RESUMO
Background: Allergic fungal sinusitis (AFS) is the most common form of fungal sinus disease with a high rate of recurrence ratedespite the advent of advanced endoscopic sinus surgery and usage of steroids. Refractory AFS is defined as a condition ofallergy due to fungal antigenic elements not amenable to surgical removal or prolonged medical management. Oral itraconazoleis an antifungal agent that seems to be benefit to the patients with refractory AFS. Hence, this study was conducted to comparethe outcome of AFS after addition of oral itraconazole to the treatment protocol.Aim of the Study: The aim of the study was to evaluate the acceptance and usefulness of itraconazole, an oral antifungaldrug, in the treatment of refractory AFRS.Materials and Methods: A total of 84 patients with refractory AFS were included in this study. The medical records of these patientswere retrieved from the medical records section and analyzed. A detail history of the AFS was elicited and demographic data weretabulated. Nasal endoscopy was done before and 3 months after the itraconazole therapy and the findings were classified according toLund-Kennedy endoscopic grading system, Scoring from 7 to 10 was graded as severe; scoring from 4 to 6 was graded as moderateand 1 to 3 as mild grade. Itraconazole was administered in the form of capsule 100 mg 2 times daily for 3 months. Prior hepaticfunction and renal function tests were undertaken for all the patients. All the data were analyzed using standard statistical methods.Observations and Results: Among the 84 patients, there were 52 (61.90%) males and 32 (38.09%) females with a male tofemale ratio of 1.6:1. The patients were aged between 18 years and 78 years with a mean age of 33.45 ± 4.15 years. Conversionof severe grade patients to mild grade following itraconazole therapy was note; post-treatment findings were severe in 5 patients,moderate in 1, and mild in 78 patients.Conclusions: Itraconazole may be useful as an adjunct in the management of AFRS. However, more studies, including aprospective randomized clinical trial, are required to determine if itraconazole is effective in the management of AFRS.
RESUMO
Background: Cisplatin is a chemotherapeutic agent that is widely used to treat a variety of malignant tumors. Serious doselimiting side effects such as ototoxicity, nephrotoxicity, and neurotoxicity are likely to occur with its use.Aim of the study: The aim of the study was to do audiological evaluation of patients on cisplatin before and after chemotherapyfor squamous cell carcinomas of head and neck and analyze for hearing loss (HL).Materials and Methods: A total of 46 patients undergoing cisplatin administration were included in the study. History taking,preliminary ENT examination, and audiological evaluation with pure-tone audiometry were done. A pure-tone average (PTA) wascalculated using the speech frequencies (500, 1000, and 1500 kHz). High-frequency pure-tone audiometry was also done in allpatients to know the basal auditory threshold before starting cisplatin therapy. Baseline audiometry was done Prior to Chemotherapyor at least 24 h after administration of Cisplatin. Monitoring audiometry was done before each cycle of Cisplatin therapy. Follow-upaudiometry was done 1, 3, and 6 months after chemotherapy. Dosage of cisplatin ranged from 50 mg to 115 mg with cumulativedose ranging from 250 mg to 850 mg in all the patients. All the data were analyzed using standard statistical methods.Observations and Results: Among 46 patients, there were 33 males and 13 females (28.26%) with a male-to-female ratioof 2.53:1. Patients were aged between 45 years and 70 years and the mean age was 55.35 ± 2.70 years. 22/46 (47.82%)patients were in the range of 55–65 years age group followed by 15/46 (32.60%) patients who were in the 45–55 yearsage group. 9/46 (19.56%) patients were in the 65–75 years age group. Patients of all age groups showed high-frequency(3000 kHz–12,000 kHz) HL in the study group. The thresholds were found to be increasing from 35 dB to 59 dB with increasingfrequencies from 3000 kHz to 12,000 kHz.Conclusions: In this study, all the patients showed significant evidence of severe mixed type of HL. The HL was significant inall the age groups and in both the genders. Six months follow-up showed no recovery of HL presumable resulting in permanentHL. Very few patients showed vestibular involvement. Audiometric monitoring may help to provide early evidence of decreasedhearing ability, leading to the possible limitation of the severity of ototoxicity.