International Journal of Otorhinolaryngology and Head and Neck Surgery

Staphylococcus epidermidis isolated sphenoiditis: a rare cause of recurrent orbital apex syndrome

2024-08-08T19:55:07+0530

Isolated sphenoid sinusitis (ISS) is a rare condition that can lead to severe complications, with orbital apex syndrome (OAS) being an exceptionally rare manifestation characterized by visual loss and multiple cranial neuropathies. We report a case of a 41-year-old female presenting with recurrent OAS caused by a chronic Staphylococcus epidermidis infection of the sphenoid sinus. Despite extensive diagnostic workups and multiple surgical interventions, the patient experienced recurrent episodes of OAS, highlighting the challenges in diagnosis and treatment. This report emphasizes the pathogenic potential of S. epidermidis, typically considered a commensal organism, in chronic sinusitis and underscores the importance of a multidisciplinary approach in managing such complex cases.

Parotid secretory carcinoma: a rare entity in a young patient

2024-06-22T00:00:35+0530

Secretory carcinoma (SC) of the parotid gland is a rare malignancy of the head and neck that presents almost equally in both genders with the average age of presentation in the mid-40. SC is often misdiagnosed as salivary acinic cell carcinoma (AciCC) as they share similar pathological morphology which is difficult to differentiate based on staining alone. We present a case of a 22-year-old female with this uncommon pathology who underwent subtotal parotidectomy after a conflicting provisional diagnosis of a benign tumor based on cytology and CT scan reporting possible malignancy involving the deep parotid lobe. It was later confirmed as SC on histopathology examination.

A rare expediting killer-primary thyroid gland sarcoma

2024-07-10T14:20:39+0530

Primary thyroid malignancies can be classified into differentiated type (follicular, papillary, medullary, and anaplastic) and un-differentiated type or non-epithelial malignancies, particularly lymphomas and sarcomas. The reported frequency of primary thyroid sarcoma (PTS) cases ranges from 0.01% to 1.5%. Based on this fact, we present a case report of rare primary thyroid sarcoma (PTS) in Hospital Sibu, Sarawak. Our patient is a 78-year-old lady with multiple co-morbidities and her clinical deterioration is so rapid that its progression mimics thyroid anaplastic carcinoma which is commonly seen in female elderly as well. To diagnose such uncommon thyroid malignancy, the histopathology of the tumour needs to be conducted with immunohistochemical staining. Radiographic imaging such as computed tomography or magnetic resonance imaging of whole body is required for staging purpose and to look for metastasis. We analyze the clinical presentations of PTS and discuss its treatment and prognosis. The treatment of PTS must be assessed individually on case-by-case basis as currently there is no general consensus on treating this cancer.

Hybrid operating room for the multidisciplinary treatment of a juvenile nasoangiofibroma at the “Dr. Eduardo Liceaga” general hospital of Mexico: case report and literature review

2024-07-27T07:17:34+0530

Nasoangiofibroma or juvenile nasopharyngeal angiofibroma is a highly vascularized benign neoplasm, which mainly affects men between the first and second decade of life. The incidence of this type of lesion is extremely rare and occurs in a 0.05 to 0.5% of all head and neck neoplasm, in which surgical treatment is considered the best treatment option. Treatment of this pathology in a hybrid operating room is considered a novel tool, to carry out an effective multidisciplinary intervention, granting better control of the procedure and hemostasis. The purpose of this publication is to describe the advantages of performing surgery in a hybrid operating room, as well as to conduct a literature review on this condition. Two cases are reported, a 14 and 16-years old male, both with a probable diagnosis of juvenile nasoangiofibroma. The surgical treatment was carried out in the hybrid operating room of the General Hospital of Mexico “Dr. Eduardo Liceaga” by the otorhinolaryngology and the oral and maxillofacial surgery department after embolization by the interventional radiology team.

Early functional restoration in cleft patients by presurgical infantile orthopedics with follow up

2024-06-23T15:37:56+0530

Cleft lip and palate present significant surgical challenges, particularly in cases of extensive clefts associated with severe nasolabial deformities. This case series focuses on the role of presurgical naso alveolar molding (PNAM) in improving surgical outcomes by reducing cleft deformities and enhancing facial symmetry. PNAM, combined with nasal stenting and presurgical orthopedics, aids in aligning the segments of the alveolar cleft and correcting nasal cartilage asymmetry. The study involved bilateral and unilateral cleft repairs, utilizing the Randall's modification of tennison triangular flap for unilateral cases and the Millard-Mulliken procedure for bilateral full clefts. Precise preoperative marking, meticulous tissue rearrangement, and multi-layer closure were key to achieving optimal results. Postoperative care included close monitoring, with skin sutures removed on the fifth day. The results align with existing literature, demonstrating the effectiveness of PNAM in narrowing the cleft and achieving nasal symmetry. This case series highlights the importance of early intervention and the application of PNAM plates in the comprehensive treatment of cleft lip and palate, contributing to favorable outcomes in reconstructive surgery.

