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Objective: To study unusual presentations of coronavirus-associated mucormycosis that are rarely seen in sinonasal mucormycosis cases. Method: The data of 400 rhino-orbito-cerebral mucormycosis patients admitted to Sawai Man Singh Hospital, Jaipur, from May 2021 to June 2021, were retrospectively collected. The diagnosis of mucormycosis was made by histological examination of biopsy samples. Results: Out of 400 patients, 62 had symptoms other than common symptoms of rhino-orbito-cerebral mucormycosis. Thirty-four patients had facial palsy, 19 complained of gum ulcers, 6 developed a cheek abscess, 2 complained of maggots in the nose along with common rhino-orbito-cerebral mucormycosis symptoms, and 1 had a cerebellar infarct. Conclusion: Mucormycosis is a disease with various presentations, and coronavirus-associated mucormycosis has added unusual presentations to the existing list of manifestations of rhino-orbito-cerebral mucormycosis. In this coronavirus disease era, mucormycosis should always be considered as a diagnosis in patients with these unusual presentations. [ABSTRACT FROM AUTHOR]

Objective: Rhino-orbito-cerebral mucormycosis is a rapidly progressive disease with high mortality rates of about 60 per cent. The increasing incidence of rhino-orbito-cerebral mucormycosis in coronavirus disease 2019 patients in India and worldwide has become a matter of concern owing to the case fatality rate. This study explored the use of low dose aspirin in decreasing the mortality rate of coronavirus disease 2019 associated mucormycosis. Method: This was a retrospective observational study. Patients suffering from post-coronavirus disease 2019 mucormycosis were included in the study. Each patient was treated with surgical debridement and systemic amphotericin B. Low dose aspirin was added, and mortality rates were compared with the patients who did not receive aspirin. Results: The demographic data and rhino-orbito-cerebral mucormycosis staging between the two groups were not significantly different. There was a statistically significant difference in mortality outcomes between the two groups (p = 0.029) and a 1.77 times higher risk of dying for patients not receiving aspirin. Kaplan–Meier survival indicated that patients receiving aspirin had better survival rates (p = 0.04). Conclusion: Low dose aspirin improves survival rates in coronavirus disease 2019 associated mucormycosis. [ABSTRACT FROM AUTHOR]

Objective: To determine the demographic, aetiopathological and diagnostic profiles of patients presenting with hoarseness to a laryngology unit of a tertiary care centre in India. Methods: A retrospective observational study was conducted. Results: The 1033 patients who presented with dysphonia showed a male predominance (70 per cent), high rates of malignancy (18 per cent), late presentation (mean, 24 months) and poor follow-up trends (53 per cent with 3 months' follow up), which contrasts with data from developed countries. The patient population hailed from different states in India and neighbouring countries around India, serving as a good sample for the subcontinent. The majority (67 per cent) were managed conservatively; however, surgical management was the preferred choice for those who presented with airway stenosis (91 per cent) and laryngeal trauma (75 per cent). Significant associations between vocal professionalism level and co-morbidities and dysphonia aetiopathologies are discussed. Conclusion: These findings give insight into the trends of hoarseness in the developing Indian subcontinent, which can aid understanding and management. [ABSTRACT FROM AUTHOR]

Objective:A possible role of the APC/beta-catenin pathway in the pathogenesis of sporadic juvenile nasopharyngeal angiofibroma has been suggested. This paper presents its current status and clinical association in our patients.Method:A prospective observational study was conducted at King George Medical University and Central Drug Research Institute, in Lucknow, India. Western blot analysis was undertaken in 16 cases to examine beta-catenin expression. The clinical details were recorded along with follow up observations, to determine associations.Results:Up-regulation of beta-catenin expression was seen in 69 per cent of cases. The clinical variables did not reveal significant differences between patients with extremes of expression (extreme under- vs over-expression). However, absent expression was shown exclusively in young adults aged over 18 years, while enhanced expression was associated with an altered facial profile.Conclusion:Although a beta-catenin association was seen in a subset of our sporadic juvenile nasopharyngeal angiofibroma cases, its expression was not homogeneous. This is in contrast to the Western literature that suggests a universal (homogenous) enhanced expression in the majority. Hence, further research is required to better define its molecular cascade. [ABSTRACT FROM PUBLISHER]

Background:The occurrence of juvenile nasopharyngeal angiofibroma is reportedly higher in India than in some other parts of the world, and our centre has seen a four-fold increase in its occurrence across seven decades.Methods:This paper reports a retrospective archival analysis of 701 juvenile nasopharyngeal angiofibroma cases from 1958 to 2013, and considers probable environmental factors in an Indian context that may affect its biology and the global distribution, as reported in the literature.Results:A continuously progressive increase in occurrence was evident, but the rapid rise observed in the current decade was alarming. The world map of juvenile nasopharyngeal angiofibroma incidence does not reflect true global distribution given the paucity of reporting. Our centre has dealt with approximately 400 cases in the last 24 years.Conclusion:With the alarming increase in juvenile nasopharyngeal angiofibroma incidence, there is a need for a registry to define its epidemiology. The world literature needs to reflect the status of juvenile nasopharyngeal angiofibroma incidence in the third world as well. Environmental factors known for hormone disruptive actions may influence its occurrence. Such aspects need to be considered to plan specific prevention policies. [ABSTRACT FROM PUBLISHER]

