A clinical study of effect of peri-tonsillar infiltration of ropivacaine on tonsillectomy haemorrhage

<p><strong>Background:</strong> The aim of this study to determine the relationship between the peritonsillar infiltration of ropivacaine hydrochloride and haemorrhage in patients undergoing tonsillectomy.</p><p><strong>Methods </strong>This prospective study was conducted in the department of otorhinolaryngology and head and neck surgery, Adichunchanagiri institute of medical sciences, B. G. Nagara, Mandya district. A sample size of 30 patients which satisfied the inclusion criteria were included in the study. <strong></strong></p><p>Ropivacaine (0.75%)<strong> </strong>was locally infiltrated on the right side (R-side) in the peri-tonsillar region before the surgery. The left side was considered as the control side. Intra-operative blood loss was estimated separately for both the sides. The data from the study will be analysed using chi square test and Student t test technique.</p><p><strong>Results:</strong> The 17 (56.7%) females and 13 (43.3%) males participated in the study. Majority of the cases belonged to &lt;10 years of age group. By analysing the data, blood loss was found to be higher on the left side (control side) compared to the right side on which peri-tonsillar infiltration of ropivacaine was given. The association between the blood loss on the right side and the left side (control side) was found to be significant (p&lt;0.0001).<strong></strong></p><p><strong>Conclusions: </strong>Based on the result of our study it can be derived that the peri-tonsillar infiltration of Ropivacaine (0.75%) is very effective in reducing intra-operative bleeding and at the same time providing a better bloodless field during surgery. Hence, we recommend the use of peri-tonsillar infiltration of Ropivacaine (0.75%) in view of better management of intra-operative blood lossissn.2454-5929.ijohns20220041</p>

A comparative study between endoscopic and microscopic type 1 tympanoplasty

<p><strong>Background:</strong> The current study aims to compare type 1 microscopic tympanoplasty and endoscopic tympanoplasty and draws an evidence-based conclusion regarding the outcome.</p><p><strong>Methods:</strong> This randomized controlled clinical study consists of 60 patients, in which 30 cases allocated as group 1 underwent endoscopic myringoplasty, and 30 cases allocated as group 2 underwent conventional myringoplasty. Tympanic membrane (TM), pure tone audiometry (PTA) evaluated preoperatively and at 3 months postoperative follow-up.</p><p><strong>Results:</strong> Demographic distribution between the groups does not show a significant difference (χ2=6.67, p=0.16). There was no significant difference observed between TM perforation size between the groups (χ2=2.32, p=0.51). For the preoperative AB gap in group 1, the mean ABG was 28.20±2.67 and in group 2 was 28.20±0.80. The postoperative AB gap in group 1, the mean ABG was 17.40±3.01, and in group 2, the mean ABG was 19.67±2.93. The mean difference is 9.13, and it shows a statistically significant difference (p=0.001). The mean duration of surgery in group 1 was 130.83±34.84 and in group 2 was 168.33±16.88 min (p=0.001). In both groups, 90% have intact graft, and in 10% of patients’ residual perforation is present. The mean duration of hospitalization in group1 is 4.10±0.09 days and in group 2 is 4.97±0.18 days.</p><p><strong>Conclusions:</strong> By using the endoscopic addition, minimal invasive tympanoplasty can made possible the similar graft success rate with minimal pain. Endoscopic tympanoplasty uses very less operative time than microscopic surgery.</p><p> </p>

Indications and complications of paediatric tracheostomies at a tertiary care centre in rural Haryana: a retrospective study

<p><strong>Background:</strong> The indications for paediatric tracheostomies have had a significant change world over during last few decades. Emergency management of paediatric airway by tracheostomy has its own share of complications which need fair amount of expertise to manage.</p><p><strong>Methods:</strong> We carried out a retrospective study at a tertiary care centre in rural area of Haryana and analysed the available data of last 5 years (2017-2021) for determining various indications of paediatric tracheostomies and complications encountered during or after the surgery.</p><p><strong>Results:</strong> The study included 65 paediatric patients (&lt;14 years of age) who underwent tracheostomy at our tertiary care institute between January 2017 and December 2021. Out of them 38 (60.3%) were males, 35 (55.17%) patients were in 0-5 years age group. Most frequent indication for paediatric tracheostomy turned out to be upper airway obstruction due to a vaccine preventable disease diphtheria (n=56, i.e., 86.15%), other less common causes were need of prolonged ventilation, subglottic stenosis, congenital airway anomalies, retropharyngeal abscess, laryngeal papilloma. Complications were observed in 30 cases (46.15%). Mortality in tracheostomized children was nearly 29.2%, which was mainly attributed to the underlying cause which turned out to be diphtheria in most of the cases.</p><p><strong>Conclusions:</strong> High number of paediatric tracheostomies and sheer presence of diphtheria in this rural area of Haryana suggests that there is dire need of proper immunisation coverage and an active participation at community level.</p>