Surgical resection of a bilateral temporomandibular joint ankylosis and interposition gap arthroplasty using bilateral temporo-parietal fascial flap in a 5 years old child: treatment challenges and literature review

2024-08-05T17:46:16+0530

Temporomandibular joint (TMJ) ankylosis is a debilitating state that involves fusion of glenoid fossa and condyle of mandible. This can lead to restriction in mouth opening and mandibular movements. Subsequently, patient develops difficulty in chewing, speech, breathing as well as poor dental hygiene. All of these have detrimental effects on patient’s wellbeing and their quality of life. TMJ ankylosis can also have secondary effects on facial growth like asymmetry of face, retro or micrognathia, malocclusion, anterior or posterior open bite and overcrowding of teeth specially if it presents at early age. Main event that leads to TMJ ankylosis is trauma but this can occur as a secondary insult to surgery, local and systemic infections or diseases like chronic otitis media, tuberculosis, juvenile rheumatoid arthritis and septic arthritis. The management of TMJ ankylosis poses a significant challenge because of technical difficulties and a high incidence of recurrence. It is mainly managed by surgery with different options like gap and interpositional arthroplasty, reconstruction arthroplasty or distraction osteogenesis and aggressive post op physiotherapy. Here, we present a case five years old girl child with post traumatic TMJ ankylosis who was managed with excision of ankylotic mass and interpositional arthroplasty by using bilateral temporo-parietal fascial flap. She was followed for a 1 year and had adequate mouth opening and no recurrence.

A rare case of non-specific chronic supraglottic laryngitis in a young female: a comprehensive case report

2024-08-10T11:28:48+0530

Chronic non-specific supraglottic laryngitis is a rare clinical condition characterized by chronic inflammation of the supraglottic structures without any evidence of infection, granulomatous disease, autoimmunity or malignancy. This is a case report of a young female presenting with a long-standing history of voice change and dysphagia. Laryngoscopy revealed diffuse inflammation of the supraglottis. Thorough workup, including radiological investigations, blood tests, bronchoscopy and biopsy, ruled out any known etiology. She was thus diagnosed with non-specific chronic supraglottic laryngitis. The patient responded well to the long-term use of oral corticosteroids and immunosuppressant drugs. This study summarizes the clinical presentation, comprehensive investigations and management of chronic, non-specific supraglottic laryngitis.

A rare presentation of nasopharyngeal mass: a case report

2024-08-06T03:56:45+0530

A Thornwaldt's cyst develops in the nasopharynx, which is the region where the throat and nasal passageways converge, extending from the back of the nasal tube to above the soft palate. A painful throat, obstruction of the eustachian tube, and pus with an unpleasant taste and odour might result from an infection of the cyst. Here in our study, we report a case of a 27-year-old male presented with symptoms of nasal obstruction and voice change for the past 1 year. On zero-degree endoscopic examination, a nasopharyngeal mass was seen arising from the roof of the nasopharynx without bony erosion of skull base. Further based on his radiological investigations, heterogeneous hyperintense lesion in T1/T2 weighted images of size 5×5 mm noted in nasopharynx most likely to be the Thornwaldt’s cyst. Thus, the surgical removal of the nasopharyngeal mass has been performed through a transoral and trans nasal endoscopic technique with no remnants at the surgical site. The histopathological findings revealed respiratory-type epithelium with underlying lymphoid tissue confirming Thornwald’s cyst as diagnosis. The patient was discharged with no complications and have been periodically advised for a follow-up. The differential diagnosis should include a meningocele or meningo-encephalocele. Various therapeutic approaches, including endoscopic, transoral, or trans palatal surgical interventions, can be used for treatment of symptomatic cysts.

An interesting case of asymptomatic giant submandibular sialolithiasis: a case report

2024-03-01T13:00:38+0530

Sialolithiasis is the most common disease of salivary glands. On the other hand, giant submandibular sialoliths or megaliths are quite rare. Our case report is of an unusually large submandibular sialolith called a giant sialolith as dimensions exceed 15 mm in size. Patient was asymptomatic on presentation and had preserved gland function. A firm mass was detected on the left floor of mouth and on transoral sialolithotomy a single large calculus of 40 mm, in greatest dimension, was removed in toto. Though submandibular gland sialoliths are generally asymptomatic in nature, giant calculi usually present with symptoms including pain and swelling of the involved gland caused by the accumulation of saliva, due to blockage of the lumen of Wharton’s duct by the calculus. This is a rare case report of an asymptomatic giant submandibular sialoithiasis, its diagnosis and management.

