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Intl. J. of Advances in Medicine     Open Access   (Followers: 2)
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Intl. J. of Community Medicine and Public Health     Open Access   (Followers: 5)
Intl. J. of Contemporary Pediatrics     Open Access   (Followers: 4)
Intl. J. of Otorhinolaryngology and Head and Neck Surgery     Open Access  
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Intl. J. of Scientific Reports     Open Access   (Followers: 1)
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Journal Cover International Journal of Otorhinolaryngology and Head and Neck Surgery
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   ISSN (Print) 2454-5929 - ISSN (Online) 2454-5937
   Published by Medip Academy Homepage  [12 journals]
  • Pattern of neck masses in adult patient in southern region KSA

    • Authors: Jibril Yahya Hudise
      Pages: 1 - 4
      Abstract: Background: Many head and neck diseases manifest as neck masses with a wide range of developmental lesions to malignancies. A neck mass can be defined as any abnormal growth or development from the skull base to the level of the clavicle. This retrospective study to assess the distribution of neck masses related to gender, age, pathology, and anatomical location of neck masses in Asir Central Hospital. Methods: During a 5-year period (2011–2016), the medical records of 158 patients with neck masses were collected from the department of pathology at Asir Central Hospital KSA. The cases were reviewed for data on gender, age, pathology, and the anatomical location. Comparisons between genders, age groups, and tissue origins were performed. We divided the age to 4 categories: from 15 to 30 years, 31 to 45 years, 46 to 60 years, and more than 60 years. All statistical tests were performed with SPSS software. We exclude thyroid, parathyroid and salivary gland masses.  Results: Over a period of 5 years, a total of 158 patients (90 men and 68 women) had neck masses resected for pathological assessments. The age of presentation was ranging from 15 to 84 years. Among the 158 cases, 40.5% developed in (from 15 years to 30 years old), 24.7% developed in (31 to 45 years), 20.9% developed, in (46 to 60 years), and 13.9% developed in age more than 60 years. The histopathological diagnosis of the neck masses were congenital 10.1%, inflammatory 28.5%, benign tumor 5.7% and malignant tumor 55.7%. Conclusions: The age and location of neck masses are the most important variables. When a neck mass is seen, neoplasms should be considered in older adults inflammatory and congenital masses in children and young patients. Although the history, medical examination and additional diagnostic methods provide important information, the exact diagnosis may only be obtained by histopathological examination.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Chronic rhinosinusitis: the correlation between symptom severity score and
           findings on plain radiographs of the paranasal sinuses

    • Authors: Omoregie J. Idugboe, Bright Otoghile, Ibrahim O. Musa, Adeleke A. Adeosun
      Pages: 5 - 10
      Abstract: Background: Chronic rhinosinusitis (CRS) is a common clinical problem with often refractory symptoms. Though computed tomography scan of the paranasal sinuses (PNS) is the radiological gold standard for confirming the diagnosis of CRS, it is not readily available and affordable in developing countries. Hence plain radiographs are heavily relied upon to confirm the diagnosis of CRS. The reliability and adequacy of plain sinus radiographs in combination with disease specific questionnaires in the management of CRS is still debatable. The objectives of the study were to determine the correlation between symptom severity score and findings on plain radiograph of the PNS in adult patients with CRS.Methods: This was an eight month prospective cross sectional study (April-November, 2014) of Fifty- two consecutive newly diagnosed adult patients with CRS.  Results: Age of patients ranged from 19–91 years. Male to female ratio was 1:1.26. There was significant positive correlation between high and moderate symptom severity score (severe and moderate disease) with findings on plain radiograph of the PNS (p=0.032 and 0.048 respectively).Conclusions: The overall symptom severity score of CRS correlates with findings on the plain radiographs of patients with CRS especially in severe and moderate disease. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Relationship between tympanic membrane perforation and conductive hearing
           loss in patients with chronic otitis media

    • Authors: Amjed H. Ali, Isam M. Alshareda
      Pages: 11 - 17
      Abstract: Background: Study performed to evaluate relationship between surface area of tympanic membrane perforation and degree of hearing loss and the effect of perforation site on that relationship in patients with chronic otitis media. Methods: Seventy-five perforated tympanic membranes from 63 patients aged between 14-45 years with inactive mucosal chronic otitis media included in this study. Rigid endoscope (0 degree) used to take an image for each perforation that analyzed by Autodesk Design Review 2013 program. Degree of hearing loss assessed by pure tone audiometry. Surface area of perforation classified into four groups according to its percentage. Perforation site categorized into three groups regarding its relation to handle of malleus. Data analysis carried out with SPSS program version 17.  Results: We studied 34 females and 29 males with different surface area and site of perforations. It observed that with increment of surface area of tympanic membrane perforation, the degree of conductive hearing loss increases (P value=0.000). This relationship expressed in a logarithmic equation. The mean hearing loss of posterior perforation was 1.7±0.5 dB for each 1% of perforation but in anterior perforation was 1.5±0.6 dB for each 1% of perforation (p value 0.185). Conclusions: In chronic otitis media, there is a quantitative logarithmic relationship between surface area of tympanic membrane perforation and degree of conductive hearing loss. The site of perforation does not play a significant role in determining degree of conductive hearing loss.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Flexible nasoendoscopy decontamination: a comparison between Rapicide and
           Tristel wipes, a prospective cohort study

    • Authors: Yijin Jereme Gan, Alex Mathews, Phua Chuqin, Ivan Khoo, David Loke
      Pages: 18 - 23
      Abstract: Background: The current disinfection of nasoendoscopes in our clinic setting is a 3-step process involving Rapicide, a peracetic acid based disinfectant. Our study aimed to validate the efficacy of Tristel wipes, a chlorine dioxide based disinfectant, as a comparable alternative.Methods: We recruited a hundred volunteers undergoing routine flexible nasoendoscopic examinations in a general ENT. We used two separate endoscopes for each examination, following which a microbiological swab was sent from the tip of each nasoendoscope. The two nasoendoscopes were then subjected to a similar 3-step decontamination process except for the second step, where they were disinfected either tristel wipes or rapicide disinfectant. After decontamination, we took a second swab from the tip of each nasoendoscope.  Results: Out of 200 swabs from the tip of the nasoendoscopes prior to decontamination, there were 82 positive cultures for the Rapicide cohort and 76 positive cultures for the Tristel wipes cohort. Regarding the post decontamination results, there were four positive swab cultures for those disinfected with Tristel wipes and one positive swab culture for the Rapicide cohort. These were analyzed by the Z score and there was no statistical difference between either the pre-decontamination swabs or the post decontaminations swabs with the p-values at p=0.298 and p=0.174 respectively. The efficacy of decontamination for the Rapicide solution was 98.8% compared to 94.7% for the Tristel wipes with p=0.147.Conclusions:This study validates the efficacy of Tristel wipes as a comparable alternative to peracetic acid based disinfectants for disinfection of flexible nasoendoscopes. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Powered endoscopic inferior turbinoplasty: clinical study

    • Authors: Sajad Al-Helo, Hasanain Falih, Ahmed Jumma
      Pages: 24 - 31
      Abstract: Background: Nasal obstruction is a common complaint in ENT clinics and significantly affect the patient`s quality of life. Inferior turbinate hypertrophy is one of the common causes of nasal obstruction, surgical reduction of inferior turbinate is indicated in refractory cases not responding to conservative measures and the optimal surgical technique is controversial. The aim of the study was to evaluate the clinical outcomes of powered endoscopic inferior turbinoplasty in the management of inferior turbinate hypertrophy. Methods: An interventional study (single group clinical trial) was conducted and powered endoscopic inferior turbinoplasty was performed on 30 patients complaining of chronic nasal obstruction due to inferior turbinate hypertrophy and other causes of nasal obstruction were excluded.  Results: Assessed preoperatively and 1st week, 1st month and 3rd month postoperatively depending on subjective visual analogue scale scores for nasal obstruction, endoscopic grading system and complications. There was significant improvement in nasal obstruction and significant reduction in inferior turbinate size and mild complications that completely absent at the third month following the surgery. Conclusions: Microdebrider-assisted inferior turbinoplasty as a safe, effective and reliable alternative method for inferior turbinate reduction.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Management of labyrinthine fistula using Surdille flap

    • Authors: Rashmi P. Rajashekhar, Vinod V. Shinde
      Pages: 32 - 37
      Abstract: Background: Labyrinthine fistula (LF) is the most common intra-temporal complication of squamosal chronic otitis media represents an erosive loss of endochondral bone overlying the semicircular canals without loss of perilymph. Main treatment of LF is surgical. The aim of our study is to discuss its incidence and sex ratio. The main objective is to describe the audio-vestibular results after closure of labyrinthine fistula by our technique using surdille flap. Methods: 234 patients with squamosal chronic otitis media presented to our institution in a period of 24 months. Out of 234 patients, 22 patients were having labyrinthine fistula. Eleven patients had fistula test positive. Rest eleven patients were found to have LF intra-operatively. All patients underwent canal wall down modified radical mastoidectomy (MRM). Treatment of LF was done surgically by using surdille flap in all the cases. Post operatively Audio-vestibular results of labyrinthine fistula surgery by our technique were studied.  Results: The results show that the cholesteatoma matrix can be removed from the fistula. Removal of the fistula generally improves the vestibular symptoms. In all patients canal wall down procedure was done with surdille flap seal over LF. In our study, incidence of LF was 9.40% and none of the patients ended up with postoperative deafness. Hearing improved in 36.40% patients whereas it remained unchanged in rest of the cases. Conclusions: Labyrinthine fistula, very commonly seen in the lateral semicircular canal has incidence of 5-10% reported in many studies. We demonstrated that open technique with removal of matrix and sealing with three layers may be a valuable choice for the surgical treatment of LF with little risk for cochlea-vestibular functions. Advantage of using surdille flap (sealing the fistula with three layers) is that it decreases the possibility of postoperative vertigo.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Surgical management of facial nerve palsy: our experience

    • Authors: Devang P. Gupta, Shreya Rai, K. S. Dinesh
      Pages: 38 - 40
      Abstract: Background: Facial nerve palsy is a challenging task to deal with in patients as it has medical as well as social implications. The aim of this study was to examine the efficacy of different surgeries for facial palsy according to pathology and the ideal time for surgery. Methods: This prospective study was conducted with the help of a structured proforma for history and examination. Defined diagnostic tests were performed and depending on complexities of cases, different surgical approaches were done.  Results: A total of 50 patients with secondary facial nerve palsies were included in our study and after thorough evaluation surgical management was planned. Ninety two percent were treated with facial nerve decompression, 4% with neurorrhaphy of the nerve and another 4% with cable graft. Conclusions: High prevalence of facial nerve palsy in today’s era necessitates early diagnosis and management in order to prevent complications and thereby reducing the risk of permanent disfigurement.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • A prospective observational study of comparison of tympanoplasty using
           endomeatal approach using tragal cartilage and perichondrium with post
           auricular approach using temporalis fascia graft: an institutional study

