bluuebunny/crossref_metadata_2025 huggingface dataset:
Comorbidities associated with cerebral palsy in children presenting at department of Pediatrics, K. T. children hospital Rajkot, India
Authors: Raja Mauli V. , T. Hapani Palak
Published: February 2019

Background: Cerebral palsy is a diagnostic term used to describe a group of motor syndromes resulting from disorder of early brain development. It describes a group of permanent disorders of the development of brain and posture causing activity limitation. The magnitude of cerebral palsy in our country is 2 to 2.5 per thousand live birth. The objective is to study co-morbidities associated in cerebral palsy patients.Methods: It was a hospital based cross sectional study carried out in KT Children Hospital, PDU Medical College, Rajkot for 1 year (April 2017-April 2018). Sample size: minimum 100 cases. Selection of subject: All the children suffering from cerebral palsy presenting at KT Children hospital, P.D.U. Medical college Rajkot, Gujarat. Cases were evaluated by history, clinical examination and necessary investigations.Results: From data collected in present study most common variety of Cerebral Palsy is spastic type (72.5%) followed by, dyskinetic (16%), ataxic (7%), and hypotonic (4.5%) type. Within spastic type; diplegic (48%) is the most common variety. Caesarean section delivered cases are more predisposed to Cerebral palsy in present study which might be due to other risk factors associated with it. Gender and consanguinity showed not major significance in association with CP child. Most of Cerebral palsy cases in present study were born full term (81.5%) and of normal birth weight (78.5%). The most common comorbidities in present study were cognitive impairment (77%) followed by epilepsy (38%), visual impairment (10%), hearing disability (9%) thyroid dysfunction (3%) and G.I. disturbances (2%). Perinatal asphyxia is the most common history finding in Cerebral palsy cases including in present study, followed by seizures during infancy, pathological jaundice, neonatal sepsis and history of NICU admission for any cause.Conclusions: Cerebral palsy in developing countries has a higher prevalence and different clinical profile regarding severity and associated disability. The perinatal and high-quality neonatal care together with physical therapy and rehabilitation programs have a significant role in preventing comorbidities in cerebral palsy cases, which is still lacking in developing countries.
Cross-sectional study reveals a high prevalence of vitamin D deficiency among healthy school children in central Kerala, India
Authors: Anitha Ayyappan , Poovathinal Suresh A. , Viswambharan Vijitha , Thanseem Ismail , Vasu Mahesh M. , M. Ranjitha
Published: February 2019

Background: Authors examined serum vitamin D status among the healthy school children belonging to the south Indian state of Kerala.Methods: A cross-sectional study, participants were recruited through medical camps organized in Thrissur and Palakkad districts of central Kerala during the months of March and April 2017. A 174 healthy school children (98 males and 76 females) aged 5-13 years were recruited for the study. The children were found to be healthy on the basis of physical examination by a Paediatrician. None of the children had any symptoms of skeletal deformities. All the children were drug-naive. Data on height, weight, skin color, food habits, physical activities and socio-economic status were recorded. A 2ml of peripheral blood samples were collected from the participants. Total vitamin D in the serum was estimated by chemiluminescence immunoassay (CLIA).Results: VDD was observed in 60.92% and insufficiency in 30.46% of the participants. Only 8.62% of the participants had normal vitamin D levels. The mean vitamin D level was 19.93 ng/ml. Males had significantly higher vitamin D levels compared to females. Factors such as age, height, weight, diet, skin color and socio-economic status did not influence vitamin D levels.Conclusions: This is the first study of vitamin D status among the school-age children of Kerala. This paper adds further evidence to the reports indicating high prevalence of subclinical VDD among children across India and calls for action.
Panayiotopoulos syndrome: a clinico-electroencephalographic presentation of three cases from Nigeria
Authors: Ogoke Christian Chukwukere
Published: February 2019

Panayiotopoulos syndrome (PS) is a common benign, childhood, focal, seizure susceptibility syndrome presenting with mainly focal aware or focal impaired awareness autonomic seizures and autonomic status epilepticus that is under diagnosed in our locality. Increased awareness through reporting will aid diagnosis, reduce misdiagnosis and prevent aggressive and deleterious interventions. The classic clinical and electroencephalographic (EEG) features of three cases are described and the literature reviewed. The aim is to underscore the presence in our locality of this remarkably benign epileptic syndrome that must be differentiated from febrile seizures, encephalopathy, migraine or cardiogenic syncope.
Brown Vialetto Van Laere syndrome, a fatal disease with a simple solution: a case series
Authors: Mittal Nishant , Kamate Mahesh
Published: February 2019

Brown Vialetto Van Laere (BVVL) syndrome is an extremely rare neuro metabolic disorder postulated to be caused by a defect in riboflavin transporter. The disease is characterized by progressive hearing loss with ataxia and difficulty in swallowing and breathing. The diagnosis of the disease requires great deal of suspicion on the part of treating physician. Here authors present 2 cases of BVVL who presented to us with dysphagia and hearing loss and responded to therapy. Brown Vialetto Van Laere (BVVL) syndrome is an extremely rare neuro metabolic disorder postulated to be caused by a defect in Riboflavin transporter. The disease is characterised by progressive hearing loss with ataxia and difficulty in swallowing and breathing. It is a subset in multiple acyl CoA dehydrogenase deficiency (MADD disorder). Age of onset is generally first to third decade of life. Lower cranial nerve involvement with LMN and UMN signs concomitantly is the striking feature. There is no specific treatment for BVVL except supportive care. Response to high dose riboflavin (20mg/kg/day) has produced promising results but the results may take anywhere from 1 week to 12 months to appear.
Partial trisomy 15: a rare occurrence
Authors: Gandhi Prachi , Malik Sushma , Subramanian Sharan , Wade Poonam , Saxena Shruti , Lichade Vinaya
Published: February 2019

