bluuebunny/crossref_metadata_2025 huggingface dataset:
Mucormycosis: Effect of Comorbidities and Repeated Debridement on the Outcome
Authors: Reddy Harshavardhan N , Patil Sanjay B , Channegowda Chandrakiran , Muralidharan Aiswarya
Published: August 2020

Introduction: Mucormycosis is an aggressive, invasive infection caused by ubiquitous filamentous fungibelonging to the subphylum Mucormycotina, order Mucorales. Mucormycosis most commonly affects immunocompromised hosts, but are rarely reported in immunocompetent hosts as well. The most common reported sites of invasive mucormycosis have been the sinuses (39%), lungs (24%), and skin (19%). The hallmark of mucormycosis is angioinvasion resulting in vessel thrombosis and hence, tissue necrosis.

 

Materials and Methods: Ambispective study of 20 cases with mucormycosis seen and treated in our hospital between 2009 and 2015 and followed up to 2017 to compare the prognosis of the cases of repeated debridement with that of single debridement and effect of comorbidities in the outcome of patients mortality .

 

Results: Out of 20 patients 19 (95%) received Liposomal Amphotericin B. 11 (55%) were male and 9 (45%) were female. All the 7 (35%) who underwent repeated debridement survived. Out of 13 (65%) patients who underwent single debridement, 5 (25%) did not survive. 2 (10%) patients were lost for follow up. The survival amongst the patients undergoing multiple debridement and single debridement was statistically significant (p=0.042)

Conclusion: The chances of survival are better in cases with better controlled comorbid conditions like diabetes mellitus. Repeated debridement with Liposomal Amphotericin B is the most effective mode of management.
A Comparative Study of Outcomes of Type I Tympanoplasty with or without Fibrin Glue
Authors: Lakshmanan Somu , Umamaheswaran Preethi
Published: August 2020

Introduction:

Various materials have been used in tympanoplasty to ensure the adherence of the graft with the remnant tympanic membrane. This study aims to compare the clinical outcomes of type I tympanoplasty done with and without fibrin glue.

Materials and Methods:          

This is a prospective comparative study conducted in a tertiary care centre between August 2014 and July 2016. A sample size of 70 patients was used. The patients were randomly divided into two groups – Group A and Group B. Patients in group A underwent tympanoplasty with fibrin glue and patients in group B underwent tympanoplasty without fibrin glue. The patients were followed up for 6 months and the postoperative hearing improvement and graft uptake rates were compared.

Results:

The pre-operative mean pure tone average for group A was 34.33±7.3dB; it improved to 22.14±6.5 at the end of 6 months. In group B, it improved from 34.25±8dB to 22.64±7.4dB at the end of 6 months. There was no statistical significance in hearing improvement between both the groups. Though there was no statistically significant difference in the graft uptake rates between group A (94.3%) and group B (91.4%), fibrin glue had better outcomes with larger perforations.

Conclusion:

The use of fibrin glue in tympanoplasty is safe and it has a particular advantage in the graft uptake in subtotal perforations.
Medial versus Medio-lateral Tympanoplasty in Large Central and Subtotal Perforation – A Prospective Study
Authors: Khaowas Ajoy , Das Chiranjib
Published: August 2020

Introduction:

Large central and subtotal tympanic membrane (TM) perforations are difficult to repair because of less vascularity of anterior TM than posterior TM and the anterior bony overhang that blocks visualization. Some studies reported very encouraging results with the medio-lateral tympanoplasty in such cases. We have undertaken this study to find out efficacy of this technique in large central and subtotal perforations and to compare the results of medio-lateral with medial tympanoplasty.

Materials and Methods:

The present prospective study was conducted in the Department of Otorhinolaryngology of a medical college and hospital, West Bengal from January 2013 to December 2014. Patients were alternatively divided into two groups. Medial technique was used in Group I and medio-lateral technique was used in Group II.   

Results:

Each group comprised of 40 patients each. Maximum number of patients in each group was in the age group of 15-25 years. The overall graft uptake rate in this study was 95% in medio-lateral technique compared to 80% of underlay technique.

Conclusion:

The medio-lateral tympanoplasty is suitable for reconstruction of large central or subtotal TM perforation. It takes advantage of both medial and lateral grafting methods while avoiding their pitfalls.
An Open-Label Observational Trial to Evaluate the Possible Effects of Individualized Homoeopathic Medicines in Symptomatic Nasal Polyp
Authors: Banerjee Aniruddha , Srivastava Birendra Prasad , Koley Munmun , Saha Subhranil
Published: August 2020

Introduction: Nasal polyps presenting with chronic rhino-sinusitis (CRS) is a commonly encountered condition characterized by nasal obstruction, loss of sense of smell (anosmia), postnasal drip, headache, and sleep disorders. Possibly 60-65% of the populations suffering from CRS has predisposition to nasal polyps. Homoeopathic literature claims to offer successful treatment of nasal polyps; but scarcely subjected to systematic research.

Materials and Methods: A prospective, open, non-randomized, single arm, observational trial of pre-post comparison design was conducted on 44 patients suffering from symptomatic nasal polyps. Sino-nasal outcome test (SNOT-20) and European Quality of Life (EQ-5D-5L) questionnaires were taken as the primary and secondary outcome measures respectively; assessed at baseline and after 3 months. Individualized homoeopathic medicines were prescribed on ‘totality of symptoms’. Intention to treat sample was subjected to statistical analysis. Data distribution was examined. Non-parametric Wilcoxon signed rank test and post hoc parametric paired t test were used accordingly. P values less than 0.05 were considered as statistically significant.