Open surgical approach to management of rhino-orbito-cerebral mucormycosis

<p class="abstract"><strong>Background: </strong>Since December 2019, when novel corona virus (COVID 19) was reported, it has spread widely to cause a pandemic. Rhino-orbito-cerebral Mucormycosis (ROCM), an opportunistic fungal infection caused by the order Mucorales and class Zygomycetes has led to an epidemic in our country.</p><p class="abstract"><strong>Methods: </strong>This prospective cross sectional study was conducted at a 1200 bed tertiary care teaching hospital in Mysore. All patients of ROCM who presented to us for treatment were selected for the study after informed consent. Only those patients who were operated via open approach were included.</p><p class="abstract"><strong>Results:</strong> Median age of the patients was 50 years (SD±10). 49 were male patients (67.1%). Diabetes mellitus was the most common underlying co-morbidity seen in 71 patients (97.3%). Facial pain (100%) and facial swelling (90.4%) were the most common presenting complaint. KOH positivity from nasal swab for Mucormycosis was positive in only 37 patients (50.7%). Traditional inaccessible areas to endoscope like the premaxilla, lateral orbit cavity, infra temporal fossa and hard palate were tackled by the open surgical approach route. Advantages of open surgical approach being the access to areas which are traditionally difficult to approach via the endoscope, aggressive debridement is possible which might be challenging endoscopically. Complications like wound dehiscence, oro-antral fistula, osteomyelitis and abscess were noted in our study.</p><p class="abstract"><strong>Conclusions: </strong>Open surgical approach offers a very viable, affordable and a very effective means for aggressive surgical debridement of infection and reduce mortality associated with ROCM.</p><p> </p>

The role of magnesium supplement in laryngopharyngeal reflux disease

<p class="abstract"><strong>Background:</strong> Laryngopharyngeal reflux disease (LPRD) is one of the most prevalent upper gastrointestinal disorder encountered in clinical practice and its optimal treatment is not standardized. The role of magnesium in the human body functions is often underestimated. Since magnesium (Mg) plays a major role in the regulation of smooth muscle contractionby relaxing the pyloric sphincter and enhancing gastric emptying, thereby decreasing the pressure on the LES, it was hypothesized that adding magnesium supplements along with the regular treatment for LPRD, can improve LPRD symptoms. Magnesium has a neutralizing action on the gastric acid and therefore, it may be pertinent to achieve optimal Mg intakes in patients with LPRD.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study done over a period of 1 year conducted in a tertiary care hospital in central India in patients presenting with LPRD of the age group 18-65 years. </p><p class="abstract"><strong>Results:</strong> The study patients were divided into two groups-one treated with esmoprazole 40 mg capsules and alginate syrup and the other with esmoprazole capsules, alginate syrup and magnesium glycinate (250 mg) supplement. Both the groups showed appreciable improvement in their mean reflux symptom index (RSI) and reflux finding score (RFS) at 1 month and 3 months follow-up. Females showed a higher preponderance than males in the disease, symptoms and the mean RSI and RFS score.</p><p class="abstract"><strong>Conclusions:</strong> Addition of magnesium supplements along with the regular treatment for LPRD, can improve LPRD symptoms and should be considered in the treatment protocol of LPRD.</p>

An increase in cases of complicated chronic otitis media: an indirect impact of COVID pandemic

<p><strong>Background:</strong> Chronic otitis media is the most common disease dealt by an otologist, the cases of complication of which are remarkably low. The use of antibiotics and mastoidectomies have resulted in the fall of the fatal complications. COVID-19 pandemic called for restrictions which lead to medical care delay.</p><p><strong>Methods:</strong> This study was conducted in the department of otolaryngology of GMC and associated hospitals, Jammu from June 2020 and May 2021. The data was retrospectively collected the data from March 2018 to June 2020. The study group included the patients diagnosed with Chronic suppurative otitis media (CSOM) on otoscopy and the patients with complications of CSOM were evaluated for the symptoms of complication, type of complication, bacteriology, treatment and hospital stay.</p><p><strong>Results:</strong> The 38 (7.5%) patients among these were diagnosed with one or other complication, out of which 29 (76.3%) cases occurred during the COVID pandemic. The extra-cranial complications were more common and young to middle age group was more commonly involved.</p><p><strong>Conclusions:</strong> COM is a common otological disease, the occurrence of which should not be taken lightly. Without timely and accurate treatment, the complications ensue which are difficult to treat and require expertise.</p>

Application of otoacoustic emissions and brainstem evoked response audiometry in newborn hearing screening