Partial trisomy 15q is a very rare entity and most of them are characterized by duplication of regions 15q21-15q26.3. This duplication is frequently associated with deletions in another chromosome resulting in unbalanced translocations. Authors report here, a rare case of partial trisomy 15, with breakpoints between 15q11.1 to q23, probably the first reported case with these breakpoints. Irrespective of the breakpoints, the phenotypic features are consistent in all affected cases and predominantly consist of craniofacial anomalies. In addition, finger abnormalities, very short neck, skeletal malformations and congenital heart disease may be present. Our neonate had typical dysmorphic features of arachnocamptodactyly, narrow face, large prominent, nose with broad nasal bridge, long philtrum, pointed chin, short neck, and low set deformed ears.  Neonates’ cytogenetic analysis revealed additional chromosomal material on the long arm of the chromosome 15 from q11.1 to q23.1, which was suggestive of partial trisomy of chromosome 15. Most cases reported have had a stormy clinical course, however, our proband had only mild respiratory distress at birth and she was discharged in a few days.
A rare case of Sprengel deformity associated with spondylocostal dysostosis in a four-year child
Authors: Mohamed Syed , Kumar Radha
Published: February 2019

Sprengel deformity is a complex congenital anomaly affecting one or both scapulae with mispositioning and dysplasia of scapula. It occurs due to failure of descent of scapula during intrauterine development and is the commonest congenital skeletal deformity of the scapula, often associated with other skeletal deformities. spondylocostal dysostosis is a rare genetic disorder which is characterized by malformation of the bones of the spine and ribs. It occurs in approximately 1 in 2,00,000 people worldwide. In spondylocostal dysostosis, affected children have wedge shaped vertebrae along with ribs that are fused, forked or sometimes missing. Based on the severity of the defect’s children may present with short stature, scoliosis or hypoplasia of lungs causing difficulty in breathing and recurrent respiratory tract infections. Management of both these skeletal deformities depends on their severity and the presence of associated deformities. Surgical intervention might be required for cosmetic and functional recovery of the shoulder. Authors had a rare and interesting case of a 4-year-old boy who had features of Sprengel deformity affecting left scapula which was associated with features of spondylocostal dysostosis.
Orbital compression syndrome: a rare complication of sickle cell disease in children
Authors: Panda Prateek Kumar , Padhy Srikant Kumar
Published: February 2019

Vasoocclusive crises in sickle cell disease commonly involve bone marrow of the long bones and vertebrae. Involvement of bones with less marrow space, including the bones of the orbit, is reported rarely in the literature. The present case is a 6-year-old boy, a known case of sickle cell disease, who presented with acute onset right upper and lower eyelid swelling, restriction of extraocular movement and pain. USG orbit showed a retroorbital hemorrhage compressing on the orbit, probably due to orbital bone infarction. The child was managed successfully with red blood cell transfusion and intravenous antibiotics, without steroids and surgical intervention. This report highlights the importance of maintaining a high index of suspicion in patients with known sickle cell disease presenting with pain, orbital swelling and restriction of ocular movement. Timely red blood cell transfusion only may be sufficient for uneventful recovery, without steroids or surgical intervention. Expedient diagnosis of orbital compression syndrome in children with sickle cell disease is crucial because this is a potentially sight-threatening entity.
Developing an integrated biosocial theory to understand juvenile delinquency: from the social, cognitive, affective, and moral (SCAM) perspectives
Authors: Du Yu
Published: February 2019

Biosocial theory has made considerable progress in explaining juvenile delinquency and making explicit references for juvenile justice policy during the past decades. However, because biosocial theory aims to identify multiple risk factors, it makes juvenile justice practice and develop delinquency prevention programs difficult. This paper proposes an integrated biosocial theory from the social, cognitive, affective, and moral (SCAM) perspectives to understand juvenile delinquency and facilitate the development and improvement of prevention and intervention programs. The article briefly summarizes the background and the key concepts of the chosen criminological theories and the logic of theoretical integration. Then it articulates the four aspects of the integrated biosocial theory and how it can contribute to criminology in details. Lastly, the paper identifies its potential limitations and provides practical implications.
Thyroid abnormalities among Down syndrome children from Kerala, India
Authors: Viswambharan Vijitha , Vasu Mahesh M. , Thanseem Ismail , Poovathinal Suresh A. , Anitha Ayyappan
Published: February 2019

