Endoscopic Versus Microscopic Stapedotomy: Our Experience.

With technological improvements leading to enhanced image resolution, as well as recognized acceptance of endoscopes within the field of rhinology, there has been greater implementation of endoscopes in otologic and neurotologic procedures. Surgeons now use endoscopes for a wide range of otological procedure, one such procedure is endoscopic stapedotomy for otosclerosis. This study is done to compare merits and demerits of endoscopic stapedotomy with microscopic stapedotomy. This is a prospective observational study conducted in SMBT Medical College and Hospital, Nashik from January 2018 to January 2020. 40 patients who presented to ENT OPD with clinical features suggestive of otosclerosis and who fulfilled inclusion and exclusion criteria were included in the study. Detailed history, complete ENT examination and audiological investigations were done. Preanesthetic evaluation was done and patients were randomly allotted into two groups. Group A: consisted of twenty patients who underwent microscopic stapedotomy under local anesthesia Group B: consisted of twenty patients who underwent endoscopic stapedotomy under local anesthesia. Data was collected in pre-structured proforma and analyzed. There was no statistically significant difference between microscopic and endoscopic procedure in terms of duration of the surgery, hearing improvements or complications. However, surgeons noted that ease of visualization of middle ear structures and the better image quality favors endoscopic procedure over microscopic procedure. There is no increased risk of complications with endoscopic stapedotomy and hearing improvement is same as that of microscopic stapedotomy however the ease of visualization of middle ear structures and the better image quality favors endoscopic procedure over microscopic procedure. Hence, we conclude that endoscopic stapedotomy is a safe alternative to microscopic stapedotomy.

Alterations in Smell During Pregnancy: Myth or Fact?

To compare the olfactory functions of pregnant and non pregnant females draining the tribal tertiary care centre. Odor identification (OI), odor discrimination (OD) and odor threshold (OT) in subjects and control group with no previous Sino-nasal symptoms or pathology were included in the study. Mean scores of all the parameters were calculated in both the groups. Group A being of 60 pregnant females in 1st trimester and Group B constituted 60 non pregnant females as control group. Both the groups were matched for Age and Normal Mucociliary clearance range. Modified Indian Smell Identification Kit was used to assess all parameters. Before doing objective olfactory assessment all the study participants were given questionnaire for subjective assessment of olfaction in which we found significant impairment in drinking beverage and fragrance perception of flowers in pregnant females compared to non pregnant females. We also found there was no significant difference in mean scores of various olfactory parameters in multigravida and non pregnant females. The mean OI score in both groups was 9.54 ± 1.87 and 8.70 ± 1.62 respectively. Mean OD score of the two groups was 8.80 ± 2.61 and 9.80 ± 2.61 respectively and the mean OT score of both the groups was 6.99 ± 4.63 and 4.13 ± 2.48 respectively.

Association of six-minute walk distance with subsequent lower extremity events in peripheral artery disease.

The prognostic significance of the six-minute walk distance for lower extremity events in people with peripheral artery disease (PAD) is unknown. This longitudinal study assessed whether a poorer six-minute walk distance at baseline was associated with higher rates of subsequent lower extremity atherosclerotic disease events in PAD. A total of 369 patients (mean age 69.4 ± 10.0 years; mean ankle-brachial index (ABI) 0.67 ± 0.17; 31% women; 30% black individuals) from Chicago-area medical centers with PAD were enrolled. Participants underwent baseline six-minute walk testing and returned for annual study visits. Lower extremity events consisted of one or more of the following: ABI decline greater than 15% or medical record adjudicated lower extremity revascularization, critical limb ischemia, or amputation. At a mean follow-up of 33.3 months, lower extremity events occurred in 66/123 (53.7%) people in the first (worst) tertile of six-minute walk performance, 55/124 (44.4%) in the second tertile, and 56/122 (45.9%) in the third (best) tertile. After adjusting for age, sex, race, ABI, comorbidities, and other confounders, participants in the first (worst) tertile of six-minute walk distance at baseline had higher rates of lower extremity events during follow-up, compared to those in the best tertile at baseline (HR = 1.74, 95% CI 1.17-2.60, p = 0.0067). Among people with PAD, a poorer six-minute walk distance was associated with higher rates of subsequent lower extremity PAD-related events after adjusting for confounders. Further study is needed to determine whether interventions that improve six-minute walk distance can reduce lower extremity adverse events in people with PAD.