Results: Forty four patients were enrolled; 4 dropped out. Skiagrams revealed complete regressions of polyps in 23 (58%) cases. Statistically significant improvements were observed in both the subjective patient-rated outcomes – mean reduction of SNOT-20 scores by 19.9 [sd 15.5; 95% CI 15.5 to 24.2; P < 0.001], EQ-5D-5L questionnaire score by 0.9 [sd 2.6; 95% CI 0.1 to 1.7; P = 0.029]; and EQ-5D-5L VAS by 14.4 [sd 4.7; 95% CI 12.9 to 15.9; P < 0.001].

Conclusion: Homoeopathic medicines showed promising treatment effect in symptomatic nasal polyps. Randomized trials are warranted.
A Correlative Study between Chronic Tonsillitis and Helicobacter Pylori
Authors: Singh Abhishek , Pandurangarao Santosh Uttarkar , Ramchandra Aravind Darga , Janarthanan Sridurga
Published: August 2020

Introduction :

Chronic tonsillitis is characterized by persistent inflammation of the palatine tonsils and seen commonly in patients attending ENT OPD. Bacterial infection is usually the cause but anaerobes and viruses may also be implicated. The possibility that tonsillar tissue possesses Helicobacter pylori or that H. pylori can colonize the palatine tonsils is explored.

Materials and Methods :

Hundred patients aged between 5-50 years of either sex diagnosed with chronic tonsillitis undergoing elective tonsillectomy and willing to participate in the study were selected. Informed and written consent was taken from all the patients (in case of minor patients, consent was taken from parents). Specimen (tonsillar tissue) was harvested from the surgically removed tonsils  and put through Rapid urease test. The results were analysed statistically using Chi square test and Unpaired t test and inference was drawn.

Results :

Amongst 100 patients, 61 (61%) patients were females and 39 (39%) patients were males. Helicobacter pylori could be detected in Chronic Tonsillitis in 64 (64%) patients.

Conclusion :

According to our study, Helicobacter pylori was found to be a common finding in cases of chronic tonsillitis. Even after regular treatment with antibiotics, the chances of getting acute  infection in chronic tonsillitis still persist. We can try treatment for H. pylori and look for changes in recurrence of tonsillitis and also it can be tried in patients who are not willing/fit to undergo tonsillectomy.
Benefit of Tympanoplasty with or without Cortical Mastoidectomy in Active Mucosal Otitis Media – A Comparative Study
Authors: Bajaj Anushree Raviprakash , Sheikh Shahnaz , Joshi Samir , Paike Bhalchandra
Published: August 2020

Introduction:

Chronic otitis media (COM) is amongst the most common diseases treated by ENT surgeons in India. It has been advocated in lot of research articles that there is no significant difference in tympanoplasty done in active and inactive COM. The objective was to see if cortical mastoidectomy in cases of active mucosal COM, improves the success rate of tympanoplasty measured as per the following parameters: improvement in the hearing threshold by 15 dB, increased graft uptake and reduction in retraction of tympanic membrane in post operative period.

Materials and Methods:            

This study comprises of 120 patients coming to the ENT OPD from October 2016 to October 2017 with active mucosal COM with central perforation requiring tympanoplasty. These patients were randomly assigned to two groups: Group 1 of 60 subjects in which tympanoplasty without mastoidectomy was done, Group 2 of 60 subjects in which tympanoplasty with mastoidectomy was done. Patients were evaluated after a post operative period of 3 months.

Results:

The Results were the hearing improvement was 73.33% in group 1 while 83.33% in group 2, graft uptake was 63.33% in group 1 and 80% in group 2, graft retraction was 33.33% and 23.33% in group 1 and group 2 respectively.

Conclusion:

There was statistically significant difference in results in group with and without mastoidectomy in active mucosal chronic otitis media with respect to graft uptake and improved hearing.
Relationship between the Recurrent Laryngeal Nerve and the Inferior Thyroid Artery in the Togolese Subject: Surgical Anatomy Study from 227 Thyroidectomies
Authors: Amana Bathokedeou , Foma Winga , Pegbessou Essobozou , Darré Tchin , Boko Essohanam , Kpemissi Eyawèlohn
Published: August 2020

Introduction

Identification of the recurrent laryngeal nerve during thyroid surgeries is recommended to preserve its functionl integrity. This study aims to determine the relationship between the recurrent laryngeal nerves and the inferior thyroid arteries during thyroidectomies, as well as any particularities and intraoperative complications.

Materials and Methods

Observational cross-sectional study of all culturally Togolese patients who underwent thyroidectomy with nerve dissection in the ENT department of Sylvanus Olympio University Hospital from 1 January 2013 to 30 June 2017, i.e. a period of 4 years 6 months.

Results

The sex ratio was 0.14 i.e., 7 women for 1 man and the average age of 41.82 years. Tissue nodules and multinodular goiters were the most operated lesions in 40.97% and 33.04%, respectively, with a plunging character in 17 cases. We had 306 cases of nerve dissection but the recurrent laryngeal nerve could not be found in 1 case on the right. It was globally retro-arterial (under the trunk and under the branches of the inferior thyroid artery) in 75.08% of cases with prevalence of the truncal, pre arterial situation in 16.07% and inter-arterial in 3.28% cases. The nerve was non-recurrent (type II pathway) in 1 case on the right. There was no recurrence injury. Parathyroid devascularization (5 cases) was autotransplanted. The surgeon's experience did not have a significant impact on the occurrence of intraoperative complications (p = 0.24).

