means. The 7 most recent manuscripts (with 15 patients described) share in common the use of endoscopic endonasal approach (EEA) to perform surgical removal. RESULTS: In this paper, we report the safe removal of epidermoid cysts arising from the pituitary using an EEA in two patients, which should be the sixth such description in literature. In both cases, resection and evolution was favourable. DISCUSSION: Surgical resection is the treatment standard for epidermoid cysts, with total resection including the cyst wall to prevent recurrence when possible. The degree of resection obtained is limited by adherence to nearby neural and vascular structures. The advent of EEA approaches has allowed safe maximal resection especially in midline lesions nearby sellar and suprasellar compartiments.

Role of Transnasal Endoscopic Surgery in the Treatment of Superficial Siderosis of Central Nervous System Secondary to Clivus Arachnoidocele: Report of Successful Case and Literature Review.

BACKGROUND: Superficial siderosis (SS) of the central nervous system is a disease characterized by deposition of hemosiderin in the leptomeninges (arachnoid and pia mater) due to chronic intradural bleeding. One of the etiologic mechanisms proposed is a dural breach secondary to trauma with a consequent arachnoidocele in contact with an exuberant venous plexus. We describe a unique case of clival arachnoidocele treated by an endoscopic endonasal approach and closure of the defect with fat and nasoseptal flap. CASE DESCRIPTION: A 35-year-old man with a history of severe head trauma 20 years ago presented with hearing deficit and a mild motor ataxia impairing gait. Magnetic resonance imaging disclosed hemosiderin deposition throughout the brain cortical layer and in the cerebellum, affecting the dentate nucleus as well. A computed tomography revealed an osteolytic formation in the clivus, involving the inner bone table and bone marrow. The patient was then submitted to an endoscopic endonasal transclival approach to close the defect. CONCLUSIONS: SS may be a result of several etiologies generating repetitive meningeal bleeding. Our patient had the diagnosis of posttraumatic clival arachnoidocele and SS probably related to trauma with some dural injury. An endoscopic endonasal approach with tear reconstruction is feasible and successful to address clival arachnoidoceles and, in this case, to avoid progression of the SS.

Chemical and cytological analysis of cerebral spinal fluid after intrathecal injection of hypodense fluorescein / Análise química e citológica do líquor após injeção intratecal de solução hipodensa de fluoresceína

ABSTRACT INTRODUCTION: Intrathecal fluorescein has been effective for topographic diagnosis of rhinoliquorrhea. Nonetheless, there are no reports on the study of cerebral spinal fluid (CSF) after use of intrathecal fluorescein. OBJECTIVE: A prospective study attempting to evaluate CSF through chemical and cytological analysis, after injection of fluorescein. METHODS: Prospective analysis of 24 samples of CSF after intrathecal injection of fluorescein for topographic diagnosis of CSF fistulae, collected at the time of puncture and after 24 and 48 h, divided by cellularity: Group 1, up to five cells, and Group 2, with more than five cells. RESULTS: The yellow-greenish color of CSF remained after 48 h in 36%, evidencing permanence of fluorescein. No changes in protein and glucose levels were observed between 0-24 h and 0-48 h. In group 2, an increase in cell count was observed between 24 h and 48 h (p = 0.019). In both groups, there was an increase of neutrophils between 0 and 48 h (p = 0.048) and a decrease between 24 and 48 h (p = 0.05). CONCLUSION: Intrathecal fluorescein provoked discreet meningeal reactions, such as an increase of cells between 24 and 48 h and an increase of neutrophils at 24 h, with a subsequent decrease at 48 h with no correlation with symptomatology.

