Comparison of Conventional Curettage Adenoidectomy Versus Endoscopic Powered Adenoidectomy: A Randomised Single-Blind Study.

Globally adenoidectomy is increasingly being performed in isolation for children who have middle ear effusion or chronic otitis media, chronic rhinosinusitis and nasopharyngeal obstruction causing sleep apnoea and mouth breathing. Several techniques have been described lately including endoscopic powered adenoidectomy with debrider. The present study was undertaken to compare the effectiveness of endoscopic powered adenoidectomy (EA) with respect to conventional adenoidectomy (CA). It is a prospective study of 60 patients requiring adenoidectomy consisting of 33 males and 27 females randomized into group A with 30 patients undergoing conventional adenoidectomy with curette and 30 patients undergoing endoscopic powered adenoidectomy with micro-debrider. The demographic data (age, sex, adenoid hypertrophy grade assessed by Clemens and Mcmurray scale) in both groups were not statistically significant (p > 0.05). However, significant differences were observed in mean operative time of both groups (CA-29.12 ± 6.70, EA-37.80 ± 6.90 min, p < 0.05). The intra-operative blood volume loss was 21.30 ± 5.80 ml, 28.24 ± 6.93 ml in CA and EA respectively. No significant difference was seen in post-operative pain assessed by Visual Analogue Scale (VAS) (p-0.39). Complete removal of adenoids was seen in 83.3% cases with EA versus 53.3% with CA (p < 0.05). The residual adenoids noted after the CA and EA in Grade I was 23.3% and 13.3% respectively while in CA, grade II with 16.7% and grade III with 6.7% cases had residual adenoids. Injury to surrounding structure was seen in 16.7% and 10% of CA and EA respectively. However, no difference in complication rate was observed between the study groups (p > 0.05). We conclude that endoscopic powered adenoidectomy is more complete, accurate, with less post-operative pain and lower incidence of recurrence in comparison with conventional adenoidectomy.

Supernumerary tooth in the nasal cavity.

Intranasal ectopic dentition is a rare clinical entity. The presence of teeth has been reported in ovaries, testes, anterior mediastinum and presacral regions. In the maxillofacial region, teeth have been found in maxillary sinus, mandibular condyle, coronoid process, chin, nose and even orbit. A 21-year-old female patient presented with complaints of intermittent right-sided epistaxis and a history of occasional headache for 6 months. An anterior rhinoscopic examination revealed a hard white mass surrounded by granulation tissue lying in the floor of the right nasal cavity. The clinical appearance was that of a rhinolith. Supernumerary teeth are extra to normal complement in dentition. They may occur unilaterally or bilaterally, single or multiple. A variety of complications can occur ranging from crowding to cyst formation. Hence, early identification and treatment are essential for management.

A study of knowledge, attitude and practices about otitis media in parents in Navi-Mumbai.

Although otitis media poses a serious health risk in developing countries, being a frequent occurrence in children below five years of age, parental awareness and practices about otitis media have not been adequately researched. Present cross-sectional study was undertaken in Navi Mumbai schools, from October 2019 to December 2019, wherein parents with children ≤5 years of age answered a questionnaire which gathered data on their knowledge, attitude and practices about otitis media in their wards. Chi-square tests, Cramer's V were used to study association between gender, age-group and education of parents with their knowledge, practice and attitude about otitis media. Out of 425 valid responses, overall most parents displayed adequate knowledge (77%), positive attitude (61%) and good care-seeking practices (70%). There was a positive correlation of knowledge and practice with level of education. This study shows acceptable levels of knowledge, attitude and practices in parents about otitis media. Parents who did not seek treatment from health centre attributed the behaviour to poverty, ignorance and lack of health insurance. The positive correlation of knowledge and practices with level of education highlights the importance of role of education in modifying parental awareness and care seeking behaviour. Our findings call for a need to further strengthen community-based healthcare and improve parental confidence in healthcare services for early detection and adequate treatment of otitis media.

Sensitivity and Specificity of High-Resolution Computed Tomography (HRCT) of Temporal Bone in Diagnosing Cholesteatoma and Its Correlation with Intraoperative Findings.