Conclusion

This observational cross-sectional anatomical-surgical study supports the existing data on the relationships between the recurrent laryngeal nerve and the inferior thyroid artery by confirming their variability. Nevertheless, it was marked by the predominance of the retro arterial truncal situation of the nerve unlike the literature that most often reports a situation of the nerve under the arterial branches.
Otosclerosis Revisited
Authors: Srinivas C V
Published: August 2020

Introduction: Otosclerosis usually manifests as a progressive conductive or mixed hearing loss occurring clinically to varying degrees in 0.5% - 1% of the general population. Stapedectomy /stapedotomy is the current treatment of choice for conductive component of Otosclerosis.

Materials and Methods: Sixty patients attending the department of ENT of a Medical College Hospital in Bangalore between October 2012 and October 2017 were included in the study.

 Results: The incidence of otosclerosis is highest in the 3rd and 4th decade. Bilateral symptoms were present in 25% and 75% had unilateral symptoms, right side being more common in our study. Tinnitus and vertigo with deafness are seen in 60% and 25 % of the patients respectively.

 Ninety percent of the patients presented with moderate to moderately severe hearing loss. Twenty four (40%) out of 60 audiograms studied showed Carhart's notch. Postoperativeclosure of a-b gap to within 10dB could be achieved in 65% cases. The p value calculated comparing pre and post op results is <0.0001 and significant.

Vertigo was found to be most common post-operative complication (35%) followed by sensorineural hearing loss (6.6%). Other complications observed during the study include -  tympanic membrane tears, foot plate extrusion, lax long process of incus, perilymph leak.

Conclusion: From the assessment of the postoperative hearing gain and postoperative complications, it can be concluded that small fenestra stapedotomy gives satisfactory post-operative outcome and may be appropriatein the Indian scenario.
Intramuscular Sinusoidal Hemangioma with Masson’s Lesion, Masquerading as Parotid Tumor
Authors: Deb Tanmoy
Published: August 2020

Introduction

Sinusoidal hemangioma is a rare variant of cavernous hemangioma, described first by Calonje and Fletcher, more frequently subcutaneous and commonly found on the extremities. Fine needle aspiration cytology report was indeterminate. In such cases preoperative diagnosis is difficult. Slowly growing mass is the usual presenting complaint.

Case Report

A rare case of intramuscular sinusoidal hemangioma, with typical Masson’s lesion masquerading as a parotid tumor, in middle aged woman.

Discussion

Hemangiomas comprise 7% of all benign tumors and they are benign proliferative vascular tumors characterized by increased endothelial cell turn over. They are usually superficial and easy to diagnose whereas intramuscular hemangiomas (IMH) are uncommon and deep seated and difficult to diagnose. Fifteen percent of the IMHs are found in the head and neck area and the most common muscle affected is the masseter.
Vitamin D: A Silent Cofactor for Allergic Rhinitis
Authors: Hembrom Rabi , Patra Somnath , Sinha Rupam , Sen Indranil , Mandal Satadal , Chakrabarti Amit
Published: August 2020

Introduction  

Allergic rhinitis affects around 50% of atopies in India. Vitamin D is related to both humoral and cell mediated immunity and its receptors are found in inflammatory mediators. This study was conducted to assess any possible association between Allergic rhinitis and serum Vitamin D.

Materials and Methods

A cross sectional study was conducted amongst 41patients with Allergic rhinitis as per ARIA guidelines attending the Otolaryngology outpatient Department of a peripheral tertiary care hospital. Vitamin D levels were assessed in patients with allergic rhinitis in terms of serum Ig-E level and absolute blood eosinophil count (ABEC).

Results

Among 41 patients, 31 patients (75.6%) had deficiency of vitamin D with mean Vitamin D level of 14.87±1.56ng/ml (normal vitamin D level-30-100ng/ml and low <20ng/ml), mean serum Ig-E level was 1040±303.83Iu/ml (normal-1.90-170 IU/ml by CLIA method) and mean ABEC 1226.77±397.89 (normal-30-350/ml).

Conclusion

Low serum Vitamin D is common in Allergic rhinitis patients. Low serum Vitamin D seems to be a significant cofactor in aetiopathogenesis of Allergic rhinitis in most of the cases.
Epidemiological Profile of the Head- Neck Pathologies in a Peripheral Referral Institute
Authors: Ghosh Sabyasachi , Saha Tarak Nath , Sen Indranil
Published: August 2020

Introduction  

Head and neck lesions encompass a multitude of disorders which can be broadly classified into two groups: Benign and Malignant. Overall 57.5% of global head and neck cancers comes from Asia itself and India alone constitutes 30% of it. Therefore, it is of prime essence that need based and coordinated research for understanding the threats to the nation from chronic diseases such as head and neck cancers and ways to defy such threats should gain the utmost importance. The present study attempts to present the epidemiological profile of the patients attending a peripheral referral institute of this state with head-neck pathologies and has undergone a histopathological examination of their lesions within a period of three years period (2016-18) based on the histopathological evidences.

