Prevention and Rehabilitation of Old Age Deafness.

Hearing impairment is one of the most common sensory deficit affecting 466 million people globally and in majority of old age people it can not corrected. Since presbycusis is always associated with diminished cognition power resulting in two fold loss in understanding of speech. There is no treatment available till date to regenerate the hair cells but certainly we can augment hearing by preventing and regenerating (apoptosis) atrophy of stria vascularis, spiral neural cells degeneration, atrophy of auditory nerve and cerebral cortex by modified greeva, skandh chalan, dynamic neurobics, tratak (focused concentration), Bhramari, Kumbhak along with mindful relaxation technique.

Modified Bhramari Pranayama in Covid 19 Infection.

The Coronavirus (2019-Cov-2) infection Covid-19 is highly contagious caused by single stranded RNA virus (+ssRNA) with nucleocapsid and spreading widely all across the world and responsible for more than 3.6 million morbidity and 0.25 million mortality No specific treatment is available till date. The clinical symptoms are mainly upper respiratory leading to diffuse viral pneumonia and multiple organ failure involving. Kidney, Liver and Heart along with coagulopathies. During 2004 (SARS-CoV) pandemic role of nitric oxide in its management is well demonstrated. Nitric Oxide (NO) reversed pulmonary hypertension. Improved severe hypoxia and shortened the stay in ICU and ventilatory support. Nitric Oxide increased the survival rate. The genetic composition of Corona Virus (SARS-CoV) is almost similar to Covid-19, thus indicates good chances of effectiveness or enhancement in results by Nitric Oxide along with other modes in treatment of Covid-19. It has been proved by studies by serendipity humming increases NO Expression dramatically.It is estimated that humming increases the endogenous generation of nitric oxide level by 15-fold. Hypoxia in ARD Syndrome leads to blood coagulation by depression of body defence anticoagulatory and fibrolytic properties along with metabolic acidosis. If we go into hypoxic hypercapnic state no hyper coagulation takes place. Hence Bhramari by enhancing the expression of Nitric Oxide and increased Carbon dioxide by extended exhalation and alkaline pH prevents coagulopathies and morbidity due to Covid-19.

Role of Platelet Rich Plasma in Tympanoplasty.

To compare the efficacy of platelet rich plasma (PRP) in Tympanoplasty. Comparative study of Tympanoplasty with and without PRP. A total of 82 patients having dry large central perforation underwent type I Tympanoplasty by transcanal route under local anesthesia. Control group underwent surgery without PRP. The study group Tympanoplasty was added with PRP by PRP soaked gel foam placed in middle ear, over the graft and in bony canal along with wetting the temporal fascia by PRP graft. Preoperative and post operative audiometry was done. Result compared. Majority of the patients were of the age group of 20-30 years. Success rate of graft uptake was 85.3% in control group and 95.1% in PRP group. Hearing Improvements in control group was 46.3% and in PRP group was 78.0%. This study confirms addition of PRP in Tympanoplasty enhances the success rate in graft uptake early healing with improvement in hearing.

Symptomatic hepatic hydrothorax successfully treated with transjugular intrahepatic portosystemic shunt (TIPS)-role of titration of portosystemic gradient reduction to avoid post-TIPS encephalopathy.

KEY CLINICAL MESSAGE: We describe a challenging case of hepatic hydrothorax secondary to nonalcoholic steatohepatitis cirrhosis. Our management involved successfully treating the hydrothorax with a transjugular intrahepatic porto-systemic shunt but having to manage the subsequent complication of hepatic encephalopathy. We conclude with a review of the available literature.

Preimplantation genetic diagnosis: its role in prevention of deafness.

Deafness is a global problem. In India deafness ranges from 4 % in urban to 11 % in rural and slum areas, out of which 50 % is conductive hearing loss hence curable. Genetic transmission accounts for 50 % of the cases of congenital deafness, and of these, around 30 % are syndromic and 70 % are non-syndromic. Genetic counseling is going to make aware the parents of all appropriate treatments. Preimplantation genetic diagnosis can help to have a baby free from genetic deafness. Procedure is almost safe, harmless, non-invasive and ethically acceptable. While Amniocentesis is a non-invasive method, prenatal genetic testing through Chorionic villous sampling is invasive. The connexin 26 (CX26W 24X) mutations are the most common cause of non-syndromic hearing loss and easy to identify by polymerase chain reaction. There is always co-morbidity after cochlear implantation and the person remains handicapped while baby after PGD shall be having healthy normal life and person prone to environmental factors may be counseled and guided to prevent deafness in next generation. Public must be made aware of noise pollution, tobacco toxicity and consanguinity. The Obstetrician and Pediatrician apart from ENT surgeon should be involved to prevent antenatal or neonatal deafness.

