原发性小血管炎首诊耳科2例报告并文献复习

目的 通过报告2例以耳部症状首发并首诊耳科的原发性小血管炎患者的临床表现、诊断并文献复习,探讨原发性小血管炎基本发病机制、病理、临床表现及诊断。方法 对2例患者的临床资料及诊疗经过进行分析,并复习相关文献加以探讨。结果 2例患者临床表现不一,多种途径确诊后治疗,效果良好。结论 原发性小血管炎临床表现复杂多样,极易误诊,特别是以往临床上对血管炎导致的耳科疾病认识较少,在耳科的主要表现为耳痛、耳闷、流脓、听力下降等。早期诊治是改善预后的关键,综合判断分析能减少对此病的误诊。     

Smartphone-enabled otoscopy: method evaluation in clinical practice

ObjectiveTo assess the diagnostic agreement between smartphone-enabled otoscopy and rigid otoendoscopy in tympanic membrane and middle ear diseases.MethodsA 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.ResultsThere 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.ConclusionThere 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