Materials and Methods

The accumulated data regarding the aforesaid patients as per records of the histopathological reports available in the Department of Pathology was used as the primary material and the interrelation of different epidemiological parameters were studied using the statistical methods

Results

Six hundred and eighty seven cases from the head and neck region were analysed during this three-year period. Age range was from 3 years to 96 years with maximum cases in the age group of 20-29 years (16.1%). The Male: Female ratio in our study was 1.34:1 (Males 394, Females 293). In this study, 38.8% benign, 32.46% malignant, 25.32% inflammatory and 3.3% congenital cases were recorded. Maximum number of benign lesions was in the age group of 10-39 years. Malignancies were noted to be higher in ages 40 years and above. Squamous cell carcinoma was the most common malignancy observed.

Conclusion

 Specific data obtained like this from histopathological records is helpful in evaluating patterns of head and neck lesions and augment the base line data of institute and the region.
Ossiculoplasty using Autologous Reshaped Incus and Teflon PORP: A Comparative Study
Authors: Choudhary Ankit , Hazra Sayan , Das Arindam , Dubey Aryabrata , Janweja Mridul , Sengupta Arunabha
Published: August 2020

Introduction

Autologous reshaped Incus and Teflon partial ossicular replacement prosthesis (PORP) are commonly used for ossicular chain reconstruction. The present study attempts to assess the post-operative outcome with these two prostheses.

Materials and Methods 

A Randomized prospective study was conducted in Tertiary referral care hospital to determine which material, among autologous reshaped Incus and Teflon partial ossicular replacement prosthesis (PORP) gives better postoperative hearing result in Ossiculoplasty.

Patients presenting at outpatients’ department with the clinical diagnosis of chronic otitis media with perforation or retraction. The study population consisted of a total of 50 patients. Ossiculoplasty with reshaped Incus or PORP was performed after Canal Wall Up mastoidectomy. Hearing results were measured by Air-Bone gap in PTA after 6 months of surgery.

Results 

Selecting the criteria <20 dB ABG as success when Stapes superstructure is present, Incus has 64.29% success rate, whereas PORP has 31.81% success. Extrusion rate of different prosthesis shows PORP has 18.18% extrusion whereas autologous Incus has lower (7.14%) extrusion rate.

Conclusion 

Among these two ossiculoplasty materials, autologous Incus gives better postoperative hearing gain and lower extrusion rate.
Mastoid Osteoma
Authors: Hembrom Rabi , Sinha Rupam , Chakrabarti Amit , Sen Indranil
Published: August 2020

Introduction

Osteoma of the mastoid region is an uncommon benign tumor of bone. Osteomas may occur in the external auditory canals but are reported to be very rare in the mastoid region, with about 150 cases reported in literature.

Case Report

A 20-year-old man presented with painless lump behind the right ear since last 2 years. On examination a 3x3 cm tumour was present in the right post-auricular region. HRCT scan showing hyper-attenuating area close to the right mastoid cortex, measuring approximately 3x3cm, spherical, with cleavage areas between the tumour and the mastoid external cortex. Surgical excision was performed on cosmetic grounds. Postoperative period was uneventful.

Discussion

Osteoma over the mastoid region is rare and mainly asymptomatic with excellent prognosis after complete removal of the lesion.
Non-malignant Oral Ulcer: A Diagnostic Challenge to Otorhinolaryngologists
Authors: Aggarwal Neeraj , Dutta Sirshak , Choudhury Avijit , Dutta Mainak , Das Saumik , Sinha Ramanuj
Published: August 2020

Introduction

Apart from the malignant ulcers a wide variety of dermatological and other systemic conditions can affect oral cavity and often be a diagnostic challenge due to their similar presenting features and appearance. Despite being benign, some of them may be fatal if not diagnosed and treated timely. This study aims to assess the incidence of different non malignant ulcers in oral cavity and to estimate the need for histopathological examination for confirmation of the condition for proper management.

Materials and Methods

 An institution based observational study was conducted over a time period of 16 months at a tertiary care institute. Total 172 cases were included in the present study irrespective of age, sex and duration. Malignant lesions were excluded from the study.

Results

The present study shows a slight male preponderance (M:F = 1.48:1) with majority of cases were in age group 20-40 years of age (43.02%). Most commonly encountered were recurrent aphthous stomatitis (27.9%) followed by erosive lichen planus (16.28%), oral candidiasis, angular stomatitis, traumatic ulcers and others. 78.5% were treated successfully on the basis of clinical diagnosis while 21.5% cases needed further histopathological or other investigation for confirmation of diagnosis.

Conclusion

Though the otolaryngologists are more concerned about malignant ulcer, there are many non malignant ulcers which can cause significant morbidity and can even be fatal and should be given similar importance like malignant lesions. Majority of them can be treated successfully on the basis of clinical diagnosis but histopathological examination may be required in some cases for proper diagnosis and appropriate management.
Clinico-etiological Profile of Vocal Cord Paralysis
Authors: Senniappan Shivakumar , Gopalakrishnan Govind Krishnan , Kumar Chinnu Sudha , Panicker Anjali Mahendra , Nair Visakh Kookkal , Radhakrishnan Shankar
Published: August 2020

Introduction

Vocal Cord Paralysis may be of central or peripheral origin based on the underlying pathology. Central Causes contribute about 10% while peripheral causes about 90% and the current study evaluated the clinical profile of vocal cord paralysis.