A neglected case of chronic suppurative otitis media presented with a chest wall abscess

2024-04-16T19:26:07+0530

The objective of the study was to present a neglected case of chronic suppurative otitis media presented to us with a chest wall abscess. We encountered a case of complicated chronic suppurative otitis media in a 16-year-old male, who presented with abscess extending from the mastoid region up to the ipsilateral chest. Incision and drainage of the chest wall and mastoid abscess was under local anesthesia and approximately 250 ml pus was collected. The patient was given intravenous injections of meropenem and regular dressings. Right modified radical mastoidectomy with type 3 tympanoplasty was performed under general anesthesia after four weeks. The patient was discharged on postoperative day 6. The case is an eye-opener as having several complications at the time of presentation that reflects inattention at the community level health provider and patient. Through this article, we emphasis on early diagnosis and proper management of disease so as to avoid life-threatening complications. High index of suspicion and timely intervention is needed for any patient presenting with neck or chest swelling as it may be a complication of COM.

Large vocal polyp causing dyspnea to young patient

2024-05-31T10:53:27+0530

The vocal cords are primarily responsible for voice production and the risk factor for non-neoplastic vocal fold lesions is usually multifactorial, laryngeal trauma (endotracheal intubation), hypothyroidism, cigarette smoking, alcohol abuse, gastroesophageal reflux (GERD) and also including phonotrauma etc. we report a 30-year-old female presented with the complaint of dyspnea and hoarseness of voice. endoscopic examination showing, the very large vocal cord polyp was seen to be arising from the left vocal cord, partially blocking the glottic chink, with minimal residual airway. ML Scopy excision of the polyp was done and size was approximately 1.5 cm.

A high-riding brachiocephalic artery: a unique diagnostic dilemma

2024-05-29T00:07:06+0530

We present a case of the A high-riding brachiocephalic artery, a rare variant of neck vessels. It is clinically and surgically important, as unknowingly may lead to severe life-threatening complications. A 67-year-old male, presented with throat pain, dysphagia, heartburn with belching for 4-5 months. He was diagnosed with High riding brachiocephalic on further evaluation with USG neck which was reported as, superiorly placed right brachiocephalic artery noted in the suprasternal notch with maximum diameter 1.6 cm. Asymptomatic nature conservative line of management was followed and on follow up, patient had improvement in the symptoms.

Exceptionally rare site:the occurrence of pilomatricoma of the ear lobule

2024-06-04T14:14:56+0530

Pilomatricoma, a rare benign tumor primarily affecting the head and neck region, presents diagnostic challenges and requires histopathological confirmation for accurate diagnosis. A case of pilomatricoma in a 70-year-old female with a chronic swelling on the Left ear lobule is reported. Surgical excision was performed, confirming the diagnosis histopathologically, highlighting the importance of accurate recognition and management. Timely surgical excision of pilomatricoma is crucial, with low recurrence rates reported. Accurate diagnosis aids in appropriate management and optimal patient outcomes.

Non-Hodgkin lymphoma of vocal cord causing “pseudo-palsy”

2024-05-31T15:08:11+0530

Non epithelial lesion of vocal cord is identified as vocal cord palsy/ impaired movement without obvious mucosal ulceration. There are several nonepithelial lesions of vocal cord. Lymphoma, plasmacytoma, liposarcoma, lipoma, myxofibrolipoma, hemangioma, rhabdomyosarcoma are amongst the important differential diagnosis. These tumors occur in the submucosal layer of larynx and hence the mucosa appears intact at endoscopy. The lesions are typical non circumscribed, and invasion of adjoining structures helps in differentiating benign from malignant lesions. Presented here is a case of vocal cord (pseudo) palsy who underwent an 18F-fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG PET CT) scan which revealed a hypermetabolic trans glottic soft tissue lesion. Histology confirmed the diagnosis of Extra-nodal High Grade Diffuse Large B Cell Non-Hodgkin lymphoma (DLBCL NHL).

Application of psychodynamic model in the assessment and management of psychogenic voice disorder: a case report

2024-06-12T09:41:24+0530

The psychological state is considered to contribute to the overall well-being of an individual. Disequilibrium due to psychological reasons such as anxiety, stress, depression, or other psychological conditions may affect voice production entirely or partially, significantly affecting the person’s occupational, social, and emotional well-being. The present study discusses a sudden onset of aphonia in a 37-year-old female without an underlying physiological illness. The study illustrates the importance of interpreting the voice problem in the patient considering the influence of the individual's psychological, physiological, physical, emotional, and social health by applying the psychodynamic model.