Deafness, a Social Stigma: Physician Perspective.

Hearing is an essential sensory sense of an individual for development of speech which is crucial for verbal communication and personality development. It is the second most common form of disability after loco motor disability in India. Disabling hearing loss is more than 40 dB hearing loss in better ear in a person more than 15 years of age and greater than 30 dB hearing loss in better hearing ear below 14 years of age. WHO estimated 360 million individuals in the world with disabling hearing loss, out of which 91 % are adults and only 9 % are children. Early and accurate identification of birth asphyxia, hyperbilirubinemia, auditory neuropathy Presbyacusis and avoiding noise pollution and discouraging use of mobile phone, tobacco chewing/smoking, in those who are prone to deafness, an intervention is a must to decrease deafness from our society. Deafness prevention can only be possible with mutual cooperation with dedication of different medical and non-medical personnel and also by helping the persons with deafness. We have to focus not only on the children but also on senior citizens as most alarming, up to 40 %, incidence of deafness is in senior citizens above the age of 75 years. Timely cure and preventive measures are essential for better socio-economic state of the country. By helping the persons with deafness, we will not only be doing a great service to the Nation but also to the society at large.

Vitamin d deficiency in e.N.T. Patients.

A prospective study to observe the prevalence of deficiency of vitamin D in out patients of otolaryngology clinic at Indian Institute of ear diseases, Muzaffarnagar. The patients attending outpatient of otolaryngology clinic with various complaints and not responding to conventional treatment were advised for assessment of vitamin D [25 (OH)D] level in blood. The age, sex, occupation, colour of skin, chief complaints, obesity, provisional diagnosis, and incidence of sun exposure was noted in all cases. A total of 86 patients were examined, maximum patients were in the age group of 7-15 years. The chief complaints in majority of the patients were sore throat with recurrent upper respiratory tract infection. Only in three patient's vitamin D level was found to be with in normal limits. In rest 83 (96.51 %) it was either deficient 57 (66.28 %) or insufficient 21 (24.42 %). The incidence of vitamin D deficiency is extremely common in Ear Nose Throat disease (E.N.T.) patients. The results of vitamin supplementation were promising in cases of benign paroxysmal positional vertigo with cervical spondylosis and URTI with asthma, empirical supplementation of vitamin D in all E.N.T. patients not responding to conventional treatment is worth trying. At place of sun screen, use of pomegranates and blueberries may be encouraged to prevent sunburn and eliminate Vitamin D deficiency.

Life style management in head and neck cancer patients.

Head and neck (HN) cancers involve highly visible body parts, structurally complex, and crucial to survival. A diagnosis of HN cancer, like any cancer diagnosis, is often accompanied by much fear and uncertainty. In addition, patients treated for HN cancer face difficulties in eating, chewing, drinking, breathing, speaking, as well as changes in appearance. Simultaneously, the burden of HN cancer is often manifested in psychosocial dysfunction, which can have a negative impact on quality of life (QL). Psychosocial interventions such as education along with cognitive-behavioral therapy generally provide an overall positive effect. With the growing impetus to investigate factors associated with these dysfunctions and disfigurement caused by the treatment, and considerable advancement in the development and validation of many global and disease-specific measures, there is an opportunity for further research to develop an appropriate clinical intervention program for such patients so that these patients can live a near normal life. Life style changes including dietary habits make gross changes in QL.

Endovascular treatment of isolated systemic arterial supply to normal lung with coil and glue embolisation.

Surgery is the standard treatment for the extremely rare pathology of isolated anomalous systemic arterial supply to normal lung (ISSNL). We describe our experience with this anomaly in a 29-year-old male presenting with recurrent haemoptysis that was successfully treated with a combination of metallic coils and cyanoacrylate glue. In addition to contributing to the extremely limited data on endovascular therapeutic options in ISSNL, we also intend to raise the awareness among endovascular therapists of the need to be cautious ofand preserve the radiculomedullary/pial branches arising from an anomalous artery before embolising it.

Preimplantation genetic diagnosis and deafness.

Deafness in India ranges from 4.0 % in urban and 4.0-11 % in rural and slum areas, out of which 50 % are of conductive hearing loss hence curable. In the congenital hearing loss the incidence of syndromic hearing loss is only 30 %, rest 70 % are non syndromic. Genetic counseling is going to make aware the parents. Preimplantation genetic diagnosis can help to have a baby free from genetic deafness. Procedure is almost safe, harmless, non-invasive and ethically acceptable. While by genetic testing through prenatal genetic testing, amniocentesis and chorionic villous sampling is invasive and termination of pregnancy is difficult, social and ethical issue. The connexin 26 (CX26W 24X) has been observed as most common and easy to identify by polymerase chain reaction. There is always co morbidity after cochlear implantation and the person remains handicapped while baby after PGD shall be having healthy normal life and person prone to environmental factors may be counseled and guided to prevent deafness in next generation. Public must be made aware of noise pollution, tobacco toxicity and consanguinity. The obstetrician and pediatrician apart from ENT surgeon should be involved to prevent antenatal or neonatal deafness.

