ABSTRACT
The tympanic membrane forms a barrier between the external auditory canal and the middle ear. In the inactive mucosal type of chronic otitis media, there is a perforation in the tympanic membrane which is surgically managed by Myringoplasty. Estrogen as a growth factor has been shown to have a mitogenic effect on keratinocytes thus hastening the rate of epithelialization following injury. This property of estrogen is being studied in this study for its role in the outcomes of myringoplasty. This study was carried out from January 2021 to December 2022 in the Department of Otorhinolaryngology, of a tertiary teaching hospital in North India. Patients were assessed by history, examination, otoscopy, Audiometry, and oto-endoscopy. A total of 88 patients were taken out of which 44 patients underwent myringoplasty in which topical estrogen (estradiol valerate solution) was used, and the remaining 44 patients were taken as controls. Patients were then assessed post-operatively based on Audiometry results and graft uptake status. In the estrogen group successful Graft uptake was in seen 40 (90.9%) patients and failed in 4 (9.1%), while in the control group, it was successful in 37 (84.1%) patients and failed in 7 (15.9%), statistically there was no significant difference between two groups in terms of graft uptake (p value = 0.334). Post-operatively, in the estrogen group, the mean change in Air Conduction (AC) was 15.5 dB, the change in the air-bone gap (ABG) was 11.5 dB and for Bone Conduction (BC) it was 3.2 dB. However, in the control group mean post-operative changes in Air Conduction, Air-Bone Gap, and Bone Conduction were 12 dB, 10.7 dB, and 0.8 dB respectively. Statistically, there was a significant difference in postoperative changes in AC (p value = 0.011) and BC (p value = 0.009) between the two groups. There was no significant difference in post-operative changes in Air-Bone Gap (p value = 0.571). Topical Estrogen (Estradiol valerate) solution is cost-effective, with enriched growth factors that accelerate tympanic membrane perforation closure following myringoplasty and resulted in significant improvement in hearing thresholds both for Air Conduction and Bone Conduction.
ABSTRACT
Epithelial-Myoepithelial Carcinoma (EMC) is a very rarely seen biphasic tumour typically seen in older females and constitutes 0.5-1% of all salivary gland neoplasms. The parotid gland is most often involved and occasionally there may be involvement of submandibular and minor salivary glands. Clinical picture often reveals benign nature of the disease. Computed tomography (CT) and magnetic resonance appearances are non-specific and the cytological diagnosis may be challenging, thus more accurate diagnosis can only be made by histological and immunohistochemical study. There is no consensus regarding the optimal treatment of this neoplasm, largely due to its rarity. Wide surgical excision with a clear margin is the treatment of choice because of the tumour's tendency to infiltrate locally. Adjuvant radiotherapy is often required in cases of large primary tumours and positive surgical margins. The tumour may commonly recur locally after resection in 30-50% of cases. We herein present an unusual case of a 46-year-old male who presented with cystic swelling of left parotid gland and diagnosed as EMC on histopathology and immunohistochemical examination. The patient was treated with surgical resection followed by post-operative radiotherapy.
ABSTRACT
Keeping in view the changing flora of chronic otitis media (COM), geographical variability of its complications and differential prevalence of sinonasal predisposing diseases in these patients, we studied the microbiological profile along with the complications and sino-nasal diseases in patients with COM. It was a Cross-sectional study conducted during Nov 2017 to Dec 2019 in department of Otorhinolaryngology, Jawaharlal Nehru Medical College, AMU, Aligarh. The study included 200 cases of chronic suppurative otitis media, both Mucosal (safe) and Squamous (unsafe) type, out of which 111 (55.5%) were males and 89 (44.5%) were females. The overall prevalence of complications in patients with COM in our study was high at 6.5% with 61.54% complications being extracranial and 38.46% were intracranial. DNS was the most common sino-nasal disease found in 22.5% of patients followed by Inferior turbinate hypertrophy, Adenoid hypertrophy and polyp in 6.5%, 5.5% and 4% of participants respectively. A culture positive result was found in 84.5% of the samples with 55.5% samples being monomicrobial and 29.0% being polymicrobial. COM like the other chronic diseases impacts quality of life. As long as health-care delivery fails to target high-risk groups in developing countries such as ours infections like CSOM will persist with its adverse consequences. With the development and widespread use of antibiotics, the types of pathogenic micro-organisms and their sensitivity to antibiotics have changed. Continuous evaluation of pattern and antibiotic sensitivity of isolates is necessary to decrease the potential risk of complications by early institution of appropriate treatment.