Down syndrome (DS), caused by trisomy of human chromosome 21, is one of the most common chromosomal abnormalities in live born infants with a prevalence rate of 1 in 700 live births. Individuals with DS usually have comorbid conditions such as thyroid dysfunction, growth retardation, diabetes mellitus and obesity. The most frequent among these are the thyroid abnormalities which range from subclinical to overt hypothyroidism, and rarely hyperthyroidism.1-3 Individuals with DS are more susceptible to thyroid disorders compared to the general population. Primary hypothyroidism, referred to as elevated TSH, is the most common thyroid abnormality in DS; secondary hypothyroidism indicated by normal/reduced TSH is extremely rare. The prevalence of hypothyroidism varies between 3-54% in adults with DS.4 The aim of this study was to examine the incidence of thyroid abnormalities among children with DS registered in a tertiary referral center for neurodevelopmental disorders and non-communicable neurological disorders in Kerala, a south Indian state. 100 children with DS in the age range of 4 months-15 years, registered at Institute for Communicative and Cognitive Neurosciences (ICCONS), Shoranur, Kerala during the period of 2012-2016, were recruited for the study. The mean age of the participants (57 males, 43 females) was 5.4±3.8 years. The diagnosis of DS was confirmed by karyotyping. All the participants were drug-naive at the time of blood collection. 500 µl of serum samples was used for thyroid function test (TFT) which measured the levels of TSH, triiodothyronine (T3) and thyroxine (T4) by chemiluminescence immunoassay (CLIA). The reference range for TSH, T3 and T4 were as follows, TSH: 0.4-4mIU/ml, T3: 70-170ng/dl, T4: 4.5-12.5mg/dl.
The impact of ipsilateral central neck dissection on the 2015 American thyroid association risk stratification system and TNM staging in papillary thyroid carcinoma
Authors: Penna Gustavo C. , Corradi Patricia F. , Mendes Henrique G. , Berenstein Cynthia K. , Pires Magda C. , Fonseca Bernardo , M. Moraes Gustavo
Published: February 2019

Background: In patients with classic papillary thyroid carcinoma (PTC) and no clinical evidence of lymph node metastasis (cN0), elective central neck dissection remains controversial. This study evaluates whether elective ipsilateral central neck dissection (eICND) along with total thyroidectomy could modify the staging of these patients. Additionally, we aim to assess pN1 risk factors, the incidence of post-operative complications, and the correlation between pN1 and change in tumor classification according to the risk stratification score of the American thyroid association 2015 (ATA 2015-RSS) and the TNM Score.

Methods: This is a prospective, observational study, involving 46 patients with cN0 PTC who underwent eICND along with total thyroidectomy. The number of metastatic lymph nodes, the largest lymph node metastasis, and the extra-nodal extension were assessed.  

Results: 22 out of 46 patients (47.8%; CI 32.9–63.1) presented lymph node metastasis. Seventeen out of the 45 patients initially classified as low or intermediate ATA 2015-RSS upgraded their risk staging (37.8%; CI 23.8–53.5). Fourteen out of these reclassified patients had their initial ATA 2015-RSS changed due to lymph node metastasis larger than 2 mm (mostly between 3 mm and 4 mm). Ten out of 46 (21.7%; CI 10.49–36.4) patients had their TNM staging reviewed. General complication rate was 17.4% (8/46).

Conclusions: Elective dissection of levels VI ipsilateral and VII showed the ability to upgrade the initial ATA 2015-RSS and TNM staging in patients with cN0 PTC. However, further studies are necessary to evaluate the clinical impact of lymph node micro-metastasis.
Do eyeglasses and palatal prostheses affect the results of the Weber test?
Authors: Atar Yavuz , Salturk Ziya , Berkiten Guler , Kumral Tolgar Lutfi , Uyar Yavuz , Yildirim Guven , Aydogdu Imran , Dogan Mehmet Onder , Sari Huseyin , Ekincioglu Enis
Published: February 2019

Background: The aim of the study was to analyze the possible effects of eyeglasses and palatal prostheses on the results of the Weber tuning fork test.

Methods: We enrolled 96 patients diagnosed with unilateral conductive-type hearing loss. All were aged between 18 and 65 years. Group 1 was composed of 48 patients with eyeglasses and group 2 included 48 patients with palatal prostheses. All patients underwent the weber tuning fork test with and without their eyeglasses and prostheses, and the results were compared. Weber tests were performed using 256 Hz and 512 Hz tuning forks.  

Results: No significant between-group difference was apparent (both p>0.05).

Conclusions Neither eyeglasses nor palatal prostheses significantly affected the results of the Weber test.
Effect of nasal surgery on laryngeal mucosa
Authors: Mandour Yasser Mohammad Hassan , Badie Samer , Shendy Mohammad Fahmy
Published: February 2019

Background: The aim of the study was to compare stroboscopic features of laryngeal mucosa before and after the nasal surgery.

Methods: Prospective randomized case control study in which 60 patients divided into two groups each include 30 patients, group I with bilateral nasal obstruction due to deviated nasal septum with hypertrophic inferior turbinate, group II bilateral nasal obstruction due nasal polyposis undergoing septoplasty with turbinectomy group I and FESS in group II with video- stroboscopic examination before and 3 months after the surgery for each patient and 30 normal volunteers as a control group.  

Results: Swollen true vocal cord, laryngeal erythema and laryngeal edema were significantly decreased after the nasal surgery, As Swollen true vocal cord changed from 8 to one patient in group I and from 16 to 4 patients in group II, laryngeal erythema changed from 28 to 6 patients in group I and from 29 to 7 patients in group II and laryngeal edema changed from 28 to 5 patients in group I and from 29 to 8 patients in group II.