    • Authors: V. Krishna Chaitanya, N. Janardhan, Teja ., Vinay Singh Bhat, Rajaram .
      Pages: 41 - 44
      Abstract: Background: Evaluation of success of tympanoplasty depends on various host and surgical factors has been subject of interest for many years and still continues to be challenge. Methods: Present study was undertaken to observe results of type I tympanoplasty using tragal cartilage and perichondrium with temporalis fascia grafts using endomeatal and postauricular approach.  Results: Study group comprises of 30 patients in Group A and B operated by tympanoplasty type I by endomeatal and postauricular techniques. Success was 96.3% in Group A and 94.7% in Group B for closure of membrane perforation. During postoperative period average time taken for wound healing was 23 days in Group A and 35 days in Group B. Preoperative and postoperative assessment of hearing performed with pure tone audiometry revealed an average hearing loss of 36.50 dB in Group A before surgery and postoperative assessment at end of 1 year revealed hearing improvement of 14.23 dB. In Group B preoperative assessment revealed hearing loss of 38.23 dB lowered to 15.12 dB after surgery. When hearing improvement in both groups were compared preoperatively and postoperatively, in Group A there was improvement of 22.27 dB while in Group B was 23.11 dB. The hearing improvements in both the groups appear to be similar when the results were compared. In present study overall success rate was 89.7% which is comparable to outcome of surgery performed with post auricular approach with temporalis fascia graft which is 91.3%. When postoperative complications were studied it was observed that Group A had fewer numbers of complications as over Group B which was documented in Table 2. Conclusions: Success of tympanoplasty depends on several host and surgical factors. Tragal perichondrium appears as proven alternate for closure of perforation of tympanic membrane. Cosmetically endomeatal approach appears promising over post auricular approach.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Audiological evaluation in between patients with type 1 tympanoplasty
           alone and type 1 tympanoplasty with cortical mastoidectomy

    • Authors: K. Mallikarjuna Swamy, Arati Ganiger
      Pages: 45 - 49
      Abstract: Background: Evaluation of success of tympanoplasty depends on various host and surgical factors has been subject of interest for many years and still continues to be challenge. Methods: Present study was undertaken to observe results of type I tympanoplasty using tragal cartilage and perichondrium with temporalis fascia grafts using endomeatal and postauricular approach.  Results: Study group comprises of 30 patients in Group A and B operated by tympanoplasty type I by endomeatal and postauricular techniques. Success was 96.3% in Group A and 94.7% in Group B for closure of membrane perforation. During postoperative period average time taken for wound healing was 23 days in Group A and 35 days in Group B. Preoperative and postoperative assessment of hearing performed with pure tone audiometry revealed an average hearing loss of 36.50 dB in Group A before surgery and postoperative assessment at end of 1 year revealed hearing improvement of 14.23 dB. In Group B preoperative assessment revealed hearing loss of 38.23 dB lowered to 15.12 dB after surgery. When hearing improvement in both groups were compared preoperatively and postoperatively, in Group A there was improvement of 22.27 dB while in Group B was 23.11 dB. The hearing improvements in both the groups appear to be similar when the results were compared. In present study overall success rate was 89.7% which is comparable to outcome of surgery performed with post auricular approach with temporalis fascia graft which is 91.3%. When postoperative complications were studied it was observed that Group A had fewer numbers of complications as over Group B which was documented in Table 2. Conclusions: Success of tympanoplasty depends on several host and surgical factors. Tragal perichondrium appears as proven alternate for closure of perforation of tympanic membrane. Cosmetically endomeatal approach appears promising over post auricular approach.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Study of quality of life outcome after adenotonsillectomy in children with
           sleep disorderd breathing

    • Authors: Arshed Ali, Jasif Nisar, Ihsan Ali, Rauf Ahmad
      Pages: 50 - 55
      Abstract: Background: This prospective study was conducted in our department with the objective to study the quality of life outcome after adenotonsillectomy in children with sleep disorderd breathing. Sleep-disordered breathing, can lead to substantial morbidities, affecting the central nervous system (CNS), the cardiovascular and metabolic systems, and somatic growth, ultimately leading to reduced quality of life. Methods: This prospective study was conducted in 47 patients in the Department of Otorhinolaryngology Head and Neck Surgery, Government Medical College and associated SMHS Hospital Srinagar. The study was included the patients with SDB in pediatric age group, who visited in our OPD.OSA-18 questionnaire was used pre-operatively, at 2 and 6 months after surgery.  Results: Our study groups comprised of total 47 patients with majority of patients with in age group of 5-7 years, males were 29 (61.70%) and females were 18 (38.30%). In our study the OSA 18 scale used pre-operatively showed majority of patients 33 (70.21%) having score >80 score, with mean OSA-18 score of 84.15 showing that there was a major impact on quality of life and there was significant improvement in mean OSA-18 score in postoperative period from 30.49 to 26.85 at 2 and 6 months post- operatively and hence improvement in quality of life. Conclusions: Based on the observation made in the study we concluded that there was a significant improvement in the disease specific postoperative quality of life after both adenotonsillectomy and tonsillectomy. We also concluded that polysomnography results matched with OSA 18 questionnaire scale score done preoperatively.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Otoendoscopic management of small to medium sized tympanic membrane

    • Authors: Showkat A. Showkat, Nadhia Bhagat, Kiran Bala, Aamir Yousuf
      Pages: 56 - 59
      Abstract: Background: Chronic suppurative otitis media (CSOM) is a wide spread disease of developing countries like India especially in rural areas. A perforated tympanic membrane results in loss of hearing due to decreased drum area and liability to recurrent infection of the middle ear mucosa. Methods: A prospective study was conducted over a period of 18 months in the Department of ENT, HNS, Government Medical College, Srinagar with total of 36 patients were enrolled.  Results: This study consists of male 12 and 24 females mean age 32 yrs hearing loss average 26 db. Management methods were grouped in group A, B, C and D fat myringoplasty, chemical cauterization (trichloroacetic acid), fat myringoplasty + chemical cauterization: and transcanal transtympanic myringoplasty using tragal perichondrium respectively with least success seen in group B 55% and 100% seen in group D. Conclusions: Otoendoscopic management of small to medium sized TM perforations with different methods is a cost effective, less traumatic procedure, cosmetically better and functionally effective in terms of hearing improvement. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • A comparative study of the outcomes of temporalis fascia graft versus
           tragal perichondrium graft in type 1 tympanoplasty in our experience

    • Authors: Santhanakrishnan K., Poornima S. Bhat
      Pages: 60 - 62
      Abstract: Background: COM causes considerable morbidity with ear discharge, conductive hearing loss and complications. Type 1 tympanoplasty is a surgical procedure which intends improves the hearing and quality of the life. Comparison of the outcomes will help to determine the merits or demerits of a particular graft. Methods: The study was conducted in the department of ENT, SMVMCH, Pondicherry from April 2015 to April 2017. A detailed history taking, thorough clinical examination done for these patients. PTA was done before the procedure, post operatively at 3rd month. Hearing improvement analysed using different parameters like type of graft used, hearing gain, graft uptake; the data collected was tabulated and subjected to statistical analysis.  Results: All the patients had COM, mucosal type, with conductive hearing loss of <40 dB. 23 patients underwent type 1 tympanoplasty by underlay technique using temporalis fascia, 19 patients using tragal perichondrium. There was no significant difference in total hearing gain at 3rd month and graft uptake between temporalis fascia and tragal perichondrium. Conclusions: This study compared the outcomes of temporalis fascia and tragal perichondrium graft with respect to hearing gain and graft uptake. Tragal perichondrium graft equally effective as temporalis fascia graft in terms of hearing gain and graft uptake.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Morphometric analysis of human cricoid cartilage: a cadaveric study

    • Authors: Viswanathan Anand, Harikesh Sharma, Ashwani Sethi, Satyanjaya Sahoo
      Pages: 63 - 67
      Abstract: Background: Cricoid cartilage is the only complete ring that surrounds the airway completely. Although it is smaller than thyroid cartilage and does not house any important structures like the thyroid cartilage (vocal folds), it forms an important cog in the upper airway. Renewed interest in subglottic stenosis recently has underscored the importance of detailed knowledge of cricoid cartilage. This study aims to augment the meagre information available on this important part of upper airway. Methods: Study design was on morphometric analysis and the setting was at tertiary health care centre. Thirty one adult human cadaveric larynges were obtained for this study. Using an electronic vernier caliper, different morphometric parameters of all the cricoid cartilages were noted down in a predesigned proforma in standard computer office software. The data thus obtained was collated and compared with existing literature.  Results: The average inner transverse diameter (F: 15.05±1.02 mm; M: 17.52±2.64 mm) is greater than the average inner antero-posterior diameter (F: 12.71±0.45 mm; M: 14.11±2.55 mm). The average height of cricoid arch was F: 6.50±0.68 mm; M: 7.69±0.63 mm and the average height of cricoid lamina was F: 18.38±0.61 mm; M: 21.17±2.31 mm. Conclusions: Inter specimen disparity was noted in the various dimensions measured in the cricoid cartilages. The average transverse diameter was greater than the average antero-posterior diameter giving the cartilage an ovoid shape in nearly all specimens. Morphometrical data of the cricoid cartilage may be very useful in endotracheal intubation, laryngeal microsurgery and laryngeal framework surgery. These parameters can be helpful in evaluation of subglottic stenosis and its surgical repair. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • A study of clinical profile of patients with CSOM attending tertiary care

    • Authors: Faiz Muqtadir, Rahul S.
      Pages: 68 - 70
      Abstract: Background: Proper management of COM is significant because it is an important cause of middle ear disease. After complete history, thorough clinical examination, the disease is diagnosed. The persistent infection and resultant inflammatory responses are tackled with effective pharmacotherapy. Audiological assessment done by pure tone audiometry for air and bone conduction in order to evaluate and document. Methods: Total 50 patients diagnosed with CSOM attending the ENT OPD of Medical College were prospectively analysed. Patients fulfilling the selection criteria were included in the study after taking informed consent. All the patients in the study were clinically evaluated by taking detailed history and clinical examination including TFT, as per the proforma.  Results: The mean age of our patients was 28.88 years, ranging from 16 years to 52 years; with almost 75% between 15 and 35 years. 20 patients each had CSOM in the right as well as left ear and 10 suffered from bilateral CSOM. Conclusions: Recurrent ear infection will cause hearing impairment over the years as a result of mucosal changes in the windows and ossicles. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Prevalence of Pseudomonas aeruginosa in CSOM cases at a tertiary care

    • Authors: Deepthi Maringanti, Ganapuram J. Archana
      Pages: 71 - 75
      Abstract: Background: Chronic suppurative otitis media (CSOM) is an infectious chronic ear disease in India characterised by discharge from ear. This is the commonest infection in children more so in low socio economic group. CSOM is caused by various gram positive and gram negative organisms.Methods: Study group includes CSOM patients coming to ENT Department of Kamineni Institute of Medical Sciences, Narketpally, Telangana, India. Swabs were taken from discharging ears and sent for Gram’s staining, culture and antibiotic sensitivity. The results were analysed and a protocol was devised for effective treatment of Pseudomonas aeruginosa.  Results: Total numbers of study group were 180 of. 180 patients, 84 were males and 96 were females. CSOM infection was found to be more common in 11-30 yrs age group. When the ear discharge was sent for culture and sensitivity only 106 patients out of 180, showed culture positivity. Pseudomonas aeruginosa was the most common organism identified. Its prevalence in the present study was 23%. Methicillin Resistant Staphylococcus aureus (MRSA) and Klebsiella sps were the next common isolates, whose prevalence was detected to be 10% and 8% respectively. Pseudomonas is resistant to all routine broad spectrum antibiotics like amoxicillin, ampicillin and amoxycillin - clavulanate and cephalosporins, but sensitive to ciprofloxacin, gentamycin, imipenem, meropenem, piperacillin.Conclusions: CSOM is common among children and young adults. Pseudomonas aeruginosa was the most common isolate (23%) in our study. As Pseudomonas was found to be resistant to routine antibiotics, inadvertent use of routine antibiotics will lead to the development of multidrug resistant strains in the community which are difficult to treat. Specific antibiotic treatment should be started based on the culture and antibiotic sensitivity report of the swab.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Prevalence of Pseudomonas aeruginosa in cholesteatoma patients in tertiary
           care hospital in North India