Cemento-ossifying fibroma: an extensive fibro-osseous lesion involving paranasal sinuses

2024-06-20T13:03:13+0530

Cemento-ossifying fibroma (COF) is a fibro-osseous lesion arising from cells of the periodontal ligament. This tumor typically occurs in individuals during their third and fourth decades of life, with a predilection for women. COF primarily affects the maxillofacial region, most commonly the mandible. Its localization in the paranasal sinuses and skull base is unusual. However, we present a rare case of COF involving the right paranasal areas of the maxillofacial region in an 18-year-old female. Computed tomography (CT) revealed an expansile lesion measuring 52.45×32×74.29 mm involving the right maxillary sinus, expanding into both the anterior and posterior choanae. The patient underwent endoscopic sinus surgery (ESS) with preservation of adjoining vascular structures. Clinical, radiographic, and histologic features are presented, and differential diagnosis is discussed.

Sebaceous carcinoma of nasal ala: a case report

2024-06-26T15:33:46+0530

Nasal sebaceous carcinoma is an extremely rare adnexal skin tumor representing 0.2%-4.6% of all malignant neoplastic cutaneous lesions. It is seen most affecting the meibomian glands in the periocular region. Here we share a case of 65-year-old female patient with nasal mass over the right alar region, diagnosed as sebaceous carcinoma and managed with wide local excision of the mass was done defect was reconstructed with a nasolabial flap. Sebaceous carcinoma being very rare in nasal region we want to share the case details.

Fungal suppurative otitis media: a rare case report

2024-08-15T15:55:25+0530

A chronic inflammatory middle ear cleft syndrome also known as chronic otitis media (COM) results in the partial or total loss of the tympanic membrane and ossicles. The most common isolates in the majority of the investigations were Pseudomonas aeruginosa, Streptococcus pneumonia, and Staphylococcus aureus. Candida species and Aspergillus species were the uncommon isolates. In our study a 70-year-old woman who has been having left ear discharge for around 20 days and has a history of left chronic otitis media (COM) tubotympanic illness over the previous six months. On clinical examination of the left ear using otoscope, otomycotic debri in the outer ear canal was observed with a moderate sized perforation over the postero-superior and postero-inferior quadrants of tympanic membrane. Two swab samples were taken from the left ear discharge primarily for the microbiological investigations. The findings showed a predominance of fungal growth but no bacterial growth was observed. The patient was medically managed with 2% acetic acid wash and topical clotrimazole drops for 2 weeks and tablet itraconazole 200 mg BD for 4 weeks. The patient was symptomatically better after 4 weeks of treatment. Our case is unique of its type as fungal cause of CSOM is extremely rare.

The impact of mitomycin C in endoscopic sinus surgeries: a comprehensive review

2024-06-17T09:58:38+0530

Chronic rhinosinusitis (CRS) is an inflammation of the nasal and paranasal sinus linings, often resulting in various debilitating symptoms. Functional endoscopic sinus surgery (FESS) is a common treatment for CRS, aiming to alleviate symptoms by restoring sinus drainage and mucosal repair. However, postoperative complications, including adhesion formation, remain a concern. This systematic review aims to evaluate the effectiveness of mitomycin-C (MMC) in reducing postoperative complications, particularly adhesion formation, in patients undergoing ESS. A systematic review of available evidence on the role of MMC in FESS was conducted. Studies were selected based on predefined inclusion criteria, and relevant data were extracted and synthesized. Nineteen studies met the inclusion criteria, encompassing a total of 763 subjects. The majority of studies reported a reduction in postoperative adhesion formation with MMC use, although statistical significance varied. MMC dosages and application methods varied across studies, contributing to heterogeneity in outcomes. Overall, MMC showed promise in reducing adhesion formation and improving surgical outcomes in FESS. However, further high-quality, prospective, randomized controlled trials are warranted to establish optimal dosage, application methods, and long-term efficacy of MMC in FESS for CRS.

Attic retraction pocket: a review

2024-06-17T05:53:25+0530

Attic retraction pocket (ARP) is one of the important sequelae of eustachian tube dysfunction or otitis media with effusion. It is associated with the loss of original histological and anatomical structure at the attic region. Clinical observation usually shows that negative nasopharyngeal pressure is associated with the development of ARP. However, LaPlace’s law states that the pressure within a sphere varies with the inverse of the radius, which gives a dynamic explanation for why the pars flaccida retract more frequently than the pars tensa leading to the development of ARP. It may develop ossicular chain erosion, cholesteatoma formation, and potentially life-threatening complications due to cholesteatoma. It is thought that blockade of the tympanic isthmus results in isolation of the attic and adjacent middle ear spaces and that subsequent makes negative pressure in these spaces leading to pars flaccida retraction. The severity of ARP with cholesteatoma varies from well-localized pathology to advanced involvement with complications. The choice of treatment is surgery that depends on the initial pathology, which is also associated with hearing outcomes and the rate of recurrence. This review article discusses on epidemiology, etiopathology, classification, clinical manifestations, diagnosis, treatment, and prognosis of ARP.

