Search

Tonsillectomy is one of the commonest ENT procedures done in paediatric population, the technique of which has evolved over years to decrease the morbidity associated with the surgery. This prospective randomized comparative study is done to evaluate the efficacy of two different techniques of this surgery, conventional cold dissection and laser tonsillectomy based on operative time, blood loss, post-operative pain and occurrence of secondary complications. The study was done in 68 patients of paediatric age group, 34 in each group underwent cold dissection and laser tonsillectomy. Operative time and bleeding were significantly low for laser group. Pain score was comparable in early post-operatives days, but was high towards the end of first week. Our study reported only one incidence of complication in the form of a secondary bleeding. [ABSTRACT FROM AUTHOR]

Isolated lesions of the sphenoid sinus are uncommon. Cavernous sinus thrombosis is generally sought due to a systemic disease rather than a local pathology. It may be due to hidden primary pathology like isolated acute sphenoid fungal rhinosinusitis. In present study, we have discussed the early management of such hidden lesions with complication. A retrospective review of 5 cases of isolated acute sphenoidal fungal rhinosinusitis leading to cavernous sinus thrombosis was carried out. All cases were managed as emergency cases. Diagnostic nasal endoscopy was normal in all cases, with sinus disease evident in radiology in only 60% cases. Diagnostic endoscopic sinus surgery was performed in 40% cases. All patients underwent urgent surgical debridement along with IV antifungals. Complete recovery was seen in ocular movements in 40% and partially in 40%, whereas only 25% had complete improvement in vision. While four cases showed favourable outcome, one patient could not be saved despite all efforts. Exploring the sinus in cavernous sinus syndrome or orbital apex syndrome despite non-conclusive imaging, is warranted as early intervention may significantly impact the chances of survival. "Time is vision" in cases with acute fungal sinusitis and is equal to the aphorism of cardiologists i.e. "time is muscle. [ABSTRACT FROM AUTHOR]

Head and Neck cancer management has undergone many changes in the past few decades. Primarily advancements in reconstructive surgery for complex head and neck defects after extensive ablative surgeries. Many factors need to be considered in deciding the type of reconstruction. Any reconstruction is not without complications. We wish to present the reconstructive challenges we faced in recent times to reconstruct composite head and neck defects, situation where a salvage flap has to be chosen in a failed regional flap. An occipital artery-based pedicled fascio cutaneous flap is one such rescuer flap. It is a retrospective study of case records from January 2018 to January 2021 at our institute. Reviewed the clinical data of Cases in which occipital artery-based flap was used to reconstruct the composite head and neck defects. In the era of microvascular flap reconstruction, utilization of regional flaps is still a choice of reconstruction in the resource constraint setting. A less explored occipital artery-based flap is a reliable regional flap can be used in select cases with a good success. [ABSTRACT FROM AUTHOR]

Ossicular discontinuity is one of the most common causes of conductive hearing loss. Ossicular chain reconstruction improves conductive hearing loss. With no additional cost, cartilage ossiculoplasty is easy to perform, and also the cartilage is well tolerated being an autograft. In this study we compared the audiological outcome in ossiculoplasty done by cartilage umbrella, cartilage boomerang and alloplastic TORP. 75 patients of age group 10–50 years clinically diagnosed with chronic otitis media with conductive hearing loss and an air bone gap (ABG) of at least 20 dB posted for surgery were included. Ossiculoplasty was done in three groups with autologous cartilage boomerang, cartilage umbrella and alloplastic TORP. In mucosal disease hearing gain was better in umbrella technique (17.66 ± 1.1) dB than Boomerang (16.9 ± 0.8) dB and TORP (10.68 ± 0.9) dB. ABG closure was higher in Boomerang and TORP. Hearing improvement in patients with squamosal disease managed by canal wall up surgery was 25.01 ± 1.1 dB, 27.73 ± 3.1 dB and 20.12 ± 1.8 dB in Boomerang, Umbrella and TORP group respectively showing that umbrella method gave maximum improvement. ABG closure was better in TORP group. In canal wall down surgery patient's maximum improvement was seen in Boomerang (29.51 ± 0.9) dB followed by Umbrella (26.67 ± 1.2) dB and TORP (25.27 ± 0.8) dB group. ABG closure was higher in Boomerang group. Cartilage ossiculoplasty is a reliable and effective method of ossicular chain reconstruction for both mucosal and squamosal disease. Cartilage ossiculoplasty has the added advantage of reduced chances of prosthesis extrusion as compared to TORP. [ABSTRACT FROM AUTHOR]