    • Authors: Vikram Singh Rathore, Kamlesh Kanwar Shekhawat
      Pages: 76 - 79
      Abstract: Background: Chronic suppurative otitis media (CSOM) is middle ear infection that lasts for more than three months and is accompanied by a perforation of tympanic membrane. Cholesteatoma is a well know complication of CSOM. Prevalence of CSOM varies between racial and socioeconomic groups. The aim of present study was to determine the principal bacteria in ear discharge in patients with cholesteatoma. Methods: This was a prospective study conducted in department of ENT in tertiary care hospital and medical college in north India from March 2017 to May 2017.Total 80 patients attended ENT OPD with complain of ear discharge and deafness during the study period, but only 47 patients were clinically diagnosed unsafe type of CSOM or cholesteatoma. Ear swabs were collected and send for microbiology laboratory for bacteriological process.  Results: Out of 80 patients, 47(58.75%) were clinically diagnosed cholesteatoma and of 29(61.70%) were male and 18(38.29%) were female. Most commonly affected age group was between 10 to 20 year (40.42%) followed by 21 to 30 (21.27%). More than 60 Year was less affected by cholesteatoma. Most common isolated organism was Pseudomonas aeruginosa (66.66%) followed by Klebsiella pneumonia (19.44%) and we used Piperacillin tazobactum and amikacin, and ciprofloxacin in all cases in perioperative period and noticed good response and modified radical mastoidectomy was done in all patients. Conclusions: P. aeruginosa was found to be the most common isolate in CSOM with cholesteatoma case and piperacillin-tazobactum, amikacin, and ciprofloxacin was found to be cost effective antibiotics.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Role of MRI in audio-vestibular dysfunction; is it cost-effective'

    • Authors: Ali Amer Al-Barki, Jibril Yahya Hudise, Nadeem Malik, Montasir Junaid, Ali Almothahbi
      Pages: 80 - 82
      Abstract: Background: Till date, debate still exists among researchers regarding the use of magnetic resonance imaging (MRI) in all the cases presenting as asymmetrical sensorineural hearing loss (SNHL). The objective of the study was to investigate cost-effectiveness of MRI for evaluating patients with audiovestibular symptoms. Methods: A retrospective study was carried out included all adult patients (>12 years) presenting over a 12 month period between November 2014 and October 2015 at Otolaryngology department clinic, Armed Forces Hospital. Khamis Mushait, Saudi Arabia with asymmetrical sensorineural hearing loss (sudden or progressive) and have underwent MRI of cerebellopontine angle and internal auditory meati for evaluation of audiovestibular symptoms.  Results: The study included 52 patients with audiovestibular symptoms. Their mean age (±SD) was 46 (±13.9) years and almost two-thirds of them (65.4%) were males. Majority of them were presented with deafness (84.6%). Vertigo and tinnitus were presented in 38.5% and 53.8% of them, respectively. Over the studied 52 patients, MRI of cerebellopontine angle yielded no detectable lesion in any case. Conclusions: MRI was not cost-effective, so it is important that clinical and audiometric indications for MRI referral criteria should be reviewed and analyzed to ensure cost-effectiveness of MRI in detecting audiovestibular dysfunctions, particularly in situations with financial restraints and long waiting time.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Assessment of depth of olfactory fossa in pre-functional endoscopic sinus
           surgery computed tomography scan of paranasal sinuses

    • Authors: Abhijit Pawar, Santosh Konde, Priya Bhole
      Pages: 83 - 86
      Abstract: Background: To evaluate the olfactory fossae depth according to the Keros' classification on pre functional endoscopic sinus surgery (pre-FESS) and determine the incidence and degree of asymmetry in the height of the ethmoid roof in the population of western Maharashtra. Methods: Retrospective analysis of 200 multidetector CT studies (400 sides) of paranasal sinuses performed in between January to August, 2017.  Results: According to the Keros’ classification, the incidence of different types of olfactory fossae was as follows: type I: 18.5%, type II: 74.5% and type III: 7%. Asymmetry in the ethmoid roof height was found in 11.5% of cases. Conclusions: Keros’ type II was the commonest followed by type I and type III. There was asymmetry in the depth of the olfactory fossae in 11.5% cases. There was no significant gender predilection as far as type and asymmetry were considered.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • High resolution computed tomography of temporal bone in the evaluation of
           otologic diseases

    • Authors: Prakash S. Handi, Mallikarjun N. Patil, Nisha P.
      Pages: 87 - 92
      Abstract: Background: Conventional radiological methods like X-ray mastoid have limited ability to delineate the details of the complex temporal bone and cochlea-vestibular anatomy and disease pathology. This can be overcome by the use of High resolution computed tomography (HRCT) evaluation of the temporal bone. HRCT is helpful in evaluating the anatomy and pathology type and extent of disease, thereby helps in preoperative planning. Methods: The CT scan of forty five patients attending the outpatient department of otorhinolaryngology in a tertiary care centre between August 2014 to August 2017 was evaluated in this study. Each CT scan was interpreted by an otolaryngologist and a radiologist and interpretation was by consensus. The data collected was evaluated and results are reported as rates and proportions (%).  Results: The study evaluated CT scan of 45 patients of which 35 were male patients and 10 were female patients with age ranging from 5 years to 75 years. Most of these patients belonged to the 21-30, 31-40 age groups [9 (20%) in each group]. Infections of middle ear cleft (all with cholesteatoma), fractures of the temporal bone, anomalies and tumors of the external auditory canal and middle ear were the pathologies observed in these CT scans with infection (otomastoiditis) [23 (51.1%)] being the most common pathology observed. Conclusions: Pre-operative CT scan may not only help in identifying the nature, extent of infectious disease including ossicular, bony erosions; it may also identify anomalies in the temporal bone and surrounding structures. Thus, HRCT temporal bone will help the surgeon in planning effective surgical strategy, reducing morbidity during the surgery.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Mastoidectomy: retrospective analysis of 137 cases in a tertiary care

    • Authors: Jaya Chrisanthus, Shibu George
      Pages: 93 - 99
      Abstract: Background: Mastoidectomy is a common otologic surgery and at times can be a lifesaving procedure. The aim of the study is to analyze surgical indications, operative parameters and per-operative findings encountered. Methods: This is a retrospective study done in patients who had undergone mastoid surgeries between 1st Jan 2016 to 31st Dec 2016 in the Department of Otorhinolaryngology, Govt. Medical College hospital, Trivandrum.  Results: Of the 137 patients the peak age incidence was 16 – 30 years. Cholesteatoma was present in 32% of which 91% had canal wall down mastoidectomy. 64% patients, mostly chronic otitis media- mucosal and inactive squamosal, underwent canal wall up procedure. In 62% cases the ossicular chain was eroded, which was mainly incus (87%). Abnormalities encountered within the mastoid during surgery were mainly dehiscent facial canal (17.5%), low lying dura (16.8%) and contracted antrum (15.3%). A positive association could be noted between contracted antrum and the position of sinus and dural plates, and was statistically significant. Co-existence of facial canal dehiscence with lateral canal fistula and dural plate dehiscence were also noted. The tympanoplasty procedures commonly employed in canal wall up procedures was Type I and 2, and in canal wall down procedure was Type 3. Conclusions: Adequate skill development of the ear surgeons in the tertiary centre should be ensured, to individualize the procedure appropriate for each patient and optimize the outcome of surgery. Early referral to the nearby otological centre should be promoted not only to prevent complications but also for better post-surgical functional outcome.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Study of anatomical variants at osteomeatal complex in cases of chronic
           maxillary sinusitis

    • Authors: Aditya Pathak, Ramanand Yadav
      Pages: 100 - 102
      Abstract: Background: To study the contribution of anatomical variations at osteomeatal complex area in development of chronic maxillary sinusitis.Methods: 60 patients with chronic maxillary sinusitis, clinically diagnosed on the criteria layed by Lanza and Kennedy and radiologically supported by X-ray PNS, were included in the study. Nasal endoscopy with different angled endoscopes done under local anaesthesia to recognize the anatomical variants at osteomeatal complex area.  Results: In 41.09% of cases anatomical variants like concha bullosa, paradoxical middle turbinate, large bulla ethmoidalis or medially bent uncinate process were detected, but in rest 59.91% of cases of maxillary sinusitis there was no anatomical abnormality.Conclusions: Among the causative factors for development of chronic maxillary sinusitis different anatomical variants at osteomeatal area causes narrowing of the drainage pathway of maxillary sinus leading to development of chronic inflammation of the maxillary sinus. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Various techniques of grafting in anterior perforation of tympanic
           membrane: our experience

    • Authors: Preeti S. Raga, Amrith Laal Waghre
      Pages: 103 - 106
      Abstract: Background: The lack of anterior support for the graft frequently leads to graft failure if an underlay method is used whereas anterior blunting is a complication of overlay techniques in the anteriorly located tympanic membrane perforations. The objective of the study was to evaluate the correct surgical technique for the reconstruction of anterior tympanic membrane perforation.Methods: Our prospective study was conducted from January 2011 to December 2013. This study included 39 patients of either sex, 17-56 years of age groups, at Kamineni Institute of Medical Sciences Narketpally, Nalgonda district, Telangana state. Our surgical experience with a) Simplified underlay technique-in small perforations having healthy remnant in10 patients. b) Button hole and slitting the graft- in thin atrophic ring anteriorly in 25 patients. c) Gerlach’ quilting procedure- in inadequate anterior rim in 3 patients and d) Kerr flap-in only anterior rim annulus in 1 patient.  Results: All these methods gave 91.96% closure rate, a mean auditory threshold gain of 8.5 dB was achieved at the frequencies tested. Conclusions: Here we describe and promote the various techniques of placing grafts in anterior perforations of tympanic membrane, thereby attaining the aforementioned benefits and reducing the incidence of complications.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • A study of hearing improvement gained after tympanoplasty using various
           methods in cases of CSOM

    • Authors: Faiz Muqtadir, Rahul S.
      Pages: 107 - 111
      Abstract: Background: Chronic otitis  media  (COM),  is  a  common  ailment  with  which patients  present  to  the  ENT  OPD.  In patients with COM, the active infection needs to be controlled following which the definitive line of management is surgery. Tympanoplasty  is  the  surgery  performed  with  the  goals  of establishing  an  intact  tympanic membrane,  eradicating  middle  ear  disease, creating an  air-containing  middle  ear  space and  restoring  the  hearing  by  building  a  secure connection  between  the  ear  drum  and  the cochlea. Methods: 50 patients presenting with CSOM in ENT OPD at Medical College.  Preoperative audiometry was done before tympanoplasty, followed by post-operative audiometry after 3 months.  Results: The mean air-bone gap closure was 12.06 dB; with type I tympanoplasty with cortical mastoidectomy giving a maximum mean improvement of 16db. Minimum mean improvement of 1db was seen in type IV with modified radical mastoidectomy. Conclusions: Type I tympanoplasty with cortical mastoidectomy is a far superior method of surgical treatment of CSOM than all other methods.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Through and through suturing vs. window resection method in surgical
           management of seroma pinna: a comparative study

