International Journal of Otorhinolaryngology and Head and Neck Surgery

Pediatric otitis media post cochlear implant retrospective cohort study

Abdallah Atwa El Deghadey — 2023-02-23

Background: A cochlear implant (CI) is a greatly effective therapy for severe to profound deafness. This study aims to examine the prevalence of otitis media (OM) in children after CI and its impact on the device’s integrity with reporting the various management policies and results.

Methods: This retrospective cohort study included 307 children, aged one to five years, who had CIs performed by the surgical team between January 2016 and December 2019. A detailed pre, intra, and postoperative data collected from these patients’ medical records was reviewed retrospectively by the same surgical team.

Results: There is a statistically significant difference in the distribution of OM in the operated ears; the p value was <0.001. There is a statistically significant association between post-implant OM and getting implantation, as the p value was <0.001. Multivariate analysis showed significant associations between post-implant OM and a history of receiving vaccination (no), a perioperative history of otitis media with effusion (yes), and a history of recurrent tonsillitis and enlarged adenoids (yes) (p value< 0.05).

Conclusions: In children, the prevalence of developing post-implant OM in the implanted ears does not rise, but rather falls, contradicting the theory that foreign bodies may aggravate the infection. Our findings supported the safety of CI in children with a history of post-implant OM, as all cases of post-implant OM were managed medically, with no additional surgical intervention required. Furthermore, no case had any significant complications, such as meningitis, or had a negative impact on the device's integrity.

Estimation of triple prognostic factors: serum ferritin, D-dimer and HbA1c levels in post-COVID mucormycosis patients: a cross-sectional observational study

Nishant Gupta — 2023-02-07

Background: India was furiously hit by the second wave of COVID-19 that peaked during the months of April and May 2021. It led to an unprecedented number of rhino-orbital-cerebral mucormycosis cases that came as a bitter surprise. Several parameters were found to be consistently elevated in the patients like serum ferritin, D-dimer, and HbA1C.

Methods: A cross-sectional observational study was conducted at the SMS medical college that included 120 patients presenting with post-COVID mucormycosis from 1^st May to 31^st May 2021. HbA1c, D-dimer, serum ferritin levels were measured at the time of admission.

Results: Our study showed a mean range of serum ferritin of 539.6±484.9, mean D-dimer range was 636.3±303.5, both of which were higher than normal. In the present study 94.1% of the patients had diabetes mellitus. Among them 60.80% of the patients had newly detected diabetes and 33.30% were known cases of diabetes with mean HbA1c 9.7±2.3. The p value was less than 0.001 which was statistically significant.

Conclusions: Timely detection and categorization of the patients based on severity of the above parameters can not only help in executing the existing institutional resources but can also help in saving valuable lives, and preventing radical surgical procedures like orbital exenteration and maxillectomy.

Foreign bodies in the ear, nose and throat: an experience in a tertiary care hospital

Sandip M. Parmar — 2023-02-23

Background: The aim of this study was to analyze foreign bodies in terms of type, site, age and method of removal.

Methods: A prospective study was performed in the department of ENT, head and neck surgery in the tertiary care hospital of Muzaffarnagar medical college, Muzaffarnagar, UP. The study population includes the number of patients with ENT FB lodgment who presented in the outpatient department or in the Casualty room during the 1-year study period (June 2021 to May 2022).

Results: A total of 83 patients had FBs in the ear, nose, or throat during the study period. Of the 83 patients, 38 (45.7%) had FB in the ear, 31 (37.34%) in the nose, and 14 (16.8%) in the throat. The FB was animate (living) in 11 (28.9%) patients with FB in the ear and 02 (6.45%) patients with FB in the nose. The FB was inanimate (non-living) in 14 (100%) patients with FB in the throat, in 27 (71.05%) patients with FB of the ear, and in 29 (93.54%) patients with FB of the nose. The FB was removed with or without local anesthesia in 66 (79.51%) patients, only 17 (20.48%) patients required general anesthesia. The most common age group affected was <10 years.

Conclusions: The ear was the most common site for foreign bodies in young children followed by the nasal foreign bodies and throat (esophageal>inhaled) foreign bodies.

A case series of mucormycosis, post COVID-19 in a tertiary care centre

Lakshmi Priyanka Chillapalli — 2023-02-23

In the 3rd wave of COVID-19 especially in India, an associated angio-invasive opportunistic infection with mucormycosis is emerged. The clinical, imaging and treatment data of 22 patients with mucormycosis was analyzed. Clinical features observed are periorbital swelling, facial pain, swelling of cheek, nasal discharge, dental pain associated with loose tooth. Imaging demonstrated PNS, orbital and intracranial extension in 100%, 55%, 20% patients respectively. All received ampho-B and underwent endoscopic debridement, 20% orbital decompression and 5% maxillectomy, 2 patients died. The association of hyperglycemia and steroid intake warrants judicious use of corticosteroids and optimal glycemic control. Good clinical outcome is achieved by aggressive surgical debridement and antifungal medication with optimal glycemic control.