We compared the use of palonosetron with combination of palonosetron and dexamethasone in prevention of PONV in patients undergoing middle ear surgery under general anaesthesia. Prospective, randomized study was conducted including 90 adult patients who received either palonosetron (0.075 mg) (Group P) or combination of palonosetron (0.075 mg) and dexamethasone (8 mg) (Group PD). The primary outcome was incidence of nausea, vomiting and complete response. Secondary parameters were time to receive first rescue antiemetic, total dose required, patient's satisfaction, postoperative pain scores and total dose of rescue analgesic. The incidence of nausea was 15.5% and 8.8% (p = 0.522) and vomiting was 6.7% and 2.2% (p = 0.610) in group P and PD, respectively Complete response (CR) was observed in 84.4% patients in group P and 91% patients in group PD (p = 0.522). Combination of palonosetron and dexamethasone is not superior to use of palonosetron alone for PONV prevention. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate sphenoid sinus pneumatisation and its anatomical relation with adjacent neurovascular structures in Indian population. We performed a retrospective cross-sectional study, in which the pattern of sphenoid sinus pneumatization was studied on high-resolution computed tomography scans (n = 400), and association of the optic nerve, vidian canal and foramen rotundum along with related morphometric measurements were studied. Out of 400 CT scans, 60.5% were males. Majority had sellar type of pneumatization (89.5%) and single intersinus septum (68%). The most common configuration of relation of optic nerve canal was DeLano type 2 (34.75%). Vidian canal (VC) and Foramen rotundum (FR) were found dehiscent in 40.5% and 6.38% respectively. Average distance of FR from midline on right and left side was 16.3 ± 2.19 mm and 16.7 ± 2.23 mm respectively. Average distance of VC from midline on right and left side was 12.4 ± 5.84 mm and 12.4 ± 4.18 mm respectively. Average right FR to VC distance was 4.17 ± 2.16 mm and left FR to VC was 4.44 ± 2.20 mm. Anatomical variations of the sphenoid sinus are well known. In the present study, we have tried to highlight the importance of knowledge of various anatomical variations in relations to sphenoid sinus as they are critical in planning of surgery. Pre-operative radiological study and correlation is inevitable to assess type and extent of sinus pneumatisation, bony dehiscence and septal terminations to avoid injury to vital structures. [ABSTRACT FROM AUTHOR]

Purpose: The round window approach has become the most preferred route for electrode insertion in cochlear implant surgery; however, it is not possible at times due to difficult round window membrane (RWM) visibility. Our study aims to investigate the relationship between preoperative radiological parameters and the surgical visibility of the RWM in Cochlear implant patients. Methodology: A prospective cross-sectional study of 31 patients, age < 6 years, with bilateral severe to profound sensorineural hearing loss was conducted at a tertiary care hospital. The preoperative HRCT temporal bone scan was studied, and the parameters evaluated were facial nerve location, facial recess width, and RWM visibility prediction. All patients were operated on via the posterior tympanotomy. The surgical RWM visibility was done after optimal drilling of the posterior tympanotomy recess. The relationship between the radiological parameters and surgical visibility of RWM was evaluated. Results: The difference in the facial nerve location as per the type of RWM was found to be significant (p value < 0.05). However, the facial recess width was not significantly associated with RWM visibility. The radiological prediction of RWM visibility by tracing the prediction line over RWM was significantly associated with intraoperative RWM visibility. Conclusion: The goal to look for preoperative scans is to predict the ease or difficulty of RWM visibility during surgery. The difficult visualization of the RWM, can result in dire intraoperative consequences. A comprehensive understanding of preoperative radiological parameters, coupled with meticulous surgical planning, is crucial to address these challenges effectively by focusing on enhancing RWM visualization. [ABSTRACT FROM AUTHOR]