    • Authors: Raisa Priyadarshini, Subhalaxmi Rautray, Rajat Kumar Dash
      Pages: 112 - 114
      Abstract: Background: Seroma pinna is a collection of fluid between the auricular cartilage and the perichondrium. Seromas can occur spontaneously or after surgery or trauma. Depending on the nature of swellings and the symptoms, they can be distinguished from other conditions of the pinna. Successful treatment is challenging because of high rate of recurrence. Usual treatment used to consist of aspiration of the fluid and pressure bandage. Methods include using buttons as pressure splints, excising a piece of cartilage and perichondrium to cure recurrent seromas4,placement of a continuous portable suction drain has also been advised, suturing through and though after aspiration.Methods: In the first group of patients through and through suturing was done and in the second group window resection was done.  Results: The recurrence rate was 5% for the first group patients while 20% for the second group. The percentage of development of perichondritis was 5% for group A and 15% for group B.Conclusions: The method put forward in this study is a simple and effective way for its management. The avoidance of dressing is a positive factor and positive factor is that it can be done on an OPD basis.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Role of polysomnography in patients of snoring

    • Authors: Saurav Sachdeva, Karan Sharma, Nirmal Kajal
      Pages: 115 - 122
      Abstract: Background: A useful working definition of snoring is the production of sound by the upper aero digestive tract during sleep. Polysomnography (PSG) is the monitoring of physiological parameters and physiological or pathological events in sleep. Methods: Fifty patients of either sex, having age >16 years were randomly selected from the ENT OPD based on the pre-determined inclusion and exclusion criteria. Subjective evaluation of snoring was done using Epworth sleepiness Scale. Neck circumference and body mass index were calculated in all patients. Then, complete local ENT examination was done including diagnostic nasal endoscopy. After that, full night polysomnography test of at least 6 hours duration was conducted.  Results: Normal nasal endoscopy was seen in 64% of patients. DNS, DNS with ITH/MTH, ITH/MTH unilateral, ITH/MTH bilateral and nasal polyps were seen in 14%, 12%, 0%, 8% and 4% of patients respectively. Mean apnoea-hypopnoea index (AHI) was 6.58. 48% of the patients in our study had normal AHI (0-4). Mild, moderate and severe AHI was present in 44%, 6% and 2% of the patients respectively. Conclusions: All cases of snoring must be subjected to thorough clinical examination and nasal endoscopy and thereafter, be evaluated further for presence of sleep apnoea with polysomnography.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • The role of autologous conchal cartilage in ossiculoplasty during canal
           wall down mastoidectomy

    • Authors: Roshan Jalisatgi, Santosh S. Garag, Arunkumar J. S.
      Pages: 123 - 126
      Abstract: Background: This study was done to evaluate the hearing outcome in patients undergoing ossiculoplasty using autograft cartilage in canal wall down surgery for cholesteatoma.Methods: This is a retrospective study. This was conducted in a tertiary care hospital from January 2011 to January 2014. This study included 54 patients who underwent canal wall down mastoidectomy with tympanoplasty during this period.  Results: Preoperative and postoperative ABG for short columella were 23.13 dB (±11.21) and 12.66 dB (±8.92) respectively. Preoperative and post-operative ABG for long columella were 36.96 dB (±6.73) and 24.77 dB (±10.36) respectively. This is statistically significant.Conclusions: The use of autologous cartilage in ossiculoplasty during canal wall down mastoidectomy gives excellent hearing gain. It is also a cheaper option which is financially feasible in developing countries.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Treatment outcome of postoperative radiotherapy for squamous cell
           carcinoma of the head and neck

    • Authors: H. U. Ghori, M. Sohaib, Vivek Tiwari, Manish Ahirwar
      Pages: 127 - 131
      Abstract: Background: Though early stage malignancy of head and neck can be cured by surgery or radiotherapy, cure of patients with locally advanced disease continues to pose a therapeutic challenge. Loco regional failure is the major cause of death in head and neck cancer. As the cure of locally advance head and neck cancer is less than expectation, a combined modality approach is generally used in these type of patients. The combination of surgery, radiotherapy and chemotherapy can improve outcome in locally advance head and neck cancer.Methods: This observational study reviewed cancer patients reported in our hospital with the following inclusion criteria: primary head and neck cancer, treatment with radical surgery, and multiple nodal metastases. The prescribed dose of postoperative radiotherapy was 60–66 Gy. Patient characteristics, treatment parameters and clinical outcome were recorded.  Results: The primary end point was overall survival, and the secondary endpoint was disease status.Conclusions: Concurrent postoperative administration of chemotherapy and radiotherapy is a way to intensify treatment for resectable high-risk head and neck tumors.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Deep neck space infections: our experience

    • Authors: Naveen Kumar Korivipati, Sandeep Irvineti, Mallikarjun Rao M.
      Pages: 132 - 136
      Abstract: Background: Deep neck space infections (DNSI) are serious diseases that involve several spaces in the neck. The common primary sources of DNSI are tonsil infections, dental infections, salivary gland infections, foreign bodies and malignancies. With widespread use of antibiotics and early detection facilities, the prevalence of DNSI has been reduced. Common complications of DNSI include airway obstruction, jugular vein thrombosis, and sepsis. Treatment principally comprises airway management, antibiotic therapy, and surgical intervention. This study was conducted to investigate the age and sex distribution of patients, symptoms, presentation, sites involved, bacteriology, and management and complications of DNSI.Methods: A prospective study of deep neck space infections was done during the period July 2015 to February 2017 i.e. 20 months who attended the outpatient and were admitted as inpatient in Shadan hospital, Hyderabad.50 Cases were included in the study. All parameters including age, gender, co-morbidities, presentation, site, bacteriology, complications, and investigations were studied.  Results: Due to advent of antibiotics, deep neck space infections are in decreasing trend with admission rate accounting to 3% of total inpatients in our hospital. The common age group found to be affected is 10-20 years (28%). Out of all deep neck space infections, Ludwigs infections was common (32%) followed by peritonsillar infections (25%).Conclusions: Infection of the deep neck spaces is a common and potentially life threatening ENT disease and requires an interdisciplinary approach. Tooth infections and foreign body impaction are the commonest causes of these infections. Diabetes Mellitus is an important predisposing factor. Complications such as mediastinitis, septic shock and pleural effusion are possible; hence the surgeon should be cautious. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Outcome of primary endoscopic dacrocystorhinostomy with and without stent:
           a randomised prospective study

    • Authors: Rajesh Pandey, Pramod Kumar Yadav, Amit Kumar Patel, Poonam Rani
      Pages: 137 - 140
      Abstract: Background: The introduction of endoscopes with different degrees of angulation for endoscopic sinus surgery led to widespread use of endoscopic endonasal DCR (EDCR). The results of EDCR are not only encouraging, but are associated with many other additional advantages. Many modifications like LASER assisted endoscopic DCR, use of silicon tube for stenting, mitomycin-C application etc. have been described. However, insertion of silicon stent in endonasal DCR is most commonly used procedure. Many surgeons claim that use of silicon stent improves success rate of endoscopic DCR. On the other hand, some studies indicate that silicon stent itself is a reason for surgical failure. The present study was done to compare surgical outcome and complication of endoscopic DCR with and without silicon stent. Methods: 70 cases (total 90 EDCR) randomly taken for study. In 35 EDCR cases lacrimal stent were used and in 55 EDCR cases stent were not used. Success rate in both group was analysed using chi-square test. P value <0.05 was considered as significant.  Results: We found a success rate of 90.9% and 85.7% for group A (stent not used) and group B (stent used) respectively. The statistic evaluation among these groups does not show any significant difference (p=0.445) which means that insertion of stent in cases of primary EDCR does not significantly change the surgical outcome. Conclusions: Endonasal DCR without silicon stent is considering as effective, safe and minimally invasive primary procedure for treatment of nasolacrimal duct obstruction. Role of using stent in primary EDCR is not very promising because it is not improving the outcome of surgery.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Comparative clinical evaluation of effect of topical verses systemic anti
           -allergic drug in allergic rhinitis: a prospective study

    • Authors: Sunil Kumar Singh Bhadouriya, Mohit Srivastava, Rohit Saxena, Abhinav Srivastava
      Pages: 141 - 147
      Abstract: Background: Nasal passages form one of the chief sources of contact of the human with his environment. Hence, it is natural that the mucosa of the area is the victim of assault with multitudes of potential allergens. Allergic rhinitis is an inflammatory disease with worldwide prevalence of 10-40%. Allergic rhinitis is a disease with low mortality but significantly lowers the quality of life and functioning. Both oral and intranasal antihistamines are approved for the first-line treatment of allergic rhinitis and both formulations result in a reduction in symptoms and an improvement in quality of life. Methods: The following study was designed to assess the efficacy and safety of the azelastine nasal spray in comparison to levocetrizine in patients with allergic rhinitis. Out of the 68 patients, 34 cases were treated with topical azelastine (group A), while remaining 34 with systemic levocetrizine (group B). The effects of anti-allergic drugs have been studied on the basis of relief of symptoms and change in histopathology.  Results: The effect of levocetrizine has been studied on the basis of relief of symptoms and change in histopathology and found to have complete response in 58% and fair response in 23.5% patients of allergic rhinitis. The effect of topical azelastine nasal spray have complete response in 70.5% and fair response in 23.5% patients of allergic rhinitis. Conclusions: Comparing the post therapy clinical and histopathological results in this study, azelastine nasal spray was found to be more effective and safe in the treatment of allergic rhinitis than levocetrizine.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • A study of surgical outcomes of myringoplasty in active and inactive ears

    • Authors: Vasim Ismail Patel, N. H. Kulkarni, Jyothi A. C., ShriKrishna B. H.
      Pages: 148 - 153
      Abstract: Background: Chronic otitis media (COM) can present with inactive (dry) and active (wet) ear. It’s an accepted fact that an actively draining central perforation is not a contraindication for ear surgery. The discharging ear presents the otologists with the dilemma of operating on it or not, this is due to widespread belief that the success rate while doing ear surgeries on active ears is decidedly inferior. Hence the present study is intended to find the outcome of ear surgeries in inactive and active ear with objective to find the incidence of graft uptake and hearing improvement in both the groups.Methods: A total of 50 active ear (with mucoid discharge) and 52 inactive ears (not discharging at least 3 month before surgery) with mucosal chronic otitis media underwent myringoplasty with cortical mastoidectomy. Graft take and hearing gain rates 3 and 6 months after surgery were calculated for both groups and compared.  Results: The graft take rate was 90% for the active ear group and 94% for the inactive ear group. The hearing gain rate was 90% for the active ear group and 94% for the inactive ear group. Differences were found to be statistically insignificant for both graft intake (p=0.461) and hearing gain (p=0.543).Conclusions: The success of myringoplasty is not adversely affected by the presence of mucoid ear discharge at time of surgery, and outcomes are comparable to those of the opration done for inactive ears. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Step advancement flap technique of ear lobe repair

    • Authors: Harish M. O., Chethana R.
      Pages: 154 - 158
      Abstract: Background: Ear piercing and ornament wearing is a historical tradition. Dilated ear lobe and torn earlobe usually results from sudden trauma or continuous use of heavy earrings. Various surgical techniques have been described for the correction of the same. Each procedure has its own pros and cons. The choice will depend on individual preferences and the defect, partial or total, and should offer a lower chance of recurrence. The corrections can be made with or without preservation of the earring orifice. The aim and objectives of this study was to present and discuss a novel technique of repairing the partial and complete cleft ear practiced at Karwar Institute of Medical Sciences Hospital, Karnataka, India.Methods: A prospective study was done on the use of a novel technique “Step advancement flap” in the repair of partial and complete cleft ear lobe in 18 patients.  Results: A good post-operative results were achieved in all the patients with maintained ear lobe thickness and a sutured skin scar away from the center.Conclusions: Our technique has an advantage of maintaining the normal ear lobe thickness and the sutured skin scar away from the center on either side of the ear lobule compared to other techniques. Thus the neo piercing can be done at a fresh central skin avoiding the skin scar.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Knowledge, attitude and practice about allergic rhinitis in a rural
           population, Kancheepuram district, Tamil Nadu