Conclusions: The nasal surgery would have a significant impact on laryngeal edema, erythema and vocal cord edema.
Acute xerostomia in head and neck radiotherapy
Authors: Al-Nuaimi Dalya S. A. , Al-Rawaq Khudair J. , Noori Ali G. M. , A. N. Fattah Marwa
Published: February 2019

Background: Xerostomia is a common complaint experienced with radiotherapy to the head and neck and it is caused by salivary glands dysfunction.

Methods: Xerostomia is a common complaint experienced with radiotherapy to the head and neck and it is caused by salivary glands dysfunction.  

Results: The mean age was 51.69±13.7 years; 67% were men and 33% were women. Nasopharyngeal tumor and larynx cancer were the common tumors diagnosed (29% and 28% respectively), 78% of the tumors were squamous cell carcinoma and 53% of them in stage III. Most patients didn’t take chemotherapy during radiotherapy (90%), while 68% of them have previously received chemotherapy. The mean dose of radiotherapy used was 63.2±9.65 Gray. Post radiotherapy, the highest proportion diagnosed with xerostomia grade I (37%), while 21% of them were free of xerostomia. Female, negative past medical history, site, stage and dose of radiation were associated factors that increased prevalence of xerostomia.

Conclusions: After radiotherapy, there is a high chance for developing xerostomia. Females, negative past medical history, advanced stage of tumor, high dose of radiation and site of tumor (oral, nasopharyngeal, and parotid) were significantly associated factors. Tumor site was a significant factor associated with the grade of xerostomia.
Prevalence and clinical profile of patients with chronic fungal maxillary sinusitis
Authors: Gupta Vijay , Gupta Arindam
Published: February 2019

Background: Fungal paranasal sinus disease is considered to be rare but there has been a marked increase in the number and diversity of reported cases of fungal infections of maxillary sinus in recent years. Objectives were to study the incidence of fungal infection in case of chronic maxillary sinusitis, to identify specific type of fungus involved in maxillary sinus infection and to study clinical profile of the patients with fungal infections of maxillary sinus.

Methods: A prospective study of was conducted involving the patients attending outpatient department of Otorhinolaryngology, who were clinically and radiologically proved cases of chronic maxillary sinusitis. Patients diagnosed with underlying paranasal sinus malignancies were excluded from the study. 70 patients of chronic maxillary sinusitis were included in the study. Isolates were identified based on colonial and microscopical morphology. Subcultures were done and slide cultures were prepared to identify the fungi.  

Results: Fungus was cultured from 12.8% of patients suffering from chronic maxillary sinusitis. The most frequent victims of the disease were young persons in the second decade of life. All patients found positive for fungus had unilateral maxillary sinusitis. Aspergillus niger, Aspergillus fumigatus, Candida albicans and Mucormycosis were the various fungi isolated from cultures of antral washings.

Conclusions: The results of the study emphasise the role of fungi as important pathogens of chronic maxillary sinusitis. There must be high index of suspicion of fungal infection when a young adult with a unilateral antral opacity on X-ray with frank pus in antral washings.

 
Clinical aspects and surgical outcomes of pediatric cholesteatoma in a tertiary care teaching hospital
Authors: Gupta Vijay , Mirza Navid , Gupta Arindam
Published: February 2019

Background: Cholesteatoma in children is customarily viewed as a separate and special entity as it presents the otolaryngologist with a verity of diagnostic and therapeutic challenges. The study was planned with objective of studying the clinical aspects and surgical outcomes of pediatric cholesteatoma.

Methods: The patients younger than 15 years and diagnosed as congenital cholesteatoma were included in the present study. All the patients underwent thorough clinical examination, laboratory and radiological investigations. Depending on the stage of disease, surgical procedure was decided. All patients were followed-up for at least 12 months after surgery.  

Results: Total 46 children congenital cholesteatoma (CC) was included in the study. The mean age of diagnosis was 7.08±5.64 years. All the cases have unilateral ear involvement. 14 patients were asymptomatic and CC were found incidental. Patients with CC represented with more commonly with hearing impairment. The CC was most commonly found in the anterosuperior quadrant. All 46 patients with CC underwent operative procedure with transcanal myringotomy was commonest surgical approach. During the 12 month follow-up, 28.86% of patients presented with recurrence of disease.
Conclusions:Despite of improved understanding of this disorder with better surgical techniques and skill, high recurrence rate is still major challenge for successful management of CC. 
 
Transoral laser microsurgery for supraglottic and hypopharyngeal squamous cancers
Authors: Garg Rishav , Aggarwal Kushal , Sandhu Seerat
Published: February 2019

Background: Open partial laryngectomies for supraglottic and hypopharyngeal cancers have a very high incidence of aspiration in the post-operative period with resultant delay in restoration of swallowing. The present study examines the functional efficacy and oncological safety of transoral laser microsurgery (TLM) for select subset of T1/T2/T3 squamous cancers of the supraglottis and hypopharynx with freely mobile vocal cords that are easily accessible on suspension microlaryngoscopy.

Methods: This is a retrospective study of squamous cancers of the supraglottis and hypopharynx treated with transoral CO2 laser resection.  

Results: Oncologically, resections performed under the magnification of the operating microscope are safe and yield high local control rates ranging from 79% to 85% for supraglottic cancer and from 63% to 89% for hypopharyngeal cancer.