Myiasis is an infestation of living tissue of animals or humans by fly larvae. It is quite common in tropical countries due to hot and humid climates. Trichosporonosis is an invasive disseminated fungal infection caused by Trichosporon species. Disseminated trichosporonosis is usually a fatal disease with poor prognosis. The aim of this manuscript is to report a clinical case of concomitant nasal myiasis and Trichosporonosis infection in an uncontrolled diabetic patient which was treated successfully by two weeks of Voriconazole therapy. [ABSTRACT FROM AUTHOR]

This study was conducted to evaluate the existence of otoscopic abnormality, hearing status and radiological changes in contralateral ear of patients with chronic otitis media. 300 patients having unilateral Chronic Otitis Media attending OPD in the Department of Otorhinolaryngology, Institute of Medical Sciences, Banaras Hindu University, Varanasi during the period of March 2019 to March 2020 were selected. Otoscopy, Pure Tone Audiometry and Bilateral X-ray mastoids (lateral oblique view) and/or HRCT Temporal bone were done. Contralateral ear was affected in more than 30% cases. Out of 188 patients having Mucosal COM, 58 cases (30.9%) had abnormal TM. Out of 112 patients having Squamosal COM, 48 cases (42.9%) had abnormal CLE. Out of 300 cases, 231 (77.0%) of them had normal hearing in contralateral ear. It was followed by 65 cases (21.6%) with conductive hearing loss. Mixed hearing loss and SNHL were seen in 2 patients each. In contralateral ear of Mucosal COM, pneumatic pattern of pneumatisation was seen in 69.1% followed by Diploic pattern (30.9%). In squamosal COM, X-ray mastoid showed pneumatic pattern (64.3%) followed by Diploic pattern (33.9%) in the contralateral ear. Sclerotic pattern was seen in only 1.8% of cases in contralateral ear. Chronic otitis media as a disease is not limited to one ear. The precise and critical evaluation of both ears does not play a role in prognostic evaluation of the patient only, but it can also serve as a guide for early detection of probable evolution of the disease process in a patient in contralateral ear with unilateral chronic otitis media. [ABSTRACT FROM AUTHOR]

Unilateral Sensorineural Hearing Loss (USNHL) can present with varying symptoms apart from hearing loss, such as dizziness and tinnitus. Impaired sound localization, inability to identify speech in noise and decreased temporal summation can significantly impair the daily activities of an individual. This along with dizziness and tinnitus affects the physical, mental and social health as well. The purpose of this study is to assess and correlate the spectrum of handicap faced by USNHL patients. Validated questionnaires were used to evaluate handicap in 42 USNHL patients due to hearing loss (Hearing Handicap Inventory for Adults–HHIA), dizziness (Dizziness Handicap Inventory–DHI) and tinnitus (Tinnitus Handicap Inventory–THI). These handicaps were then correlated with each other using Spearman's correlation coefficient. Statistically significant strong positive correlation of HHIA was seen with DHI (rho = 0.60, p ≤ 0.001) and THI (rho = 0.74, p ≤ 0.001). Similarly, strong positive correlation was seen between emotional subscales of HHIA and DHI (rho = 0.73, p ≤ 0.001). USNHL can lead to significant emotional and social handicap which is compounded in the presence of hearing loss, dizziness and tinnitus. These handicaps are strongly correlated to one another. Hence, a holistic approach is needed for USNHL rehabilitation. There exists a need to develop a comprehensive measure to assess and grade the handicap faced by these patients. [ABSTRACT FROM AUTHOR]

Majority of unilateral sensorineural hearing loss are idiopathic. Hence, outcome depends on factors which are associated with nature of disease and its treatment. These can be sudden or progressive. Various studies are done to evaluate the association in sudden variety, however causality still lacks evidence. There are limited studies regarding progressive variety and its outcome. A prospective study of 40 patients with idiopathic unilateral SNHL was carried out which attempts at identifying factors associated with either disease severity or its prognosis. A significant association was seen between distribution of random blood sugar and post treatment improvement in patients with sudden USNHL (p = 0.045). No significant association was seen with other blood parameters to treatment outcome in sudden SNHL, and severity of progressive SNHL to any blood parameters. Elevated blood sugar may affect a negative effect on treatment outcome in unilateral ISSNHL. There is scarcity of evidence in scientific literature related to "Unilateral Idiopathic Progressive Sensorineural Hearing Loss" for any association/correlation with nature of disease. [ABSTRACT FROM AUTHOR]