    • Authors: Valli Rajasekaran, Puja Ghosh
      Pages: 159 - 162
      Abstract: Background: Allergic rhinitis presents a global health problem. The lack of awareness about allergic rhinitis leads to poor adherence to management protocol.Methods: Our cross sectional study in 100 patients with allergic rhinitis was aimed at assessing the knowledge, attitude and practice about the disease. This was done using a questionnaire. Descriptive analysis was made in the three domains and expressed in percentage.  Results: The knowledge about the cause and the treatment options was low. Most of the patients were worried about the long term side effects and dependence of the drugs used for treatment of allergic rhinitis. Most patients ignore the symptoms and do not seek medical advice.Conclusions: Improving the patient’s knowledge and attitude through health education can improve practices among allergic rhinitis patients. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Laryngeal cancer: a clinicopathological study of 65 cases

    • Authors: Jitendra Pratap Singh Chauhan, Bhartendu Bharti, Sunil Singh Bhadouriya, Abhay Kumar, Prem Narain, Jaypal Singh
      Pages: 163 - 168
      Abstract: Background: The larynx serves protective, respiratory and phonatory functions in humans. Cancer of the larynx is common cancer of head and neck region. This study was done to determine the predisposing factors, clinical aspects and histopathological pattern of the laryngeal malignancies. Patients were studied with particular significance given to the mode of presentation, risk factors, topography and histopathology of the tumour.Methods: This prospective study was conducted at Department of Otorhinolaryngology Head and Neck Surgery, Uttar Pradesh University of Medical Sciences, Saifai, Etawah. All 65 cases of laryngeal cancer presented from July 2016 to July 2017were included in this study.  Results: Most of cases belonged to age group 51-60 years. Tobacco intake in the form of smoking was the major risk factor and present in 80% of cases. Commonest presenting symptom was the dysphagia followed by hoarseness of voice. Supraglottic area was the commonest site (69.23%) for laryngeal cancer in this study. Squamous cell carcinoma was found in 98.46% of patients. Moderately differentiated category seen in 49.23% of patients. Most of the patients presented in the stage III and IV (30.77% and 44.62%). 37 (56.92%) cases out of 65 cases had cervical lymph node metastasis at the time of presentation.Conclusions:Diagnosis is based on proper history, clinical examination, direct visualization of the larynx, CT scan and established by histopathological examination. This study has been done to improve comprehension and care of patients with laryngeal carcinoma. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Evaluation of efficacy of Ultrasound in diagnosis of Neck Swellings

    • Authors: Akriti Rastogi, Karan Sharma, Neelam Gauba
      Pages: 169 - 175
      Abstract: Background: Neck swellings are a common cause of dilemma to clinicians. Accurate diagnosis of neck swellings is of paramount importance. This study evaluated patients with neck swellings to study their ultrasonographic features and correlated the ultrasound findings with the final diagnosis.Methods: 100 patients with neck swellings were evaluated clinically and divided into four groups– congenital, inflammatory, benign and malignant. Thereafter, they underwent high-resolution Ultrasound (US) and the ultrasonographic features of each type of swelling were studied. A final diagnosis was established after further evaluation using FNAC, further imaging, surgical intervention in the form of incision and drainage or excision/incisional biopsy with histopathological examination or successful non-surgical treatment. Ultrasound findings were compared with final diagnosis.  Results: For swellings of inflammatory nature, this study showed the sensitivity, specificity, PPV and NPV of US to be 87.2%, 96.6%, 94.4%, 91.9% respectively. For benign swellings, sensitivity, specificity, PPV and NPV was 97.5%, 91.3%, 88.6% and 98.1% respectively. Sensitivity of US in diagnosing malignant lesions of the neck was 87.5% with a specificity of 98.7%, PPV 93.3% and NPV 97.5%. Sensitivity of US in detecting thyroid malignancy in the present study was 83.3% and in diagnosing malignant lymph nodes was 87.5%.Conclusions: Ultrasound is the ideal modality for initial imaging for neck swellings. Later on, as per the need and Ultrasound findings, one can go in for further haematological investigations, Fine Needle Aspiration Cytology and Radiological investigations. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • A comparative study in the use of topical mitomycin-C versus nasolacrimal
           stent in endoscopic dacryocystorhinostomy for chronic dacryocystitis

    • Authors: Vikas Gupta, Inderdeep Singh, Gunjan Dwivedi, Sunil Goyal, Manoj Kumar, Amit Sood, Madhukar Upadhyay
      Pages: 176 - 184
      Abstract: Background: Inflammation of the lacrimal sac and duct is a common and unpleasant condition, leading to troublesome epiphora and recurrent dacryocystitis. Surgery is the preferred treatment modality of chronic dacryocystitis which can be performed by external approach or endoscopic nasal approach. Endoscopic dacrycocystorhinostomy (EnDCR) is now a well-established procedure to relieve nasolacrimal duct obstruction, becoming ENT surgeons’ domain. The aim of this study is to assess the efficacy and compare results of intraoperative use of nasolacrimal stent in comparison of mitomycin-C (MMC) in endoscopic dacryocystorhinostomy.Methods: A prospective study of 56 patients with acquired NLDO with epiphora and recurrent dacryocystitis who were evaluated and managed between Oct 2014 and Oct 2016. All patients were offered surgical line of management by endoscopic route. They were randomly assigned into two groups-mitomycin-C group (Group A) and silastic nasolacrimal stenting (Group B). 46 patients who matched inclusion criteria’s were included in the study after formal evaluation by ENT surgeon and Ophthalmologist. 26 patients underwent endoscopic dacryocystorhinostomy with Mitomycin-C application intra – op, 20 patients underwent nasolacrimal silicone stent placement.  Results: At 6-month follow-up visit, the management was considered successful if the lacrimal sac irrigation succeeded with relief of symptoms. The success rate in Group A was 92.30%. Group B had 85% success rate. However, no significant (p value=0.37) was noticed between two groups.Conclusions: Despite, no significant difference in outcome between two modalities, there is a trend towards the better outcome with use of mitomycin-C. Mitomycin-C is a safe, effective, and economical adjuvant in endoscopic DCR assisting in improved outcomes of surgery. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • A comparative study between amoxicillin + clavulanic acid and levofloxacin
           in the management of acute maxillary sinusitis at RIMS, Ranchi

    • Authors: Sandeep Kumar, Abha kumari
      Pages: 185 - 188
      Abstract: Background: Acute rhinosinusitis is an acute viral or bacterial in which there is inflammation of the mucosa of the nose and paranasal sinuses. The aim of study was to compare the efficacy of oral amoxicillin-clavulanate with levofloxacin in the management of acute maxillary sinusitis.Methods: The present prospective study was conducted in the Department of ENT, Rajendra Institute of Medical Sciences, Ranchi during a period of 8 months i.e. from July 2016 to June 2017. In Group I patients 1 gm of amox­icillin-clavulanate was given two times a day and in Group II, 500 mg of Levo­floxicin was given once a day for a period of 10 days. Patient’s complete demographic details were recorded including name, age and gender. Xylometazoline nasal spray and steam inhalations were given to all the patients.  Results: The mean age of the subjects was 36.43±6.43 years. In both the groups, majority of the subjects were between 36-45 years of age. There were 34.7% (52) in Group I and 38.7% (n=58) in Group II who belonged to this age group. Least number of subjects was those aged more than 48 years. There were 88% subjects (n=132) in group I and 86% (n=129) subjects in Group II in whom complete resolution of symptoms was seen.Conclusions: From the above study we can conclude that both amoxicillin–clavulanic acid and levofloxacin are equally efficacious in managing cases of acute sinusitis. In this study there was no difference in the rate and duration of resolution amongst both the groups.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Evaluation of FNAC of head and neck swellings: a retrospective study

    • Authors: Arvind Kumar B. Sangavi, Inder Raj Itagi, Suhas Y. Choudhari, Venkatesh U.
      Pages: 189 - 192
      Abstract: Background: Neck swellings are on­­e of the commonest clinical presentations encountered by the practicing physicians. Hence; we undertook the present study to assess the incidence and nature of various head and neck swellings by FNAC.Methods: The present study included evaluation of data of all the patients that underwent FNAC for various head and neck swellings. A total of 100 patients were included in this study in which FNAC was performed with lesions in the head and neck regions in the otorhinolaryngology, pediatric, and surgery departments. Cleaning of the area, to be aspirated, was done and a 23‑gauge needle with syringe and trocar was inserted at convenient angles to the lesions and multiple hits was made within the lesion, with sufficient negative pressure; the needle was removed and the pressure was applied to the area of aspiration to avoid bleeding or hematoma formation.  Results: Majority of the patients with head and neck swellings belong to the age group of 21 to 30 years. Only 6 and 4 patients were having age of 51 to 60 years and 61 years and above respectively. Out of 100 patients, 36 were males and 64 were females. In a total of 54 patients, diagnosis of inflammatory lesion was made while in case of 34 and 12 patients; diagnosis of benign and malignant lesions was made respectively.Conclusions: Most of the swellings occurring in the head and neck region are inflammatory in nature and affect females more frequently than males.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Rhinocerebral mucormycosis: a case series

    • Authors: Basavaraj N. Walikar, Anand N. Patil, Raveendra M. Madraki, Wasifa S. Biradar, Yashaswini K.
      Pages: 193 - 196
      Abstract: Background: The study is aimed to evaluate the role played by predisposing conditions like diabetes mellitus and precipitating factors like renal failure are discussed briefly here.Methods: The prospective study of treatment of rhinocerebral mucormycosis on dialysis for renal failure without control subjects was evaluated. Subjects were patients with uncontrolled diabetes with renal failure presenting with rhinocerebral mucormycosis. Complete blood count, renal function tests, CT scan of paranasal sinuses and brain, nasal endoscopy and biopsy was done in all the 10 patients.  Results: Seven patients were on long term dialysis except one patient who was on dialysis for the first time. Amphotericin was started for all 10 patients. Seven patients who were on long term dialysis did not recover from mucormycosis and succumbed to death (70% patients showed 30.71±17.18 days prognosis). Three patients (30% patients), who were not on dialysis and had a lesser degree of renal failure, responded to aggressive antifungal and surgical debridement treatment, and recovered from infection.Conclusions: Mucormycosis in patients on dialysis is fatal. Improvement in renal function is a favourable prognostic factor for the successful treatment of mucormycosis. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Changes in response characteristics of cortical auditory evoked potentials
           in bilateral cochlear implantees

