Angiolymphoid Hyperplasia of the Orbit: A Rare Case Report and Review of the Literature.

Background: Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare vascular tumour of the skin which mainly involves the head and neck regions. Case Report: A 41 year old male presented to the ENT outpatient department with a swelling in the anterosuperomedial aspect of right orbital rim since two year. Following a contrast enhanced CT of the Head, complete surgical excision was done and diagnosis of ALHE was confirmed by histopathology. Methodology: We performed a systematic review of the literature following the preferred reporting items for Systematic reviews. Literature searches were conducted in web based search engines using MeSH terms and key words. We found seven publications that fit the inclusion criteria which included case reports and case series. Conclusion: ALHE involving the orbit has been very rarely reported and is a challenging diagnosis. Complete surgical excision is the treatment of choice and recurrence can occur with incomplete removal.

Microbiology of Active Mucosal Chronic Otitis Media and Shifting Trends in Etiology in Idukki, Kerala: A Prospective Observational Study.

INTRODUCTION: Active mucosal Chronic Otitis Media (COM) is an important cause of preventable hearing loss particularly in the developing world and may have long term effects on early communication, language development, school performance and social interaction. AIM: This study aimed to isolate the bacterial flora in the middle ear of patients suffering from active mucosal COM in Idukki district of Kerala and also to study the antibiotic sensitivity pattern of these organisms to commonly used antimicrobial agents. METHODS: This was a clinical prospective observational study conducted over a period of 3 years involving 137 patients of all age groups, who were clinically diagnosed with active mucosal COM. The inclusion criteria were patients presenting with a central tympanic membrane perforation and ear discharge (either unilateral or bilateral) of more than 3 months duration. RESULTS: Microbial growth was seen in 128 (94.1%) patients with aerobic bacteria (83.5%), anaerobic bacteria (6.25%) and fungi (7%), of which Pseudomonas aeruginosa (39.8%) and Staphylococcus aureus (31.2%) were the most predominant etiological agents for active mucosal COM. Pseudomonas aeruginosa showed highest susceptibility to Piperacillin-Tazobactam combination and highest resistance to Ampicillin, while Staphylococcus aureus showed highest susceptibility to Gentamicin and highest resistance to Ampicillin and Ceftriaxone. CONCLUSION: The increasing trends in the antibiotic resistance pattern in Staphylococcus aureus over the years poses a threat to Idukki district, Kerala. Due to the irrational use of antimicrobials, multi-drug resistant bacterial strains are frequent, and so, there is need for continuous surveillance of the local microbiological profile of active mucosal COM.

A Comparative Study of Treatment Outcomes of Music Therapy, Tinnitus Maskers and Pharmacotherpy in Chronic Subjective Tinnitus.

Tinnitus represents one of the most common and distressing otologic problems, and it causes various somatic and psychological disorders that interfere with the quality of life. This study aimed to compare the outcome of music therapy, tinnitus maskers and pharmacotherapy on patients with chronic tinnitus, to observe and analyse the etiological factors of tinnitus and to find out whether music can be used as an active listening mode by which tinnitus perception can be decreased. This was a comparative longitudinal study involving 90 patients with chronic tinnitus who were randomly assigned to 3 groups of 30 each: Group A (Music therapy), Group B (Pharmacotherapy) and Group C (Tinnitus masker). After a detailed clinical history and examination, Tinnitus Handicap Inventory and Visual Analogue Scores were recorded both prior to and following therapy, and patient were followed up monthly up to 2 months. There is a significant difference in the mean THI score (p = 0.002) and mean VAS(p = 0.0006) at 2 months follow up in patients treated with Music therapy and patients had a satisfactory outcome after music therapy and did not require any further treatment. Patients in pharmacotherapy and hearing aid group had a good clinical improvement but mean THI and mean VAS score was not statically significant. It was also noticed that loud noise exposure and hypertension were main etiological factors in 37.77% and 26% of patients respectively. Music therapy appears to be an effective and cost-efficient mode of therapy for chronic tinnitus and could be suitable for widespread implementation for patients with tinnitus of varying severity. Pharmacotherapy and hearing aid application in the treatment of tinnitus has good outcome in our study but requires long term treatment and follow up.

Design and Implementation of Competency Based Postgraduate Medical Education in Otorhinolaryngology: The Pilot Experience in India.

The worldwide call for a shift towards competency based postgraduate medical education has until recently gone largely unheeded in India, despite the Medical Council of India enshrining the principle in its regulations for postgraduate institutions. This paper details the first concrete attempt at establishing a CBME curriculum in Otorhinolaryngology in India. The design and implementation of the CBME curriculum was carried out in four phases, in a time-bound manner over a period of 6 months. Phase I consisted of an extensive literature review and a clarification of the major objectives of the program. Phase II involved the listing out of 20-30 entrustable professional activities (EPAs) for each specialty and the 13 core EPAs common to all incoming residents and the subsequent mapping of these EPAs to their respective domains of competence and year-wise levels of competence. This was followed by the development of milestones for each EPA and appropriate clinical vignettes. Phase III focused on development of 360° assessment strategies, including the in-house development of an e-portfolio. Phase IV was dedicated to the implementation of the CBME curriculum, and involved various sensitization and orientation programs for faculty and the new residents. This exercise in designing and implementing a CBME program showed the important role that intra-departmental and inter-institutional cross-communication and exchange of ideas vies-a-vie workshops and personal communication play in bridging the lapses in knowledge in this emerging area, reaching consensus to achieve project goals and for finding relevant solutions to common problems. Medical education in India presents its own peculiar set of logistical and cultural challenges. Keeping in line with the recommendations of the Medical Council of India regarding Postgraduate Medical Education, it is essential that medical colleges in India not fall behind the international paradigm shift towards CBME.

A Retrospective Epidemiological Study of Rhinosporidiosis in a Rural Tertiary Care Centre in Pondicherry.

INTRODUCTION: Rhinosporidiosis is an age old endemic scourge which has affected various parts of the world, most notably India and Sri Lanka. Although a large body of literature exists regarding this problem, postoperative recurrence rates continue to vary, and the effect of public health education in the eradication of this disease has not been taken into account. AIM: The aim of this study was to find out the site, presentation and postoperative recurrence rate in patients with rhinosporidiosis. MATERIALS AND METHODS: This was a retrospective study involving operated cases of rhinosporidiosis in the Department of Ear, Nose and Throat of a rural tertiary care referral centre over a period of 3 years. The behavioural pattern of the disease, its epidemiology, rate of recurrence and outcomes of surgical management were analysed. RESULTS: A statistically significant correlation could be found between male gender and rural residential status and incidence of rhinosporidiosis. Bathing in rivers and ponds were found to be strongly associated with rhinosporidiosis (p=0.005). Almost all patients were found to be of low socioeconomic status. Nasal obstruction and epistaxis were the most common presenting complaints. CONCLUSION: Rhinosporidiosis is strongly associated with male gender, young and middle aged adults, agricultural occupations, rural residential status, a history of bathing in ponds and rivers and a low socioeconomic status. Post-surgical recurrence of rhinosporidial masses can be avoided with careful and complete clearance of the mass and cauterization of the base. Appropriate and consistent public health education helps to reduce the incidence of rhinosporidiosis in endemic communities.