Incidence of KOH Positive Elements in Chronic Discharging Ear -A Retrospective Study.

The term chronic suppurative otitis media (CSOM) refers to middle ear infections lasting more than three months that lead to perforated tympanic membrane. Low socioeconomic strata of the society are more likely to have the disease in developing countries. There have been many studies focusing on the bacterial flora of CSOM, but little is known about the mycological aspects, which have become increasingly important over the last few decades. The present study was aimed to speculate the presence of fungal flora responsible for the cases of CSOM among patients who attended the Ear, Nose, and Throat Department of our hospital a tertiary care center. This retrospective study was conducted in a tertiary care centre after taking the approval of the protocol review committee and institutional ethics committee. Total 100 Patients of chronic otitis media were included with no history using ear drops for last one week and using two sterile swab without touching the external auditory canal, discharge was taken from middle ear and placed in sterile container and sent for potassium hydroxide (KOH) mount and observed. The age ranged from 18 months to 87 years and the mean age was 37.27+/- 12.59 years. The study population of male is 42 (41.6%) and female is 59 (58.4%). Distribution of KOH positivity observed for 33 (32.7%) and KOH negative for the study population of 68 (67.3%). When antibacterial treatment does not seem to relieve persistent otorrhea, otologists should suspect mycotic otitis media probable cause.

Histomorphological Study of Thyroidectomy Specimens in Tertiary Care Hospital -A Retrospective Study.

Thyroid disorders are the most common endocrine disorder affecting the general population. Diseases of the thyroid glands present with either an alteration of hormone secretion or as an enlargement of the thyroid gland. They vary from non-neoplastic to neoplastic lesions. The prevalence and pattern of these disorders depend on the factors like age, sex and geographic patterns. The aim of the study is to determine the histomorphological features of thyroid lesions in thyroidectomy specimens in patients who underwent thyroidectomy in tertiary care hospital. This is a retrospective study, conducted in tertiary care centre attached to government hospital. All thyroidectomy specimens received in the Department of Pathology, from January 2021 to January 2023 were included in the study. The patients who underwent thyroidectomy in view of thyroid swelling, over a period of 2 years, were selected. Data was collected from histopathological examinations done on the thyroidectomy specimens. Different histomorphological patterns were observed on microscopy. The thyroid lesions were classified into Neoplastic and Non-neoplastic based on histomorphological features and the data was segregated according to this and analysed. There was a total of 194 specimens, of which 175 were from female and 19 were from male patients. Maximum number of thyroid lesions were seen in the age group of 30-50 years. Among 194 patients, 52 (26.8%) were found to have neoplastic lesions, of whom, 25 (12.8%) patients had benign and 27(14%) patients had malignant lesion. 141(72.7%) patients had non neoplastic conditions. One patient had lymphoproliferative disorder (0.5%). In Neoplastic lesions, Among Benign lesions, Follicular adenoma was found be present in 25 patients. In malignant lesions, Papillary carcinoma was the most commonly found lesion (25 cases, 12.9%). 141(73%) patients had Non neoplastic conditions. Most commonly occurring Non neoplastic lesions were Nodular goiter (50 cases, 25.8%) followed by Colloid goiter (34cases, 17.5%), Multinodular goiter (33 cases, 17%), Hashimoto's thyroiditis (5 cases, 2.6%). Followed by Chronic lymphocytic thyroiditis (4 cases, 2.1%). The frequency of carcinoma is more common in females amongst the total thyroid lesions. Papillary carcinoma was the most frequent malignancy (12.9%) among the thyroidectomy specimens. Papillary carcinoma was the commonest malignant lesion with female preponderance whereas, nodular goiter and colloid goiter were the commonest non neoplastic lesions with female preponderance.

Comparative Case Study of Efficacy of Oral Bilastine Monotherapy to Concomittant Administration of Oral Bilastine with Probiotic in Patients with Allergic Rhinitis.

