An Unusual Neck Tumor in Adult: A Case Report.

Cystic Hygroma (CH) also referred to as lymphangioma, is a cystic malformation of the lymphatic vessels that can occur anywhere in the body. Its incidence in adulthood is considered rare and its occurrence in the neck is even rarer and only a few case reports are available till date. We present a case of adult CH of the neck and the literature review of the same. A 30-year-old male presented with painless swelling in the left side of the neck of 2 years duration. Investigations showed a cystic mass on the left lower anterior part of the neck which was surgically removed in-toto with the intact capsule. The biopsy report confirmed the diagnosis. A differential diagnosis of CH should be considered when a cystic lesion is encountered in the neck of an adult, cytological and radiological evaluation is necessary for defining its location and diagnosis. Although various conservative modalities of management are available, they are employed only in certain situations, and surgical excision of CH is considered the gold standard. The chances of recurrence range from 15 to 20%.

Knowledge, Attitude, and Practices Regarding Risk Factors for Otitis Media among Caretakers of Children in Puducherry- A Descriptive Cross Sectional Study.

Otitis media is a common childhood disease in developing countries and is the most important cause of preventable hearing loss among Indian children. To study the knowledge, attitude, and practices regarding risk factors for otitis media among caretakers of children in Puducherry. This was a questionnaire based descriptive cross-sectional study conducted from April 2023 to June 2023. All the caregivers of children aged 2-12 years presented or diagnosed with otitis media under our inclusion criteria were interviewed. Overall, most caretakers displayed good knowledge (67%), positive attitude (62%) and good care-seeking practices (49%). There was a positive correlation with sociodemographic parameters. The odd's ratio for overcrowding was high (OR = 4, p = 0.042 for knowledge and attitude, OR = 3.929, p = 0.041 for practices). Higher score was seen among middle class with odd's ratio 1.417 for knowledge and attitude and 4.875 for practices (p = 0.041). Graduate parents had higher score with the odd's ratio that was statistically significant. Most of the caregivers had a good knowledge regarding symptoms of otitis media and an acceptable level of caregivers' attitude and care seeking practices. Higher scores were associated with overcrowding, socioeconomic status, parental education. Improvement in risk factors and providing health education will reduce prevalence of OM in children and thereby reduce preventable hearing loss in children. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04551-9.

To Evaluate the Indications for Adenotonsillectomy Surgery and the Quality-of-Life Post-Surgery- A Descriptive, Cross-Sectional Study.

Aim: To determine the indications of adenotonsillectomy and to evaluate the quality-of-life post-adenotonsillectomy surgery. Materials and Methods: This is a descriptive cross-sectional study done in the department of ENT, Indira Gandhi Medical College and Research Institute (IGMCRI), Puducherry among patients who underwent adenotonsillectomy surgery from the year 2015 to 2022. The data regarding their clinical profile and indications for surgery were collected from the medical case records and these patients were contacted through telephone to know their quality of life using a standardized questionnaire. Results: A total of 98 patients were included in the study, 43 males and 55 females, between the age of 4 to 48 years. Adenotonsillitis (infection) was the indication for adenotonsillectomy in 69 out of 98 patients (70.4%), and Adenotonsillar hypertrophy (Obstruction) in 29 out of 98 patients (29.5%). Postoperatively, the symptoms like frequency of episodes of throat pain had decreased from 6.162.08 to 1.240.44 (p<0.001), snoring (72-1%), mouth breathing (70.4-3.1%), average number of doctor visits due to throat pain (3.911.44 to 1) and average number of days absent to school/ work (3.81 1.26 to nil) had decreased significantly. Conclusion: Adenotonsillitis (Infection) as an indication is more common than adenotonsillar hypertrophy (Obstruction) for performing adenotonsillectomy in our study. Majority of the patient's symptoms had markedly decreased post-surgery and hence a significant improvement in overall quality of life, both physical and general well-being. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04113-5.

Unusual Cause of Neonatal Stertor.

We report a case of neonatal respiratory distress caused by an epignathus. This rare tumour, arising from the basisphenoid and protruding from the mouth, is associated with high perinatal mortality. We highlight unique clinico-radiological findings and multidisciplinary approach for a successful outcome. We review oropharyngeal teratomas reported in the literature with current management approaches.

Depression in Chronic Suppurative Otitis Media: A Complication Brewing Unnoticed.

INTRODUCTION: Chronic suppurative otitis media (CSOM) is a chronic infection of the middle ear cleft with a permanent perforation resulting in mucopurulent discharge and may include otalgia or fever, vertigo, hearing loss, and tinnitus. These compromise the quality of life of CSOM patients and affect their social communication and professional life also, which may induce social withdrawal and depression. MATERIALS & METHODS: This cross-sectional study was conducted at the Department of ENT, Indira Gandhi Medical College & Research Institute (IGMC&RI), Pondicherry, India, from May 2019 to May 2020. CSOM patients fulfilling the inclusion and exclusion criteria were recruited for the study.The association of disease characteristics and hearing loss was evaluated by the Spearman correlation test. Correlation of variables such as age, sex, type of disease, laterality hearing loss type, and severity with respect to depression was done using Chi-square test. RESULTS: One hundred forty-two participants were recruited for this study, the majority being females (65%) the mean age being 44.08 years ± SD 15. The safe type of CSOM (tubotympanic disease) was common among the participants (96%) with unilateral disease (78%) more predominating and left side being most frequently (58%). There was a significant and linear correlation of depression and hearing loss to the duration of the disease.

Clinical Prognostic Indicators in Predicting the Outcome in Patients with Bell's Palsy: A Descriptive, longitudinal Study from Puducherry, South India.