Endovascular exclusion of aberrant splenic artery aneurysm with covered stent.

The splenic artery arising from the superior mesenteric artery is an uncommon anatomical variant. This aberrant origin may rarely be associated with an aneurysm. Previous cases have been managed with surgery and combined surgical/endovascular or endovascular techniques, with the latter involving occlusion of the aneurysm with coils. We report a case of aberrant splenic artery aneurysm that was excluded with a balloon-mounted covered stent, and discuss the technical issues encountered in using this approach. A follow-up computed tomography performed six months after the covered stent placement showed persistent exclusion with marked shrinkage of the aneurysm sac.

Endovascular revascularisation of popliteal artery occlusions: two complex cases.

Peripheral vascular disease-related occlusions of the arteries are complex lesions that can be treated surgically or through endovascular means in symptomatic patients. In this case report, we describe two interesting cases of popliteal occlusion that were revascularised using advanced endovascular techniques to salvage the limb. The first case was a chronic popliteal artery occlusion that required atypical arterial access along with embolisation due to earlier attempted intervention to revascularise the artery. The second case was an acute embolic occlusion that was excluded from the circulation primarily rather than through the typical approach of thrombolysis or mechanical thrombectomy.

Foreign Body Wharton's Duct.

A case of fingernail sliver lodged in the Wharton's duct is reported as the incidence of foreign body in duct is scarcely reported due to small puncta. Foreign body was removed under local anesthesia by opening the Wharton's duct as a day care procedure.

Intra turbinate diathermy cautery V/S high frequency in inferior turbinate hypertrophy.

OBJECTIVE: To compare the efficacy of intraturbinate monopolar cautery, bipolar cautery, high frequency monopolar and high frequency bipolar cautery in inferior turbinate hypertrophy. STUDY DESIGN: Prospective randomized single blinded clinical study METHOD: The study comprised of 80 patients divided in 4 groups each of 20 patients who underwent monopolar cautery, Bipolar cautery, high frequency monopolar and bipolar intra-turbinate cautery. Patients were evaluated on the 7th post operative day and 1 year after the surgery & saccharine transit time test also performed and compared. RESULTS: Remarkable improvement was recorded in nasal obstruction and quality of life. The Saccharine transit time test showed a comparable frequency and confirmed maintenance of mucociliary mechanism.

Chronic adrenaline treatment fails to down-regulate the Del301-303-alpha2B-adrenoceptor in neuronal cells.

BACKGROUND AND PURPOSE: A polymorphism of the human alpha(2B)-adrenoceptor (Del(301-303)-alpha(2B)-adrenoceptor) has been described, and this receptor exhibits reduced G-protein-coupled receptor kinase (GRK) phosphorylation and impaired short-term desensitization. Expression of the Del(301-303)-alpha(2B)-adrenoceptor also is associated with an increased risk for myocardial infarction in humans. Recent evidence from our laboratory suggests a quantitative relationship between cellular GRK3 expression levels and the sensitivity of the alpha(2B)-adrenoceptor to agonist-induced down-regulation. Therefore, the present study was undertaken to study agonist-induced down-regulation of the wild-type (WT)- and Del(301-303)-alpha(2B)-adrenoceptor in a neuronal cell model. EXPERIMENTAL APPROACH: Haemagglutinin (HA) epitope-tagged WT- and Del(301-303)-alpha(2B)-adrenoceptor containing plasmids were constructed and the receptors were stably or transiently transfected in neuroblastoma/glioma hybrid NG108 cells. The expression levels in stable transfects were approximately 50 fmol x mg(-1). These cells were used to examine agonist-induced down-regulation and phosphorylation of the WT- and Del(301-303)-alpha(2B)-adrenoceptor. KEY RESULTS: The Del(301-303)-alpha(2B)-adrenoceptor, compared with the WT-alpha(2B-)adrenoceptor, displayed reduced adrenaline-stimulated (20 microM) phosphorylation and did not down-regulate in response to adrenaline (20-1000 microM). Using immunofluorescence labelling, we observed that transiently transfected WT-alpha(2B)-adrenoceptors internalized upon adrenaline treatment whereas the Del(301-303)-alpha(2B)-adrenoceptor did not. Finally, we determined the effect of adrenaline on the Del(301-303)-alpha(2B)-adrenoceptor in cells stably over-expressing GRK3 3-fold. In spite of the GRK3 over-expression, 20-1000 microM ADR failed to down-regulate or to increase phosphorylation of the Del(301-303)-alpha(2B)-adrenoceptor in these cells. CONCLUSIONS AND IMPLICATIONS: The results suggest that the 301-303 deletion mutation of the alpha(2B)-adrenoceptor eliminates agonist-induced down-regulation, an effect that cannot be overcome by increasing agonist concentration or by modest GRK3 over-expression.