High resolution computed tomography (HRCT) of temporal bone helps in understanding the complex anatomy of temporal bone and in identifying disease in temporal bone. However, its role in diagnosing cholesteatoma and analyzing its extent and complications is not established unequivocally. Present study was undertaken to check sensitivity and specificity of HRCT in diagnosing cholesteatoma and assessing its extent and in identifying ossicular destruction and other complications. In this prospective study in 50 patients with clinical diagnosis of cholesteatoma, preoperative high-resolution temporal bone CT scans axial and coronal view were carried out and compared with intra-operative findings. Kappa statistics was used for radio-surgical correlation. Comparison of CT scan findings with intraoperative findings revealed perfect correlation for sigmoid plate erosion, mastoid cortex dehiscence and scutum erosion, strong correlation for erosion of malleus, posterior superior wall and peri labyrinthine cells, good for erosion of incus and stapes, labyrinthine fistula, tegmen erosion and extent of disease and moderate correlation for facial canal dehiscence. HRCT scan of the temporal bone is useful preoperative investigation for cholesteatoma surgery for identification and documentation of ossicular status, location and extent of disease, erosion of tegmen or sinus or labyrinthine dehiscence, with the exception of facial canal dehiscence. Although it serves as road map for surgery, it still has some false positives and false negatives and the importance of a skilful, aware and alert surgeon cannot be overemphasized.

Role of endoscopy in surgical management of cholesteatoma: A systematic review.

Endoscopes are increasingly being used in cholesteatoma surgeries either as an adjunct to microscopes or sometimes exclusively. Their role at present is more as adjunct to microscope which still remains the work-horse for mastoidectomy. However, as endoscopy and endoscopic instruments are increasingly getting refined, role of endoscopy in management of cholesteatoma is continuously being appraised with progressively newer studies. This review aims to assess outcomes of several studies in which endoscopic techniques were used in cholesteatoma surgery and recognize common trends. An extensive review of literature on this theme was performed. Sixteen studies comprising of 1685 patients treated endoscopically either exclusively or in combination with microscope were included. Intra-operatively, in 267 (15.82%) cases, residual cholesteatoma was identified by endoscope in hidden areas after completion of surgery with microscope. On follow-up, recidivism was identified in 108 cases (6.4%) in second look procedures. Common sites of recurrence were hidden areas like sinus tympani. This review while acknowledging the value of microscope, highlights the merit of endoscope usage in cholesteatoma surgery and its role in reducing recurrence.

COVID19 Infection in Health Care Professionals: Risks, Work-Safety and Psychological Issues.

COVID-19 infection has spread widely over past 5 months to become a pandemic of global proportions affecting almost every country. While HCPs are expected to tackle this crisis by working in hospital and intensive care setting, there is real risk of them contracting infection and even dying. This article aims to report cases of healthcare personnel (HCPs) contracting COVID19 in various settings in a tertiary care hospital, a designated COVID centre, with view to disseminate information and review safety and psychological health issues of healthcare professionals. This study is a cross-sectional hospital-based survey from April 2020-June 2020. Data on demographics, workplace safety and psychological parameters from HCPs was collected by both interview and an online questionnaire form. A total of 40 healthcare workers were infected in the hospital in a period of 2 months since the first COVID case was admitted in the hospital. Almost 57.5% reported positive on several psychological parameters like anxiety, fear, anger, irritability and insomnia. About 42.5% had no psychological counselling after testing positive. These cases illustrate work-place risks for healthcare workers of acquiring COVID19 and highlight the problems faced in terms of risks of transmission to patients and colleagues, isolation of contacts in departments leading to near-breakdown of services and psychological stress to healthcare workers. Healthcare workers being at frontline of exposure to corona patients are at increased risk of developing COVID19 infections. Healthcare workers are working under tremendous stress in this pandemic and it is necessary to combat fear with facts and work towards safe work atmosphere so that they can discharge their duties to best of their ability.

An Objective Ergonomic Risk Assessment of Surgeons in Real Time While Performing Endoscopic Sinus Surgery.

There are increased reports of high prevalence of work related musculoskeletal symptoms in surgeons performing otolaryngology procedures. However, real time ergonomic risk assessment in the OR is difficult due to issues related to sterility, cooperation and acceptance from surgeons. Although such analyses can provide valid risk estimate and guide corrective actions, they are scarce. Hence, this study was undertaken to assess the postural ergonomic risk on RULA in otolaryngologists while performing Functional Endoscopic Sinus Surgery in OR, in real time. A cross sectional, observational multi-centric study was conducted in tertiary referral hospitals. Spinal, shoulder and elbow movements of 10 surgeons performing FESS were measured intraoperatively using orientation sensor-based, motion-analysis system (Noraxon myomotion). Postural ergonomic risk on RULA was computed using the motion analysis data. RULA is a method of quantifying the physical postural risk of the trunk and upper limb based on the postures adopted by an individual during work. 10 surgeons (9 males and 1 female) with the mean (± SD) age of 38 ± 7.5 years participated in the study. The motion analysis data results indicate that the surgeons often adopt awkward spinal and upper extremity postures during the surgery. All the surgeons scored higher than the acceptable RULA score (1 or 2) with the mean RULA scores being in the range of 6-7. The physical ergonomic risk in surgeons performing FESS is high (> 6 on RULA). There is a need for urgent ergonomic attention to the working environment of FESS surgeon.