Electrophysiological studies can objectively predict the functional recovery in Bell's palsy but, the clinical prognostic indicators seem to be more practical where the nerve conduction studies are not available. To determine the clinical prognostic indicators in Bell's palsy patients and to determine the indicators with poor outcome for recovery. We designed a prospective, descriptive, and observational analysis of Bell's palsy patients, who presented to our ENT outpatients department. 34 patients with Bell's palsy were recruited for this study. We studied the demographic characteristics, sidedness, associated symptoms, time of presentation, grade, and therapeutic options. All the patients were followed up for 8 weeks and the final grade of functional recovery of the nerve was recorded. The patient information was entered in Epicollect 5software and the output was analysed as descriptive statistics. Hypothesis testing was accomplished by means of χ2 test or Fischer exact test, to compare the proportions of categorical data and continuous data using the Mann-Whitney U test. 91.17% (31/34) of Bell's palsy patients had complete facial nerve function recovery at the end of 8 weeks. Higher Age > 40 years (p = 0.022) and BP patients with coronary artery disease (p = 0.005) were the only two significant indicators for incomplete recovery. We suggest that all Bell's palsy patients seek medical advice early at the onset,especially the BP patients of older age and with coronary artery disease for faster recovery.

Finding My New Balance.

All of us walk with faith, unaware of what lies ahead in our life, until we have that fall, my story is about how I lost my balance and regained it in a better form. Little did I know about this rare brain tumor that was slowly taking over my neural commands. To fight for my life was the only aim prior to surgery and getting back to living my life after neurosurgery was aiming higher than before. This narrative essay is about my trials and tribulations of a rare brain tumor that presented with audio-vestibular symptoms. It portrays vividly my experience of this brain tumor, and importantly vestibular rehabilitation that which allows the brain to achieve recovery of neural functions due to its inherent properties of neural plasticity.

Difficult Laryngeal Exposure in Microlaryngoscopy: Can it be Predicted Preoperatively?

The aim of the present study was to identify preoperative clinical predictors for difficult laryngeal exposure (DLE) and to define a simple grading system for laryngeal exposure. This is a prospective descriptive study carried out in a tertiary teaching hospital in South India. Patients above 18 years undergoing microlaryngoscopy had presurgical evaluation of 11 physical parameters. Grading of Modified Cormack-Lehane Score (MCLS) and rigid laryngoscopy were done during procedure. On logistic regression analysis, with a 95 % confidence interval (CI) MCLS was found to be a statistically significant predictor (odds ratio 12). With 90 % CI, neck circumference, atlanto-occipital extension and MCLS were significant (odds ratio of 4, 4, 12 respectively). Neck circumference of more than 34.25 cm and limited atlanto-occipital extension of less than 19.50, predicts difficult laryngeal exposure. A simple grading system for laryngeal exposure during microlaryngoscopy is being proposed. MCLS grade more than 2a done intra operatively correlates well with difficult intubation.

Flunarizine in the prophylaxis of migrainous vertigo: a randomized controlled trial.

Migrainous vertigo is a common cause of dizziness presenting to an otorhinolaryngology/otoneurology clinic. Although it causes a substantial burden to the individual and society there are no randomized controlled trails on prophylactic medication for this condition. Flunarizine, a calcium channel blocker has been used effectively in both migraine and vestibular conditions. This randomized control trial was undertaken in a tertiary academic referral center to evaluate the efficacy of flunarizine in patients with migrainous vertigo when compared to non-specific vestibular treatment of betahistine and vestibular exercises. The effect of flunarizine on two particularly disabling symptoms of vertigo and headache was studied. A total of 48 patients who were diagnosed with definitive migrainous vertigo completed the study of 12 weeks duration. Patients in arm A received 10-mg flunarizine daily along with betahistine 16 mg and paracetamol 1 gm during episodes, and arm B received only betahistine and paracetamol during episodes. Symptom scores were noted at the start of the study and at the end of 12 weeks. Analysis of the frequency of vertiginous episodes showed a significant difference between arm A and arm B (p = 0.010) and improvement in severity of vertigo between the two groups (p = 0.046). Headache frequency and severity did not improve to a significant degree in arm A as compared to arm B. The main side effects were weight gain and somnolence and this was not significantly different between the two groups. Flunarizine (10 mg) is effective in patients with migrainous vertigo who suffer from considerable vestibular symptoms.

Spontaneous bacterial peritonitis results in oxidative and nitrosative stress in ascitic fluid.

BACKGROUND AND AIM: Spontaneous bacterial peritonitis (SBP) is a major complication of liver cirrhosis and accounts for significant mortality. Although oxygen free radicals and nitric oxide been implicated in the pathophysiology of liver cirrhosis, information on their role during the development of SBP is scarce. This study examined these active species in ascitic fluid from patients with SBP, and in response to treatment. METHODS: Forty-nine consecutive patients with cirrhosis and ascitic fluid neutrophil counts less than 250/cumm were studied as controls. Another 21 patients whose ascitic neutrophil count exceeded 250/cumm were treated as cases. Ascitic fluid was collected from these patients at entry and 48 h after treatment with antibiotics. Nitrate and markers of oxidative stress such as malondialdehyde, protein carbonyl content and total and protein thiols were measured. RESULTS: A significant increase in malondialdehyde and protein carbonyl levels was seen in ascites from patients with SBP when compared to controls. This was accompanied by a decrease in total thiols and protein thiols. In addition, there was a significant increase in ascitic fluid nitrate in patients with SBP when compared to control patients. After antibiotic treatment, malondialdehyde, protein carbonyl and nitrate levels dropped back towards control values, and total thiols also recovered. CONCLUSIONS: This study demonstrated the presence of oxidative stress in ascitic fluid from patients with SBP, and showed that ascitic fluid nitrate may be a marker for diagnosing SBP and a useful index in determining therapeutic response to antibiotic treatment.