Background: The coronavirus disease 2019 pandemic has resulted in various changes in knowledge, attitude and practice among doctors. A survey was conducted of otolaryngologists in India regarding these aspects in relation to the coronavirus disease 2019 pandemic. Method: Otolaryngologists from West Bengal (India) were invited to participate in an online self-administered survey. Data were collected and analysed using appropriate methods. Results: Responses from 133 participants, grouped into 4 groups by their career stage, were collected and analysed. Of the participants, 36.8 per cent were directly involved in treating a known or suspected coronavirus disease 2019 patient, although 66.2 per cent considered the personal protective equipment inadequate. Ninety-four per cent indicated that their willingness to perform procedures depended on personal protective equipment availability. Of the respondents, 83.5 per cent revealed additional mental stress due to the pandemic. Of the participants, 41.4 per cent took hydroxychloroquine as coronavirus disease 2019 prophylaxis. Conclusion: This study provides an insight into which issues may need attention, to help ENT surgeons tackle the coronavirus disease 2019 pandemic more effectively based on analysis of responses in the survey. [ABSTRACT FROM AUTHOR]

Objectives: The primary goal of rhinoplasty is patient satisfaction and improved quality of life. The present study was conducted to assess patient satisfaction with face and nose appearance, and quality of life after rhinoplasty. Methods: Patients presenting for rhinoplasty completed the FACE-Q survey. This is a new instrument that measures patient-reported outcomes in those undergoing aesthetic procedures. The FACE-Q scales include satisfaction with facial appearance overall, satisfaction with the nose, psychological well-being, psychosocial distress and social function. Results: Sixty-five patients completed the FACE-Q at pre-operative and at post-operative follow-up visits. Post-operative scores increased significantly in terms of: satisfaction with facial appearance (p < 0.0001, t = 15.639, degrees of freedom = 64); social function (p < 0.0001, t = 12.208, degrees of freedom = 64); psychosocial distress (p < 0.0001, t = 13.864, degrees of freedom = 64); psychological function (p < 0.0001, t = 12.681, degrees of freedom = 64); and satisfaction with nose (p < 0.0001, t = 16.421, degrees of freedom = 64). Most patients reported more than 79 per cent satisfaction with the post-operative outcome. Conclusion: The FACE-Q is an adequate instrument for determining successful aesthetic surgery based on patient satisfaction. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including anosmia prognosis, fish bones and management of ingested fish bones during the pandemic.

Background:Frontal sinus involvement in aspergillosis associated with the nose and paranasal sinuses is a common occurrence, but the incidence of primary frontal sinus aspergillosis is rare, and there are few reports in the English literature.Objective:This study aimed to evaluate the role of the endonasal endoscopic surgical approach for isolated primary frontal sinus aspergillosis.Method:This paper describes a retrospective study of 16 cases of primary frontal sinus aspergillosis. The patients had presented to the out-patient services of the Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India, between January 1999 and July 2011.Results:The overall success rate of the endonasal endoscopic approach was 82.25 per cent. The disease recurred in three patients and was subsequently managed using the modified Lothrop procedure.Conclusion:Minimally invasive endonasal endoscopic sinus surgery was found to be an effective and a safe approach for managing primary frontal sinus aspergilloma, even in cases with larger bony defects involving the posterior table of the frontal sinus. [ABSTRACT FROM AUTHOR]

Objective:Abnormalities of the third branchial arch are less common than those of the second arch and usually present with left thyroid lobe inflammation. This paper describes 15 cases of pyriform sinus fistulae of third branchial arch origin usually presenting as recurrent thyroid abscess on the left side.Method:A retrospective review of 15 cases of third arch fistulae managed 2000 and 2008, diagnosed based on histopathology and radiological evidence of a fistulous tract, and treated with fistulectomy with left hemithyroidectomy.Results:All patients (six boys and nine girls, aged three to 15 years) presented with recurrent low neck inflammation. Pre-operative ultrasound, computed tomography fistulography and barium swallow demonstrated a third arch fistulous tract, left-sided in all cases. The fistula was detected intra-operatively and pathologically in all cases. Surgery (successful in all cases) emphasised complete recurrent laryngeal nerve and ipsilateral pyriform sinus exposure, to facilitate tract excision, with left hemithyroidectomy. There was no recurrence over three to five years' follow up.Conclusion:Paediatric recurrent low neck inflammatory episodes, due to thyroidal abscess, especially left-sided, should raise suspicion of pyriform sinus fistulae. [ABSTRACT FROM PUBLISHER]

Objective: This study aimed to evaluate the long-term hearing outcomes in stapedotomy surgery using skeeter oto-drill and to assess safety in difficult situations. Method: A retrospective study was conducted with 944 patients who underwent 1007 stapedotomy procedures over 16 years, performed by a single surgeon using a trans-canal approach and a self-retaining ear canal retractor. Hearing thresholds were calculated over four frequencies. Air–bone conduction hearing thresholds were obtained at 1, 5 and 10 years post-operatively and compared to the pre-operative records. Results: Out of 1007 operated ears with one year follow up, 98.61 per cent of cases showed a negligible air–bone gap of equal to or less than 5 dB, 1.19 per cent of cases showed an air–bone gap equal to or more than 5 dB but less than 10 dB, and only 0.2 per cent of cases showed an air–bone gap of more than 10 dB. Conclusion: In this study, using skeeter drill with a 0.6 mm diamond burr to make the fenestra was constant in all the cases and one of the safest techniques, showing persistent long-term hearing results. [ABSTRACT FROM AUTHOR]

