Outpatient Department Of Otorhinolaryngology Research Articles

Endoscopic dacrocystorhinostomy: Reasons for failure and possible solutions.

Endoscopic dacryocystorhinostomy is a well-established procedure with high success rate. There are multiple causes of failure of this procedure which affect surgical success. To analyze causes of failure in endoscopic dacryocystorhinostomy and ascertain methods to overcome causes of failure. After approval from the Institutional Review Board a retrospective review of 119 patients was undertaken over an 11-year period from 2008 to 2018. A tertiary care hospital in North India. Patients presenting to the Otorhinolaryngology out-patient department and diagnosed as failed endoscopic dacryocystorhinostomy cases. After thorough preoperative workup consisting of history, examination and diagnostic nasal endoscopy, patients underwent revision endoscopic dacryocystorhinostomy. After exclusion of 2 cases, 117 patients were included in the study. The mean age at presentation was 31.4 years. Number of previous surgeries: 92 patients had had one surgery, 20 patients had had two surgeries, 5 patients had had three surgeries and 9 patients had had multiple surgeries before presentation. All patients (100%) had epiphora, 75 (64.1%) patients had associated discharge and 4 (3.4%) had persistent medial canthal swelling. Duration of symptoms following previous surgery was 1-6 weeks. Commonest cause of failure was incomplete sac exposure in 117/117 cases (100%). Other causes were cicatricial closure of ostium in 47 (40.1%), synechiae in 20 (17%), canalicular obstruction in 4(3.4%), lacrimal sac diverticulum in 3 (2.5%), nasal polyps in 2 (1.7%), concha with adhesion in 2 (1.7%), septal deviation in 2 (1.7%) cases. Meticulous and thorough sac exposure is the most important factor affecting surgical success. Comprehensive preoperative assessment of cases, meticulous surgical technique, and postoperative follow up are needed for successful outcomes.

Demographic and Clinical Features of Allergic Rhinitis Presenting at a Postgraduate Teaching Hospital

Allergic rhinitis is a common disorder that affects millions worldwide and it represents a global concern. Objective: To determine the frequency of clinical variables, and demographic pattern of the allergic rhinitis patients in the otorhinolaryngology outpatient department in a Teaching Hospital. Methods: This cross-sectional study was conducted at the Department of Ear, Nose, and Throat of Kulsumbai Valik Site Postgraduate Teaching Hospital Karachi from 1st July 2022 to 31st December 2023. The study comprised allergic rhinitis patients. A total of 750 patients were included in this study after diagnosing allergic Rhinitis mentioned on their prescription. Data were collected properly on a predesigned questionnaire. Variables included age, gender, socioeconomic status, residence, sneezing, itching in the eye and nose, rhinorrhea, nasal discharge, bluish pale nasal mucosa (Nasal Congestion), edematous turbinate, and headache. Data were entered in SPSS software version 23.0 and analyzed. Results: The mean age of patients were 39 ± 13 years. Male were reported 447 (59.6%) and female patients were 303 (40.4%). 390 (52%) patients have resided in Industrial areas while 360 (48%) patients were in city areas. The most common symptom was nasal itching 522 (69.6%) followed by rhinorrhea 492 (65%) and nasal discharge 465(62%). Conclusions: It was concluded that allergic rhinitis patients presenting at the ENT outpatient department showed that males were commonly affected with the productive age group 59% of males suffered from Allergic Rhinitis. The most frequent and common symptom was nasal itching (69.6%) followed by rhinorrhea (65%) and nasal discharge (62%).

Risk Factors for Isolated Sphenoid Sinusitis after Endoscopic Endonasal Transsphenoidal Pituitary Surgery.

(1) Background: Transsphenoidal pituitary surgery can be conducted via microscopic or endoscopic approaches, and there has been a growing preference for the latter in recent years. However, the occurrence of rare complications such as postoperative sinusitis remains inadequately documented in the existing literature. (2) Methods: To address this gap, we conducted a comprehensive retrospective analysis of medical records spanning from 2018 to 2023, focusing on patients who underwent transsphenoidal surgery for pituitary neuroendocrine tumors (formerly called pituitary adenoma). Our study encompassed detailed evaluations of pituitary function and MRI imaging pre- and postsurgery, supplemented by transnasal endoscopic follow-up assessments at the otolaryngology outpatient department. Risk factors for sinusitis were compared using univariate and multivariate logistic regression analyses. (3) Results: Out of the 203 patients included in our analysis, a subset of 17 individuals developed isolated sphenoid sinusitis within three months postoperation. Further scrutiny of the data revealed significant associations between certain factors and the occurrence of postoperative sphenoid sinusitis. Specifically, the classification of the primary tumor emerged as a notable risk factor, with patients exhibiting nonfunctioning pituitary neuroendocrine tumors with 3.71 times the odds of developing sinusitis compared to other tumor types. Additionally, postoperative cortisol levels demonstrated a significant inverse relationship, with lower cortisol levels correlating with an increased risk of sphenoid sinusitis postsurgery. (4) Conclusions: In conclusion, our findings underscore the importance of considering tumor classification and postoperative cortisol levels as potential predictors of postoperative sinusitis in patients undergoing transsphenoidal endoscopic pituitary surgery. These insights offer valuable guidance for clinicians in identifying at-risk individuals and implementing tailored preventive and management strategies to mitigate the occurrence and impact of sinusitis complications in this patient population.

Chronic Suppurative Otitis Media: A Prospective Descriptive Study of the Microbiology and Antimicrobial Susceptibility Patterns.

This study aims to identify dominant causative pathogens of chronic suppurative otitis media (CSOM) and their antimicrobial susceptibility patterns. The secondary objective is to assess the cholesteatoma concurrence among this population. A prospective descriptive study. Port Elizabeth Provincial Hospital, Eastern Cape, South Africa. Aural swabs of purulent otorrhoea were collected from patients with CSOM attending the otorhinolaryngology outpatient department between April 2022 and June 2023. Samples were analyzed to determine the microbiological spectrum and evaluate antimicrobial sensitivities. Patient files were reviewed to identify cases with cholesteatoma. The study population size of 169 enabled representative results for a confidence interval of 90%. Patients were divided into 2 age categories: children (0-12 years) and adults (>12 years). Adults represented the majority of cases (76.9%) and females (58.6%) were affected more than males. Fungal isolates, Candida species and Aspergillus species, were the most common (20.8%). This was followed by Pseudomonas aeruginosa (12.4%) and Staphylococcus aureus (11.8%). 3.6% of cases cultured Mycobacterial tuberculosis which was high compared to global estimates. Susceptibility patterns showed 94.3% sensitivity of fungal cultures to fluconazole. Pseudomonas aeruginosa was 100% susceptible to piperacillin-tazobactam and cefepime, but only 76.2% sensitive to ciprofloxacin. Cholesteatoma concurrence was identified in 17.8%. CSOM remains a public health challenge. This study highlights the need to consider fungal etiology in instances where standard antibiotic treatments prove ineffective. Given the variety of cultured organisms and their susceptibility patterns, incorporating culture-directed therapy should be considered standard practice for chronic otorrhoea patients.

Diagnostic spectrum of cysts of head and neck: Case series and review of literature

One of the foremost problems that brings patients to Otorhinolaryngology clinics are cystic swellings in the head and neck region. We aimed to study the presentation, configuration of cystic swellings of head and neck for diagnosis and management. A retrospective study of 30 patients belonging to diverse age group and presenting with complaints of swelling in the craniofacial domain to the otorhinolaryngology outpatient department was conducted. Based on the characterization of cystic swellings of head and neck, most turned out to be usually benign. The most common cyst was epidermoid cyst (56%), followed by second arch branchial cyst (26%). A single case each of nasopalatine cyst and intra-parotid lymphatic cyst was also reported. Swellings in the head and neck can have various presentations. Cytologic examination of head and neck cysts along with pre-operative clinical examination and imaging offer imperative information concerning the nature of the cystic lesions, and may rarely lead to any misdiagnosis.

Laser acupuncture and photobiomodulation therapy in Bell’s palsy with a duration of greater than 8 weeks: a randomized controlled trial

To investigate the efficacy of laser acupuncture and photobiomodulation therapy in alleviating symptoms among patients diagnosed with Bell’s palsy with duration of greater than 8 weeks. The randomized controlled trial has been performed from May 2021 to April 2023. Patients were eligible who had Bell’s palsy with duration of greater than 8 weeks on out-patient Department of Otorhinolaryngology in Beijing Tongren Hospital. The laser acupuncture group received class IV laser treatment for 3 times per weeks, a total of 72 times. The control group received the same treatment procedure except the laser parameter. The primary outcome measures comprised House–Brackmann facial nerve grading system and electroneurography. Secondary outcome measures comprised Sunnybrook facial grading system, electromyography, and the blink reflex. A total of 84 participants were included (42 control group, 42 laser acupuncture group). After treatment, House–Brackmann facial nerve grading system (OR, 0.11; 95% CI, 0.04–0.30; P < 0.001), and the pathologic numbers of electroneuronography were statistically different between the laser acupuncture group and control group, including orbicularis oculi (OR,0.08; 95% CI, 0.02–0.21; P < 0.001), Frontalis muscle (OR,0.14; 95% CI, 0.05–0.39; P < 0.001), Orbicularis oris (OR,0.13; 95% CI, 0.04–0.36; P < 0.001), Ala nasi muscle (OR,0.06; 95% CI, 0.02–0.18; P < 0.001). In secondary outcomes, Sunnybrook facial grading system, has significant difference between the two groups (20.26; 95% CI, 14.69 to 25.83; P < 0.01). Latency by ENoG, include orbicularis oculi (-0.61; 95% CI, -0.43 to -0.09; P < 0.001), frontalis muscle (-0.12; 95% CI, -0.21 to -0.03; P < 0.01), orbicularis oris (-0.28; 95% CI, -0.41 to -0.16; P < 0.001), and ala nasi muscle (-0.26; 95% CI, -0.38 to -0.16; P < 0.001). All amplitudes of MUAPs and durations by electromyography (EMG) showed statistically significant differences compared with the control group after treatment. For the frontalis muscle, the amplitude of MUAPs was -64.23 (95% CI, -80.89 to -47.56; P < 0.001) and duration was -1.18 (95% CI, -1.49 to -0.87; P < 0.001). For orbicularis oris, amplitude of MUAPs was -29.82 (95% CI, -55.03 to -4.62; P = 0.02) and duration was -0.57 (95% CI, -0.94 to -0.20; P < 0.001). For depressor angulli oris, amplitude of MUAPs was -47.06 (95% CI, -62.15 to -31.97; P < 0.001) and duration was -2.21 (95% CI, -2.69 to -1.72; P < 0.001). Blink reflex, including R1 (OR, 0.03; 95% CI, 0.01–0.16; P < .001), R2 (OR, 0.04; 95% CI, 0.004–0.29; P < .001), and R2 latency differences (OR, 0.15; 95% CI, 0.05–0.51; P < .001), have significant difference between the two groups, respectively. The findings suggest that laser acupuncture relieve symptoms for patients with Bell’s palsy with a duration of greater than 8 weeks.Trial registration: ClinicalTrials.gov Identifier: NCT05846217.

Nasal Microbiota and Sensitivity Pattern in Rhinosinusitis.

To know the microorganism causing rhinosinusitis & to study the antibiotic sensitivity pattern for the isolated nasal microbiota in this region. Rhinosinusitis is inflammatory condition of nose and paranasal sinuses [1]. It is multifactorial condition, in which microorganisms play pathogenic role [2]. Interactions between microorganisms, mucosa and environmental changes influence on composition of bacterial ecosystem [2]. Though antibiotics are frequently used for medical management of rhinosinusitis, sensitivity directed antibiotics are rarely prescribed. So, this study is directed to know microbial isolate in rhinosinusitis and its antibiotic sensitivity pattern. in this 6 months prospective study during March to September 2022, done at Department of Otorhinolaryngology, Raichur Institute of Medical Sciences, Raichur; patients attending Otorhinolaryngology outpatient department and diagnosed to have rhinosinusitis were selected. Nasal swabs were collected from the middle meatus by diagnostic nasal endoscopy and were sent for culture and sensitivity. Statistical tests were applied for results(Size = 100). Out of 100 patients, 52 were males, 48 were females; 88 were adults & 12 were paediatric patients. 59 patients had acute, 32 chronic and 9 had recurrent rhinosinusitis. Most common organisms isolated in acute rhinosinusitis was Klebsiella 28%, Staphylococcus aureus 56% & 66% in chronic & recurrent rhinosinusitis respectively. Klebsiella was sensitive to beta lactams & quinolones, while Staphylococcus aureus was sensitive to beta lactams & cephalosporins. Increase in antibiotic use has led to antibiotic resistance. Hence judicious, sensitivity directed antibiotic usage reduces the risk of antibiotic resistance and unnecessary use of antibiotics.

Prognostic Significance of Pre-Treatment Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Head and Neck Malignancies.

Carcinoma is the second most common cause of death worldwide. The neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR) are essential markers of inflammation and tumorigenesis in various cancers including head and neck cancers. Pretreatment platelet- lymphocytic ratio can be used as an independent predictor of mortality whereas neutrophil- lymphocytic ratio is an independent predictor of recurrence. The main aim of this study is to compare the pre-treatment neutrophil lymphocyte ratio and platelet-lymphocyte ratio in the patients of head and neck malignancies with those of the control group. 100 patients with histologically diagnosed cases of head and neck malignancies. Age and sex matched healthy subjects attending Otorhinolaryngology out-patient department for any other complaints (100 control subjects). Complete blood count had been done to calculate absolute neutrophil count and absolute lymphocyte count. The mean age of the subjects in the study group was 55.73 ± 11.56years. In control group, the mean age group was 54.11 ± 10.46years. NLR and PLR significantly increased in cases than controls. NLR associated with T stage, histological type and histological grade but not with site and nodal involvement. PLR associated with T stage, metastasis but not with the histological grade, histological type, site and nodal involvement. From this study, we conclude that pre-treatment NLR and PLR were closely associated both with the size of primary tumor and also with the stage of malignant disease in patients of head and neck malignancies.

Diphtheritic tonsillitis in an immunized adult: A case report

Corynebacterium diphtheriae is a Gram-positive bacillus which can be either toxigenic or non-toxigenic depending on the production of the diphtheria exotoxin. Diphtheria is a potentially fatal infectious disease caused by toxigenic strains of C. diphtheriae. Despite the national immunization program, India accounts for approximately 20% of the total cases according to the recent World Health Organization reports. Even though it is a vaccine preventable disease, cases are being reported, which may be due to lack of booster doses or waning of immunity with increasing age. Here, we report a case of diphtheritic tonsillitis in a 30-year-old immunized adult who came to the otorhinolaryngology outpatient department with acute onset of throat pain and difficulty in swallowing. C. diphtheriae was isolated from bacteriological culture of throat swab. The patient was symptomatically better with 2 weeks of treatment with oral erythromycin 500 mg twice a day.

Effects of Increased Nasal Volume due to Topical Adrenaline on the Voice

Resonance properties of the nasal and sinus cavities are involved in the individuality of speech. However, detailed information on how alterations in the nasal cavity morphology affect voice quality is lacking. The aim of the present study was to investigate the effects of structural changes in the nasal cavity on voice production by spraying a topical adrenaline solution with a vasoconstrictive effect into the nasal cavity, causing nasal mucosal contraction. Prospective. Overall, 51 adult volunteers were recruited from the Otorhinolaryngology Outpatient Department of the Jikei University Hospital from June to September 2022. Among them, 20 completed acoustic rhinometry and voice recordings before and after adrenaline spraying. The nasal consonant [N] uttered with the mouth completely closed was recorded for 5seconds. The remaining 31 volunteers completed all auditory experiments. This was conducted to determine whether the changes in voice before and after adrenaline spraying could be discriminated against by the participants. The nasal volume had increased 5 and 10minutes after spraying compared to that before spraying, reaching a significance at 10minutes (P=0.06). It had increased at 2 and 5cm from the external nostrils compared to that within 3cm of the external nostrils (P=0.04). Among the 31 volunteers in the auditory experiments, 30 had a discrimination rate >90%, with a mean of 96.3% (standard error, 3.2). The spectral envelope of the 16 frequency bands varied significantly at 500-Hz increments (P=0.0006). In particular, changes in the high-frequency bands were larger between 4500 and 6000Hz. Nasal enlargement with 0.02% topical adrenaline affects the spectral envelope, particularly in the high-frequency bands between 4500 and 6000Hz, and perceptibly alters the voice.

The effect of accompanying anxiety and depression on patients with different vestibular syndromes.

This study aims to investigate the situation of vertigo disorder combined with anxiety and depression in patients with different types of vestibular syndrome. A total of 330 patients with vertigo in otolaryngology outpatient department were selected, and clinical information such as age, gender, and scores of Dizziness handicap inventory (DHI), Generalized anxiety disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) were collected. Analyzed the differences among acute vestibular syndrome (AVS), episodic vestibular syndrome (EVS) and chronic vestibular syndrome (CVS) in terms of age, gender, comorbid anxiety and depression, and the multivariate ordered logistic regression analysis was used to evaluate the relationship between the above factors and the degree of vertigo disorder. The three types of vestibular syndrome had no significant difference in age composition, sex composition, anxiety and depression. There was no significant difference in the probability of anxiety and depression among vertigo patients of different ages and genders. The total score of vertigo disorder and each sub-item score were higher in patients with anxiety and depression. Patients with anxiety mainly manifested in EVS and CVS, while patients with depression mainly manifested in EVS and AVS. The probability of increased vertigo in anxious patients was 4.65 times that of non-anxious patients, and the probability of increased vertigo in depressed patients was 3.49 times that of non-depressed patients. Age and gender had no statistically significant effect on the degree of vertigo. In patients with EVS, anxiety and depression had a significant effect on the degree of vertigo; in patients with CVS, anxiety had a significant effect on the degree of vertigo, but depression had no significant effect. Age and gender do not significantly affect the degree of vertigo disorder and mental state in various vestibular syndromes. Instead, anxiety and depression are the risk factors for aggravating the degree of vertigo disorder, and manifest differently in each type of vestibular syndrome. Therefore, it is necessary to use a quick scale tool to conduct a standardized screening of the psychological status of patients with vertigo.

A Clinico- Etiological Evaluation of Vocal Cord Paralysis

Introduction: This is a case study of 61 cases admitted in our hospital to study the various etiologies of vocal cord immobility (including both paralysis and paresis of vocal cord) and to study the incidence of vocal cord immobility.Vocal cord paralysis is a common symptom of the disease which can be originated from laryngeal nerve paralysis following laryngeal carcinoma, oesophageal carcinoma, bronchogenic cancers, thyroid neoplasms, surgical procedures in neck and thorax, post anaesthesia complication,or neurologic diseases. Materials and methods: The present study includes all the cases having vocal cord paralysis presenting in out-patient department of Otorhinolaryngology, examination of larynx externally,by indirect laryngoscopy and direct laryngoscopy was done.All the routine and systemic examination were done. Results: In our study, left vocal cord was the most commonly involved and was observed in 40(65.5%) patients, with neoplasm being the most common cause in 19(31.1%) patients. Right vocal cord involvement was found in 20(32.8%) patients, with neoplasm being the most common cause in 13 (21.3%) patients. The ratio of left side and right side involvement of vocal cord was 2:1 in our study. The longer course of the Left Recurrent Laryngeal Nerve might account for the difference. Conclusion: In our study the etiology which was found to be more common was neoplasms then that of idiopathic causes. The reason behind this could be advanced investigation procedures which allows us to do a thorough work upon any case, but even after that we have found some of Idiopathic causes as well.

ASSESSMENT OF OUTCOME OF FUNCTIONAL ENDOSCOPIC SINUS SURGERY IN PATIENTS WITH CHRONIC SINUSITIS WITH OR WITHOUT SINONASAL POLYPOSIS

Introduction:- Chronic rhinosinusitis is a multifactorial disease causing inammation of sino-nasal mucosa. Functional endoscopic sinus surgery (FESS) causes less morbidity, complication and less recurrence rates. This study aims to assess various presenting symptoms, nasal endoscopic and Computed tomography (CT) ndings, to compare relief of various symptoms &amp; to conrm the effectiveness of FESS as standard modality of treatment. Methodology:- In this study we include 100 cases of chronic sinusitis with or without sinonasal polyposis age between 15 to 65 years attending otorhinolaryngology outpatient department which full our inclusion criteria &amp; undergoing Functional endoscopic sinus surgery. All the patients were pre- &amp; post-operatively evaluated clinically using Rhinosinusitis symptom inventory score in to major &amp; minor criteria, radiologically and endoscopically. The overall result reveal male is to fe Results:- male ratio was 1:1.27. Preoperatively on CT scan and endoscopic examination most commonly involved sinus was max illary sinus 99% &amp; anterior ethmoid sinus (70%), most common anatomical variation was Deviated nasal septum/spur seen in (98%) &amp; Concha bullosa in (82%). Most common symptoms observed was Nasal obstruction (93%), headache (81%) &amp; Nasal discharge (72%). Post-operatively 91.66% of the patients were asymptomatic at the end of the 3 months with p value &lt;0.0001 (statistically signicant) and 8.33% of patients were still symptomatic at the end of 3 months. No major complication directly related to FESS occurred. Conclusion:- In conclusion FESS is minimally invasive, safe and effective procedure &amp; has better impact in relieving symptoms of chronic rhinosinusitis, as it clears only the involved sinus pathology, establishing normal mucociliary drainage of the paranasal sinuses

Antimicrobial Prescription Pattern in ENT Outpatient Department in a Tertiary Care Teaching Hospital, Telangana, India

Introduction Otorhinolaryngological infections are very common in adults and in children also. These infections are caused by various microorganisms and to treat these infections, antimicrobial agents are used frequently. As irrational use of antimicrobials leads to the development of antibiotic resistance and it is a big threat to the society, the present study was planned to get awareness among the practitioners regarding the antimicrobial prescription pattern. Aim To study the prescription pattern of antimicrobial agents in outpatient department of otorhinolaryngology in a tertiary care teaching hospital. Materials and Methods An observational study was planned over a period of 8 months from July 2019 to February 2020 in ENT outpatient department (OPD) at Mamata General Hospital, Khammam in Telangana. In total, 562 prescriptions were collected. Patient's details, probable diagnosis, prescribed medication details such as generic name, dose, and dosage forms were taken. The collected data was analyzed and the conclusions were drawn using descriptive analysis. Results Total number of prescriptions were 562. The majority of the prescriptions belonged to the 21 to 40 years of age group. Males were included more than females (males 320 and females 242). Chronic suppurative otitis media (CSOM) (16.2%) was the commonest infection. Most commonly prescribed antimicrobial was amoxicillin and clavulanic acid combination (26.17%), followed by cefpodoxime with clavulanic acid (21.9%) and ciprofloxacin (19.06%). In 371 (66.01%) prescriptions, only one antimicrobial was prescribed, whereas in 36 (6.40%) prescriptions no antibiotic was given. The average number of drugs per prescription was 3.18 and the average number of antimicrobials per prescription was 1.25. Tablet form (52.9%) was the commonest dosage form and most of the drugs were prescribed by generic name (74.06%). Conclusion The present study though prescription pattern of antibiotics and adherence to the hospital formulary by the physicians in the hospital is encouraging, still there is a chance in reducing the number of drugs prescribed per patient. The findings of this study will be useful to prescribe antimicrobials rationally so that the patient and health care system on the whole will be benefited.

A Study of Relationship Between Serum Lipids and Sensorineural Hearing Loss.

The modern life style poses new challenges on the normal physiological mechanisms of the human body. Drug abuse, tobacco smoking, and alcohol drinking, as well as lack of exercise may also increase the risk of developing certain diseases, especially older age.To study the relationship between degree of sensorineural hearing loss and serum lipid level (total cholesterol, triglyceride, low density lipoproteins, high density lipoproteins).A cross-sectional study was conducted in 150 patients aged between 15 to 60years diagnosed with sensorineural hearing loss at Otorhinolaryngology outpatient department at Sir Sunder Lal hospital, IMS, BHU. All the 150 patients were amongst age group of 15 to 60years who were registered from August 2019 to July 2021.The serum levels of total cholesterol, triglyceride and low-density lipoprotein directly correlate with the severity of sensorineural hearing loss significantly (p < 0.05) whereas the serum levels of high-density lipoprotein had no direct co-relation with the severity of sensorineural hearing loss. Hyperlipidemic state is a major risk factor for SNHL. Regular screening and monitoring of serum lipid might prevent morbid SNHL and improve patients' quality of life in long term.

Noise-induced Hearing Loss among Patients Requiring Pure Tone Audiometry Evaluation in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Noise-induced hearing loss is a type of sensorineural hearing loss caused by long-term exposure to loud noise. This study provides insight into hearing loss problems the general population faces. The study aimed to find out the prevalence of noise-induced hearing loss among patients needing pure tone audiometry evaluation in a tertiary care centre. A descriptive cross-sectional study was conducted from 1 January 2021 to 30 July 2021 among patients requiring pure tone audiometry evaluation in the outpatient Department of Otorhinolaryngology in a tertiary care centre. The study was conducted after ethical approval from Institutional Review Committee (Reference number: 2812202001). Pure tone audiometry was used to diagnose noise-induced hearing loss. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Out of 690 patients, 14 (2.02%) (0.97-3.06, 95% Confidence Interval) were diagnosed with noise-induced hearing loss. The prevalence of noise-induced hearing loss among patients requiring pure tone audiometry evaluation was similar to other studies conducted in similar settings. audiometry; noise-induced hearing loss; tinnitus.

“A STUDY OF DEMOGRAPHIC AND CLINICAL PARAMETERS AND ROLE OF FNAC AS PRIMARY MODALITY IN DIAGNOSING PATIENTS WITH THYROID SWELLINGS”

Background: Thyroid swellings are one of the commonest presentations in ENT. Fine needle aspiration cytology (FNAC) is now accepted as a cost effective, minimally invasive, non-operative diagnostic procedure for most of the thyroid lesions. Materials And Methods: 30 patients presenting with thyroid swellings to the otorhinolaryngology outpatient department during the period February 2022 – August 2022 who were willing to participate in this study were included. FNAC was performed followed by thyroidectomy and the thyroid specimen was sent for histopathological examination. Results: Out of 30 cases, as per FNAC, benign cases reported were 76.66% and malignant cases were 23.33%. Based on histopathology 70% were benign and 30% were malignant. Sensitivity of FNAC was 77.7 percent while specicity was 100 percent. Conclusion : FNAC can be used as the primary modality of investigation in a patient with a thyroid swelling as it is cheap, cost effective, easily performed.

An Unconventional Presentation of Mucormycosis in a 10-Year-Old Child: A Case Report

Since the Coronavirus Disease (COVID-19) pandemic, there have been several unusual presentations of mucormycosis in India, especially amongst immune-competent adults. COVID-19 infection has been found to have profound effects on the patient’s immunity and some patients, though asymptomatic for COVID-19, can be infected by mucormycosis and develops dangerous complications. Skin involvement of the orbital, zygomatic and maxillary areas is a common occurrence in extensive cases of rhinoorbital mucormycosis, however, isolated involvement of the alar skin is an extremely rare occurrence in such patients. Paediatric cutaneous mucormycosis is by itself a rare entity, seen majorly in children with history of allogeneic hematopoietic stem cell transplantations, chemotherapeutic treatment, or patients with human immunodeficiency virus infections, herpes and other lifethreatening viral infections. Patients receiving long-term steroid therapy are also predisposed to invasive fungal infections. This case was about a 10-year-old boy presented with a black crusted lesion over the nose to the otolaryngology outpatient department. The patient had history of contact with a COVID-19 positive individual. Examination revealed a necrotic patch over the palate and Non Contrast CT Scan of (NCCT) the paranasal sinuses showed pansinusitis. A KOH mount showed fungal elements and the patient underwent emergency debridement of nasal skin with endoscopic sinus and palatal debridement. Injectable liposomal Amphotericin-B was started. Over a period of one month, the patient showed significant clinical improvement. Though rare, sinonasal mucormycosis can present in the form of a cutaneous lesion which is an unconventional symptom. A general awareness amongst healthcare professionals, with a multidisciplinary approach, timely diagnosis and specialist intervention can improve outcomes in this sinister disease.

Risk factors of acute otitis media among infants in a tertiary care hospital in Rawalpindi: a descriptive cross-sectional study

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Acute otitis media (AOM) is the second most common disease of childhood. Many factors play role in the causation of AOM. However, the research-based data on risk factors for AOM in infants is still inadequate. Objective were this study&lt;strong&gt; &lt;/strong&gt;aimed to determine the risk factors for AOM in infants with AOM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This descriptive cross-sectional study was conducted among 189 infant patients with AOM in the otorhinolaryngology outpatient department of allied hospital of Rawalpindi medical university, Rawalpindi. Established inclusion and exclusion criteria and non-probability convenience sampling technique were utilized for the selection of patients. After taking informed consent, data were collected through a self-adapted questionnaire. Descriptive analysis was accomplished through SPSS version 25.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;AOM was more common among patients who had, an age group with a range of 9-12 months (41.28%), male gender (55.02%), lower birth order (49.73%), mothers with illiterate educational status (53.96%), mothers with the job (57.14%), lower socioeconomic status (59.25%), used bottle-feeding (46.56%), supine position during feeding (61.37%), used a pacifier (67.73%), poor feeding hygiene (58.21%), unvaccinated pneumococcal status (57.15%), and large family (63.50%). In the case of family ear infection and passive smoking, AOM incidence was more frequent among infants whose family had no history of ear infection (69.85%) and no smoking exposure (53.44%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In short, the age group with a range of 9-12 months, male gender, low birth order, illiterate mothers, mothers with the job, lower socioeconomic status, bottle-feeding, supine feeding position, pacifier use, poor feeding hygiene, unvaccinated pneumococcal status, and large family size, all raise the risk of AOM incidence in infants.&lt;/p&gt;

Post Covid-19 Mixed Fungal Orbito-Pansinusitis Caused by Rhizopus Oryzae and Exophiala Jeanselmei-Review and Reports

We report a rare case of mixed fungal orbito-pansinusitis caused by Rhizopus oryzae and Exophiala jeanselmei in post-COVID-19 individuals. A 65-year-old patient was COVID-19-positive and treated as per the protocols. Following recovery after 3 weeks presents to the otorhinolaryngology outpatient department with complaints of nasal obstruction, stuffiness, pain over the maxilla, occasional fever spikes, and swelling over eyelids. He was diagnosed with a case of orbito-pansinusitis mucormycosis based on magnetic resonance imaging, nasal endoscopy, and microbiological findings. Intravenous (IV) fluconazole and amphotericin B were the conservative management initially followed by surgical debridement later. There was minimal residual deformity after patient recovery. Generally, secondary to immunosuppression or debilitating diseases leads to mucormycosis. The mode of entry for molds and spores of zygomycetes are through the respiratory tract through the nose and then reaches the sinuses, orbit, and intracranial structures. Hence, a good prognosis and to reduce morbidity by zygomycosis can be achieved by early clinical diagnosis, direct smears, and proper interventions. The diagnosis of fungal infections at the earliest is very important because the therapeutic management of fungal infection is quite challenging, especially in the case of R. oryzae and E. jeanselmei with immunocompromised state. The prophylactic drugs, steroids, and immunosuppressants for the treatment of COVID-19 should not be misused and must be used as per protocol and guidelines judiciously.