Effect of Combined HAART Plus ATT in Patients of Extrapulmonary Tuberculosis in HIV Patients and Effect on Quality of Life.

HIV is a disease which reduces human resistant to fight. When our immunity becomes so weak that we are not able to fight even the common commensals of our body, this leads to what is called as an opportunistic infection. Tuberculosis is one of those most common type of opportunistic infection and in this pulmonary tuberculosis is more common. Extrapulmonary tuberculosis with HIV is the area of lesser research. In this study we tried to prove the Prevalence of extrapulmonary tuberculosis in AIDS patients and also the effect of combined HAART and ATT on prevalence of extrapulmonary tuberculosis and also its effect on Quality of life of the patient. This is a retrospective study conducted in a tertiary centre in the Department of Otorhinolaryngology & head and neck surgery from January 2020 to December 2020. A total of 80 patients were studied for 1 year. Confirmed cases of AIDS with extra pulmonary tuberculosis in head and neck region were studied, keeping all ethical issues in mind and after complete treatment of ATT along with HAART. After treatment, a significant number of patients got resolved with EPTB and gave positive response on their quality of life. Not only pulmonary tuberculosis, extrapulmonary tuberculosis with HIV is on the rise nowadays. Combined treatment of both can help in decreasing prevalence of extrapulmonary tuberculosis and improves quality of life.

Novel Use of Tracheostomy Shield for Emergency Tracheostomy in Covid 19 Era.

To evaluate the problems in doing emergency tracheostomy and tracheostomy care of patients with unknown COVID-19 status. Study the usefulness of the specially designed Tracheostomy Shield. A prospective hospital-based study was conducted at a tertiary care center in India treating COVID and Non COVID patients. The study was done from April 2020 to December 2020. A total of 80 tracheostomy were done using Tracheostomy shield. Open tracheostomies were 38 while 42 patients were already intubated (closed circuit). The Tracheostomy shield was also used in 380 tracheostomy tubes changes. Two patients were found COVID positive on RT-PCR after tracheostomy. There was no scope for testing all tube changes with RT-PCR. The use of our indigenously designed Tracheostomy shield has been effective in reducing the aerosol spread and there was no COVID transmission reported. The use of patient Tracheostomy shield is of uttermost importance in reducing the respiratory droplets splashing on to the surgeon and assistant while doing awake tracheostomy. It is extremely useful while changing tubes as there are chances of false negatives antigen test which might be miss leading. The use of Tracheostomy shield is very important in the current context of new and fast evolving respiratory infections.

Utility of Optical Forceps and Tracheotomy for Tracheobronchal Foreign Body.

Tracheobronchial foreign body is a life-threatening situation where quick decisions need to be taken. The preparedness for the same can never be over emphasized. This study was undertaken to understand the preference and utility of various types of foreign body forceps. This is a retrospective study in a tertiary care center. Data over 5 years (2016-2021) was analyzed to understand the utility of the optical forceps and the conventional (standard) forceps in the current scenario. The difficult cases where tracheotomy was done were also studied. Observations: 109 bronchoscopies were done during this period. In 90 patients optical forceps was used, flexible fiberoptic bronchoscope was used in 10 situations to locate and confirm the foreign body (FB) before extraction with standard or optical forceps. In 2 adult patients flexible fiber optic bronchoscope with forceps was used to extract, peripheral lying FB (pin). Standard (conventional) forceps with size 3 bronchoscope was used in 13 patients who were below 1 year. There were 2 postoperative mortalities. Tracheotomy was done in 6 patients, 4 were repaired primarily and in 2 tracheostomy tube was inserted. Conclusion: Optical forceps took care of 86% of foreign body. The Standard forceps have stood the test of time and are still useful. Having flexible fiberoptic in the armamentarium is a necessity now with newer challenges. Large swollen FB which cannot be extracted through glottis should be removed with tracheotomy rather than struggling at the glottis-sub glottis and have a complete obstruction. The optical forceps, standard forceps, ventilating rigid bronchoscope, flexible fiberoptic bronchoscope, Dormia basket, Fogarty's catheter are necessary in the armamentarium of an otolaryngologist and are not replaceable for one another.

Role of Otoacoustic Emission Test in Early Diagnosis of Hearing Impairment in Infants.