Materials and Methods

A cross-sectional observational study was conducted in the department of ENT for a period of one year. Patients with complaints of hoarseness or aspiration who on laryngoscopy examination with 45° telescope have been diagnosed to have vocal cord paralysis were included for the study. A total of 83 patients were included in our study.

Results

Vocal cord palsy was found most commonly after thyroidectomy (20.4%) followed by the idiopathic cause (19.2%). Certain cancers like lung cancer and neck cancers (hypopharyngeal, laryngeal and thyroid) carcinoma had also contributed significantly in the development of vocal cord palsy.  Left sided vocal cord palsy (65%) was found to be the commonest side affected followed by bilateral vocal cord palsy.

Conclusion

A proper protocol is necessary for identifying the factors responsible for vocal fold paralysis which would help in managing the condition more effectively. Before making a diagnosis as idiopathic vocal cord paralysis, detailed investigations should be carried out to rule out the possibilities of cancer, causing vocal cord paralysis.
Managing Rhino-cerebral Mucormycosis: Institutional Experience
Authors: Patel Kalpesh , Gugliani Abhishek , Mehta Dhwani
Published: August 2020

Introduction

Rhinocerebral mucormycosis is a rapidly progressive life threatening opportunistic fungal disease and usually occurs in individuals with weakened immune system. It is caused by filamentous fungi of Mucorales from class Mucormycotina. After nasal inoculation, it usually spreads to orbit and brain. The common presenting complaints are purulent sinusitis, facial swelling, headache, complaints of vision or palatal ulceration. Despite the many recent advances in the diagnosis and management of mucormycosis, it still carries a high mortality rate.

 

Materials and methods

Here we present our experience in managing 30 such cases of mucormycosis that presented to our department between June 2016 to June 2018.

 

Results

All these patients were started on systemic antifungals with or without surgical debridement. The patients were followed up with repeated nasal endoscopies and imaging studies.

 

Conclusion

Successful treatment of mucormycosis consists of aggressive repeated surgical debridement of necrotic tissue, systemic antifungal therapy and immediate control of underlying systemic diseases. Since there are no clear-cut guidelines, the treatment needs to be individualized on a case to case basis.
Sinonasal Polyps: A Diagnostic Challenge
Authors: Sarkar Sucharita , Saha Rama , Das Mou , Sardar Samares
Published: August 2020

Introduction

Sinonasal polyps, presenting as mass lesion of nose and paranasal sinuses ranges pathologic entity including infective diseases to malignant lesions. 80% are non-neoplastic lesions and less than 1% are malignant. They all present with symptoms of nasal stuffiness or obstruction and mass lesion, producing significant diagnostic challenges as they possess extremely varied clinical behaviour, etiopathogenesis, treatment protocol as well as prognosis.

 

Case Series

During period of one year (March 2017 to February 2018), we had six patients presenting with nasal polyp having special features that need attention. After proper investigation each case was operated and gross examination followed by histopathology was done. They   revealed six different diagnoses e.g., Olfactory neuroblastoma, Adenoid Cystic Carcinoma, Basal Cell Adenocarcinoma, Sinonasal Mucosal Melanoma, Primitive Neuroectodermal Tumour (PNET) and Aspergilloma.

Discussion

Clinicians’ attention is drawn to the fact that, similar presentation may have varied differential diagnoses, some of which may be very rare and histopathology is essential for coming to definitive diagnosis.
Human Bite on Nose
Authors: Biswas Prasit , Sinha Shriyash , Saha Somnath
Published: August 2020

Introduction

Human bites are notorious due to chance of infection by direct inoculation of pathogens from saliva and must be managed properly. Human bite injuries cause dilemma to the treating doctor regarding its way of management. The options of management are primary closure, delayed closure with skin/tissue grafting and conservative.

Case Report                                            

A 43 year old male patient with a human bite injury with tissue loss on the tip of nose was admitted in hemodynamically stable condition. He was given tetanus toxoid and anti-rabies vaccination as per current guidelines.  Delayed wound closure was done in 2 steps with forehead flap, in 3 weeks interval. Patient was discharged after suture removal. There was good color matching and no complications.

Discussion

Human bite injuries are mostly due to inter personal violence, alcohol intoxication and psychiatric illnesses. Multiple instances of such bite injuries have been reported. Delayed closure of bite injuries with forehead flap provides good colour and texture match as well as good flap survival due to rich vascularity.
Laryngopharyngeal Reflux: Inter-rater Reliability of Reflux Finding Score in Clinical Practice
Authors: Keshavamurthy Venkatesha Belur , Sadashivappa Yogeesha Beesanahalli , Harsham Nithin K
Published: August 2020

Introduction

Laryngopharyngeal reflux (LPR) is a clinical entity, caused due to retrograde flow of gastric content into the larynx. It imposes great diagnostic challenge to clinicians because of lack of specific symptoms, signs and validated tool. Reflux Finding Score (RFS) has been proposed for clinical diagnosis of LPR. Inter observer reliability of RFS tool was found out using two independent observers

Materials and Methods 

In this Cross sectional study, ninety LPR subjects were subjected to 90° rigid endoscopic examination of larynx and RFS scores were calculated by two observers. Inter observer reliability of RFS was calculated using Kappa value.