Conclusions: Transoral laser microsurgery (TLM) in selected cases of supraglottis and hypopharyngeal squamous cancers is safe procedure with several advantages over the open partial laryngectomy procedures as also over radiotherapy.
A study on the efficacy of prophylactic antibiotics in recurrent acute otitis media
Authors: Vijayakumar Lakshmi , Santhi T.
Published: February 2019

Background: To study the efficacy of broad spectrum antibiotics in the prophylaxis of recurrent acute otitis media.

Methods: 86 patients of age group between 2 and 15 years with history of recurrent otitis media were enrolled to study the efficacy of the prophylactic antibiotics used in this condition. The children were treated with amoxicillin or azithromycin during the acute episode. Then they were divided equally into two groups and assigned to receive amoxicillin in one group and azithromycin in the other group at one third the therapeutic dose as prophylaxis for 6 months. The children were evaluated at the end of every month and recurrent episodes if any, was documented.  

Results: At the end of 6 months it was observed that prophylactic antibiotics were more effective in the younger age group of 2-7 years. Efficacy rates of 87.5% with azithromycin and 77.4% with amoxicillin were noted.

Conclusions: As azithromycin is given once a week compared to amoxicillin which is given daily and was found to be equally effective as a prophylactic drug in recurrent acute otitis media with a better compliance, it is a good alternative to amoxicillin as a prophylactic antibiotic.  Proper dosage goes a long way in bringing down resistance to the therapeutic agents.
Radiological study of the myriad variations in frontal sinus anatomy: an institutional study
Authors: Vepamininti Sreenivas , Seetharam Soumya M. , George Jomy , Vamanshankar Hemanth , Saidha Poonam K.
Published: February 2019

Background: The frontal sinus is a challenging area for endoscopic surgeons. The variations in the frontal sinus differs so much among individuals that there are forensic applications. A detailed radiological study of the sinus is important for understanding the pathophysiology of sinusitis and as a prerequisite for frontal sinus drainage procedures. Aims and objectives were to document the anatomical variations of the frontal sinus (radiological) and to correlate the variations with the signs and symptoms of sinusitis.

Methods: Coronal and axial CT paranasal sinuses scans of 30 consecutive patients who attended the Otolaryngology clinic OPD in St. John’s medical college and hospital, Bangalore, India with signs/symptoms of  chronic sinusitis were evaluated between January to July 2018.  

Results: The average frontal sinus diameter in patients with sinusitis was 6.65 mm. The prevalence of frontal cells in our study was 48%. Agger nasi cells were the most common cells seen. Frontal sinus disease was found in 72% of the studied sides in the scans.

Conclusions: Frontal sinus anatomy varies with different ethnicities. It is very important to study the frontal sinus anatomy before exploring the sinus for disease clearance and avoid surgical complications.
Assess the outcome of pre and postoperative bacterial culture in sinonasal polyposis cases under FESS
Authors: Sudheer C. P. , Singh T. Dinesh
Published: February 2019

Background: Sinonasal polyposis is multifactorial condition characterised by mucous membrane lesions in nose and paranasal sinuses. Pre and post-operative management of cases undergoing functional endoscopic sinus surgery (FESS) give ideal surgical outcome. This study designed to assess pre and postoperative bacterial profile in sinonasal polyposis cases undergoing Functional endoscopic sinus surgery.

Methods: A total 100 cases ready for endonasal endoscopic surgery with chief complaints of sinonasal polyposis were recruited for the study. Pre and post-operative nasal swabs were collected from lateral wall, floor and area over the polyps. Sensitivity test was performed by using commonly available antibiotics i.e. ceftriaxone, erythromycin, ampicillin, gentamycin, ciprofloxacin, cephalexin, doxycycline and co-trimoxazole.  

Results: Pre-operative bacterial culture showed growth of Staphylococcus coagulase negative (CONS) in 32% cases, Staphylococcus aureus in 24%. Post-operative bacteria culture showed Staphylococcus coagulase negative (CONS) in 22% cases, Staphylococcus aureus in 22% cases. Staphylococcus coagulase negative (CONS) and Staphylococcus aureus had resistance to Ampicillin and Gentamycin.

Conclusions: Staphylococcus coagulase negative (CONS) and Staphylococcus aureus are isolated commonly in pre and post-operative bacteria culture. Ampicillin, gentamicin, cefotaxime and ceftriaxone are primary choice for intravenous antibiotics in current clinical practice and in al surgical procedures including endoscopic sinus procedures.
Nasal endoscopy: an excellent tool for the novice
Authors: Suraneni Visweswara Rao , Kudamala Suneel , Begum Karishma
Published: February 2019

Background: Nasal endoscopy has revolutionized the ease of diagnosing nasal pathologies over the recent years. It offers the advantage of detailed examination of the intra-nasal architecture and precise identification of the pathology. It is cost effective and a useful adjunct for performing minor procedures in the office setting. Thus, nasal endoscopy has evolved as a tool with multiple roles of diagnosing the disease, planning of treatment and post treatment examination.

Methods: This is a prospective study conducted at a tertiary care hospital during a period of 2 years on 100 patients to evaluate the role of nasal endoscopy in diagnosing the disease and planning the management. 60 cases were managed conservatively depending on the initial finding on nasal endoscopy while the other 40 cases underwent surgery. Pre-treatment symptoms and post treatment outcomes were observed objectively on nasal endoscopy.  

Results: Majority of the patients (60%) were managed conservatively and were labeled as cured after enough evidence was obtained both subjectively from the patient and objectively as seen on endoscopy. The remainder of patients (40%) underwent surgery and follow up endoscopy was done in all of them.