Variants in the superior attachment of uncinated process and their corresponding frontal sinus drainage pattern: a computed tomography-based retrospective clinical study

2024-07-25T19:19:10+0530

Background: Understanding the morphology and spatial relationships of the uncinate process and its associated spaces is crucial for diagnosing and treating conditions affecting sinus drainage and ventilation. This consistent anatomical structure is an important surgical landmark for endoscopic sinus surgery.

Methods: Computed tomography (CT) records of 100 patients over two years were extracted via the hospital's PACS system. The type of superior insertion of uncinate process (UP) was observed in coronal cuts of CT scan images, and classification was done based on the Friedmann and Landsberg classification system and tabulated. The corresponding variations in the frontal sinus outflow tract were noticed, and their effect on frontal sinusitis was recorded. Sinusitis of the frontal sinus was in guidance with EPOS 2020 (mucosal changes within the ostiomeatal complex or sinus).

Results: Type 2 was the most common of uncinate attachments (39.5%). The least common variant was type 5 (4%). Medial-type frontal sinus drainage pathway was observed in 78.5% of patients. Sinusitis was present in 23.5% of our study population. Type 2 had a 25% contribution to the occurrence of sinusitis. The medial frontal sinus drainage pathway contributes 24% to sinusitis with a significant p value of 0.010.

Conclusions: Uncinate process, with its varying superior attachment, influences the frontal sinus outflow tract and may contribute to the development of frontal sinusitis. Awareness of the possible variations in the attachment of the uncinate process is vital in the preoperative planning process, which will serve as a road map to surgeons and aid in preparedness for intraoperative complications.

Cross-sectional study of the factors predisposing to obstructive sleep apnea in the adult population attending ENT outpatient department with snoring in tertiary care center

2024-08-05T13:39:02+0530

Background: Obstructive sleep apnea (OSA) is characterized by repetitive upper airway obstruction leading to stimulation of the cardiovascular system, oxygen desaturation, and sleep fragmentation. Overnight polysomnography (PSG) is the standard diagnostic test for Obstructive sleep apnea. The objective of the study was to assess the prevalence and severity of OSA and the factors predisposing to OSA.

Methods: In this cross-sectional study, 98 patients with snoring were subjected to undergo polysomnography. Apnea-hypopnea index (AHI), Oxygen desaturation events per hour, and Lowest oxygen desaturation events per hour were statistically analyzed. The Chi-square test and analysis of variance (ANOVA) test were used and the p value was calculated. Statistical package for the social sciences (SPSS) version 20 was used for statistical analysis.

Results: In our study, the most common age group affected was between 51-60 years. The most common comorbidity found among the patients was hypertension. There was a positive correlation between OSA and neck circumference. The most common type of apnea was obstructive apnea. AHI was found to have a positive correlation with OSA and its severity. There was a significant association between average oxygen desaturation and OSA. There was also a positive correlation between ODI and OSA.

Conclusions: Increasing age, neck circumference, deviated nasal septum, and inferior turbinate hypertrophy had a strong association with OSA. Polysomnography shows the strong association of AHI, and oxygen desaturation events per hour with OSA.

Analysis of epidemiological and clinicopathological risk factors for locoregional recurrence of oral cavity squamous cell carcinoma: retrospective analysis of 150 patients with buccal mucosal carcinoma in a tertiary care centre

2024-08-24T21:07:27+0530

Background: Oral cavity cancers, the second most common type in India, are responsible for 10% of the overall cancer burden. With a recurrence rate of 30% to 40% and a 5-year survival rate of 50%, these malignancies account for substantial morbidity and mortality. Despite advances in treatment modalities, survival rates following treatment completion have not improved significantly. The present study aimed to establish specific epidemiological and pathological factors which are responsible for recurrence after treatment completion in buccal mucosa cancers.

Methods: A retrospective analysis of the data of 150 patients treated for biopsy-proven cancers of the buccal mucosa was undertaken 2 years after treatment completion. Factors such as age, sex, education, lymphovascular invasion, extranodal extension (ENE), perineural invasion, depth of invasion, and pathological margin status were compared between patients who presented with recurrence and those who did not. Statistical significance was set at p<0.05.

Results: Of the 150 patients, 52 (34.6%) developed a recurrent disease within 2 years. The mean age of the study population was 45.6 years, and males constituted 84% of the included patients. Ipsilateral buccal mucosa was the commonest site of disease recurrence. Neck node metastasis, ENE, and margins of resection <5 mm, lymphovascular invasion, perineural invasion, and depth of invasion >10 mm, tobacco consumption, smoking were significantly related to the recurrence of disease.