RESUMO Introdução: A fluoresceína intratecal tem sido efetiva no diagnóstico topográfico da rinoliquorréia. Entretanto, não há estudos no líquor após o uso de fluoresceína intratecal. Objetivo: Estudo prospectivo visando avaliar o líquor, através de análise química e citológica, após injeção de fluoresceína. Método: Análise prospectiva de 24 punções após injeção intratecal de fluoresceína para diagnóstico topográfico de fístula liquórica, coletado no momento da punção, 24 e 48 horas, divididos pela celularidade: grupo 1, com até 5 células e grupo 2 com mais de 5 células. Resultado: A coloração amarelo-esverdeada do líquor permaneceu após 48 horas em 36%, evidenciando permanência de fluoresceína. Observou-se ausência de mudanças no nível de proteína e glicose entre 0-24 horas e 0-48 horas. No grupo 2, um aumento na contagem celular foi observado entre 24 e 48 horas (p = 0,019). No dois grupos juntos, observou-se um aumento de neutrófilos entre 0 e 48 horas (p = 0,048) e uma diminuição entre 24 e 28 horas (p = 0,05). Conclusão: Fluoresceína intratecal provocou discretas reações meníngeas, como o aumento de células entre 24 e 48 horas e aumento dos dos neutrófilos em 24 horas com uma subsequente dimi nuição em 48 horas sem correlação com sintomas.

Chemical and cytological analysis of cerebral spinal fluid after intrathecal injection of hypodense fluorescein.

INTRODUCTION: Intrathecal fluorescein has been effective for topographic diagnosis of rhinoliquorrhea. Nonetheless, there are no reports on the study of cerebral spinal fluid (CSF) after use of intrathecal fluorescein. OBJECTIVE: A prospective study attempting to evaluate CSF through chemical and cytological analysis, after injection of fluorescein. METHODS: Prospective analysis of 24 samples of CSF after intrathecal injection of fluorescein for topographic diagnosis of CSF fistulae, collected at the time of puncture and after 24 and 48h, divided by cellularity: Group 1, up to five cells, and Group 2, with more than five cells. RESULTS: The yellow-greenish color of CSF remained after 48h in 36%, evidencing permanence of fluorescein. No changes in protein and glucose levels were observed between 0-24h and 0-48h. In group 2, an increase in cell count was observed between 24h and 48h (p=0.019). In both groups, there was an increase of neutrophils between 0 and 48h (p=0.048) and a decrease between 24 and 48h (p=0.05). CONCLUSION: Intrathecal fluorescein provoked discreet meningeal reactions, such as an increase of cells between 24 and 48h and an increase of neutrophils at 24h, with a subsequent decrease at 48h with no correlation with symptomatology.

Brazilian Academy of Rhinology position paper on topical intranasal therapy.

This documents aims at educating those who treat sinonasal diseases - both general practitioners and specialists - about topical nasal treatments. By means of scientific evidence reviews, the Brazilian Academy of Rhinology provides its practical and updated guidelines on the most utilized topical nasal medication, except for the drugs that have topical antibiotics in their formulas.

Posicionamento da Academia Brasileira de Rinologia sobre terapias tópicas nasais / Brazilian Academy of Rhinology position paper on topical intranasal therapy

Opresente documento tem por objetivo esclarecer àqueles que tratam das doenças nasossinusais, tanto especialistas quanto generalistas, sobre as terapêuticas tópicas nasais. Por meio de uma revisão das evidências científicas, a Academia Brasileira de Rinologia vem proporcionar sua visão prática e atualizada sobre as medicações tópicas nasais mais utilizadas, excetuando-se as medicações que possuam antibióticos tópicos na sua formulação.

This documents aims at educating those who treat sinonasal diseases - both general practitioners and specialists - about topical nasal treatments. By means of scientific evidence reviews, the Brazilian Academy of Rhinology provides its practical and updated guidelines on the most utilized topical nasal medication, except for the drugs that have topical antibiotics in their formulas.

A brief history of otorhinolaryngolgy: otology, laryngology and rhinology.

UNLABELLED: 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.

Breve história da otorrinolaringologia: otologia, laringologia e rinologia: [revisão] / A brief history of otorhinolaryngolgy: otology, laryngology and rhinology: [review]

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.