To assess the parameters' setting of the microscope during parotidectomy and the impact of microscopic parotidectomy on facial nerve functional status. A prospective study was conducted on 28 patients in a tertiary care center, who underwent microscopic parotidectomy. Microscope's settings' like magnification, focal length, diameter of the visualized field, and clock position were recorded. Facial nerve functional status was also recorded. All surgeries were performed by right-handed surgeons using Leica F 20 M525 microscope. Clock position of microscope for right parotidectomy ranged between 7 and 10 o clock and for left, it ranged between 7 and 12 o clock. Magnification ranged between 1.3 × and 3.2 ×; magnifications of 1.3 × and 1.8 × were preferred from incision to separation of parotid from sternocleidomastoid muscle, 1.8 × and 2 × for dissection of the facial nerve trunk, and 2 × and 3.2 × for individual branches of the facial nerve. Focal length ranged between 251 and 410 mm and the diameter of the visualized field ranged between 7 and 14.7 cm. Out of 24 cases of benign lesions, 2 (8.3%) developed facial paresis which resolved in 3 months. Two out of four cases of malignancy developed permanent palsy as nerve branches were sacrificed to achieve tumor clearance. Using a microscope for parotidectomy is advantageous for facial nerve dissection, reducing chances of facial paralysis. The microscope was also found to be useful for teaching. The use of appropriate microscopic parameters avoids the glitch of transition from open to microscopic approach. [ABSTRACT FROM AUTHOR]

This retrospective study was carried out to know the incidence of unilateral sensorineural hearing loss (USNHL) (type and degree). (1) To know the incidence of USNHL (other ear being normal) in patients undergoing Pure Tone Audiometry (PTA) for hearing loss (HL). (2) To establish the type and degree of USNHL in patients. Study was conducted over a period of more than 4 years to find out the incidence and pattern of USNHL (other ear being normal) in the patients attending ear, nose, and throat outpatient department (OPD) with a complaint of HL. Pure tone audiometry data of 10,000 cases between August 2014 and December 2018 with HL were analyzed for this study. Demographic characteristics were compared with types and degrees of unilateral sensorineural hearing impairment. A total of 10,000 OPD cases who had a complaint of HL and had undergone pure tone audigram (PTA) in a period of more than 4 years in the Department of Otorhinolaryngology and Head and Neck Surgery were studied. SNHL type was the highest with 3935 cases (39.3%). Out of 3935 cases of SNHL, 1436 (36.50%) were USNHL—out of which, only 872 cases (60.72%) had USNHL with other ear being normal; this constituted the study group, i.e., 872 cases (8.72%) out of 10,000 PTA and 872/3935 (22.16%) of SNHL cases. Hence, incidence of USNHL (with other ear being normal) is 8.72% among all cases of HL and 22.16% among cases of SNHL. Age of cases ranged from 8 to 76 years (mean age - 39.5 years). Male:Female ratio was 1.6:1.0. Both ears were almost equally involved. 35.6% cases had profound (> 90 dB) hearing loss, followed by mild (25–40 dB) in 32.1%. [ABSTRACT FROM AUTHOR]

Deafmutism affects communication and wholesome development of an individual. India has a significant burden of deafness in the country. Even fourteen years after the launch of a National Program for Prevention and Control of Deafness in year 2006, we lack detailed data about the disability from most regions of the country. This study aims at finding out the prevalence, clinical history-examination and audiological profile of deaf-mute patients visiting the Out Patient Department (OPD) of a tertiary care institute in Uttarakhand, and compare the results with similar studies published during last 20 years from India to generate a literature review. Out of 46,049 patients that visited OPD of the institute during the given period of 24 months, 73 cases were short-listed clinically to be enrolled in the study. However, only 55 (75%) of them completed the questionnaire and audiological testing. All information was extracted from the patients/relatives with the help of a questionnaire in the Hindi language. The prevalence of deafmutism in patient presenting in our OPD in the study period was 0.3%. The history of pre-, peri- and post-natal risk factors was present in high percentage (58.2%, 78.2% and 34.5% respectively) of patients. This warrants review of our maternal and child healthcare strategies. The literature review revealed lack of uniform and standardized tool in conducting and reporting of studies on deafmutism. The questionnaire used in this study can be further improved and modified in the future as per the requirements of data collection. [ABSTRACT FROM AUTHOR]