Comparative Study of Inlay and Overlay Cartilage Perichondrium Composite Graft Myringoplasty.

To compare results of inlay and overlay cartilage-perichondrium composite graft myringoplasty. The present study was conducted in the department of otorhinolaryngology, Pt. B. D. Sharma PGIMS, Rohtak. The study was conducted on 40 patients of either sex in age group of 15-50 years having unilateral or bilateral inactive (mucosal) chronic otitis media with dry ear over a period of at least 4 weeks without use of topical or systemic antibiotics after obtaining their informed and written consent. Mean age in group I was 25.25 ± 7.27 years and in group II was 25.95 ± 9.06 years. Maximum number of patients in both groups were in the age group 15-24 years. Out of the total patients, 60% were males and 40% were females. At 6 months post operatively, 95% cases in group I had successful graft take-up compared to 85% cases in group II. However, at long term follow up for 24 months, graft success rate was statistically significant in group I. In group I, 100% graft uptake was seen in large size perforation of 4 and 5 mm along with 2 mm as compared to group II, with 100% graft uptake for only small size perforation of 2 mm. The mean hearing threshold gain was 16.50 ± 5.52 dB in group I as compared to 13.03 ± 6.44 dB in group II. Mean postoperative improvement in air bone (AB) gap of 16.50 ± 5.52 dB was seen in group I as compared to 13.07 ± 6.44 dB seen in group II. The graft take up rate was found to be better in long term with inlay cartilage- perichondrium composite graft myringoplasty technique compared to over lay technique with both the groups showing significant hearing improvement post-operatively. This high success rate for graft uptake and ease to perform under local anaesthesia makes in-lay cartilage perichondrium composite graft myringoplasty technique relatively optimal to use for office based myringoplasty. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03487-w.

Epidemiological, Clinical and Radiological Profile of Patients with Foreign Body Oesophagus: A Prospective Study.

To analyse the patients with foreign body oesophagus in relation to the clinico-radiological and socio-economic profile. The present prospective study was conducted on 100 consecutive patients of all age groups who underwent oesophagoscopy for suspected foreign body ingestion in a tertiary care hospital. The most common age group affected was 0-5 years. The median age was 5 ± 14.37 years. There was preponderance in males as compared to females, male to female ratio was 2.23:1. Majority (70%) of the patients, both males and females, belonged to rural areas. Lower socio-economic group was more commonly affected (54%). The most commonly reported symptom was foreign body sensation (55%) followed by vomiting (54%) and difficulty in swallowing (51%). Foreign body ingestion was witnessed in only 19% cases by the family members. The mean time between ingestion of the foreign body and admission to the hospital was found to be 4.5 h. The majority (97%) of foreign bodies were radio-opaque. The most common site of lodgement was just below the cricopharynx (89%). The most common foreign body retrieved in our series were coins (65%). The majority of foreign bodies (68%) were retrieved in 20-40 min after induction of general anaesthesia. In 99% of the patients we did not encounter any complications. The majority (93%) of the patient's parents/relatives had curiosity to have a glimpse of the foreign body till they actually saw the retrieved foreign body. Foreign body lodgement is more common among children of lower socio-economic strata more so in rural areas. Rigid oesophagoscopy is a safe and effective procedure for removal of the foreign body. Early intervention makes it easier to extract the foreign body without complications.

The Clinicopathological Study of Benign Lesions of Vocal Cords.

Benign vocal lesions are non-malignant growths of abnormal tissue on the vocal cords. The common benign lesions of vocal cord are singer's nodule, polyps, papilloma, polypoidal degeneration and cysts. The aim of this study was to analyze the demographics such as age, sex, occupation, symptomatology, site of involvement. An objective evaluation of voice handicap was done pre and postoperatively using VHI-10 scale to see improvement in patient's symptoms. In this prospective study, a total of 50 cases were selected with benign lesions in regional hospital of India. The pre and post operative assessment for voice handicap was assessed by VHI-10. Chi square test (SPSS 20.0 version) used to analyze result; value of p < 0.05 was taken significant. In this study of 50 patients, the benign lesions were most common in 20-29 age group. Male (70%) outnumbered females (30%). Most common was Vocal polyp (56%), followed by nodule (32%), cyst (10%) and papilloma (2%) respectively. All patients showed improvement after phonosurgery and postoperative speech therapy, being assessed by VHI-10 scale. The benign lesions of vocal cords produces symptoms which can vary from hoarseness to stridor, affect social functioning, work performance. Speech therapy following microlaryngeal surgery forms an essential part of treatment, to avoid recurrence. VHI-10 scale as found to be a useful and convenient tool in measuring patient voice handicap and to see improvement after surgery.

To Evaluate the Pre and Post Shunt Sensorineural Hearing Loss in Hydrocephalus Patients.

