National Infant Screening for Hearing Program in India: Necessity, Significance and Justification.

Hearing impairment is one of the most prevalent disorder in children and adults worldwide, which not only interferes with the acquisition, development and maintenance of speech and language skills but also adversely deprive the auditory nervous system for future learning. It can have long term harmful effect on educational, social, emotional and cognitive skills in young children; restrict the vocational options and employment opportunities in adults; and can cause isolation, loneliness and depression in older adults, if remain undetected and intervened at the earliest. However, early identification and intervention is known to greatly reverse the ill effects and improve the quality of life of children and adults with hearing impairment. Current clinical means and methods to identify and intervene hearing loss are convenient, cost effective, reasonably accurate beneficial and evidenced based, can be easily employed nation-wide for early identification and intervention of hearing loss. This paper attempts to convince medical colleagues, public health care experts and policy makers by justifying the hearing, as public health issue and relevance of medical screening criteria for hearing. It also discusses the preferred model of hearing screening and intervention strategies in India.

Peritonsillar Ropivacaine Infiltration in Paediatric Tonsillectomy: A Randomised Control Trial.

INTRODUCTION: Various efforts have been made to reduce post tonsillectomy pain in children. The present study was undertaken to evaluate the efficacy and safety of Ropivacaine in post-operative pain management in these children. MATERIALS AND METHODS: This study is a Randomized control study on 140 patients between 4 - 12 years of age, in whom tonsillectomy was performed in a tertiary care centre between January 2017 to November 2018 using standard dissection and snare surgical technique. Postoperatively, patients were randomized into 2 groups of 70 patients each, receiving tonsillar fossa infiltration with 0.2% Ropivacaine or 0.9% normal saline respectively. Patients were assessed as per Wong Baker's Faces Scoring System at 2 hours, 4 hours, 8 hours, 18 hours, 24 hours, and 48 hours postoperatively. All the results were analyzed by SPSS software. Chi- square test and Mann-Whitney test were used for assessment of level of significance, with P- value of less than 0.05 taken as significant. RESULTS: Both the groups were comparable with respect to age and sex. At 48 hours, in study group, maximum number of patients 35 (50%) had Wong Baker score 0, while in control group, maximum number of patients 52 (74.3%) had Wong Baker score 4 (P< 0.01). The difference in the mean Deglutition time between both groups was significant (P< 0.01). CONCLUSION: Ropivacaine infiltration is a effective modality for post-tonsillectomy pain management in children, with minimal side-effects.

Role of MRI in Evaluation of Malignant Lesions of Tongue and Oral Cavity.

BACKGROUND: Aim of the present study was to evaluate the role of MRI in staging of malignant lesions of the oral cavity and to correlate MRI findings with clinical/surgical and anatomical-pathological findings, wherever possible. MATERIAL/METHODS: The study included 50 patients who presented with malignant lesions of the oral cavity and were referred to radiology departments for MRI. All patients included were subjected to a detailed physical examination following which MRI was carried out on Philips Gyroscan Achieva 1.5 Tesla unit. RESULTS: In the study, the highest number of patients were found to have tongue malignancy (82%) followed by buccal mucosa and gingivobuccal sulcus malignancy (18%). The highest number of patients was in the age group of 51-60 years (32%). The incidence was higher in males (96%). There was moderate agreement (k=0.537) for T stage between the clinical and MRI staging assessments. The agreement for N stage between clinical and MRI staging assessments was fair (k=0.328). The final diagnosis was made by histopathology in 22 patients. The agreement for T stage was good/substantial (k=0.790) and for N stage was moderate (k=0.458) between MRI and histopathology staging assessments. CONCLUSIONS: MRI provides satisfactory accuracy for preoperative estimation of tumor thickness and predicting occult cervical nodal metastasis. MRI is the preferred modality in evaluation and staging of oral cavity malignancy which helps a clinician for planning of treatment.

Role of High Resolution Computed Tomography in Evaluation of Pathologies of Temporal Bone.

BACKGROUND: High Resolution Computed Tomography (HRCT), a modification of routine CT, provides a direct visual window in the temporal bone providing minute structural details. Purpose of the present study was to evaluate the normal variations, pathological processes (infections and congenital anomalies) and their extent involving the temporal bone along with their complications on HRCT and to correlate these imaging findings surgically, wherever available. MATERIALS AND METHODS: The prospective study included 50 patients who were referred to the radiology department with clinically suspected temporal bone or ear pathologies. After detailed clinical examination, the patients were subjected to high resolution computed tomography (HRCT) examination. The imaging findings were correlated with the surgical findings wherever available. The surgical findings were considered as final. RESULTS: From a total of 50 cases, 83.33% had cholesteatoma. The surgical and radiological findings showed a high level of sensitivity (89.29%) in the identification of cholesteatoma. HRCT provides a good sensitivity of 80.65% in the identification of changes to the ossicular chain despite the presence of surrounding soft tissue. HRCT was highly informative in identification of erosion of lateral semicircular canal. In diagnosis of facial canal dehiscence HRCT had a low sensitivity of 33.33%. In the evaluation of any congenital abnormality of the ear HRCT proved to be beneficial in depicting the anatomical details. CONCLUSION: The clinical and radiological findings showed a high level sensitivity with intraoperative findings as regards to the presence of cholesteatoma, changes of the ossicular chain and erosion of the lateral semicircular canal. HRCT findings, in the treatment of any congenital abnormality of the ear were a good guide to the surgeon for planning and management.

Unusual parapharyngeal lipoma.

Lipomas of the parapharyngeal space (PPS) are extremely rare. CT scan and MRI are indispensable tools to investigate these hard to access tumors. PPS lipomas are confined to either the prestyloid or post styloid compartments. We report an unusual parapharyngeal lipoma involving both the compartments of the PPS.

High frequency tympanometry in neonates with normal otoacoustic emissions: measurements and interpretations.

Tympanometry is used in evaluating middle ear functional conditions. Before 6 months of age its results may be misleading. High-frequency studies aim to provide more valid procedures. In this study, 236 healthy newborns (127 male, 109 female; 73 % rural, 27 % urban) with age between 0 and 42 days (mean 27 days) no risk for hearing impairment; were analyzed for DPOAE. 209 babies who passed DPOAE were further analyzed for high-frequency tympanometry using Interacoustic AT235h tympanometer, which was possible for 399 ears. The success rate for HFT was 95.3 %. Descriptive statistics for six parameters TPP, Y 200, Y peak, Y tail, YpC-200 and Ypc-tail were analyzed and compared with previous studies. All the parameters except the Ypc-tail were in the range of previous studies.

Bilateral single sitting myringoplasty using tragal cartilage from one ear.

Though single sitting myringoplasty using temporalis fascia under general anesthesia has been documented in many studies, but ours is the first center to have started using tragal cartilage harvested from one ear to do bilateral myringoplasty in one sitting using local anesthesia with excellent results including very good graft uptake rate and audiological improvement without significant complications.