    • Authors: Sathiya Murali, Sunil Goyal, Kiran Natarajan, Senthil Vadivu Arumugam, Neha Chauhan, Mohan Kameswaran
      Pages: 197 - 202
      Abstract: Background: Cochlear implants (CIs) represents the most successful intervention to restore hearing in profoundly hearing impaired children and adults. An objective measures such as cortical auditory evoked potentials (CAEPs) would provide more insights to the auditory process involved in post implantation. Aim of the study was to profile the change in response characteristics of CAEPs in simultaneous binaural cochlear implantees. Objective was to measure change in latency and amplitude in monoaural and binaural condition for speech stimulus with change in intensities.Methods: Ours study is an observational retrospective study done at a tertiary ENT referral centre in south India, between Jan 2014 to Dec 2015. Out of total 15 patients with bilateral cochlear implantation, 7 consecutive bilateral simultaneous cochlear implantees with chronological age between 2-6 years were included in the study. Only pre-lingual congenital hearing loss children with no syndromic associations and normal cochlear anatomy were included while, peri-lingual, post-lingual children and children with sequential bilateral implantation were excluded from the study.  Results: Amplitude of P1 was higher for binaural stimulation compared to monoaural stimulation. Latency of P1 was smaller for binaural compared to monoaural stimulus. In monaural stimulation the latency of P1 was smaller in right ear compared to left ear. However the difference between the right ear, left ear and binaural conditions were not statistically significant. Ours is a preliminary study and more bilateral implantees will be included in future studies to give more power to the study.Conclusions: We suggest that CAEPs can be used as a useful objective tool for assessment of post CI outcome.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Role of adenoid hypertrophy in causation of chronic middle ear effusion

    • Authors: Timna C. J., Chandrika D.
      Pages: 203 - 209
      Abstract: :Background: Hearing  plays  a  valid  role  in  speech  development  in  children. Otitis media with effusion is one among the commonest causes of hearing loss in children especially below 12 years. It is defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infectionMethods: A prospective study was carried out in Lourdes Hospital, Kochi, over a period of 1 year from January 2013 to December 2013. Thirty patients with chronic middle ear effusion  below the age of 12 years were selected for the study.Results: of the 30 patients  59.5% of patients were in the age group of 5-7 years of age, 16.6 % of patients were in the age group of 9-11 years of age .13.3%  of patients  each were in  the age group of 3-5 years and 7-9 years of age.Among  the 30 patients ,60% were male children and 40% patients were female children.Among the 30 patients , 40% of them had grade 3 adenoid hypertrophy ,33.3% of them had grade 2 adenoid  hypertrophy and  30% of them had grade 4 adenoid hypertrophy and none had grade 1 adenoids. majority of them had grade 3 adenoid hypertrophy by endoscopic assessment.Among  the 30 patients ,66.6 % of them had eustachian tube blockade by the adenoid mass and  33.4% of  them didn’t have eustachian tube blockade.  100% of them  with eustachian tube blockade found to have fluid on doing myringotomy  and  there was  20% of chance of absence of  fluid ,if there is absence of  eustachian tube blockade.            Significant association was found between  type B tympanogram and presence of fluid on myringotomy .92.5% of patients with type B tympanogram had fluid on myringotomy . 57.1 % of patients with type C tympanogram  had fluid on doing myringotomy.There were 2 patients with grade 4 adenoid hypertrophy ,without eustachian tube blockade with  bilateral type C tympanogram and  there  was  bilateral dry tap on myringotomy. This reveals that type B tympanogram  and  eustachian tube blockade  better predictor of  otitis media with effusion   than grade of adenoid hypertrophy.Conclusion:    The present  study  showed that  chronic middle ear effusion was found to be most common  in the age group of  3-5  years of age group and  relatively common in the male children. Tympanogram type B was found to be  strongly associated with fluid on myringotomy .All the children with chronic middle ear effusion in the study group were found to have  ,grade 3 grade 2,and grade 4  adenoid hypertrophy in the  descending order of frequency.Grade 3 adenoid hypertrophy was present in majority of  the children in the study group .Lateral  adenoid hypertrophy ,abutting on the nasopharyngeal orifice of Eustachian tube was present in majority of children. Eustachian tube obstruction was found to be strongly  associated with  fluid on myringotomy and grommet insertion 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Orbital complications of ENT diseases

    • Authors: Abhay Kumar, Jitendra P. S. Chauhan, Sunil K. S. Bhadouriya, Bhartendu Bharti, Prem Narain, Jaypal Singh
      Pages: 210 - 216
      Abstract: Background: Orbital complications are fairly common in Otorhinolaryngology practice because of close proximity of orbit to adjacent ENT regions. Orbital complications must be suspected whenever ENT patients present with complaints of proptosis, diplopia, vision loss and epiphora. Early diagnosis and treatment is necessary to prevent morbidity and mortality in these patients.Methods: This prospective study was conducted in the ENT department for a period of 1 year from August 2016 to July 2017 and comprised of 38 cases. This study was conducted to see the incidence, etiology, clinical, radiological and histopathological profile in relation to ophthalmic complications in ENT diseases.  Results: Male to female ratio was 1.71:1. Patients mean age at presentation in present study was 39.71±19.86 (SD) years and maximum number of cases 10 (26.32%) were between 41-50 years of age. Among 38 patients of our series, most common clinical presentation was proptosis followed by nasal obstruction. Commonest ENT diseases responsible for orbital complications were the different sinonasal tumours comprising 18 cases, in which carcinoma maxilla constituted 6 cases.Conclusions: In conclusion, correct diagnosis, adequate antibiotic therapy, and surgical intervention are important for management of orbital and ophthalmic complications. Cooperation between Ophthalmologist and the Otolaryngologist is clearly desirable for proper management of these cases.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Early complications of tracheostomy: a study on 100 patients at a single
           tertiary care centre

    • Authors: Pooja Pal, Arvinder Singh Sood, Sumant Singla
      Pages: 217 - 221
      Abstract: Background: Tracheostomy is a life saving procedure, which when performed correctly greatly impacts the final outcome of the patient. Although uncommon, fatal complications have been known to occur. The present study was conducted to observe the incidence of early complications of tracheostomy in a tertiary care centre.Methods: 100 consecutive patients subjected to tracheostomy were enrolled, and data pertaining to the indication, and intraoperative and early postoperative complications was collected.  Results: The overall incidence of complications was 77%, with 53% cases of intraoperative bleeding and 13% tube obstruction. A higher incidence of complications was noted in emergency procedures and pediatric tracheostomies. No mortality was seen in the present series.Conclusions: Serious complications may be associated with tracheostomies, many of which can be avoided by meticulous surgical technique and postoperative care.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • A comparative study on the nasal endoscopic findings in patients with
           chronic otitis media

    • Authors: Anie Melootu Thomas, Arjun Gopinatha Menon, Pooja Pradeep, Arayamparambil Rajagopalan Vinayakumar
      Pages: 222 - 227
      Abstract: Background: Nasal and/or sinus disease may well contribute to the development of middle ear disease. In this study, the nasal endoscopic findings in patients with chronic otitis media (COM) compared with a group of people who do not have any otologic relevant disease to evaluate the association of anatomical variations with COM.Methods: A descriptive comparative study was done. A detailed history, clinical examination and diagnostic nasal endoscopy (DNE) had been done. DNE analysis include eustachian tube blockage, adenoid hypertrophy and inferior turbinate hypertrophy. The results were statistically analysed.  Results: Total 108 cases (45 males and 63 females of age 31.17±14.50 years) and in the control group (48 males and 60 females of average age was 36.06±14.32 years) were included in the study. Most of the COM patients (66.7%) had multiple abnormalities of sinonasal regions compared to controls. Findings of DNE like eustachian tube blockage (p value=0.003), adenoid hypertrophy (p value=0.028) and inferior turbinate hypertrophy (p value=0.035) were significantly associated with chronic otitis media.Conclusions: Nasopharyngeal pathology causing eustachian tube dysfunction, has higher prevalence among chronic otitis media patients. So early recognition by diagnostic nasal endoscopy is warranted especially when surgery is considered for the comprehensive management of this overwhelming and enigmatic disease.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Identification of external branch of superior laryngeal nerve during
           thyroid surgery: a prospective study

    • Authors: Vipin R. Ekhar, Ramkumar V., Ritesh N. Shelkar, Akshay V. Sarode
      Pages: 228 - 232
      Abstract: Background: Identification of external branch of superior laryngeal nerve (EBSLN) according to Cernea et al classification and to describe a surgical technique of superior pole dissection to preserve EBSLN during thyroid surgeries.Methods: The study was done over 2 years period in a tertiary care hospital. 105 nerves were studied among the 90 patients who underwent thyroid surgeries. Avascular dissection over the JOLL’S triangle was carried out and identified EBSLN were classified according to Cernea et al classification. Individual ligation of superior pole vessels was carried out after identifying the nerve. Outcome was studied relating the identified nerve with sides of thyroidectomy performed, size of thyroid gland and nerves at risk according to Cernea et al classification.  Results: Of the 105 nerves studied, in 81.90% of patients the nerve was identified. There were 34.88% of Type 1 nerves, 52.33% of Type 2A nerve and 12.79% of Type 2B nerves identified. Less number of nerves could be identified on the left side. Type 2B nerves were more common on left side inspite of less number of dissections carried out on left. Type 2 variation was more common in large goiters.Conclusions: Careful dissection should be done in superior pole in avascular cricothyroid space, with lateralization of superior pole and individual identification of superior pole vessels once the nerve is identified. Identification of the nerve is mandatory in all patients who undergo thyroid surgery for optimal functions of the larynx. These results showed a better identification of nerves by proper surgical techniques without use of any sophisticated equipments. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Clinico-mycological study of otomycosis in Raichur, Karnataka: a hospital
           based study

    • Authors: Arvind Kumar B. Sangavi, Basavaraj Peerapur, Nirmita Gummadi
      Pages: 233 - 236
      Abstract: Background: Otomycosis is a fungal infection of the ear canal. It is mostly seen in hot and humid climatic conditions of the tropical and subtropical countries. It can also occur as a result of decreased immunity (and has been seen as a common occurrence as an opportunistic infection in the immunocompromised). Methods: Patients clinically diagnosed with otomycosis and coming to the ENT department RIMS teaching hospital were first subjected to detailed history taking. The samples from ear will then be collected by three sterile cotton swabs and sent to Microbiology Department, RIMS. Fungal, bacterial cultures were performed and microscopic examination was done.  Results: Patients presented with a wide age range, the youngest patient being 6 months old and eldest being 28.31 years old. The mean age of the study population was 28.31 years. The ratio between male and female patients was 1.13:1 with male predominance. There were 26 patients (81.2%) who had a habit of using pins or sticks. The chief complaints of majority of the patients were pain and itching. Pain ranged from mild to severe type. Least common symptom was tinnitus. Conclusions: In our study male predominance was seen and majority of cases were unilateral. There were only 5 patients who were immunocompromised. The most common presenting symptom was pain and itching. There were 81.2% patients who had a habit of using pins/ sticks.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Bacteriological study and antibiotic sensitivity profile in patients with
           ear discharge visiting ENT OPD at tertiary care center

