Saccharin Test Time as a New Prognostic Predictor of Tympanoplasty.

In India, Chronic suppurative otitis media (CSOM) is a general public health issue leading to hearing loss which can be corrected surgically by Tympanoplasty. By applying predictors for a successful surgery the effectiveness of the surgery can be improved. In this study we aim to determine the usefulness of prognostic factors in predicting outcome of surgery for better patient compliance. 1. To compare MERI scores and saccharin test time in predicting graft uptake and hearing outcomes in Tympanoplasty surgery. A prospective study included all cases of mucosal type of CSOM of either sex according to the inclusion and exclusion criteria. Saccharin clearance time was used to assess Eustachian tube function and Pure Tone Audiometry has been done Pre-operatively to assess Hearing. Risk categories were assigned using MERI scoring chart and severity of disease assessed by otomicroscopy during surgery. Patients were post-operatively followed up to 6 months. Outcomes were assessed using Graft uptake, Hearing improvement and for recurrence of infection, compared with different categories of MERI and Saccharin time. The overall graft uptake was 96.6%. 100% successful graft uptake was seen among normal eustachian tube function. Hearing improvement after surgery may be predicted by saccharin and MERI test. Abnormal Saccharin test shows guarded prognosis in predicting the success of middle ear surgeries. Based on the MERI score and saccharin clearance time, hearing benefit and Surgical success can be assessed and patients can be counselled prior surgery regarding the expected outcome.

Endoscopic Grading, Radiological Grading and Clinical Features in Children with Chronic Adenoid Hypertrophy: A Correlational Study.

To obtain a correlation between endoscopic findings, radiological findings and clinical features in children with symptomatic Chronic Adenoid hypertrophy. A cross sectional study was conducted in 42 pediatric patients (3-14 years) who visited the Department of Otorhinolaryngology in a tertiary care centre from November 2019 to April 2021 (18 months). The patients were subjected to complete history taking; ENT examination, Rigid nasal endoscopic examination, a lateral X-ray nasopharynx were performed prior to surgery after obtaining consent from the parents of the patients. The endoscopic findings were assessed using ACE grading system and the X-ray nasopharynx was assessed using Adenoid- Nasopharyngeal ratio. A male predominance was noted with mouth breathing, snoring, nasal obstruction and recurrent rhinitis as common presentation. Grade 3 hypertrophy was the most common finding in X-ray Nasopharynx (Mean ANR-0.682). Children with Grade 3 adenoid hypertrophy with more than 50% choanal obstruction and Eustachian tube abutment in nasal endoscopy were noted to be the most symptomatic clinically. A positive correlation between reduced hearing (p value-0.004) and blocked ear sensation (p value- < 0.01) with eustachian tube abutment was noted. The children with more symptoms did not show higher-grade adenoid hypertrophy radiographically in our study. The adenoid- nasopharyngeal ratio on X-ray correlated with endoscopic grading of adenoid hypertrophy (p value-0.006) and degree of choanal obstruction (p value-0.003) but not with the abutment of the eustachian tube. The endoscopic grading correlated with clinical grading, but not the X-ray grading. Hence, endoscopic grading appears to be more accurate in assessing the adenoid size and endoscopic grading is nearer to clinical grading than X-ray grading. Though, the digital X-ray nasopharynx lateral view is a more convenient method, nasal endoscopy is the gold standard method to determine whether the adenoid hypertrophy is clinically significant or not.

Coswara: A respiratory sounds and symptoms dataset for remote screening of SARS-CoV-2 infection.

This paper presents the Coswara dataset, a dataset containing diverse set of respiratory sounds and rich meta-data, recorded between April-2020 and February-2022 from 2635 individuals (1819 SARS-CoV-2 negative, 674 positive, and 142 recovered subjects). The respiratory sounds contained nine sound categories associated with variants of breathing, cough and speech. The rich metadata contained demographic information associated with age, gender and geographic location, as well as the health information relating to the symptoms, pre-existing respiratory ailments, comorbidity and SARS-CoV-2 test status. Our study is the first of its kind to manually annotate the audio quality of the entire dataset (amounting to 65 hours) through manual listening. The paper summarizes the data collection procedure, demographic, symptoms and audio data information. A COVID-19 classifier based on bi-directional long short-term (BLSTM) architecture, is trained and evaluated on the different population sub-groups contained in the dataset to understand the bias/fairness of the model. This enabled the analysis of the impact of gender, geographic location, date of recording, and language proficiency on the COVID-19 detection performance.

Incidence and Prevalence of Fungal Sinusitis in Cases of Chronic Rhinosinusitis.

To study the incidence and prevalence of fungal sinusitis and its variants in cases of chronic rhinosinusitis in department of ENT and Head and Neck surgery. The study group consisted of 100 patients of chronic rhinosinusitis attending the outpatient and inpatients in department of Otorhinolaryngology. History was taken and diagnostic nasal endoscopy was performed. Patients underwent endoscopic sinus surgery and systemic treatment when required. Pre surgery serum IgE and post-surgery Histopathology was sent. Out of 100 patients, Males > Females and median age was 45.50 years (range 34.25-59.25 years). On DNE, 88% had polyps with 88.1% males and 87.8% females in their respective groups. 47% had allergic mucin with 49.2% males and 43.9% females in their respective groups. 34% had discharge with 28.8% males and 41.5% females in their respective groups. 37% had fungal filaments with 37.3% males and 36.6% females in their respective groups. 26% had fungal sinusitis in our study among which 53.8% were males and 46.1% were females. Peak fungal sinusitis was in 3rd to 5th decade. Commonest organism isolated was Aspergillus. Serum IgE was higher in patients with fungal sinusitis and nasal polyposis. In conclusion, the proportion of patients with Fungal Sinusitis was 26% among 100 patients with chronic rhinosinusitis. We isolated Aspergillus as the predominant fungus followed by Biporalis and Mucorales genus. Serum IgE was higher in patients with fungal sinusitis and Nasal polyposis. Both immunocompromised and competent individuals were managed surgically and/or medically when required. Our study showed that early fungal sinusitis detection leads to better management practices and prevents its progression into more severe disease with complications.