Hydrocephalus means watery head and defined as disturbance of formation, flow, or absorption of cerebrospinal fluid. The clinical presentation of hydrocephalus includes hearing loss especially sensorineural hearing loss (SNHL). Ventriculoperitoneal (VP) shunting is the most commonly performed procedure in these patients. Pure tone audiogram, impedence and BAEPs, were done for preoperative hearing assessment in 20 hydrocephalus patients. Out of 20 patients, 12 cases (60%) had SNHL while, rest 8 (40%) patients had mixed hearing loss. Post VP shunting hearing improvement was observed in 14 patients (70%) whereas it worsened in 30% of patients. The result is even better if shunt is placed at early age.

Studying the result of underlay myringoplasty using platelet-rich plasma.

OBJECTIVE: Perforations of the tympanic membrane are treated with various surgical techniques and materials. This study aimed to determine the efficacy of platelet-rich plasma during underlay myringoplasty. METHODS: The study included 40 patients. Autologous platelet-rich plasma was applied in-between temporalis fascia graft and tympanic membrane remnant during underlay myringoplasty in group 1 (n = 20). The outcome was evaluated after three months and compared with group 2 (n = 20), a control group that underwent routine underlay tympanoplasty. RESULTS: After three months' follow up, graft uptake was 95 per cent in group 1 and 85 per cent in group 2 (p < 0.03). Mean hearing threshold gain was 18.62 dB in group 1 and 13.15 dB in group 2. This difference was statistically significant (p < 0.01). CONCLUSION: Platelet-rich plasma, with its ease of preparation technique, availability, low cost, autologous nature and good graft uptake rate, justifies its use in tympanoplasty type I procedures.

Assessment and clinicopathological correlation of p16 expression in head and neck squamous cell carcinoma.

INTRODUCTION: Oral squamous cell carcinoma is a major cause of death throughout the developed world. It is associated with smoking and alcohol consumption. Human papillomavirus (HPV) type 16 has also been suggested to play a role in etiology of head and neck squamous cell carcinoma (HNSCC). p16 expression is now being used as a surrogate marker of HPV infection in squamous cell carcinoma and provides important prognostic information and future therapy planning. MATERIALS AND METHODS: In this prospective study, total of 75 cases of HNSCC were taken. Tumor grade was determined according to World Health Organization (WHO) criteria. p16 expression was determined by immunohistochemical staining. The obtained results were analyzed and evaluated using Chi-square test (Statistical Package for Social Sciences (SPSS) version 20), value of P <0.05 was taken significant. RESULTS: Out of 75 cases, 78.7% cases were positive for p16 (inclusive of all grades), while 21.3% cases were negative. Expression of p16 was higher in nonsmokers and nonalcohol consumers and significantly associated with paan chewing habit. No significant correlation was seen with history of abnormal sexual habits, but p16 expression was significantly correlated in cases with multiple sexual partners (P = 0.003), with increasing histological grade (P = 0.045) and in cases with lymph node metastasis (P = 0.03). CONCLUSION: As HPV integration with transcription of viral oncoprotein induces overexpression of p16, immunohistochemical expression of p16 can be used as a surrogate marker of HPV. This approach can be implemented in diagnostic laboratories and can provide support for vaccination program in high risk group.

Tuberculoma of the tongue presenting as hemimacroglossia.

The underdiagnosis of extrapulmonary tuberculosis lesions, along with an emerging global resistance to antitubercular drugs, warrants an increased awareness of the involvement of Mycobacterium tuberculosis in atypical lesions of oral cavity. Tongue is the most common site of oral tuberculosis. We report a rare presentation of lingual tuberculosis in a 65-year-old male, a chronic tobacco chewer, who came to us with swelling of the tongue which apparently looked like hemimacroglossia, leading to the clinical diagnosis of submucosal carcinoma of tongue. Enlargement of tongue is a slow process resulting from gradual invasion and lodging of bacilli in the tongue. Biopsy and histopathological examination revealed tuberculous etiology of the lesion and the patient responded well to antitubercular therapy.

Endo-DCR: is it an end of the road for external DCR?

Endo-DCR is a safe, quick, less traumatic, with minimal blood loss and post-operative discomfort and last but not the least, avoids external scar. It has high success rate in both primary and secondary cases. Fifty two cases of chronic dacryocystitis were treated by the endoscopic technique including 33 females and 19 males in mean age group 35.8 year, 29 left eye and 23 right eye with 8 patients cannulated with nasolacrimal tube with very good results and few complications.

Obstructing mass lesion of epiglottis: it can be tubercular.