Conclusions: Neck node metastasis, ENE, and margins of resection <5 mm, lymphovascular invasion, perineural invasion, depth of invasion >10 mm were the histopathological factors associated with recurrence in cancers of the buccal mucosa.

Relationship of anterior ethmoidal artery with skull base and posterior wall of frontal sinus: a computed tomography-based retrospective clinical study

2024-09-03T22:31:14+0530

Background: The close proximity of anterior ethmoidal artery (AEA) to the skull base predisposes the artery to injury during ESS. This study aims to decipher the course of AEA and determine its relationship with the skull base and posterior wall of frontal sinus with the help of computed tomography.

Methods: The vertical distance between the skull base and the anterior ethmoidal foramen in the coronal scans, the horizontal distance between posterior wall of frontal sinus ostium and AEA in the sagittal scans and the number of intervening cells between posterior wall of frontal sinus and AEA were analyzed in CT scans of 75 patients over a period of six months.

Results: The AEA was lying 2.5-5 cm below the level of skull base in majority of the CT scans analyzed. Most of the CT scans studied demonstrated only a single intervening cell between posterior wall of frontal sinus ostium and AEA on either side. In our study there was a strong positive relationship between the AEA- skull base distance and between the AEA-posterior wall of frontal sinus distance on either side.

Conclusions: Distance between the AEA and skull base is variable, but a freely running AEA within a bony canal was a more common variant than skull base variant in our study. AEA-skull base distance and AEA-frontal sinus distance on right side correlated with values of left side indicating symmetrical course of the AEA on either side in an individual.

Expert perspectives on the prescription pattern of levocetirizine₊montelukast and fexofenadine₊montelukast for the management of allergic rhinitis in the Indian settings

2024-04-27T12:53:41+0530

Background: Studies have shown that oral antihistamines are considered as the gold-standard therapy for allergic rhinitis. However, there is dearth of studies among clinicians, so this study aimed to gather expert opinion on the prescribing pattern of levocetirizine₊montelukast and fexofenadine₊montelukast for managing AR in India.

Methods: This cross-sectional study, conducted through a multi-response questionnaire comprising 24 questions, gathered insights from experts across diverse Indian settings. It explored perspectives on clinical observations, experiences, demographic profiles, treatment characteristics in AR, and the utilization of fexofenadine₊montelukast and levocetirizine₊montelukast for AR management in clinical practice. The data were analyzed through descriptive analysis.

Results: Majority of clinicians (52%) preferred levocetirizine₊montelukast for AR, with half of them recommending a 2-week course. Additionally, 38% of clinicians noted its effectiveness in addressing all AR symptoms. Most clinicians agreed that levocetirizine and montelukast combination therapy was effective in improving nighttime nasal symptoms (74%) and nasal congestion (69%). Furthermore, majority of clinicians acknowledged that the combination offers both immediate (74%) and long-term (56%) relief from AR symptoms. Approximately 58% of the healthcare providers reported overall improvement across categories with fexofenadine₊montelukast, encompassing daytime nasal symptoms, nighttime nasal symptoms, and daytime eye symptoms.

Conclusion: Clinicians recommended the combination of levocetirizine₊montelukast and fexofenadine₊montelukast to manage AR. Levocetirizine₊montelukast combination was preferred by clinicians for its efficacy in alleviating nighttime nasal symptoms and congestion. Fexofenadine₊montelukast combination was also endorsed for overall improvement across various symptoms.

Transadaptation and validation of dysphagia handicap index in Bangla

2024-05-09T07:09:31+0530

Background: The aim of this study was to transadapt and validate the Bangla version of DHI (DHI-B). The objective of the study was to translate and culturally adapt the Dysphagia Handicap Index (DHI) in Bangla language.

Methods: Thirty individuals (mean age-42.23, SD±12.52) with dysphagia and an equal number of healthy individuals (mean age-28.23, SD±10.68) participated to fill up the questionnaire of DHI-B. Establishment of validity was done by comparing DHI-B scores of healthy controls and patients with dysphagia. Test–retest reproducibility, content validity and concurrent validity were established and internal consistency were used for reliability testing.

Results: The overall Cronbach’s α for DHI-B was 0.84, indicating good internal consistency. Pearson’s correlation on test–retest reliability of DHI-B was found to be 0.9. Correlation that achieved between subscales of DHI-B and total DHI-B was analysed using Pearson’s correlation which was found very high. Compared to the dysphagic group, the control group showed significantly lower scores for all scales.

Conclusion: From this study it was concluded that DHI-B showed good internal consistency, test-retest reliability, and concurrent validity. Therefore, it could be claimed that for assessment of dysphagia related handicap in Bangla, DHI-B is a reliable and valid tool.

