Management of Paediatric Airway in Post-intubation Subglottic Stenosis Associated with Japanese Encephalitis.

Subglottic stenosis is narrowing of the area in between the vocal cords and the cricoid cartilage. It can cause respiratory problems which can be mild to severe. Study the management of paediatric airway in post-intubation subglottic stenosis associated with Japanese encephalitis. Case Setting and Design: Retrospective study of 18 patients presenting with encephalitis out of which 6 cases were of post-intubation subglottic stenosis associated with Japanese encephalitis between the study period of one year (September 2017-September 2018) in the, Department of Otolaryngology and Head and Neck Surgery, North Eastern Indira Gandhi Regional Institute Of Health And Medical Sciences, Shillong, Meghalaya, India. Fifteen patients were treated in the study period. Different approaches were used. Post-intubation subglottic stenosis depends on the duration of intubation and the quality of life post-tracheostomy depends on the type of tube used. Bronchoscopic assisted procedures during the tracheostomy or after an interval helps to decrease the morbidity. Management of paediatric airway in post-intubation subglottic stenosis associated with Japanese encephalitis needs proper strategy and dedicated and intensive post-operative care. Bivona® silicone tracheostomy tube is a better option.

Unusual Branchial Cleft Cyst at Parapharyngeal Space: Case Report and a Review of Literature.

Branchial cleft cyst in parapharyngeal space is a very rare occurrence. Only 0.5% of all head and neck tumours constitute parapharyngeal space tumours. It is mainly congenital but can be seen at a later age following infection. MRI is the gold standard for diagnosis. This is a case report of a 19-year-old with right sided neck swelling without any significant history. It has been excised by transcervical approach.

Kimura Disease-A Case Report.

Kimura Disease, an eosinophilic hyperplastic granulomatous disease of idiopathic origin is most commonly seen in young males. It mostly presents with deep subcutaneous tissue swelling along with enlargement of salivary glands and regional lymphadenopathy. Diagnosis is mainly based on histopathological findings and raised serum IgE and hypereosinophilia. The radiological investigation of choice is Magnetic Resonance Imaging. Management strategy includes surgery and steroid therapy. Chemotherapeutic agents are also frequently used by some centres. Relapse and recurrence stands to be a common problem with management of this disease process. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03817-y.

Sigmoid and Transverse Sinus Thrombosis in a Child with Chronic Otitis Media: a Case Report.

Sigmoid sinus and transverse sinus thrombosis may occur as intracranial complications of chronic otitis media. Central venous sinus thrombosis typically presents with picket fence fever along with otalgia, otorrhea, and altered mental status. CT and MRI are investigations of choice for diagnosis. Once diagnosed, one should be started on empiric antibiotics. The use of anticoagulants has been debatable. From a surgical point of view, the current trend is to perform a mastoidectomy with the removal of inflammatory tissue from the sinus walls.

High-grade transformation of adenoid cystic carcinoma of parotid gland with isolated intratemporal facial nerve involvement: a case report and literature review.

BACKGROUND: High-grade transformation Adenoid cystic carcinoma (HGT-AdCC) of the parotid gland is a rare transformation noted in slow growing low grade AdCC. Perineural invasion and spread is an important feature of this tumor. Temporal bone involvement is rare. A total of only 10 cases of HGT-AdCC in parotid gland has been reported in literature so far predominantly in the elderly with peak incidence in 5th-6th decade. CASE PRESENTATION: We present a young lady of HGT-AdCC of right parotid gland with temporal bone involvement in the form of isolated perineural invasion (PNI) of facial nerve till the tympanic segment. She underwent right radical parotidectomy with modified radical neck dissection with modified lateral temporal bone resection and pectoralis major myocutaneous flap reconstruction. Histopathological examination revealed both low- and high-grade areas. Sections from facial nerve showed tumor invasion. CONCLUSION: The radiological features of isolated perineural spread in intratympanic part of facial nerve can be easily missed if not specifically looked for. Every attempt should be made preoperatively and intraoperatively to determine the complete extent of the tumor for adequate disease clearance. A combined clinico-radiological approach aided by histopathology examination helps in early detection of this carcinoma and in better patient management.