Introduction: Allergic rhinitis continues to pose a global burden in both adult and paediatric population and requires adequate medical therapy to avoid long term complications making it a challenging concern. This prompts the need to find a suitable and appropriate treatment regimen for this condition. Aim: To study the clinical efficacy of Oral Bilastine and Probiotics in patients with allergic rhinitis. To compare the effectiveness of Bilastine monotherapy to Oral Bilastine combined with Probiotics in patients with allergic rhinitis. Materials and Methods: Total of 100 patients were selected and randomized into two groups- Group 1 and Group 2 and were treated with Oral Bilastine 20 mg OD and Oral Bilastine 20 mg with Oral Probiotics OD (Lactobacillus fermentum & L. paracasei - 4 billion cells) respectively to maintain uniformity. Baseline scoring and follow up scoring after 6 weeks was done using the Total symptom score, Absolute eosinophil count and Nasal smear eosinophil count and were evaluated and documented as per their response to treatment. Results: A significant reduction was observed in the severity of symptoms especially nasal obstruction, sneezing in patients of both groups along with extra nasal symptoms, with average mean score in Group 1 being 7.72 before treatment that reduced to 3.66 and that of Group 2 from 9.32 to 5.02. The mean score of Group 2 was greater in both before and after treatment which is highly significant. (p < 0.001). Conclusion: Monotherapy with Oral Bilastine has proven in relieving allergic symptoms. Addition of Oral Probiotics along with Bilastine has shown to have synergistic effect in further improving overall symptoms in allergic rhinitis.

Relationship Between Rhinitis, Nasal Obstruction and Hypothyroidism: A Follow Up Study with Pre-post Treatment with Levothyroxine.

Hypothyroidism is the most common form of thyroid disorder in India, while, Rhinitis and Nasal obstruction are frequent complaints treated on regular basis in ENT OPD. Studies show that there is relationship between Rhinitis and Nasal obstruction with hypothyroidism. To assess the improvement in symptoms associated with Rhinitis and nasal obstruction in patients with hypothyroidism after treating with levothyroxine. 50 patients presenting in ENT OPD with rhinitis and nasal obstruction and diagnosed with hypothyroidism were selected. Complete history was taken and clinical examination was performed, Nasal Obstruction Symptom Evaluation Score, (NOSE) and Peak nasal inspiratory flow rate (PNIF) were noted. Biochemically proven hypothyroid patients were treated with adequate dosage of Levothyroxine. The patients were followed up and the above-mentioned tests were repeated at regular intervals (1 month and 3 month), Changes in these readings were recorded and maintained. Significant difference was found in TSH level, NOSE questionnaire, and PNIF reading in patients with hypothyroidism after treatment with levothyroxine (P value < 0.001). This was most commonly noted to occur in young and middle-aged population of age 15 years to 50 years (88%). In our study - An attempt was made to correlate the symptomatology with hypothyroidism. Treatment with levothyroxine in patients with rhinitis, nasal obstruction and biochemically proven hypothyroidism was found to be effective in improvement of symptoms. It was found that there is significant association between hypothyroid status and rhinitis with nasal obstruction.

Thyroidectomy Under Regional Anaesthesia: An ORL Perspective.

BACKGROUND: The use of regional anaesthesia as an effective alternative to general anaesthesia in thyroid surgeries is now being accepted in many parts of the world. In this day of computers and technology, there is an increased awareness among the people of the available options of anaesthesia and the adverse effects of general anaesthesia. They thus have an inclination to avoid general anaesthesia wherever feasible. This study dwells on the use of regional anaesthesia as an alternative tool that can be offered to the patients undergoing thyroidectomy. AIMS: This study aims at analysing the effectiveness, safety, ease and patient acceptability of performing thyroidectomies under regional anaesthesia. SETTINGS AND DESIGN: This prospective study was performed at a university - affiliated hospital. MATERIALS AND METHODS: Twenty nine patients who underwent thyroidectomy for benign thyroid diseases under regional anaesthesia were included in this study: 20 patients under deep cervical plexus block and 9 patients under cervical epidural anaesthesia. STATISTICAL ANALYSIS USED: Z-test and validity test. RESULTS: In our study, all the 29 patients who underwent thyroidectomy under regional anaesthesia found the anaesthesia effective and were comfortable throughout the procedure. The surgeon too was at ease while performing the surgery. No complications were recorded. CONCLUSION: In our present study, regional anaesthesia (Cervical epidural anaesthesia and Cervical plexus block) has been used safely and effectively in 29 thyroid surgeries. We conclude that although regional anaesthesia has been reserved for high risk thyroidectomies it may be offered as effective alternative to general anaesthesia even in routine thyroid surgeries.