Retrospective Analysis of Transnasal Endoscopic CSF Rhinorrhea Repair in a Tertiary Care Centre.

To analyse the outcome of transnasal endoscopic repair of CSF Rhinorrhea in a tertiary care centre. This is a retrospective study conducted on 81 patients who underwent CSF Rhinorrhea repair in a tertiary care hospital for a period of 11 years. Following confirmation of diagnosis using bio-chemical and radiological investigations, all patients underwent transnasal endoscopic repair of CSF Rhinorrhea using a multilayer graft. Patients were followed up for 6 months. The most common etiology in our study was spontaneous CSF rhinorrhea (60.49%) and subjects with BMI > 25.5 kg/m2 were more prone to it. Cribriform plate was found to be the most frequent site of leak in our study (58.02%), followed by fovea ethmoidalis (12.35%). Overall success rate was 96.30%. Transnasal endoscopic approach for cerebrospinal fluid rhinorrhea repair shows good success rate and also offers the advantages of better visualization and identification of site of leak, less complications, rapid postoperative recovery, and low recurrence rate. Transnasal endoscopic CSF Rhinorrhea repair has shown good results in terms of low recurrence rates and high patient satisfaction among other advantages. Hence this approach should be commonly used for CSF rhinorrhea repair by surgeons.

Bilateral Posterior Nasoseptal Flap - Double Breasting Technique.

BACKGROUND AND INTRODUCTION: The success of endoscopic skull base surgery is largely based on the effective repair of the skull base defect. A pedicled nasoseptal flap (NSF), described by Hadad-Bassagateguy is the workhorse of contemporary endoscopic skull base repair. We describe a modification in the technique, "double breasting technique," using the bilateral posterior NSF for skull base repair. OBJECTIVE: In this video article, we describe the technique of harvesting bilateral posterior nasal septal flaps and overlaying the flaps in a double breasting technique to cover the skull base defect. The posterior NSF can be used to cover medium to large skull base defects effectively. SURGICAL TECHNIQUE: A 40-year-old female patient presented with headache and decreased vision for 2 months. MRI with gadolinium showed a sellar suprasellar lesion with chiasmal compression. Visual field charting showed bitemporal hemianopia. She underwent endoscopic transnasal transsphenoidal surgery (binostril approach) and complete excision of tumor. Intraoperatively, there was evidence of arachnoid breach with high flow cerebrospinal fluid (CSF) leak. Sella was repaired with fat, fascia, fibrin glue, and overlaid with the bilateral posterior NSF in a double breasting technique, as described in the video. RESULTS: The skull base repair was successful, with no CSF leak postoperatively.

Serum Adenosine Deaminase Levels and Human Papillomavirus as Prognostic and Predictive Factors for Laryngeal and Pharyngeal Carcinomas.

Head and neck cancer is one of the most common cancers in the world, accounting for up to 30-40% malignancies in India. Research is always on the lookout for parameters that help in early diagnosis of such disease and to explore the possibility of discovering such parameters that would assist in management of the disease by its potential to predict and prognosticate the disease. To estimate serum ADA levels and to correlate with response to therapy and also to correlate between different clinical stages and serum ADA levels and to correlate HPV status to response to therapy. A prospective cohort study. 30 patients who were diagnosed with squamous cell carcinoma of the oropharynx, hypopharynx and larynx were considered in this study. The pre and post treatment values of serum ADA was estimated in these patients and the tumour was assessed for HPV status. The difference in the in the serum ADA levels before and after treatment was 9.982 which was statistically significant with a p value of < 0.001. HPV positive status and response to therapy in the form of recurrence shows a p value of 0.485 which is not statistically significant. Serum ADA level can be used as a parameter to assess the severity of the disease and the response to treatment in cases of carcinoma of the oropharynx, hypopharynx and larynx. HPV status of the disease has its limitation in prediction and prognosis of the disease.

Tympanoplasty with and without cortical mastoidectomy - a comparative study.

Perfimttion of the tympanic membrane is nature's may of maintaining the middle far vntilation under the pressure of inflammatory process in the tempanomastoid cleft. An attempt at reconstruction with the possibility of infection lurking in and around the mastoid air cells may seem futile. Vow the quntinn arises as to whether a cortical Mastoidectomy is essential before an attempt at reconstruction is made. Our experience with one hundred and twenty patients is presented here. Our study shovn that conicul mastoidectomy does not signifieantly improve the results in well-selected ears.

Unusual cases of foreign bodies in air passage in children.

Tracheobronchial foreign bodies when not treated promptly continue to be a source of morbidity and mortality specially in the paediatric population. Chevaliar Jackson, through meticulous analysis of mechanical problems related to foreign bodies in the air and food passages and their solution, created a science of rehearsed and tested instrumental techniques for their extraction (Jackson and Jackson, 1936). They developed instruments to achieve remarkable results with an almost unbelievably low morbidity and mortality.Aspiration of foreign bodies is seen more commonly in the paediatric age group and nearly 94% of them occur in infants and children (Holinger and Holinger, 1978). According to Jackson, nearly 90% of these foreign body accidents are due to carelessness, and are therefore avoidable. We present two unusual cases of inorganic foreign bodies in the air passages in children with special reference to the problems encountered in their diagnosis and management.