Results 

Most commonly observed laryngeal findings were erythema/hyperemia, posterior commissure hypertrophy, and vocal fold edema. Subglottic edema, thick endolaryngeal mucus and erythema had fair agreement.

Conclusion

There was a poor agreement between observers for total RFS score. The variables like subglottic edema, erythema/hyperemia, and thick endolaryngeal mucus showed fair agreement between the raters. The findings of diffuse laryngeal edema and posterior commissure hypertrophy showed poor inter rater reliability.
Impact of Intravenous Tranexamic Acid on Intraoperative Bleeding during Endoscopic Sinus Surgery
Authors: Padhy Pawan Kumar , Narayanaswamy Ramakrishnan
Published: August 2020

Introduction

Bleeding during surgery is one of the most important concerns in endoscopic sinus surgery (ESS). The study conducted was aimed at assessing the efficacy of tranexamic acid on bleeding during endoscopic sinus surgeries. 

Materials and Methods

A total of 30 patients were enrolled for the study. Lund and Mackay symptom score and radiological staging was used to compare clinical profile. The surgical field was assessed by the surgeon who was blinded, i.e., was not aware of which set of patients were receiving the drug. Boezaart and van de Merwe grading scale was used to assess the intraoperative surgical field. Both groups were selected so as to comprise of patients having similar clinical profile in terms of symptom score and radiological staging. 

Results

In the arm receiving tranexamic acid, blood loss was found to be less and statistically significant (p=0.0157). The surgical field in endoscopic sinus surgery is more important factor in determining the completion and satisfactory outcomes of the surgery. Significantly high percentage (80%) of patients who were given the drug had a grade 2 scale when compared to (26.7%) in patients not receiving the drug. The difference in score in surgical field grading scale was also statistically significant (p=0.0034). The reported side effects of tranexamic acid mainly include nausea, vomiting, and possibly arterial or venous thrombosis, however none of the patients in our study had any side effects of the drug. Post-operative stay in the hospital was uneventful. 

Conclusion

Intravenous Tranexamic acid reduced the intraoperative bleeding significantly and was useful in providing a better operative field.
Third Party Disability among Spouses of People with Hearing Loss
Authors: Rajasekaran Valli , Rajasekaran Preeti
Published: August 2020

Introduction

With increasing life expectancy globally, hearing loss has become a major issue of concern. In addition to the negative implications on the people with hearing loss, it is also found to have a significant negative impact on the communication partners especially the spouse. Understanding the impact of hearing loss on their partners can aid us in addressing these issues during rehabilitation.

Materials and Methods

A cross sectional study was conducted among 60 people who presented with hearing loss and were living with their spouse. The hearing loss was assessed using pure tone audiometry. The third party disability among the spouses was assessed by using HII-SOP questionnaire. The disability scores were calculated and correlated with the severity of hearing loss using chi square test.

Results

The hearing loss was associated with some degree of third party disability (58.3%). The degree and duration of hearing loss did not correlate with the degree of third party disability. Female significant others had more difficulty than the male significant others. However, increasing age of the spouse, longer duration of married life and presence of chronic illness in the spouse were associated with more third party disability.

 Conclusion

Hearing loss causes third party disability among spouses. In addition to treating hearing loss, the health care professionals should involve the spouses in treatment and rehabilitation. This highlights the need for family centred policies in treatment of hearing loss.
Efficacy and Safety of Microdebrider Assisted Adenoidectomy over Conventional Adenoidectomy
Authors: Harugop Anil S , Soni Samanvaya , S Tejaswini J
Published: August 2020

Introduction

Adenoidectomy has conventionally been performed by curetting the adenoid tissue blindly with St. Clair Thompson curette leading to inadequate removal of tissue. Here the use of endoscopic guided adenoidectomy with microdebrider has been employed to compare the two methods.

 

Materials and Methods

It is a one-year randomized control trial conducted from January 2018 to December 2018. Patients were allocated into 2 groups i.e. conventional adenoidectomy and microdebrider adenoidectomy group. Pre and post-operative endoscopic grading of adenoid was compared and intraoperative blood loss and operative time were studied.

 

Results

Total 45 patients included 25 in conventional and 20 in microdebrider group. Following adenoidectomy operation the percentage of reduction of adenoid grading in microdebrider group was 63.79 % whereas 30.29% in conventional group, the average time taken by microdebrider assisted surgery was 16.45 mins as compared to 13.28 mins in conventional curettage. The average amount of blood loss in conventional group was 44.76 ml whereas in microdebrider group was 77.30 ml.

 

Conclusion

Microdebrider assisted adenoidectomy has proven to deliver completeness of clearance at the expense of slight increase in bleeding and the operative time.
Sure Shot Technique for Management of Ranula
Authors: Das Chiranjib , Chatterjee Pritam
Published: August 2020

Introduction

Ranula is a pseudocyst in the floor of the mouth originating from the sublingual salivary gland.A variety of surgical procedures have been quoted in the literature. But the main concern is high rate of recurrence. Aim of the present study is to describe a definitive technique for managing ranula and compare the result with review of literature.

Materials and Methods

A prospective study was done in the department of ENT in a tertiary care hospital of West Bengal from 1st April, 2014 to 31st March, 2019. Patients presenting with ranula irrespective of age and sex; size of the mass; whether primary or recurrent case were included in the study. Patients presenting with congenital and plunging ranula were excluded. Patients were treated with total excision of ranula along with sublingual salivary gland. Patients were followed up regularly for at least one year post-operatively.

