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Background- With the high morbidity and mortality year 2020 will be remembered as Covid19 pandemic year. Occupational exposure to COVID 19 among health care workers poses a major risk to their lives. Hydroxychloroquine (HCQ) prophylaxis has been indicated for their use without much scientific evidence. Objective- to find if HCQ prophylaxis had association with Covid19 infection prevention among health care workers. Material &Method- A retrospective cohort study was conducted; through online by utilizing social media platform, among Health care workers of a tertiary care hospital from 1st June 2020 to 27 July 2020. Those HCWs who have taken HCQ (exposed) and who have not taken (nonexposed) and PCR tested Covid19 Positive were taken as diseased. Results Out of 527 who were analyzed, study subjects who took HCQ prophylaxis had 30% less chance of having Covid19 test positive, {RR- 0.709(0.383-1.296)} as compared those who didn’t took it, but the results were not significant. Conclusion- Hydroxychloroquine prophylaxis does not prevent Covid 19 infection and more evidence may be required for use of HCQ prophylaxis for Covid19 infection. Keywords- Hydroxychloroquine prophylaxis, Covid19 infection, Health care workers, Retrospective cohort study

Tinnitus is hypothesized to be an auditory phantom phenomenon resulting from spontaneous neuronal activity somewhere along the auditory pathway. The neural abnormalities underlying tinnitus are largely unknown. We evaluated the functional characteristics and the auditory system synchronization using Auditory Brainstem Response (ABR) in normal hearing tinnitus patients. In this observational comparative cross-sectional study, patients with chief complaints of Tinnitus and equal number of age and sex matched controls without hearing loss and tinnitus were enrolled. All patients underwent a full ENT assessment, pure tone audiometry and Brainstem evoked response audiometry (BERA) tests. The study population consisted of 100 patients with tinnitus, 55 controls without tinnitus and 45 controls with tinnitus. Statistical analysis showed significant relation (p

Various studies have shown variations in size and shape of different anthropometric measurements of external auditory canal. We conducted an anthropometric study of the three-dimensional anatomy of the osseous external auditory canal (OEAC) using high-resolution computed tomography the temporal bone to identify the variations in subset of Indian population from North India. A retrospective review of high-resolution computed tomography images of the temporal bones of 125 patients (250 external auditory canals) of different ages (mean 28.43 years) acquired from September 2014 to February of 2015 was performed. Using a method, as proposed by Mahboubio et al. (Otol Neurotol 33:715–720, 2012), six defined dimensions of the OEAC in the parasagittal planes were recorded at the level of annulus, midcanal and the outermost point of osseous external auditory canal at bony-cartilaginous junction. The length and shape of the OEAC were also studied and the frequency rate of each was recorded. The most prevalent shape of the OEAC was found to be conical (64%) and the mean osseous external auditory canal length was 9.61 mm. The length of the OEAC was significantly different between ages above and below 12 years while the 6 defined cross sectional dimensions were statistically significant between ages above and below 8 years. The history of chronic suppurative otitis media had a significant bearing on the inferior mid-anteroposterior dimension at the level of bony-cartilaginous junction. There was statistically significant difference in supero-inferior diameter in the posterior half at the level of mid-canal and outer bony-cartilaginous junction between males and females. The comprehensive set of standardized measurements collected in this study provides three-dimensional information on osseous external auditory canal geometry. These measurements and the methodology will contribute to the development of element models of the osseous canal for computational modeling purposes and also provide important measurements for design of in-the-canal hearing aids, specialized earplugs and for defining average sizes for canalplasty procedures, in pre- and postoperative surgical planning and assessment of canal atresia and stenosis in Indian population. No such previous study has been done in North Indian population.

Aim and background Osteomas are common benign tumors of the paranasal sinuses, but are usually asymptomatic and found as a coincidental finding during routine radiological investigations. The aim is to demonstrate typical radiological findings of osteomas and demonstrate rare occurrence of osteoma in middle turbinate. Case report Patient presenting with recurrent headaches, left-sided facial pain, and intermittent nasal obstruction was evaluated using Philips Brilliance 40-multislice computed tomography scanner, which showed bilateral maxillary and ethmoid sinusitis with bilateral fluid-filled concha bullosa with left-sided concha bullosa showing a well-defined lesion of bone attenuation suggestive of osteoma. Conclusion Osteomas can rarely occur in nasal turbinates and may be symptomatic requiring endoscopic/surgical removal. Clinical significance Radiological investigations are diagnostic for osteomas and play an important role in preoperative planning. Osteomas arising from the turbinates are more easily accessible by endoscopy than sinus osteomas; hence, removal carries less risk. Therefore, it is important to diagnose nasal osteoma when it is small in size, follow it up, and resect it when its size is appropriate for endoscopic surgery. How to cite this article Singh P, Mittal MK, Mathur NN, Sinha M. Concha Bullosa Osteoma: An Unusual Cause of Headache. Clin Rhinol An Int J 2017;10(1):25-27.