    • Authors: Kailas R. Patel, Alpesh D. Fefar, Paresh J. Khavdu, Sejal N. Mistry, Manish R. Mehta
      Pages: 237 - 241
      Abstract: Background: Otitis media (OM) is a big menace in countries like India. Chronic suppurative otitis media (CSOM) is chronic inflammation of middle ear, which affects the tympanic membrane, middle ear mucosa and other middle ear structures characterised by the presence of persistent perforation or persistent mucoid or muco-purulent discharge for at least 8 weeks. Variety of organisms founds in patients suffering from chronic otitis media like, Pseudomonas, Staphylococcus aureus, Proteus mirabilis, Klebsiella pneumonia and Escherichia coli found. The pattern of organisms varies in different geographical areas. The objectives of the study were to isolate bacteria from patients with ear discharge, to find out antibiotic sensitivity of isolated organismsMethods: This is an observational cross sectional study done in the OPD department of otorhinolaryngology, at P.D.U medical college and hospital, Rajkot, for a period of six months from January 2017 to June 2017. A total number 200 patients of both gender between 5 to 74 years who visited the OPD department of otorhinolaryngology with chronic ear discharge taken for study.  Results: Out of 200 patients of 5-74 years with chronic suppurative otitis media were examined and out of this Hundred and twelve (54%) of the patients were males with mean age of 33.44. Pseudomonas aeruginosa was the commonest identified organisms the sensitivity pattern highly favoured Pipercillin, Amikacin and Polymyxin B, Cefoparazone. Conclusions: Chronic otitis media is more prevalent in males than females. Commonest organisms found were Pseudomonas aeruginosa followed by Staphylococcus aureus. Piperacillin, Amikacin, Gentamicin, Polymyxin B and Cefoperazone were found most effective agents against Pseudomonas aeruginosa.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Present scenario of laryngeal tuberculosis

    • Authors: Marina Saldanha, Natashya H. Sima, Vadisha S. Bhat, Shrinath D. Kamath, Rajeshwari Aroor
      Pages: 242 - 246
      Abstract: Background: The objectives of the study were to document the presentation of laryngeal tuberculosis, response to anti-tubercular treatment and objective evaluation of larynx during and post anti-tubercular treatment.Methods: A before and after treatment study including 15 subjects with laryngeal tuberculosis treated in our tertiary health care centre during a three year study period. Clinical presentation, management, subjective self-assessment of voice and objective assessment of larynx by videostroboscopy at the beginning, at two months and at six months of anti-tubercular treatment were documented.  Results: Two patients had primary laryngeal tuberculosis and thirteen patients had laryngeal tuberculosis associated with pulmonary tuberculosis. Only one patient was immuno-compromised. Most common presenting symptom was hoarseness (93%). Ulcerative lesions were the most common clinical finding (87%) with the vocal cords being the commonest site involved (80%). All patients responded well to anti-tubercular treatment. Videostroboscopy showed an improvement in vocal cord lesions during treatment. Subjective assessment of voice after two months of anti-tubercular treatment showed marked improvement in voice. At completion of treatment, voice was better but all patients had complaints of residual hoarseness.Conclusions: Primary laryngeal tuberculosis is less common in comparison to laryngeal tuberculosis secondary to pulmonary tuberculosis. With early diagnosis, the response to treatment is satisfactory. Videostroboscopy can be used as an effective tool in monitoring vocal cord changes during the follow- up period.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Base of tongue schwannoma on a 22 year old lady: a rare case

    • Authors: Sagung Rai Indrasari, Jessica Fedriani
      Pages: 247 - 252
      Abstract: Schwannomas are benign tumours arising from the Schwann cells. Around 25-45% schwannomas have been reported occured in head and neck region, but only 1% located intraoral. We report a case of 22 year old woman who presented with foreign body sensation in throat, dysphagia, change of voice, and snoring. There was a slowly growing, solitary, encapsulated, painless, mass on the tongue base. Microscopically, it had the typical features of schwannoma, the diagnosis being supported by a strong positivity for S-100 protein. Ki67 staining showed low proliferative index (<5%) indicated benign schwannoma. CT-scan of oropharynx demonstrated a well-circumscribed soft tissue density mass, oval shape, connected with the left portion base of tongue, homogenous, and strong enhancement mass. The entire mass was removed in general anesthesia with conservative surgical excision via trans-oral route, histopathologic reported consistent as schwannoma. The patient remained disease-free, without any residual problems. Although the rarity of schwannoma on the tongue base, this case highlights the importance of including it in the differential diagnosis of mass from the tongue base. To the best of our knowledge, our case is only the twentieth of schwannoma at the base of tongue that reported in the literature.  
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Chiari type 1 malformation presenting as an atypical benign paroxysmal
           positional vertigo in a 16 year old patient

    • Authors: Ajinkya A. Kelkar, Philip D. Yates
      Pages: 253 - 255
      Abstract: Dizziness and vertigo are very common symptoms and can be difficult to distinguish clinically. Vertigo is a specific subtype of dizziness in which a patient experiences the illusion of motion (often rotatory) of either themselves or their surroundings. Vertigo can be either peripheral (arising within the labyrinth) or central (brain). It is important to identify central aetiologies as they can be fatal if missed. This case report narrates a 16-year-old male who presented complaining of vertigo related to changes in head position which was initially misdiagnosed as a benign paroxysmal positional vertigo (BPPV). It was several years before he was correctly diagnosed as having Chiari type 1 malformation on MRI scan. He underwent a surgical decompression with complete alleviation of his symptoms. All cases of atypical vertigo should be evaluated in detail. Patients with failure of initial management should undergo imaging to identify any central pathology. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • A rare sinonasal tumour with orbital manifestation: glomangiopericytoma

    • Authors: Hui Jean Yap, Ida Sadja'ah Sachlin, Bee Lian Khaw
      Pages: 256 - 259
      Abstract: Sinonasal glomangiopericytoma is a tumor showing similarities to a glomus tumour but is less aggressive and has a lower malignancy potential. It was initially reported by Stout and Murray in 1942. Our patient was a 19 years old lady who presented to us with unilateral epistaxis during her pregnancy. Further investigations including a nasopharyngeal biopsy showed signs of an aggressive behaving sinonasal glomangiopericytoma. She underwent left medial maxillectomy via lateral rhinotomy approach to achieve complete excision of the tumor. This was vital as past literatures suggest that incomplete excision of tumor is the most pertinent factor to tumor recurrence. Distant metastasis is rare. Complete excision with regular long term follow up is the treatment of choice. The role of chemo and radiotherapy remains controversial. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Management of dysphagia following radiation therapy and tracheostomy

    • Authors: Mansi A. Jagtap, Shlok Shrivastava
      Pages: 260 - 262
      Abstract: Dysphagia (swallowing disorders) have been reported commonly following oral and laryngeal cancers. Patients undergoing radiation therapy usually complaint of deterioration in swallowing functions due to fibrosis. Also, presence of tracheostomy causes aspiration while swallowing by reducing the hyolaryngeal excursion and also leading to inadequate subglottic pressure and fixation of trachea. An 85 year old male with history of supraglottic carcinoma managed by radiation therapy and tracheostomy reported for swallowing assessment. Detailed assessment was performed using clinical swallow examination and instrumental assessment (modified barium swallow) using thin, thick and paste consistencies. Results revealed no overt signs of penetration on clinical swallow while modified barium swallow revealed severe intraswallow aspiration due to incomplete hyolaryngeal elevation on all consistencies (more for liquids). This clearly indicated silent aspiration. Swallowing therapy focused on hyolaryngeal elevation using protective maneuvers. Reassessment was performed following 7 sessions using the above mentioned protocol which revealed improvement in hyolaryngeal elevation (complete hyolaryngeal closure during swallow) and no aspiration on all consistencies. Dysphagia is a common complication following radiation therapy. An instrumental assessment is mandatory to rule out silent aspirations as seen in the present case. Swallowing intervention has an important role to treat dysphagia following radiation therapy and has shown to be effective in the present study and literature. Hence, patients who have indications for radiation therapy should undergo swallowing intervention in order to ensure safe oral intake.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Schwannoma of the cervical vagus nerve: a rare case report

    • Authors: Chandra Mohan Setty L. N.
      Pages: 263 - 266
      Abstract: Schwannomas, also called as neurilemomas, are well-encapsulated, slowly growing tumors that arise from schwann cells of peripheral nerves. Clinically, schwannomas present as asymptomatic, slowly enlarging lateral neck masses and so they tend to present late. The nerve of origin is not often made until the time of surgery. Preoperative diagnosis is aided by imaging studies such as magnetic resonance imaging and computed tomography. The treatment of choice of schwannomas of the neck typically involves complete surgical resection. Rapidly growing tumors with evidence of invasion, or complete loss of nerve function should trigger complete surgical excision of the tumor. Here, we report a rare case of cervical vagal schwannoma in a 45 year old female who got admitted with the complaint of a firm, painless mass on the left side of the neck. The management of the case is discussed along with the relevant literature.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • A novel technique in the treatment of post traumatic parotid duct

    • Authors: Atishkumar B. Gujrathi, Vijayalaxmi Ambulgekar
      Pages: 267 - 270
      Abstract: Stenson's duct of parotid gland is a major duct which drains saliva into the oral cavity. Deep penetrating wound in the form of cut or crush injury to the buccal area carries the risk of parotid duct injury. It is in the form of ductal exposure, laceration, total severing, or crushing of the duct. These conditions are difficult to diagnose because of complex anatomy and variable nature of injury. Successful management of parotid duct injury depends on early diagnosis and appropriate intervention, failing of which may lead to complications like sialocele or salivary fistula. Many techniques have been proposed for diagnosis and management of parotid duct injuries. This article presents an easy and an innovative technique to diagnose and manage the parotid duct injuries using an "epidural catheter" which is often used for inducing spinal anesthesia. The technique of epidural catheter usage, its advantages, and limitation over other techniques proposed for the management of parotid duct injury are discussed. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Bilateral temporal bone fractures: a case report

    • Authors: Kiran Natarajan, Koka Madhav, A. V. Saraswathi, Mohan Kameswaran
      Pages: 271 - 275
      Abstract: Bilateral temporal bone fractures are rare; accounting for 9% to 20% of cases of temporal bone fractures. Clinical manifestations include hearing loss, facial paralysis, CSF otorhinorrhea and dizziness. This is a case report of a patient who presented with bilateral temporal bone fractures. This is a report of a 23-yr-old male who sustained bilateral temporal bone fractures and presented 18 days later with complaints of watery discharge from left ear and nose, bilateral profound hearing loss and facial weakness on the right side. Pure tone audiometry revealed bilateral profound sensori-neural hearing loss. CT temporal bones & MRI scans of brain were done to assess the extent of injuries. The patient underwent left CSF otorrhea repair, as the CSF leak was active and not responding to conservative management. One week later, the patient underwent right facial nerve decompression. The patient could not afford a cochlear implant (CI) in the right ear at the same sitting, however, implantation was advised as soon as possible because of the risk of cochlear ossification. The transcochlear approach was used to seal the CSF leak from the oval and round windows on the left side. The facial nerve was decompressed on the right side. The House-Brackmann grade improved from Grade V to grade III at last follow-up. Patients with bilateral temporal bone fractures require prompt assessment and management to decrease the risk of complications such as meningitis, permanent facial paralysis or hearing loss. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Primitive neuroectodermal tumor of thyroid: a rare presentation

    • Authors: Shravan S. Shetty, Dhairyasheel N. Savant, Hozefa Lokhandwala, Akanksha Chichra
      Pages: 276 - 277
      Abstract: Extraskeletal Ewing’s sarcoma (EES) commonly arises in the soft tissues of trunk or extremities. EES is rare in the head and neck region; most having been documented in nasal cavity, paranasal sinuses and neck. Head and neck PNETs have an intermediate prognosis. We report the case of a 12 year old boy who presented with primitive neuroectodermal tumor of the thyroid and was treated with multimodal treatment including surgery, chemotherapy and radiotherapy. The patient is alive and fit with a functional larynx. Major drug regimens use vincristine, doxorubicin, ifosfamide or cyclophosphamide, dactinomycin and/or etoposide. Complete surgical excision is undertaken whenever possible to improve long-term survival. However, the relative radiosensitivity of tumors of the Ewing family, suggest multimodal treatment including adjuvant radiotherapy in case of positive margins or poor response to chemotherapy rather than resection with 2-3 cm margins, which would imply laryngeal sacrifice for thyroid tumors.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Laryngeal mucormycosis: a rare entity