Self-expanding nitinol stents in recanalisation of long-length superficial femoral artery occlusions in patients with critical limb ischaemia.

INTRODUCTION: This study aims to evaluate our experience with self-expanding nitinol stent- enabled recanalisation of long-length occlusions (30 cm or more) of the superficial femoral artery (SFA). METHODS: 573 patients underwent 842 lower limb interventions from August 2006 to December 2008. A retrospective review of patients undergoing recanalisation of long-length SFA occlusions with self-expanding nitinol stents and an evaluation of their patency and impact on limb salvage, were done. RESULTS: 22 patients (mean age 62.5 years, male: female ratio 11:11) underwent 22 long-length SFA stenting procedures. The spectrum of critical limb ischaemia included rest pain (five), ulcer (six) and gangrene (11). Length of occlusions varied from 30 cm to 45 cm (average length 36.4 cm). Five patients had stents placed through the ipsilateral popliteal artery approach, and the rest had stents placed through the femoral artery approach. All patients were followed up over an average duration of 12 months. One patient died due to associated medical conditions during this period. Six out of 21 (28.6 percent) of the stents thrombosed completely on one year follow-up. Of these, two patients underwent amputation, one patient had a bypass, and the stent in two patients were recanalised with balloon angioplasty. All remaining patent stents showed varying degrees of stenoses at one year. The overall limb salvage rate at one year following stent placement was 81 percent. CONCLUSION: Our experience showed the beneficial result of long-length SFA stent placement with good limb salvage outcome. Repeat interventions may be required to maintain the patency of stents in these patients.

Intra-hepatic arterial pseudoaneurysm causing life-threatening upper gastrointestinal bleed after removal of biliary drainage catheter.

Hepatic artery pseudoaneurysms are an uncommon complication of percutaneous biliary drainage catheter insertion. The authors report a case of a hepatic artery pseudoaneurysm following percutaneous internal-external biliary drain insertion. This led to massive haemobilia when the catheter was removed and presented clinically as life-threatening upper gastrointestinal bleed. The clinical and imaging manifestations are discussed along with the management of the patient.

Renal vascular injuries following nephron-sparing surgery and their endovascular management.

INTRODUCTION: This study aims to describe renal vascular injuries following nephron-sparing surgery and the efficacy of transcatheter embolisation in management of these complications. METHODS: A retrospective review was performed on 96 patients who underwent nephron-sparing surgery from 2001 to 2005. Selective angiography was performed on all patients referred for significant postoperative haematuria and internal bleeding, followed by embolisation where indicated. Patient presentation, type of vascular injury, embolisation technique and treatment outcome were reviewed in each case. Efficacy of embolisation in preservation of renal function was assessed. RESULTS: Seven arterial lesions were identified in four patients (three male and one female; age range 47-70 years). Three patients developed pseudoaneurysms (mean size 2.1 cm, range 1.5-3 cm). One patient revealed four separate areas of active contrast extravasations. All patients were successfully treated with coil embolisation with complete symptomatic relief within one to three days. Renal function was preserved in all patients over a follow-up period of 90 days. CONCLUSION: Renal arterial injuries, especially pseudoaneurysms, are an important though uncommon cause of haematuria following nephron-sparing surgery. Coil embolisation is an effective treatment for management of these iatrogenic injuries.

Blunt dissection to bipolar forcep tonsillectomy- a comparision.

Bipolar diathermy forcep or scissors dissection is safe and trusted and established procedure now and have an edge over blunt dissection. If monopolar diathermy is used, high voltage current should be used for dissection with fine point and if bipolar is used, low voltage current should be used, diathermy tip should be cleaned with wet gauge piece, fossae should be packed with wet gauge only, minimum required current and only coagulation should be attempted, avoid injury to surrounding tissue resulting to minimum sloughing. Avoiding thermal injury to surrounding tissues leads to lesser post operative pain. Results depends upon the precision of technique and expertise developed over a time especially coagulating the vessel during dissection before spurt. Considering cost effectiveness, bipolar diathermy is much economical than ultrasonic and laser to provide comparable results in terms of better results, duration of surgery, anaesthesia and overall postoperative morbidity.