Background: Surgical Site Infections (SSIs) are the third most common nosocomial infections. Emergence and spread of drug resistant strains have been found to pose a serious challenge in the management of such infections. There is limited information on the epidemiology of such pathogens. The antibiotic sensitivity patterns of aerobic bacterial isolates from post-operative SSIs show wide variations that lead to difficulties in empirical selection of the right kind of drug for treatment. Properly planned studies about antibiotic sensitivities patterns of such isolates can help in judicious management of SSIs and cause reduction in morbidity and mortality.Methods: A total of 50 patients diagnosed by the surgeon and fulfilling the case definition of SSI, were studied for bacteriological analysis. All the clinical specimens were cultured and identified applying standard culture techniques. The aerobic bacterial isolates were subjected to antimicrobial susceptibility testing by Kirby Bauer Disc Diffusion method to arrive at the drug sensitivity patterns. Data were entered in MS Excel spread sheet and analysed using SSPP software version 21.00Results: A total of 32 patterns of sensitivity were observed. For Esch. coli, a total of nine patterns were observed. All strains of Esch. coli were found sensitive to tigecycline (100%) and colistin (100%). For Klebsiella spp. a total of 9 patterns were obtained with TIG-COL being the predominant pattern in 6 cases. For Acinetobacter spp. only colistin was found most effective drug. In case of Pseudomonas aeruginosa, except colistin (100% sensitivity), there were wide variations in sensitivity with imipenem (71%) as next most effective drug. In Proteus spp. - most of the in-use drugs were effective except cephalosporins. Among gram positive organisms, only three strains of Staphylococcus aureus were isolated, and these were MRSA (100%). Two strains of enterococcus were isolated, and these showed sensitivity to linezolid only.Conclusions: Wide variations in sensitivity status observed in the study are suggestive that antibiotic usage should be tailored to individual needs and proper selection of antibiotics for management of SSIs must be guided by laboratory antibiogram.

Context: Treatment of patients with cleft lip and palate (CLP) anomaly requires a multidisciplinary approach from birth until adulthood. Many children with cleft anomaly are born in rural areas where resources for treatment and awareness on cleft care are limited. Consequently, many patients may receive limited or suboptimal care due to multitudes of reasons. Aims: The current study was aimed to record the baseline data on the spectrum of clinical profile of cleft patients, treatment protocols, quality of treatment and the residual treatment needs of patients with CLP anomaly visiting three major hospitals across Delhi and National Capital Region (NCR). The experience gained from the three-center study would be used to lay a framework to conduct a nationwide multicenter study in terms of logistics, feasibility and difficulties. Materials and Methods: The study titled "CLP anomaly in India: Clinical profile Risk factors and current status of treatment: A hospital based study" was started in 2010 as a Task Force project of Indian Council of Medical Research. The Pilot phase, which started in 2012, encompassed three cleft centers across Delhi and NCR, namely, All India Institute of Medical Sciences, Safdarjang Hospital and Medanta - The Medicity. Data for 126 non-syndromic CLP subjects was recorded on a specially designed performa. Each case was evaluated by a team of specialists comprising of a Plastic Surgeon, an Orthodontist, ENT Surgeon, Dental Surgeon, Speech therapist and an Audiologist. Clinical records included profile and intraoral photos, dental study models, audiometric and speech evaluation data. The current paper attempts to highlights a few of relevant observations of the pooled data from three centers. Results and Conclusions: The results indicate a lack of uniform protocol followed in providing care to cleft patients. A great variation was found in the quality of treatment received by many of the patients.

To compare the anatomic and functional outcomes of the cartilage and temporalis fascia graft materials in type 1 tympanoplasty in paediatric and adolescent population. A total of 55 patients aged 0.05). ABG closure ratio in cartilage group was 58.54 ± 23.10% and in temporalis fascia group was 56.46 ± 27.4% (p > 0.05). Pre operatively all patients had type B tympanogram in both the groups. While post operatively either type A or C curve was seen in 80% patients of cartilage and 68% patients of temporalis fascia group. Hearing outcomes and graft success rates were high in both fascia and cartilage graft groups but not significantly different.

Decannulating a patient on a tracheostomy is a procedure that has to be dealt with vigilantly. This study evaluated both external and telescopic/bronchoscopic findings at the peristomal level of subjects being considered for decannulation. The patients did not undergo any intervention after above observations and before attempting decannulation. Thereafter peristomal findings and their contribution towards failure to decannulate were correlated. Thirty subjects were studied prospectively, of whom 21 (70 %) demonstrated peristomal complications including granulation tissue, ulceration, mucopurulent discharge, suprastomal granulations, suprastomal collapse and suprastomal flap. Complications were more common in the younger age group (p = 0.007) as well as in tracheostomies of longer duration with mean duration >20 months (p = 0.045). However there was no statistically significant correlation between the success of decannulation and various peristomal findings. Therefore the success of decannulation in a particular case cannot always be correctly predicted by peristomal assessment.