Results

We treated thirteen primary and four recurrent cases of ranula. Among them eight were male and nine were female. Patients were from seven to thirty three years of age with most being in the second decade of life. There was no injury to lingual nerve or submandibular duct in any patient. We did not observe any recurrence till date.

Conclusion

Successful management of a ranula includes identification of the extent of the cyst and removal of the cyst along with the sublingual salivary gland.  When done meticulously, this technique gives 100% success without any complication.
Feasibility of Transoral Thyroidectomy by Vestibular Approach
Authors: Shah Kshitij , Patekar Shivali , Patel Tejal , Bradoo Renuka
Published: August 2020

Introduction

An open approach to thyroidectomies through neck provides good exposure and safe dissection however, the patient still has a scar. Endoscopic thyroid surgery has been practised since the late 90s. The latest addition is the transoral endoscopic thyroidectomy by vestibular approach.

Materials and Methods

We at our centre performed this surgery on 3 patients. Here we present our initial experience of transoral endoscopic thyroidectomy by vestibular approach (TOETVA).

Results

Two of the three patients did not have any complication. Diffuse bleeding was encountered during one instance and decision was taken to convert it into an open procedure.

Conclusion

The preliminary experience of transoral thyroidectomy by vestibular approach shows it to be a feasible and promising ‘scarless’ and ‘minimally invasive’ surgery.
Endoscopic Excision of Juvenile Nasopharyngeal Angiofibroma: Case Series of 20 Patients
Authors: Parsana Monil , Patel Kalpesh , Gugliani Abhishek
Published: August 2020

Introduction

Juvenile Nasopharyngeal Angiofibroma (JNA) is a highly vascular, benign, locally aggressive tumour of the nasopharynx. Endoscopic approach is the current accepted modality for the excision of Juvenile Nasopharyngeal Angiofibroma. The current study was undertaken to assess the outcome of this procedure at our institute.

Materials and Methods

A total of 20 patients of JNA at a medical college in Ahmedabad between the period of July 2015 to July 2017 were included. The tumour was staged according to Fisch system and clinical presentation, local examination, nasal endoscopy findings, radiological findings, approach of surgical resection, complications and recurrence were noted.

Results 

We found that endoscopic approach for the excision of juvenile nasopharyngeal angiofibroma is safe and effective technique associated with reduced post operative morbidity and low recurrence rates. 

Conclusions 

JNA is a rare but a potentially life-threatening disease. All young males presenting with profuse, spontaneous and recurrent epistaxis should be evaluated for JNA. Endoscopic approaches have become the procedure of choice for resection of these tumours.
Epidemiological Analysis of Maxillofacial Injuries in Road Traffic Accidents: A Peripheral Hospital Based Study
Authors: Mondal Satadal , Sen Indranil , Hembrom Rabi , Roy Swagato , Sinha Rupam , Nair Mayur , Mahato Tapas Kumar
Published: August 2020

Introduction

The aetiology of maxillofacial fractures is greatly influenced by geographic location, socioeconomic status of the cohort, and the period of investigation. The aim of this study is to analyze and identify characteristics of maxillo-facial fractures that took place in and around Midnapore- Kharagpore city of West Bengal and who presented to a peripheral medical college hospital during a period of 1 year.

Materials and Methods

   A detailed database analysis was performed based on data collected from the patients of Road Traffic Accidents (RTA) with sustained facial trauma admitted to General Surgery and Otorhinolaryngology ward of a peripheral medical college hospital. Detailed clinical examination as well as radiological data was collected.

Results

The highest frequency of maxillo-facial injury due to RTA was among the young adults 18-40 years. Most common type of injury encountered is abrasion (44%) followed by bruise and closed fracture. Mandible is the most common bone to get fractured and most common type of Le fort type is Type II. Significant number of patients having RTA were young adults under the influence of alcohol riding in two-wheeler .

ConclusionWith the increasing incidence of RTA awareness must be created concerning safety rules and more policies need to be addressed.
A Clinical Study of Serum Vitamin D Levels in Chronic Tonsillitis among Paediatric Age Group
Authors: M.S. Sudhakar Rao , Karade Deepak
Published: August 2020

Introduction

Infectious diseases of the faucial tonsils are most frequently encountered by Oto-rhino-laryngologists. Vitamin D has got an important role in the production of surface Anti-microbial peptides (AMPs). Overall, the active form of vitamin D plays a vital role in maintaining the immune system of the body. This study aims to evaluate the association of vitamin D deficiency in chronic tonsillitis among paediatric age group.

Materials and Methods

It is a clinical study carried out in the Department of Oto-rhino-laryngology and Head and Neck surgery at a medical college in Ballari, Karnataka, India from January 2018 to January 2019 for the time period of 12 months. Patients were evaluated with the relevant investigations and digital X-ray nasopharynx along with serum Vitamin D level assessment.

Results

A total of 60 children with chronic tonsillitis were enrolled in this study. There were 26(43.3%) male children and 34(56.7%) females, ranging in age group from 5 to15 years, mean age is 9.82. The common clinical presentation was recurrent episodes of throat pain seen in all the patients (100%). On serum 25-hydroxyvitamin D assessment, 40(66.7%) patients were found to have deficiency and 20(33.3%) patients were having insufficiency. Mean is 17.99ng/ml and ranging from 9.13-28.58ng/ml.