<p class="abstract"><strong>Background: </strong>Newborn hearing screening was conducted in a tertiary care hospital in a step by step manner using otoacoustic emissions (OAE) and brainstem evoked response audiometry (BERA) and details were recorded.</p><p class="abstract"><strong>Methods:</strong> A prospective institutional based study was conducted. All the newborns born in the hospital over a period of 18 months from December 2018 to May 2020 were considered in the study. Healthy newborns were screened bedside within 24 hours of delivery and NICU (Neonatal Intensive Care Unit) babies were screened in the NICU. Handheld OAE apparatus was used as the initial screening tool. A total of 3 OAEs were done for babies with a “refer” result in the OAEs, which were done 1 month apart. Babies with a “refer” in the third OAE were subjected for BERA.</p><p class="abstract"><strong>Results:</strong> A total of 14226 babies were screened at 24-48 hours of birth. Among them, 13,069 babies passed the first OAE screening in both ears. Remaining babies were referred for further follow-up. After subsequent follow-ups and successive testing, 11 babies were found to have hearing loss, which was diagnosed within 4-5 months of the child’s birth.</p><p class="abstract"><strong>Conclusions: </strong>Universal newborn hearing screening is the need of the day. OAE is an effective screening tool for newborn hearing loss. When complemented by BERA, majority of congenitally deaf babies can be diagnosed at a very early age. This helps in early intervention.</p>

Does gestational diabetes mellitus affect the hearing of the baby?

<p><strong>Background: </strong>Hearing screening results of babies born to mothers with and without gestational diabetes mellitus done within 24-48 hours of delivery using otoacoustic emissions was compared. Babies who failed the screening were recalled for further testing.<strong></strong></p><p><strong>Methods: </strong>A prospective institutional based study was conducted between December 2018 and May 2020. All the babies were screened for hearing impairment using handheld OAE apparatus within 24-48 hours of delivery. History of gestational diabetes mellitus in the mother was enquired. Any baby with a “refer” result in the OAE study was recalled for a repeat OAE testing after a month. This was repeated two more times if the baby failed the test every time. In case of failing the test for the third time, the baby was sent for brainstem evoked response audiometry for confirmation of hearing loss.<strong></strong></p><p><strong>Results: </strong>Screening was done for 14226 babies. Among them, 44 babies were born to mothers with gestational diabetes mellitus. The hearing screening results did not show a significant association between gestational diabetes mellitus and hearing impairment in the baby.<strong></strong></p><p><strong>Conclusions: </strong>Gestational diabetes is considered as one of the risk factors for deafness in the baby. This study could not establish such a relationship.<strong></strong></p>

Giant cell tumor of the tenosynovial type in the prevertebral space with a cervical approach

<p class="abstract">The complex anatomy of the neck makes surgical interventions of cervical neoplasms a very complex process. The aforementioned challenges the surgeon to find a surgical approach with the least morbidity and cosmetic sequelae. This is particularly true in tumoral occupation of the prevertebral space (PVS), most frequently due to the extension of neoplasms from naso and oropharynx; whereas primary tumors of the PVS are extremely rare. There are a number of surgical approaches to access the skull base and the anterior region of the upper cervical spine, such as the transcervical-transtemporal approach, retraction and dissection of the soft palate, mandibular osteotomy, medial glossotomy, among others. The following article presents a case report in which a less invasive combined transcervical-transoral approach was performed on a tenosynovial giant cell tumor of the PVS. As an alternative in the treatment of these type of lesions, it is in our opinion equally effective and less morbid.</p>

A study to evaluate bone and cartilage ossiculoplasty in patients of ossicular disruption due to chronic suppurative otitis media

<p class="abstract"><strong>Background:</strong> Ossiculoplasty for ossicualar disruption in patients of chronic otitis media (COM) can be done by using either bone or cartilage. The present study was planned to compare bone and cartilage ossiculoplasty in patients of ossicular disruption due to COM.</p><p class="abstract"><strong>Methods:</strong> The prospective observational study was carried out in patients, who were admitted in the department of otorhinolaryngology of a tertiary care teaching hospital of Rajasthan during two years from November 2017 to November 2019. All patients with ossicular disruption due to COM and conductive hearing loss more than 40db were included in the study. Patients with sensorineural hearing loss were excluded from the study. Pure tone audiometry (PTA) was done before surgery. Hearing improvement was assessed 3, 6 and 12 months after surgery. </p><p class="abstract"><strong>Results:</strong> In the present study 20 patients underwent bone ossiculoplasty using autologous incus and autologous cartilage was used in 80 patients for ossiculoplasty. Post-operative hearing gain was significantly more in autologous incus patients (22.7±4.2 db) compared to autologous cartilage (19.5±3.4 db) (p=0.002).</p><p><strong>Conclusions:</strong> The present study concluded that post-operative hearing gain was significantly better with autologous incus compared to autologous cartilage although both showed good results in terms of hearing gain. </p>