We report a case of 60-year old male who had difficulty in breathing as well as in swallowing. On examination, he was found to be having proliferative growth of epiglottis and right aryepiglottic fold mimicking neoplasm. So emergency tracheostomy was performed and biopsy taken. He was found to be having asymptomatic miliary mottling on routine x-ray chest PA view. Further on HRCT, it turned out to be lesion suggesting tubercular etiology. Histopathology (epiglottic biopsy) report confirmed the whole process as tubercular. The patient recovered promptly in due course with anti-tubercular treatment. Point remains to be seen that if we can avoid tracheostomy and its complications in such cases.

Secretory otitis media: A school health survey.

The present study was carried out to find out prevalence of secretory otitis media in 200 school going children between the age group of 5-7 years by impedance audiometry besides clinical evaluation. 100 children were taken from two different schools catering to higher and lower socioeconomic strata of society. The overall prevalence of secretory otitis media came out to be 20.75%. It was 28.5% in lower socioeconomic group and, 13% in the other group. This high prevalence warrants routine screening for secretory otitis media. Further impedance audiometry was found to be very good method of screening secretory otitis media.

Fatal pyothorax: a rare complication of retropharyngeal abscess.

Fatal pyothorax following a massive acute retropharyngeal abscess in an adult is reported. Acute non-tuberculous retropharyngeal abscess usually develops following a penetrating injury due to a foreign body or endoscopy. Microbial isolates are mixed and consists of aerobic and anaerobic organisms. It may lead on to mediastinitis since there is a potential communication between the two spaces. Immediate cervical, pleural and mediastinal surgical drainage along with appropriate antibiotics can be life saving.

Oesophageal candiasis in AIDS.

With the explosion in the number of AIDS patients, many of these are likely to consult to otolaryngologists the head & neck is a rather common site to be affected. Sometimes only oesophageal candidiasis is the presenting feature as in the present case which is being reported show typical radiological appearance. the differential diagnosis and treatment of nesophageal candidiasis is briefly discussed.

Nasal mucociliary clearance in patients with tracheostomy.

Nasal mucociliary clearance (NMC) time was estimated in 30 tracheostomized patients (24 males & 6 females) in the age group of 13-55 years which was 7.04±0.38 minutes: The patients suffering from nose and paranasal sinus disorders; taking drugs like bromhexine; undergoing radiotherapy and smokers were excluded from the study. The nasal mucociliary clearance in 30 age & sex matched healthy controls was 9.16±0.62 minutes. The NMC was found to he significantly lowered in patients with tracheostomy (p<0.01). This decrease in NMC tune was significant in tracheostimized patients of more than 3 weeks duration (p<0.01), whereas, it was not found significantly lowered in patients with tracheostomy of less than 3 weeks duration (p>0.1).

Mucormycosis.

A rare case of mucormycosis in a 58 years old healthy house-wife is reported which occurred without any predisposing factors like immuno-suppresion. Etiology, clinical features and treatment is outlined with the caution that the most effective drug i.e. amphotericin B may have very serious side effects as in this case. The disease is acutely fatal and treatment has potential hazards which may prove fatal. However, if the disease entity is kept in mind, with early diagnosis and treatment, the outcome would be quite favourable.

Oesophageal foreign body in four month old infant.

A 4 month old male infant was brought with only strong suspicion of foreign body ingestion without any symptomatology. X-ray examination revealed foreign body at cricopharyngeus, which was managed successfully emphasizing the fact that a strong suspicion and relevant radiography is the key to early and successful management.

Serum selenium levels in patients with head and neck cancer.

OBJECTIVE: The objective of this research was to estimate serum selenium levels in patients with head and neck cancer and to correlate them with tumour burden, as well as to study the effect of radiotherapy on serum selenium levels to determine its prognostic significance. DESIGN: This prospective study was carried out by selection of head and neck cancer patients using periodic random numbers. SETTING: This was a hospital-based study. METHODS: Estimation of serum selenium was done using the Atomic Absorption Spectrophotometer (Model AAS 4129; Electronic Corporation of India Ltd., Hydrabad, India) with a hydride generator after digestion of the serum sample. MAIN OUTCOME MEASURES: Patients were followed for 1 year postradiotherapy for any change in serum selenium level and its correlation with the outcome of the treatment. RESULTS: All 30 patients had serum selenium levels significantly lower as compared with controls, and these levels decreased further as tumour burden increased. Levels came within normal range after 1 year of radiotherapy in 10 patients who were cured but in the remaining patients who had residual disease, levels remained persistently low. CONCLUSIONS: The serum selenium level may serve as a useful marker in head and neck cancer.

Gallstone expectoration following laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is the treatment of choice for uncomplicated gallstone disease. Laparoscopic cholecystectomy may result in lost (spilled) gallstones. Such stones may precipitate various infective intra-abdominal complications. An unusual case of spilled gallstones eroding the diaphragm and eventually being expectorated out 12 months after laparoscopic cholecystectomy is reported.