 

Conclusion

The study concludes that, the serum vitamin D levels in chronic tonsillitis among the paediatric age groups is found to be below normal levels and is unrelated to the socio demographic factors.
Influence of Khasi Language on Nasal and Oral Passages in English: A Nasometric Study
Authors: Chatterjee Indranil , Bhatt Shubhangi Shree , Kumari Kavita , Raj Divya , Saxena Vidushi
Published: August 2020

Introduction

Speech is a overlaid function of respiratory, phonatory, resonatory, articulatory systems . Nasalance can be defined as the relative amounts of oral and nasal acoustic energy in speech done by modification of oral and nasal cativities that is complex activity of the resonator system. Nasometer was developed by Samuel Fletcher, Larry Adams, and Martin McCutcheon at the University is a computer based instrument facilitating accurate analysis of signal yielding nasalance scores. There is no report regarding nasalence score variance in khasi language speakers speaking English.

Materials and Methods

The study aims at analysing and measuring nasalence score in Khasi speakers reading English passages. A total of 5 female subjects were chosen who were native speakers of khasi language and who had exposure of English language since childhoods were selected. Nasometer II Model 6400 (Software version 2.6) of Key Elemetrics Corporation was used. Three standardized passages (Zoo passage, Rainbow passage and nasal sentences) were used for the study.

Results

The mean nasalance scores obtained for zoo, rainbow and nasal sentences in female were 19.39± 12.21 SD, 38.13 ± 14.83 SD, 68.33 ± 15.29 SD and 18.26 ± 3.53 SD, 33.13 ± 1.68 SD, 63.20 ± 88 SD respectively. Standard norms show significant differences in nasalance scores obtained for Zoo, Rainbow and Nasal Sentences. Paired t-test was used for comparison among the sentences and computation of data show more significant differences for nasal sentences as compared to zoo and rainbow sentences, that is significant (p>0.05). Rainbow sentences revealed more nasalance scores than zoo sentences (p>0.05) i.e. level of significance.

Conclusion

The reported normative Nasalance data can be used by several voice clinicians for assessing resonance quantitively for khasi speakers using austrioasiatic language.
Varied Presentations of Non-Hodgkin Lymphoma in Head and Neck Region
Authors: Das Chiranjib , Chatterjee Pritam
Published: August 2020

Introduction

Majority of lymphomas involving the head and neck are Non-Hodgkin lymphoma (NHL). Most of them present as cervical lymphadenopathy. The objectives of this study are to present the problems encountered in the diagnosis of extra-nodal NHL in head and neck region and show the importance of thorough clinical examination and proper investigation.

Materials and Methods

A prospective study was done in the department of ENT in a tertiary care hospital of West Bengal from July 2015 to June 2018. Patients diagnosed as NHL on the basis of histopathology and immunohistochemistry were included in this study. Patients who were lost in follow up were excluded from the study. Patients were treated with chemotherapy and radiotherapy by Oncologist. All patients were followed up routinely both by Otorhinolaryngologist and Oncologist.    

Results

There were 26 male and 11 female patients in this study. Patients were between 22 years to 76 years of age with highest incidence in 6th decade of life. Patients presented with only cervical lymphadenopathy; asymmetrical tonsillar enlargement with cervical lymphadenopathy; unilateral tonsillar enlargement only; huge inta-oral mass with stridor; parotid gland swelling; thyroid swelling with multiple cervical lymphadenopathy; epistaxis, palatal ulcer and cheek swelling; severe trismus with inconspicuous retro-mandibular mass. Majority of patients did well with chemoradiotherapy. Two patients succumbed to death, one with huge intra-oral NHL and another with nasal T/NK-cell lymphoma. 

Conclusion

Good knowledge of the clinical characteristics of extra-nodal NHL and the methods to establish the diagnosis are essential for a correct and timely therapy of the disease.
Stress Response Pathways in Dairy Cattle: A Brief Review
Authors: Islam Md. Zakirul , Khandakar Md. Mehedi Hasan , Rashid Md. Harun-ur , Siddiki Mohammad Shohel Rana
Published: August 2020

Stress is an external event or condition that places a strain on a biological system. The animal response to stress involves the expenditure of energy to remove or reduce the impact of stress. This increases the maintenance requirements of the animal and results in loss of production. The biological response to stress is divided into acute and chronic phases, with the acute phase lasting hours to a few days, and the chronic phase lasting several days to weeks. The acute response is driven by homeostatic regulators of the nervous and endocrine systems and the chronic phase by homeorhetic regulators of the endocrine system. Both responses involve alterations in energy balance and metabolism. The thermal environment affects all animals and therefore represents the largest single stressor in animal production. Other types of stressors include housing conditions, overcrowding, social rank, disease, and toxic compounds. "Acclimation" to stress is a phenotypic response developed by the animal to an individual stressor within the environment. Acclimation is a homeorhetic process that takes several weeks to occur and occurs via homeorhetic, not homeostatic, mechanisms. It is a phenotypic change that disappears when the stress is removed. Milk yield and reproduction are extremely sensitive to stress because of the high energy and protein demands of lactation and the complexity of the reproductive process and multiple organs that are involved. Improvements in the protection of animals against stress require improved education of producers to recognize stress and methods for estimating the degree of stress on animals.