Background: Decades of clinical observation have led our subspecialty team to suspect that negative nasopharyngeal pressure is associated with attic retraction pocket formation. Furthermore, LaPlace's law, which states that the pressure within a sphere varies with the inverse of the radius, provides the dynamic explanation for why the attic area of the tympanic membrane tends to retract more frequently than the pars tensa. Methods: The attic retraction pockets of 154 patients were classified into grades of severity (grades I–V). Impedance audiometry of middle-ear pressure was measured in the resting state, and after sniffing, swallowing and the Valsalva manoeuvre. Results: Negative nasopharyngeal pressure (sniffing) caused a diminution of middle-ear pressure of −5 daPa on average in normal ears, and of −24 daPa to −45 daPa for tympanic membranes with attic retraction pockets of grade I to grade V. Conclusion: Attic retraction pockets are associated with greater collapse of middle-ear volume when negative pressure is created in the nasopharynx. LaPlace's law, and the composition of the pars flaccida, suggests an explanation for why the attic region retracts more than the pars tensa. [ABSTRACT FROM AUTHOR]

Background: Treatment of coronavirus disease 2019 infection can result in immunosuppression. Rhino-orbital-cerebral mucormycosis is a frequent co-infection, even after recovery. Methods: An ambispective interventional study was conducted of 41 coronavirus patients with rhino-orbital-cerebral mucormycosis at a tertiary care centre from March to May 2021. Results: There were 28 males and 13 females with a mean age of 48.2 years (range, 21–68 years). Twelve had long-standing diabetes mellitus and 28 had been recently diagnosed. Thirty-six had received systemic corticosteroids for coronavirus disease 2019. Nasal signs were present in 95 per cent of patients, ophthalmic symptoms and signs in 87 per cent, palatal necrosis in 46.3 per cent, facial signs in 24.3 per cent, nerve palsies in 60.9 per cent, and intracranial involvement in 21.9 per cent. Treatment with amphotericin B was based on clinical features and co-morbidities. Endonasal debridement was performed in 51.2 per cent of patients, total maxillectomy in 14.6 per cent and orbital exenteration in 9.7 per cent. At the last follow up, 37 patients (90.24 per cent) were on antifungal therapy; 4 (9.75 per cent) did not survive. Conclusion: Early detection may improve survival. Follow up of high-risk patients after coronavirus disease 2019 infection is paramount. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate serum otolin-1 levels in patients with benign paroxysmal positional vertigo and to compare these levels with healthy individuals. Method: This was a case-control study. After obtaining institutional ethical committee clearance, the serum level of otolin-1 was calculated in adult individuals (18–75 years old) who were divided into group 1 (patients presenting with benign paroxysmal positional vertigo) and group 2 (healthy patients without benign paroxysmal positional vertigo as the control group). Data analysis was carried out to compare the serum levels in the cases and controls. A p-value less than 0.05 was considered significant. Results: A total of 70 age-matched individuals (cases, n = 40; controls, n = 30) were included in the study. The mean serum level of otolin-1 was 636.8 pg/ml (range, 259–981 pg/ml) in the group of patients with benign paroxysmal positional vertigo and 236.2 pg/ml (range, 189–370 pg/ml) in the control group. The difference was statistically significant (p = 0.0000). Conclusion: The serum levels of otolin-1 in patients with benign paroxysmal positional vertigo are significantly higher compared with individuals without benign paroxysmal positional vertigo. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence of nasolacrimal duct injury after functional endoscopic sinus surgery radiologically, using computed tomography. Methods: Fifty patients of either sex who underwent functional endoscopic sinus surgery were evaluated for nasolacrimal duct injury by computed tomography. Computed tomography was conducted pre-operatively, and post-operatively at the end of four weeks, and nasolacrimal duct injury was analysed. Results: The prevalence of nasolacrimal duct injury dehiscence was 1.16 per cent, with a similar incidence of 1.16 per cent for nasolacrimal duct injury post-operatively. However, no cases of symptomatic nasolacrimal duct injury were recorded. Conclusion: Computed tomography scan is an effective, non-invasive method to evaluate nasolacrimal duct injury following functional endoscopic sinus surgery, in accordance with evidence-based medicine. [ABSTRACT FROM AUTHOR]

Background: This study investigated health-related quality of life outcomes for children with cochlear implants in India using the Glasgow Children's Benefit Inventory questionnaire. Cochlear implantation is associated with improved language outcomes. Some studies show this gives higher quality of life after implantation. Previous research demonstrates that India presents unique circumstances that impact perspectives regarding cochlear implantation. Method: Children (aged under 18 years) who had undergone cochlear implantation were recruited from Vani Pradan Kendra, an organisation for individuals with hearing loss based in Bangalore, India. Demographic data including age, sex, duration of hearing loss and age at implant were collected, and the children's parents or caregivers completed the Glasgow Children's Benefit Inventory questionnaire. Results: Sixty-nine children (mean age: 8.0 ± 3.89 years) were recruited, and all reported improved quality of life after cochlear implantation. There was no effect of age, gender or education on reported benefits. However, a younger age at implant and longer experience with an implant were associated with greater quality of life improvements. Conclusion: Cochlear implantation leads to improved quality of life, with greater improvements associated with earlier implantation. This supports early intervention in children with profound hearing loss. [ABSTRACT FROM AUTHOR]

Objective: A single-centre, single-blinded prospective experimental study was conducted to determine the effectiveness of autologous platelet-rich plasma applied to the tonsillar bed post-operatively in reducing post-operative pain and haemorrhage. Methods: Platelet-rich plasma, prepared prior to surgery, was applied with calcium gluconate to one randomly chosen tonsillar fossa. Pain and haemorrhage were analysed, using a visual analogue scale and a pre-defined grading scale respectively, four times on the day of surgery at 2-hourly intervals, and thrice on the following day. Results: The pain score and haemorrhage grade on the test side were lower than on the control side. These findings were statistically significant. Conclusion: This pilot study, conducted in India, revealed valid positive results for a promising new technology. The manual preparation of platelet-rich plasma could be automated in the future to allow a larger sample size. [ABSTRACT FROM AUTHOR]

Objective:Tuberculosis is a global health problem that is especially prevalent in developing countries such as India. Recently, atypical presentation has become more common and a high index of suspicion is essential. This study analysed the various presenting symptoms and signs of tuberculous otitis media and the role of diagnostic tests, with the aim of formulating criteria for the diagnosis.Methods:A total of 502 patients underwent tympanomastoidectomy over a two-year period. Microbiological and histopathological examinations and polymerase chain reaction analysis of tissue taken during tympanomastoidectomy were performed.Results:A total of 25 patients (5 per cent) were diagnosed with tuberculous otitis media. Severe mixed hearing loss, facial palsy, labyrinthine fistula, post-aural fistula, perichondritis and extradural abscess were noted.Conclusion:There seems to be a resurgence in tuberculous otitis media in India. Microbiological, histopathological and polymerase chain reaction tests for tuberculosis are helpful for its diagnosis. [ABSTRACT FROM AUTHOR]

Background:Aspiration pneumonia is an important cause of death in head and neck cancer patients. This study therefore aimed to evaluate the risk factors associated with aspiration pneumonia in head and neck cancer patients.Methods:Hospital death records from 12 years (2000–2012) were reviewed to obtain the number of deaths. Treatment details and cause of death were analysed. Statistical analysis was performed to identify the risk factors for aspiration pneumonia.Results:The records revealed that aspiration pneumonia was the cause of death in 51 out of 85 patients. Primary tumour site (oropharynx and hypopharynx, odds ratio 3.3; 95 per cent confidence interval 1.17–9.4, p = 0.02) and advanced tumour stage (odds ratio 4.2, 95 per cent confidence interval 1.16–15.61, p = 0.02) had significant negative impacts on aspiration pneumonia related mortality.Conclusion:Advanced pharyngeal cancer patients are at an increased risk of aspiration pneumonia related death. Investigations for the early detection of this condition are recommended in these high-risk patients. [ABSTRACT FROM PUBLISHER]

Objective:This study aimed to assess the prevalence and profile of ear diseases in children from Delhi, India.Methods:A population-based cross-sectional door-to-door survey was carried out in two districts of Delhi, and involved children of all demographic sections of the region. A total of 4626 children aged between 18 days and 15 years underwent examinations including otoscopy, impedance audiometry and hearing screening.Results:In all, 14.8 per cent of the study sample was diagnosed with one or more ear morbidities, the most common being cerumen impaction (7.5 per cent) and chronic suppurative otitis media (3.6 per cent). There was clinical evidence of otitis media with effusion in 2 per cent of children, and 0.96 per cent had otitis externa (bacterial and fungal). The point prevalence of acute suppurative otitis media was 0.39 per cent. In all, 0.45 per cent of children were found to have an undiagnosed foreign body within the ear canal.Conclusion:The high prevalence of ear disease poses a significant public health problem in Delhi. [ABSTRACT FROM PUBLISHER]

Background:Cartilage-perichondrial grafts are often used for tympanic membrane and middle-ear reconstructions. Tragal and conchal cartilages are most frequently used for this purpose. Studies have shown that slicing the cartilage to less than 0.5 mm thickness improves acoustic benefit. However, the thickness of the cartilage in a given population may not be uniform.Objective:This descriptive cross-sectional study aimed to determine the average thickness of tragal cartilage (in terms of age and sex) in an Indian population.Method:A prospective study of 61 tragal cartilages harvested during serial tympanoplasty and modified radical mastoidectomy were analysed according to thickness.Results:The total average thickness of tragal cartilage was 1.228 ± 0.204 mm in males and 1.090 ± 0.162 mm in females. The overall thickness was 1.018 ± 0.139 mm in those aged less than 15 years, 1.139 ± 0.238 mm in those aged 15–30, and 1.189 ± 0.155 mm in those aged over 30 years.Conclusion:The findings help us to determine age-related cartilage thickness for slicing techniques in tympanoplasty. [ABSTRACT FROM PUBLISHER]

Objectives:A multidisciplinary team approach is required for the preservation of voice and appropriate management of glottic cancer. This study aimed to investigate the outcomes of surgically treated glottic cancers of all stages. All aspects of surgical management, such as laser cordectomy, partial laryngectomy, total laryngectomy with voice prosthesis, and salvage laryngectomy, conducted at a single tertiary care institute in India, were reviewed.Method:A retrospective analysis of hospital records was performed for 192 glottic cancer patients who were surgically treated between 2003 and 2007.Results:Patients with tumour stages 1 or 2 glottic cancer treated with laser cordectomy had a local control rate of 85 per cent and five-year survival rate of 98.6 per cent. The findings suggest that the number of partial laryngectomies performed for stage 3 tumours is declining. Patients with a tumour stage 3 lesion with a fixed hemilarynx or a tumour stage 4 lesion, treated with total laryngectomy, were found to have a five-year survival rate of 61.6 per cent. Nodal status was significantly associated with five-year survival rate.Conclusion:Surgery offers a viable five-year survival rate in glottic cancer patients. [ABSTRACT FROM PUBLISHER]

Objective:To compare anatomical and audiological results using sliced tragal cartilage and temporalis fascia in type I tympanoplasty.Method:A retrospective review was undertaken of primary tympanoplasties using sliced tragal cartilage and temporalis fascia from May 2005 to January 2008. In total, 223 ears were operated on using sliced tragal cartilage graft and 167 using temporalis fascia. Statistical analysis of the outcome data was performed.Results:At the two-year and four-year follow ups, successful closure of the tympanic membrane was achieved in 98.20 per cent and 97.75 per cent, respectively, of the cartilage group compared with 87.42 per cent and 82.63 per cent, respectively, of the temporalis fascia group. At the four-year follow up, the average air–bone gap was 7.10 ± 3.01 dB in the cartilage group and 8.05 ± 3.22 dB in the temporalis fascia group.Conclusion:The overall success rate for primary cartilage tympanoplasty is higher when using sliced cartilage than with temporalis fascia grafting. [ABSTRACT FROM PUBLISHER]

Objective:To study the presence of bacterial biofilm on the sinus mucosa of healthy individuals (controls) and patients with chronic rhinosinusitis with or without nasal polyposis.Methods:An analytical, prospective and observational study was conducted. Tissue samples were obtained from the sinus mucosa. The bacteria were isolated and typified, and the material was examined for biofilm formation using tissue culture plate, Congo red agar detection and tube methods.Results:A total of 100 cases were analysed for the presence of biofilm. Bacterial biofilm was present in 26 of 50 disease group cases (52 per cent) and in 4 of 50 control group cases (8 per cent) (p < 0.01).Conclusion:The presence of biofilm on the mucosa of chronic rhinosinusitis patients offers a possible cause for the persistent inflammation, and for antibiotics resistance and antimicrobial therapy failure. These findings could change the approach to treatment. [ABSTRACT FROM PUBLISHER]

Objectives:Multidetector computed tomography virtual bronchoscopy is a non-invasive diagnostic tool which provides a three-dimensional view of the tracheobronchial airway. This study aimed to evaluate the usefulness of virtual bronchoscopy in cases of vegetable foreign body aspiration in children.Methods:The medical records of patients with a history of foreign body aspiration from August 2006 to August 2010 were reviewed. Data were collected regarding their clinical presentation and chest X-ray, virtual bronchoscopy and rigid bronchoscopy findings. Cases of metallic and other non-vegetable foreign bodies were excluded from the analysis. Patients with multidetector computed tomography virtual bronchoscopy showing features of vegetable foreign body were included in the analysis. For each patient, virtual bronchoscopy findings were reviewed and compared with those of rigid bronchoscopy.Results:A total of 60 patients; all children ranging from 1 month to 8 years of age, were included. The mean age at presentation was 2.01 years. Rigid bronchoscopy confirmed the results of multidetector computed tomography virtual bronchoscopy (i.e. presence of foreign body, site of lodgement, and size and shape) in 59 patients. In the remaining case, a vegetable foreign body identified by virtual bronchoscopy was revealed by rigid bronchoscopy to be a thick mucus plug. Thus, the positive predictive value of virtual bronchoscopy was 98.3 per cent.Conclusion:Multidetector computed tomography virtual bronchoscopy is a sensitive and specific diagnostic tool for identifying radiolucent vegetable foreign bodies in the tracheobronchial tree. It can also provide a useful pre-operative road map for rigid bronchoscopy. Patients suspected of having an airway foreign body or chronic unexplained respiratory symptoms should undergo multidetector computed tomography virtual bronchoscopy to rule out a vegetable foreign body in the tracheobronchial tree and avoid general anaesthesia and invasive rigid bronchoscopy. [ABSTRACT FROM PUBLISHER]

Objectives:To study the role of mometasone furoate aqueous nasal spray for the management of adenoidal hypertrophy in children with more than 50 per cent obstruction, and to assess its impact on change in quality of life.Methods:A prospective, randomised, double-blind, interventional placebo-controlled study was conducted. A total of 100 children aged 2–12 years completed treatment and follow up. The symptoms and degree of obstruction were evaluated by nasopharyngoscopy conducted pre-treatment and 24 weeks post-treatment. Subjects received mometasone furoate nasal spray at a daily dose of 200 µg for 8 weeks, followed by a dose of 200 µg on alternate days for 16 weeks. Results were compared with those of a matched control group who were given saline nasal spray.Results:With mometasone treatment, there was an 89.8 per cent reduction in clinical symptom score, and the degree of obstruction dropped from 87 to 72 per cent (p < 0.0001). A statistically significant change in quality of life scores was seen in patients treated with the mometasone nasal spray (score change of 37.47) as compared with those given saline nasal spray (score change of 11.25) (p = 0.0001).Conclusion:Mometasone nasal spray appears to be effective in treating children with obstructive adenoids. [ABSTRACT FROM PUBLISHER]

Objective:To explore the treatment outcomes of patients treated with re-irradiation for recurrent or second primary head and neck cancer.Method:An analysis was performed of 79 head and neck cancer patients who underwent re-irradiation for second primaries or recurrent disease from January 1999 to December 2011.Results:Median time from previous radiation to re-irradiation for second primary or recurrence was 53.6 months (range, 2.7–454.7 months). Median age at diagnosis of first primary was 54 years. Median re-irradiation dose was 45 Gy (range, 45–60 Gy). Acute grade 3 or worse toxicity was seen in 30 per cent of patients. Median progression-free survival for recurrent disease was 15.0 months (95 per cent confidence interval, 8.33–21.66). The following factors had a statistically significant, positive impact on progression-free survival: patient age of less than 50 years (median progression-free survival was 29.43, vs 13.9 months for those aged 50 years or older; p = 0.004) and disease-free interval of 2 years or more (median progression-free survival was 51.66, vs 13.9 months for those with less than 2 years disease-free interval).Conclusion:Re-irradiation of second primaries or recurrences of head and neck cancers with moderate radiation doses yields acceptable progression-free survival and morbidity rates. [ABSTRACT FROM PUBLISHER]

Background:Allergic rhinitis is the most common form of non-infectious rhinitis, affecting 500 million people worldwide, with one-fifth of those affected living in the Indian subcontinent. The skin prick test is the most valuable test for detecting offending allergens, and can be helpful for patient education, allergen avoidance and immunotherapy planning.Method:The skin prick test was performed with 49 allergens in 486 patients who presented with symptoms of allergic rhinitis, and the allergen profile was studied.Results:Of the 486 allergic rhinitis patients, 335 (68.93 per cent) showed allergen positivity to the skin prick test. Dust mite was the most common allergen, with positive results in 44.65 per cent of cases.Conclusion:The most common offending allergen in our study was the dust mite. Identification of specific allergens for a particular geographical area aids patient education and enables allergen-specific immunotherapy. [ABSTRACT FROM PUBLISHER]

Objectives:This study aimed to evaluate the demographics of spasmodic dysphonia in the Indian population and to analyse the optimum dose titration of botulinum toxin type A in this group. A comparative analysis with international studies was also performed.Method:The study involved a retrospective analysis and audit of botulinum toxin type A dose titration in spasmodic dysphonia patients who visited our voice clinic between January 2005 and January 2012.Results:The average total therapeutic dose required for patients with adductor spasmodic dysphonia was 4.2 U per patient per vocal fold (total 8.4 U per patient), and for patients with abductor spasmodic dysphonia, it was 4.6 U per patient.Conclusion:Our audit revealed that 80 per cent of the spasmodic dysphonia patients were male, which contrasts dramatically with international studies, wherein around 80 per cent of spasmodic dysphonia patients were female. Our study also revealed a higher dose titration of botulinum toxin for the Indian spasmodic dysphonia population in both adductor and abductor spasmodic dysphonia cases. [ABSTRACT FROM PUBLISHER]

Background:Head and face dimensions vary according to race and geographical zone. Hereditary factors also greatly affect the size and shape of the head. There are important medical applications of craniofacial data specific to different racial and ethnic groups.Methods:Various cranial and facial anthropometric parameters were assessed in singleton, healthy, full-term newborns of Sikkimese origin in a tertiary care hospital in Sikkim, India. The data were then analysed to determine statistically significant differences between sexes.Results:Forty-five newborns were included in the study. Both male and female newborns were observed to be hyperbrachycephalic and hyperleptoprosopic. The only significant difference between the sexes was in commissural length, which was observed to be greater in male newborns.Conclusion:Craniofacial parameters in Sikkimese newborns vary in comparison with those of other newborns from around the world. Larger studies are needed in order to reveal sex-related variations. Similar studies on various racial groups in North-East India are needed to establish standards for populations with East Asian features. [ABSTRACT FROM PUBLISHER]

Background:Necrotising otitis externa, which is typically seen in elderly diabetics, is a severe infective disorder caused by Pseudomonas aeruginosa. There is lack of standard management policy for necrotising otitis externa, hence this study attempted to frame a protocol for management based on clinical parameters.Method:A retrospective study of 27 patients with necrotising otitis externa was conducted over 6 years in a tertiary care hospital. Data were analysed with regards to demographic characteristics, clinical features, investigations, staging and treatment modalities.Results:Out of 27 patients, 26 were diabetics. The commonest organism isolated was P aeruginosa, which was sensitive to third generation cephalosporins and fluoroquinolones. Nine patients had cranial nerve involvement. Twelve of 15 patients treated with medical therapy recovered, as did 11 of 12 patients that underwent surgery.Conclusion:A high index of suspicion, early diagnosis and prompt intervention are key factors to decrease morbidity and mortality. Fluoroquinolones, third generation cephalosporins and surgical debridement are the mainstay of treatment. [ABSTRACT FROM PUBLISHER]

Objective:The purpose of this study was to evaluate the effect of lengthening of voice onset time and burst duration of selected speech stimuli on perception by individuals with auditory dys-synchrony. This is the second of a series of articles reporting the effect of signal enhancing strategies on speech perception by such individuals.Methods:Two experiments were conducted: (1) assessment of the ‘just-noticeable difference' for voice onset time and burst duration of speech sounds; and (2) assessment of speech identification scores when speech sounds were modified by lengthening the voice onset time and the burst duration in units of one just-noticeable difference, both in isolation and in combination with each other plus transition duration modification.Results:Lengthening of voice onset time as well as burst duration improved perception of voicing. However, the effect of voice onset time modification was greater than that of burst duration modification. Although combined lengthening of voice onset time, burst duration and transition duration resulted in improved speech perception, the improvement was less than that due to lengthening of transition duration alone.Conclusion:These results suggest that innovative speech processing strategies that enhance temporal cues may benefit individuals with auditory dys-synchrony. [ABSTRACT FROM PUBLISHER]

Objectives:This study investigated the personality traits of patients with allergic rhinitis. It also examined the association between personality type and the type of allergic rhinitis, and compared this with the general population.Methods:A descriptive observational pilot study was carried out on 50 consecutive cases of allergic rhinitis who presented to the allergy clinic between June and October 2010. These patients were compared with a control group comprising 50 individuals from the general population that had no symptoms of allergic rhinitis. Both groups completed the International Personality Disorder Examination questionnaire for the assessment of personality traits.Results:Persons falling into cluster C personality type showed a positive correlation with the type and severity of allergic rhinitis. The majority of control group individuals fell into cluster A. This indicated a correlation between allergic rhinitis and a dominant anxious trait compared with the control group.Conclusion:In psycho-allergological research, the potential relevance of personality factors in the maintenance and exacerbation of atopic symptoms is still a matter of debate. More attention should be paid to the psychological status of allergic rhinitis patients, and appropriate treatment should be provided to improve their symptoms and quality of life. [ABSTRACT FROM PUBLISHER]

Background:There is a considerable scarcity of reliable population-based data on the prevalence of preventable ear disorders in developing countries. This study was conducted to determine the prevalence of preventable ear disorders in primary school children (aged 5 to 12 years) in northern India.Method:A pro forma questionnaire was used to screen 15 718 primary school children in New Delhi for ear disorders. Ear examinations were conducted using otoscopy and impedance audiometry.Results:Impacted cerumen was prevalent in 7.93 per cent of schoolchildren, 4.79 per cent suffered from chronic otitis media and 3.06 per cent suffered from otitis media with effusion. Acute otitis media was detected in 0.65 per cent and foreign bodies were found in 0.34 per cent of the children.Conclusion:Preventable ear diseases posed a significant health problem among children at primary school level. Regular screening of children during this stage would ensure that their school lives were not affected by hearing impairments or preventable ear disorders. Information gathered in this study will help in effective treatment prioritisation of ear disorders, planning and resource allocation. [ABSTRACT FROM PUBLISHER]

Objective:We report an extremely rare case of the simultaneous occurrence of a thyroglossal duct cyst and a lingual thyroid in the absence of an orthotopic thyroid gland, in a seven-year-old girl from South India.Method:Case report and a review of the English language literature on the subject.Results:The patient presented with a mass on the tongue that had been present for three years, and an anterior neck swelling that had been present for two years. Examination revealed a midline, pinkish, firm mass present on the posterior one-third of the tongue. The neck showed a midline cystic swelling in the infrahyoid position. Radiological imaging confirmed the clinical findings, revealing the absence of her thyroid gland in the normal location. Sistrunk's procedure was performed leaving behind a lingual thyroid. At 13-month follow up, the patient was euthyroid with no recurrence.Conclusion:To our knowledge the association of a lingual thyroid and a thyroglossal cyst has only been reported once in the literature. The presence of a lingual thyroid in the absence of a normally located thyroid gland or functioning thyroid tissue along the thyroglossal tract, confirmed by radionuclide and computed tomography imaging, may indicate the failure of the normal descent of the thyroid gland during embryonic development. This probable absence of the descent of the thyroid raises questions regarding the origin of thyroglossal duct cysts. [ABSTRACT FROM PUBLISHER]

Background:Allergic rhinitis is associated with excess specific immunoglobulin E. Inner ear involvement (via both cellular and humoral immunity) is poorly understood, but appears to arise from the endolymphatic sac and duct.Aims:To assess the otological and audiological status of patients with allergic rhinitis.Methodology:Thirty allergic rhinitis patients (14 men, 16 women; age 17–45 years, mean 31 years) and 20 controls (12 men, eight women; age 21–42 years, mean 27 years) underwent audiological investigation.Results:All study group patients had sensorineural (rather than conductive) hearing loss, worse at high frequencies. All had abnormal transient evoked otoacoustic emissions and 27 had abnormal distortion product otoacoustic emissions. All had a statistically significantly prolonged wave I latency, and shortened absolute wave I–III and I–V interpeak latencies, compared with controls.Conclusion:Allergic rhinitis patients had a higher prevalence of hearing loss and otoacoustic emission abnormalities than controls. The endolymphatic sac can process antigens and produce its own local antibody response; the resulting inflammatory mediators and toxic products may interfere with hair cell function. Additional research is needed to determine the clinical value of audiometry and otoacoustic emission testing in allergic rhinitis. [ABSTRACT FROM PUBLISHER]

Objective:We report a rare case of successful surgical management of tubercular tracheal stenosis. There was no history of tracheostomy except for trauma management.Case report:A 24-year-old man presented with breathing difficulty. He had previously sustained blunt chest injury, a fractured mandible and minor head injury in a traffic accident. Despite successful mandibular fracture fixation, he subsequently developed progressive breathing difficulty with stridor. The patient was treated successfully with surgical resection and bronchoplastic reconstruction. Post-operatively, endotracheal tuberculosis was diagnosed.Conclusion:Endotracheal tuberculosis is rare despite the high incidence of pulmonary tuberculosis in India. Early diagnosis and prompt treatment are necessary to prevent tuberculous tracheobronchial stenosis, an extremely rare but serious clinical problem which can cause obstructive pneumonia and exertional dyspnoea. Surgical resection and bronchoplastic reconstruction is the established treatment for such stenosis. Patients with active tuberculosis usually respond to conventional antitubercular treatment. [ABSTRACT FROM PUBLISHER]

