Page 28 - Portuguese Journal - SPORL - Vol 61. Nº1
P. 28
statistically significant. These variations may cases were absent from the present study
be attributed to the superior image resolution sample, although they are often seen in our
and quality with DCL ; no irregularities were center. This is due to the follow-up of these
7,8
found that could correspond to artifacts in children in the larynx consultation of the HDE,
the previously obtained images, which were similar to what Centeno and Penna (2019)
diagnosed as VC nodules considering the have described. The videolaryngoscopes that
16
epidemiology of the study population. On the were used not only differed in the technology
12
other hand, we think that the increase in the but also in the diameter and light options.
number of LPR diagnoses is related to the fact The smaller diameter of the DCL may have
that DCL provides images of superior resolution contributed to the fact that the exam was
and brightness that allow detection of small well tolerated, thereby allowing more detailed
1,12
epithelial changes and small variations, such as and prolonged observations, which may have
subtle differences in the color and roughness led to an eventual bias in the comparison of
of the laryngopharyngeal mucosa, which can the diagnoses that were made. However,
be missed in images obtained through optical the systematic use of topical anesthesia may
methods with insufficient resolution. 7,8 have reduced the impact of this disparity.
The diagnoses made using DCL were The difference in the lighting options did
subsequently confirmed by observation under not interfere with the conclusions because
stroboscopic light. Ramos et al. compared all diagnoses were made based on the data
the diagnoses made before and after the obtained under continuous light and were
use of laryngeal stroboscopy and reported a not altered by the subsequent observation
reduction from 54% to 33% in the proportion of under stroboscopic light, even in the cases in
diagnosed VC nodules, as well as an increase which this option was available. The existence
in the number of diagnosed CV cysts (from of multiple etiological diagnoses means that
13% to 32%), which show the ability of this some of them are represented by a small
technique to distinguish between bilateral number of children, which has an impact on
and unilateral lesions with reactive changes the statistical power. This may explain why
of the contralateral VC. 1,4,5,14 Although a trend some data described in the study did not reach
of reduction in the number of diagnosed VC statistical significance. Thus, further studies
nodules was observed, there was no increase with larger samples and more observers are
in the number of unilateral lesions; this necessary to confirm the reported findings
variation may be explained by a more precise and draw more robust conclusions.
evaluation of the VC structure as a result of the
superior images obtained with DCL. 7,8 Conclusion
The main limitation of the present study is its The patients evaluated in the voice clinic of
retrospective nature, which was potentially the HDE were aged between six and 12 years
detrimental to the collection, analysis, and and were mostly boys, with the main cause of
comparison of data and the uniformity of the dysphonia being VC nodules. There were no
evaluations. However, we think that this was statistically significant differences between the
mitigated by the fact that all consultations two analyzed methods of evaluation, although
and laryngoscopy exams were performed there appears to exist, in this population, an
by the same senior otorhinolaryngologist, association between the use of DCL and a
who followed a predefined protocol that reduction in the number of diagnoses of VC
ensured more standardized consultations, nodules and normal laryngoscopy exams,
observations, and guidance. Some children as well as an increase in the number of LPR
with dysphonia may have more specific diagnoses.
etiologies, such as recurrent laryngeal
papillomatosis and VC paralysis , but these
1,5
28 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery
