Head And Neck Surgery Research Articles

Bacteriological Trends of Chronic Mucosal Otitis Media in a Tertiary Care Hospital in the Northern Region of Bangladesh

Background: Chronic otitis media (COM) is a disease of multiple etiology caused by bacteria and its importance lies in its chronicity and awful complications. The microbiological study shows the growth of a lot of organisms, frequently multiple and those differ based on geographical variation, patient population, climate, and many other factors. Objective: To evaluate current bacteriological trends of ear infections in patients with chronic otitis media which will be beneficial for appropriate treatment as well as for reducing complications. The study also focuses on rapid diagnosis by exploring other factors like age and sex-wise distribution, socioeconomic status, distribution of patients according to the type of dwelling, and bathing habits of patients. Methods: This cross-sectional, observational study was conducted in the Department of ENT and Head-Neck Surgery, Rangpur Medical College Hospital in Rangpur, a northern district of Bangladesh, over 6 months on a total of 80 patients who had attended outpatient and inpatient departments. Aural swab was taken from the discharging ears which were inoculated on blood agar and MacConkey’s agar media. The organism pattern was then tabled based on the culture reports. Results: The most common bacteria causing COM was Pseudomonas aeruginosa in (45.0%) followed by Staph. aureus (27.5%), mixed isolates in 8.75%, E. coli in 5%, Proteus in 3.75%, S. pneumoniae in 2.5%, and Klebsiella in 1.25%. Conclusion: The study proved to be useful for clinicians in management of COM and its complications. Early and effective microbiological diagnosis and intervention is the best solution. From this study, it is observed that Pseudomonas aeruginosa is the commonest pathogen for bacterial ear disease followed by S. Aureus. Mugda Med Coll J. 2023; 6(2): 83-87

Bacteriological Study and Antibacterial Susceptibility in Ludwig’s Angina in a Tertiary Level Hospital in Dhaka, Bangladesh

Background: The knowledge of the local pattern of infection and antibacterial sensitivity in Ludwig’s angina is essential to enable efficacious treatment for it. Objective: To find out the pattern of bacteria responsible for developing Ludwig’s angina and their antibacterial susceptibility. Methods: It is a prospective, observational type of study carried out in the Department of Otolaryngology & Head-Neck Surgery, Dhaka Medical College Hospital, Dhaka, and the Department of Clinical Microbiology, ICDDR, B, Dhaka, Bangladesh, between April and September of 2016. A total of 100 patients were included in this study. Results: This study was done among 100 patients. In this study, 42 cases (42%) were in the 31-45 years age group. The male patients were 60 (60%) and females were 40 (40%). Majority of patients 70(70%) came from poor class family with educational level up to HSC (75%), maximum 35(35%) patients use meswak to clean teeth, 70 (70%) patients came from rural area, 70 (70%) patients had dental infection, 25 (25%) patients had diabetes mellitus, all the cases (100%) presented with swelling in the floor of the mouth and neck, pain and tenderness and fever. The major complication was necrotizing fasciitis 8 (8%), 36 (36%) patients were discharged within 1-2 weeks after treatment, Streptococcus 40 (40%) was the most common organism and the most effective antibiotic was Ceftriaxone (65%). Conclusion: The most frequently isolated organism in Ludwig’s angina is Streptococcus and sensitivity results showed a majority of isolates are susceptible to Ceftriaxone. Mugda Med Coll J. 2023; 6(2): 71-76

Feasibility of an enhanced low-fidelity ear simulator for otomicroscopy training.

Otoscopic skills are essential for ENT doctors. Early-stage doctors develop skills whilst treating patients, with minimal teaching, potentially increasing risk to patients. Simulation allows skill development without patient risk; however, simulation often requires subjective expert review of technique. This study compared enhanced low-fidelity simulation with performance feedback against standard simulation using a basic otoscopy skills simulator. Two low-fidelity ear simulators were created: a basic model without feedback and an enhanced model which alarms when the aural instrument tip touches the canal wall. Participants were evaluated in a randomised crossover pilot study, using both models to assess whether objective feedback reduced tip touches. The enhanced simulator reduced tip touches more than the control model, suggesting better and more sustained skill uptake. Participants reported that the enhanced model improved learning. Enhanced low-fidelity models provide a low-cost opportunity to improve otoscopy skills without patient risk or the need for subjective expert feedback.

Antibiotics Prescriptions in the Otolaryngology Department of the Departmental and Teaching Hospital of Borgou-Alibori in 2020

Aims: The aim of this study was to assess the quality of antibiotic prescriptions in the ENT department of the Departmental and Teaching Hospital of Borgou-Alibori (DTH-BA).
 Study design: This was a prospective descriptive study.
 Place and Duration of Study: Departmental and Teaching Hospital of Borgou-Alibori (DTH-BA), from June 15 to September 15, 2020.
 Methodology: All patients admitted to the department during the study period who had received a on for an antibiotic and had given informed consent were recruited exhaustively. A team of experts consisting of an infectious diseases physician and an ENT physician was responsible for analyzing and assessing the quality of antibiotic prescriptions.
 Results: Of the 455 consultations recorded over the period, 141 patients were included, 132 of them treated on an outpatient basis and nine hospitalized. The most frequently diagnosed conditions were acute otitis media (AOM) in 36 patients (25%), chronic otitis media (COM) in 24 patients (16.7%) and sinusitis in 14 patients (9.7%). The most commonly prescribed antibiotics were penicillins (84 patients or 59.6%), followed by macrolides (30 patients or 21.3%) and cephalosporins (21 patients or 14.9%). Antibiotic therapy was justified in 54.6% of cases, and dosage and duration were correct in 73.9% and 37.7% respectively.
 Conclusion: This study suggests that ENT doctors should be given more training in the basics and procedures for the proper use of antibiotics.

Repetitio est mater studiorum-implementation of ENT cases in case-based e-learning

German university otorhinolaryngology has aneed for digital teaching content. Case-based e‑learning represents adigital teaching methodology. The data on student use of case-based e‑learning in university teaching of ENT medicine are limited. The aim of this work was to determine the extent to which voluntary case-based e‑learning is used by otolaryngology students and what influence the quality of the e‑learning has on motivation to use e‑learning and on the interest in otolaryngology. Fifteen voluntary e‑learning cases were created based on the content of the ENT lecture in the winter semester 2022/2023. Subsequently, adescriptive evaluation of the usage statistics of the cases of 157students was conducted. Likewise, an evaluation of the quality of the e‑learning as well as the motivation to complete it and the interest in otorhinolaryngology was carried out using avoluntary questionnaire. Voluntary case-based e‑learning was used to varying degrees by 66% of the students. The quality of e‑learning correlated significantly with the motivation and the interest in otolaryngology. The teaching content of otorhinolaryngology can be implemented sufficiently in case-based e‑learning and is characterized by satisfactory student acceptance. Integration should be accomplished in ahigh-quality manner to increase motivation and interest in otorhinolaryngology.

Chapter 5: Surgery for Neck in Well-differentiated Thyroid Cancers

ABSTRACT Thyroid cancers frequently metastasize to neck nodes. However, most of these are occult micrometastases with no impact on survival, while only a small percentage have clinically apparent neck nodes. The impact of nodal metastases on overall survival is very low, as compared to other head-neck sites and pathologies. Hence the surgical management of neck nodes has to be balanced with the likely morbidity of these procedures. This narrative review deals with the management of neck nodal metastasis of well differentiated thyroid cancers.

Incision and Drainage Versus Needle Aspiration for Peritonsillar Abscess: A Prospective Randomized Controlled Trial

Background and Objectives Peritonsillar abscess (PTA) is an accumulation of pus between the palatine tonsil and pharyngeal constrictor muscle. It is a common cause of emergency on-call consultations among ENT doctors and occurs due to the possibility of sepsis, airway obstruction, and progression to deep neck infection. This study aims to compare the effectiveness of needle aspiration (NA) to incision & drainage (I&D) for the treatment of PTA.Subjects and Method From September 2018 to March 2020, 58 patients with PTA were admitted to our ENT Department. After a comprehensive diagnostic procedure, 38 patients were enrolled in the study and they underwent either I&D (20 patients) or NA (18 patients) treatment. Patients were discharged when edema decreased on the endoscopic findings and their symptoms improved, with a visual analogue scale (VAS) score <3 points. For each patient, we evaluated the abscess volume, age, body mass index, hypertension, diabetes mellitus, smoking and drinking history, abscess size, and duration of hospitalization. White blood cell (WBC) count, C-reactive protein (CRP) level, and erythrocyte sedimentation rate (ESR) were estimated on the 1st, 3rd, and 5th days of hospitalization.Results The mean age of participants was 42.8±15.5 years and 40.3±14.7 years in the I&D and NA groups, respectively. Except for ESR, the mean hospitalization duration, initial volume of abscess size, VAS pain score, WBC count and the CRP level were not different between the groups.Conclusion Our study revealed no significant differences in hospital stay duration, VAS score, WBC counts or in the CRP level among patients admitted for PTA, whether they underwent I&D or NA.

The peritonsillar abscess and its management – is incision and drainage only a makeshift to the tonsillectomy or a permanent solution?

IntroductionThis study aims to examine the long-term management of peritonsillar abscess and compare needle aspiration, incision with drainage, and tonsillectomy in terms of comorbidities, complication rates, and recurrences in the largest study cohort published to date.MethodsWe conducted a retrospective analysis of patients, both adults and children, who were treated for peritonsillar abscess between 2007 and 2019. Patient charts were analyzed to assess surgical treatment, infection and inflammation rates, risk of bleeding, recurrence rates, duration of illness, and sick certificates. Additionally, patient imaging and blood levels were compared. Postal questionnaires were sent to all patients to evaluate subjective success rates, complications, and long-term benefits of the different treatment regimens. General practitioners and ENT doctors in private practices were contacted to gather missing data on the long-term course of the disease.ResultsA total of 821 patients with peritonsillar abscess were included in this study. Two patients had to be excluded due to incidental pathological findings. Of the remaining 819 patients, 180 were successfully treated with needle aspiration or incision. Among these patients, 37.7% required tonsillectomy during the same inpatient stay. Laboratory parameters such as leukocyte count or C-reactive protein levels were not indicative of the need for tonsillectomy. Furthermore, computed tomography was only necessary in cases of suspected parapharyngeal abscess, not in clear cases of peritonsillar abscess. Among the 641 patients who underwent tonsillectomy, 11.4% experienced postoperative bleeding requiring treatment. Only patients who underwent bilateral tonsillectomy reported recurrent episodes of sore throat and pharyngitis resulting in absence from work. The ipsilateral recurrence rate for peritonsillar abscess after needle aspiration or incision was 2.8%. There were no contralateral recurrences during the observation period.ConclusionDue to the lower risk of postoperative bleeding, shorter absence from work, and shorter inpatient stay, incision and drainage are the preferable treatment for peritonsillar abscess. Additionally, patients who underwent bilateral tonsillectomy reported higher rates of work incapacity due to sore throat caused by pharyngitis. No patient met the clear indication for bilateral tonsillectomy due to recurrent acute tonsillitis. The recurrence rate after drainage without tonsillectomy was very low (2.8% ipsilaterally, no recurrence contralaterally).

Тонзилектомія в дітей: терапевтичні можливості в оптимізації результатів хірургічного втручання

Tonsillectomy is one of the most common surgical interventions. The search for effective medical measures to optimize the course of regeneration processes in a postoperative wound is urgent. Purpose - to evaluate the effect of the complex homeopathic preparation Tonsilotren on the reparative processes of the postoperative period in children who underwent tonsillectomy. Materials and methods. The test group of 70 patients with chronic tonsillitis and 30 patients of the control group aged from 6 to 17 years were under observed and compared. All patients in the test group received Tonsilotren 7 days before surgery and for 2 weeks after surgical tonsillectomy. The examination of the ENT doctor was carried out during 5 visits: 1 visit before the operation, 2-5 visits - corresponded to the period from 1 to 14 days of the postoperative period. The results of observation were evaluated according to the following indicators: hyperemia of the mucous membrane of the faucial pillars, swelling of the mucous membrane of the faucial pillars, fibrinous pellicle in the postoperative wound, epithelization of the postoperative wound, bleeding from the postoperative wound, blood clots in the postoperative wound, scarring of the faucial pillars, pain intensity to VAS scale during swallowing and eating solid food, side effects, tolerability of the Tonsilotren medicine, complications of the disease, the need and duration of use of analgesics. Results. Prescribing of the Tonsilotren medicine to patients with chronic tonsillitis during and after surgical treatment (tonsillectomy) significantly increases the effectiveness of the treatment, namely: it helps to reduce the intensity of pain during swallowing and eating solid food, hyperemia and swelling of the mucous membrane of the faucial pillars, acceleration of epithelization of the postoperative wound, reduces scaring of faucial pillars (p<0.05). Epithelization of the postoperative wound with an area of more than 75% of its surface was observed in 24 (34.3%) patients on the 10th day and in 68 (97.1%) patients on the 14th day after the operation in the test group, while this indicator occurred in the control group only in 13 (43.3%) children on the 14th day after surgery. During observation, no side effects of the Tonsilotren medicine and adverse events were detected, which confirms the safety of its use. Conclusions. Course use of the Tonsilotren medicine in children in preparation for tonsillectomy and in the postoperative period demonstrates better effectiveness compared to standard treatment in terms of indicators of postoperative wound healing, rates of epithelization, absence of scarring and blood clots, and less pronounced pain syndrome. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Language Patterns in Letters of Recommendation for Residency Applicants in Otolaryngology.

Assess for gender and race patterns in agentic and communal language used in letters of recommendation for Otolaryngology-Head and Neck Surgery (OHNS) residency applicants. Retrospective content analysis. Applications from OHNS applications at a single training institution for the 2019 and 2020 match cycles. A total of 2283 letters of recommendation for 611 OHNS applicants were analyzed. Applicant and letter writer gender, applicant race and ethnicity, and applicant characteristics including United States Medical Licensing Examination® Step 1 score, research productivity, and medical school rank were extracted. Agentic and communal word use from the letters of recommendation was compared across applicant and writer characteristics using multilevel negative binomial regression modeling. Letter writers use a greater rate of agentic terms when describing applicants who self-identify as Asian (incidence rate ratio [IRR] = 1.16, p < .01) or "Other/not reported" (IRR = 1.23, p < .01) as compared to white applicants. Further, standardized letters of evaluation had significantly more communal language and less agentic language. Although there was an increase in communal language in letters for female applicants compared to male applicants, these gender differences disappeared in the multivariate model. Multivariate analysis demonstrated no significant gender-based patterns in the communal or agentic language in letters of recommendation for OHNS residency applicants. However, letters for applicants identifying as Asian or "other/not reported" had more frequent use of agentic terms. Future studies should investigate other components of residency applications to assess how gender and race bias might unfairly influence an applicant's chances at a given program.

Evaluation of the Factors Affecting of Epistaxis: A Study in a Tertiary Care Hospital, Dhaka.

Introduction: Epistaxis refers to the occurrence of bleeding from the nose or nasal cavity. It is widely recognized as one of the most common emergencies encountered in medical settings, particularly in the ear, nose, and throat departments, as well as in accident and emergency departments across the globe. The management of epistaxis depends on the severity of the bleeding and may involve various interventions, including conservative measures like nasal packing, cauterization techniques, or, in more severe cases, surgical interventions. Objective: The primary goal of this study was to investigate the various causes of epistaxis. Materials and Methods: This cross-sectional observational study was conducted at the Department of Otolaryngology and Head-Neck Surgery (ENT) in City Medical College &amp; Hospital from May 2021 to April 2023. The study involved 220 patients who presented with epistaxis complaints at the ENT Outpatient Department or Emergency unit of hospital. Diagnosis of the cases was based on their medical history, clinical examination, radiological and laboratory investigations. Result: 220 patients were studied during the period. The mean age ± standard deviation was determined to be 36.67 ± 18.06 years. The age range spanned from 1 to 85 years. Patients less than 25 years old were 124 (56.36%) and more than 25 years old were 96 (43.74%). Males (139) predominated in both indoor and outdoor patients with a male-to-female ratio of 1.7:1. The nasal cavity most involved was left 103 (47%) compared to right 85 (38.6%). Bilateral involvement was seen in 32 (14.4%) cases. Higher incidence was also noticed during winters 93 (42.1%), followed by summer 63 (28.7%), then autumn 38 (17.2%), and least in spring 26 (11.9%). The circadian rhythm was also noted where we found epistaxis to be more during night 82 (37.6%), followed by evening 78 (35.3%), and finally morning 60 (27.1%). Previous history of hypertension (HTN) is seen in 26.3% of cases (58). The history of taking medications with hemorrhagic risk currently or stopped within the last 10 days was 3.5% (8). We also found a relationship between the age group (&lt;25 years, &gt; 25 years) and the type of treatment. Conclusion: Epistaxis, or nosebleeds, can be caused by various factors such as trauma, inflammation, tumors, blood disorders, cardiovascular issues, and foreign bodies. Younger individuals are more prone to traumatic causes, while older individuals may experience more severe nosebleeds. Hypertension is a significant contributor, emphasizing the importance of blood pressure management. Understanding these diverse causes is crucial for effective treatment and prevention of potential complications. Medicine Today 2023 Vol.35(2): 124-128

Tinnitus characteristics and risk factors in the Bali region

Introduction: It has been recognized that suitable external sounds can reduce or even make tinnitus impossible to hear. The working principle of sound therapy will be used to create a new tool or approach that suits the conditions of Indonesian society. This study aimed to describe the characteristics of tinnitus and its associated risk factors. Method: This was a cross-sectional study conducted in Denpasar City, Gianyar Regency, and Badung Regency for one year. Patients who visited the ENT doctors' practices in these areas were interviewed with prepared instruments. The patients were then subjected to clinical and audiometric examinations. The data will be analyzed descriptively to get an overview of tinnitus's sociodemographic and clinical characteristics. Result: A total of 101 participants were included in this study. Most tinnitus patients were unilateral on the left side of the ear. The most common sound is ringing, up to 70.3% of 101 research subjects, followed by sound types such as pulse and roaring sound. Furthermore, the frequency and amplitude of tinnitus sounds are quite varied, but the majority is dominated by high frequencies (3000 - 8000Hz). Based on the ear affected, the largest number of tinnitus sufferers were found in the left ear (47.0%). In this study, 82 people (81.2%) had a history of frequently using earphones, while 19 other people never used earphones in everyday life. Among all participants, 95 people (94.1%) were not exposed to noise at work. Conclusion: The clinical characteristics of the tinnitus sound type were mostly ringing sounds, followed by pulse-like sounds and buzzing sounds. The frequency and amplitude of tinnitus sounds quite varied. Stress factors and the use of earphones occur in most tinnitus sufferers.

Dissection Method and Diathermy Cauterization in Tonsillectomy- A Hospital Based Comparative Study

Tonsillectomy is one of the most common procedures performed by otolaryngologists. It is a surgical operation that removes both palatine tonsils from the tonsillar fossa. It is typically performed in youngers for recurrent tonsillitis and tonsillar hypertrophy. This study was done to compare the dissection and diathermy methods of tonsillectomy and evaluate their advantages and disadvantages during surgery and convalescence. This study was a retrospective analysis of 400 patients from January 2015 to January 2020 in Otorhinolaryngology and Head-Neck Surgery department of Bangabandhu Sheikh Mujib Medical College Hospital, Faridpur. Out of 400 patients 200 patients underwent tonsillectomy by dissection method and rest 200 patients underwent electrocautery method. Total 400 patients were analyzed separately their hospital stay, blood loss per-operatively, complications in each method and overall outcome of the patients. The overall hospital staying in both types was 1-3 days. The average intra operative blood loss was 5-7 ml in cautery and average 50 ml in dissection method. The average operative time was 25-30 minutes in dissection method and 10-15 minutes was in electrocautery. We found higher amounts of blood loss and intra - operative time in dissection method than electrocautery. The chance of secondary haemorrhage was more in electrocautery method than dissection method. Pain, scar formation, odynophagia were more in cauterization method. Complete healing time was more in cauterization method than dissection method. There was no death in both methods. Although per-operative blood loss, operation time were less in cauterization method but post operative bleeding, pain, odynophagia and infection were more in electro cauterization method. In both methods, there were some advantages and some disadvantages. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(1): 40-44

Risk Factors of Oral Carcinoma in a Tertiary Level Hospital in Bangladesh

Background: Cancer continues to be a major health problem despite advances in medical technology for its diagnosis and treatment. Oral cancer is the eighth most common cancer in the world. Oral cancer is a multifactorial disease- smoking, betel-nut and betel-leaf chewing habit, bad oral hygiene, and drinking alcohol are the most important factors associated with oral cancer Objectives: To identify the risk factors of oral cancer in a tertiary level hospital in Bangladesh. Methods: A total of 52 patients, aged between fifth to seventh decades, were included in this observational type of cross-sectional study. The study was conducted over the period of six months, from March to August, 2016, in the department of ENT &amp; Head Neck surgery in Dhaka Medical College Hospital, Dhaka. Patients were randomly assigned to one of three groups by card sampling. Results: Among the 52 patients with oral cavity carcinoma, 30(57.69%) were males and 22(42.31%) females. Most patients were from rural areas (30, 57.69%), including agricultural workers 17(32.69%), daily labourers (5, 9.62%), fishermen (3, 5.77%) and others (5, 9.62%). High-risk habits were prevalent among the cases, with 24(46.14%) engaged in Pan (betel leaf) chewing and 15(28.85%) in smoking. Clinical features included ulceration, neck lump, pain, swelling, dysphagia, and bleeding. The most affected areas were buccal mucosa (19, 36.54%) and oral tongue (14, 26.92%). Histopathologically, 27(42.31%) were well-differentiated, 22(51.92%) moderately differentiated, and 3(5.77%) poorly differentiated squamous cell carcinoma. The study provides insights into the demographics and characteristics of oral cavity carcinoma patients. Conclusion: Personal habits like pan, betel-nut, tobacco chewing, ignorance, lack of proper education of oral hygiene, lack of medical facilities and poor referral system are the common factors for aggressiveness of the disease. Journal of Monno Medical College, June 2023; 9 (1): 11-14

Indications and Outcomes of Tracheostomy: A Descriptive Study Using the Outcome-Based Evaluation Forms of Otorhinolaryngology - Head and Neck Surgery Department in a Tertiary Hospital (2016-2020)

Introduction: Tracheostomy is a surgical procedure that creates a neck opening directly into the trachea, typically performed to establish an alternative airway for individuals who experience difficulty breathing as a result of certain medical conditions. Tracheostomy can be temporary or permanent, and it plays a crucial role in the management of both acute and chronic respiratory issues and can significantly improve the quality of life for those who require it. Objective: This study aims to investigate the incidence, common indications and outcomes of tracheostomy in the Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) department of a tertiary hospital in Manila, Philippines. Methodology: This is a retrospective descriptive study including all admissions and in-patient referrals to the clinical division of the Department of Otorhinolaryngology-Head and Neck Surgery who underwent tracheostomy from January 2016 to December 2020. Data were retrieved by review of medical records and Outcome Based Evaluation (OBE) form of all patients who underwent tracheostomy during the study period. Results: Our study involved 74 patients with a male-to-female ratio of 22:15. The patients' ages ranged from 5 to 89 years. Prolonged intubation was the main reason for tracheostomy, followed by upper airway obstruction due to supraglottic mass for males and vocal cord paralysis for females. Only three patients who had tracheostomy experienced complications and were managed accordingly. Conclusion: Tracheostomy is one of the most valuable and reliable surgical procedures for managing airway obstructions. Proper patient and caregiver education as well as constant follow-up are crucial to prevent complications. Keywords: Airway, Tracheostomy, ORL-HNS, Outcome Based Evaluation form, Head and Neck Surgery

Epidemiological Study and Surgical Outcome of Preauricular Sinus

Background: Preauricular sinus (PrAS) is a common congenital external ear malformation affecting mainly children. Symptomatic Preauricular sinus and asymptomatic for unusual scar marks, surgery is the mainstay of treatment. Due to variationsin presentation and recurrence, surgeons practice different surgical procedures to treatthe Preauricular sinus.&#x0D; Objectives: To compare the relative frequency and incidence of the Preauricular sinus and find the best surgical approach. Methods: It is a cohort retrospective study of forty-four cases of Preauricular sinus in the Department of Otorhinolaryngology and Head-Neck Surgery, Comilla Medical College, Bangladesh, from 01-07-2016 to 31-06-2019. All forty-four patients were clinically diagnosed with Preauricular sinus and confirmed by history, examination, and investigations. Special investigations included Audiological analysis and Ultrasonography of the renal system.&#x0D; Results: Theincidence of Preauricular sinus out of 1,16,128 patients in the outpatient department was 44 (0.05%), and out of inpatient routine operative 2738 patients were 1.61%. Fortypatients (90.90%) were treated by traditional sinusectomy, and the rest of the four patients (9.10%) were treated by extended supra-auricular sinusectomy procedures. Relapse was taken place in two patients (4.54%). Gender issuance shows that female was 24(54.54%) and males was 20(45.46%). The age distribution exhibited in the case of children was 34(77.27%), and adult, was 10(22.73%). Anatomical site allocation reveal that right side was 22(50%), left side was 20(45.45%), bilateral was 2(4.55%) whereas unilateral was 42(95.45%). Presenting features display non-infected putty like discharge was 21(47.72%), infected abscess was 19(43.18%) and asymptomatic was 4(9.1%). A syndrome related tothe Preauricular sinus was not found in our study.&#x0D; Conclusion: Children were more affected by the Preauricular sinus as a congenital disease. Incidence and recurrence are always countable fromthe perspective of treatment. As surgery is the treatment principle, it should be perfect without recurrence. We appreciate the supra-auricular approach for the excision of the Preauricular sinus, which best complements the patient’s wishes.&#x0D; J Com Med Col Teachers Asso Jan 2023; 27(1): 09-13

Acute sore throat in frequently ill children: potential of topical therapy

Sore throat is the most common reason for visiting primary care doctors, pediatricians, and ENT doctors. Acute sore throat, as a rule, is not an independent disease and most often accompanies tonsillopharyngitis caused by respiratory viral infections. In childhood, the share of acute respiratory viral infections among other infectious diseases can reach up to 90%, and the proportion of frequently ill children ranges from 30 to 50%. A feature of frequently ill children is a high incidence of illness, regardless of seasonality, and a tendency to a protracted course of the inflammatory process. Uncontrolled systemic antibiotic therapy for acute sore throat in frequently ill children leads to the development of dysbacteriosis and a decrease in mucosal immunity. The use of the topical antibacterial drug Faringazon for sore throat in children reduces inflammation in both viral and bacterial infections and reduces the need for systemic antibiotic therapy. The active substance of Ambazon has a bacteriostatic effect when is kept in the mouth until it resorbs and is effective against Streptococcus haemolyticus, Streptococcus pneumoniae, Streptococcus viridans, and also has antifungal effects against Candida albicans yeast fungus, which is a saprophyte, but exhibits pathogenic properties in decreased body’s immune defence and dysbiosis. The use of topical antimicrobial therapy helps reduce inflammation and speed up the recovery of patients without prescription of systemic antibiotics, and also ensures the preservation of microbiome, reducing the probability of emergence of antibiotic resistant strains to the minimum.

Клинический случай транссудативной отслойки сетчатки при этмоидите

A clinical case of diagnosis and treatment of transudative retinal detachment in ethmoiditis was analyzed. Application of modern diagnostic methods allowed to determine transudative retinal detachment. MRI of the sinuses made it possible to find evidence for ethmoiditis. Confirmation of the diagnosis and treatment by an ENT doctor led to the patient's recovery. Keywords: transudative retinal detachment, ethmoiditis

Impact of Perioperative Immunonutrition on Postoperative Outcomes for Patients Undergoing Head and Neck or Gastrointestinal Cancer Surgeries: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

To clarify whether perioperative immunonutrition is effective in adult patients with or without malnutrition undergoing elective surgery for head and neck (HAN) or gastrointestinal (GI) cancers. It is important to avoid postoperative complications in patients with cancer as they can compromise clinical outcomes. There is no consensus on the efficacy of perioperative immunonutrition in patients with or without malnutrition undergoing HAN or GI cancer surgery. We searched MEDLINE (PubMed), MEDLINE (OVID), EMBASE, Cochrane Central Register of Controlled Trials, Web of Science Core Selection, and Emcare from 1981 to 2022 using search terms related to immunonutrition and HAN or GI cancer. We included randomized controlled trials. Intervention was defined as immunonutritional therapy including arginine, n-3 omega fatty acids, or glutamine during the perioperative period. The control was defined as standard nutritional therapy. The primary outcomes were total postoperative and infectious complications, defined as events with a Clavien-Dindo classification grade ≥ II that occurred within 30 days after surgery. Of the 4825 patients from 48 included studies, 19 had upper GI cancer, 9 had lower, and 8 had mixed cancer, whereas 12 had HAN cancers. Immunonutrition reduced the total postoperative complications (relative risk ratio: 0.78; 95% CI, 0.66-0.93; certainty of evidence: high) and infectious complications (relative risk ratio: 0.71; 95% CI, 0.61-0.82; certainty of evidence: high) compared with standard nutritional therapy. Nutritional intervention with perioperative immunonutrition in patients with HAN and GI cancers significantly reduced total postoperative complications and infectious complications.

Promoting Surgeon-Scientists in Otolaryngology–Head and Neck Surgery—From Bench to Bedside

Surgeon-scientists (defined as principal investigators [PIs] with a Doctor of Medicine [MD] degree or a combined MD and Doctor of Philosophy [PhD] degree) in otolaryngology-head and neck surgery (OHNS) are imperative for achieving clinical translation in the OHNS field. To (1) raise awareness about the current state of surgeon-scientists in OHNS, (2) contextualize the landscape of surgeon-scientists in OHNS by comparing it to those of neurosurgery and ophthalmology, and (3) identify strategies for attracting and retaining surgeon-scientists in OHNS. Research funding data from fiscal years 2015 to 2021 among surgeon-scientists in OHNS, neurosurgery, and ophthalmology were obtained from the National Institutes of Health (NIH) Research Portfolio Online Reporting Tools Expenditures and Results and the US Department of Defense (DOD) Congressionally Directed Medical Research Programs awards database. The Association of American Medical Colleges provided the total number of active physicians in each specialty per year and the number and percentage of residents with an MD-PhD degree in each specialty per year. Cohen d was used to express the standardized value of the magnitude of the mean difference between compared groups. From 2015 to 2021, on average, there were 9566 active physicians in OHNS, 5559.8 in neurosurgery, and 18908.8 in ophthalmology. In OHNS, a greater number of NIH K (research career development) grants were held by surgeon-scientists than by PIs with a PhD degree (21.4 vs 5.1; mean difference, 16.3; 95% CI, 14.3-18.3; Cohen d = 9.6), whereas most NIH R (research) and U (cooperative agreement) grants (144.1 vs 81.6; mean difference, 62.6; 95% CI, 46.3-78.9; Cohen d = 4.5) and DOD grants (9.9 vs 4.1; mean difference, 5.7; 95% CI, 1.0-10.4; Cohen d = 1.4) were held by PIs with a PhD degree. In a comparison of OHNS to neurosurgery and ophthalmology, after the number of R and U grants was scaled by the number of physicians in each field, neurosurgery had a much greater number of grants per surgeon than OHNS (0.02 vs 0.01; mean difference, 0.01; 95% CI, 0.01-0.02; Cohen d = 4.2). Additionally, neurosurgeons received a much larger R and U grant amount per physician than otolaryngologists ($10 630.20 vs $4511.80; mean difference, $6118.40; 95% CI, $2625.90-$9610.80; Cohen d = 2.0). For the R and U grant metrics, there were no meaningful differences between OHNS and ophthalmology. Results of this database study showed that from 2015 to 2021, the number of governmental grants held by surgeon-scientists in OHNS increased, but there is room for improvement given the metrics of neurosurgeons, a population smaller than otolaryngologists. Possible strategies include intramural research grants, surgeon-scientist training programs, and partnerships between specialty societies and NIH administering institutes and centers.