Anesthesia protocol for ear surgery in Wistar rats (animal research).

OBJECTIVE: To formulate an anesthesia protocol for safe and satisfactory anesthesia for ear surgery in rats. METHODS: The rats were anesthetized with xylazine (10 mg/kg body weight) and ketamine at doses of 80, 50, 40, and 30 mg/kg body weight or with isoflurane anesthesia (2%-3.5% in 100% oxygen; maintenance dose 1.5%-3.5%). The anesthesia induction, surgery, and recovery time were recorded. RESULTS: In total, 17 rats were induced by varying doses of ketamine-xylazine and 28 rats with isoflurane. Mean induction time with ketamine-xylazine was 6 ± 2.9 min compared with 3.8 ± 1.1 min with isoflurane. Mean recovery time with ketamine-xylazine was 142.6 ± 49.3 min compared with 4.1 ± 1.2 min with isoflurane. A mortality of 4 animals after developing dyspnea was recorded with ketamine-xylazine. CONCLUSION: Isoflurane anesthesia offers appropriate induction and recovery times and low mortality rates for the surgeries performed. Isoflurane anesthesia offers reliable results for ear surgery in rats. However, more equipment and technical skills are needed.

Improved postauricular surgical approach to the round window of rats.

OBJECTIVES: Research using rat as an in-vivo model has played an important role in otological research. The rat ear anatomy has been described; however, detailed surgical procedures to access the temporal bone are limited. The authors present a technique to approach the inner ear of rat that was standardized by cadaveric dissections and later replicated in living animals. METHODS: Adult Wistar albino rats were dissected via the post-auricular approach. The emphasis was on early identification of the facial nerve that formed a reliable landmark for the tympanic bulla, which in turn houses the round window and stapedial artery. The point of identification of facial nerve was postero-inferior to the external auditory meatus. The procedure was then repeated in living animals. RESULTS: Seventeen cadaveric rats were dissected. Initially, the investigators attempted to identify the facial nerve at its crossing over the external auditory meatus. However, that method was found to be unsatisfactory. The facial nerve was then attempted to be identified in its course postero-inferior to the external auditory meatus. The technique improved drastically, and the facial nerve was identified promptly and reliably. The procedure was then repeated in seven living rats under general anaesthesia. The major issues encountered were bleeding from the stapedial artery, hematoma of the pinna in one rat. CONCLUSION: This study suggests that the post-auricular approach is a feasible and less time consuming route for round window drug delivery experiments in Wistar albino rats. Recognition of anatomical landmarks, particularly the facial nerve is the key to surgery.

Effect of Duration of Exposure to Personal Listening Devices on Hearing Thresholds in Young Adults.

To analyze the effect of duration of use of personal listening devices on hearing impairment in young adults. Hospital-based cross-sectional study. Department of ENT, NEIGRIHMS, India. 50 consenting undergraduate medical students. This study was conducted over a period of 2 months. After eliminating all previous and current otological pathologies, Pure Tone Audiometry was conducted on each subject for both air and bone conducted sound stimuli. The subjects were divided into different groups based on duration of exposure. The audiograms were then closely evaluated for the existence of an association between the duration of personal listening devices (PLD) use and hearing impairment. The data was then evaluated by Chi Square test and Mann-Whitney U test using GraphPad InStat 3 software for the existence of an association between the duration of PLD usage and hearing impairment. The hearing thresholds varied only in isolated frequencies irrespective of the categorisation of duration of exposure to PLDs. There was no significant association between duration of use of personal listening devices and hearing impairment in young adults.

Psychological adaptation of Indian expeditioners during prolonged residence in Antarctica.

BACKGROUND: In view of the growing human activities in Antarctica and increasing exposure of humans to prolonged isolation under extreme conditions, such as space travel and deep sea diving, it is necessary to study the psychological adaptation to such an environment. The current study aimed to assess the psychological adaptation of Indian expeditioners to prolonged residence in Antarctica. MATERIALS AND METHODS: Twenty-four winter team members of 27th Indian Scientific Expedition to Antarctica were administered seven instruments 5 times during the expedition. The instruments measured cognition and memory, general psychological health and tobacco, and alcohol consumption. RESULTS: Alcohol consumption was maximum during the initial days of arrival on the continent and decreased thereafter, with another spike during the peak of the winter season. Externalized psychological reactions peaked during the midwinter period. Anxiety and insomnia peaked during the coldest period whereas depressive symptoms did not change throughout the expedition. Cognition was at its worst during the final phase of Antarctic residence. No significant change was noted in the third quarter of wintering. CONCLUSION: Each phase of Antarctic residence could be equated with a particular stage in psychological adaptation. There was no third quarter phenomenon.

Impact of Antarctica winters on vital parameters and anthropometric variables.

INTRODUCTION: We studied the variations in vital parameters and anthropometric variables in Antarctica to identify the effect of extreme weather and isolation on the vital parameters and adipose tissue distribution in humans. METHODS: A descriptive observational cohort study on three vital parameters and nine anthropometric measurements was conducted among the 26 winter team members of the 27th Indian Scientific Expedition to Antarctica. The parameters were evaluated in March, May and July 2008. The data was analyzed for: (1) undivided team, (2) groups based on physical activity levels, and (3) groups based on age. Intergroup variations were analyzed. RESULTS: The diastolic blood pressure of the undivided team fell significantly during the study. The systolic and diastolic blood pressure of non-convoy team decreased but the systolic blood pressure of the convoy team increased. The pulse rate of the two physical activity groups increased. No significant changes were observed in rest of the vital parameters and any of the anthropometric variables. CONCLUSION: The blood pressure of the expedition members may show unpredictable changes. But in a modern day Antarctic station, no significant variations in body fat are observed. Though the stress factors have been mitigated in Antarctica to a large extent, they might still be substantial. Quantification of the impact of such factors is difficult.

Reasons for medical consultation among members of the Indian Scientific Expeditions to Antarctica.

The article attempts to analyze the disease burden in a healthy, pre-screened population subjected to prolonged residence in the hostile environment of Antarctica. This retrospective epidemiological study was conducted utilizing data from medical consultation room on board the Indian Antarctic expedition vessels and at Indian Antarctic station, Maitri from seven Indian Scientific Expeditions to Antarctica (ISEA). The study group (n=327) consisted of 325 men and two women. The total number of medical room consultations was 1989. Maximum consultations were for injuries (27.25%); 14.68% were musculoskeletal and 10.31% were bruises and lacerations. Disturbances of gastrointestinal tract (19.66%) were the second most common disorders. Psychological disturbances accounted for 2.66% consultations. Cold injuries constituted 2.01% consultations and photophthalmia accounted for 1.06% consultations.

Morbidity pattern of the 27th Indian Indian Scientific Expedition to Antarctica.

OBJECTIVE: To evaluate morbidity prototype of 27th Indian Scientific Expedition to Antarctica (ISEA). METHODS: Twenty-six team members of 27th ISEA wintered over at the Indian Antarctic Station, Maitri, from February 2008 to January 2009. The morbidity pattern was sourced from the medical records. Preexisting illnesses were also considered in this analysis. RESULTS: The team consisted of men between 27 and 59 years of age (mean age, 43 years). Nine team members had preexisting illnesses. A total of 93 illness incidents were recorded during the stay in Antarctica. Most of these (27) were musculoskeletal injuries, bruises, and lacerations. Thirty-two (34%) incidents of illness were noted under the purview of medicine; 26 (28%), surgery; 15 (16%), orthopedics; 9 (10%), otorhinolaryngology; 8 (9%), ophthalmology; 2 (2%), dentistry; and 3 (3%), psychiatry. Oral ulcers were noted in 8 (8%) participants primarily during early wintering. CONCLUSIONS: Injuries continue to be the most common cause of morbidity in Antarctica. Nutritional deficiencies and cold-related injuries are relatively less common.

An unusual case of labial cysticercosis with a natural history.

Cysticercosis is a common disease in developing countries. Labial lesions produced by this parasitic infestation are rare. The most frequently involved oral locations are the tongue, labial or buccal mucosa, and mouth floor. We present here a case report of a 33-year-old-female patient from Maharashtra, who reported to our department with a swelling in the left lower lip, which was diagnosed as cysticercosis on histpathological examination.