Unusual cause of ear wax

Sonali Malhotra — 2023-02-23

Sir,

We were provoked to write this short piece after we encountered around 50 cases presenting to us in Otorhinolaryngology OPD (from August 2020 till May 2021) at our institution with an atypical cause of ear wax. The current COVID-19 pandemic has imposed the worldwide use of masks in addition to social distancing. With this background, we present an interesting cause of ear wax. We had 186 patients coming to the OPD with ear wax out of which only 50 adult patients never had accumulation of wax before. Patients using ear buds on regular basis, using earphones/ headphones for prolonged durations i.e., more than one hour/day, history of ear discharge or any otological surgeries in the past, using masks with strings were excluded from the study.

Foreign body in the right nasal cavity secondary to embedded dacryocystorhinostomy tube

Mohamed Al-Arayedh — 2023-02-23

A 39-year-old male patient was presented with foreign body sensation eight months post unilateral dacryocystorhinostomy (DCR) tube procedure in his right lower Punctum. On examination, the (silicon-based stent) was patent on the right orbital Punctum. However, the nasal element of the DCR tube was undetected during examination using the nasal speculum. endoscopic examination of the nasal cavity failed to reveal the nasal portion of the tube. None of the approaches performed were successful to detect the exact site of the stent. Therefore, the patient was transferred to the theatre to remove the tube surgically under general anaesthesia. In the operating table, endoscopic examination of the right nasal cavity revealed a granuloma over the nasal portion of the tube, embedded in the lateral nasal wall. Accordingly, the granuloma was then suctioned, which led to the appearance of the DCR tube. The tube was then removed, and the patient established a patent nasal airway. The patient was discharged on the same day, with no postoperative complication. As per the presented case, the following case report will be discussing the potential causes that might have led to the granuloma formation. We aim in the analysis of this case to scale down post DCR procedure complications by comparing the efficacy of silicon-based stents to other type of stents, as to guide surgeons into a safer and lesser invasive approach. In the majority of complicated DCR procedures with granuloma formation, the granulomas are suctioned in a clinical setting. However, the patient needed a more invasive approach, by removing the granuloma surgically to establish a patent nasal airway.

Myoepithelioma of parotid gland: a case report

Ricardo Costa S. Lemos — 2023-02-23

Myoepithelioma (ME) is a benign tumor, arising predominantly from major and minor salivary glands (SG). Clinically, it presents as a painless mass with a slow growth. In our case report, this lesion occurred in a 51-year-old man, and presented as a well-defined oval mass on the right parotid region. The magnetic resonance imaging study confirmed the presence of a lesion with benign features that was excised surgically by partial superficial parotidectomy. The histopathological and immunohistochemical analysis confirmed the diagnosis of parotid ME. Other SG tumors such as pleomorphic adenoma are differential diagnoses of ME. Complete surgical excision reduces the rate of recurrence.

An unusual case of meat bolus impaction in an adult

Sonali Malhotra — 2023-02-23

Esophageal food impaction is a common emergency faced by ENT surgeons and gastroenterologists. It is important to know what techniques and instruments are indicated for different situations. Endoscopic treatment is a reliable and safe procedure in skilled, expert hands with a high success rate and low morbidity and mortality.

Mandibular adenomatoid odontogenic tumor: case report

Kulbhushan Bali — 2023-02-23

Adenomatoid odontogenic tumor (AOT) is a rare tumor of epithelial origin which accounts for 3% of odontogenic tumors. The most common area of involvement is the maxilla, about 65% of cases, followed by the mandibular region accounting to 35% of cases. This case report is of a 16 year old girl operated and diagnosed with AOT at the anterior aspect of the mandible. This case report also discussed about the necessity for a detailed descriptive, differentiating features of AOT from other odontogenic tumors, the most common misdiagnosis being dentigerous cyst.

The impacted oro-pharnygeal fish bone-surgeon’s dilemma

Manish Munjal — 2023-02-23

Pisces are a delicacy on the table of almost every non-vegetarian household. Unfortunately, pharyngeal impaction of fish bones is a frequent emergency in the oto-rhino-laryngological clinics or trauma units of tertiary health care facilities. Sequentially the sites of retention noted are the lymphoid tissue of tonsillar fauces, the coffin corner, the base of the tongue, either valleculae and the pyriform sinuses. Lancinating pain on deglutition with a typical history is diagnostic, therapy necessitating timely intervention to avoid an untoward sequel. It poses a queer situation for the laryngologist whether to go ahead and straightaway attempt to extract the same under local anesthesia or wait for the requisite 6 hrs for administration of general anesthesia. The waiting duration being equally painful and a testing period for the patient and the surgeon alike. The latter is more apprehensive about deeper migration of the bone. The out-patient extraction in a cooperative individual was undertaken with a three-handed modality, adopting an angled viewing telescope and respective instrumentation.