ABSTRACT
This prospective study has been carried out to observe the outcomes of canal wall up (CWU) and canal wall down (CWD) Tympano-mastoidectomies in ears with cholesteatoma. Outcomes of the procedures have been done in terms of recurrence of cholesteatoma, complications, graft uptake rates and post-operative hearing gain. This study was carried out in the Department of Otorhinolaryngology of a reputed tertiary teaching hospital of North India from January 2016 to June 2020, with a mean follow-up of 32 months. The study included 100 patients of otitis media with cholesteatoma. In Canal Wall Up Tympano-mastoidectomy (CWUT) group, the number of males and females were 22 each. On the other hand, 36 males and 20 females underwent Canal Wall Down Tympano-mastoidectomy (CWDT). Each surgery was done as a single-staged and at the end of the surgical procedure angled oto-endoscopes were used for ensuring complete removal of the disease. Though there is no statistically significant difference in recurrence of cholesteatoma and complications rate in CWU and CWD Tympano-mastoidectomy techniques, but CWUT is superior to CWDT in terms of better graft uptake (p = 0.0156), and better average audiological gain (8.56 ± 0.93 dB) with p value = 0.0315. A diligent post-operative follow-up is must for assessing the outcomes of different types of mastoidectomies. This study shows no statistical difference in the disease recurrence and complication rates between Canal Wall Up and Down Tympano-mastoidectomies, though the anatomical changes and creation of the mastoid cavity in canal wall down procedure may affect the graft uptake and post-operative hearing gain. Use of Oto-endoscopes in cholesteatoma surgery helps in improving the outcomes of both techniques and thus recommended if the facility for the same is available.
ABSTRACT
The bacteriological and antimicrobial sensitivity profile of chronic otitis media (COM) varies from region to region and from time to time and may vary among different age group as well. It was against this backdrop of the changing bacteriological profile and sensitivity pattern together with the paucity of categorically separated data of pediatric and adult population, that the present study was undertaken. A total of 193 patients of clinical diagnosis of cholesteatomatous COM with ear discharge and positive culture results were included in the study. Pus sample was collected under aseptic conditions and cultured on solid media and broth. Isolates were identified via standard biochemical tests and sensitivity patterns analysed. Chi square (χ2) test was used to analyse the significance. Pseudomonas was the most common isolate in both the pediatric (37.80%) and adult (51.46%) population. Methicillin sensitive staph aureus (MSSA) was found exclusively in pediatric population (p = 0.003).Piperacillin-Tazobactam combination was the single most effective drug regimen overall. 75% of pseudomonas isolates in pediatric and 87.5% in adults were sensitive to this regimen in vitro. Amikacin was the next most effective drug with 56.69% sensitivity in pediatric and 64.08% sensitivity in adult population. The present study finds piperacillin-tazobactam as the most effective therapy and pseudomonas as the most common isolate in the study population.In order to address the varying and changing bacteriological and sensitivity profile of chronic otitis media occurring among different geographical regions and also within a region over time, the authors recommend its periodic evaluation.
ABSTRACT
As there are changing trends in the microbiology of chronic otitis media, this study was carried out to look for the current aerobic microbes and their antimicrobial susceptibilities in patients of chronic otitis media from north Indian region. A total of 322 patients who met the inclusion criteria were studied and aerobic ear swab culture was done under aseptic conditions. Gram staining was performed and antibiotic susceptibility testing was done using Kirby-Bauer disc diffusion method on Mueller-Hinton Agar. A total of 341 culture positive results were obtained from 322 patients. The culture results revealed 10 different aerobic microbes. Gram-positive floras were seen in 152 (44.57%), and Gram-negative in 189(55.43%) isolates. Staphylococcus aureus was the most common isolate present in 131 samples (38.41%), followed by pseudomonas aeruginosa in 101 (29.62%) and proteus in 36 (10.56%). In overall susceptibility of antibiotics against Gram-positive culture isolates, Vancomycin was most effective (97.37%). For Gram-negative microbes, Piperacillin-Tazobactum combination was most effective with overall susceptibility of 79.37% susceptibility. Microbiological assessment of Chronic Otitis Media should be carried out in an area on regular intervals because of the changing patterns of bacteriology and their antimicrobial susceptibilities.
ABSTRACT
INTRODUCTION: Osteochondroma of the coronoid process also known as Jacob's disease, has rarely been reported in the literature and it posses a challenge as diagnosis may be overlooked in favour of other causes of limited mouth opening. CASE REPORT: This is a case report of an adult male patient who presented with restricted mouth opening in whom radiological imaging, especially 3D computed tomography, played a role in establishing the diagnosis of Jacob's disease. CONCLUSION: An osteochondroma of the coronoid process of the mandible (Jacob's disease) is a rare cause of restricted mouth opening and its diagnosis can be overlooked in favour of TMJ ankylosis. The CT scan plays an important role in diagnosis and in planning for surgery.
ABSTRACT
Management of Head and Neck Cancers poses a challenge inspite of several advances because of poor success in terms of response rate, survival and reduced morbidity of the patients. In the present study 30 untreated histologically proven cases of head and neck cancers were subjected to weekly radiotherapy with adjuvant chemotherapy (cisplatin 30 mg/m(2) intravenously). This study group was compared with a group of 30 patients who were given only radiotherapy. Results have shown that combination of chemotherapy with radiotherapy gives a significantly better results in tumour as well as nodal response with minimal toxicities.