    • Authors: Manish Munjal, Archana Arora, Amanjeet Singh, Gopika Talwar, Neena Sood, Simrat Kaur
      Pages: 278 - 280
      Abstract: "Mucormycosis" term is used in context to a group of fungal diseases caused by the order mucorales. Typically with predilection for the pulmonary and the sino-nasal-orbital tissues, it can very rarely affect the laryngeal as well as the tracheal mucosa either as skip lesions or in continuity. The management of such an involved airway is quite challenging. Literature documents sporadic cases of laryngeal manifestation of mucormycosis. Reported here is such a case of a diabetic male presenting with dyspnoea of sudden onset. Video laryngoscopy revealed extensive glottic edema with a reduced glottis chink. Elective prophylactic tracheostomy followed by direct laryngeal trucut biopsy was undertaken. Histopathology was suggestive of mucormycosis and the patient was administered titrated intravenous Amphoterecin B. The response was favorable and the patient at present is symptom free. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • An atypical case of Kartagener’s syndrome

    • Authors: Gurumani Sriraman, Valli Rajasekaran, Roopak Visakan Raja
      Pages: 281 - 284
      Abstract: Kartagener’s syndrome is an autosomal recessive disease characterized by the tetrad of situs inversus, bronchiectasis, sinusitis and infertility. It is a subset of a larger group of disease known as primary ciliary dyskinesia. A 23 year old male patient presented to our hospital with complaints of Right sided headache for the past 3 weeks. General Physical examination was normal except that the heart sounds were heard over the right side. Dextrocardia was suspected. Routine ENT and Diagnostic nasal endoscopy examination revealed deviated septum towards the left along with pale greyish polyp like mass in the right nasal cavity. CT PNS was ordered. It showed bilateral frontal, ethmoidal and maxillary sinusitis with Right nasal polyp. Routine Blood investigations were normal but Chest X-ray showed dextrocardia with fundal shadow over the right side and normal ECG was obtained only when the chest leads were reversed. USG abdomen confirmed the suspicion of situs inversus totalis. To rule out Kartageners syndrome HRCT Chest was done which revealed normal lungs with no findings. Sperm analysis was also done which was normal except for the count (<15 million/ml). Saccharin test was performed and it was delayed (>20 min). Anesthetic fitness was obtained and he was taken up for surgery - Septoplasty with fess. The diagnosis of kartageners syndrome was done based on clinical and radiological findings, with variation in form of no bronchiectasis and oligospermia. This type of atypical presentation of Kartagener’s syndrome might be a rare sub type of the disease which is infrequently reported.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Tumor associated tissue eosinophilia: a case report with review

    • Authors: Bhuvan Nagpal, Usha Hegde, Prasannasrinivas Deshpande, Soumadip Dey
      Pages: 285 - 288
      Abstract: Cancer is one of the most deadly diseases. Even today a lot of research is going on to understand the various aspects of this neoplasm in order to improve the treatment modalities and thus the life of the affected. The role of tumor associated tissue eosinophilia (TATE) has gained much impetus as it is believed to play important role in the biological behavior of the tumor. There are contradictory reports with respect to malignancy and hence its functional role remains ambiguous. We report a case of oral squamous cell carcinoma (OSCC) with TATE and review of literature of the same. A 58 year old female patient presented with a shallow ulcer on the palate. On clinical examination, left submandibular lymph nodes were enlarged and tender on palpation with slightly raised surface temperature. Fine needle aspiration cytology from submandibular lymph nodes was suggestive of squamous cell carcinoma. Incisional biopsy from ulcer confirmed the diagnosis of moderately differentiated squamous cell carcinoma, with the striking feature of tissue eosinophilia. Haematological investigations revealed differential & absolute eosinophil count which was not significant. The review of literature revealed contradictory findings with respect to TATE as a prognostic factor in OSCC patients. It has been found to have a favourable, a poorer or even no influence on patient’s outcome, thus remaining a matter of controversy.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Chondroid syringoma of face (nasomaxillary groove): case report

    • Authors: Chandra Shekar Reddy, Gowri Sankar Marimuthu, Sivaraman Ganesan, Arun Alexander
      Pages: 289 - 291
      Abstract: Chondroid syringoma, is a benign neoplasm of sweat gland origin with an overall reported incidence of 0.01-0.098 percent. These tumours being rare can easily be misdiagnosed and should be included in the differential diagnosis of any slowly growing nodule in the skin of the face. The diagnosis is confirmed after histopathologic examination of tissue obtained by excisional biopsy. Treatment of choice is local surgical excision with a cuff of normal tissue, in order to prevent recurrence. We present a case of chondroid syringoma of the face (nasomaxillary groove), highlighting the rarity of the tumour and the surgical incision resulting in excellent cosmetic result.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Rare case of combined laryngocoele masquerading as laryngeal carcinoma: a
           case report and review of literature

    • Authors: Gunjan Dwivedi, Vikas Gupta, Inderdeep Singh, Sunil Goyal, Manoj Kumar, Amit Sood, Meenakshi Rajput
      Pages: 292 - 296
      Abstract: Laryngocoele is an abnormal dilatation of the laryngeal saccule. It is a rare entity. Patient generally presents with hoarseness, dysphagia, dyspnea, foreign body sensation in throat and swelling in the neck. It is a benign condition, however the risk of malignancy is always associated with it, especially, if a patient is smoker or tobacco chewer. Once the diagnosis is established, laryngocoele are best treated by surgery. We present a rare case of combined laryngocoele in a 62 year old male patient, a chronic smoker, with history of recurrent swelling in neck right side for 2 years and hoarseness for duration of 1 month. It was a diagnostic dilemma as to what we were dealing with, a benign condition or malignancy. Eventually patient underwent excision by external approach. Resected specimen histo-pathological examination was consistent with laryngocoele. Post excision his normal voice was also restored.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • A rare case report of Eagle‚Äôs syndrome complicated with chronic mouth
           opening, its management and complete rehabilitation; dental perspective

    • Authors: A. Navin Kumar, Bhushan Kumar, Gaurav Dua, Sandeep Mehta
      Pages: 297 - 300
      Abstract: Eagle’s syndrome is a rare condition of either elongated styloid process or ossification of its ligaments; which is less appreciated and often ignored condition by clinicians because of its vague symptoms which can be easily confused with other oral or paraoral conditions presenting with similar signs and symptoms. Since it is not a routine clinical problem, it is not given the first priority thought while diagnosing such a case; especially in the absence of sound clinical knowledge and good radiographs. This article is aimed to summarize unusual clinical presentations, diagnosis and standardized tonsil-sparing trans-oral surgical approach for Eagle’s Syndrome case and its unique postoperative management. A 80 years old female patient presented with the tendency of uncontrolled wide mouth opening with severe pain in both ears, temporal region; submandibular area extending up to back of neck with intensity on right side. The patient was diagnosed as a case of the Eagle’s syndrome with a unique finding of pain relief on wide mouth opening. The patient was operated for bilateral styloidectomy followed by postsurgical rehabilitation with custom made chin cup appliance and mouth opening exercises. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Fungus ball in concha bullosa, an unusual site: a case report from hilly

    • Authors: Shaweta ., R. S. Minhas, Vineeta Sharma, Santwana Verma, Trilok C. Guleria
      Pages: 301 - 303
      Abstract: Fungus is a rare cause of rhinosinusitis in children. Its incidence has been reported as ranging between 13.5 and 28%. Fungus balls are extramucosal tangled masses of fungal hyphae. It commonly involves just one paranasal sinus. Most commonly maxillary sinus is involved and occasionally sphenoid sinus. Concha bullosa is one of the most common anatomical variations in the nasal cavity, with a frequency of reporting ranging from 14-53.6%. There are very few case reports in which Concha bullosa was affected with fungus ball. In this case report 13 years female child presented with complaints of swelling right cheek. The patient underwent endoscopic sinus surgery and there was involvement of concha bullosa and sphenoid sinus with fungus ball. Fungus was confirmed on microscopic examination and culture. Fungus ball is a rare presentation of fungal rhinosinusitis. It should be considered in enlarged middle turbinate with heterogenous opacity on CT. The diagnosis should be confirmed by microscopy or culture.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • A rare case of Ewing’s sarcoma in the sinonasal tract

    • Authors: Deepthi Satish, Nandakumar R., Balasubramanya A. M, Nitty Mathew
      Pages: 304 - 307
      Abstract: Ewing's sarcoma (ES) first described by James Ewing in 1921, is a primary neoplasm of the skeletal system. Extraskeletal Ewing’s sarcoma (EES) is a rare, rapidly growing, round cell malignant tumour that can develop in the soft tissue at any location. Extraskeletal Ewings sarcoma of the head and neck is uncommon. Nearly 80% of patients are younger than 20 years with peak incidence in the second decade. Ewings sarcoma rarely affects the sinonasal tract. Diagnosis is after histopathological examination immunohistochemical studies and cytogenetic studies. Treatment will include a multidisciplinary approach with surgery as the first line followed by chemotherapy and radiotherapy. Ewings sarcoma in the head and neck region do not metastazise early hence carries a better prognosis. Evaluation of lesion using imaging, biopsy followed by histopathology and immunohistochemistry and cytogenetic analysis are necessary for early diagnosis and treatment. We present a case of an 18-year-old male patient with left sided epistaxis and left sided nasal obstruction, on examination a mass was seen the nasal cavity, endoscopic excision and biopsy of the mass was suggestive of an Ewings sarcoma. He received post-operative chemotherapy and radiotherapy. 2 years on regular follow up patient is fine without signs of metastasis or recurrence. We are presenting this case due to the rarity of its presentation in the sinonasal tract.
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
  • Dysphagia following total laryngectomy: a myth or a reality' How can
           we help

    • Authors: Mansi A. Jagtap, Mansi Bhavesh Sheth
      Pages: 308 - 311
      Abstract: Total laryngectomy leads to drastic anatomical changes in the swallowing and breathing mechanism. Reduced tongue base retraction, poor pharyngeal clearance, stricture and prominence in the posterior pharyngeal wall have been reported to cause swallowing difficulties in individuals with total laryngectomy. The present case study describes the swallowing characteristics in an individual with total laryngectomy and discusses efficacy of swallowing maneuvers in total laryngectomy. A 55 yr/male, operated case of total laryngectomy using TEP reported with complaint of food getting stuck in the throat and vomiting sensation. He was fed orally and could tolerate only thick liquids. Swallowing assessment was carried out by clinical and instrumental tools (modified barium swallow) which revealed cricopharyngeal prominence, poor pharyngeal clearance and significant post swallow residue. Effortful swallow was attempted to explore the change in swallowing mechanism. Relaxation of pharyngeal wall with better pharyngeal clearance was seen with the maneuver. Clinically, the case reported of ability to swallow semisolids and solids well with the maneuver. At 3 month follow up, the case reported no difficulty in swallowing semisolids and solids orally. The above case study highlights on radiological evidence of swallowing abnormalities following total laryngectomy and further on the efficacy of maneuver on mechanism of swallowing. Hence, it can be noted that swallowing intervention has strong implications in patients with total laryngectomy. 
      PubDate: 2017-12-22
      Issue No: Vol. 4, No. 1 (2017)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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