Objective To compare the post-operative outcomes in using temporalis fascia and full thickness broad cartilage palisades as graft in type I tympanoplasty. Methods This study, conducted at a tertiary referral institute, included 90 consecutive patients with mucosal type chronic otitis media requiring type I tympanoplasty with a 60/30 distribution of cases with fascia and cartilage palisades, respectively. The fascia group consisted of primary cases in adults and excluded revision cases, near-total or total perforations and pediatric cases. The cartilage group included pediatric, revision cases and near-total or total perforations. The fascia group utilized the underlay technique for grafting, whereas the cartilage group used tragal full thickness broad cartilage palisades with perichondrium attached on one side placed in an underlay or over-underlay manner. Post-operative graft take-up and hearing outcomes were evaluated after 6 months and 1 year with subjective assessment and pure tone audiometry. Results The graft take-up rate was 83.3% in the fascia group and 90% in the cartilage palisade group. The mean pure tone air–bone gaps pre- and post-operatively in the fascia group were 30.43 ± 5.75 dB and 17.5 ± 6.94 dB, respectively, whereas for the cartilage group, these values were 29 ± 6.21 dB and 7.33 ± 3.88 dB, respectively. Conclusion Cartilage grafting with full thickness palisades is more effective than fascia as graft material, particularly in “difficult” tympanoplasties fraught with higher failure rates otherwise.

To evaluate the functional and hearing outcomes using full thickness broad cartilage palisades for tympanic membrane reconstruction in type 3 tympanoplasty with titanium prostheses. The retrospective study performed at a tertiary referral institute included 30 patients with posterior mesotympanic retraction pockets or tympanic membrane perforations requiring tympanic membrane and type 3 ossicular reconstruction. Patients with disease extending beyond the aditus requiring canal wall down mastoidectomy were excluded. Disease removal from posterior mesotympanic and epitympanic recesses was confirmed using angled endoscopy and ossicular reconstruction was performed using titanium partial or total ossicular replacement prostheses. Tympanic membrane reconstruction was done, with or without attic reconstruction, using full thickness broad cartilage palisades harvested from the tragus with perichondrium attached laterally. Patients were assessed at 24 and 48 weeks for graft status and any evidence of implant extrusion. Hearing evaluation was done using subjective assessment and pure tone audiometry. In total, 27 out of 30 patients had intact and completely healed grafts at 48 weeks postoperatively (a success rate of 90 %) showing full union and epithelialization of palisades, and with three patients displaying small defects. The mean pure tone air bone gap pre- and postoperatively was 32.4 and 8.8 dB, respectively, with most patients reporting satisfactory postoperative hearing. No evidence of implant extrusion was found in the 48-week period. Tympanic membrane reconstruction using full thickness palisades of tragal cartilage provides good functional and hearing outcomes in type 3 tympanoplasty with titanium prostheses.

The objective of this study was to evaluate the efficacy and outcome using the maxillary swing approach for the management of extensive nasopharyngeal angiofibromas. A retrospective analysis in a tertiary care center revealed five cases with extensive nasal angiofibromas operated using the maxillary swing approach between 2010 and 2012. All patients had tumor extension to the lateral-most portions of the infratemporal fossa with complete occupation and destruction of the lateral wall of the sphenoid sinus causing abutment to the cavernous sinus and complete involvement of the pterygopalatine fossa and pterygoid base. One patient displayed full occupancy of the maxillary sinus as a consequence of erosion of the posterior and medial walls of the maxillary sinus, while another had severe temporal lobe compression through the roof of the infratemporal fossa. All patients underwent tumor excision using the maxillary swing approach. Patients were followed up for a minimum period of 1 year after surgery. The maxillary swing approach gave optimal exposure of the entire central skull base including the infratemporal fossa and its extreme lateral and superior aspects. Adequate tumor exposure and vascular control could be achieved in all cases resulting in complete tumor excision. The mean operative time was 4.5 h. Post-operative healing was satisfactory with palatal fistula formation in two cases and all patients remaining disease-free up to the present time. One had minimal misalignment of the halves of the upper jaw and two had epiphora, of which one required dacryocystorhinostomy. The maxillary swing is an effective approach in the management of extensive nasopharyngeal angiofibromas and leads to optimal anatomical exposure with minimal morbidity.

We present one of the largest lingual hamartomas of the tongue base to have been reported, along with a review of the current literature and a description of the management of this case, as well as insights into the histopathology of the lesion. A 21-year-old woman presented with a mass on the base of her tongue, extending to the vallecula. The mass was found to be over 4 cm and enhancing on computed tomography. The size, vascularity, and site of the lesion merited its excision using the suprahyoid pharyngotomy approach. Histopathology confirmed the mass to be a vascular hamartoma. In reviewing the literature, we encountered 61 reported cases of lingual hamartomas, which are described with a number of pathological variants and sites of occurrence and with different methods of surgical excision. The size, vascularity, and site of the lesion we found merited a different approach from the conventional transoral approach that was used in all of the previous reports. Also, our study agrees with current world literature that histopathological examination plays an important role in the final diagnosis.