Intrathyroid Injection of Steroid in Benign Thyroid Swellings.

INTRODUCTION: Benign thyroid swelling disorders are common conditions, frequently encountered in clinical practice. Though medical management has been useful in treating the hormonal variations, it has not been very significant in reducing the size of the swelling. OBJECTIVE: To study the efficacy of intra thyroid injection of triamcinolone in benign thyroid swelling disorders. MATERIALS AND METHODS: A total of 20 patients were selected for this study. All the patients with thyroid swellings, were evaluated with history and clinical examination followed by routine blood investigations, thyroid function tests (T3,T4,TSH), Fine Needle Aspiration Cytology (FNAC) and Ultrasonography (USG) of the neck. The treatment adopted in this study was intrathyroid injection of triamcinolone acetonide. RESULTS: In this study there were 20 patients, all were females in the age group of 17- 55 years. Four patients did not come for regular follow up, and hence were excluded. Sixteen patients were followed up regularly. Thirteen (81.25 %) patients showed excellent results with no visible swelling, confirmed sonologically. Two patients (12.5%) showed fair results with residual swellings, and one patient did not show any reduction in size of the swelling. CONCLUSION: Intrathyroid injection of triamcinolone acetonide is a safe, minimally invasive technique in reducing the size of benign thyroid swellings with minimal or no side effects.

Preoperative Preparation with Lugol's Iodine in Thyroidectomy of Euthyroid Patients-Is it Really Mandatory?-An Otorhinolaryngologist's View.

OBJECTIVE: To elucidate the necessity of Lugol's iodine in preoperative preparation of patients undergoing thyroidectomy. MATERIALS AND METHODS: Hundred and five euthyroid patients who underwent surgery without preoperative preparation of patients with Lugol's iodine were enrolled in this retrospective study conducted during the period May 2009 to August 2013 in Teaching Hospital. Indication of surgery was ranging from suspected malignancy to cosmetic reasons and compressive features like dysphagia , dyspnoea and hoarseness of voice. RESULTS: All patients were operated by the same surgeon where in hemi, total and subtotal thyroidectomies were performed without any usage of Lugol's iodine preoperatively. During the postoperative period the following events occurred, five patients (4.7%) had incurred recurrent laryngeal nerve palsy (RLNP) which was confirmed with postoperative indirect laryngoscopic examination and two patients (1.9%) with hypocalcemia (serum calcium less than 8mg/dl) which was managed conservatively and effectively. Among these five patients, three patients had (Right RLNP) and two patients had (Left RLNP) palsies. Of these four RLNP (3.8%) were temporary which improved with conservative management within 3weeks-6months duration and one (0.9%) was a permanent Rt RLNP with no improvement even after six months. CONCLUSION: Hence, we conclude that it is not of much importance to use Lugol's iodine preoperatively in patients undergoing thyroidectomy. There does not appear any convincing evidence of advantages of preoperative preparation of patients with lugol's iodine in euthyroid state undergoing surgery.

Topical vs Combination Ciprofloxacin in the Management of Discharging Chronic Suppurative Otitis Media.

OBJECTIVES: To study the microbial flora and determine the efficacy of topical ciprofloxacin ear drops in comparison with combination of topical and oral ciprofloxacin as first line management in patients diagnosed with chronic suppurative otitis media. MATERIALS AND METHODS: Prospective randomized interventional clinical trial on 100 patients who presented with an acute episode of CSOM to our outpatient department. RESULTS: In our study, topical ciprofloxacin therapy was found to be an effective treatment for an acute on chronic otitis media as was the combination therapy though the overall recurrence rate was found to be more in the former group. CONCLUSION: In the absence of systemic infection or serious underlying disease, topical antibiotics alone constitute first line treatment for most patients with chronic suppurative otitis media, finding no evidence that systemic antibiotics alone or in combination with topical preparations improve treatment outcomes compared with topical antibiotics alone.