Hearing impairment is most common congenital dissorder and undiagnosed hearing loss can cause disorder in speech, language with delay in social and emotional developments. Early detection of Hearing Impairment in Infants and too access the relationship between selected risk factor and hearing loss. Neonates age upto 15 days randomly selected from pediatric and obstetrics and gynaecology department, born during this period were screened by OAE before their discharge from the hospital and after stabilizing high risk neonates. Informed consent of neonates parent/guardian was obtained before babies were subjected to OAE. A total of 400 neonates were screened for hearing loss by otoacoustic emission. Out of that 18 (4.5%) neonates failed the test in initial screening and were asked for follow up screening. Two neonates were lost to follow up. Out of 16 neonates, 2 (12.5%) neonate failed the test on follow up screening by otoacoustic emission and was referred for BERA. Neonates were classified as low and high risk basis of risk factors present. Out of 76 neonates having high risk of hearing loss, 16 failed the test. Similarly out of 324 neonates with low risk of hearing loss, only one neonate failed the test. Chi square analysis has revealed highly significant results (p < 0.001). Late identification of hearing loss presents a significant public health concern. However, without screening, children with hearing loss are usually not identified until 2 years of age, which results in significant delays in voice communication, language communication, social, cognitive, and emotional development. In contrast, early recognition, and intervention prior to 3 months of historic period has a significant positive impact on development.

Dilemmas in Current Management of Complicated Chronic Otitis Media.

To evaluate the distribution of complications of chronic otitis media, dilemma of how soon to operate a seriously ill patient with CSOM and treatment outcomes. A retrospective study was done in a tertiary care centre. Clinical data from 2013 to 2015 was compiled, surgical management with outcome was analysed. A total of 425 patients with chronic otitis media were evaluated. Single/multiple complications were seen in 147 (34.5%) patients. Majority of the complications were seen in active squamosal type of chronic otitis media i.e. 137 (59.5%) cases out of the 147. Meningitis (3.3%) was the most common intracranial complication. Patients with intracranial complications were referred from other departments and did not primarily present to ENT, indicating a major fact that treatment was sort for the complication and not for chronic otitis media. Headache with or without ear discharge was the most common presenting complaint. Fever and pain were not prominent indicators of complications, posing a diagnostic dilemma as patients were already receiving antibiotics and analgesics before reaching tertiary care centre. The patients with severe intracranial complications were promptly taken up (within 3-5 days) for canal wall down mastoidectomy with intravenous broad spectrum antibiotic (vancomycin) and mannitol with high risk consent. However ill the patients were, especially children with very poor general conditions, there was dramatic recovery as soon as the mastoidectomy was done. There were no deaths due to the complications of chronic otitis media in our 3 years study period. Delay in resorting to surgical management of chronic otitis media was the main reason for patients going into complications. Timely mastoidectomy in patients with poor general condition with high risk of mortality, the surgery actually had a major role in reducing the morbidity and mortality. Lack of awareness that chronic otitis media is a condition that can lead to life threatening complications resulted in procrastination of surgery. Chronic otitis media requires speedy surgical management i.e. as soon as patient is fit to tolerate anaesthesia: Tympanoplasty and Canal wall up or down Mastoidectomy to prevent complications from arising or to resolve the present complication.

Alteration of Serum Lipid in Oral Sub Mucous Fibrosis in Central India.

Oral sub mucous fibrosis is the most common precancerous lesion in India. Lipids are the major cell membrane components essential for various biological function including cell growth and division for the maintenance of cell integrity of normal and malignant tissue. Low levels of lipids serves as a marker and prognostic indicator in the early detection of oral precancerous and cancerous states. In spite of high prevalence and its potential to undergo malignant transformation, this condition has not widely been investigated with respect to serum lipid levels. In present study an attempt is made to analyze the complete serum profile, total cholesterol, triglycerides, high density lipoprotein. Low density lipoprotein, and very low density lipoprotein in oral precancerous lesion and control. Study was conducted in 30 clinically and histopathologically diagnosed cases of premalignant lesion and 30 age and sex match controls. The complete lipid profile including TC, TG, HDL, LDL, and VLDL was analyzed. Serum lipid levels were significantly lower in patients with oral lesion than in controls. From the finding it appears that the decreases in the lipid levels may be considered as useful marker in the early diagnosis of oral premalignant lesion.

Innovative Use of Insulated Microear Ball Probe Cautery in Creation of Nasal Mucosal Flap in EnDCR.

To study the outcome and complications of endoscopic endonasal dacryocystrhinostomy without stenting. Randomised prospective observational design. Tertiary academic centre. Seventy patients, clinically diagnosed as chronic dacryocystitis with nasolacrimal duct obstruction on the basis of syringing, were enrolled. Endoscopy was done for nasal pathology especially mucosal disease, hypertrophied turbinate, DNS. Seventy-eight eyes were operated with endoscopic-dacryocystorhinostomy along with additional surgeries and periodically followed up on OPD-basis at the end of 1st week, 2nd week, 1st month and 3rd month and evaluated clinically and by syringing (Ophthalmologist) and endoscopy done, wherever required. Insulated microear ball probe cautery was used to create nasal mucosal flap in all cases. Eleven patients underwent septal surgery along with one concha bullosa and one agger nasi removal (p < 0.05). Nil intraoperative complications (p < 0.05) and single postoperative complication noted (p < 0.05). Functional and anatomical patency found to be 100% at the end of 1st week, 98.7% at the end of 2nd week, 93.6% at end of 1st month and 91% at end of 3rd month. Nasal endoscopy showed restenosis in 1 patient at end of 2nd week, 4 patients at end of 1st month, 1 patient at the end of 3rd month along with granulation in 1 patient at the end of 3rd month. Revision surgery was done on 2 patients. Endoscopic dacryocystorhinostomy is safe and successful procedure for chronic dacryocystitis, due to nasolacrimal duct obstruction with less complications without stenting. The associated intranasal pathology, which might be the cause, can be corrected and bilateral dacryocystorhinostomy can be performed in single sitting reducing patient's morbidity and hospital stay. Use of cautery with insulated ball probe for making nasal mucosal flaps gives an precise and excellent blood less field.

Presentations and Challenges in Tuberculosis of Head and Neck Region.

(1) To study the different patterns of presentations of tuberculosis in Head and Neck region. (2) To know the importance and reliability of ESR and Mantoux test as an aid in diagnosis of tuberculosis. This study was conducted at Department of ENT and Head and Neck Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh from January 2014 to June 2015. Patients presenting with lesions in the Head and Neck region suspected of tuberculosis were subjected for cytological and histological investigations. Those cases confirmed to be tuberculosis on the basis of either of these tests were included in the study. Study comprised of 113 proven cases of tuberculosis of Head and Neck region. A female preponderance of 1:1.97 (M:F) ratio was noted. Most commonly involved structure was cervical lymph node (92.92 %) followed by larynx, skin and oral mucosa (1.76 %). It was also noted that Mantoux test was positive in 93.8 % of patients and ESR was >30 mm (first hour) in 95.5 % of patients with tuberculosis. Most common presentation of Tuberculosis in Head and Neck area was cervical lymphadenopathy. In a developing country like India the population is mostly in the lower socioeconomic strata. Access to various modern investigations is limited and diagnosis is challenging. Here ESR and Mantoux test are helpful in purusing the case for further evaluation. Based on these pointers cytologically negative cases can be taken up for biopsy.

Changing Trends of HIV/AIDS in Otorhinolaryngology with CD4 (+) Count Correlation.

Human immunodeficiency virus (HIV) affects the vital cells of the immune system eventually leading to a fall in the cell mediated immunity. As the disease progresses CD4 (+) (cluster of differentiation4) cells reduce, therefore is a good indicator of the ongoing disease process [1]. HIV infection has myriads of disease presentation; the aim of our study was to correlate the otorhinolaryngological manifestations with the CD4 (+) counts. A clinical study, of 100 HIV positive patients was done from 2008 to 2011. A clinical evaluation revealed 76 % incidence of otorhinolaryngological findings. Oropharyngeal manifestations were the commonest, seen in 48 %, predominantly oropharyngeal candidiasis. Neck nodes were found in 20 % of the patients. 31 % had otological manifestations of which retracted tympanic membrane (eustachian tube dysfunction) was the commonest. 18 % had nasal symptoms of which rhinosinusitis was the commonest being 14 %. The mean CD4 (+) count was below 200 in patients who presented with oropharyngeal candidiasis, otitis externa and epistaxis. With the use and availability of HAART (Highly active antiretroviral therapy) more and more patients with higher CD4 (+) count are presenting with a different spectrum of more subtle disease manifestations, with lower incidence of the classical diseases like candidiasis. A routine otorhinolaryngological evaluation at every visit with high index of suspicion can help in better disease control and give a better quality of life.