Evaluation and Customization of WHO Safety Checklist for Patient Safety in Otorhinolaryngology.

The WHO has designed a safe surgery checklist to enhance communication and awareness of patient safety during surgery and to minimise complications. WHO recommends that the check-list be evaluated and customised by end users as a tool to promote safe surgery. The aim of present study was to evaluate the impact of WHO safety checklist on patient safety awareness in otorhinolaryngology and to customise it for the speciality. A prospective structured questionnaire based study was done in ENT operating room for duration of 1 month each for cases, before and after implementation of safe surgery checklist. The feedback from respondents (surgeons, nurses and anaesthetists) was used to arrive at a customised checklist for otolaryngology as per WHO guidelines. The checklist significantly improved team member's awareness of patient's identity (from 17 to 86%) and each other's identity and roles (from 46 to 94%) and improved team communication (from 73 to 92%) in operation theatre. There was a significant improvement in preoperative check of equipment and critical events were discussed more frequently. The checklist could be effectively customised to suit otolaryngology needs as per WHO guidelines. The modified checklist needs to be validated by otolaryngology associations. We conclude from our study that the WHO Surgical safety check-list has a favourable impact on patient safety awareness, team-work and communication of operating team and can be customised for otolaryngology setting.

A Survey of Work-Related Musculoskeletal Disorders Among Otolaryngologists.

There are increased reports of prevalence of work-related musculoskeletal disorders (WRMSDs) in surgeons performing minimal access surgeries. Due to the nature of the speciality, otolaryngologists spend their work days in performing markedly precise procedures in small workspaces i.e. the patients' ear, nose and throat. Due to this, they frequently adopt awkward neck, back and shoulder postures while using devices like otoscope, endoscope and microscope. The field of otolaryngology has barely received any attention with respect to ergonomic assessment. Thus, the aim of this study was to find out the prevalence of WRMSDs in otolaryngologists in Mumbai and Navi Mumbai. A pre-validated, structured questionnaire was distributed to 150 otolaryngologists. Seventy-three otolaryngologists responded to the questionnaire. The questionnaire comprised of demographic and workload data, report of musculoskeletal symptoms and otolaryngologists' interpretation of casual and preventive factors of symptoms at workplace. Response rate of the survey was 48.6%. The total prevalence of WRMSDs in the otolaryngologists was 87.67%. Majority of those surveyed reported that they suffered from musculoskeletal problems which they attributed to the ergonomic flaws encountered during surgery (60.27%) and OPD (69.86%) respectively. Pain and discomfort during surgery experienced by the surgeons were most frequently attributed to the awkward and sustained postures adopted during surgery. Effective time management, ergonomically apt postures, intermittent change of posture, using back rest and availing skilled assistance during OPD and surgery, were the self-assessed corrective measures suggested by the respondents. The otolaryngologists' job profile puts them at high risk for WRMSDs.

Correlation of nasal nitric oxide measurement with computed tomography findings in chronic rhinosinusitis.

Nitric oxide (NO) is a biological messenger produced by mammalian cells serving various functions including regulation of blood flow, platelet function, immunity, and neurotransmission. The paranasal sinuses and nasal mucosa are a major source of exhaled NO. The aim of the study is to compare the nasal NO (nNO) levels in patients with chronic rhinosinusitis with those of common cold patients and controls and to correlate CT scores with nNO levels. The nasal concentration of NO was measured by electroluminescence in 13 healthy volunteers, in 13 patients suffering from common cold and 13 patients with chronic rhinosinusitis. The concentration of NO was correlated with symptom scores, endoscopic findings and CT findings. The measured levels of NO did not differ between healthy volunteers and common cold patients, but they were significantly lower in patients suffering from chronic rhinosinusitis. As NO is a regulator of mucociliary activity and has bacteriostatic and antiviral effects, the decreased concentration of nNO in patients suffering from sinusitis suggests that lack of NO may contribute to the pathogenesis of this disease. Thus, nNO, which is easily measured, provides a valuable non-invasive objective measure of chronic rhinosinusitis.