Conclusions: Diagnostic nasal endoscopy is of immense help to the novice surgeon in understanding and managing various nasal pathologies. Through this study, it can be concluded that most of the nasal symptoms can be managed conservatively and surgery advised for absolute indication, with the help of nasal endoscopy.
Understanding acute invasive fungal rhinosinusitis for better treatment outcomes
Authors: Patel Monika , Kaushik Maitri , Dehadaray Arun , Kar Gargi
Published: February 2019

Background: Objectives of the study were to identify factors that affect patient survival, determine treatment outcomes in various clinical presentations, increase awareness amongst clinicians and provide more accurate treatment options to patients. Study design was a retrospective study. Study places were Tertiary care centre and a Medical College.

Methods: A series of patients diagnosed and treated for acute invasive fungal rhinosinusitis over a period of 7 years.  

Results: Twelve patients were reviewed out of which eleven were diabetic. Most common fungus encountered was mucor. Six cases presented as sinonasal disease, four as rhino-orbital disease and two as rhino-orbito-cerebral disease. All the patients underwent surgical debridement with systemic antifungal treatment. It was seen that diseases confined to sino nasal areas had good prognosis. Early diagnosis and prompt intervention is major factor for better prognosis.

Conclusions: Immunocompromised patients in ICU with ocular symptoms should be meticulously screened for invasive fungal rhinosinusitis. Early diagnosis and prompt management with surgical debridement and systemic antifungal treatment is utmost important factor in good prognosis. Intensivists and also the physicians should be made cognizant as they play important role in patient management as well. Multidisciplinary approach is the need of hour.
Merits of Kerrisons punch over powered drill in endonasal DCR
Authors: Sheikh Shahnaz , Vaze Vikrant Vilas , Bajaj Anushree , . Bhalachandra
Published: February 2019

Background: DCR is an operation used to treat nasolacrimal duct obstruction. Various types of DCR are conventional, endonasal/endoscopic DCR and endolaser DCR. Several modalities like Kerrison punch and powered drill are used in endoscopic DCR to improve success rate, reduce complications and shorten operative time. Aim of the study were, to compare the advantages of non powered Kerrison  punch over powered drill regarding time in endoscopic DCR and to compare the advantages of non powered Kerrison punch over powered drill regarding complication rate in endoscopic DCR

Methods: The study was carried out at ENT department of Dr. Ulhas Patil Medical College and hospital Jalgaon from March 2017 to July 2018. Total of 61 patients were included in the study (35 Kerrison punch and 33 drill).  

Results: A total of 68 endoscopic DCRs. Procedure success rate among Kerrison punch group was 88.00% vs 91% in drill group. The complications for both groups were statistically not significant(P=0.91).The mean operating time among Kerrison punch group was significantly lower than in drill group 80 vs. 135 min (P=0.0001).

Conclusions: Kerrison punch showed significant reduction in operating time when compared to drill for endoscopic DCR. No statistically significant difference was found between both groups regarding procedures, success rate and complications.
Role of PET CT in the detection of second synchronous primary tumors and distant metastasis in head and neck cancers at initial presentation
Authors: Gandla Sowjanya , Rao Vishal
Published: February 2019

Background: The patients with the head and neck cancer are strongly at risk of developing a second primary tumor which can be related to share etiological factors such as tobacco, alcohol and smoking. The aim of the study is to evaluate the percentage of synchronous second primaries and distant metastasis that are identified on PET CT imaging in head and neck cancer patients at initial presentation.

Methods: This study is a retrospective observational study. A total of 503 patients with histological confirmation of head and neck cancer and who had undergone 18F FDG PET CT imaging from 2007 to 2013 were included in the study. The PET CT scan images of all 503 patients were reviewed. The patients with PET CT scan images indicating the presence of abnormal metabolic uptake suggestive of additional primary malignant lesion or distant metastasis were identified.  

Results: Out of the total 503 patients with histological confirmation of head and neck cancer, 34 patients were excluded due to non-availability of complete details, among the 469 patients of head and neck cancer, 7 patients (1.49%) were diagnosed with synchronous primary tumors and 33 patients (7.03%) were diagnosed with distant metastasis in PET CT imaging at the time of initial presentation.

Conclusions: PET CT imaging is a useful tool to detect distant metastasis and second primary synchronous tumors in advanced head and neck cancers. The incidence of distant metastasis is a much more valid indication for the PET CT imaging in advanced head and neck cancers.
Pattern of paediatric ear, nose and throat disorders in a district hospital
Authors: Gupta Vijay , Gupta Arindam
Published: February 2019

Background: ENT disorders such as otitis media, serous otitis media, sinusitis, and tonsillitis are among the commonest childhood disorders and important reasons for parents and children to visit the physicians/otolaryngologists. The pattern of ENT disorders also varies from community to community or hospital to hospital based on the availability of specialist personnel or facilities for the management. Present study was carried out with the objective of to study the pattern of paediatric ENT disorders in our Government district hospital.

Methods: The patients of both gender and age between 0 to 16 years and presenting with ENT problems were screened. The patients having END disorders diagnosed by ENT surgeon were enrolled into the study. All information to accomplish objectives was collected by studying the patients’ treatment record and by personal interview of each of the study participants/parents for 5 to 10 minutes using case record form.  