Working memory capacity in children with early and late cochlear implantation: a P300 evaluation

2024-06-03T10:10:54+0530

Background: Cochlear Implant helps in improving hearing sensitivity, speech perception and production, cognitive abilities, and enhances academic performances, peer relationships and quality of life. Hearing impaired individuals has reduced working memory capacity and working memory depends on the ability of hearing and processing of information to the brain. P300 act as an electrophysiological test to assess the working memory capacity. The aim of the study was to evaluate the effect of age of cochlear implant on working memory capacity.

Method: A total of 30 participants were included in this study, which were divided into two groups. Group 1 consisted of 15 individuals who had done cochlear implant (CI) before 3 years of age. In Group 2, 15 subjects were included who had done their CI after 3 year of age and before 6 years of age. P300 was carried out among these individuals using speech stimulus and the result was compared between groups.

Result: The t test value for P300 amplitude (t:10.34, p<0.05) and latency (t:4.66, p<0.05) indicate that there are statistically significant differences exist between the two groups in terms of P300 amplitude and latency. From the mean value we can conclude that early-implanted individuals have higher amplitude and shorter latency compared to late-implanted individuals.

Conclusion: The results of this study have significant ramifications for how the therapeutic strategy for kids with congenital hearing loss is planned. It highlights the need of early action and the crucial timeframe. It assesses the neuromodulation of the brain's auditory regions directly and connects it to the implanted age.

Role of reflux symptom index score in diagnosis of laryngopharyngeal reflux

2024-06-03T10:40:46+0530

Background: The retrograde flow of gastric contents to the upper aero digestive tract is known as laryngo pharyngeal reflux disease (LPRD). Diet and lifestyle play a huge role in the pathophysiology of LPR.

Methods: A hospital based cross sectional study in the Department of ENT, KMCT, Kozhikode. 291 Patients were selected from those who presented to the OPD with throat symptoms who scored >10 in a questionnaire (Reflux symptom Index) that was provided and were advised to undergo video laryngoscopy and their reflux finding score (RSI)was calculated. LPRD prevalence, RSI/Reflux Findings Score (RFS) correlations, and clinical/ laryngoscopic (video laryngoscopy) associations were analyzed.

Results: LPRD prevalence was 68.7%, higher in females (60.1%) and the 41-50 age group (31.3%). Increased spicy food/caffeine intake and shorter dinner-bedtime intervals were significantly associated. Heartburn/indigestion was the most common symptom, with RSI mean 12.94±2.26. Erythema/hyperaemia was the most frequent laryngeal finding, with RFS mean 8.47±2.40. RSI and RFS scores significantly correlated.

Conclusions: This study demonstrates a high LPRD prevalence among patients with throat symptoms, particularly in females aged 41-50 and influenced by dietary/lifestyle factors. RSI effectively identified LPRD in this resource-constrained setting, highlighting its diagnostic value. These findings provide valuable insights for managing and further investigating LPRD.

A study on impact of tinnitus masking on psychophysical and tinnitus tuning curve in participants with hearing impairment suffering from severe tinnitus

2024-06-12T09:21:49+0530

Background: Tinnitus can be treated by using different pedagogies of management approaches in which tinnitus masking has been acclaimed most evidence-based approach. Psychophysical tuning curve and tinnitus tuning curve explored as least interested procedures in tinnitus research. This noteworthy but nonspecific psychophysical domain may throw a light on need of the present research. Aim of the study was to find out the effect of tinnitus masking on Psychophysical tuning curve and tinnitus tuning curve.

Method: A total of 30 native Bengali speaking participants were included in this study, having mean age of 45.9 years and SD was 6.46. All the participants had unilateral subjective tinnitus with Mild to Moderately severe sensorineural hearing loss. Quasi-experimental research design was used. Dual channel audiometer (MAICO MA 53) with supra-aural TDH 39 headphone was used for psychoacoustic measurements of tinnitus (including pitch matching, loudness matching, minimum masking level etc.) and to provide tinnitus masking therapy. MATLAB version 9.5 was used to develop noise to assess PTC and TTC using Sennheiser HD 201 headphone routed through MAICO MA 53 audiometer via stereo jack and cable. Tinnitus masking therapy was carried out for 30 sessions by using regimen of MML +20 dB of masking level for 30 minutes duration for each session with matched pitch. PTC and TTC were measured before and 30 sessions-after tinnitus masking therapy. PTC was measured using 1000 Hz pure tone at 10 dBSLl as reference followed by four narrow band noise with centre frequency of 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz pertaining to 312 Hz band width as developed by MATLAB software. TTC was measured using the same noise with reference to matched tinnitus pitch. All the above-mentioned conditions forced choice procedure was carried out in dBHL frame work.