Introduction:Tinnitus is a disturbing symptom and is often the main reason for otology referral. It is usually associated with hearing loss of varying aetiology, and is thought to begin in the cochlea, with later abnormal central activity. We hypothesise that tinnitus without hearing loss may be caused by central and subcortical abnormalities and altered outer hair cell function.Aim:To compare the auditory brainstem responses, middle latency responses and otoacoustic emissions in normal-hearing individuals with and without tinnitus.Methodology:The audiological test results of 25 normal hearing subjects with tinnitus (age 18–45 years) were determined, and compared with those of a control group.Results:A statistically significant difference was found between study group tinnitus ears vs control group ears, as regards wave I latency prolongation, shortening of wave V and absolute I–III and I–V interpeak latency, enlargement of wave Na and Pa amplitude, and distortion product and transient evoked otoacoustic emission signal-to-noise ratios. There was no statistically significant difference between unilateral vs bilateral tinnitus ears.Conclusion:The pathogenesis and optimum management of tinnitus are still unclear. It often occurs with primary ear disease, usually associated with hearing loss, but may occur in patients with normal hearing. Observed changes in auditory brainstem and middle latency responses indicate central auditory alterations. Tinnitus involves both peripheral and central activity, and complete audiological and neurophysiological investigation is required. Management should be based on both audiological and neurophysiological findings. [ABSTRACT FROM PUBLISHER]

Introduction:We report a prospective, randomised study of 51 patients with benign paroxysmal positional vertigo treated with Epley's manoeuvre alone or Epley's manoeuvre plus labyrinthine sedative, at Sundaram Medical Foundation, Chennai, India.Aim:To compare the efficacy of Epley's manoeuvre versus Epley's manoeuvre plus labyrinthine sedative in the treatment of benign paroxysmal positional vertigo.Materials and methods:Consecutive patients were selected based on history and positive Dix–Hallpike test. Patients were randomised to receive either Epley's manoeuvre alone or Epley's manoeuvre plus labyrinthine sedative for one week. Both groups were followed up for four weeks.Results:Univariate analysis showed that one- and four-week outcomes were influenced by the number of episodes, symptom duration and treatment type. Multivariate logistic regression analysis showed that the one-week outcome was significantly influenced by symptom duration and treatment type, while the four-week outcome was significantly influenced by symptom duration alone. Patients receiving Epley's manoeuvre alone showed better recovery than those receiving both Epley's manoeuvre and labyrinthine sedative.Conclusion:Labyrinthine sedatives do not aid recovery from benign paroxysmal positional vertigo when used in addition to Epley's manoeuvre. [ABSTRACT FROM PUBLISHER]

Objective:This study aimed to evaluate the effect of lengthening the transition duration of selected speech segments upon the perception of those segments in individuals with auditory dys-synchrony.Methods:Thirty individuals with auditory dys-synchrony participated in the study, along with 30 age-matched normal hearing listeners. Eight consonant–vowel syllables were used as auditory stimuli. Two experiments were conducted. Experiment one measured the ‘just noticeable difference’ time: the smallest prolongation of the speech sound transition duration which was noticeable by the subject. In experiment two, speech sounds were modified by lengthening the transition duration by multiples of the just noticeable difference time, and subjects' speech identification scores for the modified speech sounds were assessed.Results:Subjects with auditory dys-synchrony demonstrated poor processing of temporal auditory information. Lengthening of speech sound transition duration improved these subjects' perception of both the placement and voicing features of the speech syllables used.Conclusion:These results suggest that innovative speech processing strategies which enhance temporal cues may benefit individuals with auditory dys-synchrony. [ABSTRACT FROM PUBLISHER]

Objective: We report an extremely rare case of rhinosporidiosis with involvement of both larynx and trachea, together with coexisting nasal, nasopharyngeal and oropharyngeal lesions, in a 32-year-old man. Method: Case report and review of the world literature concerning laryngotracheal and disseminated rhinosporidiosis. Results: A 32-year-old, South Indian man presented with a nasal mass of four years' duration, with progressive hoarseness for one year. Strawberry-like rhinosporidial masses were seen in both nasal cavities. Fibre-optic laryngoscopic examination revealed reddish masses with whitish surface specks, involving the glottis, subglottis and trachea. Computed tomography revealed soft tissue opacities involving both nasal cavities and the nasopharynx and extending to the oropharynx, with involvement of the larynx and trachea. Direct laryngoscopy and rigid bronchoscopy guided excision of the laryngeal and tracheal lesions was performed. Conclusion: Rhinosporidiosis is a chronic, granulomatous disease which usually affects the mucous membranes of the nose and nasopharynx. Lower dissemination into the trachea is extremely rare. Laryngotracheal involvement poses many diagnostic and therapeutic challenges, due to the potential risk of bleeding and aspiration. In the presented case, local spread of rhinosporidiosis, due to direct spillage of spores from the nasopharynx into the larynx during episodes of bleeding or previous surgery, may have resulted in laryngotracheal involvement, although systemic spread cannot be excluded. [ABSTRACT FROM AUTHOR]