Results: Children from rural community were more affected than children from urban community. The maximum children were suffered from ear disorders (49.32%) followed by throat disorders (34.55%); and nose disorders (16.14%). CSOM found the commonest ENT disorder, OME, AOM, tonsillitis, adenoid hypertrophy, and acute pharyngitis. In 0-5 years-age-group, AOM and OME were the commonest; CSOM and OME in 5-10 years age group while acute pharyngitis and CSOM were the commonest in age-group of 10-16 years.

Conclusions: These results of the present study clearly show the wide prevalence of ENT disorders, particularly in the rural communities. There is urgent need to establish better healthcare especially ENT services for the rural population of our country. The general physicians and paediatricians should be trained and taught enough recognize common ENT disorders promptly; therefore they are able to refer early and prevent complication.
Pre-operative predictors of ossicular necrosis in chronic otitis media-mucosal type
Authors: Rasheed Razim Abdul , . Mubeena , Gangadhara Somayaji K. S.
Published: February 2019

Background: Chronic suppurative otitis media can cause a wide range of pathologies in the middle ear that include irreversible mucosal changes, granulation tissue formation, cholesteatoma, tympanosclerosis, and destruction of ossicles. Knowledge regarding ossicular discontinuity before surgery enables the surgeon to be prepared for ossiculoplasty. Objective was to study the pre-operative clinical, audiological and microscopic findings in chronic otitis media mucosal type and correlate preoperative findings with intra-operative ossicular necrosis. 

Methods: Study design was observational, descriptive and cross sectional study. All patients were subjected to detailed clinical, otoscopic and microscopic examination to assess the size and site of perforation, presence or absence of ear discharge, granulation tissue, tympanosclerosis in the middle ear, exposure of incudostapedeal joint and condition of middle ear mucosa. Pure tone audiogram was also done. All patients underwent tympanoplasty±cortical mastoidectomy and the intraoperative findings of ossicular necrosis were noted.  

Results: Of the 105 patients, 18(17.1%) had ossicular necrosis. Bivariate analysis showed positive correlation for long standing disease (p=0.004), presence of discharging ear (p=0.014), polypoidal middle ear mucosa (p=0.000) granulations in middle ear (p=0.000) and also when incudostapedeal joint was exposed (p=0.005). Mean Air bone gap was higher with 35 dB in ossicular necrosis and 22.7 dB in intact ossicular chain was also statistically significant (p=0.0001).

Conclusions: Ossicular necrosis was best indicated by the presence of polypoidal mucosa, granulation in the middle ear and higher air-bone gap on audiometry. However longer duration of disease, persistent active stage of disease and exposure of incudostapedeal joint were also found to be significant.
Outcome of conchal cartilage shield type I tympanoplasty: a prospective study of 70 patients
Authors: Kunnumal Ayisha , Priyadarshini G.
Published: February 2019

Background: Tympanoplasty is a surgical procedure performed to reconstruct hearing mechanism with or without reconstruction of tympanic membrane perforation. Cartilage shield tympanoplasty was first reported in literature by Duckert et al in 1995.The purpose of the present study was to prepare the cartilage shield graft and to evaluate its effect on the success rate of tympanoplasty.

Methods: In this study 70 patients who presented to ENT OPD of Aarupadai Veedu medical college, Puducherry, with chronic otitis media (COM) mucosal type, who were treated during the period between December 2016 to April 2018 were enrolled. Patients with COM mucosal type, with mild to moderate conductive hearing loss, dry or moist ear were included in the study. Detailed history was taken in the selected patients including a thorough otological examination and blood investigations required for surgery.  

Results: In the present study male to female ratio was 1.6:1. 30% patients were in the age group between 20-24years. In our study 33% patients had pre-operative airbone gap in the range of 31-40 dB and post-operative improvement in airbone gap was in the range of 0-10 dB in 49% patients.

Conclusions: Conchal cartilage shield tympanoplasty is an effective technique in tympanic membrane reconstruction and shows no detrimental effect to the hearing outcome. Conchal cartilage is preferred graft as it can be harvested from same incision. The graft uptake rates are excellent with this technique.
Adenoid hypertrophy in adults
Authors: Thimmappa T. D. , Gangadhara K. S.
Published: February 2019

Background: Adenoid is a nasopharyngeal tonsil becomes active between 3 to 7 years of age. Starts involution by adolescence. Few of the occasions, the adenoid persists causing various symptoms including ear, nose, throat and facial deformities. It is also important while addressing the cause for nasal obstruction due to the co-existent adenoid tissue which may fail to diagnose pre-operatively becomes an on-table surprise.

Methods: Adult patients above 16 years are subjected to study. Routine clinical examination done followed by diagnostic nasal endoscopy and the size of the adenoid tissue and other associated findings are recorded.  

Results: 100 patients were included in the study and gradings were done.

Conclusions: We conclude the presence of adenoid tissue is due to persistence of a childhood problem, which is supported by presence of associated findings like high arched palate, supernumerary teeth.
Panorama of foreign body in upper digestive tract in the population of Uttarakhand
Authors: Bansal Chetan , Bharti Prerana , Singh V. P.
Published: February 2019

Background: Foreign body aspiration is more common in children than adults because they explore the world with their hands and mouth and also have incomplete control and immature judgment. Foreign bodies in ENT are a medical emergency as their removal demands great skill due to unpredictability in the procedure and the complications associated with it.