Results: Wilcoxon sign rank test was used at 95% confidence level to check the influence of tinnitus masking therapy on PTC and TTC measures. Significant changes were portrayed at 1000 Hz and 4000 Hz respectively in PTC measure and at 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz respectively in TTC measures.

Conclusion: This study preliminarily provides information regarding influence on tinnitus pitch domains which has been psychoacoustically systematically measured as PTC and TTC. These two psychoacoustic signatures may be treated as prognostic biomarker of tinnitus management in future using replicable research using different methodology or using statistical basis of data mining. At that point conclusive remarks may not throw a clear indication based on the results found in this study.

Comparison of voice quality in patients with oral cancer at both pre and post treatment stage

2024-06-14T21:41:36+0530

Background: Patients with oral cancer have very common complaints of change in voice. This research is designed to study the effect of oral cancer and its treatment on the various domains of voice like functional, physical, and emotional along with parameters of voice like pitch, loudness and quality.

Method: This study included total 48 participants (34 males and 14 females) with oral cancer. The voice quality of the participants was analysed both before and after treatment using Dr. speech and the voice handicap index (VHI). First, the voice analysis done when the patient was diagnosed as a case of oral cancer by the head-neck oncosurgeon after completion of all required investigations. Patients were recalled for voice analysis after completion of treatment.

Results: There was a significant difference observed in all three domains of the VHI at both before and after treatment. The difference in the functional domain was more prominent. The VHI was not linked to tumor or nodal staging. However, post treatment the voice parameters are greatly affected as compared to pre-treatment stage.

Conclusions: The administration of the VHI should be made mandatory prior to treatment of oral cancer and the findings of the test should be discussed with the patient prior to start of any treatment modality and accordingly the realistic expectations can be set. Therefore, voice analysis using Dr speech will also help in timely assessment and rehabilitation of voice before and after treatment.

A clinical study on hoarseness of voice, etiology and its management

2024-06-29T15:27:27+0530

Background: Voice is an inherent means of communication intended to convey feelings of intimacy. One of the most frequent symptoms otolaryngologist’s encounters is hoarseness. The aims of this study are to determine the causes of hoarseness predisposing factors, to assess the clinical profile as well as how to evaluate and treat hoarseness of voice. To estimate the proportion of common causes of hoarseness in patients, identify predisposing factors and evaluate outcomes of various treatment methods.

Methods: This was a cross-sectional study conducted at ENT department of tertiary care center. A total of 80 cases presenting with hoarseness were studied. A detailed history was taken, followed by a comprehensive local and systemic examination, leading to a clinical diagnosis supported by relevant investigations.

Results: The most frequent cause of hoarseness of voice among patients was determined to be laryngeal cancer, with a 32.5% incidence rate. The incidence of hoarseness was 0.40% among the total ENT cases. Out of total 80 study subjects with hoarseness of voice 40% were from lower socioeconomic class, 30% had habit of smoking. Among them,35% were treated medically, 50% were treated surgically/radiotherapy and for remaining 15% study subjects no treatment was given.

Conclusion: Therefore, based on this study, we conclude that hoarseness of voice is a primary symptom warranting investigation, as it could signal early laryngeal malignancy.

Audit of hypocalcemia as a clinical marker following total thyroidectomy: a retrospective chart review

2024-07-03T11:40:54+0530

Background: Surgical removal is one of the most important treatment options for the thyroid swellings. Metabolic derangement due to injury to parathyroid glands is one of the complication to be dealt with frequently. The aim of this study is to assess the incidence of postoperative hypocalcemia after total thyroidectomy and to analyze various pre-operative risk factors that lead to the same.

Methods: A retrospective study was conducted on patients who underwent total thyroidectomy at department of ENT and head and neck surgery over a period of 2 years. The level of post-operative serum calcium was analyzed, to determine the incidence of hypocalcemia. In all the patients the following parameters were assessed – age, gender, pre and post-operative serum calcium and type of thyroid disease. Unpaired t test and Mann-Whitney U test was used for statistical analysis.

Results: The total study population was 65. The mean age of the patients was 45.5 and 83% of the patients were female. The incidence of postoperative hypocalcemia was noted to be 37%. Pre-operative serum calcium (p<0.0001) was found to be significant risk factor (p<0.05) for prediction of post-operative hypocalcaemia. The same was not noted between variables like age, gender and type of thyroid disease and incidence of hypocalcemia.

Conclusions: A thorough knowledge of normal anatomy of neck, possible anatomical variations and parathyroid physiology is of paramount importance to prevent complications during thyroid surgery. Early identification of hypocalcemia can be achieved only by stringent postoperative monitoring, which in turn will reduce morbidity to the patient.