Methods: A prospective study was conducted on 40 cases of digestive tract foreign bodies in relation to age, sex, type, site, clinical presentation, extraction and complications.  

Results: Youngest child was 5 months old. Most predisposed age group was 0-5 years (60% of cases). Cricopharynx (24 cases) was the most common site of impaction for foreign body. In the present study toys (22.5%) were most common foreign bodies followed by coins (15%) ingestion.

Conclusions: Avoid carelessness. Avoid hasty drinking, eating, talking and running with anything in the mouth. Keep the things out of reach of the children. Be particular in sleep, anesthesia, coma or delirium. Avoid putting objects into mouth.
Study and correlation of clinical, cytological and histopathological findings in diagnosis of parotid gland masses
Authors: Dutta Angshuman , Bhat Sweekritha , Dutta Debmita , Sharma Pragya , Gianchand Shikha
Published: February 2019

Background: Parotid masses comprise a variety of benign and malignant tumors and tumor-like conditions, which may present diagnostic challenges to the surgeon and pathologist as well. Fine needle aspiration cytology is considered to be a useful diagnostic tool used for preoperative evaluation of parotid masses. However its role may not be conclusive for evaluation. This study was aimed to evaluate fine-needle aspiration cytology in the diagnosis and management of parotid lesions.

Methods: The present study was a prospective study done over a 3 year period included 38 patients with parotid gland lesions who underwent preoperative fine-needle aspiration cytology, MRI/USG followed by surgical procedure and histopathological examination. The clinical, cytological findings were compared with the final histological diagnosis and concordance assessed.  

Results: Of the 38 cases with parotid lesions 31(81.5%) were neoplasms and 7 (18.4%) were non-neoplastic lesions. Out of the neoplasms, 25 (80%) were benign and 6 (19%) were malignant parotid tumors. Deep lobe lesions were 9 (23.6%) and superficial lobe were 29 (76.31%). In this study correlation between FNAC and final histopathology was studied. In some situations cytological features could not provide correct tumor characterization. In our study the sensitivity of FNAC in diagnosing the lesion was 96.55% and specificity was 66.6%.

Conclusions: FNAC is a simple and reliable technique for preoperative evaluation of parotid masses. Due to the minimally invasive nature of the technique, fine-needle aspiration cytology offers valuable information for planning of subsequent therapeutic management.
A clinical study of endoscopic management of benign tumors of nasopharynx
Authors: Gupta Devang P. , Rai Shreya , Gupta Shalu , Ganvit Nikita , Makwana Jaydeep
Published: February 2019

Background: Benign tumors of nasopharynx are extremely rare; seen predominantly in children and young adults. Patients usually present with seemingly innocuous symptoms and an error in judgment can be catastrophic. Aim of our study is to analyse the incidence of these lesions, common presenting features and outcomes of endoscopic management.

Methods: This is a retrospective analysis of patients diagnosed to have benign tumours of nasopharynx by histopathological examination in our ENT department of civil hospital, B. J. Medical College, Ahmedabad. The period of study is from January 2016 to January 2018. Forty patients with complete clinical data were identified and included in the study. 33 patients out of 40 (83%) were males and 7 were females (17%). Following surgical excision patients were followed up for a mean period of 2 years. The Clinical profile, investigation modalities, treatment options are being analysed here.  

Results: Forty patients had undergone surgical excision for tumours arising from the nasopharynx. The mean age was 21.37 years (range 10–43). Thirty three patients were males and seven were females. Indications for resection were juvenile nasopharyngeal angiofibroma in thirty cases, lobular capillary hemangioma in four cases, paraganglioma in two cases, hemangiopericytoma in two cases, and neurofibroma in two cases. There were no significant post-operative complications. Recurrence due to residual lesion was seen in three cases. The mean follow up period was 2 years (range 1-3 years).

Conclusions: It is important to note that patients with similar symptoms have varied pathology and thus need for radiological evaluation, JNA is commonest benign nasopharyngeal tumor and surgical approach depends on size and extent of tumor.
A cross sectional study of hearing thresholds in medical students
Authors: Katiyar V. M. Hemlata , Elango D. , Prasanna Vincent
Published: February 2019

Background: The hearing thresholds of young adults with no known hearing loss or noise exposure is expected to be closer to 0 dB HL, though with the increasing usage of recreational noise through personal amplification devices there is shift in thresholds noted. Some studies have highlighted the effect of these devices on the hearing thresholds and a general shift of thresholds towards 25 dB. Objective was to determine the audiometric thresholds of a screened sample of medical students with presumed normal hearing.

Methods: A total of 103 medical students in the age group of 20 to 23 years were screened and subjected to PTA. The Pure tone average was calculated for air conduction (AC) and bone conduction (BC) separately and also for high frequencies (HF). The average for the female students was compared with that of male students. The right ear average was compared with that of left ear.  

Results: There was a statistically significant difference with higher thresholds for males in BC and HF, however the difference in AC was not significant. Between the right and left ears, there was statistically significant elevation observed in BC average in the right ear, but no significant difference was found in the HF and AC thresholds.

Conclusions: There is evidence of thresholds especially BC, shifting more towards 25 dB HL in young adults considered to have normal hearing. Early screening will help in identifying this and prevent further elevation by judicious use of mobile phones, personal music players and personal listening devices.